Diphallus: a rare condition in which a man’s penis is duplicated

The first known case of this condition was reported in 1609. Typically only one of the organs is fully formed, but there have been occurrences in which both penises are fully functional! This strange disorder affects an estimated 1 in 5.5 million men.

It’s very uncommon for both penises in diphallus to be fully functional. Usually one of them only has rudimentary functionality. While it might sound awesome, most people would rather not have it. In 2006, for instance, an Indian man in Uttar Pradesh had his second penis surgically removed.

Duplication of the penis is an extremely rare anomaly. Approximately 100 cases have been reported since the first case report by Wecker in 1609. There are broadly three types of diphallus,viz. true diphallus with two independent penises, bifid phallus that may be glandular or complete and pseudodiphallus having a rudimentary phallus in addition to the normal penis. Numerous associated genitourinary and gastrointestinal anomalies have been described with diphallus.

Journal of Indian Association of Pediatric Surgeons

more here in the  Journal of Indian Association of Pediatric Surgeons

When diphallia is present, it is usually accompanied by other congenital anomalies such as renalvertebralhindgut or anorectal duplication. There is also a higher risk of spina bifida. Infants born with PD and its related conditions have a higher death rate from various infections associated with their more complex renal or colorectal systems.

It is thought diphallia occurs in the fetus between the 23rd and 25th days of gestation when an injury, chemical stress, or malfunctioninghomeobox genes hamper proper function of the caudal cell mass of the fetal mesoderm as the urogenital sinus separates from the genital tubercle and rectum to form the penis.

  • Those in possession of a diphallus tend to be sterile, due to either congenital defects or difficulties in application.
  • Urine may be passed by both penises, by only one, or through some other aperture in the perineum.
  • A range of duplication types have been seen, ranging from organs that fissure into two, to the presence of two distinct penises positioned at some distance from each other.
  • Most diphalluses lie side by side and are of equal size, but they can be seated atop one another, with one distinctly larger than the other.
  • Most men with diphallus learn to use it for intercourse, though they cannot penetrate two partners at the same time.

This rare condition has been documented in pigs and other mammals.

Diphallia is a medical condition and should not be confused with genital bisection, which is an elective procedure which involves the splitting of the penis. There have been many cases of diphallia males leading excellent sexual lives able to have full penile vaginal intercourse. Some diphallia males have fathered babies with their female partners. Most male babies sired by diphallia males have normal penises.

Meanwhile:

Supernumerary body parts are most commonly a congenital disorder involving the growth of an additional part of the body and a deviation from the body plan. Body parts may be easily visible or hidden away, such as internal organs.

Many additional body parts form by the same process as conjoined twins: the zygote begins to split but fails to completely separate. This condition may also be a symptom of repeated occurrences of continuous inbreeding in a genetic line.

It has been suggested that deliberately adding supernumerary limbs to humans may be possible, as a form of body modification.

Specific types of occurrence

Specific types of additional body parts include:

Peace and tolerance

H


Bad news for HIV in Jamaica: HIV/AIDS Programme Hit By Funding Woes

Anastasia Cunningham, Senior Gleaner Writer

Dr Karen Hilliard (centre), mission director, United States Agency for International Development, responds to President of the Jamaica Chamber of Commerce, Milton Samuda (right), during a meeting of private sector leaders to discuss establishing a foundation to ensure the financial sustainability of Jamaica’s HIV programme, at the Wyndham Kingston hotel, New Kingston, Tuesday. At left is chief consultant at the Jamaica Business Council

The announcement by the World Bank that due to the global financial crisis, within the next four years, they will stop external funding of Jamaica’s HIV/AIDS programme has thrown the business community into a crisis mode.

With the core productivity age group, 20-44, at the greatest risk, it has hit home that the economy could be in serious trouble and the productivity level of the country greatly affected if left unchecked.

This reality has caused the Jamaica Business Council on HIV/AIDS (JaBCHA), to seek to establish a J$1 billion foundation to support the national treatment and prevention programme. As the council’s chief fundraiser Earle Moore puts it, “A strong hurricane is heading our way and we have ample time to prepare for it.”

Human resources

Moore added, “If we don’t control the HIV epidemic, it will lead to reduced market sizes for businesses. There will be a decline in the total number of human resources available for production and investment, and managing human resources within our companies will become more difficult and complicated.”

JaBCHA has the strong backing of the Ministry of Health, Jamaica Employers’ Federation (JEF), Private Sector of Jamaica, Jamaica Chamber of Commerce (JCC), Jamaica Hotel and Tourist Association (JHTA) and USAID/ Jamaica. Several key organisations are already onboard, among them Jamaica National, LIME, GraceKennedy, Supreme Ventures, LASCO, Bank of Nova Scotia, Jamaica Broilers and Digicel.

Speaking at JaBCHA’s launch, on Tuesday, JEF President Wayne Chen said: “We are concerned about the increasing number of employees with HIV/AIDS, so we now have to take an enlightened approach to deal with it.”

JCC President Milton Samuda said, “if it is left unchecked, Jamaica will be faced with a crisis, so the private sector has to put heart and soul into it to prevent it. We need to do more for ourselves, instead of depending on others. We have to clean up our own mess. We have to fund the things that are of national importance.”

Wayne Cummings, JHTA president, said he wanted the private sector to take it one step further and “make a bold move. Remove HIV/AIDS persons from the list of persons who cannot get insurance.”

Mission Director of USAID/Jamaica, Dr Karen Hilliard said she was proud to see the greater business community come together to commit funding to fight an epidemic that threatened the productivity sector.

Dr Kevin Harvey, HIV/STI senior medical officer in the Ministry of Health, announced that there is a 2007-2012 National Strategic Plan in place to deal with the epidemic, which is estimated to cost over US$200 million.

Funding

Jamaica has relied heavily on external funding to support its HIV/AIDS programme. Over the last two years, the national HIV programme was funded largely by global donors to the tune of US$80.4 million, with treatment and prevention receiving 33 per cent and 38 per cent, respectively. Only one per cent of Jamaica’s National Capital Expenditure was allocated to the health service.

On the other hand, countries like Trinidad and Tobago, Barbados and St Kitts & Nevis finance their HIV/AIDS programmes primarily from domestic revenue. While The Bahamas’ programme is solely financed by the private sector.

