Messages: Show Message Summaries (Group by Topic)

#19270

From: "k_gilzow" <k_gilzow@...>
Date: Wed Nov 1, 2006 1:17 am
Subject: Probiotic Diet

Offline

So, I introduced myself to the group about a week ago now, and thank
you ALL for the comments, links, etc. for support w/ my fiances
condition.

Today, in combination w/ seeing his infectious disease doctor, we
visited an acupuncturist, as his CD4 count is still only at 80 since
starting his med "cocktail" in April 2006. (Although his CD4 count has
risen from 30) She recommended a Probiotic Diet as all the good
bacteria was probably being cleaned out of his body from the meds he
is on.

Does anyone have any insight to the benefits (personally) to a
Probiotic Diet?! Recipes would be great as well..

Thank you in advance for your help. I look forward to hearing from you
all! ~Kelli~

Reply | Forward | Messages in this Topic (1)

#19269

From: PoWeRTX@...
Date: Tue Oct 31, 2006 7:26 pm
Subject: Ritonavir-Fluticasone Interaction Causing Cushing Syndrome in HIV-Infected Child

nelsonvergel

Offline

Send Email

Comment:

This email applies for anyone taking corticoid steroids with Norvir.

Fluticasone is a glucocorticoid often prescribed as treatment for asthma and allergic rhinitis. Fluticasone is in a class of medications called corticoid steroids. It works by reducing swelling in the airways.

Fluticasone is often use in combination with salmeterol to prevent wheezing, shortness of breath, and breathing difficulties caused by asthma.

Fluticasone is marketed with the brand name Flixotide� and Flixonase� by Allen & Hanburys and Flovent� and Flonase� by GlaxoSmithKline.

1: Pediatr Infect Dis J. 2006 Nov;25(11):1044-1048. Links

Ritonavir-Fluticasone Interaction Causing Cushing Syndrome in HIV-Infected Children and Adolescents.

From the *Division of General Pediatrics & Adolescent Medicine and the daggerDivision of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD.

BACKGROUND:: Ritonavir, a potent inhibitor of CYP3A4 enzyme, can lead to high systemic concentrations of fluticasone when these 2 drugs are coadministered. Exogenous Cushing syndrome (CS) in HIV-infected patients receiving ritonavir and fluticasone has been reported frequently in adults but not in children. Three patients, all receiving ritonavir-fluticasone, developed weight gain and altered fat distribution concerning for either lipodystrophy or CS. METHODS:: Three patients were initially identified by their clinicians as having weight gain and altered fat distribution concerning for either lipodystrophy or CS. All 3 patients were receiving fluticasone and ritonavir, leading to concern about a potential medication interaction. After suspecting exogenous CS, all patient medication lists were reviewed to identify all children prescribed ritonavir-fluticasone. Blood adrenocorticotropic hormone (ACTH) and cortisol were obtained during routine clinic visits. Medication history, laboratory data and physical examination findings were abstracted from medical records. RESULTS:: Seventeen (9%) of 189 patients in this pediatric HIV clinic had been prescribed ritonavir-fluticasone. Of 7 patients still taking ritonavir-fluticasone, CS features were present in 4 (57%) patients, including the 3 patients initially suspected of CS or lipodystrophy. Five (71%) patients, including all 4 with CS features, had low serum concentrations: median cortisol <0.2 mug/dL (normal, <0.2 mug/dL). Three of these 5 had ACTH measured, all of which were low: median ACTH 3.0 pmol/L (range, 2.2-<5.0 pmol/L). One patient taking ritonavir-fluticasone had suppressed cortisol but no CS features. The 2 patients with normal serum cortisol and ACTH values had persistent HIV viremia and were suspected of medication nonadherence. Clinical and laboratory abnormalities generally normalized in affected patients within 3 months after discontinuation of fluticasone alone (2) and ritonavir-fluticasone (3). CONCLUSIONS:: Pediatric HIV physicians frequently prescribe fluticasone and ritonavir together. The combination can cause CS and adrenal suppression in children, potentially leading to misdiagnosis of lipodystrophy syndrome and to increased risk of adrenal crisis during acute illness. Alternatives to fluticasone should be used for treating children receiving ritonavir.

Regards,

Nelson Vergel
powerusa dot org

"What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do." - John Ruskin

Reply | Forward | Messages in this Topic (3)

#19268

From: "Patrick Satterthwaite" <satterthp001@...>
Date: Tue Oct 31, 2006 9:56 pm
Subject: Re: Fwd: NATAP: Screening for Diabetes (and Risk Factors)

patricky69

Offline

Send Email

Seems there is always something new that we need to be aware of. And of course diabetes is a very real concern for both HIV+ and HIV- folks. Here is another article about connection between diabetes and depression (but the question of chicken or egg hasn’t been determined yet!).

Diabetics often suffer depression. Depressed people often get diabetes. Why?

There are no clear explanations yet, but researchers are turning up clues that might lead to treatments for both diseases

By Alice Dembner, Globe Staff | October 30, 2006

Millions of Americans face a two-headed beast -- diabetes and depression -- that gnaws at them from the inside out.

The struggle of coping with diabetes feeds deep sadness. Depression gets in the way of dieting, exercising, and even taking the medicines that can control diabetes. The resulting downward spiral can make the depression unrelenting, increase diabetic complications, and more than double the risk of death, according to a growing body of research.

Brookline resident Marthajoy Aft got caught in that vortex when she was diagnosed with diabetes six years ago.

"I could hardly function" because of deep depression, said Aft, who is 64. "I was so angry. All I wanted to do was stay on the sofa and watch my fish swim in the tank."

For months she rarely checked her blood sugar and continued to eat candy while taking medicine to help her body handle the sugar. As with many diabetics, her depression went undiagnosed. She hid it during doctor's visits, and no one thought to ask.

Because so many patients, like Aft, suffer both diabetes and depression, scientists are seeking common causes and investigating whether depression might predispose people to diabetes. In addition, researchers are testing possible treatments to attack both diseases at once.

"Many diabetic patients are not being treated for depression or are not responding to antidepressants," said Frans Pouwer, a senior researcher at the VU University Medical Center in Amsterdam. "We need improvements in treatment, and we need more studies to test the underlying mechanisms."

The connection between diabetes and depression was first described in the late 1600s, when Thomas Willis, a prominent British physician, noted that diabetes was more common in people who'd suffered long-term sorrow. Recent estimates suggest that up to 15 percent of diabetics have major depression and 25 percent have depressive symptoms at some point, rates significantly higher than those in people without diabetes. Among the 21 million Americans with diabetes, that means as many as 5 million also suffer depressive symptoms.

Scientists aren't sure which comes first -- the diabetes or the depression -- or whether the sequence is different in people with Type 1 or Type 2 diabetes. Type 1 is a genetically based autoimmune disease that develops early in life and destroys the cells that make insulin. Type 2 is far more common and typically occurs in older adults who are overweight and whose bodies don't respond properly to insulin.

Since both diabetes and depression often go undiagnosed for years, answering the chicken-and-egg question is complicated. In Marthajoy Aft's case, for instance, doctors told her for years that she was a "borderline diabetic," but she wasn't diagnosed until 2000. Similarly, she suffered mild depression during hard times in her life, but never deep, lasting despair until after the diabetes diagnosis.

Last spring, Pouwer and some Dutch colleagues reviewed the strength of evidence suggesting that depression might come first. They concluded that being depressed increases a person's risk of developing diabetes by 37 percent -- about equal to the risk posed by smoking or lack of exercise. Although the evidence is growing, they also said there is not yet proof that depression causes diabetes, and there are no definitive explanations of what underlies the connection.

But scientists are turning up some clues.

A study at the Joslin Diabetes Center in Boston, published in the journal Diabetes in February, found differences in the brains of people with and without Type 1 diabetes. The brains of diabetics were less dense and less responsive in an area of the prefrontal cortex that helps control emotions and is believed to contribute to depression, said Dr. Alan Jacobson, director of behavioral and mental health research at the Joslin. Future research is planned to help explain how these changes affect behavior and whether they get worse over time.

Other scientists are looking at the stress hormone cortisol, which builds up in many depressives. Cortisol decreases the body's production of insulin and reduces sensitivity to insulin's effects, which are key characteristics of diabetes. Without enough insulin, the body can't use food to fuel activity.

"That could be the direct link," said Pat Lustman, a professor of psychiatry at Washington University in St. Louis.

Lustman is testing whether using diet and exercise or drugs to improve insulin sensitivity will boost the effect of antidepressants. Already, other research suggests that easing depression improves diabetics' control of their blood sugar, possibly by improving their body's ability to cope and certainly by increasing their willingness to work at it.

One study, presented in June at the American Diabetes Association meeting, suggested that antidepressants themselves might be part of the connection between depression and diabetes. As a whole, patients reporting symptoms of depression at the beginning of the three-year study were not more likely to get diabetes, contradicting many earlier studies, but those taking antidepressants were. The findings were part of a study to prevent diabetes in 3,000 people at high risk for the disease because of elevated blood sugar levels.

However, patients taking antidepressants and metformin, a drug that lowers blood sugar, did not develop diabetes, suggesting that metformin's protective effect was stronger than any potentially detrimental effect of the antidepressants.

The researchers can't yet explain the puzzling results. But Richard Rubin, the associate professor at the Johns Hopkins University School of Medicine who led the study, urged patients not to give up on antidepressants, since the study did not prove that the drugs caused diabetes.

Another part of the puzzle might be disruptions of the immune system that cause inflammation. Both Type 2 diabetes and depression are marked by increased cytokines, immune system proteins that carry messages to the hypothalamus, a part of the brain that helps regulate both mood and blood sugar levels. Researchers are testing treatments that reduce inflammation.

The Dutch group studying depression and diabetes is pursuing a related avenue -- that omega-3 fatty acids are a crucial link. These substances, which occur in some fish and plant oils, help brain cells communicate and help reduce inflammation. Low levels of omega-3 fatty acids are linked to depression and may reduce the body's ability to control blood sugar. The group is testing whether doses of omega-3 fatty acids can both improve mood and reduce insulin resistance in diabetics who are depressed.

For Aft, getting treatment for depression also helped her diabetes. Friends at her gym urged her to see a Joslin therapist. Counseling and a daily antidepressant helped her quell her anger and despair. She stepped up her gym visits, controlled her diet, lost about 70 pounds over several years, and no longer needs diabetes medicine.

"As the depression lifted, I was able to get a handle on what I had to do," she said. "My diabetes is totally under control now, and I'm on a lower dose of antidepressant."

Reply | Forward | Messages in this Topic (2)

#19267

From: "albert.benson" <al@...>
Date: Tue Oct 31, 2006 6:35 pm
Subject: Bio-Alcamid Inflamation

albert.benson

Offline

Send Email

First of all Scott, don't be scared. The reaction you seem to have had is being reported a little too often lately for my peace of mind as I have been a huge proponent of Bio-Alcamid.

I myself had such a problem when the Bio-Alcamid in my forehead was compromised. It became inflamed and appeared to be infected. I was placed on a strong broad spectrum antibiotic and after a few days the redness and inflammation went away.

It seems that when the original encapsulation of Bio-Alcamid is disturbed or compromised (pierced or nicked or traumatized by a punch form a boxing glove), we are often seeing redness and inflammation that suggests an infection. The reasons for it are not clear, but in a conversation with Dr. Casavantes, one of the most experienced Md's in the world in the use of Bio-Alcamid, I get the feeling that bacteria might get encapsulated inside the Bio-Alcamid implant when it's originally injected, and so when it's ruptured in any way and the bacteria gets out of it, it begins to infect the surrounding tissues. Dr. Casavantes is is about to publish a retrospective study on this issue in a EU medical journal. If you wish to contact him for input, he can be found at www.facialwasting.net.

My conversation with him has also made me feel, that for those of us with Bio-Alcamid in our faces, infections arising from these sort of situations, will be a life long concern, and that before having any sort of surgery close to where Bio-Alcamid is placed, we must be pretreated with a good strong broad spectrum antibiotic.

As to the issue of the original implant looking like it has a divot in it, well I lost the implant in my forehead, and will have to have it 'redone'.

I am going with PMMA at Dr. Casavantes' office, since PMMA is a vascular implant. That means that blood vessels and fibroblast tissue infiltrates it. and since it has blood flow through it, it is inherently safer from infection then a non-vascular implant like Bio-Alcamid or a large volume of injected silicone oil. Dr. Casavantes also uses the same PMMA as Dr. Sera in Brazil. So, no longer will anyone who wants the the most cost effective and longest in use PMMA implant in the world have to suffer on the beaches of Rio and be forced to look mostly nekid people with perfect bodies, we can drive, if we are close enough to Tijuana and get it there...what a relief!

Take heart, it will get better, and it can be fixed.

Al Benson

Al@...

Reply | Forward | Messages in this Topic (1)

#19266

From: PoWeRTX@...
Date: Tue Oct 31, 2006 3:59 pm
Subject: Fwd: CATIE News - The impact of HIV and HAART on menstruation

nelsonvergel

Offline

Send Email

In a message dated 10/31/2006 12:08:15 P.M. Central Standard Time, egraber@... writes:

The impact of HIV and HAART on menstruation

Many studies have found that the use of highly active antiretroviral therapy (HAART) has greatly reduced deaths from AIDS-related complications. But HAART can also cause long-term side effects, including biochemical changes, such as changes to levels of cholesterol, insulin and sugar in the blood. Physical changes, such as alterations in body shape, can also occur.

HIV infection causes changes to the body’s energy cycles, metabolism and hormone production. Hormones help regulate the operation of many processes in the body, including menstrual cycles. HAART’s impact on menstruation has not been well studied. So, to find out more about it, researchers from several large American cities collaborated in a large, long-term study that enrolled women with HIV infection. They found that HIV positive women appeared to be at increased risk for some menstrual changes. Women with relatively high CD4+ cell counts who used HAART for at least two years were much less likely to have problems with their periods.

Study details
Researchers recruited women who were HIV positive as well as women who were at high-risk for contracting HIV. Any woman with a condition that might have affected her menstrual cycle—a history of cervical cancer, ovarian surgery, being pregnant, using supplementary hormones—was not recruited.

Enrollment in the study occurred between 1994 and 2002. Every six months during this period volunteers had extensive health-related interviews, as well as medical tests and pelvic examinations. For this report on menstrual abnormalities, the researchers focused on data collected from 1,635 HIV positive women and compared it to data from 595 HIV negative women. Our report focuses on the HIV positive women. The profile of these women at the start of the study was as follows:

* average age – 35 years
* major ethno-racial groupings – 56% Black, 26% Hispanic, 15% White
* 51% were cigarette smokers
* 91% had previously used street drugs
* 58% were either overweight or obese
* most women had more than 200 CD4+ cells
* 16% were using HAART at the time data was analysed

Results—In general
Overall, the research team found that symptoms of menstrual abnormalities were “low” among all women in this large study. Also, after taking into account many factors (including age, weight and substance use), having HIV infection was not linked to any specific menstrual problem. For instance, 62% of HIV positive women reported periods that were more than three days early or three days late, but so did 62% of HIV negative women.

The researchers found that HIV positive women with less than 200 CD4+ cells had more reports of menstrual problems than those whose CD4+ counts ranged between 200 and 500 cells. Also, the use of HAART was not linked to any specific menstrual problem.

Results—Specific menstrual abnormalities
The study team focused on the following specific menstrual problems among HIV positive women:

* amenorrhea – no periods in the past six months
* oligomenorrhea – skipping periods
* intermenstrual bleeding – spotting or bleeding between periods
* menorrhagia – menstrual bleeding for more than one week

Amenorrhea
The team found that women who used HAART had a reduced risk for developing this complication. The longer women used HAART, the less likely this problem would occur.

Oligomenorrhea
This problem was also less likely to occur the longer women used HAART. For instance, women who used HAART for less than two years still experienced this complication. However, once women used HAART for more than two but less than four years, the risk of this problem decreased significantly. And women who used HAART for more than four years had the least risk of skipping periods.

Intermenstrual bleeding
Using HAART for less than two years was associated with an increased risk of bleeding between periods. However, once women used HAART for two or more years, this risk was reduced. Increased CD4+ cell counts were also linked to a decreased risk of intermenstrual bleeding.

Menorrhagia
The longer women used HAART, the lower their risk of experiencing prolonged periods (lasting more than one week). For instance, there was almost no risk of prolonged periods for women who had used HAART for four or more years. Women who had used HAART for between two and four years had a slightly increased risk for prolonged periods. But for women who had used HAART for less than two years the risk of experiencing menorrhagia was three times greater than normal. Also, as CD4+ counts increased, the risk for this problem was reduced.

Points to consider
1. The research team notes that “serious menstrual abnormalities” were uncommon in its study of HIV positive women. “Minor menstrual irregularities” were common in HIV positive women, but, the researchers added, “no more so than in demographically comparable HIV uninfected women.”

