Pot Vending Machines in LA

I like Bill's database, but if microsoft access is a little heavy for you, i use a few simpler things.

1. a word document listing current drugs and dosages and dates (started stopped changed). I should add pill sizes, but i keep that on another document. I split the document into two sections, active drugs and stopped drugs, and adding the reason i stopped and what replaced it to the drug when i move it to the stopped section.

2. For labs, i use a simple spreadsheet, each row is a lab test. columns are test name, normal range, then a column for each date test, usually four a year. I highlight each out-of-range test in yellow and dangerously out in red (this may be a daunting task for some members). I've divided the rows into sections - A.-wbc/t's/ratio's/vl; B.-standard blood stuff; C-lipids/cholesterol/etc D.-other stuff, about 35 tests alltogether, just enuf to fiill an 8-1/2x11 sheet landscape. I have added all my tests back to 1988 (yes, 1988), 85 tests altogther (now THAT'S anal). For you, I would start with the current test, then add backwards as time permits. This is a wonderful way to track trends versus time. Each test, I just insert a new column and fill it in.

3. I also keep an annual spreadsheet with a section for each doctor or lab or hospital or meds, keeping track of billed / allowed / insurance paid / i paid.

The first two i give a updated copy to each of my 3 main docs at least once a year.

If anyone would like a sanitized format file, just ask.

cheers
edward

san francisco

Start the year off right. Easy ways to stay in shape in the new year.

Reply | Forward | Messages in this Topic (5)

#24273

From: "Jonathan Goldman" <yangzpa@...>
Date: Thu Jan 31, 2008 8:10 pm
Subject: Still deciding what to do about haart

yangzpa

Offline

Hello Joe,

I am sure there will be many people offering twice as many ideas from
their concerns about your choosing to wait starting haart. A useful
tool can be found among Project Inform's Treatment publications-  "
Making Decisions about Therapies: issues to consider when developing
your personal treatment plan." located at
http://www.projectinform.org/info/decisions/index.shtml. It is
available in pdf, too.

It's great that you've become as knowledgable as you have to
understand your healthcare and even better that you are asking
questions. Keep in mind that preventing an OI, such as PCP is easier
on a body than the treatment which may include a hospital stay. And,
sick people in hospitals often pick up other infections while
there....PCP is a walk in the park compared to another OI, PML which
is rarely seen in 2008 when PLWHIV/AIDS are on HAART. The truth is, no
one can predict the future and what it holds for any one person. And,
as Dear Abby would say, 'if you are asking a question like that, you
probably know the answer....'

Healthfully & Electronically,

Jonathan Goldman
San Francisco, CA

>
> Hello all, I am new here but poz for two years that I know of
> (probably more like 2.5 years) Anyways I was scared at first when my
> first labs came back with Tcells of 279 and % at 20. I decided from
> the start I would not panic but the first year was not easy. I have
> fluctuated from a Low Tcell count of 116 to around 200 for the past
> year. It's been under 200 pretty much for about the last year or so.
> My viral load has always been around 50,000 or so. I figured I would
> not go on meds right away and have never been on meds to this day. I
> know everyone tells me to especially my Dr. But, I have not ever had
> an OI. I have only been sick once with Bronchitis which was just this
> year. I asked my Dr. what options I had for medication to treat the
> bronchitis and expressed a desire not to take antibiotics if there was
> another alternative (just want to make sure antibiotics are really
> needed) He put me on a low dose of Prednisone for 8 days along with an
> inhaler and this worked great and got rid of it. My body was able to
> fight it with the prednisone when my t-cells were under 200 is this normal?
> Anyways, I'm still not sure when I will go on the haart meds. I feel
> like if I feel ok and am able to work and do my normal routine like
> exercise 3x a week running 3 miles each time and eating great that
> I'll be ok. My Dr. thinks perhaps this is why I haven't come down with
> an OI yet even with the low CD4. Oh, my % now is 10, forgot to mention that.
> What do you all think of this strategy of waiting? Should I have come
> down with an OI after being poz for 2.5 years is this unusual with
> such a low count? Maybe my immune system is stronger than the CD4
> shows. If I get an OI like PCP I figure I'll take the Bactrim and get
> rid of it. Oh, I'm not taking the Bactrim either currently even though
> my Dr. wants me to. It just doesn't make logical sense to me to take
> such a strong antibiotic and deal with the side effects for a disease
> I may never even get.
> Your thoughts are appreciated.
> Joe.
>
>
>

#24272

From: PoWeRTX@...
Date: Thu Jan 31, 2008 12:18 pm
Subject: Expect delays in postings

nelsonvergel

Offline

Gang

Expect delays in postings after Saturday for two weeks. I will try my best not to let emails accumulate. Sorry for the inconvenience.

Regards,

Nelson Vergel
powerusa dot org

Start the year off right. Easy ways to stay in shape in the new year.

#24271

From: lsmyle@...
Date: Thu Jan 31, 2008 5:12 pm
Subject: Re: Still deciding what to do about haart

larrysmyle

Offline

Joe,

I'm sure you're going to get this answer from most of us here. YOU SHOULD BE ON MEDS! Are you going to wait until you get PCP until you decide. You're playing with fire here, and I think the odds are NOT in your favor. All the science says you should be on meds under 200 t-cells. You are leaving yourself open for a lot of nasty OI's that can be easily avoided with meds. The newer meds are not as toxic as the older ones and side effects are minimal.

Larry over 25 yrs HIV+, been on meds since 1990. I'd be dead if I wasn't on meds.

-------------- Original message --------------
From: "strongfast77" <strongfast77@...>

Hello all, I am new here but poz for two years that I know of
(probably more like 2.5 years) Anyways I was scared at first when my
first labs came back with Tcells of 279 and % at 20. I decided from
the start I would not panic but the first year was not easy. I have
fluctuated from a Low Tcell count of 116 to around 200 for the past
year. It's been under 200 pretty much for about the last year or so.
My viral load has always been around 50,000 or so. I figured I would
not go on meds right away and have never been on meds to this day. I
know everyone tells me to especially my Dr. But, I have not ever had
an OI. I have only been sick once with Bronchitis which was just this
year. I asked my Dr. what options I had for medication to treat the
bronchitis and expressed a desire not to take antibiotics if there was
another alternative (just want to make sure antibiotics are really
needed) He put me on a low dose of Prednisone for 8 days along with an
inhaler and this worked great and got rid of it. My body was able to
fight it with the prednisone when my t-cells were under 200 is this
normal?
Anyways, I'm still not sure when I will go on the haart meds. I feel
like if I feel ok and am able to work and do my normal routine like
exercise 3x a week running 3 miles each time and eating great that
I'll be ok. My Dr. thinks perhaps this is why I haven't come down with
an OI yet even with the low CD4. Oh, my % now is 10, forgot to mention
that.
What do you all think of this strategy of waiting? Should I have come
down with an OI after being poz for 2.5 years is this unusual with
such a low count? Maybe my immune system is stronger than the CD4
shows. If I get an OI like PCP I figure I'll take the Bactrim and get
rid of it. Oh, I'm not taking the Bactrim either currently even though
my Dr. wants me to. It just doesn't make logical sense to me to take
such a strong antibiotic and deal with the side effects for a disease
I may never even get.
Your thoughts are appreciated.
Joe.

#24270

From: <babeler@...>
Date: Thu Jan 31, 2008 5:11 pm
Subject: Re: does fuzeon give bone and muscle ache?

babeler1983

Offline

I've been doing it for about 2 years and never had arthritic type pain. Are you
doing something else that might cause this? I have never heard of anyone
complain of this side effect before either. Of course, I'm not a doctor.

I get site reactions sometimes, they look like insect bites and hurt. Warm
compresses and Benadryl lotion sometimes help. Sometimes don't. But they do
eventually seem to go away.

Best,
Babeler
---- WEBcfm@... wrote:
> I've been doing the fuzeon injections (ackk) for over three weeks now, and all
of a sudden I'm getting arthritic type pain.? I'm getting it in my hands and
legs.? My fingers ache and hurt when I pick things up sometimes too.? I have
never had this type of thing before.? I have no history of achey bones or
muscles.? Is this a side effect from the fuzeon?
> Alot of you were so helpful with advice before I started using the
medication.? I'm also taking Isentress and Truvada, but I took them for a short
while before and didn't experience this.
> I would appreciate any feedback on this.?
>
> thanks,
> Charlie in Ct.
> ________________________________________________________________________
> More new features than ever.  Check out the new AOL Mail ! -
http://webmail.aol.com

#24269

From: John Barrow <pozbod@...>
Date: Thu Jan 31, 2008 3:29 pm
Subject: Re:HIV-positive prostitute holidayed in NZ

johnftl59

Offline

Gosh,

I mean, would anyone just assume that a sex worker is not HIV positive
before having sex, male or female?

Seems rather crazy.

JB

Reply | Forward | Messages in this Topic (3)

#24268

From: John Barrow <pozbod@...>
Date: Thu Jan 31, 2008 3:24 pm
Subject: Re:Still deciding what to do about haart

johnftl59

Offline

I have
fluctuated from a Low Tcell count of 116 to around 200 for the past
year. It's been under 200 pretty much for about the last year or so.
My viral load has always been around 50,000 or so. I figured I would
not go on meds right away and have never been on meds to this day. I
know everyone tells me to especially my Dr. But, I have not ever had
an OI.

Joe,

You really need to start meds, and now.

One of my favorite analogies is the story of the man who jumps off the Empire State Building, and at the 57th floor, yells in a window, "See? I'm doing fine, so far!!!!"

It seems clear that the longer you wait to start HAART, the more irreversible damage is done to the immune system. Medications allow your own immune system to recover and fight disease, naturally. This is the best strategy.

You are now at a high risk for opportunistic infections. There are people who ride the down escalator to zero T cells with no O.I.s, but this is not a good strategy.

It is not at all uncommon for HIV positive people to show up in the emergency room with the first sign of AIDS complications, Pneumocystis carinii pneumonia, a dangerous, and still frequently lethal disease. Even in people who survive PCP, the complications of high-dose corticosteroid therapy include weakened bones and fractured hips. You don't want this.

It also seems that people with untreated HIV are at higher risk for lymphomas.

Medications have improved so much; we really don't see nearly as much of the terrible fat changes in new patients that used to be so common. It's often only a once a day thing.

I've been on meds now for 15 years or so. It's all good.

I would strongly, strongly urge you to start medications, as soon as possible.

#24267

From: PoWeRTX@...
Date: Thu Jan 31, 2008 10:00 am
Subject: Pot Vending Machines in LA

nelsonvergel

Offline

http://ap.google.com/article/ALeqM5hiL8dtDwoW4iYiA0h-PDjgTkkP3wD8UG58V00

Pot Vending Machines in LA

By DAISY NGUYEN – 1 day ago

LOS ANGELES (AP) — The city that popularized the fast food drive-thru has a new innovation: 24-hour medical marijuana vending machines.

Patients suffering from chronic pain, loss of appetite and other ailments that marijuana is said to alleviate can get their pot with a dose of convenience at the Herbal Nutrition Center, where a large machine will dole out the drug around the clock.

"Convenient access, lower prices, safety, anonymity," inventor and owner Vincent Mehdizadeh said, extolling the benefits of the machine.

But federal drug agents say the invention may need unplugging.

"Somebody owns (it), it's on a property and somebody fills it," said DEA Special Agent Jose Martinez. "Once we find out where it's at, we'll look into it and see if they're violating laws."

At least three dispensaries in the city, including two belonging to Mehdizadeh, have installed vending machines to distribute the drug to people who carry cards authorizing marijuana use.

Mehdizadeh said he spent seven months to develop and patent the black, armored box, which he calls the "PVM," or prescription vending machine.

A sliding fence protects the tinted windows of his dispensary, barely distinguishing it from a busy thoroughfare of strip malls, automobile dealers and furniture shops. A box resembling a large refrigerator stands inside the nearly empty shop, near a few shelves stocked with vitamins and herbs.

