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This Month in HIV: A Podcast of Critical News in HIV
  

This Month in HIV: Top 10 HIV/AIDS Stories of the Past Year

May 2008

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.

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Survival With HIV: Great Expectations

Number nine has some good news!

Number nine is good news, and that has to do with survival with HIV infection. One of the questions I'm often asked after a person learns that he or she is HIV infected is, "How long do I have to live?" The good news is that we know it's on the order of decades. In a really, very well done study that came out of Denmark, we see a really nice estimation of how long people can expect to live using modeling. The researchers were able to accomplish this, because they keep track of every single person with HIV infection in Denmark, and they also have great data on the population as a whole.36

What they were able to show us was that someone who's age 25, the hypothetical 25-year-old you mentioned before, who's HIV infected, can expect to live on the order of 20 or more years with their HIV infection. Now, that is less than for the general population, but I think it's really very encouraging.

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When you look at survival for people with HIV infection who were diagnosed more recently, that number goes up to 32 years, and that reflects the use of potent HIV therapy. Just looking at the aggregate over a time period of a decade or two, we see that there are already indications that the longevity number is just going to keep getting bigger and bigger.

What I tell people is, if we say that you have 20 to 30 years of life expectancy from now, just imagine what's going to happen in the next 10, 20, or 30 years -- imagine the advances we're going to see realized, and how that's going to extend your life even further.

I think this is great news. It's encouraging and also, importantly, it puts forth a fixed number that people sometimes just need to be able to grab on to. So if I say to this 25-year-old, we're looking at 32.5 more years of your life, in general, and that things are going to happen that'll be amazing during that time period that'll extend it even further, I hope that's reassuring to that person, that they'll be around for a long time and that they will probably succumb to something other than HIV infection.

So they shouldn't get stuck on the numbers -- shouldn't say 25 plus 32 equals 57. I'm going to be dead at 57 and I should plan for my funeral that year.

I think that's important. [If they did get stuck on the numbers,] I think that would be understandable, but naive [of them]. Remember, these are aggregate numbers that come from thousands of people -- this is not individual. I think we have to understand that for all the research we're talking about.

When we look at studies, they don't tell us what's going to happen to the individual patient, they tell us what'll happen to a group of people. Any individual person has to decide for themselves, is this study a good study? Do I look like the people who were studied? Do I live in Denmark? Do I have a system like they have in Denmark, where there's universal health care?

You can't necessarily apply everything you read from one study to yourself, but this gives us sort of a ballpark figure we can use when thinking about this. We certainly know that it's obsolete to say you have 10 more years to live after you get HIV diagnosed, data we had generated from 15 to 20 years ago in a different world.

"I tell people, 'Chances are that if you do most of what we talk about and take care of yourself, you can get old.'"

I find this reassuring; it kind of does tag that number on along with our perceptions. I tell people, "Chances are that if you do most of what we talk about and take care of yourself, you can get old." I think that this study shows that.

One thing the study also showed, though, and about which we have to be very careful, was that this longevity was truncated, limited, among people who have hepatitis C. We really should try hard to make sure that people understand that and do not become infected with hepatitis C if they don't have hepatitis C right now. It also means that, for people with hepatitis C, we have to really take care to neutralize that problem the best we can by offering them treatment.

Immune Function and the Risk of Cancer

On to number 10.

Number 10. This follows a similar sort of line, and that's trying to understand what are the risks as people live longer with HIV infection. We've talked a little already about cardiovascular disease, and it makes sense that, as people live longer with their HIV infection and do not succumb to HIV-related diseases, well ? everyone's gotta die of something. None of us are immortal. If you're an HIV-negative person living in the United States or Europe, you're probably going to die of cardiovascular disease or cancer. What we really want to understand is whether there is a greater risk of cancer due to the HIV infection. Is there a greater risk of cardiovascular disease due to the HIV infection itself? We want to know whether this is not just a normal process.