The research team suggested that because minor menstrual irregularities were common among HIV positive women, these women may perceive HIV infection as being responsible for fluctuations in menstrual cycles that are typically normal. The good news is that over the long-term, at least in this large study, HIV positive women were generally not at increased risk for serious menstrual problems. Indeed, the researchers added that women can be “reassured that infection with HIV is unlikely to cause major disturbances in menstrual function until [HIV] disease becomes advanced.”

2. Prolonged use of HAART appeared to confer a reduced risk for developing menstrual abnormalities, as did higher CD4+ cell counts. This likely happened because the overall health of the women improved over time. The research team suggests that severely ill HIV positive women (who have lower CD4+ cell counts) may be at heightened risk for abnormal menstrual cycles. They do not think that HAART has a direct impact on menstrual cycles.

3. As women age, changes in menstrual cycles occur. The present study assessed volunteers who were relatively young in age—35 years. Results may differ in older women. Indeed, HIV infection and HAART may have different effects on menstrual problems as women get closer to menopause, so the study team is planning research that will explore the transition to menopause in this group of women.

4. The study team did not specifically assess any differences among different classes of anti-HIV medications for their effects on menstrual functions. This decision might have had important consequences for their conclusions. For instance, there are reports that women who use protease inhibitors can sometimes experience heavier bleeding during periods.

—Sean R. Hosein

REFERENCES:
1. Massad LS, Evans CL, Minkoff H, et al. Effects of HIV infection and its treatment on self-reported menstrual abnormalities in women. Journal of Women’s Health 2006 Jun;15(5):591-8.

2. Santoro N, Arnsten JH, Buono D, et al. Impact of street drug use, HIV infection and highly active antiretroviral therapy on reproductive hormones in middle-aged women. Journal of Women’s Health 2005 Dec;14(10):898-905.

****************************************************
CATIE-News Subscription Information
=================================

CATIE-News is a moderated mailing list operated by the Canadian AIDS Treatment Information Exchange to distribute information about the treatment of HIV/AIDS and related infections in Canada.

To see a directory of archived messages, visit CATIE's Web site at http://www.catie.ca/catienews.nsf

To subscribe to the list, visit https://www.catie.ca/mailing.nsf/subscribe

To cancel your subscription to the list, visit https://www.catie.ca/mailing.nsf/Unsubscribe

For assistance with your subscription from a real human being, please send a message to web@...

CATIE-News is written by Sean Hosein, with the collaboration of other members of the Canadian AIDS Treatment Information Exchange, in Toronto. Your comments are welcome.

Permission to Reproduce:
This document is copyrighted by the Canadian AIDS Treatment Information Exchange (CATIE). All CATIE materials may be reprinted and/or distributed without prior permission. However, reprints may not be edited and must include the following text:

From Canadian AIDS Treatment Information Exchange (CATIE). For more information visit CATIE's Information Network at http://www.catie.ca

For permission to edit any CATIE material for further publication, please send an e-mail to info@...

If you are changing your e-mail address, please be sure to inform us of this change so that we can update your records and ensure that you continue to receive the latest treatment information. E-mail us at info@...

Regards,

Nelson Vergel
powerusa dot org

"What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do." - John Ruskin

The impact of HIV and HAART on menstruation

Many studies have found that the use of highly active antiretroviral therapy (HAART) has greatly reduced deaths from AIDS-related complications. But HAART can also cause long-term side effects, including biochemical changes, such as changes to levels of cholesterol, insulin and sugar in the blood. Physical changes, such as alterations in body shape, can also occur.

HIV infection causes changes to the body’s energy cycles, metabolism and hormone production. Hormones help regulate the operation of many processes in the body, including menstrual cycles. HAART’s impact on menstruation has not been well studied. So, to find out more about it, researchers from several large American cities collaborated in a large, long-term study that enrolled women with HIV infection. They found that HIV positive women appeared to be at increased risk for some menstrual changes. Women with relatively high CD4+ cell counts who used HAART for at least two years were much less likely to have problems with their periods.

Study details
Researchers recruited women who were HIV positive as well as women who were at high-risk for contracting HIV. Any woman with a condition that might have affected her menstrual cycle—a history of cervical cancer, ovarian surgery, being pregnant, using supplementary hormones—was not recruited.

Enrollment in the study occurred between 1994 and 2002. Every six months during this period volunteers had extensive health-related interviews, as well as medical tests and pelvic examinations. For this report on menstrual abnormalities, the researchers focused on data collected from 1,635 HIV positive women and compared it to data from 595 HIV negative women. Our report focuses on the HIV positive women. The profile of these women at the start of the study was as follows:

* average age – 35 years
* major ethno-racial groupings – 56% Black, 26% Hispanic, 15% White
* 51% were cigarette smokers
* 91% had previously used street drugs
* 58% were either overweight or obese
* most women had more than 200 CD4+ cells
* 16% were using HAART at the time data was analysed

Results—In general
Overall, the research team found that symptoms of menstrual abnormalities were “low” among all women in this large study. Also, after taking into account many factors (including age, weight and substance use), having HIV infection was not linked to any specific menstrual problem. For instance, 62% of HIV positive women reported periods that were more than three days early or three days late, but so did 62% of HIV negative women.

The researchers found that HIV positive women with less than 200 CD4+ cells had more reports of menstrual problems than those whose CD4+ counts ranged between 200 and 500 cells. Also, the use of HAART was not linked to any specific menstrual problem.

Results—Specific menstrual abnormalities
The study team focused on the following specific menstrual problems among HIV positive women:

* amenorrhea – no periods in the past six months
* oligomenorrhea – skipping periods
* intermenstrual bleeding – spotting or bleeding between periods
* menorrhagia – menstrual bleeding for more than one week

Amenorrhea
The team found that women who used HAART had a reduced risk for developing this complication. The longer women used HAART, the less likely this problem would occur.

Oligomenorrhea
This problem was also less likely to occur the longer women used HAART. For instance, women who used HAART for less than two years still experienced this complication. However, once women used HAART for more than two but less than four years, the risk of this problem decreased significantly. And women who used HAART for more than four years had the least risk of skipping periods.

Intermenstrual bleeding
Using HAART for less than two years was associated with an increased risk of bleeding between periods. However, once women used HAART for two or more years, this risk was reduced. Increased CD4+ cell counts were also linked to a decreased risk of intermenstrual bleeding.

Menorrhagia
The longer women used HAART, the lower their risk of experiencing prolonged periods (lasting more than one week). For instance, there was almost no risk of prolonged periods for women who had used HAART for four or more years. Women who had used HAART for between two and four years had a slightly increased risk for prolonged periods. But for women who had used HAART for less than two years the risk of experiencing menorrhagia was three times greater than normal. Also, as CD4+ counts increased, the risk for this problem was reduced.

Points to consider
1. The research team notes that “serious menstrual abnormalities” were uncommon in its study of HIV positive women. “Minor menstrual irregularities” were common in HIV positive women, but, the researchers added, “no more so than in demographically comparable HIV uninfected women.”

The research team suggested that because minor menstrual irregularities were common among HIV positive women, these women may perceive HIV infection as being responsible for fluctuations in menstrual cycles that are typically normal. The good news is that over the long-term, at least in this large study, HIV positive women were generally not at increased risk for serious menstrual problems. Indeed, the researchers added that women can be “reassured that infection with HIV is unlikely to cause major disturbances in menstrual function until [HIV] disease becomes advanced.”

2. Prolonged use of HAART appeared to confer a reduced risk for developing menstrual abnormalities, as did higher CD4+ cell counts. This likely happened because the overall health of the women improved over time. The research team suggests that severely ill HIV positive women (who have lower CD4+ cell counts) may be at heightened risk for abnormal menstrual cycles. They do not think that HAART has a direct impact on menstrual cycles.

3. As women age, changes in menstrual cycles occur. The present study assessed volunteers who were relatively young in age—35 years. Results may differ in older women. Indeed, HIV infection and HAART may have different effects on menstrual problems as women get closer to menopause, so the study team is planning research that will explore the transition to menopause in this group of women.

4. The study team did not specifically assess any differences among different classes of anti-HIV medications for their effects on menstrual functions. This decision might have had important consequences for their conclusions. For instance, there are reports that women who use protease inhibitors can sometimes experience heavier bleeding during periods.

—Sean R. Hosein

REFERENCES:
1. Massad LS, Evans CL, Minkoff H, et al. Effects of HIV infection and its treatment on self-reported menstrual abnormalities in women. Journal of Women’s Health 2006 Jun;15(5):591-8.

2. Santoro N, Arnsten JH, Buono D, et al. Impact of street drug use, HIV infection and highly active antiretroviral therapy on reproductive hormones in middle-aged women. Journal of Women’s Health 2005 Dec;14(10):898-905.

****************************************************
CATIE-News Subscription Information
=================================

CATIE-News is a moderated mailing list operated by the Canadian AIDS Treatment Information Exchange to distribute information about the treatment of HIV/AIDS and related infections in Canada.

To see a directory of archived messages, visit CATIE's Web site at http://www.catie.ca/catienews.nsf

To subscribe to the list, visit https://www.catie.ca/mailing.nsf/subscribe

To cancel your subscription to the list, visit https://www.catie.ca/mailing.nsf/Unsubscribe

For assistance with your subscription from a real human being, please send a message to web@...

CATIE-News is written by Sean Hosein, with the collaboration of other members of the Canadian AIDS Treatment Information Exchange, in Toronto. Your comments are welcome.

Permission to Reproduce:
This document is copyrighted by the Canadian AIDS Treatment Information Exchange (CATIE). All CATIE materials may be reprinted and/or distributed without prior permission. However, reprints may not be edited and must include the following text:

From Canadian AIDS Treatment Information Exchange (CATIE). For more information visit CATIE's Information Network at http://www.catie.ca

For permission to edit any CATIE material for further publication, please send an e-mail to info@...

If you are changing your e-mail address, please be sure to inform us of this change so that we can update your records and ensure that you continue to receive the latest treatment information. E-mail us at info@...

Reply | Forward | Messages in this Topic (1)

#19265

From: "jim98122x" <jim98122x@...>
Date: Tue Oct 31, 2006 8:58 pm
Subject: Re: ARTES MEDICAL ANNOUNCES FDA APPROVAL FOR ARTEFILL� AS THE FIRST NON-RESORBABLE I

jim98122x

Offline

Send Email

Anyone want to take bets on what happens to the price of Sculptra now? I'm betting a price drop of 65-75% ...any other guesses?

--- In PozHealth@yahoogroups.com, PoWeRTX@... wrote:
>
> 10/30/06 Artes Medical Announces FDA Approval for ArteFill® as the
> First Non-Resorbable Injectable Wrinkle Filler to Correct Smile Lines
> ARTES MEDICAL ANNOUNCES FDA APPROVAL FOR ARTEFILL® AS THE FIRST
> NON-RESORBABLE INJECTABLE WRINKLE FILLER TO CORRECT SMILE LINES
> -ARTEFILL First Product In New Dermal Filler Category-
>
> San Diego, Calif., October 30, 2006 �" Artes Medical, Inc., a medical
> technology company focused on developing, manufacturing and commercializing a new
> category of aesthetic injectable products for men and women, today announced
> the United States Food and Drug Administration’s approval of ArteFill®.
> ArteFill is the first and only non-resorbable aesthetic injectable implant approved
> by the FDA. The product is indicated for the correction of facial wrinkles
> known as nasolabial folds, or smile lines. Unlike existing dermal fillers that
> are completely metabolized by the body, ArteFill represents the first product
> in a new category of non-resorbable dermal fillers providing a permanent
> support structure for enduring wrinkle correction. Artes Medical intends to
> begin marketing and selling ArteFill to dermatologists, plastic surgeons and
> cosmetic surgeons in the U.S. through the Company’s direct sales force.
> “We are pleased to introduce ArteFill, a uniquely-designed product, for the
> expanding aesthetic market,” said Diane S. Goostree, President of Artes
> Medical. “Based on ArteFill’s proven results and high level of patient
> satisfaction observed in our clinical trials, ArteFill addresses the unmet patient
> demand for enduring wrinkle correction.”
> ArteFill contains a proprietary combination of ArteFill Precision-Filtered
> Microspheres™ suspended in a carrier gel containing purified bovine collagen.
> Artes Medical produces the microspheres from one of the most commonly used
> synthetic implant materials in medicine, polymethylmethacrylate (PMMA). The
> size of the microspheres is strictly regulated to help ensure consistent and
> safe results. The microspheres are 30 to 50 microns in size, barely visible to
> the naked eye. Artes Medical produces the purified collagen gel in accordance
> with both FDA and USDA guidelines. After ArteFill is injected into a patient’
> s smile line, the microspheres provide a permanent support structure beneath
> the skin to support the wrinkle and to prevent further wrinkling.
> “For the first time, U.S. consumers have an FDA-approved, non-resorbable
> aesthetic injectable product available that is designed to provide correction
> for smile lines, the primary external sign of facial aging,” said Stefan M.
> Lemperle, MD, a founder of Artes Medical.
> The Company manufactures ArteFill at its fully integrated, cGMP compliant,
> dedicated facility located in San Diego, California.
>
> About ArteFill
> ArteFill is indicated for the correction of facial wrinkles known as
> nasolabial folds or smile lines. An ArteFill Skin Test is required before initial
> treatment. The most common adverse events associated with ArteFill injections,
> similar to those observed with other dermal fillers, are lumpiness,
> persistent swelling or redness and increased sensitivity at the injection site. For
> more information on ArteFill, including complete product information, visit
> _www.artefill.com_ (http://www.artefill.com/) . Artes Medical intends to offer a
> comprehensive training program to dermatologists, plastic surgeons and
> cosmetic surgeons. The goal of the training program is to maximize patient and
> physician satisfaction with ArteFill by fostering consistent and high-quality
> treatments. ArteFill and the ArteFill Skin Test are expected to be available in
> the U.S. in the next 45 to 60 days.
> U.S. Clinical Study
> The FDA approval of ArteFill was based on data from the Company’s 12-month,
> controlled, randomized, double-masked, prospective, multi-center U.S.
> clinical trial. Patients treated with ArteFill (n=251) showed significantly greater
> and persistent improvement compared to those treated with the collagen
> control (Zyplast®). At the 6 month evaluation, which was the primary efficacy
> evaluation period, the wrinkle correction in the patients treated with ArteFill
> persisted, while the patients treated with the collagen control returned to
> their pretreatment status. The safety profiles for ArteFill and the collagen
> control group were comparable. ArteFill patients were also evaluated one year
> after treatment, demonstrating continued safety and wrinkle correction. Based
> on our clinical data, the FDA approved ArteFill as a safe and effective
> non-resorbable injectable implant for the correction of nasolabial folds in men
> and women.
>
> About Artes Medical, Inc.
> Artes Medical is a medical technology company focused on developing,
> manufacturing and commercializing a new category of aesthetic injectable products
> for the dermatology and plastic surgery markets. The Company’s initial product,
> ArteFill, is a non-resorbable aesthetic injectable implant for the
> correction of facial wrinkles known as nasolabial folds, or smile lines, which will be
> marketed as a treatment for men and women. Based in San Diego, Calif., Artes
> Medical was founded in 1999 and is privately-held. Additional information
> about Artes Medical and ArteFill is available at _www.artesmedical.com_
> (http://www.artesmedical.com/) and _www.artefill.com_ (http://www.artefill.com/) .
>
> Forward-Looking Statements
> This news release contains forward-looking statements that are based on the
> Company’s current beliefs and assumptions and on information currently
> available to its management. Forward-looking statements involve known and unknown
> risks, uncertainties and other factors that may cause the Company’s actual
> results, performance or achievements to be materially different from any future
> results, performance or achievements expressed or implied by the
> forward-looking statements. As a result of these risks, uncertainties and other factors,
> readers are cautioned not to place undue reliance on any forward-looking
> statements included in this press release. These forward-looking statements
> represent beliefs and assumptions only as of the date of this news release, and
> the Company assumes no obligation to update these forward
>
> Regards,
>
> Nelson Vergel
> powerusa dot org
>
>
> "What we think, or what we know, or what we believe is, in the end, of
> little consequence. The only consequence is what we do." - John Ruskin
>

Reply | Forward | Messages in this Topic (2)

#19264

From: "Norm Stuart" <nspop2@...>
Date: Tue Oct 31, 2006 7:26 pm
Subject: Re: New to the group and had a few questions...

norm_w_stuart

Offline

Send Email

Trust your own intuition. Others can share their experience and specific resources, but I'm certain you know better than anyone what needs to be done.

In retrospect, I can easily say that I have done a much better job of providing for myself and giving myself happiness after I was HIV+ than before. And have become even better at that over time. HIV is an opportunity which most who are sleep-walking through life are never given.

When people find out they are HIV+, after attending to the neccessary details of finding medical care and learning about treatments, they often find compromises they were making in their life are no longer acceptable. You can gradually discover you are free to do as you like. Even more curious, you will find that people you thought might disapprove of your new decisions are actually indifferent - the constraints were almost all of you own making.