A guard in a black T-shirt emblazoned with the word "Security" on the front stands at the door. A poster of Bob Marley decorates a back room.

The computerized machine requires fingerprint identification and a prepaid card with a magnetic stripe. Once the card and fingerprint are verified, a bright green envelope with the pot drops down a slot.

Mehdizadeh says any user approved for medical marijuana and registered in a computer database at his dispensaries can pre-purchase the drug and then use the machine to pick up.

The process provides convenience and privacy for users who may otherwise feel uncomfortable about buying marijuana, Mehdizadeh said.

At the Timothy Leary Medical Dispensary in the San Fernando Valley, the vending machine is accessible only during business hours. An employee there said the machine was introduced about five months ago, and provides speedy service.

"It helps a lot of patients who are in a lot of pain and don't want to wait around to get help," Robert Schwartz said. "It's been working out great."

Mehdizadeh said he sought the advice of doctors, and decided to limit the amount of marijuana per user to an ounce per week. Each purchase from the machine yields 1/8th or 2/8th of an ounce. By eliminating a vendor behind the counter, he said, the machine offers users lower drug prices. The 1/8th ounce packet would cost about $40 — $20 lower than the average price at other dispensaries.

A spokesman for a marijuana advocacy group said the machine also benefits dispensary owners.

"It limits the number of workers in the store in the event of a raid, and it'll make it harder for theft," said Nathan Sands, of The Compassionate Coalition.

Marijuana use is illegal under federal law, which does not recognize the medical marijuana laws in California and 11 other states.

The Drug Enforcement Agency and other federal agencies have been actively shutting down major medical marijuana dispensaries throughout the state over the last two years and charging their operators with felony distribution charges.

Mehdizadeh said the Herbal Nutrition Center was the target of a federal raid in December. He said no arrests were made and no charges have been filed against him.

Kris Hermes, a spokesman for advocacy group Americans for Safe Access, said the machine might benefit those who already know how much and what strain of marijuana they're looking for. But he said others will want to see and smell the drug before they buy it.

A man who said he has been authorized to use medical marijuana as part of his anger management therapy said the vending machine's security measures would at least protect against illicit use of the drug.

"You have kids that want to get high and that's not what marijuana is for," Robert Miko said. "It's to medicate."

Regards,

Nelson Vergel
powerusa dot org

Start the year off right. Easy ways to stay in shape in the new year.

#24266

From: PoWeRTX@...
Date: Thu Jan 31, 2008 9:54 am
Subject: HIV-positive prostitute holidayed in NZ

nelsonvergel

Offline

wow...what a witch hunt. This seems so extreme and wrong to me.

Any Kiwis here?

HIV-positive prostitute holidayed in NZ

January 31, 2008 12:42pm

Article from: AAP

NEW Zealand health authorities are warning people about an HIV-positive Australian prostitute after it was revealed he went on holiday there over Christmas.

Hector Scott, 41, of Canberra, is facing charges of providing a commercial sexual service while knowing he was infected with a sexually transmitted disease and failing to register as a sex worker.

He appeared in ACT Magistrates Court on January 18 - the first time it came to public attention even though the ACT Government had been warned about Mr Scott a month before by West Australian officials.

"At that point in time the only information we had - on the 19th of December - was a query about whether this man may be in the ACT or may not and whether or not he may be engaging in an activity such as work as a sex worker,'' ACT Health Minister Katy Gallagher said on ABC radio today.

Ms Gallagher said local government and health officials acted immediately, informing police and scrutinising advertisements in the local media.

"Through that detailed investigation it became clear that the man was not in the ACT and we remained in contact with the jurisdiction where he was found to be ... it was in New Zealand,'' she said.

Health officials in New Zealand say they have no idea where Mr Scott spent his holiday after arriving in Auckland on December 23 and leaving on December 30.

The Ministry of Health said it had sought further information from Australian authorities about Mr Scott's activities in New Zealand.

"We do not know if he had sex with anyone in New Zealand or whether he may have had sex in Australia with New Zealanders who have travelled there,'' said ministry adviser Alison Roberts.

"Nor do we know if he practised unsafe sex in these situations, but given the fact he is being prosecuted in Australia it is wise to pass on the warning here.''

When Mr Scott returned to the ACT on January 4 he was arrested and given a public health order telling him not to work as a prostitute.

The public was not informed of his arrest or the order until he appeared in court two weeks later.

ACT health authorities yesterday started calling about 250 people who had been in contact with Mr Scott and may have been infected with HIV.

Mr Scott is due back in court on February 7.

Regards,

Nelson Vergel
powerusa dot org

Start the year off right. Easy ways to stay in shape in the new year.

Reply | Forward | Messages in this Topic (3)

#24265

From: PoWeRTX@...
Date: Thu Jan 31, 2008 9:49 am
Subject: Fwd: NATAP: Doubts Raised About Statins

nelsonvergel

Offline

Great Drug, but Does It Prolong Life?

NY Times
By TARA PARKER-POPE
Published: January 29, 2008

Statins are among the most prescribed drugs in the world, and there is no doubt that they work as advertised - that they lower not only cholesterol but also the risk for heart attack.
Skip to next paragraph

But in the fallout from the headline-making trial of Vytorin, a combination drug that was found to be no more effective than a simple statin in reducing arterial plaque, many people are asking a more fundamental question about statins in general: Do they prolong your life?

And for many users, the surprising answer appears to be no.

Some patients do receive significant benefits from statins, like Lipitor (from Pfizer), Crestor (AstraZeneca) and Pravachol (Bristol-Myers Squibb). In studies of middle-aged men with cardiovascular disease, statin users were less likely to die than those who were given a placebo.

But many statin users don't have established heart disease; they simply have high cholesterol. For healthy men, for women with or without heart disease and for people over 70, there is little evidence, if any, that taking a statin will make a meaningful difference in how long they live.

“High-risk groups have a lot to gain,” said Dr. Mark H. Ebell, a professor at the University of Georgia who is deputy editor of the journal American Family Physician. “But patients at low risk benefit very little if at all. We end up overtreating a lot of patients.” (Like the other doctors quoted in this column, Dr. Ebell has no ties to drug makers.)

How is this possible, if statins lower the risk of heart attack? Because preventing a heart attack is not the same thing as saving a life. In many statin studies that show lower heart attack risk, the same number of patients end up dying, whether they are taking statins or not.

“You may have helped the heart, but you haven't helped the patient,” said Dr. Beatrice Golomb, an associate professor of medicine at the University of California, San Diego, and a co-author of a 2004 editorial in The Journal of the American College of Cardiology questioning the data on statins. “You still have to look at the impact on the patient over all.”

A 2006 study in The Archives of Internal Medicine looked at seven trials of statin use in nearly 43,000 patients, mostly middle-aged men without heart disease. In that review, statins didn't lower mortality.

Nor did they in a study called Prosper, published in The Lancet in 2002, which studied statin use in people 70 and older. Nor did they in a 2004 review in The Journal of the American Medical Association, which looked at 13 studies of nearly 20,000 women, both healthy and with established heart disease.

A Pfizer spokeswoman notes that a decline in heart disease death rates reported recently by the American Heart Association suggests that medications like statins are having an impact. But to consistently show a mortality benefit from statins in a research setting would take years of study. “We've concentrated on whether Lipitor reduces risk of heart attacks and strokes,” says Halit Bander, medical team leader for Lipitor. “We've proven that again and again.”

This month, The Journal of the American College of Cardiology published a report combining data from several studies of people 65 and older who had a prior heart attack or established heart disease. This “meta-analysis” showed that 18.7 percent of the placebo users died during the studies, compared with 15.6 percent of the statin users.

This translates into a 22 percent lower mortality risk for high-risk patients over 65. A co-author of the study, Dr. Jonathan Afilalo, a cardiology fellow at McGill University in Montreal, says that for every 28 patients over 65 with heart disease who take statins, one life will be saved.

“If a patient has had a heart attack,” Dr. Afilalo said, “they generally should be on a statin.”

Of course, prolonging life is not the only measure that matters. If preventing a heart attack improved the quality of life, that would be an argument for taking statins even if it didn't reduce mortality. But critics say there's no evidence that statin users have a better quality of life than other people.

“If you can show me one study that people who have a disability from their heart are worse off than people who have a disability from other causes, I would find that a compelling argument,” Dr. Golomb said. “There's not a shred of evidence that you've mitigated suffering in the groups where there is not a mortality benefit.”

One big concern is that the side effects of statins haven't been well studied. Reported side effects include muscle pain, cognitive problems and impotence.

“Statins have side effects that are underrated,” said Dr. Uffe Ravnskov, a retired Swedish physician and a vocal critic of statins. “It's much more frequent and serious than has been reported.”

Dr. Ebell acknowledges that there are probably patients with heart disease who could benefit from a statin but who aren't taking it.

But he added, “There are probably more of the opposite - patients who are taking a statin when they probably don't need one.”

Start the year off right. Easy ways to stay in shape in the new year.

#24264

From: "Bill Gaul" <wgaul1@...>
Date: Thu Jan 31, 2008 7:02 am
Subject: Re: Re: Teeth and HIV

upstatedv8

Offline

I'm old enough to get receding gums anyway, but have had a problem with dry mouth from meds for a while now. I find that if I keep after it, the recession has ceased, and even reversed. Biggest problem for me has been exposure of the root - it can be very sensitive.

You won't necessarily lose your teeth because of HIV. Just make sure you get regular dental attention and take care of your mouth. Having water handy, Biotene, flossing (including getting an interdental brush - very effective - Oral B makes a good one) - all good suggestions. There may be an HIV dental clinic around, too. It's really good to have a dentist that knows about HIV and oral medicine.

----- Original Message -----

From: TucChico@...

To: malebeyo@... ; pozhealth@yahoogroups.com

Sent: Tuesday, January 15, 2008 11:51 AM

Subject: [Norton AntiSpam] Re: [PozHealth] Teeth and HIV

That happens with age anyway. But the meds seem to make them recede at a slightly accelerated rate. I would not worry about the gums receding I would worry about the cavities and cracks. I don't get dry mouth from the meds at all I produce plenty of saliva. The teeth are still there and are strong but the enamel wears thin due to the meds. There is no need to be scared about it. Its just living with the virus and medications. I am currently on 20 different medications. But I am alive and kicking and that's the important thing. The tooth decay and other problems are just small things. You can handle what is thrown your way.

FRANK

In a message dated 1/15/2008 8:48:31 A.M. US Mountain Standard Time, malebeyo@... writes:

Do your gums receed regardless of if you are on HAART or not?
Do most people with HIV loose some of their teeth as a result of receeding gums?
I am scared!

Reply | Forward | Messages in this Topic (15)

#24263

From: "Bill Gaul" <wgaul1@...>
Date: Thu Jan 31, 2008 6:34 am
Subject: Re: Personal Health Resume for New Medical Providers

upstatedv8

Offline

Hi Ken - Been busy - sorry to reply so late, but this caught my eye.

I've been doing a similar kind of thing using MS Access. I keep a list of my
meds in an easy table with doses, Rx no, refills left, etc. I can generate a
report with a short medical history and contacts at the bottom with one
click. Then I print out lab values, meds I've taken, and dates from about 15
years back on the other side of the page, from a spreadsheet I keep. I've
been told "this is gold" by doctors I haven't seen before, especially if
it's the ER or a surgical procedure intake. I include vitamins and
supplements, too. There's a check field for each item, so I can pick refills
I need - run a query - and fax the results to my pharmacy from my computer.
Since I pick up about 15 prescriptions a month - it really makes things a
lot easier for them and me, and I have a printed hard copy to check
everything before I leave the place. It also helps me to check on
vaccination dates and such. The last thing I want to do when I'm sick is sit
there trying to remember what dose of what I take when, and that hernia
repair I had 7 years ago.

If I knew programming better, I'd develop it and market it. Once it's set up
it's just a matter of updating. It's always a good idea to let them know
you're on top of your own healthcare.

