Posts Tagged ‘aids’
Starting antiretroviral (ARV) therapy with a CD4 count above 500 doesn’t decrease the risk of AIDS or death from any cause, according to a new report from a large cohort study published in the September 26 issue of Archives of Internal Medicine.
For people living with HIV with CD4s below 350, the Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE) study confirmed the clinical benefits of starting and remaining on ARV treatment. as for those with CD4s between 350 and 500, CASCADE indicated slower rates of disease progression associated with starting treatment, though there were too few new AIDS cases or deaths in this particular group during the study to yield firm conclusions.
The question of when ARV therapy should be started has not yet been answered. Though there are data from at least one major study indicating that HIV treatment, initiated as early as possible, profoundly reduces the risk of ongoing transmission of the virus–an important public health benefit of ARV therapy–many advocates contend that it will be necessary to prove that early treatment also protects the health and lives of those actually taking the medications, without an increased risk of side effects or drug resistance.
Three large cohort studies indicate that people should not wait until their CD4s fall below 350 to start ARV therapy to protect their own health. as for waiting until the CD4 count falls below 500, one cohort—the NA-ACCORD study—suggested this is detrimental, whereas another did not; the third cohort only included patients with fewer than 500 CD4s, thus a detailed analysis was not possible. NA-ACCORD also pointed to disease-free survival advantages when therapy is started when the CD4 count is between 500 and 800.
Acting on the initial cohort findings, the U.S. Department of Health and Human Services changed its ARV treatment recommendations in 2009. whereas the guidelines previously recommended treatment for all people living with HIV with CD4s below 350, the threshold was increased to below 500 in light of the important—but inconclusive—findings.
Some experts argue that the only way to know the absolute benefits and risks of starting therapy early—indeed, even immediately after HIV is diagnosed—is to examine the results of a randomized prospective study. The international Strategic Timing of Antiretroviral Treatment (START) trial is exploring this question, but data are unlikely to be available until 2015. Taking place at roughly 90 sites in nearly 30 countries, START is randomizing more than 4,000 antiretroviral-naive HIV-positive individuals with CD4s above 500 cells to either begin treatment immediately or defer treatment until their CD4s are less than 350 cells.
In the meantime, additional data are available from the CASCADE study, a large cohort consisting of 23 small cohort studies being conducted throughout Europe, Australia and Canada. The report published in Archives of Internal Medicine by Michele Jonsoon-Funk, PhD, of the University of North Carolina at Chapel Hill and her colleages is similar to a preliminary review of the data orally presented in July 2010 at the XVIII International AIDS Conference in Vienna.
Unlike other cohorts, which began following people from the time they started therapy, the new CASCADE analysis involved 9,455 people who were infected within the previous two years and followed them until they started ARV therapy. In other words, CASCADE researchers were in the unique position to document what happened to patients before they began treatment.
Between January 1996 and May 2009, the CASCADE researchers enrolled new patients every month, thereby created 161 small groups of patients for comparisons purposes. Patients were followed, on average, for nearly five years in the study. when ARV treatment was started, the investigators noted the patients’ CD4 counts. Where there were AIDS-defining conditions or deaths, the investigators noted how long they occurred after each patient joined the cohort.
The greatest benefits were seen among those who started therapy with immune systems that were clearly compromised. for example, those who started treatment as soon as their CD4 count fell below 50 were nearly 70 percent less likely to develop an AIDS-defining illness or die, compared with those who waited. Among those with CD4s between 50 and 200, starting therapy as quickly as possible reduced the risk of AIDS or death by 70 percent, compared with those who delayed treatment.
Of interest, the researchers reported a number-needed-to-treat (NNT) analysis for patients starting HIV treatment in each CD4 group. an NNT analysis is a relatively simple measure of effectiveness of a particular medical intervention, and it aims to determine the average number of people living with a disease who need to be treated to prevent one additional outcome. for example, the NNT analysis employed in CASCADE set out to determine the number of people living with HIV and a CD4 count within a particular range who need to be treated with ARV therapy to prevent one new AIDS case or death.
