UNDERSTANDING LAB TESTS - CD4 CELL COUNT TESTS

A regular part of HIV health care involves having blood tests done every 3-6 months to monitor your overall health, the progression of HIV disease, your immune system's response to medications that you are taking, and any medication-related side effects or complications. Some of the most common laboratory tests done are the CD4 cell count, HIV viral load, blood chemistry (includes liver and kidney function tests), blood lipid panels (cholesterol, blood fats), blood sugar tests, and complete blood count, or CBC (checks for low white cell counts and anemia). It is important for a person who is being treated for any chronic disease to be educated about the disease and its treatment in order to be a true "partner" in their own health care. HIV is no exception. You should know what lab tests are being done, what they are measuring or monitoring, and the implications of the results. In this post I will discuss the CD4 cell count (T Cells).

In order to understand how HIV breaks down the immune system, it is important for you to have a basic understanding of how the immune system works when it is healthy and not compromised by HIV. The immune system is one of the most complex systems in the human body. HIV harms the body's immune system by targeting and infecting the CD4 cells, or T-cells, which are a type of white blood cell whose purpose in the body is to resist infection and protect the body from illness. The CD4 cells are a major part of the body's natural first-line defense against illness. Once inside the CD4 cells, HIV takes over the cells and turns them into "virus factories" within the body, making thousands of copies of itself in each cell. As the amount of virus grows, the original CD4 cell is damaged and eventually destroyed. HIV eventually kills so many of these cells that the immune system is weakened and the body is no longer able to defend itself against infections (bacteria, viruses, parasites, molds) and certain cancers. If left untreated, HIV can lead to the development of opportunistic infections, AIDS, and death.

So, why do you need to know all of this? Because you need to understand how HIV affects the immune system in order to understand and appreciate the role of antiretroviral medications (drugs used to treat HIV and AIDS) in your treatment plan. I have found from dealing with patients that those patients who had a good basic understanding of how the medications worked and why it was important to keep the CD4 cell count higher remained healthier and had much better medication adherence rates and fewer missed doses.

Your HIV specialist will monitor many laboratory tests besides the absolute CD4 cell count, which is the measurement of the total number of CD4 cells (T cells) in your body; this reflects the health of your immune system. They will also monitor the CD4 cell percentage and the ratio of CD4 to CD8 cells, but as a start you should focus on the absolute number of CD4 cells. A normal, healthy person who is not infected with HIV has a CD4 count of 500-16oo cells; this number varies from day to day, depending on the physical and emotional strssors on the body. In an HIV infected person, the CD4 count declines gradually as HIV kills more and more cells. The more CD4 cells a person has, the stronger the immune system is; a CD4 cell count above 500 indicates that the immune system is fairly intact, and the chances of becoming sick are minimal. As the CD4 count decreases, the chances of permanent immune system damage and of developing symptoms of HIV disease are increased. That is why most HIV specialists will begin to discuss starting antiretroviral medications (ARV) to treat the HIV when your CD4 count is between 350-500. United States Government guidelines currently recommend starting ARV medications when the CD4 cell count falls below 350, but this starting point is constantly being debated by the experts and thought-leaders in the field as the risks of opportunistic illness and the toxicities of the medications are considered and compared. If the CD4 count falls below 2oo, your disease has progressed from HIV to AIDS, and you are at a high risk for developing certain opportunistic illnesses; your provider will prescribe certain medications to try to prevent some of these illnesses, but it will be important for you to also take the ARV medications that are prescribed to treat the HIV/AIDS in order to hopefully bring your CD4 count up again. Studies have shown that waiting too long to start treatment with ARV medications and letting the CD4 cell count drop to low may compromise the ability of the immune system to respond to the ARV medications.

A common question is "how long from the time of infection with HIV will it take for the CD4 cells to fall to the level where ARV medications are needed?". This is very difficult to answer, because there are many different variables to consider. First of all, it depends on the CD4 count at baseline. When HIV infection occurs initially, there will be a very rapid rise in HIV viral load and a decrease in the CD4 cell count as the body responds to the acute infection. Over a period of 3-6 months, the CD4 count will stabilize at a somewhat consistent level, and it is predicted that on average about 45 CD4 cells will be lost every 6 months, with slightly higher numbers lost with very high counts. Obviously, it will take longer to progress to needing medications if one starts off with a CD4 count in the high 800's (which is not at all uncommon) than if the baseline CD4 count is 350. This decrease of 45 cells every 6 months is an average, and there are many other factors to consider. Lifestyle plays a very important role in the destruction of CD4 cells, with factors such as high stress, drug use, alcohol abuse, and smoking causing some dramatic drops in CD4 cells in many cases. That is why you will be educated thoroughly about lifestyle changes and the importance of good nutrition, exercise, and sleep habits from the beginning of your treatment. All of these things will affect your overall health and the progression of the disease.