--- In PozHealth@yahoogroups.com, "hiflipinvert" <hiflipinvert@...> wrote:
>
> Hey to all? My name is Brian and I am new to the group here. I have
> been poz for 2ish years now. It has been one hell of a two years
> trying to keep life together. I'm sure a lot kind of know what I mean,
> but I guess I am at the point where it became kind of a conscious
> decision to get it together so to speak and I am wondering if there
> are any websites that are trusted to go to, etc. Personal stories or
> just being able to chat with somebody who has come out of this and is
> moving right along I guess. Hopefully these are the right choices of
> words for what I am trying to talk about.
> Second, where would one go I guess to move on and find someone to
> spend the rest of their life with. I live in a town in southeastern
> wisconsin with about 5000 people in it and am probably the only one
> around nor would I dare say anything to anyone. Would be a bad
> situation.
> Cheers to all who are movin right along and all is well. Looking
> forward to getting there....
>

Reply | Forward | Messages in this Topic (3)

#19263

From: Bob Munk <bobmunk@...>
Date: Tue Oct 31, 2006 6:31 pm
Subject: How many people on ART?

bobmunkster

Offline

Send Email

Hi all,

It seems like this shouldn't be so hard to find, but does anyone have
a source for how many people in the US are on ART?

And how many "qualify" under the treatment guidelines?

Can't seem to find it!

Thanks,

Bob Munk

Reply | Forward | Messages in this Topic (1)

#19262

From: John Barrow <pozbod@...>
Date: Tue Oct 31, 2006 7:28 pm
Subject: Re: New to the group and had a few questions...

johnftl59

Offline

Send Email

"Hey to all? My name is Brian and I am new to the group here. I have�

been poz for 2ish years now. It has been one hell of a two years�

trying to keep life together. I'm sure a lot kind of know what I mean,�

but I guess I am at the point where it became kind of a conscious�

decision to get it together so to speak and I am wondering if there�

are any websites that are trusted to go to, etc. Personal stories or�

just being able to chat with somebody who has come out of this and is�

moving right along I guess. Hopefully these are the right choices of�

words for what I am trying to talk about.�

Second, where would one go I guess to move on and find someone to�

spend the rest of their life with. I live in a town in southeastern�

wisconsin with about 5000 people in it and am probably the only one�

around nor would I dare say anything to anyone. Would be a bad�

situation.

Cheers to all who are movin right along and all is well. Looking�

forward to getting there...."

I'm glad you've survived those difficult first two years, and are looking forward to getting on with your life.� �I think you'll find that many of us here have stories of survival.

You may need to make many changes as you go forward.� Certainly, it's more difficult to find friends and support in a small town, but you may have other ties that keep you there. � �Only you can decide how to deal with that.

Good luck with your voyage..........to a new, wonderful life.

John Barrow

pozbod@...

Reply | Forward | Messages in this Topic (3)

#19261

From: fauxscott@...
Date: Tue Oct 31, 2006 1:21 pm
Subject: Re: bioalcamide inflamation

fauxscott

Offline

Send Email

Well...I went to a local Dr.. (The guy who did the Bio is located in Amsterdam). And she was able to make an incision and remove tons of ooze. She said it was mainly infection with a little bio mixed in probably. Definately my bodies effort to reject the implants. If the infection continues to build we will have to continue to remove more as we can. Things seem calm today without any swelling.First time in weeks! I can tell I lost alot of my filler.grrrrrrrrrrrrrrrrrr I will wait and see what happens.

Reply | Forward | Messages in this Topic (3)

#19259

From: Bob Munk <bobmunk@...>
Date: Tue Oct 31, 2006 6:37 pm
Subject: Re: What Are Common Lab Values?

bobmunkster

Offline

Send Email

We also offer fact sheets on normal lab values at the AIDS InfoNet, at
http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=120 (Normal
Laboratory Values)

http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=121 (Complete
Blood Count)

http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=122
(Chemistry Panel) and

http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=123 (Blood
Sugar and Fats)

Bob Munk
AIDS InfoNet



On Tue, 31 Oct 2006 00:30:49 -0000, you wrote:

>
>Although the lab values you see on your blood tests as the "normal"
>range, can vary from lab to lab, I have found this list useful in
>understanding what my lab results mean and where my results devate from
>what is generally considered normal and healthy.
>
>____________________________________
>
>
>Hematology Values
>    * HEMATOCRIT (HCT)
>
>    * Normal Adult Female Range: 37 - 47%
>Optimal Adult Female Reading: 42%
>Normal Adult Male Range 40 - 54%
>Optimal Adult Male Reading: 47
>Normal Newborn Range: 50 - 62%
>Optimal Newborn Reading: 56
>    * HEMOGLOBIN (HGB)
>
>    * Normal Adult Female Range: 12 - 16 g/dl
>Optimal Adult Female Reading: 14 g/dl
>Normal Adult Male Range: 14 - 18 g/dl
>Optimal Adult Male Reading: 16 g/dl
>Normal Newborn Range: 14 - 20 g/dl
>Optimal Newborn Reading: 17 g/dl
>    * MCH (Mean Corpuscular Hemoglobin)
>
>    * Normal Adult Range: 27 - 33 pg
>Optimal Adult Reading: 30
>    * MCV (Mean Corpuscular Volume)
>
>    * Normal Adult Range: 80 - 100 fl
>Optimal Adult Reading: 90
>Higher ranges are found in newborns and infants
>    * MCHC (Mean Corpuscular Hemoglobin Concentration)
>
>    * Normal Adult Range: 32 - 36 %
>Optimal Adult Reading: 34
>Higher ranges are found in newborns and infants
>    * R.B.C. (Red Blood Cell Count)
>
>    * Normal Adult Female Range: 3.9 - 5.2 mill/mcl
>Optimal Adult Female Reading: 4.55
>Normal Adult Male Range: 4.2 - 5.6 mill/mcl
>Optimal Adult Male Reading: 4.9
>Lower ranges are found in Children, newborns and infants
>    * W.B.C. (White Blood Cell Count)
>
>    * Normal Adult Range: 3.8 - 10.8 thous/mcl
>Optimal Adult Reading: 7.3
>Higher ranges are found in children, newborns and infants.
>    * PLATELET COUNT
>
>    * Normal Adult Range: 130 - 400 thous/mcl
>Optimal Adult Reading: 265
>Higher ranges are found in children, newborns and infants
>    * NEUTROPHILS and NEUTROPHIL COUNT  - this is the main defender of
>the body against infection and antigens. High levels may indicate an
>active infection.
>
>    * Normal Adult Range: 48 - 73 %
>Optimal Adult Reading: 60.5
>Normal Children’s Range: 30 - 60 %
>Optimal Children’s Reading: 45
>    * LYMPHOCYTES and LYMPHOCYTE COUNT - Elevated levels may indicate an
>active viral infections such as measles, rubella, chickenpox, or
>infectious mononucleosis.
>
>    * Normal Adult Range: 18 - 48 %
>Optimal Adult Reading: 33
>Normal Children’s Range: 25 - 50 %
>Optimal Children’s Reading: 37.5
>    * MONOCYTES and MONOCYTE COUNT - Elevated levels are seen in tissue
>breakdown or chronic infections, carcinomas, leukemia (monocytic) or
>lymphomas.
>
>    * Normal Adult Range: 0 - 9 %
>Optimal Adult Reading: 4.5
>    * EOSINOPHILS and EOSINOPHIL COUNT  - Elevated levels may indicate an
>allergic reactions or parasites.
>
>    * Normal Adult Range: 0 - 5 %
>Optimal Adult Reading: 2.5
>    * BASOPHILS and BASOPHIL COUNT - Basophilic activity is not fully
>understood but it is known to carry histamine, heparin and serotonin.
>High levels are found in allergic reactions.
>
>    * Normal Adult Range: 0 - 2 %
>Optimal Adult Reading: 1
>
>
>
>Electrolyte Values
>
>    * SODIUM -  Sodium is the most abundant cation in the blood and its
>chief base. It functions in the body to maintain osmotic pressure,
>acid-base balance and to transmit nerve impulses. Very Low value:
>seizure and Neurologic Sx.
>
>    * Normal Adult Range: 135-146 mEq/L
>Optimal Adult Reading: 140.5
>    * POTASSIUM - Potassium is the major intracellular cation. Very low
>value: Cardiac arythemia.
>
>    * Normal Range: 3.5 - 5.5 mEq/L
>Optimal Adult Reading: 4.5
>    * CHLORIDE - Elevated levels are related to acidosis as well as too
>much water crossing the cell membrane. Decreased levels with decreased
>serum albumin may indicate water deficiency crossing the cell membrane
>(edema).
>
>    * Normal Adult Range: 95-112 mEq/L
>Optimal Adult Reading: 103
>    * CO2 (Carbon Dioxide) - The CO2 level is related to the respiratory
>exchange of carbon dioxide in the lungs and is part of the bodies
>buffering system. Generally when used with the other electrolytes, it is
>a good indicator of acidosis and alkalinity.
>
>    * Normal Adult Range: 22-32 mEq/L
>Optimal Adult Reading: 27
>Normal Childrens Range - 20 - 28 mEq/L
>Optimal Childrens Reading: 24
>    * CALCIUM - involved in bone metabolism, protein absorption, fat
>transfer muscular contraction, transmission of nerve impulses, blood
>clotting and cardiac function. Regulated by parathyroid.
>
>    * Normal Adult Range: 8.5-10.3 mEq/dl
>Optimal Adult Reading: 9.4
>    * PHOSPHORUS - Generally inverse with Calcium.
>
>    * Normal Adult Range: 2.5 - 4.5 mEq/dl
>Optimal Adult Reading: 3.5
>Normal Childrens Range: 3 - 6 mEq/dl
>Optimal Childrens Range: 4.5
>    * ANION GAP (Sodium + Potassium - CO2 + Chloride) - An increased
>measurement is associated with metabolic acidosis due to the
>overproduction of acids (a state of alkalinity is in effect). Decreased
>levels may indicate metabolic alkalosis due to the overproduction of
>alkaloids (a state of acidosis is in effect).
>
>    * Normal Adult Range: 4 - 14 (calculated)
>Optimal Adult Reading: 9
>    * CALCIUM/PHOSPHORUS Ratio
>
>    * Normal Adult Range: 2.3 - 3.3 (calculated)
>Optimal Adult Reading: 2.8
>Normal Children’s range: 1.3 - 3.3 (calculated)
>Optimal Children’s Reading: 2.3
>    * SODIUM/POTASSIUM
>
>    * Normal Adult Range: 26 - 38 (calculated)
>Optimal Adult Reading: 32
>
>
>
>Hepatic Enzymes
>
>    * AST (Serum Glutamic-Oxalocetic Transaminase - SGOT ) - found
>primarily in the liver, heart, kidney, pancreas, and muscles. Seen in
>tissue damage, especially heart and live
>
>    * Normal Adult Range: 0 - 42 U/L
>Optimal Adult Reading: 21
>    * ALT (Serum Glutamic-Pyruvic Transaminase - SGPT) - Decreased SGPT
>in combination with increased cholesterol levels is seen in cases of a
>congested liver. We also see increased levels in mononucleosis,
>alcoholism, liver damage, kidney infection, chemical pollutants or
>myocardial infarction
>
>    * Normal Adult Range: 0 - 48 U/L
>Optimal Adult Reading: 24
>    * ALKALINE PHOSPHATASE - Used extensively as a tumor marker it is
>also present in bone injury, pregnancy, or skeletal growth (elevated
>readings.  Low levels are sometimes found in hypoadrenia, protein
>deficiency, malnutrition and a number of vitamin deficiencies
>
>    * Normal Adult Range: 20 - 125 U/L
>Optimal Adult Reading: 72.5
>Normal Childrens Range: 40 - 400 U/L
>Optimal Childrens Reading: 220
>    * GGT (Gamma-Glutamyl Transpeptidase) - Elevated levels may be found
>in liver disease, alcoholism, bile-duct obstruction, cholangitis, drug
>abuse, and in some cases excessive magnesium ingestion. Decreased levels
>can be found in hypothyroidism, hypothalamic malfunction and low levels
>of magnesium.
>
>    * Normal Adult Female Range: 0 - 45 U/L
>Optimal Female Reading: 22.5
>Normal Adult Male Range: 0 - 65 U/L
>Optimal Male Reading: 32.5
>    * LDH (Lactic Acid Dehydrogenase) - Increases are usually found in
>cellular death and/or leakage from the cell or in some cases it can be
>useful in confirming myocardial or pulmonary infarction (only in
>relation to other tests). Decreased levels of the enzyme may be seen in
>cases of malnutrition, hypoglycemia, adrenal exhaustion or low tissue or
>organ activity.
>
>    * Normal Adult Range: 0 - 250 U/L
>Optimal Adult Reading: 125
>    * BILIRUBIN, TOTAL - Elevated in liver disease, mononucleosis,
>hemolytic anemia, low levels of exposure to the sun, and toxic effects
>to some drugs, decreased levels are seen in people with an inefficient
>liver, excessive fat digestion, and possibly a diet low in nitrogen
>bearing foods
>
>    * Normal Adult Range 0 - 1.3 mg/dl
>Optimal Adult Reading: .65
>
>
>
>Renal Related
>
>    * B.U.N. (Blood Urea Nitrogen) - Increases can be caused by excessive
>protein intake, kidney damage, certain drugs, low fluid intake,
>intestinal bleeding, exercise or heart failure. Decreased levels may be
>due to a poor diet, malabsorption, liver damage or low nitrogen intake.
>
>    * Normal Adult Range: 7 - 25 mg/dl
>Optimal Adult Reading: 16
>    * CREATININE - Low levels are sometimes seen in kidney damage,
>protein starvation, liver disease or pregnancy. Elevated levels are
>sometimes seen in kidney disease due to the kidneys job of excreting
>creatinine, muscle degeneration, and some drugs involved in impairment
>of kidney function.
>
>    * Normal Adult Range: .7 - 1.4 mg/dl
>Optimal Adult Reading: 1.05
>    * URIC ACID - High levels are noted in gout, infections, kidney
>disease, alcoholism, high protein diets, and with toxemia in pregnancy.
>Low levels may be indicative of kidney disease, malabsorption, poor
>diet, liver damage or an overly acid kidney.
>
>    * Normal Adult Female Range: 2.5 - 7.5 mg/dl
>Optimal Adult Female Reading: 5.0
>Normal Adult Male Range: 3.5 - 7.5 mg/dl
>Optimal Adult Male Reading:5.5
>    * BUN/CREATININE - This calculation is a good measurement of kidney
>and liver function.
>
>    * Normal Adult Range: 6 -25 (calculated)
>Optimal Adult Reading: 15.5
>
>
>
>Protein
>
>    * PROTEIN, TOTAL - Decreased levels may be due to poor nutrition,
>liver disease, malabsorption, diarrhea, or severe burns. Increased
>levels are seen in lupus, liver disease, chronic infections, alcoholism,
>leukemia, tuberculosis amongst many others.
>
>    * Normal Adult Range: 6.0 -8.5 g/dl
>Optimal Adult Reading: 7.25
>    * ALBUMIN - major constituent of serum protein (usually over 50%).
>High levels are seen in liver disease(rarely) , shock, dehydration, or
>multiple myeloma. Lower levels are seen in poor diets, diarrhea, fever,
>infection, liver disease, inadequate iron intake, third-degree burns and
>edemas or hypocalcemia
>
>    * Normal Adult Range: 3.2 - 5.0 g/dl
>Optimal Adult Reading: 4.1
>    * GLOBULIN - Globulins have many diverse functions such as, the
>carrier of some hormones, lipids, metals, and antibodies(IgA, IgG, IgM,
>and IgE). Elevated levels are seen with  chronic infections, liver
>disease, rheumatoid arthritis, myelomas, and lupus are present, . Lower
>levels in immune compromised patients, poor dietary habits,
>malabsorption and liver or kidney disease.
>
>    * Normal Adult Range: 2.2 - 4.2 g/dl (calculated)
>Optimal Adult Reading: 3.2
>    * A/G RATIO (Albumin/Globulin Ratio)
>
>    * Normal Adult Range: 0.8 - 2.0 (calculated)
>Optimal Adult Reading: 1.9
>
>
>
>Lipids
>
>    * CHOLESTEROL - High density lipoproteins (HDL) is desired as opposed
>to the low density lipoproteins (LDL), two types of cholesterol.
>Elevated cholesterol has been seen in artherosclerosis, diabetes,
>hypothyroidism and pregnancy. Low levels are seen in depression,
>malnutrition, liver insufficiency, malignancies, anemia and infection.
>
>    * Normal Adult Range: 120 - 240 mg/dl
>Optimal Adult Reading: 180
>    * LDL (Low Density Lipoprotein) - studies correlate the association
>between high levels of LDL and arterial artherosclerosis
>
>    * Normal Adult Range: 62 - 130 mg/dl
>Optimal Adult Reading: 81 mg/dl
>    * HDL (High Density Lipoprotein) - A high level of HDL is an
>indication of a healthy metabolic system if there is no sign of liver
>disease or intoxication.
>
>    * Normal Adult Range: 35 - 135 mg/dl
>Optimal Adult Reading: +85 mg/dl
>    * TRIGLYCERIDES - Increased levels may be present in
>artherosclerosis, hypothyroidism, liver disease, pancreatitis,
>myocardial infarction, metabolic disorders, toxemia, and nephrotic
>syndrome. Decreased levels may be present in chronic obstructive
>pulmonary disease, brain infarction, hyperthyroidism, malnutrition, and
>malabsorption.
>
>    * Normal Adult Range: 0 - 200 mg/dl
>Optimal Adult Reading: 100
>    * CHOLESTEROL/LDL RATIO
>
>    * Normal Adult Range: 1 - 6
>Optimal Adult Reading: 3.5
>
>
>
>Thyroid
>
>    * THYROXINE (T4) - Increased levels are found in hyperthyroidism,
>acute thyroiditis, and hepatitis. Low levels can be found in Cretinism,
>hypothyroidism, cirrhosis, malnutrition, and chronic thyroiditis.
>
>    * Normal Adult Range: 4 - 12 ug/dl
>Optimal Adult Reading: 8 ug/dl
>    * T3-UPTAKE - Increased levels are found in hyperthyroidism, severe
>liver disease, metastatic malignancy, and pulmonary insufficiency.
>Decreased levels are found in hypothyroidism, normal pregnancy, and
>hyperestrogenis status.
>
>    * Normal Adult Range: 27 - 47%
>Optimal Adult Reading: 37 %
>    * FREE T4 INDEX (T7)
>
>    * Normal Adult Range: 4 - 12
>Optimal Adult Reading: 8
>    * THYROID-STIMULATING HORMONE (TSH) - produced by the anterior
>pituitary gland, causes the release and distribution of stored thyroid
>hormones. When T4 and T3 are too high, TSH secretion decreases, when T4
>and T3 are low, TSH secretion increases.
>
>    * Normal Adult Range: .5 - 6 miliIU/L
>
>
>
>
>Cardiac
>
>    *  Creatine phosphokinase (CK) - Levels rise 4 to 8 hours after an
>acute MI, peaking at 16 to 30 hours and returning to baseline within 4
>days
>
>    * 25-200 U/L
>    * 32-150 U/L
>    * CK-MB CK isoenzyme  - It begins to increase 6 to 10 hours after an
>acute MI (heart attack), peaks in 24 hours, and remains elevated for up
>to 72 hours.
>
>    * < 12 IU/L if total CK is <400 IU/L
>    * <3.5% of total CK if total CK is >400 IU/L
>    * (LDH) Lactate dehydrogenase  - Total LDH will begin to rise 2 to 5
>days after an MI; the elevation can last 10 days.
>
>    * 140-280 U/L
>    * LDH-1 and LDH-2  LDH isoenzymes - Compare LDH 1 and LDH 2 levels.
>Normally, the LDH-1 value will be less than the LDH-2. In the acute MI,
>however, the LDH 2 remains constant, while LDH 1 rises. When the LDH 1
>is higher than LDH 2, the LDH is said to be flipped, which is highly
>suggestive of an MI. A flipped pattern appears 12-24 hours post MI and
>persists for 48 hours.
>
>    * LDH-1 18%-33%
>    * LDH-2 28%-40%
>    * SGOT  - will begin to rise in 8-12 hours and peak in 18-30 hours
>
>    * 10-42 U/L
>    * Myoglobin -  early and sensitive diagnosis of myocardial infarction
>in the emergency department This small heme protein becomes abnormal
>within 1 to 2 hours of necrosis, peaks in 4-8 hours, and drops to normal
>in about 12 hours.
>
>    * < 1