Between 1982 and 2009, approxi-mately 1.6 per cent or some 27,000 Jamaicans had HIV, 14,354 of which had AIDS, 7,772 of that number have died. Men and women age 20-44, the labour force’s most productive years, accounted for 65 per cent of the reported AIDS cases. Kingston, St Andrew and St James had the majority of cases. Last year, 378 persons died of AIDS, a decline of 43 per cent, when compared to 665 persons who died in 2004.

anastasia.cunningham@gleanerjm.com

Jamaica Gleaner Company

Discordant HIV Levels in the Brain and Blood Are More Common Than Expected says US study

Source

Up to 10 percent of people on antiretroviral (ARV) therapy have active HIV replication in the brain and spinal fluid despite having undetectable HIV levels in the blood, according to a study published online November 4 in The Journal of Infectious Diseases. This could explain why low-level inflammation and cognitive decline persist in people being successfully treated with HIV drugs. It may also have implications for treatment recommendations and the ongoing study of different treatment strategies.
A number of studies in recent years have documented two key findings about HIV in the brains of people taking ARVs. First, that HIV reproduction in the brain and central spinal fluid (CSF) is sometimes different from what occurs in the blood; and second, that immune inflammation and cognitive decline are frequently detected in people who otherwise have very good control of their HIV on ARV therapy.

Another key factor that some researchers believe can significantly affect HIV’s activity in the brain and CSF is the ability of individual drugs to cross the blood-brain barrier. Some ARVs cross easily, while others have poor penetration into these compartments.

In an effort to explore the interaction of these three factors—differences in viral replication in blood and brain, signs of immune inflammation, and the brain penetration potential of a person’s regimen—Arvid Edén, MD, from the Sahlgrenska Academy at the University of Gothenburg, in Sweden, and his colleagues examined blood and CSF samples from 69 HIV-positive people taking ARV therapy.

The blood and brain samples were taken between 2002 and 2010. To be included in the study, in which CSF levels were obtained by a lumbar puncture, a person needed to have been on ARVs for at least six months and to have had undetectable HIV levels in the blood for at least three months.

All of the people were taking either Sustiva (efavirenz), Norvir (ritonavir)-boosted Reyataz (atazanavir) or Kaletra (ritonavir plus lopinavir). These drugs were combined with either Viread (tenofovir), Ziagen (abacavir) or Retrovir (zidovudine), plus either Emtriva (emtricitabine) or Epivir (lamivudine).

Edén and his colleagues found that 10 percent of the participants had detectable HIV levels in CSF, many more than they expected. When the team compared the characteristics of those with measurable virus in CSF with those who did not have measurable virus in CSF, they found that people with measurable CSF levels were more likely to have been on ARVs longer, to have had periodic increases in HIV in the blood (blips), and to have taken a treatment interruption.

Edén’s team also found that people with measurable CSF HIV levels were more likely to have high levels of brain inflammation, as determined by measuring neopterin levels.

The makeup of the ARV regimen was not statistically meaningful in regards to discordant viral load responses in the blood and brain. However, there was a trend toward an increased risk of HIV replication in the brains of those who took either Viread or Ziagen compared with those who took Retrovir.

Interestingly, a new method of calculating the likelihood of good ARV control of HIV in the brain, called the central nervous system penetration effectiveness (CPE) rank, was not a good predictor of neither discordant blood and brain HIV levels nor the likelihood of brain inflammation.

Though the brain penetration of the regimens did not significantly affect the likelihood of having discordant HIV levels in the blood and brain, other studies have found that it does. In an accompanying editorial, David Clifford, MD, from Washington University in St. Louis, said this issue needs critical attention, as the most commonly used ARVs today often have only minimal to moderate brain penetration. “If these findings are replicated by others, suggesting 10 percent failure rate of current therapy in the critical CNS compartment, this would be a serious shortcoming for present therapy,” he warned.

“This topic also touches on the interaction of HIV with aging, particularly as it affects the brain and cognitive status,” he continued, noting that cognitive decline from HIV replication and activation could hasten or worsen age-related cognitive problems.

“If control of virus in the brain becomes increasingly difficult to maintain over time,” he concluded, “this implies that increasing neurologic symptoms associated with the virus might augment the cognitive decline of aging, resulting in much more serious late-life neurological issues for HIV-infected patients.”

Ultimately, both doctors, along with Edén’s colleagues, emphasize that this is a very important area of exploration that demands larger studies going forward.

See also:

“Cerebrospinal fluid”

Some People Control HIV Without Drugs Due To 5 Amino Acids In A Protein

Medical News Today

Tiny differences in five amino acids in HLA-B, a protein, are linked to whether people can control levels of HIV (human immunodeficiency virus) with just their immune systems, an international team of researchers wrote in the journal Science. These small variants in the protein appear to alert the immune system that there is an infection.

Co-senior author Bruce Walker, MD, director of the Ragon Institute, said:

 

We found that, of the three billion nucleotides in the human genome, just a handful make the difference between those who can stay healthy in spite of HIV infection and those who, without treatment, will develop AIDS. Understanding where this difference occurs allows us to sharpen the focus of our efforts to ultimately harness the immune system to defend against HIV.

 

Co-senior author, Paul de Bakker, PhD, of the Broad Institute and Brigham and Women’s Hospital, said:

Earlier studies had showed that certain genes involved with the HLA system were important for HIV control. But they couldn’t tell us exactly which genes were involved and how they produced this difference. Our findings take us not only to a specific protein, but to a part of that protein that is essential to its function.

The authors explain that approximately 1 in every 300 patients infected with HIV is naturally able to undermine viral replication just with their immune system, resulting in permanent very low viral loads.

Such people are known as HIV Controllers, or simply Controllers.

Florencia Pereyra, MD, at the Ragon Institute, set up the International HIV Controllers Study in 2006, in order to determine what genetic features drove this unique ability to keep viral loads down naturally. Their aim was to enroll 1,000 HIV controllers from clinics and centers of research worldwide. So far, 1,500 controllers have been enrolled and the goal was upped to 2,000 of them.

This study started with a GWAS (genome-wide association study) of nearly 1,000 controllers and 2,600 patients with progressive HIV infection, provided through a collaboration with the AIDS Clinical Trials Group.

The GWAS located about 300 sites that were statistically linked to HIV immune control – all 300 sites were in chromosome 6, in the regions that code for HLA proteins. The scientists eventually pinned down the gene sites to four, but could not tell whether they were just located close to casual variants or really had an impact on viral control.

They could not fully sequence that genome region in all participants. They used a process developed by Sherman Jia to identify specific amino acids – directly testing those sites linked 5 amino acids within the HLA-B protein with variations in viral control. Sherman Jia is a medical student in the Harvard-MIT Health Sciences and Technology program.