There was a very nice and interesting study published in The Lancet that looked at this in a very creative way.37 What they were able to do was look at different published studies of cancer rates among people with HIV infection, and they compared it to another group of people who also suffer from problems with their immune system, and that's organ transplant recipients. These are people who take medicines that reduce their immune system function so that their body doesn't reject that organ.

Looking at these two groups, the investigators were able to understand the patterns of cancer, and how much this might be related to immunosuppression.

Most of us think of the immune system as protecting us against germs. The immune system also protects us against cancers. We're just starting to understand that over the last several years. When a cell becomes cancerous, the body responds to it by saying, "You don't look like me, you look foreign." That's the same response the body has when a germ comes into it. It says, "You don't belong here, and we're going to attack you." A healthy immune system will take care of a cancer cell. People develop cancer cells all the time, and the immune system gets rid of them -- you don't even know it!

In people who have problems in their immune system, that protective mechanism is faulty. That's why we do see cancers in people with HIV infection. Two of the first things we saw, Kaposi's sarcoma and non-Hodgkin's lymphoma, are cancers that people developed with HIV infection.

People with solid organ transplants also developed cancers. What the investigators found was that the patterns of increased cancer risk were actually not that dissimilar between HIV-positive patients and those who received transplants. The rates of cancers with an infectious cause -- those are cancers we know are triggered by viruses, such as cancers related to human papillomavirus (HPV); Hodgkin's lymphoma, which can be triggered by Epstein-Barr virus (EBV); or liver cancers caused by hepatitis C or hepatitis B. There were more of those cancers in both groups. The patterns were a little bit different, but not as different as you'd think, suggesting that the immunosuppression that occurs both with HIV and transplants leads to a development of malignancies.

This is important data because it really indicates to us that we cannot tolerate poor immune function among people with HIV infection. If we do, we risk the development of malignancies. This is not the focus of this paper; in fact, it wasn't mentioned, but to me it brings up the issue of when do we treat HIV infection. Do we allow people's T-cell counts to go down so low that we may be placing them at risk for these infections that could lead to cancers? I think this is part of that discussion, and it goes along with also the effect on the brain and central nervous system of having a lower CD4 cell count, and long-term exposure to virus.

Is there a risk of cardiovascular disease that occurs with uncontrolled HIV infection, and is there increased risk of cancer? Those are things we're going to have to try to figure out over time.

I think this is a very important study that puts another dot on the paper; we just have to connect the dots and try to understand the data.

Runners Up

On to the runners up.

There were a few runners up.

HIV Among Street Youth in St. Petersburg

One of them was a nightmarish report from St. Petersburg.38 It looked at the HIV prevalence -- how much HIV was present -- in street youth in St. Petersburg, Russia.

For listeners and readers who are in the United States, you might say, "Oh, Russia, who cares?" But I think that this is important because there are some lessons for us as well here, including lessons about how society should take care of its people.

St. Petersburg is a big city, the second-biggest city in Russia. What the researchers found was an alarming amount of HIV among these kids. These are kids who have been basically abandoned; most of these kids are orphans.

The researchers looked at 313 street youth and found 37 percent were HIV infected. These are very young people between the ages of 15 and 19; these are people who are living on the streets, often drug addicted, and often abused. Forty-two percent of the male street youths were found to be HIV infected, and 29 percent of the females. Most didn't know that they were HIV infected. It was just amazing. Two-thirds of those who were double orphans were HIV infected; so it's a huge risk to be an orphan in St. Petersburg, especially a double orphan. Seventy percent of the teens who didn't have a place to live or who had a sexually transmitted disease were HIV infected.

These are numbers that blow away seroprevalence studies of HIV in Africa.39 This is just amazing. This is in a country where there are hospitals, there's medication, there are doctors, there are roads, there is electricity. This is just total neglect of a group of people within a society. There's a cautionary tale here; for the people who live in Russia, this is a wake-up call. If these youths have such high rates -- four out of 10 of these street youths are HIV infected -- then you have to think about what's going on in that society as a whole.

"The rate of HIV infection is climbing so steeply in parts of the former Soviet Union that in a decade or two when we think about HIV, it's going to be in that part of the world."

