Medical News Jan

Medical News

Is anyone surprised? Unsafe sex, especially with partners who are on the opposite side of monogamous are playing with the deck stacked against them. How many did he infect after he was infected? Is that something to be proud of? Might they enter the medical system when they are gravely ill and maybe die? Did he and his contacts get regular tests? He says he has known for 4 years. You are most infectious the first few months after catching it? If he is smart and does what he is told by his specialist, he will be at the worst inconvenienced by having blood tests and medical visits every 3-6 months for many years. If he doesn’t follow instructions (he calls this “Winning!, March, 2011) he will most likely suffer and/or die. Are you living a fantasy? Are you “winning” like Charlie Sheen?

The number of new cases worldwide continues to drop as more and more treatment is given. Treatment As Prevention is working; those on treatment pass HIV rarely. The World Health Organization is quite encouraged.

A large study in Uganda shows that those HIV patients taken off Bactrim® since their immune status improved had a higher risk of getting malaria. It is now recommended to not stop Bactrim® and to start it ASAP when HIV is diagnosed; this is what we do in Malawi.

I found this article interesting. Here is a partial list: 1) germs causing disease, 2) we give our children our genes for better or for worse, 3) treating cancer by strengthening the immune system, 4) moderate head trauma during sports can cause permanent damage, 5) hand washing by health care staff, 6) some viruses causing cancer, 7) baby incubators, 8) proteins that can infect people (like mad cow disease), and 9) balloons for opening up heart arteries. When a person has heart symptoms, and the tests confirm it, many have dye put through their heart arteries to find narrow spots that should be widened by this balloon which crushes the clot and fat against the wall. Then a stent is sometimes put in; it is a spring loaded rigid mesh tube that keeps the artery open. These are very common procedures and have saved many lives.
Also 10) the germ Helicobacter pylori causes ulcers. We give 3 medications to get rid of this germ and that cures the patient who doesn’t have to take medication for many years. The test is performed during a scoping or on a stool sample.

Those of you in enough pain to take a narcotic are well aware of the new rules: must have a visit with a provider, pharmacy must have a hard copy of the prescription, some plans limit the number of pills given, a general increase in hassle to pharmacies, providers, and patients. There is a new law that all pharmacists and physicians must be registered on a California State website to receive reports on their patient’s use of controlled substances. We can print out a report of a patient’s use for the last months or years and see who prescribed it, date, pharmacy name, and number of pills. I have used this to reinforce the common rule that there should only be one prescriber and one pharmacy for such medications to minimize abuse suspicion otherwise the patient has to go somewhere else to receive these prescriptions.

Surveys were given, scans were done, and psychological tests were performed on HIV negative and positive people who had their virus well controlled. The positives had no major differences but had more mild problems: with processing information (like this article), anxiety, and depression. They perceived more problems with energy, social functioning, and general health. So, prevention and safe sex is still a good idea as well as early, effective treatment.
This study did not find more depression or mental problems in those using efavirenz (in Atripla®) as previous studies have shown.
It was done in the Netherlands which has 82% of their HIV patients controlled; The US has ~30%. It is a small country with national health insurance they see as a right for all. This means higher taxes but the benefit is a huge bargain, just like being taxed for road maintenance.

Here is another reason for Pre-Exposure Prophylaxis besides getting married and not using a condom. Breast feeding can involve a little blood if there is trauma, like biting or an infection. So HIV can be transmitted sometimes via that route. Using PrEP during breastfeeding time (up to a year) can take care of this. Some countries have such poor water that breast feeding is recommended for HIV+ mothers, even though there is a transmission risk.

Be Safe! Wear protection. Keep those questions coming.

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 County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside
Researcher, Inland Empire Liver Foundation and Clinical & Translational Research Center