 

Overcome HIV infection and AIDS Regain your health and strength

HLA-B plays a vital role in the immune system’s process of identifying and destroying cells which are infected by virus. HLA-B usually attaches onto viral peptides (protein segments) inside the cell and carries them to the cell’s membrane where CD8 “killer” T cells are flagged to destroy the infected cell.

All the 5 identified amino acid sites are in the lining of the binding pocket – the part of the HLA-B protein that grabs and displays the viral peptides.

 

CONTINUE HERE

FDA and CONRAD Chart U.S. Regulatory Path for 1% Tenofovir Gel for HIV Prevention

For Immediate Release
October 25, 2010

FDA and CONRAD Chart U.S. Regulatory Path for 1% Tenofovir Gel for
HIV Prevention

Collaborative meeting held with key stakeholders

Arlington, VA – – The U.S. Food and Drug Administration (FDA) held an end-of-Phase II
meeting to determine the next steps required for U.S. licensure of 1% tenofovir gel, a
microbicide product recently found to be effective at reducing the rate of HIV and herpes infection
in women when used before and after sex.

The meeting, held on October 20, 2010, was requested by CONRAD, a division of the Eastern
Virginia Medical School in Norfolk, VA. CONRAD was one of the partners in the Phase II
study, “CAPRISA 004,” which evaluated 1% tenofovir gel in prevention of male-to-female HIV
transmission in 889 women in South Africa. USAID provided funding for the trial, conducted
by the Centre for Programme Research for AIDS in South Africa and U.S. based FHI, which was
the first study to show that a vaginal gel can reduce the risk of HIV and herpes infection in
women. CONRAD manufactured and provided the tenofovir gel for the study.

Tenofovir gel was found to be 39% effective in reducing a woman’s risk of becoming infected
with HIV during sex and 51% effective in preventing genital herpes infections in the women
participating in the trial. Results of the CAPRISA 004 clinical trial were reported in July 2010
and represent the first “proof of concept” for a vaginal microbicide.

A number of key stakeholders contributed to the collaborative meeting with the FDA, including
representatives from the U.S. National Institutes of Health, the U.S. Agency for International
Development, Gilead Sciences, Microbicides Trial Network (MTN), South African clinical
investigators, the International Partnership for Microbicides (IPM) and FHI.

During the meeting, the FDA stated their preference for two well-controlled studies to verify the
safety and efficacy of 1% tenofovir gel prior to submission of a New Drug Application (NDA).
The FDA furthermore stated that the NIH-sponsored Phase IIB study, MTN-003, known as
VOICE (Vaginal and Oral Interventions to Control the Epidemic), represents a second adequate
and well-controlled study that would, if successful, serve as the second pivotal trial together with
CAPRISA 004 to support the submission of an NDA for 1% tenofovir gel.

In addition, the FDA has granted Fast Track approval designation for 1% tenofovir gel, which
facilitates the development and expedites the review of drugs that are intended for treating
serious diseases and fill an unmet medical need. With Fast Track designation, an NDA can be
submitted as a “rolling review”, which allows a clinical trial sponsor to submit completed
sections of its NDA for review by the FDA, rather than waiting until every section of the
application is completed before the entire application can be reviewed.

The agency agreed that the current preclinical program for 1% tenofovir gel is sufficient to
support a future NDA. However, they stated that additional safety data on adolescents would be
needed and that information on in vivo drug interaction studies with commonly used vaginal
products should be obtained. Also, the FDA will ultimately need data on post menopausal
women. It was also agreed that a future meeting with the FDA would be held to address any
outstanding discussions associated with product quality, including chemistry, manufacturing and
controls (CMC). Since much of the clinical work on 1% tenofovir gel has been and will be
conducted in South Africa, FDA officials indicated that they can work through the FDA’s
“Office of International Programs” with the goal of coordinating the data and review processes
with the South African Medicines Control Council.

CONRAD and its partners appreciate the contributions and detailed recommendations put forth
by the FDA, which have helped clarify the next steps required for testing and licensure of 1%
tenofovir gel.

In 2006, CONRAD and IPM obtained a co-exclusive, royalty-free license from Gilead Sciences
to develop 1% tenofovir gel as a topical microbicide for use by women in developing countries
to prevent HIV.

For more information, please contact Annette Larkin, +1 703 772 6427 or
larkinannette@yahoo.com

October is Breast Cancer Month – Male Breast Cancer ……

What is Male Breast Cancer ?

Breast cancer is a malignant tumor that has developed from cells of the breast. The disease occurs primarily in women, but occasionally in men.
Many people do not realize that men have breast tissue, and that it’s possible for them to develop breast cancer. Until puberty, young boys and girls have a small amount of breast tissue consisting of a few ducts located under the nipple and areola (the area around the nipple). At puberty, a girl’s ovaries produce female hormones that cause breast ducts to grow, cause lobules (milk glands) to form at the ends of the ducts, and increase the amount of stroma (fatty and connective tissue surrounding the ducts and lobules). On the other hand, male hormones produced by the testicles prevent further growth of breast tissue.

Like all cells of the body, a man’s breast duct cells can undergo cancerous changes. Because women have many more breast cells than men do, and perhaps because their breast cells are constantly exposed to the growth- promoting effects of female hormones, breast cancer is much more common in women.

There are many types of breast disorders that can affect both men and women. Most breast disorders are benign (not cancerous). Benign breast tumors do not spread outside of the breast and are not life-threatening. Other tumors are malignant, (cancerous), and may become life- threatening. Benign tumors, such as papillomas and fibroadenomas, are quite common in women but are extremely rare in men.

Gynecomastia is the most common breast disorder of males. It is not a tumor, but is just an increase in the amount of a man’s breast tissue. Usually, men have too little breast tissue to be felt or noticed. A man with gynecomastia has a button-like or disk-like growth under his nipple and areola, which can be felt and sometimes seen. Gynecomastia, common among teenage boys, is due to changes in hormone balance during adolescence. The same condition is not unusual in older men, also due to changes in their hormone balance.

Gynecomastia may also rarely be caused by tumors or other diseases of certain endocrine (hormone- producing) glands that cause a man’s body to produce more estrogen (the main female hormone). Some estrogen is normally produced by men’s glands, but not enough to cause breast growth. Because the liver is important in male and female hormone metabolism, liver diseases can change a man’s hormone balance and cause gynecomastia.