Not surprisingly, the NNT among patients starting with very low CD4s was also low—a total of three people living with HIV with CD4s below 50 needed to be treated with ARV therapy to prevent one AIDS case or death. Among those with CD4s between 50 and 100, the NNT was 7. The NNT for those with CD4s between 200 and 350 was 21.
There was also an appreciable benefit for those who started therapy as soon as their CD4s landed between 350 and 500, compared with those who delayed therapy—a 25 percent reduction in the risk of AIDS or death. however, Funk and her colleagues note, when treatment was started with CD4s in this range, “the benefits of treatment initiation become evident only beyond two years, suggesting that patients need to consider the long-term course of treatment, including the risk of adverse effects of [ARV therapy] during an extended period.”
Here the NNT was significantly higher—34 HIV-positive individuals with CD4s between 350 and 500 needed to be treated with ARV therapy to prevent a new AIDS case or death.
As for those with CD4s above 500, there was no advantage in terms of AIDS-free survival. here, no NNT could be calculated in terms of preventing AIDS or death, though the researchers did suggest that 239 people living with HIV and high CD4 counts would need to be treated with ARV therapy to prevent a single death, from any cause.
A limitation of the CASCADE study is that it didn’t monitor participants for some of the non-AIDS-related health complications that are believed to be more common among people living with HIV. “Patient well-being is adversely affected my many serious non-AIDS-defining conditions,” Funk’s team writes. “For example, immunodeficiency and uncontrolled viremia have been implicated in the development of cardiovascular disease and non-AIDS-defining malignancies. although CASCADE does not pool data on non-AIDS morbidity, this analysis reflects the most serious outcome (death) due to non-AIDS conditions.”
While awaiting the results of SMART, treatment decisions for those with CD4s above 350 “will need to be made based on the available evidence from observation cohorts,” Funk’s team concludes. “We used a novel approach applied to a unique cohort of seroconverters to reduce the potential for lead time bias. We found that treatment initiation and CD4 cell counts of 350 to 499 was associated with slower disease progression. We did not observe any benefit to treatment initiated at 500 to 799.”
Imagine that you work for some local newspaper. And tomorrow is the World AIDS Day. Editor gives you a task to compose a thematic crossword for the entertainment section. Crossword where all words are somehow related to AIDS. Now, I ask you to take a minute and try to think what words you would use for the puzzle…
Most of my colleagues to whom I gave this challenge said that the first word that came to their mind was “condom”. Funnily enough, only few came up with more than one word at all (so, possibly the newspaper’s issue wouldn’t have a crossword ).
I am telling you this story in order to illustrate how strongly westerners associate the usage of condoms with the prevention of AIDS and other STDs. And I am almost sure that Chinese respondents would give a different answer. because according to a 2003 survey, 17% of China’s population had never heard of HIV/AIDS and 77% did not know that condom use could prevent its transmission!
For a long time (and in many places until now) condoms in China have been associated mainly with contraception. As such they could be distributed among population by family planning officials – but to married couples only. Advertisement of condoms for out-of-wedlock usage was viewed as a decadent Western trend unacceptable in Chinese society. not surprisingly many brands of Chinese condoms feature mainly Western bodies on their boxes.
In the article “Vilifying and Promoting Condoms” Tiantian Zheng – professor of sociology from the State University of New York – recalls the story told to her by a 28 years old Chinese woman:
Although I am married, people always say that I look like I am 21. one day after work, I had time to stroll along the street and happened to step into a drug store. Dozens of colorful packages of condoms lying under the counter caught my eyes and aroused my curiosity. I thought I should get one and try it out.
