Does Undetectable Equal Uninfectious?

Hours before the XVII International AIDS Conference began in Mexico City, A panel of experts engaged in a heated debate over statements made by the Swiss Federal AIDS Commission in January, which affirmed that an undetectable viral load renders an HIV-positive person uninfectious under optimal conditions, Aidsmap.com reports.“We never thought of it as a statement that was to be delivered worldwide,” says Pietro Vernazza, MD, president of the Swiss Federal AIDS Commission. “It was meant only to be delivered to Swiss physicians to help them discuss sexual risk-taking with their patients and their steady partners.”According to the article, Dr. Vernazza added that the title of the statement—“HIV-positive people with no other STIs and on effective antiretroviral therapy do not transmit HIV sexually”—was “misleading.”

The statement was made primarily to protect positive people in Switzerland, where HIV exposure laws enable the state to prosecute HIV-positive people who had unprotected sex with HIV-negative and fully informed partners. Vernazza affirmed that the statement could be used in court to show that positive people on effective treatment could not expose or transmit the virus.Vernazza says the statement was made to clear up discrepancies between what some doctors tell their patients privately and what they say in public to eliminate what he calls the “risk of uncontrolled diffusion” of information regarding HIV transmission.

What is a rectal microbicide

What is a rectal microbicide?….click title for more
Currently in development, a microbicide is a cream or gel, or maybe a douche or an enema, that could be used to reduce a person’s risk of HIV infection vaginally or rectally. Rectal microbicides could offer both primary protection in the absence of condoms and back-up protection if a condom breaks or slips off during anal intercourse.
For those unable or unwilling to use condoms, rectal microbicides could be a safe and effective alternative means of reducing risk, especially if they were unobtrusive and/or enhanced sexual pleasure enough to motivate consistent use. Such alternatives are essential if we are to address the full spectrum of prevalent sexual practices and the basic human need for accessible, user-controlled HIV and STD prevention tools.
You will find a plethora of information on the research and development of rectal microbicdes on this site. You will also learn of advocacy actvities underway to help move the science forward and make these important prevention tools a reality for the women and men around the world who need them. Please take advantage of the presentations and other materials you find here!