Many commonly prescribed medications can sometimes cause gynecomastia, too. These include some drugs used to treat ulcers and heartburn, high blood pressure, and heart failure. Men with gynecomastia should ask their doctors about whether any medications they are taking might be the cause of this condition.

Klinefelter’s syndrome, a rare genetic condition, can cause gynecomastia and can increase a man’s risk of developing breast cancer. It is discussed further in the sections on male breast cancer risk factors and causes.
Understanding some of the key words used to describe various types of breast cancer is important. An alphabetical list of terms, including the most common types of breast cancer, is provided below:

Adenocarcinoma: This is a general type of cancer that starts in glandular tissues anywhere in the body. There are several subtypes of adenocarcinoma which account for nearly all breast cancers.

Ductal carcinoma in situ (DCIS): Ductal carcinoma in situ is a type of breast adenocarcinoma that does not spread outside the breast. Cancer cells fill the ducts but do not spread through the walls of the ducts into the fatty tissue of the breast. Nearly 100% of men or women diagnosed at this early stage of breast cancer may be cured. Most cases of DCIS are diagnosed by mammography, and the diagnosis of DCIS is becoming more common among women who get routine screening mammograms. However, male breast cancer is so rare that routine breast x-rays are not recommended, and only about 5% of men’s breast cancers are found at this early stage. Sometimes DCIS causes a man to develop a breast discharge (nipple fluid leakage) and draws attention to his noninvasive cancer. Comedocarcinoma is a type of ductal carcinoma in situ (DCIS), where some of the cancer cells within ducts spontaneously begin to degenerate.

Infiltrating (or invasive) ductal carcinoma (IDC): Starting in a duct of the breast, this type of adenocarcinoma breaks through the wall of the duct and invades the fatty tissue of the breast. At this point, it has the potential to metastasize, or spread, to other parts of the body. Infiltrating ductal carcinoma (alone or mixed with other types of invasive or in situ breast cancer) accounts for 80% – 90% of male breast cancers.

Infiltrating (or invasive) lobular carcinoma (ILC): Although the male breast has no lobules, cells from the ends of a man’s breast ducts can develop into cancers which, under the microscope, look like they come from lobules. ILC is a type of adenocarcinoma. It accounts for about 10% – 15% of female breast cancers, but about only 2% of male breast cancers.

In situ: This term is used to indicate an early stage of cancer in which a tumor is confined to the immediate area where it began. Specifically in breast cancer, in situ means that the cancer remains confined to ducts (ductal carcinoma in situ, DCIS) or lobules (lobular carcinoma in situ, LCIS), and it has neither invaded surrounding fatty tissue in the breast nor spread to other organs in the body. DCIS occurs relatively often in both men and women. In contrast, LCIS is common in women, but very rare among men.

Metastases: These are satellite tumors that indicate a breast cancer has spread from the site where it began (referred to as the primary cancer) to a lymph node or a distant organ, such as the lung, liver, or brain.

Microcalcifications: These are small calcium deposits, often found in clusters by a mammogram. These deposits, sometimes called calcifications, are neither cancer nor tumors. But they are signs of changes within the breast, and certain patterns of calcifications can be associated with cancer or benign breast disease.

Node-positive and node-negative breast cancer: Node-positive means that the cancer has spread (metastasized) to the lymph nodes under the arm on the same side, which are called axillary nodes. Node-negative means that the biopsied lymph nodes are free of cancer. This is an indication that the cancer is less likely to recur.

Paget’s disease of the nipple: This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple. The areola (the dark circle around the nipple) may also be involved. With Paget’s disease of the nipple, there is usually a history of crusting, scaly, red tissue on the nipple and itching, oozing, burning, or bleeding.

Using the fingertips, a lump may be detected within the breast. If no lump can be felt, the cancer generally has a good prognosis. Paget’s disease may be associated with in situ carcinoma or with infiltrating breast carcinoma (see above). It accounts for about 1% of female breast cancers and a higher percentage of male breast cancers.

Because the male breast is much smaller than the female breast, all male breast cancers start relatively close to the nipple, so spread to the nipple is more likely.

Prevention
The large variations in penile cancer rates throughout the world strongly suggest that penile cancer is a preventable disease. The best way to reduce the risk of penile cancer is to avoid known risk factors whenever possible.

In the past, circumcision has been suggested as a strategy for preventing penile cancer. This suggestion is based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. However, most researchers now believe those studies were flawed, because they failed to consider other factors that are now known to affect penile cancer risk. For example, some recent studies suggest that circumcised men tend to have certain other lifestyle factors associated with lower penile cancer risk — they are less likely to have multiple sexual partners, less likely to smoke, and more likely to have good personal hygiene habits. Most public health researchers believe that the penile cancer risk among uncircumcised men without known risk factors living in the United States is extremely low. The current consensus of most experts is that circumcision should not be recommended as a strategy for penile cancer prevention.

On the other hand, it is reasonable to suspect that avoiding sexual practices likely to result in human papillomavirus (HPV) infection might lower penile cancer risk. In addition, these practices are likely to have an even more significant impact on cervical cancer risk. Until recently, it was thought that the use of condoms (“rubbers”) could prevent infection with HPV. But recent research shows that condoms cannot protect against infection with HPV.

This is because HPV can be passed from person to person by skin-to-skin contact with any HPV-infected area of the body, such as skin of the genital or anal area not covered by the condom. It is still important, though, to use condoms to protect against AIDS and other sexually transmitted diseases that are passed on through some body fluids. The absence of visible warts cannot be used to decide whether caution is warranted, since HPV can be passed on to another person even when there are no visible warts or other symptoms. HPV can be present for years with no symptoms, so it can be difficult or impossible to know whether a person with whom you might have sex might be infected with HPV.

It is also known that the longer a person remains infected with any type of HPV that can cause cancer, the greater the risk that infection will lead to cancer. For these reasons, postponing the beginning of sexual activity in life and limiting the number of sexual partners are two ways to reduce the chances of developing penile cancer.

Smoking is another factor associated with increased penile cancer risk. And, it is even more strongly associated with several very common and frequently fatal cancers, as well as noncancerous conditions such as heart disease and stroke. Quitting smoking or never starting in the first place is an excellent recommendation for preventing a wide variety of diseases, including penile cancer.