This is a shocking report; sometimes I just can't stop thinking about these data. When I compare them to other parts of the world, it just blows me away. It's just as important as the data we've gotten from parts of Africa, where we learned that one out of every 20 adults is HIV infected. It's mind-numbing data that goes right along that same category.

Very few people think about Russia as similar to sub-Saharan African.

In 25 years, it's going to be all different. Eastern Europe is going to be where people think about HIV. Right now we think about Africa, but the rate of HIV infection is climbing so steeply in parts of the former Soviet Union that in a decade or two when we think about HIV, it's going to be in that part of the world.

Does HIV Accelerate Aging?

Another runner up you had was about aging and HIV.

This is an emerging story, and one I think physicians and clinicians are being led to by their patients.40 People are getting older with HIV infection, and there are questions about how to do that well. There are questions about how to grow older well in general, but especially with HIV infection vis-à-vis everything we've talked about with the increased possible risks of cancer, heart attacks and the like.

A number of studies have looked at this at the biological level, looking at cells and how cells age, and markers of aging and premature aging.39,41-43 The bottom line is that there is a picture emerging that HIV does seem to cause more advanced aging in many people. We have to understand more about this. We have to understand how we can counteract that. There may even be therapies we can develop to do this.

One thing that seems clear is that controlling HIV helps. Again, this is sort of a drumbeat from study to study. Getting control of your HIV -- getting your viral load down and your immune system strong -- that is one of the best things you can do.

Not smoking is another; smoking enhances the risk of many of the things that are associated with aging -- the bad things: the cancers and the cardiovascular disease. People who smoke look older. It's not new news; anyone can understand, you don't have to be a scientist to see the deleterious effects of smoking on the body and how it can facilitate the problems that we think about as we get older.

I think there is something going on here. We're just at the beginning of understanding what's going on biologically. We do know that the immune system ages prematurely in people with HIV, so we should do everything we can to keep that immune system healthy and happy.

Underestimating HIV Rates in the United States

The final runner up was about underestimating HIV incidence in the United States. Can you talk a little about why you picked that?

Again, I think this goes along with a theme I tried to develop in picking the top 10 and the runners up, which is not so much trying to present studies that tell us what we already know, or confirm things we thought. I'm trying to look at things that help us understand what the future is going to be like. There's no better way to do that than to look at how many cases of HIV are occurring every year.

The important part of the story is that while the world is reassessing how many people are HIV infected and downgrading their estimates, saying they overestimated,44 here in the United States, we're finding we probably underestimate the number of people acquiring HIV infection.29 This is according to a leak from the CDC that has been reported in the Wall Street Journal about how the CDC is on the verge of adjusting their estimate of how many people are infected -- and increasing it substantially, to indicate that maybe they were off by 10,000 to 15,000 people per year. That would be significant.

I think that this, if it pans out, will be important. It again refers back to some of the questions I had before about: Is this a phenomenon occurring among men who have sex with men? If so, why and what can we do about it? How much is meth use playing into this? How much of this is young men who have sex with men, who don't have a historic memory of losing friends, who are not part of an active advocate community? What's going on here?

There are more questions raised than answers, but most of the data suggest that the increases are going to be largely made up of men who have sex with men, and young ones at that.

I think this is where we have to focus more energy. We don't have a vaccine; we're not going to be able to prevent HIV that way. How do we work to have prevention happen, especially among those who are most likely to acquire the infection? I find this to be a very concerning development, despite all the millions of dollars and all the intelligence and the conferences that have been dedicated to HIV prevention. It's a shame that we're not seeing the decrease that we thought we should be seeing with all this effort. It really tells us that we have to go back to the drawing board and figure out what works, and how to get that to work in different populations.

Wow. Well, an amazing top 10, with runners up. I think I could have asked you questions all day about these studies. Many of them have so many implications. What a great job picking through all this research from 2007!

I hope people take from this mostly hopeful messages. I do think that there are tremendous advances that we've seen, and I do think we'll see these kinds of things happen in the realm of prevention. I do. I think we're at the beginning of that, despite the failures. There were lots of failures when it came to therapeutics, to treatment; we're seeing treatment really mature here. We still have a ways to go; we don't have a cure yet.