Reply | Forward | Messages in this Topic (2)

#19258

From: John Barrow <pozbod@...>
Date: Tue Oct 31, 2006 7:24 pm
Subject: Re: Best way to build general health for new AIDS guys

johnftl59

Offline

Send Email

"I am a new AIDS guy and I want to know the best way to stay healthy all�

around?

I have seen only one guy in my support group that looks healthy all�

around and the rest are sickly. The healthy guy said he was really sick�

at one point but I am not comfortable talking and asking him personal�

questions, but I figure that some people here know the way to get and�

stay all around healthy like him."

The best way to stay healthy remains to live a healthy life, just as you should, positive or negative.

As an HIV positive individual, you have to keep up with your health with regular doctor visits, and routine lab work to follow T cells and viral load.

If your counts indicate, you may have to start medications, which will preserve the immune system, and allow your body to fight the disease.

Regular excercise, a good diet, rest.� Avoid excess. Don't smoke.� �Enjoy your life.

Your life is going to be long and full.� Plan for that.

John Barrow

pozbod@...

Reply | Forward | Messages in this Topic (3)

#19257

From: PoWeRTX@...
Date: Tue Oct 31, 2006 12:21 pm
Subject: ARTES MEDICAL ANNOUNCES FDA APPROVAL FOR ARTEFILL� AS THE FIRST NON-RESORBABLE I

nelsonvergel

Offline

Send Email

10/30/06 Artes Medical Announces FDA Approval for ArteFill® as the First Non-Resorbable Injectable Wrinkle Filler to Correct Smile Lines

ARTES MEDICAL ANNOUNCES FDA APPROVAL FOR ARTEFILL® AS THE FIRST NON-RESORBABLE INJECTABLE WRINKLE FILLER TO CORRECT SMILE LINES

-ARTEFILL First Product In New Dermal Filler Category-

San Diego, Calif., October 30, 2006 – Artes Medical, Inc., a medical technology company focused on developing, manufacturing and commercializing a new category of aesthetic injectable products for men and women, today announced the United States Food and Drug Administration’s approval of ArteFill®. ArteFill is the first and only non-resorbable aesthetic injectable implant approved by the FDA. The product is indicated for the correction of facial wrinkles known as nasolabial folds, or smile lines. Unlike existing dermal fillers that are completely metabolized by the body, ArteFill represents the first product in a new category of non-resorbable dermal fillers providing a permanent support structure for enduring wrinkle correction. Artes Medical intends to begin marketing and selling ArteFill to dermatologists, plastic surgeons and cosmetic surgeons in the U.S. through the Company’s direct sales force.

“We are pleased to introduce ArteFill, a uniquely-designed product, for the expanding aesthetic market,” said Diane S. Goostree, President of Artes Medical. “Based on ArteFill’s proven results and high level of patient satisfaction observed in our clinical trials, ArteFill addresses the unmet patient demand for enduring wrinkle correction.”

ArteFill contains a proprietary combination of ArteFill Precision-Filtered Microspheres™ suspended in a carrier gel containing purified bovine collagen. Artes Medical produces the microspheres from one of the most commonly used synthetic implant materials in medicine, polymethylmethacrylate (PMMA). The size of the microspheres is strictly regulated to help ensure consistent and safe results. The microspheres are 30 to 50 microns in size, barely visible to the naked eye. Artes Medical produces the purified collagen gel in accordance with both FDA and USDA guidelines. After ArteFill is injected into a patient’s smile line, the microspheres provide a permanent support structure beneath the skin to support the wrinkle and to prevent further wrinkling.

“For the first time, U.S. consumers have an FDA-approved, non-resorbable aesthetic injectable product available that is designed to provide correction for smile lines, the primary external sign of facial aging,” said Stefan M. Lemperle, MD, a founder of Artes Medical.

The Company manufactures ArteFill at its fully integrated, cGMP compliant, dedicated facility located in San Diego, California.

About ArteFill

ArteFill is indicated for the correction of facial wrinkles known as nasolabial folds or smile lines. An ArteFill Skin Test is required before initial treatment. The most common adverse events associated with ArteFill injections, similar to those observed with other dermal fillers, are lumpiness, persistent swelling or redness and increased sensitivity at the injection site. For more information on ArteFill, including complete product information, visit www.artefill.com. Artes Medical intends to offer a comprehensive training program to dermatologists, plastic surgeons and cosmetic surgeons. The goal of the training program is to maximize patient and physician satisfaction with ArteFill by fostering consistent and high-quality treatments. ArteFill and the ArteFill Skin Test are expected to be available in the U.S. in the next 45 to 60 days.

U.S. Clinical Study

The FDA approval of ArteFill was based on data from the Company’s 12-month, controlled, randomized, double-masked, prospective, multi-center U.S. clinical trial. Patients treated with ArteFill (n=251) showed significantly greater and persistent improvement compared to those treated with the collagen control (Zyplast®). At the 6 month evaluation, which was the primary efficacy evaluation period, the wrinkle correction in the patients treated with ArteFill persisted, while the patients treated with the collagen control returned to their pretreatment status. The safety profiles for ArteFill and the collagen control group were comparable. ArteFill patients were also evaluated one year after treatment, demonstrating continued safety and wrinkle correction. Based on our clinical data, the FDA approved ArteFill as a safe and effective non-resorbable injectable implant for the correction of nasolabial folds in men and women.

About Artes Medical, Inc.

Artes Medical is a medical technology company focused on developing, manufacturing and commercializing a new category of aesthetic injectable products for the dermatology and plastic surgery markets. The Company’s initial product, ArteFill, is a non-resorbable aesthetic injectable implant for the correction of facial wrinkles known as nasolabial folds, or smile lines, which will be marketed as a treatment for men and women. Based in San Diego, Calif., Artes Medical was founded in 1999 and is privately-held. Additional information about Artes Medical and ArteFill is available at www.artesmedical.com and www.artefill.com.

Forward-Looking Statements

This news release contains forward-looking statements that are based on the Company’s current beliefs and assumptions and on information currently available to its management. Forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause the Company’s actual results, performance or achievements to be materially different from any future results, performance or achievements expressed or implied by the forward-looking statements. As a result of these risks, uncertainties and other factors, readers are cautioned not to place undue reliance on any forward-looking statements included in this press release. These forward-looking statements represent beliefs and assumptions only as of the date of this news release, and the Company assumes no obligation to update these forward

Regards,

Nelson Vergel
powerusa dot org

"What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do." - John Ruskin

Reply | Forward | Messages in this Topic (2)

#19256

From: rolyatffej@...
Date: Tue Oct 31, 2006 12:08 pm
Subject: re: HPV of the Anus Prevalent Among HIV+ Women

rolyatffej

Offline

Send Email

Thanks for this post, Nelson (and Jules!) Anal cancer is not just a problem among HIV + men & women--heterosexual women are developing it in increasing numbers--usually in their 60s. There's a whole other yahoo group devoted to it: anal-cancer-owner@yahoogroups.com. Farrah Fawcett is currently battling anal cancer--perhaps she'll become a spokesperson for the disease like Pamela Anderson did for Hep C. We can only hope...

Jeff in Palm Springs.

Reply | Forward | Messages in this Topic (1)

#19255

From: "hiflipinvert" <hiflipinvert@...>
Date: Tue Oct 31, 2006 5:57 am
Subject: New to the group and had a few questions...

hiflipinvert

Offline

Send Email

Hey to all? My name is Brian and I am new to the group here. I have
been poz for 2ish years now. It has been one hell of a two years
trying to keep life together. I'm sure a lot kind of know what I mean,
but I guess I am at the point where it became kind of a conscious
decision to get it together so to speak and I am wondering if there
are any websites that are trusted to go to, etc. Personal stories or
just being able to chat with somebody who has come out of this and is
moving right along I guess. Hopefully these are the right choices of
words for what I am trying to talk about.
   Second, where would one go I guess to move on and find someone to
spend the rest of their life with. I live in a town in southeastern
wisconsin with about 5000 people in it and am probably the only one
around nor would I dare say anything to anyone. Would be a bad
situation.
   Cheers to all who are movin right along and all is well. Looking
forward to getting there....

Reply | Forward | Messages in this Topic (3)

#19254

From: PoWeRTX@...
Date: Mon Oct 30, 2006 11:54 pm
Subject: Early Voting Ends Friday, November 3!!!

nelsonvergel

Offline

Send Email

Early Voting Ends Friday, November 3!!!

Early Voting Hours of Operation

October 30th - November 3rd - 7:00 a.m. - 7:00 p.m.

Early voting may be easier than you think. You don't have to stand in long lines on Election Day. Registered voters may vote early at a location convenient to them. If you have difficulty walking. Call ahead to notify the early voting clerk that you want to vote from your car. This procedure is called "curbside voting" and is available to any voter who has difficulty walking or standing for long periods. The election official will bring your ballot to your car outside the polling place. Curbside voting is available during early voting and on Election Day. State and Federal law requires all early and Election Day polling locations to be physically accessible to voters with disabilities. Call your election official for information on your particular voting sites.

Regards,

Nelson Vergel
powerusa dot org

"What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do." - John Ruskin

Reply | Forward | Messages in this Topic (1)

#19253

From: "doug.truaxe" <DougTruaxe@...>
Date: Tue Oct 31, 2006 2:10 am
Subject: HIV Doc List

doug.truaxe

Offline

Send Email

Is there a doctors list of the best HIV docs in the US? Does anyone
have such a list? I have just joing this group and looked but couldn't
find one here.

thanks
Doug

Reply | Forward | Messages in this Topic (2)

#19252

From: PoWeRTX@...
Date: Mon Oct 30, 2006 11:59 pm
Subject: Recombinant Human Growth Hormone Produces Pronounced and Durable Reductions in V

nelsonvergel

Offline

Send Email

Recombinant Human Growth Hormone Produces Pronounced and Durable Reductions in Visceral Adipose Tissue

Coverage provided by Eric Daar, M.D.

September 30, 2006

Morphologic abnormalities continue to be a significant problem in patients with HIV disease. Fat loss syndromes appear to be closely linked to the use of nucleoside reverse transcriptase inhibitors (NRTIs) and at least partially responsive to changes in therapy. Less is known regarding the pathogenesis or optimal management strategy for those with fat accumulation syndromes. Increased visceral fat can be a particularly significant problem, both from a cosmetic perspective and from a health perspective given its association with physical complaints such as gastroesophageal reflux and respiratory compromise. It is also known that in the general population, visceral adiposity is an independent predictor of cardiovascular disease.

Several interventions for reducing visceral fat have been tested with variable results. Perhaps the best data come from case series and randomized controlled clinical trials assessing the use of recombinant human growth hormone (r-hGH). The rationale for using this agent is that it is lipolytic. Yet, although r-hGH may reduce visceral fat, there is concern that it could also increase subcutaneous fat loss and exacerbate lipoatrophy.

Markus Bickel, from Goethe University in Frankfurt, Germany, and colleagues previously reported data obtained from 26 HIV-infected adults with clinical symptoms of fat accumulation while on an unchanged antiretroviral regimen for at least three months.1 These individuals were randomized to receive r-hGH at a dose of 4 mg subcutaneously either daily or three times per week for 12 weeks followed by 2 mg subcutaneously per day for an additional 12 weeks. An MRI scan was used to assess fat distribution in these patients during the initial 24 weeks of follow-up. The individuals showed marked reductions in visceral fat at 12 weeks that did not significantly differ by dosing schedule, and these reductions were maintained during the second 12 weeks of lower dose therapy. There was a small, concomitant reduction in limb and facial fat also reported across the groups at both 12 and 24 weeks. The investigators further reported increases in high-density lipoprotein (HDL) cholesterol and fasting insulin levels.

In the current study, Bickel et al summarized long-term follow-up data from a subset of the original 26 study participants.2 The substudy included 15 men and 1 woman from the original trial who had undergone 6 to 12 months of follow-up assessment after completion of the low-dose r-hGH maintenance phase of the study. Serial MRI scans were performed to assess visceral fat, mid-thigh fat and facial fat. Select metabolic parameters were also monitored over time.

The changes in these measures are summarized in the table below. Overall, there was a decrease in visceral fat, mid-thigh fat and facial fat during the treatment phase of the study. Although there was an increase in fat off therapy -- particularly in the visceral compartment -- the fat levels remained below baseline after a median of nine months of follow-up. In addition, the metabolic profile at follow-up was better than it was at baseline, particularly with regard to lower fasting glucose and triglyceride levels. It is suspected that the improved metabolic profile may stem from the reductions in visceral adipose tissue.

Change in Body Fat and Metabolic Parameters Over Time

Parameter Baseline Week 12 Week 24 Follow-up*

Fat mass (cm2)

Visceral 121 + 70 78 + 49 68 + 37 94 + 53

Mid thigh 49 + 32 42 + 28 40 + 28 41 + 27

Face 15.0 + 6.1 11.9 + 5.8 11.7 + 5.5 12.6 + 6.2

Metabolic (mg/dL)

Glucose 92 + 9 93 + 14 94 + 11 77 + 18

Triglycerides 286 + 133 246 + 128 245 + 115 214 + 100

LDL 132 + 27 116 + 31 126 + 29 132 + 25

HDL 42 + 7 46 + 10 45 + 11 45 + 12

* Median of nine months after r-hGH was stopped.

LDL = low-density lipoprotein; HDL = high-density lipoprotein.

The investigators of this study concluded that the initial response to r-hGH is consistent with that seen in other studies. Especially encouraging was the observation that thrice-weekly dosing, in comparison with daily dosing, achieved significant reductions in visceral fat, which were then maintained with 2 mg daily dosing.