BG
>>>>>>>>>>>>

Hi, all:

I've been HIV+ for 16 years, but recently have been without an HIV
specialist.  Tomorrow I get to see a new one at Johns Hopkins
University.  Looking back at previous relationships with HIV providers,
I realize that much of the treatment has been driven by the doctor's
experience and education.  Unfortunately, much of that education is
provided to them by untrained (but very attractive) pharmaceutical reps.

So, I thought we might try to shift that pattern this go-round.  I
created a "Personal Health Resume" that I will staple or clip ON TOP OF
the standard new patient intake form.

My resume contains the following sections/headings:
Personal Health Objective
Problem List
Current Activity Level
Current Physical Modalities (i.e., complementary therapies)
Current Orthomolecular Supplements
Current Designer Molecule Interventions (i.e., traditional Western Meds)
Succesful Past Therapies
Failed Past Therapies
Recent Medical Provider List
Current Lab Values

I'm hoping that putting my information in my own format, and infused
with my own values, on top of the standard forms will encourage the
provider to not see me as just another slot in her schedule.

Comments?  Has anybody deliberately tried similar techniques to try to
get allopathic physicians to actually treat you as a whole person?

Reply | Forward | Messages in this Topic (5)

#24262

From: "strongfast77" <strongfast77@...>
Date: Thu Jan 31, 2008 5:21 am
Subject: Still deciding what to do about haart

strongfast77

Offline

Hello all, I am new here but poz for two years that I know of
(probably more like 2.5 years) Anyways I was scared at first when my
first labs came back with Tcells of 279 and % at 20. I decided from
the start I would not panic but the first year was not easy. I have
fluctuated from a Low Tcell count of 116 to around 200 for the past
year. It's been under 200 pretty much for about the last year or so.
My viral load has always been around 50,000 or so. I figured I would
not go on meds right away and have never been on meds to this day. I
know everyone tells me to especially my Dr. But, I have not ever had
an OI. I have only been sick once with Bronchitis which was just this
year. I asked my Dr. what options I had for medication to treat the
bronchitis and expressed a desire not to take antibiotics if there was
another alternative (just want to make sure antibiotics are really
needed) He put me on a low dose of Prednisone for 8 days along with an
inhaler and this worked great and got rid of it. My body was able to
fight it with the prednisone when my t-cells were under 200 is this
normal?
Anyways, I'm still not sure when I will go on the haart meds. I feel
like if I feel ok and am able to work and do my normal routine like
exercise 3x a week running 3 miles each time and eating great that
I'll be ok. My Dr. thinks perhaps this is why I haven't come down with
an OI yet even with the low CD4. Oh, my % now is 10, forgot to mention
that.
What do you all think of this strategy of waiting? Should I have come
down with an OI after being poz for 2.5 years is this unusual with
such a low count? Maybe my immune system is stronger than the CD4
shows. If I get an OI like PCP I figure I'll take the Bactrim and get
rid of it. Oh, I'm not taking the Bactrim either currently even though
my Dr. wants me to. It just doesn't make logical sense to me to take
such a strong antibiotic and deal with the side effects for a disease
I may never even get.
Your thoughts are appreciated.
Joe.

#24261

From: PoWeRTX@...
Date: Wed Jan 30, 2008 9:50 pm
Subject: Banned member- FROM THE MODERATOR

nelsonvergel

Offline

A bunch of you probably got nasty emails from someone who subscribed to this list and is probably crazy

His name is Kenneth Brown and his email is <moonshadow196913@...

I banned him today after he sent me a bunch of insulting emails

If you are still getting nasty emails from him, add him to your spam folder email list

What a nut case

Regards,

Nelson Vergel
powerusa dot org

Start the year off right. Easy ways to stay in shape in the new year.

#24260

From: Alan Brrrrrr <abstract510@...>
Date: Wed Jan 30, 2008 10:56 pm
Subject: Key info re meds desired, & yahoo's threading [was Re: jason's questions]

abstract510

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Don & others here - It would be really helpful if you would use the
"reply" function when you respond to someone's specifics, so that you
will be quoting what they said (edited, if appropriate, but at least
with the key info to put your answers in context).

Here i'm very desirous of knowing the specifics of you say that the
person was prescribed the meds with the least side effects & the
lowest toxicities. These are issues which are extremely important to
me & of great consternation, since my doctor is ready to start me on
meds & i'm very wary of such issues. But without your quoting what
jason said (or re-stating the critical facts or providing a URL to his
post), i have no idea what are those which, from your knowedge, are
the meds with the least side effects & lowest toxicities.

Althouth i should be doing more urgent things now, I even spent time
plowing through the group archives to find your original message,
hoping that yahoo's threading would lead me to the prior post which
stated those meds. But i was left with nothing, since it appears yahoo
doesn't thread them unless you use "reply" from the original post.

Groups like this one, with tons of messages every day, are
particularly hard to even keep up with (i spend waaay too much time
on-line, angering my friends who try to call me & leaving me without
the time i should be spending to do important things like trying to
get some income, & i'm still always behind trying to read the posts of
interest), & so it's all the more important for people to have links
to or quotes of what they're responding to, if their responses are to
be helpful to anyone but the person who raised the issue & knows what
he said.

Thanks for your understanding. I still would like to know what those
meds are which you referenced, since i'm to probably be put on meds
within a month or so & need to have whatever info i can get, if i'm to
challenge the prescription my doctor has suggested. (He's quite
knowledgable, so i'm neither assuming his choices are inappropriate,
nor am i thrilled at the prospect of challenging him in his specialty.
But i do know i need to advocate for myself, from the many horror
stories i've heard about such things, & meds are no minor issue to me,
especially as someone who's trying to find work & will need to be in
top form to interview & start what will undoubtedly have to be
full-time work, to be able to meet my expenses that have piled up
while i've been without any income.) If you are willing to share that
list with me, i'd appreciate your sending it to my primary personal
e-address (i have to use this yahoo one because yahoo's damned system
prevents me from getting posts from certain groups, including this
one, at the preferred e-address) which is:
whatever@...

Thanks to you & anyone else who has info they want to share about
which are the meds with the least side effects & toxicities.

I'd be grateful to hear others' views on this important subject at
this time, since there are so many meds to research & i'm sure it's
far too complex an area to have any universally-agreed answer. I value
your opinion on this but would also like to hear whether others agree
or disagree on the choice of meds to start with. (BTW, for anyone
willing to respond, i'm resistant to NNRTIs, so those must be excluded
for my particular situation.)

With thanks to all who offer info,
Alan

--- In PozHealth@yahoogroups.com, Don Bliss <donaldcbliss@...> wrote:
>
> hi jason,
>
>   i have read your posts lately and finally am getting around to
responding.
>
>   first, i commend your interest in delaying the start of
medications.  there are only so many of them, some probably won't work
for you, some might give you intolerable side effects, and your virus
will be resistent or develop resistence to some so some you won't be
able to take for that reason, or you'll have to switch to others
eventually.  once you start taking them you also start the process of
cycling through the available medications, so the longer you can go
without starting them, the better - all with your informing yourself
about the advantages and disadvantages, and while seeking the advice
of knowledgeable people, including healthcare providers.  i delayed
taking the meds as long as i could, until my numbers were about the
same as yours, and i have no regrets.
>
>   having said that, i'm glad you're planning on taking the
medications now.  this virus is powerful, and for the most part our
bodies seem to be able to fight it on their own for so long before we
need help.  considering where your t-cells and your viral load are, it
seems like your body needs the help right now.
>
>   because the virus is so powerful and so wily, the medications have
to be powerful as well.  that is why they have so many side effects,
some of which are intolerable for certain people.  you are basically
beginning chronic chemotherapy.  there are bound to be problems, and
there has been lots of research into them, although some of the
problems observed in the community of people with hiv are denied or
questioned by the medical establishment as having anything to do with
the meds, and some may have more to do with long-term hiv infection
itself.
>
>   my recommendation, then, is to take the medical reports and the
stories you hear read and hear about, put it all together and keep it
all in mind.  in your poking around you will find that what can occur
are:  cell metabolic abnormalities; lactic acidosis; sudeen liver,
heart or kidney failure; fat redistribution, accumulation or
disappearance; fatigue; diarrhea; pancreatis; diabetes; and so on and
so forth.  that is why taking care of yourself holistically is so
important, with hiv and with the medications (for everybody, right?),
meaning lots of rest, not polluting your body with bad food and other
junk, and taking a good multi-vitamin with minerals, and perhaps
additional supplements.
>
>   some people don't believe in taking supplements, but there is lots
of research out there on the micronutrient deficiencies people with
hiv have, the benefits of certain vitamins and minerals (for everyone
whether living with hiv or not) and the damage that free radicals can
do and how supplements can help with those, not to mention how
supplements help raise t-cells counts independently of other factors
and how they can help mitigate against the side effects of the
medications.  there have been recent and past postings on
supplementation here, for your reference.
>
>   from my personal experience, i have been on the meds for almost
eight years and i only had to change because of liver damage that was
completely unrelated to the medications (that's another story
altogether).  in addition, i have had relatively few unpleasant (or
disfiguring or life threatening) side effects and i believe part of
the reason is because i take supplements regularly.  as i mentioned,
that's what the research shows, too.  fortunately, i haven't had to
cycle through lots of different medications, at least not yet.  they
used to say that any given medication would only be effective for a
person from between 2 - 5 years, so i consider myself very lucky in
that regard.
>
>   your doctor has indeed prescribed a combo with one of the lowest
possibilities for side effects and the fewest known toxicitis.  he
must have listened to you well!  i would also avoid pi's as long as
possible.  i started out on basicaly the same drugs that are now in
truvada, but with videx.  i had to stop the videx because of how it
could potentially worsen my liver damage.  i tried azt as a
replacement, but had to stop that because of anemia.  (i wasn't keen
on taking it anyway, because of all the different side effects.)  then
i went to sustiva and had problems with those side effects, but they
have diminished greatly by my changing the dose to 200 mg three times
a day instead of 600 mg once a day.  except for the sustiva, then, i'm
on the same medications that i started eight years ago.
>
>   and finally, yes, dental care is important.  your mouth is a
reflection of your overall health, to some extent, and as with many
other things, hiv-ers have a tendency to have more dental problems
than the general public.  a good dentist can definitely help you with
the issues that you mentioned (and so can regularly flossing, as i'm
sure they will tell you).
>
>   that's all.  keep writing, and keep asking your questions.  best
of luck to you, and stay well!
>
>   don
>
>
>   "Most people are other people.  Their thoughts are someone else's
opinions, their lives a mimicry, their passions a quotation." - Oscar
Wilde
>
>   www.donaldcbliss.com

________________________________________________________________________________\
____
Be a better friend, newshound, and
know-it-all with Yahoo! Mobile.  Try it now. 
http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

#24259

From: PoWeRTX@...
Date: Wed Jan 30, 2008 1:46 pm
Subject: Testosterone supplementation- SURVEY RESULTS

nelsonvergel

Offline

http://www.surveymonkey.com/sr.aspx?sm=88lE4adngoj99HERi2Ei6HfxhpXlFqzFDith_2br_2b_2fIFQ_3d

90 people answered ...these are the results

If you have not done so, you can participate if go to (for men only)

http://www.surveymonkey.com/s.aspx?sm=cX85MDuJKJ8ya4NST0gsuQ_3d_3d

Regards,

Nelson Vergel
powerusa dot org

Start the year off right. Easy ways to stay in shape in the new year.

#24258

From: George Carter <fiar@...>
Date: Wed Jan 30, 2008 4:03 pm
Subject: Re: trip to Jamaica

lalzephyr

Offline

I agree with Hugo....there are many other Caribbean islands that are less homophobic.

On the other paw, there are some VERY intrepid gay and lesbian groups in Jamaica who deserve our support. See, e.g.,�

http://www.jflag.org/�

They note on their About Us page:

Where we are

Although we provide services and network island-wide, our office is located in Kingston, Jamaica's Capital and largest city.