Thanks very much.

Thank you.

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Copyright © 2008 Body Health Resources Corporation. All rights reserved. Podcast disclaimer.

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.


  

This article was provided by TheBody.com. It is a part of the publication This Month in HIV.
 

Reader Comments:

Comment by: William (London, UK) Wed., Jan. 13, 2010 at 5:38 am EST
My name is williams, I am 35 years old male from London, UK.
I do not have HIV but i am very sad to learn that many people are dying of this disease. I can help or support someone who have this disease in any way that I could. I can also be your best friend or even lover.......
I am looking for good friends from all over the world. It doesnt matter if you have HIV or not.
I am a good Christian and do not care about age, race, color or religion as we are made by the same God...
I HATE Lies, injustice, terrorism and discrimination..
If you wanna be my friend send me an email with the subject: FRIENDSHIP.
Peace and Love to you all..
This is my email address: williampeaston@yahoo.com
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Comment by: Sima (Dsm) Sat., Jan. 24, 2009 at 11:00 am EST
Thanx for the wonderfull web site.i now know where to get different information about AIDS/HIV.
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Comment by: Priscillar (South Africa, Johannesburg) Thu., Nov. 20, 2008 at 10:49 am EST
I was diagnosed last year, 2007, with a CD4 of 59. Now I am at 550, taking Truvada and Stoctrin. What are my chances of opportunistic diseases, and toxicities? I need to be linked with a friend in SA.
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Comment by: azazhu (Ethiopia) Tue., Oct. 7, 2008 at 10:06 am EDT
that is very itnteresting
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Comment by: jim (alaska) Tue., Oct. 7, 2008 at 2:12 am EDT
i get the body regularly in e-mail and I am so thankful to all the wonderful doctors that contibute. I found out I had AIDS when I was hospitalised in 2000 with pml encephalitis and thank god for great doctors and great medicines i am alive to write this and i am am doing quite well. my past doctors whom i have kept n contact with in oregon are amazed. i was paralyzed on the right side of my body and they told my mother i would not survive the week. now i am a truck driver driving big semi's! People, get tested. If applicable, get on meds and PLEASE do not miss any doses. i say this from the bottom of my heart! You can e-mail me at willow444@msn.com. have a wonderful life! GET TESTED!!!!! Thank you again wonderful doctors!!!!!!!
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Comment by: caco (florida) Mon., Sep. 22, 2008 at 11:11 am EDT
Will we ever find a cure for HIV?
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Comment by: runing.outof.time (vaal) Wed., Sep. 10, 2008 at 7:22 am EDT
we r dieying. where or when is the cure
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Comment by: simone (Rosebud,SD) Tue., Sep. 2, 2008 at 12:42 pm EDT
I'm working to get the Native American people to get tested on the Reservation we have no testing. I'm working to collaborate with IHS to start testing I'm with the CHR Program. The hardest part is trying to get the people to get tested. I'm going to do the best I can to get them tested. I just wanted to let people know that their is a problem getting people tested everywhere.
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Comment by: lashawna Mon., Aug. 11, 2008 at 8:46 pm EDT
i think people really need to understand what sex is. too many people think it's ok to have unprotected sex when it is not ok. if you are going to do something with someone, wrap it up please. be the smarter person. that goes for straight people and gay people. get it together people! life is too short, please do not make it shorter.
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Comment by: jerry morales Thu., Jul. 31, 2008 at 1:33 pm EDT
I have a comment for dissidence 101, you weren't to concerened about vaccine success when you became infected and these drugs do seem to be keeping me alive. So bravo for the new drugs. I'm on Prezista and Isentress and celebrate their arrival. I'm sorry life doesn't seem as rosey for you.
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Comment by: Casey Fri., Jul. 18, 2008 at 12:14 pm EDT
I was wondering if you knew where to find information on how to join a certain study group of individuals with HIV+ in their states?
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Comment by: Innocent Fri., Jul. 11, 2008 at 9:10 am EDT
I have recently been diagnosed HIV+ but now i have hope that i can live longer but i've got a problem with FLU & Tonsils
help....S.A
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Comment by: Jason Mon., Jul. 7, 2008 at 7:16 pm EDT
I read that CDC predicts that if someone is positive less than four months that they can eliminate the virus from the body (with meds) within an average of 7.7 years. Is this true?
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Comment by: rami Mon., Jul. 7, 2008 at 3:28 pm EDT
Thank you very much for this energy you are putting into these podcasts / reviews. i find this so importnat. this gives much hope and info. Thank you!
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Comment by: wam Sat., Jul. 5, 2008 at 12:49 pm EDT
Hi Ezekiel Otieno where are you in Kenya. I am also positive living in U.K detected about 9 mths ago single mum of three. You can email me at nan.sa08@hotmail.com
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Comment by: Gideon Lawal Mon., Jun. 30, 2008 at 9:34 am EDT
Well am kinda new to this well. i lost my brother to this disease. right now the last time i check my status i was positive too and then my cd4 count is 375 and am still on oi. i need a friend from Europe and USA and anywhere in the world to help pass through this hard time right now am having stomach pain and headache.. here is my email: gideon080seyi@yahoo.com