After studying them for a while, I still had no idea which one I should buy. so I turned to the shopping assistant, asking: “Could you please recommend one with good quality?” She looked me up and down, and then sneered at me, saying, “You don’t know? You should go ask your clients!” I was dumbfounded. I was so angry with her words that I stood there and could not say a word. Tears rolled down my eyes. I left the store, crying the whole way home and swore that I would never buy condoms again.
Thus, in today’s China we have a paradoxical situation when people are liberal enough to enjoy sex (including premarital sex), but feel too shy to talk about it and buy condoms. And the main reason for unsafe sex is not the lack of condoms but the cultural and psychological barriers related to their usage. Indicative are the results of 2002 survey in Jiangsu province where 69% of college students claimed that they could get condom if they need one, but only 30% said they know how to correctly use a condom.
In the light of this survey the following tragicomic story from Zheng’s article doesn’t seem unreal:
One of the owners of an adult health product shop told me that she used to be the leader of the city’s family planning office during the Maoist era. She told me many stories about condoms during that time. She said:
People at that time came to me complaining that condoms did not work because their wives continued having babies. so I asked the guys how they had used the condoms. the men put the condoms on their thumbs and said that was how they had used them, just the way it was demonstrated to them when condoms were distributed…
But what do you want from rural Chinese living forty years ago when today’s Chinese sex education teachers are too shy to name the parts of human body. Dr. Marty Klein – renowned psychotherapist and sex therapist – describes his meeting in March 2011 with sex education teachers-in-training at Chengdu University:
I emphasized, the effective sex education teacher needs way more than information and a curriculum; the teacher needs a healthy attitude about sexuality. That’s mostly what I’m here to discuss, I said.
And that was the biggest issue for them. Knowing what a clitoris is is one thing. Being able to say the word is another. if you can’t do that, you’ll never get your students comfortable with saying it.
These student teachers were unable to say the word. And it wasn’t just in the class – they acknowledged they’d never say it in private, either. so of course I had them say it a few times, until they were laughing.
Shyness is not the only obstacle for the widespread usage of condoms in China. another issue is related to the underestimation of possible risks bordering with criminal ignorance.
Look at the frightening statistics gathered from female sex workers in China. One survey, for example, showed that in 2000 in the province of Hunan nearly 90% of sex workers ‘never used’ condoms!
And here is the reasoning given by one KTV hostess from Shanghai in 2004:
I know I might contract STI and AIDS doing such things (commercial sexual transactions). but I have been choosy, making sure that my clients are clean. I wash myself clean and ask my clients to do the same before we began. […] Generally speaking, I don’t use condoms. I only use them in the case of dirty clients.
Regarding KTV girls Tiantian Zheng showed how the dynamics in their relationships with customers influence the incidence of condom usage. Sex workers who insisted on using condom lost clients and plenty of women were willing to forgo condoms. When a client relationship repeated itself, it was considered insulting by clients to be asked to use condoms. As repeat visits were an important step toward establishment of “husbands,” there was powerful incentive to refrain from insisting on anything in case of long term client relationships which might lead to significant support.
As you can see the ignorance about sexually transmitted infections and their prevention is a true national problem in China. And there are many factors contributing to this sad (and dangerous) situation.
I just hope that the trend for growing usage of condoms in China, as witnessed in the last years (see the chart below) will continue and people will regard it as a sign of maturity and not promiscuity.
Just a blogger, Crystal Tao
Dec 01, 10
In 2008 alone, 2000000 people died from AIDS-related infections and diseases across the world. Two million more children live with AIDS, according to the data released by World Health Organization (WHO) and UNAIDS.
Those who are hit the hardest by the virus are the disadvantaged in the poorest regions in the world. In Africa, women get HIV from their husband who engage in promiscuous sex. Reports show that women silently suffer repeated marital rape; they are forced to choose between suffering marital rape or be thrown out with their children and live in the streets, should they refuse to copulate with their spouse.