New Guidelines for Treating and Avoiding Opportunistic Infections

by David Evans
Despite the fact that HIV is now perceived as “manageable,” opportunistic infections (OIs) remain a threat, especially for those who are unaware of their HIV status and those out of HIV treatment options. In this AIDSmeds interview, National Institutes of Health (NIH) scientist Henry Masur, MD, explains the Department of Health and Human Services’ recently revised OI prevention and treatment guidelines. They help health care providers and patients steer clear of—and treat—these life-threatening illnesses.How often do we hear today that HIV is a “chronic manageable disease”?
The implication is that HIV is no longer dangerous and that it’s relatively easy to treat. But according to Dr. Masur, a lead author of the guidelines, about one-third of people who test positive for HIV in many U.S. cities do so only after they already have AIDS and require treatment for a life-threatening opportunistic infection (OI)—or are in immediate danger of experiencing one. So it can be misleading to consider HIV and its related illnesses a thing of the past.The newly revised Department of Health and Human Services’ Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents includes an entirely new section on the prevention and treatment of hepatitis B virus (HBV). The guidelines also include sections dedicated to the prevention and management of immune reconstitution inflammatory syndrome (IRIS)—a flare of potentially dangerous symptoms mimicking OIs that can occur when antiretroviral treatment is started by people with low CD4 counts and whose immunity to infections is rapidly restored. These updated guidelines will be vital for all health care providers treating people at risk for OIs, particularly those doctors who treat HIV less frequently.AIDSmeds: Rates of OIs are way down because of the widespread use of combination antiretroviral therapy. So why update the OI prevention and treatment guidelines now? Maybe a better question is: Why have these guidelines at all?Henry Masur: Yes, the incidence of OIs has declined dramatically. But it’s also true that there are an estimated 40,000 to 60,000 new cases of HIV [in the United States] per year. Those numbers haven’t changed substantially in the last two and a half decades. In most cities, 30 percent of people are diagnosed with HIV when their CD4 count is already below 200—it’s 65 percent where I live in Washington, DC—and many are finding out that they’re positive after being diagnosed with Pneumocystis pneumonia [PCP], toxoplasmosis or cytomegalovirus [CMV] in emergency rooms. So there are still a substantial number of people who develop OIs. We’re really dealing with two populations who develop OIs. One is a population that has good access to care and the other is a population that doesn’t. Even in those who have good access to care, drug resistance may develop due to poor adherence and other factors, drug options can then run out and people find themselves at risk for OIs. So [finding] strategies to prevent OIs, including immunization, and management strategies are important.Tell us about the major updates to the guidelines.In terms of diagnosis, the guidelines provide new information about the utility of new tests such as PCR or BDNA tests for Hepatitis C, Hepatitis B, CMV, and tuberculosis.We also highlight new drugs for OIs, including the antifungals voriconazole [Vfend] and posaconazole [Noxafil]. The question is, When should they be used? There are also new drugs for hepatitis B, which were not included in the 2002 version of the guidelines, so we make recommendations regarding those drugs, too.We’re seeing more and more immigrants in this country with HIV and HIV-positive U.S. citizens traveling abroad. In turn, we’re seeing more and more parasitic diseases. So there’s a new section focusing on protozoal infections and complications in the immigrant population and travelers. While I don’t think these infections are huge public health burdens in the U.S., busy health care providers will likely have to deal with them.There are a number of new sections on IRIS in the revised guidelines. How common is IRIS? What should patients and health care providers be looking for?Many HIV-positive people with low CD4 counts starting therapy for the first time experience IRIS, but it’s not always a problem. If you were to do a CT or an MRI study every two weeks in a group of people taking antiretroviral therapy for the first time, I’m sure you could find some lymph nodes that have changed in size—a sign of IRIS—but that is not usually clinically important. The question is, What is clinically important—and that clearly depends on what active diseases, or infections without symptoms, you’ve had in the past.If you’ve had cryptococcal meningitis, toxoplasmosis or even progressive multifocal leukoencephalopathy [PML] in the past, a bad flare can occur when you start antiretrovirals. People can also have a latent infection, such as Cryptococcus or Mycobacterium tuberculosis, that hasn’t caused symptoms but may cause problems once the immune system begins responding to HIV treatment.We don’t have the tools or the knowledge to predict which patients with low CD4 cell counts starting therapy will develop a severe episode of IRIS. We also don’t yet know if we should manage flares by simply monitoring our patients, prescribing steroids or stopping antiretrovirals altogether—which is usually not something you want to do.I know it’s frustrating for the people who have questions about IRIS, but unfortunately we don’t have many data-driven answers.Again, we’re talking about more and more people finding out that they’re HIV positive in emergency rooms. What is the NIH doing to make sure that health care providers, especially those in hospital emergency departments, are aware of these guidelines?We try to work with different professional societies so that they know that these guidelines exist. A major issue facing emergency medicine providers is deciding whether to deal with a health issue in the ER or elsewhere. There’s a lot of effort to make all health care providers, particularly those in emergency rooms, aware of the importance of HIV testing, the complexities of this disease and how essential it is to get infectious disease providers involved early.Any final words?We really appreciate the interest, because I think these guidelines are important. It is interesting that already 80,000 people have downloaded this document. Even without much publicity, people are looking at it and using it.The new guidelines are co-published by the NIH, the Centers for Disease Control and Prevention (CDC) and the HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA). Click here to download the document.