Hope to hear from you soon
Later
Seyi
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Comment by: mickery Sun., Jun. 29, 2008 at 2:06 pm EDT
That's a great interview that everyone (whether positive or negative) should read.
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Comment by: dorcas Thu., Jun. 26, 2008 at 8:28 am EDT
doc.a big well done 4 d enlightenment.it goes a long way to give hope and encouragement to all the infected.its a therapy.hiv is a fundamental right and not a disease that needs to be adhered to.thanks
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Comment by: abdalla Tue., Jun. 24, 2008 at 3:21 am EDT
very exciting!
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Comment by: Robert Tue., Jun. 3, 2008 at 1:42 pm EDT
Dear Drs. at "The Body"

Keep up the good work! As you say all the time, there are great drugs out there but prevention is key!

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Comment by: bruno Sun., Jun. 1, 2008 at 8:40 pm EDT
god bless us all. stay strong people.
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Comment by: jason Sat., May. 31, 2008 at 10:33 am EDT
are there some of those drugs here in the philippines and how much its cost?
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Comment by: hilary Wed., May. 28, 2008 at 6:30 pm EDT
i have just found out my wonderfull nephew is HIV. Am so upset, my world has came crashing down. Thank God i can read positive stories. i can only pray he will outlive me. This happens to other familes not mine or so i thought. feel so ashamed. i thought HIV was AIDS I'm learning, however we all pretend it is not happening. i pray for a cure.
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Comment by: araceli villafania Tue., May. 27, 2008 at 2:07 pm EDT
very good info
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Comment by: TEDDY Thu., May. 15, 2008 at 9:05 pm EDT
Good job, but we need drugs that you could take once a month,any possibility? I know the pharmaceutical companies will frown over this as it will make volumes on profitable
Reply to this comment


Comment by: johnk Wed., May. 14, 2008 at 12:55 am EDT
What a smart, sharp overview! I too think the plethora of new interesting drugs is the story of the year. They have given me lots of hope as I've undetectable for the first time in 15 years! HIV medicine has made such strides. I'm one lucky man!
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Comment by: John morse Sun., May. 11, 2008 at 10:42 pm EDT
I was diagnosed with HiV at age 70! I am currently enrolled in a trail 96 week study for HIV naieve people. I am taking MK-0518 (or Placebo) Efavirenz (or placebo) and Truvada. within three months of taking the medications My viral load was undetectable and CD was up to 415 from 275! I have been on this program for a year now.
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Comment by: dissidence101 Sun., May. 11, 2008 at 10:22 pm EDT
That's just simply amazing that the biggest story of the whole year is "THERE'S MORE DRUGS". Gezze. I have a better one. How about and to the dismay of researchers, Merck's v520 complete and utter vaccine trial failure?
Reply to this comment


Comment by: Noni Sat., May. 10, 2008 at 3:20 pm EDT
I started treatment in 2003 with CD4 of 8.I was on d4t, 3tc. I experienced loss of fats in hips and butt and changed to azt. Problem is i always worry about what if it doesnt work because in S.A we have only limited (2) regimens available. Are we S.A allowed to have or access these plenty of meds available in U.S.A and other countries? If so how do you access them?