Every day, hundreds of people die from AIDS-related infections and diseases. A family member, friend, co-worker or loved one may be HIV-positive without you knowing it. But we can help make a difference today.
This year, the AIDS awareness campaign is similar to the LGBTQI’s struggle — to recognize human rights of people living with AIDS.
Universal Access and Human Rights
The ”I AM” themeBackgroundThe World AIDS Campaign arrived at the selection of the theme Universal Access and Human Rights after close consultation with representatives of various constituencies, communications and media representatives of partner organizations, and friends of the World AIDS Campaign.
Why I AM?Understanding HIV and AIDS from a human rights perspective can be difficult. Human rights are often misunderstood and can sometimes be seen as abstract ideals with not much practical relevance for real people.
The slogans for the World AIDS Day materials were designed to bridge that gap andunderscore the importance of awareness of Human Rights.
Among the key slogans adopted:
- I am accepted.
- I am safe.
- I am getting treatment.
- I am well
- I am living my rights.
- Everyone deserves to live their rights
- Right to Live
- Right to Health
- Access for all to HIV prevention treatment care and support is a critical part of human rights.
The aim was to provide concise, informative texts designed to illustrate the relationship between Human Rights and Universal Access.
As of August 10th the supporting materials will be available in campaigning packages (four posters and two post cards) printed in English, Spanish, French and Russian. These will also be available to download from our website. Arabic, Mandarin, Hindi andPortuguese versions will also be available to download from our website.
Keep the promise. Be faithful to your partner and practice safe sex
Be safe. Practice safe sex. there are many options available now, just choose which works best for you.
Be informed. As the adage goes, prevention is better than cure and prevention starts with having the right information. Information will empower you.
It’s okay to admit that you don’t know about HIV/AIDS. We can start learning about it now. here are the basic facts and stats from worldaidsday.org:
HIV is a virus that attacks the body’s immune system – the body’s defence against diseases.
Are HIV and AIDS the same?
No. when someone is described as living with HIV, they have the HIV virus in their body. A person is considered to have developed AIDS when the immune system is so weak it can no longer fight off a range of diseases with which it would normally cope.
How is HIV passed on?
HIV can be passed on through infected blood, semen, vaginal fluids or breast milk.
The most common ways HIV is passed on are:
- Sex without a condom with someone living with HIV
- Sharing infected needles, syringes or other injecting drug equipment
- From an HIV-positive mother (to her child) during pregnancy, childbirth or breastfeeding (but with effective treatment and care the risk of transmission can be greatly reduced)
I don’t know anyone with HIV… do I?
Today there are more people than ever before living with HIV in the UK, but less people report knowing someone with HIV. People with HIV generally look healthy and many do not find it easy to tell other people, so you may not realise if someone you know if HIV positive. to learn more about the different groups of people affected by HIV view the statistics.
Is there a cure for HIV?
No, but treatment can keep the virus under control and the immune system healthy. People on HIV treatment can live a healthy, active life, although they may experience side effects from the treatment. If HIV is diagnosed late, treatment may be less effective.
How can I protect myself and others from HIV infection?
Always use a condom when having vaginal or anal sex. You also may want to use a condom or dental dam during oral sex although the risk of transmission of HIV is much lower. You can get free condoms from a sexual health clinic, which you can locate at via the fpa website. Never share needles, syringes or any other injecting equipment.
What’s it like living with HIV?
To read and hear stories from people living with HIV in the UK. Visit HIV Reality
How is HIV transmitted? when does HIV become AIDS?
Learn how HIV can be transmitted and how you can be protected here.
Did you know that many common herbs and ingredients can be made into delicious healing herbal teas? When most people think of tea, they think of green tea, black tea or maybe even white tea.
Most people do not turn to everyday herbs to make tea from, but they can be of great benefit to your body. From aiding in weight loss to reducing blood pressure. It is truly amazing what results can be achieved by making these simple true herbal teas.
