BATHOUSE WITH FREE HIV TEST KITS—GREAT UPTAKE

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A gay sauna house in England found many more got tested with this method than by having someone there to do testing.

RISKY ALCOHOL DRINKING INCREASING
A very large US study showed that risky drinking is going up, especially among minorities, women, and elderly. Risky drinking is defined as drinking more than the safe daily amount at least once a week. For men this is 3 12oz beers or 3 mixed drinks or 3 shots of spirits. For women the number for each of these is 2. The liver is damaged a little bit each time you go over the limit, but you don’t feel it until the accumulated damage reaches a limit and it is too late.

20,000 CENTRAL AMERICANS HAVE DIED FROM KIDNEY DISEASE RECENTLY
100,000 are also affected in Sri Lanka. The cause is dehydration. Many work in fields without adequate hydration and shade in hotter weather. It seems repeated dehydration episodes can damage the kidneys permanently. If you work outside you should drink enough to have clear urine, and pee at least every two hours. Caffeine drinks do not hydrate well, but make you pee more often and mask the symptoms of dehydration. Shade and rest are important too. A new machete that reduces energy to cut plants has been helpful also.

RIGHT-TO-TRY BILL
There is a bill in the US Senate to allow those with life-threatening illnesses to try experimental drugs. Hopefully this will lessen the fears of the pharmaceutical companies to allow use of their experimental medications. But from the company side, they don’t want any bad outcomes like death or complications, which might sour the hope the new drug has of getting approved and being popular.

CBD FROM MARIJUANA MAY INTERACT WITH SEIZURE MEDICATIONS
A synthetic cannabidiol (CBD) was found to cause drug interactions with newer seizure medications. Marijuana has been found in some studies to be associated with seizure control. So, taking marijuana compounds for seizures has some risks, but may have some benefits.

SHOULD SENATOR MCCAIN “FIGHT” HIS CANCER?
President Trump said that John McCain was not a war hero since he was caught even though he showed great courage in the North Vietnamese prison camp. Cancer is not a war, or a battle. If you die from Cancer it doesn’t mean you didn’t fight enough. Who are we to judge by saying “Pat gave up”, or “Pat fought to the end.” I am talking about a cancer that has no hope for a meaningful life in the future, and a cancer treatment that will cause much suffering to gain very little. Instead, enjoying the life you have as much as possible is a far more satisfying route. E.g. if you have only $20 for gas to get to Phoenix, then you won’t make it. Spending a few days at home is better than spending it in the desert without any hope for money for more gas. A wise person doesn’t fight against a solid wall. It is better to be wise than a fight a battle you will lose.

ON-DEMAND PrEP RECOMMENDED IN FRANCE FOR MEN
A new European and Canadian study showed that in 361 men that on-demand PrEP was good at preventing HIV transmission and many had condomless sex. And now the European guidelines recommend this. We worry that if this is widespread, STIs will be more common, but in this short study there wasn’t an increase in sexually transmitted infections (STIs). STIs cause breakdown of the skin and tissue barriers, making the HIV more transmissible without Truvada®; but with Truvada® it hasn’t been studied. The dosing is: two doses of Truvada® between two and 24 hours before sex, another dose 24 hours later and a fourth dose 24 hours after that.
About 14% minor stomach issues occurred which cleared up and only 4 patients quit the study.

VIRAL LOAD JUMPS JUST BEFORE DELIVERY
A Canadian study showed that checking the viral load a day or so prior to delivery (who can predict that date!) showed that some with earlier undetectable levels had higher levels just before delivery which increases the transmission risk; but none of the babies got HIV even though 2 of the viral loads were more than 10,000. Cocaine use, native Canadian race, and active Hepatitis C stood out as risk factors for this surprise lab result.

SUSTIVA NOT ASSOCIATED WITH STILLBIRTHS or the baby dying within the first year or being premature. Sustiva (in Atripla) has a reputation for causing birth defects in animals, but the warning for humans has been removed. This will be looked at again since there is much more information available now with the medication being available so many years. Sustiva is a very helpful medicine and it is first line in Malawi, Africa where I work once a year. I recommend it because it forgives a couple of missed pills a month.

Daniel Pearce, D.O., FACOI, AAHIVS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine HIV Specialist, Assistant TB Physician, Riverside University Healthcare System, Public Health (Department)
Member, Coachella Valley Clinical Research Initiative

REFERENCES: Medscape®

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