Once you begin ARV medications, your CD4 count should begin to increase slowly. The CD4 count will fluctuate normally throughout treatment, so it is important not to be too overly concerned about or place to much emphasis on a single result. Most HIV specialists will track your results over time on a graph or flow-chart, and you can download a tracker and do this yourself also. Remember, those who actively participate in their care remain healthier and do better overall; you and your provider are equal partners in the fight against HIV/AIDS.

SELENIUM SUPPLEMENTS MAY CONTRIBUTE TO REDUCED HIV VIRAL LOAD

Selenium is a trace mineral that is found in soil that can be absorbed by plants. Research has linked Selenium deficiencies to certain forms of heart disease, hypothyroidism, and immune dysfunction. This mineral has been of interest to researchers in the HIV field for years, and several previous studies have found that HIV positive persons have lower levels of Selenium in their blood than do their HIV negative counterparts, and that this mineral suppresses the replication of HIV in the laboratory. The exact mechanism of the effects of Selenium on HIV is not known, although it is postulated that Selenium has antioxidant properties which may repair damage done to the immune cells. However, much more research is needed to confirm this hypothesis.

A recent study conducted at the University of Miami in Florida has found that supplementation of the mineral Selenium may be helpful to HIV patients by reducing the HIV viral load. The results of this study was published in the January 22, 2007 issue of Archives of Internal Medicine, where the entire study and conclusions can be read online.

In the study, the researchers followed 262 HIV positive patients with normal selenium levels from 3 counties in Florida. The patients were randomly assigned to one of two groups: one group took a 200 mcg. capsule of Selenium daily, while the other group took a placebo. A total of 174 patients completed the study. About 2/3 of all of the participants were already taking antiretroviral medications to treat HIV; these medications were continued. The researchers found that the group taking Selenium experienced an average decrease in the blood HIV viral load levels (the number of copies of the HIV virus in the blood) of 12%; these patients also showed a mean increase of 30 CD4+ cells (a measure of the health of the immune system. The higher the CD4+ cell count, the healthier the immune system is), which appears to indicate that the Selenium makes the HIV less virulent and less capable of replicating, thus enhancing the immune function of the CD4+ cells. The placebo group had an increase in the HIV viral load of 10,000-20,000 viral particles per milliliter of blood and a decrease of about 30 CD4+ cells.

Put into perspective, this study shows that the mineral Selenium does appear to help immune function at a maximum dose of 200 mcg. per day, and it has no known serious side effects or drug-drug interactions. It is an inexpensive and safe adjunct ("booster") therapy to use along with conventional antiretroviral medications, and should also be considered for those HIV positive patients who are not yet taking medications for HIV, as it may help to delay the need to start treatment.

Plant foods are the major dietary sources of Selenium. It must be noted that Selenium deficiencies are rare in the U.S. in the normal population. There is a fine line between therapeutic levels and toxicity, which can have serious implications including loss of hair and nails, skin redness and blistering, vomiting, fatigue, neurological defects, and damage to the liver and spleen. Anyone considering taking a supplement should first consult with their healthcare provider and decide if this is a right for them to do. If taken as a supplement, Selenium can be purchased over the counter, and the maximum dosage should be 200 mcg. per day. Given the quality of the current research, it seems reasonable to take a daily supplement of Selenium along with any other prescribed treatment for HIV disease.

NEW YORK CITY'S OFFICIAL CITY CONDOM

New York City is the "capital" of the HIV and AIDS epidemic in the United States, with more cases than any other area of the country. Currently, more than 100,000 people in New York City are known to have HIV or AIDS, and AIDS is the city's third-leading cause of death among all people under the age of 65. During 2005, NY City Mayor Michael Bloomberg and the NY City Department of Health and Mental Hygiene began a massive free condom distribution campaign in an effort to reduce the prevalence of sexually transmitted diseases, including HIV. The condoms are distributed locally and via the Internet at no cost to the community and to social service organizations.