Because poor hygiene habits are associated with increased penile cancer risk, and some studies suggest that smegma (the material that accumulates underneath the foreskin) may contain cancer-causing substances, many public health experts recommend that uncircumcised men practice good genital hygiene by retracting the foreskin and cleaning the entire penis. If the foreskin is constricted and difficult to retract, a physician may be able to place a small cut (incision) in the skin to make retraction easier.
Since some men with penile cancer have no known risk factors, it is not possible to completely prevent this disease.
Diagnostic
The most common sign of breast cancer is a new lump or mass. A mass that is painless, hard, and has irregular edges is more likely to be cancerous, but rare cancers are tender, soft, and rounded. For this reason, it is important that any new breast mass or lump be checked by a health care provider with experience in diagnosis of breast diseases. Once certain signs and symptoms raise the possibility that a man may have breast cancer, his physician will use one or more methods to be absolutely certain that the disease is present and to determine the stage to which the cancer has developed.

Complete medical history: The first step is gathering a complete personal and family medical history from the patient. This will provide information about symptoms and risk factors for breast cancer or benign breast conditions.

Clinical breast exam: A thorough clinical breast examination will be performed to locate the lump or suspicious area and feel its texture, size, and relationship to the skin and muscle tissue. The rest of the body will also be examined to look for any evidence of spread such as enlarged lymph nodes or an enlarged liver. The patient’s general physical condition will also be evaluated.

Diagnostic mammography: Diagnostic mammography is an x-ray examination of the breast. In some cases, special images known as cone views with magnification are used to make a small area of altered breast tissue easier to evaluate. The diagnostic work-up may suggest that a biopsy is needed to tell whether or not the lesion (abnormal area) is cancer.

Breast ultrasound: Ultrasound, also known as sonography, uses high- frequency sound waves to outline a part of the body. High-frequency sound waves are transmitted into the area of the body being studied and echoed back. The sound wave echoes are picked up and converted by a computer into an image that is displayed on a computer screen. No radiation exposure occurs during this test. Breast ultrasound is sometimes used to evaluate breast abnormalities that are found during mammography or a physical exam. Ultrasound is useful for some breast masses, and is the easiest way to tell if a cyst is present without placing a needle into it to draw out fluid.

Nipple discharge examination: If there is a nipple discharge, some of the fluid may be collected. The fluid is then examined under a microscope to determine if any cancer cells are present. If cancer cells are not seen in the nipple secretions but a suspicious mass is present, a biopsy of the mass is needed.

Biopsy: A biopsy is the only way to tell if a breast abnormality is cancerous. Unless the doctor is sure the lump is not cancer, this should always be done. All biopsy procedures remove a tissue sample for examination under a microscope. There are several types of biopsies, such as fine needle aspiration biopsy, core biopsy, and surgical biopsy. Your doctor will choose a type of biopsy based on your individual situation.

Fine-needle aspiration biopsy (FNAB): FNAB is the easiest and quickest biopsy technique. A thin needle, about the size of a needle used for blood tests or for immunizations is used. The needle can be guided into the area of the breast abnormality while the doctor is feeling or palpating the lump. A FNAB of solid (not fluid-filled) lumps yields small tissue fragments. Microscopic examination of FNAB samples can determine whether most breast abnormalities are benign or cancerous. In some cases, a clear answer is not obtained by FNAB, and another type of biopsy is needed.

Core biopsy: The needle used in core biopsies is larger than that used for FNAB. It removes a small cylinder of tissue from a breast abnormality. The biopsy is done with local anesthesia in the doctor’s office.

Surgical biopsy: Surgical removal of all, or a portion, of the lump for microscopic analysis may be required.
Many doctors prefer a two-step biopsy. In this method, a sample of the mass or, sometimes, the entire mass is removed in the doctor’s office or hospital outpatient department. A local or regional anesthesia with intravenous sedation is used and the patient is awake during the procedure. If the diagnosis is cancer, the patient has time after the procedure to learn about the disease and discuss all treatment options with the cancer care team, friends, and family. If additional breast tissue or lymph nodes need to be removed, this will be done during a later operation. The short delay until additional surgery does not affect survival. Of course, a diagnosis made by needle biopsy counts as the first step of a two-step procedure.

With a one-step biopsy, the patient is given general anesthesia and is asleep during the entire process. A biopsy is performed and the tissue sample is frozen. The frozen sample is examined right away under a microscope in the pathology laboratory. If cancer cells are present, the surgeon immediately proceeds with treatment, such as mastectomy, which the patient had previously approved. The patient does not know until after waking up whether the lump was cancerous and whether surgery was performed. One-step procedures are rarely recommended for women since lumpectomy is often a surgical treatment option. Since many male breast cancers are best treated by mastectomy, one- step and two-step procedures are both appropriate options.

Laboratory Testing of Breast Cancer Biopsy Samples
Types of breast cancer: The tissue removed during the biopsy is examined in the lab to see whether the cancer is in situ (not invasive) or invasive. The biopsy is also used to determine the cancer’s type. The most common types, invasive ductal and invasive lobular cancer, are treated the same way. In some cases, special breast cancer types that tend to have a more favorable prognosis (medullary, tubular, and mucinous cancers) are treated differently. For example, adjuvant hormonal therapy or chemotherapy may be recommended for small stage I cancers with unfavorable microscopic features but not for small cancers of the types associated with a more favorable prognosis.

Grades of breast cancer: A pathologist looks at the tissue sample under a microscope and then assigns a grade to it. The grade helps predict the patient’s prognosis because cancers that closely resemble normal breast tissue tend to grow and spread more slowly. In general, a lower grade number indicates a slower-growing cancer while a higher number indicates a faster-growing cancer.

Histologic tumor grade (sometimes called its Bloom-Richardson grade): Is based on the arrangement of the cells in relation to each other, as well as features of individual cells. Grade 1 cancers have relatively normal- looking cells that do not appear to be growing rapidly and are arranged in small tubules. Grade 3 cancers, the highest grade, lack these features and tend to grow and spread more aggressively. Grade 2 cancers have features between grades 1 and 3. Grade 1, 2, and 3 cancers are sometimes referred to as well differentiated, moderately differentiated, and poorly differentiated. This system of grading is used for invasive cancers but not for in situ cancers.

Ductal carcinoma in situ (DCIS): is sometimes given a nuclear grade, which describes how abnormal the cancer cells appear. The presence or absence of necrosis (areas of degenerating cancer cells) is also noted. Some researchers have suggested combining information about the nuclear grade and necrosis together with information about the surgical margin (how close the cancer is to the edge of the lumpectomy specimen) and the size (amount of breast tissue affected by DCIS). The researchers have proposed assigning a score to each of these features and adding them together. This sum is called the Van Nuys Prognostic Index. In situ cancers with high nuclear grade, necrosis, cancer at or near the edge of the lumpectomy sample, and large areas of DCIS tend to be more likely to come back after lumpectomy.