US Senate votes to remove ban on HIV+ travellers

By Tony Grew • July 18, 2008
The United States Senate has approved a new bill that includes clauses that will end the effective ban on HIV+ people visiting the country.
Senators authorised $50 billon (£25bn) for PEPFAR, the President’s Emergency Plan for AIDS Relief, by 80 votes to 16.
The bulk of the money is for HIV prevention and AIDS treatment, but there are substantial sums to fight TB and malaria. Countries in Africa and the Carribean will benefit.
Republican Senator Gordon Smith and Democratic Senator Kerry attached an amendment to a bill repealing current US immigration law.
At present any foreign national who tests positive for HIV is “inadmissible,” meaning he is barred from permanent residence and even short-term travel in the United States.
There are waivers available to this rule, but obtaining them has always been difficult.
The ban originates from 1987, when fear about the spread of the disease led US officials to require anyone with HIV to declare their status and apply for a special visa. It became law in 1993.
As a result of the Senate vote the US Secretary of the Department of Health and Human Services can now lift the HIV ban.
It is unclear if President Bush’s administration will take action or allow the new President’s team to make the changes when they take office in January.
Changes to for PEPFAR will need to be discussed with the House of Representatives as they approved the legislation earlier this year.
The current PEPFAR programme has disbursed $15bn (£7.68bn) over five years and is to end in September.
“We applaud the Senate for rejecting this unjust and sweeping policy that deems HIV+ individuals inadmissible to the United States,” said Joe Solmonese, president of Human Rights Campaign.
“Congress has finally moved to end the HIV ban, a ban based on myth and misinformation,” said Rachel Tiven, executive director of Immigration Equality.
“For 20 years, the United States has barred HIV-positive travellers from entering the country even for one day.”
The United States is one of 13 countries in the world, including Iraq, Saudi Arabia, and Sudan, that bans entry to individuals who are HIV-positive.
Last month the European Commissioner for Justice raised the ban with Michael Chertoff, US Secretary of Homeland Security.
Jacques Barrot asked for “information on the reasons why individuals carrying HIV are excluded from using the US Visa Waiver Programme.”
MEPs have kept pressure on the Commission over the issue as the EU is in negotiations with the US authorities to secure visa-free travel (a visa waiver) for EU citizens from all 27 member states.
In May the European Parliament passed a resolution demanding the ongoing negotiations include the exclusion of Europeans with HIV from the visa waiver programme, and ensure equal treatment of all EU citizens.
The Commission says there are no objective reasons for a travel ban for HIV infected persons.
Earlier this year the Joint United Nations Programme on HIV and AIDS (UNAIDS) stated:
“There is no need to single out HIV for specific consideration as an exclusion criterion.”
UN chief Ban Ki Moon has called for an end to discrimination against people with AIDS, including travel restrictions imposed on them by some countries.
“I call for a change in laws that uphold stigma and discrimination, including restrictions on travel for people living with HIV,” he said last month at the opening of a two-day, high-level meeting in the General Assembly on UN targets, set in 2001 to roll back the disease worldwide.
“Halting and reversing the spread of AIDS is not only a goal in itself, it is a prerequisite for reaching almost all the others (poverty-reduction Millenium Development Goals by 2015),” he added.
He said that 60 years after the Universal Declaration of Human Rights was adopted, “it is shocking that there should still be discrimination against those at high risk, such as men who have sex with men, or stigma attached to individuals living with HIV.”
According to UNAIDS, the global standard-bearer in the fight against HIV, 74 countries are subjecting HIV carriers to restrictive measures, including a mention of the disease on their passports.

The Touchy Subject of Hemorhoids

Hemorhoids.
Hemorhoids are varicose veins of the rectum. The hemorhoidal veins are sited in the lowest area of the rectum and the anus. Sometimes they swell, so that the vein walls become stretched, slim, and irritated b passing bowel movements. When these veins bleed, itch, or hurt, they are known as hemorrhoids, or piles. Hemorhoids are divided in two general categories: internal and external.

 

Formation of hemorhoids
Veins in the rectum and anus are under considerable pressure whenever a stool is passed. Pushing or straining may cause veins in the rectal wall to lump, creating clusters of swollen, or dilated, veins called hemorrhoids. Internal hemorrhoids can form anywhere inside the anal canal, while external hemorrhoids are visible, or just below, the opening of the anus.

Internal hemorhoids
Internal hemorrhoids lie far inside the rectum that you can’t see or feel them. They do not usually hurt, because there are few pain sensing nerves in the rectum. Bleeding may be the only sign of their presence. Sometimes internal hemorrhoids prolapse, or enlarge and protrude outside the anal sphincter. If so, you may be able to see or feel them as moist, pink pads of skin that are pinker than the surrounding area. Prolapsed hemorrhoids may hurt, because the anus is dense with pain-sensing nerves. They usually recede into the rectum on their own; if they don’t, they can be gently pushed back into place. Most commonly the blood in stool caused by hemorrhoids is bright red but internal hemorrhoids can be reason for appearance of dark blood in stool.