This small study also showed that although fat re-accumulation occurred off treatment, visceral fat content still remained below baseline levels after a median of nine months off r-hGH. Not surprisingly, the investigators found that the lipolytic effects of r-hGH also extended to limb and facial fat; however, the degree of the observed fat loss is of unknown clinical significance.

Much larger studies have recently been reported that address the safety and efficacy of r-hGH in this patient population. The addition of pilot data on longer term follow-up and the effects on fat in other areas, particularly the face, will be relevant if this treatment strategy becomes more widely adopted in the future.

Footnotes

1. Bickel M, Zangos S, Jacobi V, et al. A randomized, open-label study to compare the effects of two different doses of recombinant human growth hormone on fat reduction and fasting metabolic parameters in HIV-1-infected patients with lipodystrophy. HIV Med. September 2006;7(6):397-403.

2. Bickel M, Zangos S, Jacobi V, et al. Maintained Effect on Body Composition After Treatment with Recombinant Human Growth Hormone (r-hGH) in HIV-1 Infected Patients with Lipodystrophy. In: Program and abstracts of the 46th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; September 27-30, 2006; San Francisco, Calif. Abstract H-1898.

View slides: Download PowerPoint

This article was provided by The Body.

Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

Regards,

Nelson Vergel
powerusa dot org

"What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do." - John Ruskin

Reply | Forward | Messages in this Topic (2)

#19251

From: "Norm Stuart" <nspop2@...>
Date: Tue Oct 31, 2006 1:19 am
Subject: Re: Hey group, off topic but about Flu shots and low t-cells

norm_w_stuart

Offline

Send Email

The CDC reccomends that all people with AIDS get annual flu vaccinations.

http://www.cdc.gov/flu/protect/hiv-flu.htm

There is some question how effective a vaccination really is in people with a supressedimmune system, but any protection is better than none.

The flu vaccination to avoid is the live-virus nasal spray vaccination. Some superstitious and uninformed Doctors mistakenly generalize the nasal-spray vaccination caution to all flu vaccinations. But this is not correct.

Another voodoo that is spread among the uninformed is the fear of a modest temporary rise in HIV viral load after vaccinations. This is an event without meaning or significance.

--- In PozHealth@yahoogroups.com, Roscoeismydog@... wrote:
>
> Does anyone have any experience with having flu shots with very low t-cells?
> A friend of mine was recommended not to have a flu shot because his t-cells
> are 20.. And of course you can not tell him anything, he insists he is gonna
> get one anyway, he got one last year with only 18 t-cells, and was fine. (he
> is having problems affording his hiv meds, long story, but because he has a
> good job and insurance he does not qualify for help from the city, yet his co
> pays are way to much for him to afford if he uses insurance).
> Has anyone on here had a flu shot while having very low t-cells?
> I realize he should do what the doc says but he is not always good at that..
>

Reply | Forward | Messages in this Topic (7)

#19250

From: "doug.truaxe" <DougTruaxe@...>
Date: Tue Oct 31, 2006 2:28 am
Subject: Best way to build general health for new AIDS guys

doug.truaxe

Offline

Send Email

I am a new AIDS guy and I want to know the best way to stay healthy all
around?

I have seen only one guy in my support group that looks healthy all
around and the rest are sickly. The healthy guy said he was really sick
at one point but I am not comfortable talking and asking him personal
questions, but I figure that some people here know the way to get and
stay all around healthy like him.

thanks
Doug

Reply | Forward | Messages in this Topic (3)

#19249

From: PoWeRTX@...
Date: Mon Oct 30, 2006 11:57 pm
Subject: Fwd: NATAP: Screening for Diabetes (and Risk Factors)

nelsonvergel

Offline

Send Email

In a message dated 10/23/2006 6:42:04 A.M. Central Standard Time, nataphcvhiv@... writes:

NATAP http://natap.org/
_______________________________________________

Screening for diabetes mellitus, and Risk Factors

David K McCulloch, MD
Diabetologist, Group Health Cooperative
Clinical Professor of Medicine
University of Washington

UpToDate.com

INTRODUCTION - The following five criteria define the optimal conditions for screening for a particular disorder [1]:

    * The disorder should be an important public health problem
    * An early asymptomatic stage should exist
    * There is a suitable screening test
    * An accepted treatment should be available
    * There is evidence that early treatment improves long-term outcome

The extent to which these criteria are met for type 1 and type 2 diabetes mellitus is reviewed here, as well as practical recommendations on how to screen for these disorders in clinical practice. Screening of pregnant women for gestational diabetes is discussed separately. (See "Screening and diagnosis of gestational diabetes mellitus").

TYPE 1 DIABETES - The prevalence of type 1 diabetes continues to increase around the world, although it still affects less than 0.5 percent of the population [2]. An early asymptomatic phase exists; many subjects in this phase can be identified, but only by a combination of immunologic, genetic, and metabolic tests. (See "Pathogenesis of type 1 diabetes mellitus" and see "Prediction of type 1 diabetes mellitus").

There is no accepted treatment for the asymptomatic phase of type 1 diabetes. In the Diabetes Prevention Trial (DPT), parenteral insulin therapy did not prevent type 1 diabetes in high-risk patients. (See "Prevention of type 1 diabetes mellitus").

Thus, routine screening for type 1 diabetes cannot be recommended except for research purposes.

TYPE 2 DIABETES - The arguments for widespread screening to identify undiagnosed cases of type 2 diabetes are much stronger than for type 1 diabetes.

    * Type 2 diabetes is a major public health problem affecting approximately 8 percent of the United States population, with probably an equal number of cases being undiagnosed. The global prevalence of type 2 diabetes continues to rise [3]. (See "Prediction and prevention of type 2 diabetes mellitus").

    * An asymptomatic period exists.

    * There is no ideal screening test, but measurement of fasting blood glucose (or, under some circumstances, random blood glucose or 2-hour post-glucose challenge) is adequate for identifying many undiagnosed cases.

    * Well-established treatments for type 2 diabetes exist. (See "Overview of medical care in diabetes mellitus" and see "Glycemic control in type 2 diabetes mellitus: Initial treatment").

In addition, undiagnosed diabetes can cause progressive microvascular damage. At the time of diagnosis, approximately 20 percent of newly diagnosed patients with type 2 diabetes have diabetic retinopathy [4] and 10 percent have nephropathy [5]. (See "Pathogenesis and natural history of diabetic retinopathy" and see "Microalbuminuria and diabetic nephropathy"). Furthermore, adults with undiagnosed diabetes often have other risk factors for macrovascular diabetic complications: 67 percent have hypertension (of whom one-half are uncontrolled); 62 percent have serum low-density lipoprotein cholesterol concentrations >130 mg/dL (3.4 mmol/L); more than 50 percent are overweight; and almost one-third smoke cigarettes [6].

The Diabetes Control and Complications Trial (DCCT) demonstrated that interventions which improve glycemic control in patients with type 1 diabetes reduce the risk of development and slow the progression of diabetic microvascular disease [7]. (See "Glycemic control and vascular complications in type 1 diabetes mellitus"). It has also been demonstrated by the United Kingdom Prospective Diabetes Study (UKPDS) that strict glycemic control has a similar benefit in patients with type 2 diabetes [8]. (See "Glycemic control and vascular complications in type 2 diabetes mellitus"). In addition, metformin and the combination of diet and exercise have been shown to be effective in reducing the risk of type 2 diabetes in patients with IGT. (See "Prediction and prevention of type 2 diabetes mellitus").

However, it has not been firmly established that early detection of type 2 diabetes and intervention improve long-term outcome.

A computer simulation model of subjects over age 25 suggested that the increases in costs attributable to screening and early treatment may be acceptable [9]. The benefits of early detection in this model were derived more from postponement of complications and the resulting improvement in quality of life than from additional life-years. Screening was more cost-effective for younger people and for blacks.

There are, however, some concerns about this study. The potential benefits are based upon the assumption that most of the population could be screened; unfortunately, those at greatest risk may well be the most difficult group to screen. In addition, if the standard of care for patients known to have diabetes was better (eg, better screening and management of nephropathy, neuropathy, retinopathy, and glycemic control from the time of diagnosis), then the benefits of screening for undiagnosed cases would fall.

In a second cost-effectiveness analysis based upon the UKPDS population and a hypertension trial, screening targeted to individuals with hypertension was more cost-effective than universal screening, and the most cost-effective strategy was targeted screening at age 55 to 75 years [10]. The impact of screening for dyslipidemia was not assessed in this analysis.

Screening tests - The most commonly used screening tests for type 2 diabetes include measurement of the blood glucose, glycosylated hemoglobin, and the urine dipstick testing for glucose.

Blood glucose - Blood glucose values are distributed over a continuum in the population, although there are some approximate thresholds above which the risk of future adverse events is substantial. An Expert Committee on the Diagnosis and Classification of Diabetes Mellitus has recommend placing individuals in one of three categories based upon the fasting blood glucose concentration [11,12] (see "Definition of diabetes mellitus"):

    * Less than 100 mg/dL (<5.6 mmol/L) - Normal

    * 101 to 125 mg/dL (5.6 to 6.9 mmol/L) - Impaired fasting glucose, or IFG, (roughly equivalent to the term impaired glucose tolerance, or IGT, which was defined using the oral glucose tolerance test)

    * Greater than 125 mg/dL (>6.9 mmol/L) - Diabetes mellitus

Patients with diabetes mellitus are at increased risk for both macrovascular and microvascular disease. Those with impaired fasting blood glucose are at increased risk for macrovascular disease (myocardial infarction, stroke, peripheral vascular disease), but not for microvascular disease (retinopathy, neuropathy and nephropathy).

In 1997, the Expert Committee lowered the fasting blood glucose value defining the presence of diabetes from 140 mg/dL (7.8 mmol/L) to 126 mg/dL (7.0 mmol/L) because the lower value more accurately reflects the blood glucose concentration at or above which the risk for microvascular disease is increased. This lower value also correlates better with the risk associated with a random (or two-hour post-glucose challenge) blood glucose concentration of 200 mg/dL (11.1 mmol/L), which was retained from the old classification as also being diagnostic for diabetes mellitus [11]. (See "Definition of diabetes mellitus" for a detailed discussion on the Expert Committee's 2003 updated report).

The sensitivity and specificity of the fasting blood glucose as a screening test vary according to the population tested and the threshold used to define diabetes. Using a 2-hour blood glucose >200 mg/dL (11.1 mmol/L) on an oral glucose tolerance test as the reference standard, the specificity of a fasting blood glucose 126 mg/dL (7.0 mmol/L) is greater than 95 percent; the sensitivity is about 50 percent, and may be lower for people over the age of 65 [13]. Among people ages 40 to 74, the specificity of a fasting blood glucose 140 mg/dL (7.8 mmol/L) is 91 percent; the specificity is 47 percent for a fasting blood glucose between 126 and 140 mg/dL (7.0 to 7.8 mmol/L) [14].

Glycosylated hemoglobin - There has been interest in the use of glycosylated hemoglobin (A1C) values for screening and identification of impaired glucose tolerance and diabetes [15]. However, there remain significant problems in the standardization of A1C assays and the American Diabetes Association currently does not recommend its use for screening purposes. There may be some value to combining measurements of A1C with the fasting glucose concentration, but this requires further validation [16]. (See "Definition of diabetes mellitus").

Urine glucose - Detection of glucose on a semiquantitative urine dipstick (anything regarded as trace positive or more) or Clinitest tablets is an insensitive means of screening for type 2 diabetes [17]. The high rate of false-negative results suggests that the urine dipstick is not adequate as a screening test. Additionally, not all patients with glucosuria have diabetes. Glucosuria can occur with defects in renal tubular function, as seen in Type 2 (proximal) renal tubular acidosis and in familial renal glucosuria, a genetic disorder associated with salt-wasting, polyuria, and volume depletion [18].

Screening recommendations by expert groups - The two approaches to screening that are usually recommended (and are not mutually exclusive) are either to screen the entire population above a certain age, or to screen certain "high-risk" groups. The ADA recommends that people be screened by measurement of fasting blood glucose every three years beginning at age 45 years; screening should be considered at an earlier age or be carried out more frequently if diabetes risk factors are present [19]. Diabetes risk factors include the following:

    * Age 45 years

    * Overweight (body mass index 25 kg/m2)

    * Family history diabetes mellitus in a first-degree relative

    * Habitual physical inactivity

    * Belonging to a high-risk ethnic or racial group (eg, African-American, Hispanic, Native American, Asian-American, and Pacific Islanders)

    * History of delivering a baby weighing >4.1 kg (9 lb) or of gestational diabetes mellitus

    * Hypertension (blood pressure 140/90 mmHg)

    * Dyslipidemia defined as a serum high-density lipoprotein cholesterol concentration 35 mg/dL (0.9 mmol/L) and/or a serum triglyceride concentration 250 mg/dL (2.8 mmol/L)

    * Previously identified impaired glucose tolerance or impaired fasting glucose

    * Polycystic ovary syndrome

    * History of vascular disease

If the fasting blood glucose concentration is above 100 mg/dL (5.6 mmol/L), the test should be repeated. Two fasting blood glucose values over 125 mg/dL (6.9 mmol/L), two post-glucose values over 200 mg/dL (11.1 mmol/L), or one of each, or a random glucose 200 mg/dL (11.1 nmol/L) with symptoms of diabetes is required to make the diagnosis. (See "Definition of diabetes mellitus").

Other predictive models using risk factor assessment have been investigated as a strategy to guide screening, but are not in widespread use [20].

The third United States Preventive Services Task Force concluded that there was insufficient evidence to recommend for or against screening for diabetes in nonpregnant adults without hypertension or hyperlipidemia [21]. This conclusion was based primarily on the lack of evidence that earlier detection of diabetes improves long-term outcomes. However, the task force found that there was fair evidence for and recommended screening in adults with hypertension or hyperlipidemia as part of an integrated approach to reduce cardiovascular risk. (See "USPSTF Guidelines: Screening for type 2 diabetes mellitus in adults: Recommendations and rationale").

The Canadian Task Force on the Periodic Health Examination similarly recommends screening patients with hypertension and hyperlipidemia for type 2 diabetes [22].

A suggested approach - Consistent with ADA guidelines, we recommend measurement of fasting blood glucose in everyone aged 45 years or older receiving health care (or maintenance). A value 100 mg/dL (5.6 mmol/L) should be considered normal and the patient should be retested in three years. If the fasting blood glucose value is above 100 mg/dL (5.6 mmol/L), the test should be repeated and the scheme in Table 1 followed (show table 1).

Among patients seeking health care who have not fasted overnight, those ages 45 years and older or considered high-risk according to the criteria listed above should have a measurement of nonfasting (random) blood glucose on that visit. A random value less than 125 mg/dL is considered normal and requires no further testing.

Patients with a random value 126 mg/dL (6.9 mmol/L) or greater should have a follow-up fasting blood glucose measured. For patients whose random blood glucose was greater than 200 mg/dL (11.1 mmol/L), a follow-up fasting glucose value 126 mg/dL (6.9 mmol/L) is consistent with a diagnosis of diabetes mellitus. The management of all other individuals should follow the scheme in Table 2 (show table 2).

Patients classified as having impaired fasting glucose (IFG) should be counseled vigorously on issues related to lowering their risk of macrovascular disease (smoking cessation, use of aspirin, diet, and exercise), and should have measurements of blood pressure and serum lipids. Screening for diabetes should be repeated annually.

Patients classified as having type 2 diabetes mellitus should be treated using the approach described separately. (See "Overview of medical care in diabetes mellitus").

REFERENCES
1.           Wilson, JM, Junger, G. Principles and Practice of Screening for Disease. Geneva, World Health Organization, 1968.
2.           Secular trends in incidence of childhood IDDM in 10 countries. Diabetes Epidemiology Research International Group. Diabetes 1990; 39:858.
3.           Wild, S, Roglic, G, Green, A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:1047.
4.           Harris, MI, Klein, RE, Welborn, TA, Knuiman, MW. Onset of NIDDM occurs at least 4-7 years before clinical diagnosis. Diabetes Care 1992; 15:815.
5.           Klein, R, Klein, BE, Moss, S, DeMets, DL. Proteinuria in diabetes. Arch Intern Med 1988; 148:181.
6.           Harris, MI. Undiagnosed NIDDM: Clinical and public health issues. Diabetes Care 1993; 16:642.
7.           The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977.
8.           Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352:837.
9.           The cost-effectiveness of screening for type 2 diabetes. CDC Diabetes Cost-Effectiveness Study Group, Centers for Disease Control and Prevention. JAMA 1998; 280:1757.
10.           Hoerger, TJ, Harris, R, Hicks, KA, et al. Screening for type 2 diabetes mellitus: a cost-effectiveness analysis. Ann Intern Med 2004; 140:689.
11.           Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20:1183.
12.           Genuth, S, Alberti, KG, Bennett, P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26:3160.
13.           Blunt, BA, Barrett-Connor, E, Wingard, DL. Evaluation of fasting plasma glucose as screening test for NIDDM in older adults. Rancho Bernardo Study. Diabetes Care 1991; 14:989.
14.           Harris, MI, Eastman, RC, Cowie, CC, et al. Comparison of diabetes diagnostic categories in the U.S. population according to the 1997 American Diabetes Association and 1980-1985 World Health Organization diagnostic criteria. Diabetes Care 1997; 20:1859.
15.           Peters, AL, Davidson, MB, Schriger, DL, et al. A clinical approach for the diagnosis of diabetes mellitus: an analysis using glycosylated hemoglobin levels. JAMA 1996; 276:1246.
16.           Perry, RC, Shankar, RR, Fineberg, N, et al. HbA1c measurement improves the detection of type 2 diabetes in high-risk individuals with nondiagnositc levels of fasting plasma glucose: the Early Diabetes Intervention Program (EDIP). Diabetes Care 2001; 24:465.
17.           Andersson, DK, Lundblad, E, Svardsudd, K. A model for early diagnosis of type 2 diabetes mellitus in primary health care. Diabet Med 1993; 10:167.
18.           Calado, J, Loeffler, J, Sakallioglu, O, et al. Familial renal glucosuria: SLC5A2 mutation analysis and evidence of salt-wasting. Kidney Int 2006; 69:852.
19.           Screening for type 2 diabetes. Diabetes Care 2004; 27 Suppl 1:S11.
20.           Glumer, C, Carstensen, B, Sandbaek, A, et al. A Danish diabetes risk score for targeted screening: the Inter99 study. Diabetes Care 2004; 27:727.
21.           Screening for type 2 diabetes mellitus in adults: recommendations and rationale. Ann Intern Med 2003; 138:212.
22.           Feig, DS, Palda, VA, Lipscombe, L. Screening for type 2 diabetes mellitus to prevent vascular complications: updated recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2005; 172:177.