Estrogen and progesterone receptors: Receptors are molecules that are a part of cells. They recognize certain substances such as hormones that circulate in the blood. Normal breast cells and some breast cancer cells have receptors that recognize estrogen and progesterone. These two hormones play an important role in the development, growth, prognosis, and treatment of breast cancer. An important step in evaluating a breast cancer is to test for the presence of these receptors. This is done on a portion of the cancer removed at the time of biopsy or initial surgical treatment. Breast cancers that contain estrogen and progesterone receptors are often referred to as ER-positive and PR-positive tumors. These cancers tend to have a better prognosis than cancers without these receptors and are much more likely to respond to hormonal therapy.

DNA cytometry: There are two types of DNA cytometry that are sometimes used to help predict a breast tumor’s aggressiveness. Flow cytometry uses lasers and computers to measure the amount of DNA in cancer cells suspended in liquid as they flow past the laser beam. Image cytometry uses computers to analyze digital images of the cells from a microscope slide. Both methods can measure the ploidy of cancer cells, which indicates the amount of DNA they contain. If there’s a normal amount of DNA, the cells are said to be diploid. If the amount is abnormal, then the cells are described as aneuploid. Some studies have found that aneuploid breast cancers tend to be more aggressive.

Flow cytometry can also measure the S-phase fraction, which is the percentage of cells in a sample that are in a certain stage of cell division called the synthesis phase. The more cells that are in this S-phase, the faster the tissue is growing and the more aggressive the cancer is likely to be. Image cytometry, when combined with special antibody tests of the tissue to for substances such as proliferating cell nuclear antigen (PCNA), can also estimate the grow rate of a cancer.

Other tests for predicting breast cancer prognosis: Many new prognostic factors, such as changes of the p53 tumor suppressor gene, the epidermal growth factor (EGF) receptor, and microvessel density (number of small blood vessels that supply oxygen and nutrition to the cancer), are currently being studied.

Treatment
Stage O and Stage I Male Breast Cancer
For most men in this group, surgical removal of the cancer is the only treatment needed. This is usually accomplished by modified radical mastectomy. Recent studies have found that extending a modified radical mastectomy to remove an area of involved muscle (and a margin of tumor-free muscle) is as effective as a radical mastectomy, which removes the entire muscle. And the modified radical mastectomy causes fewer side effects.

Lumpectomy or other breast-conserving procedures are rarely an option since the whole breast can be removed under local anesthesia. If breast conserving procedures are done, they should be followed by radiation therapy, unless the cancer is in situ (noninvasive, stage 0).

Chemotherapy may be recommended for some young men with stage I breast cancer. Women with early stage breast cancer who are under 35 have a high chance of cancer recurrence. This is reduced by chemotherapy. But women older than 35 also benefit from adjuvant chemotherapy. As they get older, women benefit less and doctors must balance the risk of recurrence against the side effects of treatment. Most doctors feel these considerations also apply to men with breast cancer. Therefore, chemotherapy will be offered to most younger men with Stage I breast cancer.

Stage II Male Breast Cancer
The surgical and radiation therapy options are the same as with Stage I cancers. But if the nodes contain cancer cells, adjuvant (additional) therapy is usually recommended. Hormonal therapy is suggested for all node-positive, estrogen receptor-positive tumors. Chemotherapy is also usually recommended. Choices about chemotherapy may be influenced by a man’s age and general state of health. It is less likely to be recommended for older men, particularly those in poor health.

When node-negative cancers involve the chest muscle or the skin, radiation therapy after surgery may reduce the risk of local recurrence.

Stage III Male Breast Cancer
The surgical and radiation therapy options are the same as with Stage I and II cancers. Except for men in poor health or elderly, chemotherapy is almost always recommended. In some cases, the chemotherapy may be given before the surgery. This is called neoadjuvant therapy.

Stage IV or Stage IV Male Breast Cancer
Systemic therapy is the primary treatment, using chemotherapy, hormonal therapy, or both. Immunotherapy with Trastuzumab (Herceptin) alone or in combination with chemotherapy is an option for men whose cancer cells have high levels of the HER2/neu protein. Trastuzumab is generally not the initial treatment for these men, however, and is usually started after standard hormonal and/or chemotherapy is no longer effective. Radiation and/or surgery may also be used to provide relief of certain symptoms. Treatment to relieve symptoms depends on where the cancer has spread to. For example, pain due to bone metastases may be treated with external beam radiation therapy and/or bisphosphonates such as pamidronate (Aredia). Bisphosphonates are drugs that can help prevent bone damage caused by metastatic breast cancer. For more information about treatment of bone metastases, refer to the ACS document on “Bone Metastasis.”

Recurrent Male Breast Cancer
If a patient has a local (breast or chest wall) recurrence and no evidence of distant metastases, cure is still possible. Surgical removal of the recurrence, followed by radiation therapy, is recommended whenever possible. If the area has already been treated with radiation, it may not be possible to give much or any additional radiation without causing severe damage to the normal tissues. Distant recurrences are treated the same as metastases found at the time of diagnosis.

Confusion around changing sexual orientation for trans-gendered persons

Prepared by A. B. Kaplan of TG Mental Health

There is a commonly heard idea in the transgender literature and community asserting that the transgendered individual will sometimes change sexual orientation after transitioning.

I have found that many patients come in with this belief.  Arlene Istar Lev (2004), a family therapist, clinical social worker and gender expert notes that “gender transition can have a tremendous impact on sexual orientation, sometimes affecting one’s sexual interests…” and in the next paragraph “Sexual orientation is not malleable and cannot be changed through force or will” (p. 301).

There seems to be a good deal of confusion and disagreement on the topic in the transgender community.

Putting aside for a moment the fact that transitioning is a long process with no particular end point (where a change in sexual orientation could be assessed) and can often mean different things to different people and that most transsexuals do not have surgeries;

perhaps what is really happening in these cases is that individuals are choosing partners more for the complex array of factors that help the individual feel confirmed in their authentically felt gender rather than for their desirability based on their maleness or femaleness.

Just thinking about this logically for a minute one sees that claims of so called “reparative therapies” on non-trans homosexuals have been thoroughly debunked over the past few decades (for summaries see Haldeman, 1994; Drescher, 1998  and Bright 2004).