  • They are usually mild and painless.
  • There is usually an incomplete bowel clearance and a feeling of incomplete defecation.
  • These mostly occur inside of the anus unlike external hemroids.
  • Those of you who suffer can explain well how everytime you sit on the commode, you have to struggle very hard to clear your bowels.You have to squeeze your abdominal muscles repeatedly and aggresively to push down those obsitinate dry stools to squeeze their way out through the rectum.
  • This somehow pushes forward the hard dry stools few centimeters down through the lower rectum. In doing so you invariably strain the tissues and the blood vessels tremendously. This damages the inner wallls of the rectum in the long run due to over exertion. Neverthless, the stools wriggle their way out through the tortuous anal canal with several fits and starts. Finally you succeed to excreate them out through the anus.
  • Under such circumstances its quite likely that you notice tickle of blood stains that flowed along with the fecal matter that you passed and may be few dropped on the rim of the commode as well.
  • You realize that there was no feeling of pain at all inspite of the little amount of blood that flowed out resulting from some injury to the tissues and blood vessels in the lower rectum including the anus. This is because the inside of the rectum lacks pain receptors, which makes passing of stools painless, no matter how dry and hard they are. This is quite typical of any internal hemorrhoids.
  • The blood oozes because of the bruises. When the veins constrict in the anus, they enlarge. Its vulnerable to punctures under the slightest strain, that cause the blood to leak before its again plugged back due to coagulation of the blood.
  • The swollen veins narrows the passage through the anal canal (the portion between the rectum and anus, 2.5 to 4 cm long ). When passing very hard stools, it injures the tissues and blood vessels, as they are pushed hard to forcibly squeeze through the narrowed rectum, towards the anus from where the feces/faeces are excreted outside.
  • When the hemorrhoids grow bigger inside they protrude or prolapse through the anus.It may even prolapse upon defecation outside the anal canal but auto retracts immediately upon completion.
  • However when oversized, the swollen mass is no longer able to retract back on its own into the anal canal. It has to be gently pushed back into the anus using your fingers.

External hemorhoids
External hemorrhoids are situated within the anus and are usually painful. If an external hemorrhoid prolapses to the outside (usually in the course of passing a stool) you can see and feel it. Blood clots sometimes form within prolapsed external hemorrhoids, causing an extremely painful condition called a thrombosis. If an external hemorrhoid becomes thrombosed, it can look rather frightening, turning purple or blue, and possibly bleeding. Despite their appearance, thrombosed hemorrhoids are usually not serious and will resolve themselves in about a week. If the pain is unbearable, your doctor can remove the thrombosis, which stops the pain, during an office visit.

  • But those that are complex, hangs from the anal sphincter outside the anal canal due to gravity. It remains critically exposed, and can no longer be manually retracted. This can cause acute pain, mucus discharge and puritus ani (itching).
  • They are exquisitely painful, more so when the external hemorrhoids are tightly strangulated with  presence of blood clot (thrombosis) in it. The pain is so painful that only those who have suffered can best describe it. Other than the kind of pain that one endures either from child birth or kidney stones, the pain from thrombosed external hemorrhoids is the most terrible of all.

Threat of Gangerene from Thrombosed Hemorrhoids – A Remote Possibility

  • Hemorrhoids mostly occur in veins. If it did in arteries then the surrounding tissues would be deprived of vital oxygen carried by the blood through the arteries. Eventually the portion of the flesh will die, as the tissues begin to necrotise that causes gangrene to set the flesh to rot.
  • An external thrombosed hemorrhoid must not be neglected. If the blood remains stagnant for too long in the swollen veins, large blood clot will set in. The blood will keep oozing from the damaged tissues and collect under the skin to clot, due to prolong lack of muscle movement. The toxin cells just cannot be flushed away, as circulation of blood becomes sluggish.
  • It begins to then block the veins that cause it to massively swell under pressure, as the heart pumps blood harder. But that too has its limitations, and the cell toxins quickly spreads. In extreme and rare cases it may also spread to the arteries and block blood circulation, resulting in gangrene from cell necrosis.