It is estimated that as many as 20,000 people in NY City alone are HIV positive but are unaware of their status, which puts literally thousands of other people at risk for becoming infected with the virus. Aggressive HIV testing programs and free condom distribution are among the initiatives that have been implemented in NY to help prevent the spread of HIV and other sexually transmitted diseases. HIV testing is offered free and anonymously to anyone in an effort to identify infection earlier and possibly prevent the inadvertent spread of the disease. Consistent use of latex condoms has been proven to be an effective means of preventing HIV infection as well as most other sexually transmitted diseases. Condoms are manufactured according to strict standards, and the minuscule failure rate of condoms has been shown to be mostly due to human error, such as improper size, improper application, condoms not being used for the entire duration of intercourse, or condoms being used with spermicides or oils which cause them to rip and tear.

NY City hands out 18 million free condoms each year for distribution at health clinics, advocacy groups, bars and nightclubs, restaurants, beauty salons, and prisons. That is about 1.5 million condoms each month! It is estimated that the city spends approximately $750,000 per year to buy the condoms. NY City officials are predicting that people would be even more likely to use the condoms if they came in distinctive packages, as marketing experts will confirm that brands and effective packaging work and that people are more likely to use a branded item. They also feel that the use of a memorable package might help them to more accurately conduct health surveys and track the effectiveness of the campaign; if a respondent describes the wrapper, then it is more likely that they have used the condoms.

The NY Post recently reported that NY Mayor Bloomberg is about to unveil the city's own "NY City brand" of free condoms for distribution. The condoms will be packaged in noticeable and memorable foils featuring a variety of different colors representing the city's different subway lines. NY will be the first city in the nation to have its own signature condoms. The condoms will be made of standard, lubricated latex and will continue to be distributed free of charge in order to promote safe sex and prevent HIV/AIDS and other sexually transmitted diseases.

Of course there has been opposition to the distribution of free condoms by some social conservatives and religious groups who claim that the government is encouraging and condoning sexual promiscuity, but the campaign has been largely well-received by the government and the public.

New York may be the first city to have its own signature condoms, but I can see that many other cities will soon be following in its footsteps. Here In Buffalo, NY I hope that our condoms are packaged in foils with hockey players and Chicken Wings!

NEW HIGH-TECH CONDOMS BEING DEVELOPED

SPRAY-ON CONDOMS: "TAILOR-MADE" FOR ALL SIZES OF MEN, MAKING SAFE SEX EASIER?
Reuters Photo: December, 2006; Jan Vinzenz Krause of the Institute for Condom Consultancy in Berlin, Germany produces a prototype of a new spray-on condom that is currently being developed.


A Reuters News article recently described the efforts of a German research team to develop "the perfect condom" for men that would be suited to every size of penis, enabling people to enjoy more comfortable and safer sex lives. The researcher reported that his inspiration for this idea came from evaluating and considering the difficulties that many men report when using condoms.

The biggest prevention message since the beginning of the HIV/AIDS epidemic has been to practice safe sex using a latex condom with a water-based lubricant with every intimate encounter. Research studies have confirmed that some people really do experience practical difficulties with the use of condoms. Problems with the use of condoms can make them less effective or cause the couple to be less likely to use them.

• Access to condoms is sometimes reported as a problem. Even though condoms are reasonably priced, the cost may be prohibitive for people who have difficulty making ends meet and live from paycheck to paycheck; condoms may fall to the bottom of the priority list. Couples are encouraged to check if their health insurance will cover all or part of the cost of condoms, or to go to the local Health Department, family planning center, STD clinic, or HIV testing center for access to free condoms.
  
• Many men report difficulty putting condoms on. Men are encouraged to read the insert in the package and to follow the instructions for putting the condom on properly; they can also get information about condom use at most clinics offering STD testing and testing.
  
• All men are not built alike, and penises come in a variety of shapes and sizes. One size of latex condom does not fit all men comfortably. Finding the right size and fit for a condom may take some experimenting. Men may prefer a slightly looser or snugger fit, or may want to try a flared condom which is a bit roomier at the head. The important thing is that the condom fits snugly enough so that it does not slip off during intercourse.
  
• Both slippage and breakage of condoms can be prevented by choosing the right fit and type of condom. If a man's penis is thick but not exceptionally long, he may need to experiment with sizes to find a condom that is not likely to break. Ultra-strong or thicker latex condoms are recommended for heavy-duty, rough sex or for anal intercourse. Condoms must be used with plenty of water-based lubricant; the use of oils and oil-based lubricants, spermicidal creams, or antifungal vaginal creams will cause the condom to break down and rupture quickly. Condoms have expiration dates and specific storage recommendations that ensure the quality of the latex. If a condom has been stored in a wallet or the glove-box of a car for "emergency use", it will most likely be prone to breakage and should not be used. In order to prevent the condom from slipping off, the man should apply lubricant to the outside of the condom, never on the penis itself or on the inside of the condom. He should also hold the base of the penis and condom when pulling out after sex to prevent the condom from slipping.
  