Due to the potential for violent retribution, we cannot publish the exact location. We do receive mail at Box 1152, Kingston 8.

Of course, the biggest screaming homophobes are usually just "wannabes." Abstract below.

George M. Carter

Adams HE; Wright LW Jr; Lohr BA. Is homophobia associated with homosexual arousal? J Abnorm Psychol 1996 Aug;105(3):440�445.
�
Department of Psychology, University of Georgia, Athens 30602�3013, USA.

The authors investigated the role of homosexual arousal in exclusively heterosexual men who admitted negative affect toward homosexual individuals. Participants consisted of a group of homophobic men (n = 35) and a group of nonhomophobic men (n = 29); they were assigned to groups on the basis of their scores on the Index of Homophobia (W. W. Hudson & W. A. Ricketts, 1980). The men were exposed to sexually explicit erotic stimuli consisting of heterosexual, male homosexual, and lesbian videotapes, and changes in penile circumference were monitored. They also completed an Aggression Questionnaire (A. H. Buss & M. Perry, 1992). Both groups exhibited increases in penile circumference to the heterosexual and female homosexual videos. Only the homophobic men showed an increase in penile erection to male homosexual stimuli. The groups did not differ in aggression. Homophobia is apparently associated with homosexual arousal that the homophobic individual is either unaware of or denies.

Reply | Forward | Messages in this Topic (2)

#24257

From: PoWeRTX@...
Date: Wed Jan 30, 2008 9:55 am
Subject: Aspirin Cousin May Lower Diabetes Risk

nelsonvergel

Offline

Aspirin Cousin May Lower Diabetes Risk

Salsalate Improves Glucose Control in Small Study

By Salynn Boyles
WebMD Medical News

Reviewed by Louise Chang, MD

Jan. 28, 2008 -- A chemical cousin of aspirin that is more than a century old could prove to be the next big thing for type 2 diabetes treatment and even prevention if early studies are confirmed, researchers say.

The nonsteroidal anti-inflammatory drug salsalate is similar to aspirin but has a much lower risk for stomach bleeding at higher doses. It has been approved for decades for the treatment of arthritis pain.

In a newly published study, researchers from Harvard Medical School's Joslin Diabetes Center found that salsalate had a positive impact on blood sugar levels and inflammation in obese young adults at risk for developing type 2 diabetes.

The study was small, involving just 20 people who took salsalate or a placebo for only a month.

But Joslin researcher Allison B. Goldfine, MD, characterized the early findings as "very exciting," in part because salsalate has been proven to be a very safe drug over decades of use.

"This drug has been marketed for more than 40 years and the safety profile looks quite good," she tells WebMD.

Salsalate Targets Inflammation

Earlier studies by the Joslin research team and others suggest that chronic inflammation plays a major role in obesity-related diseases like type 2 diabetes.

This may explain why very high doses of aspirin have been shown to improve blood sugar levels in diabetes patients with poor glucose control.

The hope of the Joslin researchers was that salsalate would do the same thing with much less bleeding risk.

Their latest study included obese people in their 20s treated with either 4 grams of salsalate or placebo daily. Glucose levels were assessed at study entry and after a month of treatment, as was a key marker of inflammation.

Compared with placebo, salsalate was associated with a 13% reduction in fasting glucose levels and a 20% reduction in blood sugar response to an oral glucose tolerance test. The test measures the body's ability to control glucose after a patient consumes a specific amount of glucose. It can be used to diagnose diabetes.

Treatment with the anti-inflammatory drug was also associated with a 34% reduction in circulating levels of the inflammation marker C-reactive protein.

"This study is limited by the relatively small sample size and short-term duration," the researchers write in the February issue of the journal Diabetes Care. "However, the excellent efficacy ... in this proof of principle trial does support potential use of anti-inflammatory modulators for prevention of insulin resistance and diabetes."

More Studies Under Way

The preliminary findings prompted the National Institutes of Health to fund a much larger trial designed to examine the safety and effectiveness of salsalate as a treatment for diabetes.

The three-year trial is now under way at 16 diabetes centers across the U.S.

A three-month study evaluating salsalate for the prevention of diabetes in patients at high risk for developing the disease has also been funded, as has a study examining the drug's impact on cardiovascular disease in high-risk patients.

Joslin researcher Steven Shoelson, MD, PhD, tells WebMD that if early findings are confirmed, salsalate could prove to be even more beneficial than the widely prescribed diabetes drug metformin.

The generically available drug would also be much cheaper for patients than most other drugs used in the treatment of diabetes.

"If we establish that this drug works, it could be the second metformin, with the added benefit of possibly lowering the risk of cardiovascular disease" he says.

Regards,

Nelson Vergel
powerusa dot org

Start the year off right. Easy ways to stay in shape in the new year.

#24256

From: jfrdmn@...
Date: Wed Jan 30, 2008 1:11 am
Subject: trip to Jamaica

jfrdmn@...

NO MEMBER OF THE GAY/QUEER COMMUNITY OF ANY STRIPE SHOULD SUBSIDIZE THE ECONOMY OF JAMAICA. It is one of the most dangerous places in the world for gay men, especially, to go, although all of the West Indies are more or less risky at this time; but the Jamaican scene is under surveillance by the Human Rights Watch. Here in NYC, the several gay papers report frequently on life-threatening anti-gay events happening in Jamaica as part of normal life there, and many of their leading artists are unrepentant about inciting violence against 'battymen.'
I have not been there myself, but I would feel safer in, say, Sanaa in Yemen, than Kingston--Hugo.

Reply | Forward | Messages in this Topic (2)

#24255

From: PoWeRTX@...
Date: Wed Jan 30, 2008 9:20 am
Subject: Fwd: NATAP: Exercise May Reduce Age by 10 Years/Telomere Length

nelsonvergel

Offline

NATAP http://natap.org/
_______________________________________________

Exercise May Reduce Age by 10 Years, Telomere Length

The Association Between Physical Activity in Leisure Time and Leukocyte Telomere Length

Arch Intern Med. Jan 28 2008;168(2):154-158.

Lynn F. Cherkas, PhD; Janice L. Hunkin, BSc; Bernet S. Kato, PhD; J. Brent Richards, MD; Jeffrey P. Gardner, PhD; Gabriela L. Surdulescu, MSc; Masayuki Kimura, MD, PhD; Xiaobin Lu, MD; Tim D. Spector, MD, FRCP; Abraham Aviv, MD
Author Affiliations: Twin Research and Genetic Epidemiology Unit, King's College London, St Thomas' Hospital Campus, London, England (Drs Cherkas, Kato, Richards, and Spector and Mss Hunkin and Surdulescu); and The Center of Human Development and Aging, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark (Drs Gardner, Kimura, Lu, and Aviv).

inactive subjects may be biologically older by 10 years compared with more active subjects….. The likely culprits that are involved in these metabolic pathways are oxidative stress and inflammation…. The US guidelines recommend that 30 minutes of moderate-intensity physical activity at least 5 days a week can have significant health benefits.36 Our results…..show that adults who partake in regular physical activity are biologically younger than sedentary individuals.

ABSTRACT
Background Physical inactivity is an important risk factor for many aging-related diseases. Leukocyte telomere dynamics (telomere length and age-dependent attrition rate) are ostensibly a biological indicator of human aging. We therefore tested the hypothesis that physical activity level in leisure time (over the past 12 months) is associated with leukocyte telomere length (LTL) in normal healthy volunteers.

Methods We studied 2401 white twin volunteers, comprising 2152 women and 249 men, with questionnaires on physical activity level, smoking status, and socioeconomic status. Leukocyte telomere length was derived from the mean terminal restriction fragment length and adjusted for age and other potential confounders.

Results Leukocyte telomere length was positively associated with increasing physical activity level in leisure time (P < .001); this association remained significant after adjustment for age, sex, body mass index, smoking, socioeconomic status, and physical activity at work. The LTLs of the most active subjects were 200 nucleotides longer than those of the least active subjects (7.1 and 6.9 kilobases, respectively; P = .006). This finding was confirmed in a small group of twin pairs discordant for physical activity level (on average, the LTL of more active twins was 88 nucleotides longer than that of less active twins; P = .03).

Conclusions A sedentary lifestyle (in addition to smoking, high body mass index, and low socioeconomic status) has an effect on LTL and may accelerate the aging process. This provides a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular exercise.

INTRODUCTION
Regular exercise plays a role in health and well-being. Frequent exercisers display reduced cardiovascular risk factors1 and reduced cardiovascular-related mortality and morbidity.2 Also, frequent exercisers have a lower risk for type 2 diabetes mellitus,3 cancer, hypertension, obesity, and osteoporosis,4 which are considered aging-related diseases. Despite the known benefits of physical activity, inactivity continues to be a major public health problem.5 A sedentary lifestyle increases the propensity to aging-related diseases and premature death.4 Inactivity may diminish life expectancy not only by predisposing to aging-related diseases but also because it may influence the aging process itself.

Aging is the progressive loss of metabolic and physiologic functions,6 but the biological features of aging vary considerably among individuals. This variability may be because of a host of genetic and environmental factors that affect oxidative stress7 and inflammation8 and, consequently, leukocyte telomere dynamics (telomere length and age-dependent attrition rate).

Telomeres consist of tandemly repeated DNA sequences that play an important role in the structure and function of chromosomes. Telomeres and associated proteins cap eukaryotic chromosomes, protecting them from degradation and end-to-end-fusion.9 Telomeres of cultured somatic cells undergo erosion with each cell division, ultimately leading to replicative senescence. Therefore, telomeres progressively shorten in somatic cells and their length diminishes with age.10-12 Oxidative stress enhances telomere erosion with cell replication,13 whereas inflammation entails an increase in turnover of leukocytes. Telomere dynamics in leukocytes might, therefore, chronicle the cumulative burden of oxidative stress and inflammation and, as such, serve as an index of biological age.14

Leukocyte telomere length (LTL) is short in diseases associated with increased oxidative stress, such as coronary artery disease,15 diabetes mellitus,16 heart failure,17 and osteoporosis,18 and predicts early myocardial infarctions.12 Moreover, LTL is associated with systemic oxidative stress19 and is inversely correlated with body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared).20 Given that BMI ultimately reflects caloric consumption and expenditure, we tested the a priori hypothesis that physical activity level may have an effect on telomere attrition independent of other risk factors influencing the aging process.

COMMENT
Our key finding is that women and men who were less physically active in their leisure time had a shorter LTL (adjusted for age, sex, and extraction year) than their more active peers, regardless of the age group. Such a relationship between LTL and physical activity level remained significant after adjustment for BMI, smoking, SES, and physical activity at work. The mean difference in LTL between the most active and least active subjects was 200 nt, which means that the most active subjects had telomeres the same length as sedentary individuals up to 10 years younger, on average. This difference suggests that inactive subjects may be biologically older by 10 years compared with more active subjects. Therefore, individuals who are more sedentary are subjected to factors (other than obesity, smoking, and low SES) that speed up leukocyte telomere erosion. The data suggest that intermittent physical activity specifically in leisure time is beneficial, because adjusting LTL for physical activity at work did not affect the results. Findings in twins discordant for physical activity level in leisure time further support those in the population at large. There was no significant difference in prevalence of reported chronic disease status between more active and less active subjects, showing that the shorter LTL in sedentary subjects could not be explained by differences in disease status leading to reduced physical activity.

Our findings are compatible with previous evidence1-4,29 linking regular physical activity with health and decreased risk of aging-related diseases. The relationship between physical activity level in leisure time and LTL suggests that a sedentary lifestyle, low SES, high BMI, and cigarette smoking share metabolic pathways that incrementally affect leukocyte telomere dynamics. The likely culprits that are involved in these metabolic pathways are oxidative stress and inflammation because these 2 processes accelerate the rate of leukocyte telomere attrition.14

Exercise has been reported to decrease some oxidative stress-related diseases and paradoxically increase oxidative damage.29-31 Hormesis theory, which suggests that there are beneficial effects of low doses of potentially harmful substances29 (ie, some stress is good for you), is controversial but may be one possible explanation of this apparent paradoxical effect, possibly also because of up-regulation of anti-inflammatory processes.32 Therefore, the longer LTL associated with increased physical activity level may be mediated through an overall diminished burden of oxidative stress and inflammation.