Cayenne for example added to a tea can help curb your appetite and aid in weight loss. Cayenne Herb is actually quite good when added to a tea and gives it a little kick
Peppermint Tea can ease an upset stomach, and aids in digestion, especially after a big meal. It reduces bloating and gas and can stop naseau and motion sickness if we just think about it, peppermint is usually a candy or mint provided at restaurants, and the digestive aid properties are why this is such a popular choice for the candy bowl on your way out of a restaurant.
Chamomile Tea can help to reduce stress and calms the nervous system. This is why Chamomile is often suggested as a sleepy time tea to help you to get a good nights sleep. Chamomile has long been known as a nervous system regulator and can really help those with the jitters.
Basil Tea can help to reduce swelling of the gums and treat gum disease Who would of thought of drinking a tea made from basil. It is really quite delicious and if you are suffering from gum pain, drink up. This powerhouse herb will really provide you with results. Basil Tea is also used to treat disorders of the liver, lungs and even the brain.
The Recipe for Basil Tea is really simple. take fresh water and bring to a boil. for each cup of basil tea, add 8 fresh leaves of basil to your teapot.
Let the Basil Tea steep for 8-10 minutes and drink this tea warm. Treat your brain, lungs and liver with this herbal tea remedy and holistic health tea.
I hope you enjoyed this article and seek out information on other herbs to add to your tea
Asked if teenagers should carry condoms, mr Mechai Viravaidya, a famous activist encouraging people to carry and use condoms, asked the public which option will be safer: having sex with or without using condoms. he said failure to carry and use condoms might lead to infections of sexually transmitted diseases, including HIV/AIDS.
Mr Mechai, also founder and chairperson of a foundation in his own name, shot another rhetorical question if teenagers will be more interested to have sexual intercourses when they carry condoms. he explained that teenagers are in the age of discovery as they want to try new things but he uttered that it does not mean that they will have immediate sexual urges when they walk pass convenience stores where condoms are sold.
The condom campaigner expressed his opinion that the importance of this issue is not with the mother of the young idol suggesting her son to carry condoms. he pointed out that he is a human being and all human beings are created to have sexual interest by nature; therefore, he said a more crucial point of discussion here should be how to have sex safely.
As for the mother of the young actor, mr Mechai said he wants to compliment her to be such a smart mother and she should be nominated the best modern mother on the National Mother’s Day. he explained that teenagers in average have their first sexual experience when they are about 15-16 years old; thereby, parents should teach their children well.
Following this news, the Ministries of Public Health and Education as well as related sectors should use this little phenomenon as their opportunity to call for social recognition on the use of condom at early age. Cultural values should be adapted to the modern world, and the related ministries should join hands in making sure that sex is no longer a taboo but is taught in classrooms properly.
Like many, I am a sucker for the Chicago Public Radio program, This American Life. So when I loaded up the latest episode for my commute home yesterday, I was prepared to be entertained — especially since the show was billed to be about “Gossip.”
This American Life – Gossip
And I did love the show… But only the first few minutes were what I expected (a story about how a man inadvertently spread news about the sex life of his wife’s hairdresser…) the bulk of the program investigated Susan Watkins’ fantastic project studying how people talk about HIV/AIDS and sex in rural Malawi. It is seriously entertaining and informative, highlights all sorts of mistaken premises of longstanding prevention programs (like the idea that people don’t talk about sex or AIDS because she finds that they do all the time), and some of the popular ideas that fuel attitudes, behavior, and transmission of the epidemic. One particularly amusing anecdote is the discussion among men that it’s a better idea to sleep with a “bargirl” because “everyone” knows she sleeps around and has AIDS, and in such cases, there’s no question that you would wear a condom.
Anyway, Watkins’ work is some of the most important social science research on the social determinants of disease, and her approach — of getting ordinary people to keep journals, rather than conducting more artificial surveys — clearly bears a lot of fruit. Information about this breath-taking project are available here.