_______________________________________________
NATAP nataphcvhiv mailing list -- nataphcvhiv@...

This is an annoucement-only mailing list. Do not reply.

To unsubscribe: send a blank email to nataphcvhiv-request@... with a subject of unsubscribe.

For more information, see http://seven.pairlist.net/mailman/listinfo/nataphcvhiv

Regards,

Nelson Vergel
powerusa dot org

"What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do." - John Ruskin

NATAP http://natap.org/
_______________________________________________

Screening for diabetes mellitus, and Risk Factors

David K McCulloch, MD
Diabetologist, Group Health Cooperative
Clinical Professor of Medicine
University of Washington

UpToDate.com

INTRODUCTION - The following five criteria define the optimal conditions for screening for a particular disorder [1]:

    * The disorder should be an important public health problem
    * An early asymptomatic stage should exist
    * There is a suitable screening test
    * An accepted treatment should be available
    * There is evidence that early treatment improves long-term outcome

The extent to which these criteria are met for type 1 and type 2 diabetes mellitus is reviewed here, as well as practical recommendations on how to screen for these disorders in clinical practice. Screening of pregnant women for gestational diabetes is discussed separately. (See "Screening and diagnosis of gestational diabetes mellitus").

TYPE 1 DIABETES - The prevalence of type 1 diabetes continues to increase around the world, although it still affects less than 0.5 percent of the population [2]. An early asymptomatic phase exists; many subjects in this phase can be identified, but only by a combination of immunologic, genetic, and metabolic tests. (See "Pathogenesis of type 1 diabetes mellitus" and see "Prediction of type 1 diabetes mellitus").

There is no accepted treatment for the asymptomatic phase of type 1 diabetes. In the Diabetes Prevention Trial (DPT), parenteral insulin therapy did not prevent type 1 diabetes in high-risk patients. (See "Prevention of type 1 diabetes mellitus").

Thus, routine screening for type 1 diabetes cannot be recommended except for research purposes.

TYPE 2 DIABETES - The arguments for widespread screening to identify undiagnosed cases of type 2 diabetes are much stronger than for type 1 diabetes.

    * Type 2 diabetes is a major public health problem affecting approximately 8 percent of the United States population, with probably an equal number of cases being undiagnosed. The global prevalence of type 2 diabetes continues to rise [3]. (See "Prediction and prevention of type 2 diabetes mellitus").

    * An asymptomatic period exists.

    * There is no ideal screening test, but measurement of fasting blood glucose (or, under some circumstances, random blood glucose or 2-hour post-glucose challenge) is adequate for identifying many undiagnosed cases.

    * Well-established treatments for type 2 diabetes exist. (See "Overview of medical care in diabetes mellitus" and see "Glycemic control in type 2 diabetes mellitus: Initial treatment").

In addition, undiagnosed diabetes can cause progressive microvascular damage. At the time of diagnosis, approximately 20 percent of newly diagnosed patients with type 2 diabetes have diabetic retinopathy [4] and 10 percent have nephropathy [5]. (See "Pathogenesis and natural history of diabetic retinopathy" and see "Microalbuminuria and diabetic nephropathy"). Furthermore, adults with undiagnosed diabetes often have other risk factors for macrovascular diabetic complications: 67 percent have hypertension (of whom one-half are uncontrolled); 62 percent have serum low-density lipoprotein cholesterol concentrations >130 mg/dL (3.4 mmol/L); more than 50 percent are overweight; and almost one-third smoke cigarettes [6].

The Diabetes Control and Complications Trial (DCCT) demonstrated that interventions which improve glycemic control in patients with type 1 diabetes reduce the risk of development and slow the progression of diabetic microvascular disease [7]. (See "Glycemic control and vascular complications in type 1 diabetes mellitus"). It has also been demonstrated by the United Kingdom Prospective Diabetes Study (UKPDS) that strict glycemic control has a similar benefit in patients with type 2 diabetes [8]. (See "Glycemic control and vascular complications in type 2 diabetes mellitus"). In addition, metformin and the combination of diet and exercise have been shown to be effective in reducing the risk of type 2 diabetes in patients with IGT. (See "Prediction and prevention of type 2 diabetes mellitus").

However, it has not been firmly established that early detection of type 2 diabetes and intervention improve long-term outcome.

A computer simulation model of subjects over age 25 suggested that the increases in costs attributable to screening and early treatment may be acceptable [9]. The benefits of early detection in this model were derived more from postponement of complications and the resulting improvement in quality of life than from additional life-years. Screening was more cost-effective for younger people and for blacks.

There are, however, some concerns about this study. The potential benefits are based upon the assumption that most of the population could be screened; unfortunately, those at greatest risk may well be the most difficult group to screen. In addition, if the standard of care for patients known to have diabetes was better (eg, better screening and management of nephropathy, neuropathy, retinopathy, and glycemic control from the time of diagnosis), then the benefits of screening for undiagnosed cases would fall.

In a second cost-effectiveness analysis based upon the UKPDS population and a hypertension trial, screening targeted to individuals with hypertension was more cost-effective than universal screening, and the most cost-effective strategy was targeted screening at age 55 to 75 years [10]. The impact of screening for dyslipidemia was not assessed in this analysis.

Screening tests - The most commonly used screening tests for type 2 diabetes include measurement of the blood glucose, glycosylated hemoglobin, and the urine dipstick testing for glucose.

Blood glucose - Blood glucose values are distributed over a continuum in the population, although there are some approximate thresholds above which the risk of future adverse events is substantial. An Expert Committee on the Diagnosis and Classification of Diabetes Mellitus has recommend placing individuals in one of three categories based upon the fasting blood glucose concentration [11,12] (see "Definition of diabetes mellitus"):

    * Less than 100 mg/dL (<5.6 mmol/L) - Normal

    * 101 to 125 mg/dL (5.6 to 6.9 mmol/L) - Impaired fasting glucose, or IFG, (roughly equivalent to the term impaired glucose tolerance, or IGT, which was defined using the oral glucose tolerance test)

    * Greater than 125 mg/dL (>6.9 mmol/L) - Diabetes mellitus

Patients with diabetes mellitus are at increased risk for both macrovascular and microvascular disease. Those with impaired fasting blood glucose are at increased risk for macrovascular disease (myocardial infarction, stroke, peripheral vascular disease), but not for microvascular disease (retinopathy, neuropathy and nephropathy).

In 1997, the Expert Committee lowered the fasting blood glucose value defining the presence of diabetes from 140 mg/dL (7.8 mmol/L) to 126 mg/dL (7.0 mmol/L) because the lower value more accurately reflects the blood glucose concentration at or above which the risk for microvascular disease is increased. This lower value also correlates better with the risk associated with a random (or two-hour post-glucose challenge) blood glucose concentration of 200 mg/dL (11.1 mmol/L), which was retained from the old classification as also being diagnostic for diabetes mellitus [11]. (See "Definition of diabetes mellitus" for a detailed discussion on the Expert Committee's 2003 updated report).

The sensitivity and specificity of the fasting blood glucose as a screening test vary according to the population tested and the threshold used to define diabetes. Using a 2-hour blood glucose >200 mg/dL (11.1 mmol/L) on an oral glucose tolerance test as the reference standard, the specificity of a fasting blood glucose 126 mg/dL (7.0 mmol/L) is greater than 95 percent; the sensitivity is about 50 percent, and may be lower for people over the age of 65 [13]. Among people ages 40 to 74, the specificity of a fasting blood glucose 140 mg/dL (7.8 mmol/L) is 91 percent; the specificity is 47 percent for a fasting blood glucose between 126 and 140 mg/dL (7.0 to 7.8 mmol/L) [14].

Glycosylated hemoglobin - There has been interest in the use of glycosylated hemoglobin (A1C) values for screening and identification of impaired glucose tolerance and diabetes [15]. However, there remain significant problems in the standardization of A1C assays and the American Diabetes Association currently does not recommend its use for screening purposes. There may be some value to combining measurements of A1C with the fasting glucose concentration, but this requires further validation [16]. (See "Definition of diabetes mellitus").

Urine glucose - Detection of glucose on a semiquantitative urine dipstick (anything regarded as trace positive or more) or Clinitest tablets is an insensitive means of screening for type 2 diabetes [17]. The high rate of false-negative results suggests that the urine dipstick is not adequate as a screening test. Additionally, not all patients with glucosuria have diabetes. Glucosuria can occur with defects in renal tubular function, as seen in Type 2 (proximal) renal tubular acidosis and in familial renal glucosuria, a genetic disorder associated with salt-wasting, polyuria, and volume depletion [18].

Screening recommendations by expert groups - The two approaches to screening that are usually recommended (and are not mutually exclusive) are either to screen the entire population above a certain age, or to screen certain "high-risk" groups. The ADA recommends that people be screened by measurement of fasting blood glucose every three years beginning at age 45 years; screening should be considered at an earlier age or be carried out more frequently if diabetes risk factors are present [19]. Diabetes risk factors include the following:

    * Age 45 years

    * Overweight (body mass index 25 kg/m2)

    * Family history diabetes mellitus in a first-degree relative

    * Habitual physical inactivity

    * Belonging to a high-risk ethnic or racial group (eg, African-American, Hispanic, Native American, Asian-American, and Pacific Islanders)

    * History of delivering a baby weighing >4.1 kg (9 lb) or of gestational diabetes mellitus

    * Hypertension (blood pressure 140/90 mmHg)

    * Dyslipidemia defined as a serum high-density lipoprotein cholesterol concentration 35 mg/dL (0.9 mmol/L) and/or a serum triglyceride concentration 250 mg/dL (2.8 mmol/L)

    * Previously identified impaired glucose tolerance or impaired fasting glucose

    * Polycystic ovary syndrome

    * History of vascular disease

If the fasting blood glucose concentration is above 100 mg/dL (5.6 mmol/L), the test should be repeated. Two fasting blood glucose values over 125 mg/dL (6.9 mmol/L), two post-glucose values over 200 mg/dL (11.1 mmol/L), or one of each, or a random glucose 200 mg/dL (11.1 nmol/L) with symptoms of diabetes is required to make the diagnosis. (See "Definition of diabetes mellitus").

Other predictive models using risk factor assessment have been investigated as a strategy to guide screening, but are not in widespread use [20].

The third United States Preventive Services Task Force concluded that there was insufficient evidence to recommend for or against screening for diabetes in nonpregnant adults without hypertension or hyperlipidemia [21]. This conclusion was based primarily on the lack of evidence that earlier detection of diabetes improves long-term outcomes. However, the task force found that there was fair evidence for and recommended screening in adults with hypertension or hyperlipidemia as part of an integrated approach to reduce cardiovascular risk. (See "USPSTF Guidelines: Screening for type 2 diabetes mellitus in adults: Recommendations and rationale").

The Canadian Task Force on the Periodic Health Examination similarly recommends screening patients with hypertension and hyperlipidemia for type 2 diabetes [22].

A suggested approach - Consistent with ADA guidelines, we recommend measurement of fasting blood glucose in everyone aged 45 years or older receiving health care (or maintenance). A value 100 mg/dL (5.6 mmol/L) should be considered normal and the patient should be retested in three years. If the fasting blood glucose value is above 100 mg/dL (5.6 mmol/L), the test should be repeated and the scheme in Table 1 followed (show table 1).

Among patients seeking health care who have not fasted overnight, those ages 45 years and older or considered high-risk according to the criteria listed above should have a measurement of nonfasting (random) blood glucose on that visit. A random value less than 125 mg/dL is considered normal and requires no further testing.

Patients with a random value 126 mg/dL (6.9 mmol/L) or greater should have a follow-up fasting blood glucose measured. For patients whose random blood glucose was greater than 200 mg/dL (11.1 mmol/L), a follow-up fasting glucose value 126 mg/dL (6.9 mmol/L) is consistent with a diagnosis of diabetes mellitus. The management of all other individuals should follow the scheme in Table 2 (show table 2).

Patients classified as having impaired fasting glucose (IFG) should be counseled vigorously on issues related to lowering their risk of macrovascular disease (smoking cessation, use of aspirin, diet, and exercise), and should have measurements of blood pressure and serum lipids. Screening for diabetes should be repeated annually.

Patients classified as having type 2 diabetes mellitus should be treated using the approach described separately. (See "Overview of medical care in diabetes mellitus").

REFERENCES
1.           Wilson, JM, Junger, G. Principles and Practice of Screening for Disease. Geneva, World Health Organization, 1968.
2.           Secular trends in incidence of childhood IDDM in 10 countries. Diabetes Epidemiology Research International Group. Diabetes 1990; 39:858.
3.           Wild, S, Roglic, G, Green, A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:1047.
4.           Harris, MI, Klein, RE, Welborn, TA, Knuiman, MW. Onset of NIDDM occurs at least 4-7 years before clinical diagnosis. Diabetes Care 1992; 15:815.
5.           Klein, R, Klein, BE, Moss, S, DeMets, DL. Proteinuria in diabetes. Arch Intern Med 1988; 148:181.
6.           Harris, MI. Undiagnosed NIDDM: Clinical and public health issues. Diabetes Care 1993; 16:642.
7.           The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977.
8.           Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352:837.
9.           The cost-effectiveness of screening for type 2 diabetes. CDC Diabetes Cost-Effectiveness Study Group, Centers for Disease Control and Prevention. JAMA 1998; 280:1757.
10.           Hoerger, TJ, Harris, R, Hicks, KA, et al. Screening for type 2 diabetes mellitus: a cost-effectiveness analysis. Ann Intern Med 2004; 140:689.
11.           Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20:1183.
12.           Genuth, S, Alberti, KG, Bennett, P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26:3160.
13.           Blunt, BA, Barrett-Connor, E, Wingard, DL. Evaluation of fasting plasma glucose as screening test for NIDDM in older adults. Rancho Bernardo Study. Diabetes Care 1991; 14:989.
14.           Harris, MI, Eastman, RC, Cowie, CC, et al. Comparison of diabetes diagnostic categories in the U.S. population according to the 1997 American Diabetes Association and 1980-1985 World Health Organization diagnostic criteria. Diabetes Care 1997; 20:1859.
15.           Peters, AL, Davidson, MB, Schriger, DL, et al. A clinical approach for the diagnosis of diabetes mellitus: an analysis using glycosylated hemoglobin levels. JAMA 1996; 276:1246.
16.           Perry, RC, Shankar, RR, Fineberg, N, et al. HbA1c measurement improves the detection of type 2 diabetes in high-risk individuals with nondiagnositc levels of fasting plasma glucose: the Early Diabetes Intervention Program (EDIP). Diabetes Care 2001; 24:465.
17.           Andersson, DK, Lundblad, E, Svardsudd, K. A model for early diagnosis of type 2 diabetes mellitus in primary health care. Diabet Med 1993; 10:167.
18.           Calado, J, Loeffler, J, Sakallioglu, O, et al. Familial renal glucosuria: SLC5A2 mutation analysis and evidence of salt-wasting. Kidney Int 2006; 69:852.
19.           Screening for type 2 diabetes. Diabetes Care 2004; 27 Suppl 1:S11.
20.           Glumer, C, Carstensen, B, Sandbaek, A, et al. A Danish diabetes risk score for targeted screening: the Inter99 study. Diabetes Care 2004; 27:727.
21.           Screening for type 2 diabetes mellitus in adults: recommendations and rationale. Ann Intern Med 2003; 138:212.
22.           Feig, DS, Palda, VA, Lipscombe, L. Screening for type 2 diabetes mellitus to prevent vascular complications: updated recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2005; 172:177.