Several recent studies25, 33-35 support an association between perceived stress levels and telomere length. Therefore, it is plausible that the relationship between leisure time physical activity and LTL may be mediated in part by a reduction in psychological stress levels induced by exercise.

The US guidelines recommend that 30 minutes of moderate-intensity physical activity at least 5 days a week can have significant health benefits.36 Our results underscore the vital importance of these guidelines. They show that adults who partake in regular physical activity are biologically younger than sedentary individuals. This conclusion provides a powerful message that could be used by clinicians to promote the potential antiaging effect of regular exercise.

A limitation of this type of study is that physical activity level was self-reported. Moreover, a large variation in exercise frequency, duration, and intensity probably existed within each of the 4 physical activity categories. Operational definitions of regular exercise in leisure time have differed across studies,37 and there is no universal standard of assessment. However, the assessment of physical activity in the present study (4-point scale) was strongly correlated with a more in-depth current assessment of time spent in physical activity, based on the Allied Dunbar National Fitness Survey.24 In addition, large differences in LTL between most active and inactive subjects were present for current and past activity (activity in individual's 20s).

Similar recalled scores have been used in other populations, and good correlations have been shown with aging-related diseases, such as osteoporosis.38 Furthermore, self-reported measures of exercise have been used successfully by other groups. Similar self-reported physical activity measures from 7 countries have been used to assess the genetic contribution to exercise participation.39 Highly comparable heritability estimates were found in all countries (median, 62%). If individuals were misclassified for exercise participation, this would increase the error term and therefore reduce heritability. Accordingly, self-reported measures of physical activity are ostensibly valid. Moreover, the use of the discordant twin analysis helped to minimize the effects of any cultural and environmental or cohort differences that may have led to differences in reporting of physical activity.

For future research, a long-term prospective study monitoring intensity, duration, and frequency of exercise in participants over different periods of life (or monitoring consumption of kilojoules per day) would help in the understanding of the complex relationship and the key periods of life for maximal benefit of exercise.

The results of this study can be extrapolated to other white individuals (men and women) of North European origin because twins have been shown to be comparable to age-matched population singletons in disease and lifestyle factors.23

In conclusion, physical activity in leisure time affects leukocyte telomere dynamics. An increased physical activity level is associated with longer LTL in white individuals, an effect that cannot be explained by variations in age, sex, genes, smoking, BMI, or SES. These findings underscore the importance of health promotion of regular exercise to retard aging and diminish the risk of aging-related diseases.

RESULTS

Descriptive statistics of participants (aged 18-81 years), by sex and physical activity level, are presented in the Table. Age, sex, and extraction year-adjusted LTL was highly variable and ranged from 4.9 to 9.1 kilobases (kb), with a mean (SD) of 7.0 (0.6) kb. (Age and extraction year-adjusted LTL was 7.0 (0.6) kb in women and 6.8 (0.7) kb in men separately.) The coefficient of variance of the telomere assay in this study was 1.5%. Leukocyte telomere length decreased with age, with a mean (SE) loss of 21.0 (1.3) nucleotides (nt) per year, and a significant negative correlation was detected (r = - 0.38, P < .001).

In a subsample of individuals who had full information on more in-depth assessments, including current leisure time, physical activity level (4-point scale) was significantly correlated with time spent in that activity (P < .001). The mean time spent in physical activity per week for each physical activity level was as follows: inactive, 16 minutes; light activity, 36 minutes; moderate activity, 102 minutes; and heavy activity, 199 minutes.

Increasing BMI was significantly associated with a decreased physical activity level (P < .001), and there was a significant difference in physical activity level between smokers and nonsmokers (P = .005) and between manual and nonmanual workers (P = .05). There was no significant relationship between age and physical activity level (P = .69). Increasing BMI (P = .001), being a smoker (P = .01), and being a manual worker (P = .02) were also significantly associated with a shorter age-adjusted LTL.

Figure 1 shows the mean adjusted LTL for each current physical activity level in leisure time. There was a significant positive association of LTL (adjusted for age, sex, and year of extraction) with increasing leisure time physical activity level (P < .001). The same trend between LTL (adjusted for age, sex, and year of extraction) and physical activity level was found separately in men (P = .27) and women (P < .001). However, there was probably insufficient power to detect a significant association in men because of the small sample size (n = 249). Subdividing the female sample into 2 age and menopause subgroups still resulted in significant associations between age-adjusted LTL and physical activity level for subjects younger than 50 years (P < .001) and for those 50 years and older (P = .04). After further adjustment for BMI, smoking, and SES, in a subsample of individuals who had full information on these variables (n = 1531), the association for the whole sample remained significant (P = .002). Leukocyte telomere length was then additionally adjusted for physical activity at work, and the association between LTL and physical activity in leisure time remained significant (P < .001). There was no significant difference in the proportion of current disease status between active (groups 2-4) and inactive (group 1) individuals (P = .23).

Age, sex, and extraction year-adjusted LTL of the most active subjects (group 4) was on average 200 (SE, 79) nt longer than that of the inactive subjects (group 1) (P = .006). This difference was increased to 213 nt after further adjustment for BMI, smoking, and SES in a subsample of individuals who had full information on these variables (P = .02). A similar result was found when examining physical activity levels of individuals in the past. Age, sex, and extraction year-adjusted LTL of the most active subjects (> 6 hours of activity per week during subjects' 20s) was on average 151 (SE, 53) nt longer than that of the inactive subjects (no time spent in activity in subjects' 20s) (P = .002). This difference was relatively unchanged at 150 nt, after further adjustment for BMI, smoking, and SES (P = .009).

Leukocyte telomere length has been shown to be heritable, ranging from 36% to 78%.10, 28 To check the consistency of the main analysis and to partly adjust for the influence of genetic, cohort, and shared early life effects, we looked at the difference in LTL within twin pairs discordant for physical activity ( 2-point difference on the physical activity score). Summing the difference between 67 discordant pairs, there was a mean difference in LTL between more active and less active twins of 88 (SE, 46) nt (P = .03) (Figure 2).

METHODS
PARTICIPANTS AND PROCEDURES
We studied 2401 white twins (2152 women and 249 men) from the UK Adult Twin Registry. Twins were recruited from the general population through national media campaigns in the United Kingdom and have been used previously in various studies since 1992 (described in more detail elsewhere).21 Twins who had measurements of LTL performed and who responded fully to a postal questionnaire, detailing their self-reported physical activity level during the past 12 months (crude response rate, 86.8%), were selected for the study. The sample used comprised 167 monozygotic twin pairs, 915 dizygotic twin pairs, and 237 unpaired twins. Zygosity was determined using a validated questionnaire,22 and in cases of uncertainty, DNA fingerprinting was used for confirmation. Twin volunteers have been shown to be comparable to age-matched population singletons for lifestyle and disease characteristics.23 Individuals in this sample completed questionnaires covering a wide range of health and lifestyle issues and underwent detailed clinical assessment. All subjects provided written informed consent approved by the St Thomas' Hospital Research Ethics Committee.

Subjects completed a questionnaire detailing their self-reported physical activity level during leisure time and at work during the past 12 months, where 1 indicates inactive; 2, light activity; 3, moderate activity; and 4, heavy activity. Individuals also completed a questionnaire involving an in-depth physical activity assessment recording how much time subjects spent in moderate and vigorous non-weight-bearing and weight-bearing activity, on average per week (based on the Allied Dunbar National Fitness Survey).24 This assessed current and retrospective physical activity level (when subjects were in their 20s).

Height and weight were recorded during a clinical visit, from which BMI was calculated. Smoking-ascertained from a self-reported measure-was recorded as a dichotomous variable with 2 levels: 0, never smoked or ex-smoker; and 1, current smoker. Subjects were assigned to a socioeconomic status (SES), in accordance with the new UK National Statistics Socio-Economic Classification measure, as described previously.25 For this study, SES was then grouped into manual and nonmanual workers.

Subjects were also asked in the questionnaire about current disease status and whether they had ever been diagnosed as having any of the following conditions: heart disease, heart attack, stroke, diabetes mellitus (type 1 or 2), osteoarthritis (of the hip or knee), Parkinson disease, or cancer (skin, breast, or colon). This information enabled us to assess whether any difference in LTL between active and inactive subjects was because of a greater prevalence of chronic disease in inactive subjects.

The female sample was stratified into 2 subsets (those <50 and those 50 years) that served as proxies for menopausal status because full accurate data were unavailable because of hormone therapy use and hysterectomies. The age of 50 years is the median age of menopause in these twins, as used previously.26

A venous blood sample was taken from each twin following an overnight fast from midnight. DNA was extracted from isolated leukocytes. The mean of the terminal restriction fragment length was used as a measure of LTL. The terminal restriction fragment length was measured in duplicate using the Southern blot method, as described previously.11 The laboratory conducting the terminal restriction fragment length measurements was blinded to all characteristics of the leukocyte donors, who were identifiable only by coded identification numbers.

STATISTICAL ANALYSIS
Standard multiple linear regression techniques were used to correlate continuous variables. The relationship between physical activity level (categorical variable) and other continuous variables was measured using a nonparametric test for trend. Unpaired 2-tailed t tests were used to test for differences in LTL within dichotomous variables (smoking and SES). 2 Tests were performed to test for physical activity level differences within dichotomous variables (smoking and SES). A test for difference of proportions was performed to look for disease status differences between active and inactive groups. Leukocyte telomere length was adjusted for age, sex, smoking status, BMI, and SES (to account for the contribution of risk factors that have been shown to relate to LTL20, 25, 27), physical activity at work, and year of DNA extraction for LTL measurements to account for batch effects. In all analyses, the clustering of twins within pairs was taken into account and the level of significance was fixed at .05. Stata 8.2 software was used (Statacorp LP, College Station, Texas; http://www.stata.com).

DISCORDANT TWIN-PAIR ANALYSIS
As a further confirmation of the larger analysis, we looked at within-twin-pair LTL differences (using a paired 2-tailed t test) for 67 twin pairs who were raised together but who are currently discordant for physical activity in leisure time by at least a 2-point difference in physical activity level (ie, 1 vs 3, 1 vs 4, and 2 vs 4, because there were only 2 pairs in the most extreme discordant group [1 vs 4]). The discordant twin pairs comprised 52 dizygotic pairs and 15 monozygotic pairs. This comparison helped to reduce the effect of random genetic and environmental variation on terminal restriction fragment length because monozygotic twins share 100% of their genes, dizygotic twins share 50% of their genes, and both shared near-equal environments as children.

Start the year off right. Easy ways to stay in shape in the new year.

#24254

From: PoWeRTX@...
Date: Wed Jan 30, 2008 9:25 am
Subject: BioSante Pharmaceuticals Announces FDA Special Protocol Assessment (SPA) for Lib

nelsonvergel

Offline

BioSante Pharmaceuticals Announces FDA
Special Protocol Assessment (SPA) for LibiGel^® in FSD

LINCOLNSHIRE, Ill.--(BUSINESS WIRE)--BioSante Pharmaceuticals, Inc. (NASDAQ: BPAX) announced today that it successfully has completed and reached agreement with the U.S. Food and Drug Administration (FDA) under the Special Protocol Assessment (SPA) process for its Phase III safety and efficacy clinical trials for LibiGel (transdermal testosterone gel) in the treatment of female sexual dysfunction (FSD), specifically, hypoactive sexual desire disorder (HSDD).