Worried in South Africa
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Comment by: ezekiel otieno Sat., May. 10, 2008 at 9:10 am EDT
this website has given me a lot of strength.Through this I've learnt that i can live long enough than the seven years since i knew my status and i'm not alone.
I'm requesting this website to connect me one person living positively in Europe or Asia. I am from Kenya.
Reply to this comment


Comment by: Carole Ricks Wed., May. 7, 2008 at 7:45 pm EDT
Hello Everyone;

I would like to say how happy I am for all that have found their meds to work and they are doing great, Thank God for that, because He is always looking out for us all the time. I lost my brother to Hiv/Aids last year because he didn't and wouldn't seek treatment until it was too late. I miss him very much and I also have another brother who is Hiv positive as well. He is keeping up with his doctor's visits and taking care of himself. Please know that there are programs out there that can help you if you are sick. Don't wait! Seek help right away and remember that knowledge is power. God bless you all.
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Comment by: Dr. Elizabeth Mwanukuzi Wed., May. 7, 2008 at 10:20 am EDT
It is very interesting to note that the problem of late diagnosis is not limited to resource poor countries but what is particularly challenging to us in Africa is the poor accessibility of care and treatment facilities for rural communities because of poverty and poor travel intfrastructure
Reply to this comment


Comment by: A AL YAZOURY Wed., May. 7, 2008 at 10:02 am EDT
THANK U GUYS FOR THIS GEART WEBSITE,THANK U VERY MUCH DOC FOR YOUR GREAT EFFORTS, I SUGGEST HIV TESTING FOR EVERY PERSON ONCE THEY ARE IN THE PROCESS OF GETTING ENSURACE CARD SO THIS WILL MAKE IT MORE EASY FOR EARLY DETECTION FOR THE VIRUS AND EARLY HELP AND BETEER PROGNOSIS, GOD BLESS U ALL.
Reply to this comment


Comment by: Akan Ituk Wed., May. 7, 2008 at 9:33 am EDT
A major problem with the HIV pandemic is that most folks is yet to come in terms with the reality. They "believe" they are uninfectable and as such need not to go for HIV screening. It is not until HIV is succesfully demystified, social immunization will not be achieved.
Reply to this comment


Comment by: AMAL Wed., May. 7, 2008 at 7:46 am EDT
THANKS DOC FOR YOUR WORK, PRAYERS FROM THE HEART FOR ALL THE POZs TO GET WELL SOON. IT'S A MATTER OF TIME, ONCE YOU R IN THE ACCEPTANCE STAGE YOU CAN LIVE NORMALLY. THANKS
Reply to this comment


Comment by: Brown Family Foundation Tue., May. 6, 2008 at 9:26 pm EDT
This article was very informative. Our organization promotes HIV Prevention and Detection. We've established a program called "Sisters Can We Talk". This program consist of panel discussions and small group sessions dealing with the subject of HIV and AIDS. We utilize local organizations to provide testing at each event.

This confirms that more opportunities are needed to present testing.
Reply to this comment


Comment by: Stuart Lee Carlson Tue., May. 6, 2008 at 5:46 pm EDT
Doc, thanks for your good work!

I've been poz for over 18 years now, and can say with confidence the hiv bug is a manageable disease.

Reason for writing is this: Fat has been stripped from my arms, legs, and butt. If it would help, I am quite able to give you the litany of all the drug regimens between start to the present. In summary first drug was AZT in 1992, when CD4 was 290. Currently I am taking Isentress, Aprivus, Norvir, and Epzicom and my CD4 is 770, wowee ! and VL is und.

For all I know, it seems to be a metabolic puzzle, and fortunately, no facial wasting, thank God.

Please advise.

Cheers!
Lee
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