_______________________________________________
NATAP nataphcvhiv mailing list -- nataphcvhiv@...

This is an annoucement-only mailing list.  Do not reply.

To unsubscribe: send a blank email to nataphcvhiv-request@... with a
subject of unsubscribe.


For more information, see http://seven.pairlist.net/mailman/listinfo/nataphcvhiv

_______________________________________________

Reply | Forward | Messages in this Topic (2)

#19248

From: John Barrow <pozbod@...>
Date: Tue Oct 31, 2006 3:02 pm
Subject: Re: Fwd: NATAP: HPV of the Anus Prevalent Among HIV+ Women

johnftl59

Offline

Send Email

Conclusion:

In HIV-infected women, prevalence and diversity of HPV are greater in the�

anal canal than cervix. Studies in HIV-infected persons examining the clinical�

consequences of long-term anal HPV infection and anal cancer screening�

methods should include women.

Additional conclusion:� Tops and bottoms are both at risk.

John Barrow

pozbod@...

Reply | Forward | Messages in this Topic (2)

#19247

From: "albert.benson" <al@...>
Date: Tue Oct 31, 2006 12:30 am
Subject: What Are Common Lab Values?

albert.benson

Offline

Send Email

Although the lab values you see on your blood tests as the "normal" range, can vary from lab to lab, I have found this list useful in understanding what my lab results mean and where my results devate from what is generally considered normal and healthy.

____________________________________

Hematology Values

HEMATOCRIT (HCT)

Normal Adult Female Range: 37 - 47%
Optimal Adult Female Reading: 42%
Normal Adult Male Range 40 - 54%
Optimal Adult Male Reading: 47
Normal Newborn Range: 50 - 62%
Optimal Newborn Reading: 56

HEMOGLOBIN (HGB)

Normal Adult Female Range: 12 - 16 g/dl
Optimal Adult Female Reading: 14 g/dl
Normal Adult Male Range: 14 - 18 g/dl
Optimal Adult Male Reading: 16 g/dl
Normal Newborn Range: 14 - 20 g/dl
Optimal Newborn Reading: 17 g/dl

MCH (Mean Corpuscular Hemoglobin)

Normal Adult Range: 27 - 33 pg
Optimal Adult Reading: 30

MCV (Mean Corpuscular Volume)

Normal Adult Range: 80 - 100 fl
Optimal Adult Reading: 90
Higher ranges are found in newborns and infants

MCHC (Mean Corpuscular Hemoglobin Concentration)

Normal Adult Range: 32 - 36 %
Optimal Adult Reading: 34
Higher ranges are found in newborns and infants

R.B.C. (Red Blood Cell Count)

Normal Adult Female Range: 3.9 - 5.2 mill/mcl
Optimal Adult Female Reading: 4.55
Normal Adult Male Range: 4.2 - 5.6 mill/mcl
Optimal Adult Male Reading: 4.9
Lower ranges are found in Children, newborns and infants

W.B.C. (White Blood Cell Count)

Normal Adult Range: 3.8 - 10.8 thous/mcl
Optimal Adult Reading: 7.3
Higher ranges are found in children, newborns and infants.

PLATELET COUNT

Normal Adult Range: 130 - 400 thous/mcl
Optimal Adult Reading: 265
Higher ranges are found in children, newborns and infants

NEUTROPHILS and NEUTROPHIL COUNT - this is the main defender of the body against infection and antigens. High levels may indicate an active infection.

Normal Adult Range: 48 - 73 %
Optimal Adult Reading: 60.5
Normal Children’s Range: 30 - 60 %
Optimal Children’s Reading: 45

LYMPHOCYTES and LYMPHOCYTE COUNT - Elevated levels may indicate an active viral infections such as measles, rubella, chickenpox, or infectious mononucleosis.

Normal Adult Range: 18 - 48 %
Optimal Adult Reading: 33
Normal Children’s Range: 25 - 50 %
Optimal Children’s Reading: 37.5

MONOCYTES and MONOCYTE COUNT - Elevated levels are seen in tissue breakdown or chronic infections, carcinomas, leukemia (monocytic) or lymphomas.

Normal Adult Range: 0 - 9 %
Optimal Adult Reading: 4.5

EOSINOPHILS and EOSINOPHIL COUNT - Elevated levels may indicate an allergic reactions or parasites.

Normal Adult Range: 0 - 5 %
Optimal Adult Reading: 2.5

BASOPHILS and BASOPHIL COUNT - Basophilic activity is not fully understood but it is known to carry histamine, heparin and serotonin. High levels are found in allergic reactions.

Normal Adult Range: 0 - 2 %
Optimal Adult Reading: 1

Electrolyte Values

SODIUM - Sodium is the most abundant cation in the blood and its chief base. It functions in the body to maintain osmotic pressure, acid-base balance and to transmit nerve impulses. Very Low value: seizure and Neurologic Sx.

Normal Adult Range: 135-146 mEq/L
Optimal Adult Reading: 140.5

POTASSIUM - Potassium is the major intracellular cation. Very low value: Cardiac arythemia.

Normal Range: 3.5 - 5.5 mEq/L
Optimal Adult Reading: 4.5

CHLORIDE - Elevated levels are related to acidosis as well as too much water crossing the cell membrane. Decreased levels with decreased serum albumin may indicate water deficiency crossing the cell membrane (edema).

Normal Adult Range: 95-112 mEq/L
Optimal Adult Reading: 103

CO2 (Carbon Dioxide) - The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the bodies buffering system. Generally when used with the other electrolytes, it is a good indicator of acidosis and alkalinity.

Normal Adult Range: 22-32 mEq/L
Optimal Adult Reading: 27
Normal Childrens Range - 20 - 28 mEq/L
Optimal Childrens Reading: 24

CALCIUM - involved in bone metabolism, protein absorption, fat transfer muscular contraction, transmission of nerve impulses, blood clotting and cardiac function. Regulated by parathyroid.

Normal Adult Range: 8.5-10.3 mEq/dl
Optimal Adult Reading: 9.4

PHOSPHORUS - Generally inverse with Calcium.

Normal Adult Range: 2.5 - 4.5 mEq/dl
Optimal Adult Reading: 3.5
Normal Childrens Range: 3 - 6 mEq/dl
Optimal Childrens Range: 4.5

ANION GAP (Sodium + Potassium - CO2 + Chloride) - An increased measurement is associated with metabolic acidosis due to the overproduction of acids (a state of alkalinity is in effect). Decreased levels may indicate metabolic alkalosis due to the overproduction of alkaloids (a state of acidosis is in effect).

Normal Adult Range: 4 - 14 (calculated)
Optimal Adult Reading: 9

CALCIUM/PHOSPHORUS Ratio

Normal Adult Range: 2.3 - 3.3 (calculated)
Optimal Adult Reading: 2.8
Normal Children’s range: 1.3 - 3.3 (calculated)
Optimal Children’s Reading: 2.3

SODIUM/POTASSIUM

Normal Adult Range: 26 - 38 (calculated)
Optimal Adult Reading: 32

Hepatic Enzymes

AST (Serum Glutamic-Oxalocetic Transaminase - SGOT ) - found primarily in the liver, heart, kidney, pancreas, and muscles. Seen in tissue damage, especially heart and live

Normal Adult Range: 0 - 42 U/L
Optimal Adult Reading: 21

ALT (Serum Glutamic-Pyruvic Transaminase - SGPT) - Decreased SGPT in combination with increased cholesterol levels is seen in cases of a congested liver. We also see increased levels in mononucleosis, alcoholism, liver damage, kidney infection, chemical pollutants or myocardial infarction

Normal Adult Range: 0 - 48 U/L
Optimal Adult Reading: 24

ALKALINE PHOSPHATASE - Used extensively as a tumor marker it is also present in bone injury, pregnancy, or skeletal growth (elevated readings. Low levels are sometimes found in hypoadrenia, protein deficiency, malnutrition and a number of vitamin deficiencies

Normal Adult Range: 20 - 125 U/L
Optimal Adult Reading: 72.5
Normal Childrens Range: 40 - 400 U/L
Optimal Childrens Reading: 220

GGT (Gamma-Glutamyl Transpeptidase) - Elevated levels may be found in liver disease, alcoholism, bile-duct obstruction, cholangitis, drug abuse, and in some cases excessive magnesium ingestion. Decreased levels can be found in hypothyroidism, hypothalamic malfunction and low levels of magnesium.

Normal Adult Female Range: 0 - 45 U/L
Optimal Female Reading: 22.5
Normal Adult Male Range: 0 - 65 U/L
Optimal Male Reading: 32.5

LDH (Lactic Acid Dehydrogenase) - Increases are usually found in cellular death and/or leakage from the cell or in some cases it can be useful in confirming myocardial or pulmonary infarction (only in relation to other tests). Decreased levels of the enzyme may be seen in cases of malnutrition, hypoglycemia, adrenal exhaustion or low tissue or organ activity.

Normal Adult Range: 0 - 250 U/L
Optimal Adult Reading: 125

BILIRUBIN, TOTAL - Elevated in liver disease, mononucleosis, hemolytic anemia, low levels of exposure to the sun, and toxic effects to some drugs, decreased levels are seen in people with an inefficient liver, excessive fat digestion, and possibly a diet low in nitrogen bearing foods

Normal Adult Range 0 - 1.3 mg/dl
Optimal Adult Reading: .65

Renal Related

B.U.N. (Blood Urea Nitrogen) - Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise or heart failure. Decreased levels may be due to a poor diet, malabsorption, liver damage or low nitrogen intake.

Normal Adult Range: 7 - 25 mg/dl
Optimal Adult Reading: 16

CREATININE - Low levels are sometimes seen in kidney damage, protein starvation, liver disease or pregnancy. Elevated levels are sometimes seen in kidney disease due to the kidneys job of excreting creatinine, muscle degeneration, and some drugs involved in impairment of kidney function.

Normal Adult Range: .7 - 1.4 mg/dl
Optimal Adult Reading: 1.05

URIC ACID - High levels are noted in gout, infections, kidney disease, alcoholism, high protein diets, and with toxemia in pregnancy. Low levels may be indicative of kidney disease, malabsorption, poor diet, liver damage or an overly acid kidney.

Normal Adult Female Range: 2.5 - 7.5 mg/dl
Optimal Adult Female Reading: 5.0
Normal Adult Male Range: 3.5 - 7.5 mg/dl
Optimal Adult Male Reading:5.5

BUN/CREATININE - This calculation is a good measurement of kidney and liver function.

Normal Adult Range: 6 -25 (calculated)
Optimal Adult Reading: 15.5

Protein

PROTEIN, TOTAL - Decreased levels may be due to poor nutrition, liver disease, malabsorption, diarrhea, or severe burns. Increased levels are seen in lupus, liver disease, chronic infections, alcoholism, leukemia, tuberculosis amongst many others.

Normal Adult Range: 6.0 -8.5 g/dl
Optimal Adult Reading: 7.25

ALBUMIN - major constituent of serum protein (usually over 50%). High levels are seen in liver disease(rarely) , shock, dehydration, or multiple myeloma. Lower levels are seen in poor diets, diarrhea, fever, infection, liver disease, inadequate iron intake, third-degree burns and edemas or hypocalcemia

Normal Adult Range: 3.2 - 5.0 g/dl
Optimal Adult Reading: 4.1

GLOBULIN - Globulins have many diverse functions such as, the carrier of some hormones, lipids, metals, and antibodies(IgA, IgG, IgM, and IgE). Elevated levels are seen with chronic infections, liver disease, rheumatoid arthritis, myelomas, and lupus are present, . Lower levels in immune compromised patients, poor dietary habits, malabsorption and liver or kidney disease.

Normal Adult Range: 2.2 - 4.2 g/dl (calculated)
Optimal Adult Reading: 3.2

A/G RATIO (Albumin/Globulin Ratio)

Normal Adult Range: 0.8 - 2.0 (calculated)
Optimal Adult Reading: 1.9

Lipids

CHOLESTEROL - High density lipoproteins (HDL) is desired as opposed to the low density lipoproteins (LDL), two types of cholesterol. Elevated cholesterol has been seen in artherosclerosis, diabetes, hypothyroidism and pregnancy. Low levels are seen in depression, malnutrition, liver insufficiency, malignancies, anemia and infection.

Normal Adult Range: 120 - 240 mg/dl
Optimal Adult Reading: 180

LDL (Low Density Lipoprotein) - studies correlate the association between high levels of LDL and arterial artherosclerosis

Normal Adult Range: 62 - 130 mg/dl
Optimal Adult Reading: 81 mg/dl

HDL (High Density Lipoprotein) - A high level of HDL is an indication of a healthy metabolic system if there is no sign of liver disease or intoxication.

Normal Adult Range: 35 - 135 mg/dl
Optimal Adult Reading: +85 mg/dl

TRIGLYCERIDES - Increased levels may be present in artherosclerosis, hypothyroidism, liver disease, pancreatitis, myocardial infarction, metabolic disorders, toxemia, and nephrotic syndrome. Decreased levels may be present in chronic obstructive pulmonary disease, brain infarction, hyperthyroidism, malnutrition, and malabsorption.

Normal Adult Range: 0 - 200 mg/dl
Optimal Adult Reading: 100

CHOLESTEROL/LDL RATIO

Normal Adult Range: 1 - 6
Optimal Adult Reading: 3.5

Thyroid

THYROXINE (T4) - Increased levels are found in hyperthyroidism, acute thyroiditis, and hepatitis. Low levels can be found in Cretinism, hypothyroidism, cirrhosis, malnutrition, and chronic thyroiditis.

Normal Adult Range: 4 - 12 ug/dl
Optimal Adult Reading: 8 ug/dl

T3-UPTAKE - Increased levels are found in hyperthyroidism, severe liver disease, metastatic malignancy, and pulmonary insufficiency. Decreased levels are found in hypothyroidism, normal pregnancy, and hyperestrogenis status.

Normal Adult Range: 27 - 47%
Optimal Adult Reading: 37 %

FREE T4 INDEX (T7)

Normal Adult Range: 4 - 12
Optimal Adult Reading: 8

THYROID-STIMULATING HORMONE (TSH) - produced by the anterior pituitary gland, causes the release and distribution of stored thyroid hormones. When T4 and T3 are too high, TSH secretion decreases, when T4 and T3 are low, TSH secretion increases.

Normal Adult Range: .5 - 6 miliIU/L

Cardiac

Creatine phosphokinase (CK) - Levels rise 4 to 8 hours after an acute MI, peaking at 16 to 30 hours and returning to baseline within 4 days

25-200 U/L
32-150 U/L

CK-MB CK isoenzyme - It begins to increase 6 to 10 hours after an acute MI (heart attack), peaks in 24 hours, and remains elevated for up to 72 hours.

< 12 IU/L if total CK is <400 IU/L
<3.5% of total CK if total CK is >400 IU/L

(LDH) Lactate dehydrogenase - Total LDH will begin to rise 2 to 5 days after an MI; the elevation can last 10 days.

140-280 U/L

LDH-1 and LDH-2 LDH isoenzymes - Compare LDH 1 and LDH 2 levels. Normally, the LDH-1 value will be less than the LDH-2. In the acute MI, however, the LDH 2 remains constant, while LDH 1 rises. When the LDH 1 is higher than LDH 2, the LDH is said to be flipped, which is highly suggestive of an MI. A flipped pattern appears 12-24 hours post MI and persists for 48 hours.

LDH-1 18%-33%
LDH-2 28%-40%

SGOT - will begin to rise in 8-12 hours and peak in 18-30 hours

10-42 U/L

Myoglobin - early and sensitive diagnosis of myocardial infarction in the emergency department This small heme protein becomes abnormal within 1 to 2 hours of necrosis, peaks in 4-8 hours, and drops to normal in about 12 hours.

Reply | Forward | Messages in this Topic (2)

#19246

From: PoWeRTX@...
Date: Mon Oct 30, 2006 11:54 pm
Subject: Green tea shows promise in HIV fight

nelsonvergel

Offline

Send Email

Green tea shows promise in HIV fight
Part of drink blocks access to immune system's cells, study finds

By LEIGH HOPPER
2006 Houston Chronicle

Chalk up another one for green tea.

In test-tube experiments, a component of the ubiquitous health beverage blocks the ability of the AIDS virus to hijack and destroy immune-system cells, scientists from Houston and the United Kingdom say.

Green tea's benefits stem from a substance called epigallocatechin gallate, or EGCG. EGCG is a flavonoid, a compound that gives green tea its color, and has anti-cancer, anti-microbial and anti-inflammatory properties. EGCG-based cancer drugs already are in clinical trials.

It also holds some promise in fighting HIV - though nobody's recommending it yet for AIDS prevention or treatment.

Understanding why
For at least a decade, researchers have known the EGCG molecule inhibits the progression of HIV in lab experiments - but they didn't understand precisely why.

Now, work by Baylor College of Medicine and University of Sheffield, UK, scientists shows how the EGCG molecule binds to the exact spot HIV needs to infect a healthy T-cell, a type of white blood cell critical to fighting infections. Their report is online in the Journal of Allergy and Clinical Immunology.