The SPA process and agreement affirms that the FDA agrees that the LibiGel Phase III clinical trial design, clinical endpoints, sample size, planned conduct and statistical analyses are acceptable to support regulatory approval. Further, it provides assurance that these agreed measures will serve as the basis for regulatory review and the decision by the FDA to approve a new drug application (NDA) for LibiGel.

“In addition to being a major milestone for BioSante, the SPA is a significant development for the entire FSD category,” said Stephen M. Simes, BioSante’s president & CEO. “This action by the FDA confirms FDA’s position that FSD and HSDD are true diagnosable conditions that women experience, with measurable endpoints that can be evaluated and which deserve therapeutic options.”

“With this SPA and meeting minutes received from FDA, we now have a clearly defined, reasonable, feasible and affordable LibiGel development path that can lead to the approval of LibiGel. Since no pharmaceutical product is approved for the treatment of FSD or HSDD in the U.S., LibiGel, if approved by the FDA, will address a truly unserved market. BioSante is committed to the development of LibiGel which ultimately could be the first product approved by the FDA for this treatment in the U.S.”

The SPA agreement covers the pivotal Phase III safety and efficacy trials of LibiGelin the treatment of FSD, one of which already has been initiated. The Phase III safety and efficacy trials are double-blind, placebo-controlled trials each of which will enroll approximately 500 surgically menopausal women for six-months of treatment. The primary endpoints in the LibiGel clinical trials are an increase in the number of satisfying sexual events and sexual desire and a secondary endpoint of a decrease in sexual distress. These SPA trials use BioSante’s validated instruments to measure the clinical endpoints. BioSante intends to initiate the second LibiGel Phase III safety and efficacy trial in early 2008.

In addition to the two LibiGel Phase III safety and efficacy trials, BioSante recently has initiated a Phase III cardiovascular safety study of LibiGel. The safety study is a randomized, double-blind, placebo-controlled, multi-center, cardiovascular events driven study of between 2,400 and 3,100 women exposed to LibiGel or placebo for 12 months. At the end of the 12 months, BioSante intends to submit a LibiGel NDA for review and possible approval by FDA. BioSante will continue to follow the women enrolled in the safety study for an additional four years after the NDA submission and possible approval of LibiGel.

The LibiGel safety study is tracking a composite of cardiovascular events including cardiovascular death, myocardial infarction and stroke in women with FSD who are 50 years of age or older and have at least one of a number of cardiovascular risk factors such as hypertension and diabetes. BioSante announced initiation of this Phase III safety study on January 7, 2008. The objective of the safety study is to show the relative safety of testosterone compared to placebo in the number of cardiovascular events. The incidence of breast cancer also is being tracked throughout the study.

As previously announced by BioSante, treatment with LibiGelin a Phase II clinical trial significantly increased satisfying sexual events in surgically menopausal women suffering from FSD. The Phase II trial results showed LibiGel significantly increased the number of satisfying sexual events by 238 percent versus baseline (p<0.0001); this increase also was significant versus placebo (p<0.05). In this study, the effective dose of LibiGel produced testosterone blood levels within the normal range for pre-menopausal women and had a safety profile similar to that observed in the placebo group. In addition, no serious adverse events and no discontinuations due to adverse events occurred in any subject receiving LibiGel. The Phase II clinical trial was a double-blind, placebo-controlled trial, conducted in the United States, in surgically menopausal women distressed by their low sexual desire and activity.

About LibiGel^®

LibiGel is a gel formulation of testosterone designed to be quickly absorbed through the skin after application on the upper arm, delivering testosterone to the bloodstream evenly over time and in a non-invasive and painless manner. Though generally characterized as a male hormone, testosterone also is present in women and its deficiency has been found to decrease libido or sex drive. In addition, studies have shown that testosterone therapy can increase bone density, raise energy levels and improve mood, in addition to boosting sexual desire and activity.

According to a study published in the Journal of the American Medical Association, 43 percent of American women (about 40 million) experience some degree of impaired sexual function. Among the more than 1,400 women surveyed, 32 percent lacked interest in sex and 26 percent could not experience orgasm. According to IMS data, 1.4 million testosterone prescriptions were written off-label for women by U.S. physicians in 2006. The majority of women with FSD are postmenopausal, experiencing FSD due to hormonal changes following menopause, whether natural or surgical.

Regards,

Nelson Vergel
powerusa dot org

Start the year off right. Easy ways to stay in shape in the new year.

#24253

From: John Barrow <pozbod@...>
Date: Wed Jan 30, 2008 6:49 am
Subject: BBC NEWS | Health | NHS trusts 'reject homoeopathy'

johnftl59

Offline

NHS trusts 'reject homoeopathy'

NHS primary care trusts are slashing funding for homeopathic treatment amid debate about its efficacy and the drive to cuts costs, a study has suggested.

More than a quarter have stopped or cut funding for such services, research by the GP magazine Pulse has found.

The Royal London Homoeopathic Hospital, the country's largest, confirms it has lost eight contracts in a year and referrals are down by 20%.

High-profile critics of homoeopathy welcomed the development.

The controversy over the therapy has been raging for years.

It is based on the principle of treating like with like, so someone with an allergy who was using homeopathic medicines would attempt to beat it with an ultra-diluted dose of an agent that would cause the same symptoms.

But while patients often report that it makes them feel much better, clinical evidence that it works is lacking, and some scientists argue the solution is so diluted it does not contain any active ingredients at all.

Soldiering on

The investigation into 132 primary care trusts found only 37% still have contracts for homoeopathic services and referrals are decreasing.

I'm confident, for various reasons, that we will survive
Peter Fisher
Royal London Homeopathic Hospital

The clinical director of the Royal London Homoeopathic Hospital, which last year warned it may have to start charging patients, said he was nonetheless confident it would survive.

"For one, there's a lot of public and political support," said Dr Peter Fisher, adding that in any event homoeopathy comprised only 40% on the services on offer, which included nutritional medicine and relaxation techniques.

A spokesperson from the Faculty of Homeopathy, which represents doctors, said the centres in the UK offering such treatment provided good value for money.

"The homeopathic hospitals provide a specialist service that has helped hundreds of thousands of NHS patients over the last 60 years and has extremely high levels of patient satisfaction.

"They are particularly well equipped to treat patients whose complex chronic health problems have not been effectively treated by conventional medicine."

Nearly two years ago, a list of eminent doctors put their names to a letter urging the NHS to stop funding the treatment.

Michael Baum, a professor emeritus of surgery who organised the campaign, welcomed the news that funding was being cut.

"The NHS should be putting its money into evidence-based medicine, so this is a good start," he said.

"But while people are starting to realise they are being conned by the whole complementary medicine establishment, it will be a long time before we see the back of it."

#24252

From: solarjerom@...
Date: Tue Jan 29, 2008 8:54 pm
Subject: Re: HIV-infected persons on effective anti-retroviral therapy are...

solarjerom

Offline

That is indeed very good news, although I hope it will not result in people with undetectable viral load going on a BB rampage!

I am concerned with the "zero-infinity" aspects of unprotected sex with undetectable poz partners. (I have been VL <50 for many years, thanks to effective meds and compulsive focus on adherence to my fairly simple meds schedule.) Here is the dilemma for me: While the probability of infecting someone else or getting coinfected by someone with VL <50 is presumably close to zero, the consequences of infection taking place are close to infinite in human terms. So, my personal choice has been to avoid to the extent possible behavior that would result in infection or personal coinfection, even if the probability is very small.

Then, of course, the Dave Letterman ten bad other things are also still a risk in unprotected sex. We all know what they include -- hep B (yes, everyone should get the vaccine -- it is effective), hep C (no vaccine), gonorrhea (especially the variants resistant to most antibiotics), syphilis, and so on. TG for good hugs and snuggling.

Jerome

Start the year off right. Easy ways to stay in shape in the new year.

#24251

From: PoWeRTX@...
Date: Tue Jan 29, 2008 7:25 pm
Subject: HIV-infected persons on effective anti-retroviral therapy are sexually non-infec

nelsonvergel

Offline

This will be published by theSwiss Federal Commission (National Committee) on HIV/AIDS

This is a huge step!

Communicated by the Federal Commission for HIV/AIDS.

HIV-infected persons on effective anti-retroviral therapy are sexually non-infectious

P. Vernazza, B. Hirschel, E. Bernasconi

Summary.

The Federal Commission for HIV/AIDS, following the proposal of the Sub-commission on Clinical and Therapeutic Aspects, and after review of the medical literature and extensive discussion, resolves that:

An HIV-infected person on anti-retroviral therapy with completely suppressed viremia („effective ART“) is not sexually infectious, i.e. cannot propagate HIV through sexual contact.

This statement is valid if

· this person is compliant with ART, whose effect must be evaluated regularly by the treating physician, and

· the viral load has been suppressed (non-detectable) since at least six months ago, and

· there are no other sexually transmitted diseases

a) Transmission depends on the viral load.

We define „effective ART“ as fully suppressive, stable treatment, with a viral load below the limits of detection in plasma (< 40 copies/ml). Treatment is considered "stable" once the viral load has been undetectable for at least six months.

The Commission realizes that medical and biologic data available today do not permit proof that HIV-infection during effective ART is impossible, because the non-occurrence of an improbable event cannot be proven. If no transmission events were observed among 100 couples followed for two years, for instance, there might still be some such events if 10'000 couples are followed for 10 years. The situation is analogous to 1986, when the statement “HIV cannot be transmitted by kissing” was publicized. This statement cannot be proven, but after 20 years’ experience its accuracy appears highly plausible.

Concerning the statement "an HIV-infected person on anti-retroviral therapy with completely suppressed viremia („effective ART“) cannot propagate HIV through sexual contact” however, the evidence is much better than what was available in 1986 regarding kissing.

1) In sero-discordant couples (one person seropositive, the other seronegative), the risk of transmission depends on the viral load of the HIV-infected partner, see Figure 1 from reference (1).

2) In a prospective study of 393 heterosexual sero-discordant couples there were no infections among partners of persons on ART, compared to a rate of transmission of 8.6% among partners of untreated patients (3).

3) In another prospective study of 92 sero-discordant couples, where in 41 cases the HIV-positive partner had started therapy, there were 6 infections. All these occurred in partners of untreated patients (3).

4).Among 62 sero-discordant couples, where the male partner was HIV positive and on ART, with unprotected sex in order to conceive, there was no transmission (4).

5) Transmission from mother to newborn also depends on the maternal viral load, and did not occur in pregnancies where the maternal viral load was below 1000 copies per ml. If the maternal viral load is higher, transmission can be prevented by ART (5-8).

b) Effective ART eliminates virus from genital secretions

HIV-RNA, measured in sperm, declines below the limits of detection during ART (15-17). The viral load (HIV-RNA) in female genital secretions is, as a rule, below the plasma VL and below the limits of detection during effective ART. As a rule, it rises after, not before, an increase in plasma VL (18). Cell-associated viral genomes are present in genital secretions, even during ART (15, 19-21). But these are not functional virions. HIV-containing cells in sperm lack markers of viral proliferations such as circular LTR-DNA (22).

The concentration of HIV RNA in sperm (sperm VL) correlates with the risk of transmission. Transmission risk declines towards 0 with falling sperm VL, see Figure 2. These data indicate that the risk of transmission is greatly decreased by ART.

c) Exceptions and caveats

· After a few days or weeks of discontinuation of ART, plasma viral load rises rapidly. There is at least one case report of transmission during this rebound (14)

· In patients without ART, sexually transmitted diseases (STDs, for instance urethritis or genital ulcer disease) increase the genital VL; it falls again after treatment of STD (24). In a patient with urethritis, sperm VL can rise slightly even while patient is receiving effective ART. This rise is small, however, much smaller that the rise observed in patients without ART.

d) Conclusion

· During effective ART, free virus is absent from blood and genital secretions. Epidemiologic and biologic data indicate that during such treatment, there is no relevant risk of transmission.

· Residual risk can not be scientifically excluded, but is, in the judgment of the Commission, negligibly small

References

1 Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group [see comments]. N Engl J Med 2000; 342: 921-929.