   Treatments for External Hemorrhoids using Non Surgery Methods

   There are however many ways to get rid of hemorrhoids other than surgery. These includes:

  • Shrinking of small hemorrhoids using injection,
  • Banding hemorrhoids by tying of special rubber/latex band around the affected portion using a special instrument,
  • Photo coagulation that uses pointed infra red light to stop bleeding,
  • Super freezing using cryogenic treatment with liquid nitrogen to discard the external hemorrhoid portion,to allow healthy tissues to grow in its place.
  • Laser light for faster and painless treatment,
  • Cutting and coagulation of hemorrhoidal tissue using ultrasonic technology (Harmonic Scalpel),
  • Transanal Hemorrhoidal Dearterialisation using proctoscope and doppler ultrasound flowmeter to stop blood flow to the hemorrhoids by stitching the artery below,
  • Atomizing hemorrhoids by using a wave of the Atomizer Wand. The hemorrhoids are vaporized or excised one or more cell layers at a time using the Atomizer. 

   Natural Cure for at Home Hemorrhoid Treatment

There are ten important suggestions to cure your hemorrhoids:

  • Drink plenty of water, at least eight glasses in a day. This will help to keep the stools to remain moistoned and aid in lubricating its passage through the rectum. Thus help to reduce chronic constipation, if any.
  • Avoid fizzy drinks or carbonated beverages (such as coke or soda) and any caeffine as they dehydrate the body quickly.
  • Avoid food that is high on flour and sugar, such as white breads, cakes, pastries, pasta (made of white flour smothered in cream sauce) etc.
  • Eat more vegetable (beans, lentils, cheakpeas, soyabeans etc.) and fruits rich in fibres such as raw apples and pears with skin, bananas, orange, any nuts.
  • Eat whole grain food e.g oats, 100% whole-wheat pasta or brown bread rich in high fibre. According to the American Dietetic Association, an average intake of 30 gms of fibre is recommended.
  • You can also gulp down a glass of water with teaspoon of Psyllum, a natural husk, that helps in easy bowel movement.
  • Take in more biofavonoids such as those found in citrus fruits, green/black tea and dark chocolates. It helps to strengthen the walls of blood vessels and reduce inflammation. Its especially good for bleeding hemorrhoids during pregnancy.
  • Keep your anus clean and disinfectant using medicated soap and water.
  • Exercise and move frequently such as by walking or climbing up few steps to a floor or two.
  • Avoid sitting too long at one place to avoid prolong compression of the blood vessels in your bottom
  • Kerosene oil also can be applied to the area at nights and washed away in the morning or good old Preparation H cream which also contains some kerosene and other healing properties.

Treatment of Hemorrhoids – Surgical and Non Surgical Methods

Most hemorrhoid treatment does not require any surgery at all. Only when it becomes far too complex and severe such that there is unusual discharge of pus or uncontrolled bleeding accompanied with unbearable pain in the area. The doctors usually suggest for immediate surgery of the piles in such situations.

Types of Surgery for Treatment of Thrombosed Hemorrhoids

 Conventional hemorrhoid surgery includes:

         1. Milligan-Morgan Technique,
2. Ferguson Technique,
3. Stapled Hemorrhoidopexy (PPH Procedure),

All of which more or less requires full theater operation and hospitalization for post operative care (at least 3 days). You will also need time to recover completely after a painful hemorrhoid surgery, before your bowels begin to function normally. You may even suffer from anal stenosis, in case the pile surgery turns complicated. However in each case  there are both advantages and  disadvantages, none of which can claim total and effective cure.

How Hemorrhoids Affect Normal Life

  • Hemorrhoids by nature are not life threatening unless prolonged without treatment. However they make life miserable. They cause enough pain and distress to the patient. Daily routine is disturbed. The person is physically and psychologically traumatized.
  • Prolong blood loss due to bleeding from piles may result in anemia i.e. cause iron deficiency in the blood. If it grows far too big for him or her to manage, the pain becomes unbearable. The person would under such circumstance need immediate medical intervention for relief and treatment.
  • Most often doctors advise for surgery to such patients. However there are plenty of non surgical methods to cure hemorrhoids safely.

MORE READING

Symptoms: http://hemorhoids.50webs.com/symptoms_of_hemorrhoids.html

Causes: http://hemorhoids.50webs.com/causes_for_hemorrhoids.html

Diagnosis: http://hemorhoids.50webs.com/diagnostics_of_hemorrhoids.html

Treatment: http://hemorhoids.50webs.com/treatment_of_hemorrhoids.html

Nutrtition: http://hemorhoids.50webs.com/nutrition_and_diet_for_hemorrhoids.html

Home Remedies: http://hemorhoids.50webs.com/at-home_remedies_for_hemorrhoids.html

(pic from learnzon.com)