Under normal circumstances, HIV does its dirty work via an "envelope" or surface protein called gp120, which locks into a special "pocket" on the surface of susceptible host cells called CD4 T-cells. After that fusion, HIV releases its genetic material into the healthy cell. The infected cell then begins churning out the next generation of viruses.

But not if the green tea-derived molecule plugs up that pocket, leaving HIV no way to get inside.

Baylor pediatrics instructor Dr. Christina Nance, research supervisor for allergy and immunology at Texas Children's Hospital, said she and her colleagues used a fairly new approach involving nuclear magnetic resonance spectroscopy. That method allowed them to "see" structures by which EGCG, gp120 and CD4 molecules bind together. Participating in the research were Dr. Theron McCormick and Dr. William Shearer from Baylor, and Mike Williamson of the University of Sheffield.

Using spectroscopy, Nance and her colleagues observed the frequencies emitted by the hydrogen, carbon and nitrogen atoms that make up the molecules they are studying. They paired the CD4 molecule with the HIV surface protein gp120, then paired the CD4 molecule with green tea's EGCG.

Frequency data fed into a computer produced a molecular model showing EGCG and HIV shared the same "binding pocket" on the CD4 T-cell.

"One of the promising factors is, that because this is a small molecule and binds to the same exact binding pocket as (HIV's) gp120, it may not inhibit the (normal) function of the CD4 molecule," Nance said.

Like two cups a day
Nance found the amount of EGCG needed to inhibit HIV progression in the laboratory was the equivalent of the amount achieved by drinking two cups of green tea.

Much more research is needed to move Nance's observation toward drug development.

In the meantime, Nance doesn't recommend that people chug large quantities of green tea in hopes of preventing infection with HIV.

"It would be part of a cocktail of drugs," Nance said. Current HIV treatment consists of multiple drugs, or "cocktails" that block different parts of the virus's life cycle.
NATAP http://natap.org/
_______________________________________________

Regards,

Nelson Vergel
powerusa dot org

"What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do." - John Ruskin

Reply | Forward | Messages in this Topic (1)

#19245

From: "Kelly Scott" <kscott@...>
Date: Tue Oct 31, 2006 1:30 am
Subject: RE: Re: Caught with fear: I got some test results back today....

kscott@...

Send Email

One other note...

Do NOT necessarily tell anyone else your results. You might want to simply
digest them for a while.  There are some state-wide programs which firmly
believe that a lot of discrimination and stigma can be avoided if you simply
consider well before you tell people (One such program is called "Just Shut
Up").

Is this because you have something to be ashamed of?  Nope.  But you DO have
some reasons for caution, re discrimination, stigma, or becoming known as
the disease itself ("Hi: I AM HIV-infected".. rather than 'Hi: I HAVE
cancer'.  Note the difference?  Think through why...).

Kelly Scott

-----Original Message-----
From: PozHealth@yahoogroups.com [mailto:PozHealth@yahoogroups.com] On Behalf
Of pozsoul
Sent: Monday, October 30, 2006 2:51 PM
To: PozHealth@yahoogroups.com
Subject: [PozHealth] Re: Caught with fear: I got some test results back
today....

First of all, I am very sorry to hear what you are going through.
Either confirmed or not, it is a very rough situation to be in
because it is something that is life-altering.  My heart and support
goes out to you, my friend. Unfortunately, I was there and I totally
understand where you are coming from, where your fear stems from and
why the world seems to collapse on you.  It is NORMAL and it is OK
to feel this way.  This feeling will pass. if there is anything you
can make sense of in this email I hope it is that.  This will pass.
I promise it will.

It truly pisses me off when people say "Oh you'll be fine. Don't
worry about it.  It's not as bad as you think" because it is
something to worry about and it is a concern that one has to face
sooner or later no matter how you want to dice it or splice it - and
no one should tell you how you should or should not feel about it
but yourself.  Needless to say, if you think you are having a crisis
be smart and call your local AIDS hotline or call a friend.  You
will be surprised how many people are there for you to be held by at
this moment.  All you have to do is ask.

From my experience, I would suggest you:

. Try to continue your life as it was yesterday and the day
before - activity wise.
. Be positive about your thoughts and remember that baby steps
are still steps nonetheless.
. Do not worry about the future for now, but focus on one day
at a time.
. Be nice to yourself and avoid negative or destructive
thoughts.
. Be proactive and ask your doctor for some Adivan, to take
the edge off when you have a panic attack.
. When you do get a panic attack remember that it is OK to
feel weak, down, angry, lonely and pathetic - if you will.  But
mentally put a deadline for it.  For instance, I allowed myself to
feel that way for a week, then I shortened it to a couple of days,
then a day until you allow yourself to be in control again.
. Enroll in activities that you like such as dart shooting,
playing pool, volley ball, etc.  Try to stay away from the bars
though - alcohol is a depressant and you really do not need to work
against your body.  You NEED all the strength and positive energy
you can gather.
. Make a list of your close friends that you can talk to.
Burn a CD with your favorite happy music.  Buy your favorite comedy
movie.  Keep all these thing handy so when you dip into a funky
mood, you have your resources to pull yourself back out.
. Finally, know that it will get easier in time. So you have a
lot to look forward to.  Every morning is a blessing that is waiting
for you to take, so enjoy it and try to live life to it's fullest.

Also, something else I learned recently - and this is in the future
should you need to take meds - do not look at them as your enemy,
but your aid.  I did for a long time and mentally fought against
them.  This is one of the times in life when your mind needs to be
in control of your body and not vice versa.  Oh, and if you decide
to go to a support group DO NOT look at the signs on the door, just
look for the address and walk right into the offices.

You are not alone.  You are not damaged goods.  You are going
through a transition only.  Keep my email should you need to talk or
have a question that I can help with.  I am new to this too, but I
have a head start in comparison to you and I don't mind sharing
notes!  :o)

I will keep you in my mind and prayers.

PozSoul






Welcome to our PozHealth group!
If you received this email from someone who forwarded it to you and would
like to join this group, send a blank email to
PozHealth-subscribe@yahoogroups.com and you will get an email with
instructions to follow. You can chose to receive single emails or a daily
digest (collection of emails). You can post pictures, images, attach files
and search by keyword old postings in the group.

For those of you who are members already and want to switch from single
emails to digest or vice versa, visit www.yahoogroups.com, click on
PozHealth, then on "edit my membership" and go down to your selection. The
list administrator does not process any requests, so this is a
do-it-yourself easy process ! :)
Thanks for joining. You will learn and share a lot in this group!

NOTE: I moderate, approve or disapprove emails before they are posted.
Please follow the guidelines shown in the homepage. I will not allow
rudeness, sexually  explicit material, attacks, and anyone who does not
follow the rules. If you are not OK with this, please do not join the group.


Forward this email to anyone who may benefit from this information! Thanks!
In Health,

Nelson Vergel (PoWeRTX@...)
List Founder and Moderator

Yahoo! Groups Links

Reply | Forward | Messages in this Topic (6)

#19244

From: Travis32824 <travis32824@...>
Date: Tue Oct 31, 2006 12:49 pm
Subject: Re: Hey group, off topic but about Flu shots and low t-cells

travis32824

Offline

Send Email

Low T cells is a great reason to get the flu shot. The shot helps prevent the flu, and in the unlikely event that you still get the flu, it will be less severe, so they say. Can you imagine what would happen if your friend actually got the flu with only 20 t cells? That would be extremely dangerous, if not fatal. The shot is not a live virus shot, so the shot itself won't cause the flu.

I say get your flu shot each year, get the pneumonia shot every 5 years, test for TB every year, and get a Hep A-B vaccination. With lower immune systems, shots can be our friend.

Make sure handwashing happens frequently, and stay away from those that sneeze.

I got my flu shot last week, and am thankful for it, and in Sept got the pneumonia vaccine.
Lastly, you said his co-pays are too much for him to afford. Ryan White funding will pay for co-pays if you need the help financially. My case worker said that my ASO would pay my $3000 co-pay and out-of-pocket expenses for '07. And my ASO has been paying for my prescription co-pays all along for my HIV meds, and the City of Orlando pays for my non-HIV meds (cancer drugs, antibiotics, etc). So, check with your local AIDS Service Organization to see if he qualifies for help. The ASO will also pay COBRA payments as well, if this help is ever wanted.

I've learned that if I need help financially, my case worker is there for me 100% of the time. She even emails me to see how I'm doing.

Travis

Orlando

Roscoeismydog@... wrote:

Does anyone have any experience with having flu shots with very low t-cells? A friend of mine was recommended not to have a flu shot because his t-cells are 20.. And of course you can not tell him anything, he insists he is gonna get one anyway, he got one last year with only 18 t-cells, and was fine. (he is having problems affording his hiv meds, long story, but because he has a good job and insurance he does not qualify for help from the city, yet his co pays are way to much for him to afford if he uses insurance).

Has anyone on here had a flu shot while having very low t-cells?

I realize he should do what the doc says but he is not always good at that..

SEIZE THE DAY! ENJOY TODAY, SMELL THE ROSES AND HUG YOURSELF

Access over 1 million songs - Yahoo! Music Unlimited Try it today.

Reply | Forward | Messages in this Topic (7)

#19243

From: John Barrow <pozbod@...>
Date: Tue Oct 31, 2006 3:00 pm
Subject: Re: bioalcamide inflamation

johnftl59

Offline

Send Email

"I am having a problem with my bioalcamide implants. I had them done a�

couple years ago with no problems at all. I decide to have surgery to�

implant cheeks last month. The Dr placed them by making incisions under�

my cheeks through my mouth."

After the swelling has subsided, you may find things look much better.� �If not, you will need to discuss what to do with your plastic surgeon.� �You might also discuss the situation with whoever put in the bioalcamid.� �It may be possible to remove some of it, if it now looks like too� much is there.� This does, apparently, become more of a challenge when the b.a. has been in place for a long time.� You certainly want to be sure there is no infection present.

It doesn't sound like it's a situation that can't be improved on, but it may take a bit of time.

John Barrow

pozbod@...

Reply | Forward | Messages in this Topic (3)

#19242

From: John Barrow <pozbod@...>
Date: Tue Oct 31, 2006 2:53 pm
Subject: Re: Hey group, off topic but about Flu shots and low t-cells

johnftl59

Offline

Send Email

Has anyone on here had a flu shot while having very low t-cells?

I realize he should do what the doc says but he is not always good at that..

Not off topic, at all.

While I believe that all people with HIV should get flu shots, one could very reasonably wonder if someone with very low T cells would get a good immune response from a flu shot. � �

Still, to me the upside of getting it outweighs the downside, as true influenza is a very bad disease, particularly in people with HIV.� I would probably get the shot,� understanding that full protection might not happen.

John Barrow

pozbod@...

Reply | Forward | Messages in this Topic (7)

#19241

From: PoWeRTX@...
Date: Mon Oct 30, 2006 11:50 pm
Subject: Elevated Phosphate Levels in Patients Treated with Tenofovir

nelsonvergel

Offline

Send Email

Elevated Phosphate Levels in Patients Treated with Tenofovir

By Liz Highleyman

Long-term kidney toxicity is a concern with tenofovir DF (Viread), though rates of renal problems have been low in clinical trials of the drug, and observed primarily in people with pre-existing kidney dysfunction.

As reported in the October 2006 issue of HIV Medicine, researchers conducted a study to assess the incidence of Grade 2 or higher hypophosphatemia (low serum phosphate, a sign of kidney dysfunction) in the prospective HIV Outpatient Study (HOPS).

The study included 165 participants who initiated HAART regimens containing tenofovir and 90 who started regimens without tenofovir. All had normal baseline phosphate and creatinine values. Other baseline demographic and clinical characteristics were similar overall.

Results

After a median follow-up period of 8-10 months, 12.7% of patients in the tenofovir group developed Grade 2 hypophosphatemia (2.0-2.4 mg/dL), compared with 6.7% taking regimens without tenofovir.

Rates of Grade 3 hypophosphatemia (1.0-1.9 mg/dL) were 2.4% and 0%, respectively.

No patients in either group developed Grade 4 hypophosphatemia (<1.0 mg/dL).

The incidence of Grade 2 or higher hypophosphatemia was 16.7 per 100 person-years among patients receiving tenofovir vs 8.0 per 100 person-years in the tenofovir-sparing group (P = 0.11).

Conclusion

"The incidence of hypophosphatemia was somewhat elevated in HOPS patients who took [tenofovir]-containing HAART compared with those who took [tenofovir]-sparing HAART during the first 1 to 2 years of observation, but the difference was not statistically significant," the authors concluded.

They added that, "Longer follow-up of a larger population is needed to determine if this trend towards an association achieves statistical significance and to evaluate the clinical consequences of hypophosphatemia."

10/31/06

Reference
K Buchacz, J T Brooks, T Tong, and others. Evaluation of hypophosphataemia in tenofovir disoproxil fumarate (TDF)-exposed and TDF-unexposed HIV-infected out-patients receiving highly active antiretroviral therapy. HIV Medicine 7(7): 451-456. October 2006.

Regards,

Nelson Vergel
powerusa dot org

"What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do." - John Ruskin

Reply | Forward | Messages in this Topic (1)

#19240

From: "Jeff" <jherwatt@...>
Date: Tue Oct 31, 2006 2:07 pm
Subject: Re-Intro, Long Time Survivor Checks back in (Diagnosed May 13, 1985)

jherwatt

Offline

Send Email

Can you beleive it, still here after all these years. Born in 1965,
diagnosed with AIDS May 13, 1985 while serving in the US Army in
Germany.  My story is covered my Randy Shilts in Conduct Unbecoming,
(See it on Amazon Here: http://www.amazon.com/Conduct-Unbecoming-
Lesbians-Military-Vietnam/dp/0788154168/sr=8-
2/qid=1162175482/ref=pd_bbs_sr_2/002-8548805-3262461?
ie=UTF8&s=books), I was infect with the AIDS virus by the US Army in
1985 due to their lack of screening of their blood supply, even
though all civial Blood Donor were being screen at the time.  The
Army thought their supply was "clean" and did not want to spend the
$23 at the time to do an ELIZA test on each donated pint.  So what is
a life worth, according to the US Army not more than $23. Actual New
York, and one of the founding member of the orginal Act Up/SF.  nI
have had a long battle with this little virus, but it has been
nothing but a blessing!

Yes, I am on the mend, T-cells are back up, cancer is not to be
found. Still alive, and still in awe of the wonder of creation.  We
are meant to share our blessings, for years I was a private person
and did not share the ins and outs of my journey.  It has become
clear that I must, there are so many of us left from the beginning,
who remember the start, and the battles, the hate and all of it.  We
have come so far but our individual struggle battles and victories
must be shared or it is all meaningless.

I have had had a blessed life.  I have always had "enough", having
worked at places like Ask.com and google.com during there heyday.  I
have created and funded a foundation to share my blessings with those
less fortunate, and I have lived to see it grow into something
meaningful, changing lifes.  I have embraced the Gay lifestyle, and
my addictions, I have no regrets and love everything about me.

Well we can go a hundred directions from here, all of which will be
fun and enthralling I assure you!  Up to you, what are you game for?
If anything?

Some data for you number crunchers. diagnosed with AIDS May 13, 1985
after a 3 month bout with PCP while serving in the US Army Heidelberg
Germany, age, 19!

   Bouts of PCP, (to date): 13
   Number of Hospitalizations: 23
   Lowest T-Cell count: 24 - September 2006
   Highest Viral Load: 2 Million - September 2006
   Number of 'second Chances': to date - 5
   Number of failed 'Treatments': 13
   Number of Resistance Mutations: over 26
   Curent T-cells as of Oct 30, 2006: 384
   Current Viral Load as of Oct 30, 2006: 1326, and on a steady
decline, next we should be undetectable!! /WOOT/

So why am I still alive when just about everyone I know is dead,
(recently one of the old time Act Up/SF'ers - Jeff Getty died, there
are few of us left).  My address book is like a guide to the "Here
After",  and my friends are tired of waiting for me to die! Anyways,
glad to be given yet another chance to live!  After a hard year!

Feel free to check out my new space, Pics, and Blog! -

   http://aidsride.spaces.live.com/

Gay.Com Profile - http://my.gay.com/me2man

  Blessing to you

Jeff +

Reply | Forward | Messages in this Topic (1)

Yahoo! Groups Tips

Did you know...

Messages

Ritonavir-Fluticasone Interaction Causing Cushing Syndrome in HIV-Infected Children and Adolescents.

Diabetics often suffer depression. Depressed people often get diabetes. Why?

There are no clear explanations yet, but researchers are turning up clues that might lead to treatments for both diseases

Yahoo! My Yahoo! Mail
	Sign In New User? Sign Up
		Health - Groups - Help

Yahoo! Groups Tips

Did you know...

Best of Y! Groups

Messages

Ritonavir-Fluticasone Interaction Causing Cushing Syndrome in HIV-Infected Children and Adolescents.

Diabetics often suffer depression. Depressed people often get diabetes. Why?

There are no clear explanations yet, but researchers are turning up clues that might lead to treatments for both diseases