What bit of alchemy would then achieve this momentous transformation on the transsexual?  Hormone replacement therapy?  By this same logic, scores of menopausal lesbians taking feminizing hormones would have suddenly switched to becoming attracted to men.

A 1998 research paper titled “Changes in the Sexual Orientation of Six Heterosexual Male-to-Female Transsexuals” by Christopher Daskalos of the Department of Sociology, Arizona State University asserts that

“These respondents stated that before transitioning they had been sexually orientated towards females. After transitioning, these same respondents reported that they were sexually orientated towards males. Five of the six respondents reported having various sexual encounters with males since transitioning. The respondents explained the changes in their sexual orientation as part of their emerging female gender identities. Three of the respondents claimed that the use of female hormones played a role in changing their sexual orientation” (from the abstract p. 605).”

The paper was challenged in the same journal in a letter to the editor by Anne A. Lawrence (an arguably controversial figure in her own right due to her advocating the concept of  ‘autogynephilia’) who noted that “Daskalos purports to document dramatic changes in the sexual orientation of six of his transsexual informants – changes that seem to have occurred almost effortlessly.  However, a careful reading of Daskalos’ paper reveals that he has demonstrated no such thing” (p. 581). Her reasons include that sexual behavior is not the same as sexual orientation, that (a somewhat dated idea) “Sometimes such self-reports may be conscious deceptions, designed to increase the likelihood that the transsexual will qualify for sex reassignment surgery” and that “In other cases, such self-reports by transsexuals may reflect the autogynephilic fantasy of sex with a male partner” (p. 581).

However none of these refutations shed light on the reasons behind changes in behavior.  I believe Dozier’s (2005) comments from her cohort of 18 trans men to be most in keeping with what I have seen with trans people in my practice:

Respondents also challenge traditional notions of sexual orientation by focusing less on the sex of the partner and more on the gender organization of the relationship. The relationship’s ability to validate the interviewee’s masculinity or maleness often takes precedence over the sex of the partner, helping to explain changing sexual orientation as female-to-male transsexual and transgendered people transition into men (2005, p. 297).”

I’m interested in hearing your thoughts.

References:

Bright, C. (2004). Deconstructing Reparative Therapy: An Examination of the Processes Invovled When Attempting to Change Sexual Orientation. In Clinical Social Work Journal, Vol. 32, No. 4, Winter 2004 (_ 2004)

Daskalos, C. (1998).  Changes in the Sexual Orientation of Six Heterosexual Male-to-Female Transsexuals. Archives of Sexual Behavior, Vol. 27, No. 6, 1998

Dozier, R. (2005) Beards, Breasts, and Bodies: Doing Sex in a Gendered World. In Gender & Society, Vol. 19 No. 3, June 2005. 297-316

Drescher, J. (1998).  I’m Your Handyman: A History of Reparative Therapies in Journal of Homosexuality,Vol. 36(1) 1998

Haldeman, D.C.  (1994) The Practice and Ethics of Sexual Orientation Conversion Therapy. InJournal of Consulting and Clinical Psychology, Vol. 62, No. 2, 221-227

Lawrence, A. (1999) Letter to the Editor. Archives of Sexual Behavior, Vol. 28, No. 6, 1999

Lev, A. (2004). Transgender Emergence. Binghamton, NY: HaworthPress.

Vienna AIDS 2010: Global Health Leaders Say Stigma Exacerbates HIV Epidemic Among Black Gay/Bi Men

By Rod McCullom

July 22, 2010

AIDS 2010: Global Health Leaders Say Stigma Exacerbates HIV Epidemic Among Black Gay/Bi Men Vienna, Austria — From pre-conference events to the massive human rights march through downtown Vienna, world leaders, public health experts and HIV activists honed in with laser-like precision on a common message at The 18th International AIDS Conference in Vienna : The ongoing persecution and criminalization of gay, bisexual and other men who have sex with men — “MSM”, in public health shorthand — are undermining efforts to control the global HIV/AIDS pandemic.

Chief among the obstacles: More than 80 nations have laws that still criminalize same sex behavior. In some of these countries, conviction can even result in the death penalty, reports UNAIDS.

Further exacerbating the problem, according to a report by Planned Parenthood, “58 countries have laws that criminalize HIV or use existing laws to prosecute people for transmitting the virus. Another 33 countries are considering similar legislation.’

The trend is “even more pronounced” across Africa and the Diaspora, said Joel Gustave Nana, executive director of the Johannesburg, South Africa-based African Men for Sexual Health and Rights (ASMSHer). The West African laws vary in extremity — just “exposing a person to HIV, regardless of if the virus is transmitted, is a crime in Benin, and Tanzanian law carries a possible sentence of life in prison for intentional transmission,” reports Medical News Today. While the overall life for Black MSM may be better for in North America, there are drawbacks. The United States and Canada lead the world when it comes to prosecuting people who infect or expose others to HIV, a surprising new study reveals. Black men have been disproportionately targeted with these prosecutions. A Black, gay, HIV positive Michigan man was recently as charged as a bioterrorist for allegedly biting a neighbor’s lip during a scuffle, Black AIDS Weekly reported in June.

“The prosecutions are arbitrary,” said Nana, in an interview after a press conference organized by The Global Forum on MSM & HIV. On Sunday, the day before the conference officially opened, the Global Forum held a 24-hour event to address the soaring global rates of MSM seroconversions.

“The stigma, discriminatory laws and criminalization of HIV transmission encourage the spread of this disease,” adds Nana. “Why should someone seek testing or medical advice come forward if you could be arrested? There is no incentive.”

The fear of “coming out”, pop culture which celebrates homophobia and churches and churchgoers that demonize gay Black men compound the problem for black MSM in America, the Caribbean and Africa.

“This is the context in which you have a runaway, dangerous HIV epidemic in Jamaica,” adds Robert Dr. Robert Carr, the co-chair of ICASO, the International Council of AIDS Service Organizations (ICASO). “There is a clear link between religious condemnation, criminalization, stigma and HIV infections. We see this all the time in the Caribbean.”

Carr adds: “Politicians and church leaders endorse homophobic violence. Police refuse to protect MSM or are complicit or directly involved in the violence,” he said, referring to a now-infamous incident of a 2,000-strong mob surrounding several gay men and stoning them. The police were called to the scene and the officers also struck the young men.

Carr sighs. “With Jamaican MSM infection rates at 32 or 33 percent, it became obvious that you couldn’t do effective HIV work in this context.”