2 Castilla J, del Romero J, Hernando V, Marincovich B, Garcia S, Rodriguez C. Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. J Acquir Immune Defic Syndr 2005; 40: 96-101.

3 Melo M, Varella I, Nielsen K, Turella L, Santos B. Demographic characteristics, sexual transmission and CD4 progression among heterosexual HIV-1 serodiscordant couples followed in Porto Alegre, Brazil. 16th International AIDS Conference, Toronto, 13-18.August 2006, TUPE0430. 2006.

4 Barreiro P, del Romero J, Leal M, et al. Natural pregnancies in HIV-serodiscordant couples receiving successful antiretroviral therapy. J Acquir Immune Defic Syndr 2006; 43: 324-326.

5 Garcia PM, Kalish LA, Pitt J, et al. Maternal Levels of Plasma Human Immunodeficiency Virus Type 1 RNA and the Risk of Perinatal Transmission. New England Journal of Medicine 1999; 431: 394-402.

6 Rousseau C, Nduati R, Richardson B, et al. Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease. J Infect Dis 2003; 187: 741-747.

7 Kilewo C, Karlsson K, Massawe A, et al. Prevention of mother-to-child transmission of HIV-1 through breastfeeding by treating mothers prophylactically with triple antiretroviral therapy in Dar es Salaam, Tanzania - the MITRA PLUS study. 4th IAS Conference, Sydney, July 2007 TUAX 101. 2007.

8 Arendt V. AMATA study: effectiveness of antiretroviral therapy in breastfeeding mothers to prevent post-natal vertical transmission in Rwanda. 4th IAS Conference, Sydney, July 2007 Abstract TUAX 102. 2007.

9 Porco TC, Martin JN, Page-Shafer KA, et al. Decline in HIV infectivity following the introduction of highly active antiretroviral therapy. AIDS 2004; 18: 81-88.

10 Yerly S, Vora S, Rizzardi P, et al. Acute HIV infection: impact on the spread of HIV and transmission of drug resistance. AIDS 2001; 15: 2287-2292.

11 Yerly S, Race E, Vora S, et al: HIV Drug Resistance and Molecular Epidemiology in Patients with Primary HIV Infection. 8th Conference on Retroviruses and Opportunistic Infections, Chicago, 4.-8.Feb.2001 2001; Abstract 754(Abstract)

12 Brenner BG, Roger M, Routy JP, et al. High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis 2007; 195: 951-959.

13 Chesson HW, Pinkerton SD. Sexually transmitted diseases and the increased risk for HIV transmission: implications for cost-effectiveness analyses of sexually transmitted disease prevention interventions. J Acquir Immune Defic Syndr 2000; 24: 48-56.

14 Bernasconi E, Vernazza PL, Bernasconi A, Hirschel B. HIV transmission after suspension of highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2001; 27: 209.

15 Vernazza, P. L., Troiani, L., Flepp, M. J., Cone, R. W., Schock, J., Roth, F., Boggian, K., Cohen, M. S., Fiscus, S. A., Eron, J. J., and and the Swiss HIV Cohort Study. Potent antiretroviral treatment of HIV-infection results in suppression of the seminal shedding of HIV. AIDS. 2. 2000.

16 Cu-Uvin S, Caliendo AM, Reinert S, et al. Effect of highly active antiretroviral therapy on cervicovaginal HIV-1 RNA. AIDS 2000; 14: 415-421.

17 Vettore MV, Schechter M, Melo MF, Boechat LJ, Barroso PF. Genital HIV-1 viral load is correlated with blood plasma HIV-1 viral load in Brazilian women and is reduced by antiretroviral therapy. J Infect 2006; 52: 290-293.

18 Cu-Uvin S, Snyder B, Harwell JI, et al. Association between paired plasma and cervicovaginal lavage fluid HIV-1 RNA levels during 36 months. J Acquir Immune Defic Syndr 2006; 42: 584-587.

19 Vernazza PL, Kashuba DM, Cohen MS. Biological correlates of sexual transmission of HIV: practical consequences and potential targets for public health. Reviews in Medical Microbiology 2001; 12: 131-142.

20 Neely MN, Benning L, Xu J, et al. Cervical shedding of HIV-1 RNA among women with low levels of viremia while receiving highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2007; 44: 38-42.

21 Kovacs A, Wasserman SS, Burns D, et al. Determinants of HIV-1 shedding in the genital tract of women. Lancet 2001; 358: 1593-1601.

22 Nunnari G, Otero M, Dornadula G, et al. Residual HIV-1 disease in seminal cells of HIV-1-infected men on suppressive HAART: latency without on-going cellular infections. AIDS 2002; 16: 39-45.

23 Chakraborty H, Sen P, Pranab K, et al. Viral burden in genital secretions determines male-to-female sexual transmission of HIV-1: a probabilistic empiric model. AIDS 2001; 15: 621-627.

24 Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet 1997; 349: 1868-1873.

25 Sadiq ST, Taylor S, Kaye S, et al. The effects of antiretroviral therapy on HIV-1 RNA loads in seminal plasma in HIV-positive patients with and without urethritis. AIDS 2002; 16: 219-225.

26 Pilcher CD, Tien HC, Eron JJ, Jr., et al. Brief but Efficient: Acute HIV Infection and the Sexual Transmission of HIV. J Infect Dis 2004; 189: 1785-1792.

Regards,

Nelson Vergel
powerusa dot org

Start the year off right. Easy ways to stay in shape in the new year.

#24250

From: PoWeRTX@...
Date: Tue Jan 29, 2008 7:28 pm
Subject: Calcium Supplements Increase Vascular Events?

nelsonvergel

Offline

Calcium Supplements Increase Vascular Events?

News Author: Lisa Nainggolan
CME Author: Hien T. Nghiem, MD

from Heartwire — a professional news service of WebMD

January 24, 2008 — A new study has shown that calcium supplementation might increase vascular events in elderly women [1]. The findings are somewhat unexpected, because previous trials have shown that calcium improves blood cholesterol levels, senior author Dr Ian R Reid (University of Auckland, New Zealand) told heartwire.

Dr Mark J Bolland (University of Auckland, New Zealand) and colleagues published the findings online in BMJ January 15, 2008.

"This is quite controversial, given that the worldwide calcium-supplement market is worth $3 billion a year," says Reid. "The trial was primarily looking at what calcium supplements do to bone density, but we had a secondary hypothesis right from the outset that calcium might actually prevent heart attack. What we found, to our surprise, was that we didn't see a decrease but an increase, and the findings appear to be quite robust." Reid added, however, that there have been some clues from three other recent studies, including one from Women's Health Initiative (WHI) in the US [2]: "these three did not find significant increases in the number of heart attacks [with calcium], but they have found upward trends."

Dr Erin D Michos (Johns Hopkins University, Baltimore, MD), who was not involved with this new study but cowrote an editorial accompanying the publication of the WHI study on vitamin-D/calcium supplements last year [3], told heartwire: "This is a thought-provoking study, although not definitive, but further work should be done."

Others warned that it is premature to make any treatment decisions on the basis of this new study. British Heart Foundation spokesperson Judy O'Sullivan said more rigorous research was needed before any firm conclusions could be drawn. "Anyone who has been advised by their doctor to take calcium supplements to protect their bones should not stop doing so in light of this study alone without medical advice," she said.

Findings equivocal

The New Zealand team randomized 1471 postmenopausal women (average age 74 years) to either calcium supplementation (1 g/day calcium citrate) or placebo. As well as bone density, they looked at adverse cardiovascular events over five years: death, sudden death, myocardial infarction (MI), angina, other chest pain, stroke, transient ischemic attack, and a composite end point of MI, stroke, or sudden death.

Reid says the study collected data on MIs and strokes "in a much more careful way" than any other previous studies have done. "We got cardiologists and other people involved and audited all those things and went back to patients' hospital records and so on."

MI was more commonly reported in the calcium group than in the placebo group (45 events in 31 women vs 19 events in 14 women, p=0.01), and the composite end point was also reached more often in the calcium group (101 events in 69 women vs 54 events in 42 women, p=0.008). Even after adjudication, MI remained more common in the calcium group, as did the composite end point.

Verified vascular events self-reported by healthy postmenopausal women assigned to calcium supplementation or to placebo, or reported by family members

Vascular event	Calcium group (n = 732)	Placebo group (n = 739)	Relative risk (95% CI)	p
MI	24	10	2.12 (1.01 - 4.47)	0.047
Stroke	34	23	1.42 (0.83 - 2.43)	0.21
Sudden death	3	3	1.01 (0.20 - 4.99)	1.0
Composite end point	61	36	1.47 (0.97 - 2.23)	0.076

But when unreported events were added from the national database of hospital admissions in New Zealand, the relative risk of MI was 1.49 in those taking calcium compared with placebo recipients (p=0.16) and that of the composite end point 1.21 in those taking calcium compared with those on placebo (p=0.32).

"Thus, the present study does not unequivocally show an adverse cardiovascular event of calcium but suggests that this matter needs to be considered carefully before calcium supplementation can be broadly advocated," the researchers note.

Michos told heartwire the results are somewhat difficult to interpret, because there appear to be some imbalances between the calcium and placebo arms at baseline, "which may have influenced the higher outcomes seen in the calcium arm."

Also, the New Zealand team did not report serum vitamin-D levels, except to say they excluded those with very severe vitamin-D deficiency, she notes. "While I still believe vitamin D is important and beneficial for cardiovascular health, supplementation with calcium alone (without vitamin D) may not be beneficial for CV [cardiovascular] health."

Age may play a role

Reid says that "there is a possibility that this was a chance finding, but what makes us believe that this is not the explanation is that there have been three other recent studies — one from the UK, one from the US, and one from Australia — that have found upward trends in the numbers of heart attacks with calcium, so we are showing the same sorts of trends."

"Taken together, these four studies raise major concerns about the cardiovascular safety of calcium supplementation, particularly with respect to MI in older postmenopausal women," say the researchers in their paper.

Reid says it is important to consider age. The women in the New Zealand study were quite old, those in the Australian study were similarly elderly, but those in the US — the WHI study — were more than 10 years younger, as were the ones studied in the UK.

"Most of the trials have been done in women in their 50s and 60s, and the signal hasn't come through as strongly in those younger women, so it's probably okay [to use calcium] in those younger women."

High calcium uptake might accelerate calcification of arteries?

The findings from his study may also be stronger, Reid said, because they used quite a high dose, 1 g per day, and a more soluble calcium preparation than others have done, which probably resulted in better compliance. "And our study is a bit longer than some of the others, so that may also explain why we've got a more powerful effect.

"The other thing that makes us think that this is not a chance finding is that it is now pretty well established that patients on dialysis using calcium supplementation are at increased risk of heart attack and death.

"What we think is happening is that the higher calcium intake — and particularly the bolus of calcium that supplementation provides — is somehow accelerating the laying down of calcium in the artery walls of the heart," he notes.

"The way I interpret this is that if you have preexisting heart disease — which probably most of our participants did, although they probably weren't aware of it — then the extra calcium appears to be bad. But if, on the other hand, you are 54 and you have nice clean arteries to your heart, then probably calcium is not going to cause you any major problems. That's my take on it. But I don't know if it can be proven."

He added that the advice they have been providing to women in New Zealand in the past few months, since they became aware of these findings, "is that if you are in the older age group and are known to have heart disease, it's probably not sensible for you to take a calcium supplement. In younger people, calcium supplements look reasonable, but it may be sensible to aim for a smaller dose, say 500 mg/day."

He noted that the study also showed — "in a more clear-cut way than any other" — that calcium substantially slows bone loss, "so going down to 500 mg/day is not going to achieve the same bone benefit, although it is probably a safer balance."

But for patients who really have major problems with osteoporosis, "it's much more sensible to focus on using specific osteoporosis drugs," he said. "If you've got osteoporosis, take other things, don't just rely on extra calcium."

What's next?

Reid says his team has a number of plans to look at this issue going forward. "We are going to try to access the radiographs from women in the study and see if we can quantify calcification in them." They also have another study that has just finished, this time in a few hundred men, in which they are looking at coronary artery calcium. "In the men's study, they are younger, and there is an adverse trend, but it's much smaller," he noted.

And he hopes to coordinate a meta-analysis of the UK, US, and Australian studies and his own "to see if we can use all the available evidence to determine whether there really is something solid here."

Reid has received research support from and acted as a consultant for Fonterra and Mission Pharmacal.

Sources

Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. BMJ 2008; DOI:10.1136/bmj.39440.525752.BE. Available at: http://www.bmj.com.
Hsia J, Heiss G, Ren H, et al. Calcium/vitamin D supplements and cardiovascular events. Circulation. 2007;115:846-854.
Michos ED, Blumenthal RS. Vitamin D supplementation and cardiovascular disease risk. Circulation. 2007;115:827-828.

The complete contents of Heartwire, a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.

Clinical Context

Current evidence suggests that high intake of calcium may play a protective role against vascular disease. Calcium supplementation has been demonstrated to increase the ratio of high-density lipoprotein cholesterol to low-density lipoprotein by almost 20% in healthy postmenopausal women. Additional studies have suggested that calcium may play a role in reducing blood pressure and contributing, though inconsistently, to weight loss. Because of the high incidence of vascular disease in postmenopausal women, any effects of calcium supplementation on vascular health could be as important in their effect on morbidity and mortality as their effects on bone.

The aim of this study was to determine the effect of calcium supplementation on MI, stroke, and sudden death in healthy postmenopausal women.

Study Highlights

In this randomized placebo-controlled trial in an academic medical center in an urban setting in New Zealand, 1471 postmenopausal women (mean age, 74 years) were enrolled. 732 were randomized to 1 g of elemental calcium supplementation and 739 to placebo daily.
This study was a secondary analysis of a randomized controlled trial of calcium supplementation in healthy postmenopausal women, primarily designed to assess the effects of calcium on bone density and fracture incidence for 5 years.
Women were included if they had been postmenopausal for more than 5 years, were 55 years or older, and had a life expectancy of more than 5 years.
Baseline characteristics were similar between the groups.
The women were followed up every 6 months for 5 years.
Main outcome measures were adverse cardiovascular events in 5 years: death; sudden death; MI; angina; other chest pain; stroke; transient ischemic attack; and a composite endpoint of MI, stroke, or sudden death.
Results demonstrated that MI was more commonly reported in the calcium vs the placebo group (45 events in 31 women vs 19 events in14 women; P = .01).
The composite endpoint of MI, stroke, or sudden death was also more common in the calcium group (101 events in 69 women vs 54 events in 42 women; P = .008).
After adjudication, MI remained more common in the calcium group (24 events in 21 women vs 10 events in 10 women; relative risk, 2.12; 95% confidence interval [CI], 1.01 - 4.47;
P = .047).
For the composite endpoint 61 events were verified in 51 women in the calcium group and 36 events in 35 women in the placebo group (relative risk, 1.47; 95% CI, 0.97 - 2.23;
P = .076).
When unreported events were added from the national database of hospital admissions in New Zealand, the relative risk for MI was 1.49 (95% CI, 0.86 - 2.57), and that of the composite endpoint was 1.21 (95% CI, 0.84 - 1.74).
This process resulted in some attenuation of the calcium effect; however, the rate ratios for MI and for the composite endpoint had borderline significance.
The respective rate ratios were 1.67 (95% CI, 0.98 - 2.87) and 1.43 (95% CI, 1.01 - 2.04); event rates were 16.3 per 1000 person-years for placebo and 23.3 per 1000 person-years for calcium.
Limitations to this study included the small size and the lack of generalizability to other ages and racial groups.

Pearls for Practice

Current evidence has demonstrated that increased calcium intake may lead to improved ratio of high-density lipoprotein cholesterol to low-density lipoprotein cholesterol as well as playing a role in blood pressure reduction and weight loss.
Calcium supplementation in healthy postmenopausal women may be associated with upward trends in cardiovascular event rates.

Regards,

Nelson Vergel
powerusa dot org

Start the year off right. Easy ways to stay in shape in the new year.

#24249

From: JuLev@...
Date: Tue Jan 29, 2008 6:44 pm
Subject: NATAP: Bone Disease in HIV

jules72orange

Offline

New NATAP Section on website

Bone Disease

New Bone Drug Denosumab in Postmenopausal Women with Low Bone Mineral Density - (01/29/08)
�
Low Serum Testosterone Caused Fractures, study found - (01/29/08)
�
Bone Health: calcium, vitamin D - (01/29/08)
�
Use of Oral Bisphosphonates and the Risk of Aseptic Osteonecrosis: A Nested Case-Control Study - (01/29/08)
�
Serum 25-Hydroxyvitamin D and Bone Mineral Density in a Racially and Ethnically Diverse Group of Men - (01/29/08)
�
Muscle mass and bone mineral indices: does the normalized bone mineral content differ with age? - (01/29/08)
�
Vitamin D Reduces Risk of Fall by 23% - (01/29/08)
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Vitamin D: What's Enough? Part II - (01/29/08)
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From muscle strength to immunity, scientists find new vitamin D benefits Part 1 - (01/29/08)
�
Increased Bone Turnover in Patients with Hypercholesterolemia. - (01/29/08)
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Muscle mass and bone mineral indices: does the normalized bone mineral content differ with age? - (01/29/08)
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New Bone Therapy Denosumab vs Fosamax - (01/25/08)
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Bone Loss 62% in HIV+ - (01/23/08)
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Factors Associated with Low Bone Mineral Density (BMD) in a Large Cohort of HIV-Infected U.S. Adults - Baseline Results from the SUN Study -CROI 2007 - (01/23/08)
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80% Bone Abnormalities in France Aquitane Cohort, 27% Osteoporosis - (01/23/08)
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Bone Disease in HIV: study finds, heavily pre-treated patients had Vitamin D deficiency & serum marker abnormalities & perhaps serum markers may be better for assessing patient risk than total BMD by DEXA - (05/31/05)
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Effects of chronic liver disease on bone mineral density and bone metabolism markers in postmenopausal women - (11/07/05)
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Bone Loss in Liver Disease(02/04/02)
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Bone Density and HIV Infection David Alain Wohl, MD University of North Carolina AIDS Treatment and Research Unit - April 3, 2002
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Bone Abnormalities at ICAAC: Osteoporosis, Osteonecrosis Written for NATAP by Michael Norton, PA-C, Boriken Health Clinic, NYC - Jan 10, 2002
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Low-impact exercise can increase bone mass in women - (10/31/01)
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Nucleosides (NRTIs) and Reduced Bone Mineral Density (Osteopenia) - (5/28/2001)
�
Review of Studies on Bone Problems at ICAAC and Lipodystrophy Workshop
- (9/22/00)
�
Osteopenia in HIV Infection
(01/05/00)

**************
Start the year off right. Easy ways to stay in shape.
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Reply | Forward | Messages in this Topic (2)

#24248

From: solarjerom@...
Date: Tue Jan 29, 2008 2:03 pm
Subject: Re: Travel Restrictions to Jamaica.

solarjerom

Offline

It's a homophobic place and Kingston is also a dangerous place, especially at night.

As for rules about HIV status -- I simply never ever mention anything. I work all over the world and have never been asked. If asked I would lie. 'taint no one's business.

Unless you absolutely must go to Jamaica, I'd suggest Barbados (lovely place and the only island nation in the Caribbean with its own Zagat guide). Aqua restaurant, on the ocean, is fabulous.

And then there is always Hawaii.

Jerome

Start the year off right. Easy ways to stay in shape in the new year.

#24247

From: Roger Ramjet <roger92103@...>
Date: Tue Jan 29, 2008 4:28 pm
Subject: Re: Travel Restrictions to Jamaica.

roger92103

Offline

There are always two places to look - the country's embassy website, and the US state department site.

http://www.embassyofjamaica.org/VISnorthamericanvisitors.htm

http://travel.state.gov/travel/cis_pa_tw/cis/cis_1147.html

If you want to be sure, I would suggest calling that country's embassy and directly asking the question.

Good luck!

----- Original Message ----
From: milwjocknow <milwjocknow@...>
To: PozHealth@yahoogroups.com
Sent: Tuesday, January 29, 2008 5:55:30 AM
Subject: [PozHealth] Travel Restrictions to Jamaica.

Hey Guys,

Does anyone know if Jamaica has any travel restrictions relative to HIV
status? For example, do they bar entry to people who are HIV
Positive?

Thanks.

Looking for last minute shopping deals? Find them fast with Yahoo! Search.

#24246

From: meat packing district <meatpkgdst@...>
Date: Tue Jan 29, 2008 3:58 pm
Subject: Re: Travel Restrictions to Jamaica.

meatpkgdst

Offline

Be careful, as they're not very gay-positive there, restrictions or not. I had a horrible experience.

On Jan 29, 2008, at 8:55 AM, milwjocknow wrote:

Hey Guys,

Does anyone know if Jamaica has any travel restrictions relative to HIV�
status? For example, do they bar entry to people who are HIV�
Positive?�

Thanks.

#24245

From: PoWeRTX@...
Date: Tue Jan 29, 2008 10:21 am
Subject: New Debate on Some Blood Pressure Drugs

nelsonvergel

Offline

New Debate on Some Blood Pressure Drugs

Study Compares Diuretics and Other Treatments for People With Metabolic Syndrome, High Blood Pressure

By Jennifer Warner
WebMD Medical News

Reviewed by Louise Chang, MD

Jan. 28, 2008 -- Researchers say a new analysis questions the preferred use of certain blood pressure medications over diuretics in people with metabolic syndrome.

The analysis shows thiazide diuretics worked as effectively at treating high blood pressure -- and in some cases better -- than calcium channel blockers, ACE inhibitors, or alpha-blockers in people at high risk for complications from high blood pressure and metabolic syndrome.

The study was published in the Jan. 28 edition of Archives of Internal Medicine.

Metabolic syndrome is defined as elevated blood pressure plus at least two other risk factors, such as elevated fasting blood sugar and triglyceride levels. Having metabolic syndrome puts you at increased risk for heart disease and diabetes. Those with high blood pressure who also have metabolic syndrome are at high risk for cardiovascular disease.

Researchers say that because alpha-blockers, ACE inhibitors, and calcium channel blockers are believed to have favorable short-term effects on blood sugar or cholesterol levels, they have been suggested for treating high blood pressure in people with metabolic syndrome over diuretics.

(If you have metabolic syndrome, would you try diuretics as a treatment? Why or why not? Talk about it on WebMD's Hypertension Support Group message board.)

Diuretics for High Blood Pressure

In the study, Jackson T. Wright Jr., MD, PhD, of Case Western Reserve University, and colleagues analyzed the results of a large national study including 42,418 people at least 55 years old with high blood pressure and at least one other risk factor for heart disease.

All participants had high blood pressure and some qualified for metabolic syndrome. Groups were randomly assigned to take a diuretic, calcium channel blocker, alpha-blocker, or an ACE inhibitor. Each high blood pressure medication was used to start treatment, and other drugs could be added if needed to control blood pressure.

The participants were followed for nearly five years, except for the alpha-blocker group, which was discontinued after about three years after higher rates of stroke and heart failure were found compared with those taking diuretics.

Overall, the results show no significant advantage in preventing heart attack or other fatal heart-related complications with the use of calcium channel blockers, alpha-blockers, or ACE inhibitors over thiazide diuretics in participants with high blood pressure and metabolic syndrome. This was especially evident among African-American participants.

"These findings fail to provide support for the selection of alpha-blockers, ACE inhibitors, or calcium channel blockers over thiazide-type diuretics" to prevent cardiovascular problems in patients with metabolic syndrome, the researchers conclude.

Regards,

Nelson Vergel
powerusa dot org

Start the year off right. Easy ways to stay in shape in the new year.