Although a state sponsored, religious-based terror campaign has targeted African MSM from Algeria to Zimbabwe, there are some positive developments to report from AIDS 2010.

“We now have 14 countries out of 54 that include men who have sex with men in their national HIV strategic plans,” AMSHer’s Joel Nana said. “It doesn’t mean the services will be delivered to those populations, but it is an acknowledgment. That’s a first step.”

“Kenya was the first African nation to include MSM in their national HIV strategy,” Nairobi-based peer educator Job Akuno told Black AIDS Weekly. Akuno is a counselor with the Nairobi-based SHAP, Scaling Up HIV and AIDS Prevention, partially funded by PEPFAR, the President’s Emergency Plan for AIDS Relief. “That was in 2006. But … it seems like we are rolling back on some of the gains that we made.”

“Kenya is starting to look like one of the countries that we should look up to,” Nana adds. “The HIV movement is more open to include MSM. And there is a strong MSM movement in Kenya, too . It is one of the few countries in Africa where a MSM organization was able to place an ad in the newspaper for the International Day Against Homophobia on May 17.”

Akuno says the HIV Prevention and Control Act criminalizes deliberate HIV transmission. “The sentences are up to 10 years. No one has been prosecuted, but now there is talk to make the law harsher. If you criminalize HIV transmission or only target MSM, that will further stigmatize the disease and drive many people into not wanting to know their results. ”

Job Akuno shrugs. “What can you do but hope for the best?”

Rod McCullom, a writer and television news producer, blogs on Black gay, lesbian, bisexual and transgender news and pop culture at rod20.com.

Have a campaign of tolerance (Observer Letter) but …….

Dear Editor,

At the General Assembly of the OAS held in June this year, Jamaica joined the unanimous adoption of OAS Resolution 2604 “Human Rights, Sexual Orientation and Gender Identity”. This marks the third such resolution that Jamaica has supported in as many years which promotes the recognition of the human rights of Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) individuals.

However, between 2009 and 2010, the country continued to record numerous human rights violations of LGBTI citizens, including:

 * A 32 per cent HIV/AIDS prevalence rate among men who have sex with men due to homophobic laws driving gays underground away from effective HIV prevention.

* Six reports of persons being ejected from their homes by family members because of their sexual orientation.

* Four reports of lesbians being raped to “make them straight”.

* Four men forced to flee their homes (one at gunpoint and another after his home was stoned) because they were identified participating in a national “Walk for Tolerance” for persons infected, affected, and vulnerable to HIV/AIDS.

* Two mob home invasions of people suspected to be gay. Now more than ever, the treatment of Jamaican LGBT runs afoul of our international obligations and it is only a matter of time before we are made to account for this.

A campaign of tolerance needs to be launched and the necessary legislative changes made to recognise the human rights of all Jamaicans.

Failure to do so may well result in us being branded a pariah state by the international community, negatively impacting our access to international markets and our ability to travel.

Maurice Tomlinson                                                  maurice_tomlinson@yahoo.com

ENDS

However:

A few observations though, it is interesting that it’s only Mr. Tomlinson a human rights lawyer from Montego Bay, consultant to AIDSFREEWORLD and a Jamaica AIDS Support for Life board member who seems to be speaking publicly on these issues apart from a few bloggers, JFLAG seems quiet or is he the front man using the AIDSFREEWORLD platform? Of course independent voices such as this and other brave bloggers are not “tolerated” by the powers that be yet here we are asking for tolerance from general society.

Why doesn’t JFLAG speak out openly? this is just what the homophobes and christian right opposition needs to bolster their argument that AIDS is being used as a front to slide in or hoist homosexuality on the country. Yes I understand the co-relation between the groups and HIV/AIDS but just come out and openly tackle the issue instead of a supposed front man.

With the CARICOM meeting to be held in Montego Bay Jamaica on the weekend of July 3rd and Jamaica’s assumption of it’s leadership in the person of non other than Prime Minster Bruce “Not in My Cabinet” Golding, it is going to be interesting to see what plays out in this matter as clearly this is the new thrust now to tackle the regional legal and political structures while yet the individuals on the ground of note the homeless MSMs still are out there made nomads by dubious circumstances with the closure of the shelter earlier this year.

Hypocrisy, institutional homophobia (with an element of classism) or misappropriated priorities?

Think about these things folks.

Peace and tolernace

H

HIV-Related Kidney Troubles Linked to Age, Race, CD4 Count and Tenofovir

A new study has found that the overall rate of kidney dysfunction was only 3 percent in a group of HIV-positive military personnel, but several factors including older age, African-American race and the use of tenofovir (found in Viread, Truvada and Atripla) increased the risk of developing the condition. The study was published in the June issue of AIDS Patient Care and STDs.

The introduction of potent antiretroviral (ARV) combination therapy in the late 1990s caused a precipitous plunge in the rate of opportunistic infections (OI) and death in people with HIV. Those reductions in OI rates have been sustained, yet during the last decade researchers have noted a rise in diseases not typically associated with HIV, including cardiovascular, liver and kidney diseases.

Before combination ARV treatment was introduced, most HIV-associated chronic kidney problems were tied to low CD4 counts and African-American race. In recent years, other factors, including older age, co-occurring conditions—such as diabetes and high blood pressure, and uncontrolled HIV reproduction—have all begun to be associated with kidney problems.

To assess the prevalence of kidney disease and the factors associated with it in the modern HIV treatment era, Nancy Crum-Cianflone, MD, from the HIV clinic at the Naval Medical Center San Diego, and her colleagues assessed the medical records of 717 HIV-positive military personnel being cared for at naval clinics in San Diego or Bethesda, Maryland.

Most of the study participants were male, and roughly 40 percent were African American. The vast majority, 77 percent, were taking ARV therapy. Of those, 44 percent were on a regimen that included tenofovir. Kidney function was assessed by measuring the estimated glomerular filtration rate (eGFR).

An eGFR rate of 60 or greater was considered functional, and an eGFR of less than 60 was considered dysfunctional—the lower the number, the poorer the kidney function. Crum and her colleagues found several factors associated with kidney dysfunction.

These included older age, African American race and tenofovir use. Having a low CD4 nadir, which refers to a person’s lowest ever CD4 count, was also associated with a greater risk of kidney dysfunction. Among tenofovir users, African-American race, female gender and a lower CD4 nadir were all associated with a drop in eGFR.

“Further studies are needed to determine if differential guidelines on kidney function monitoring in select HIV populations would be beneficial,” conclude the authors.