These are the major difficulties reported by couples when using condoms. Now, with the introduction of this new spray-on condom, is it really possible that the days of fumbling with condom wrappers and condoms are going to be a thing of the past?

The research team plans to make the spray-on condom available in different strengths and colors, and hope that it will be on the market by 2008. The projected cost for the device is approximately $13 for 20 applications, which is relatively inexpensive for a condom product.

My opinion is that we will not see this product approved by the U.S. FDA and on the marketplace in the U.S. any time soon, if at all. First of all, in order for the FDA to grant approval, the company will have to conduct extensive tests in order to ensure that the latex is spread evenly over the penis when sprayed. They would also have to submit scientific proof of the quality of the condoms; in the U.S. there is an "acceptable failure rate" for products like latex condoms and latex surgical gloves, and the manufacturers of these products are held to high standards. Given that each spray-on condom is made individually, there does not seem to be any way of accurately determining the quality of the condoms and evaluating the failure rate of the product. In addition, the process of hardening and the degree of elasticity of the condoms, as well as the breakdown of the product for removal will need to be scientifically determined. Another problem would be the possibility of the spraying mechanism becoming clogged by the latex, which could interfere with the proper application of the product.

Lastly, let's consider one of the major problems with traditional condom use; many couples state that the lack of spontaneity is a major reason for not stopping to use condoms. I have to think that this spray-on protection would elicit the same response from couples. The bottom line is this: the spray-on condom is most likely a pipe-dream that we will not see in the U.S. It is an interesting concept, but it certainly nowhere near ready for "Prime Time". Continue to stock up on latex condoms for now!

TOP 10 MYTHS ABOUT HIV AND AIDS AND WHY THEY ARE NOT TRUE

There has been a tremendous amount of progress in increasing worldwide awareness about HIV and AIDS, and massive education and prevention efforts are ongoing. However, many people remain ignorant to the facts about HIV and AIDS and to how they can prevent the spread of the disease. In this video, Dr. Becky Kuhn, an HIV treatment specialist, talks about the top 10 myths on HIV and AIDS and explains why they are not true.

Dr. Becky Kuhn is the co-founder of Global Lifeworks, which is a not-for-profit organization with the goal of "Bridging Diverse Communities in the HIV/AIDS Pandemic". The vision statement of this organization is: "to pioneer new and unique methods for HIV/AIDS awareness, education, and care for the purpose of improving the quality of life of those infected and affected by HIV/AIDS". The website is full of information; it contains articles, blogs, videos, and photo galleries. I recommend that anyone interested in the worldwide AIDS pandemic visit and explore this worthwhile site.

IDEAS ON ERADICATING HIV AND AIDS WORLDWIDE

Education and Prevention Initiatives which are culturally specific and sensitive are the best chance of controlling the spread of HIV and ultimately eradicating HIV and AIDS.

Sexual transmission, whether it is heterosexual or homosexual, remains the #1 route of transmission worldwide. The blood supply is now extremely safe, due to careful screening of donors and donated blood. Hospital workers and other medical and rescue personnel who may have contact with blood or body fluids are very well trained on the proper precautions to take in order to prevent transmission of blood-borne infections. IV drug users have access to clean needles and works in many areas of the world, and there have been campaigns to educate them on the dangers of sharing needles and how to clean the needles after use.

HIV prevention efforts have failed miserably in the developed parts of the world such as the United States, as evidenced by continued new infections being diagnosed every day; even people who are well-educated on the risks of unprotected sex (including people working in the HIV field) and those who have unlimited access to free condoms are not using them consistently and are becoming infected with the virus. Given these facts, how can we expect to eradicate this disease in areas of the world where the people are poverty-stricken, uneducated, and do not have access to quality medical care or health education programs?

This makes me think that education regarding safer sexual strategies needs to be changed and improved. In most cases, it is not that people are not educated and do not understand the principles of safe sex; for some reason, people tend to make poor choices in the heat of the moment. Humans also tend to have the mindset of "it won't happen to me"... Maybe cognitive-behavioural specialists need to be involved in the education and prevention efforts; these specialists are able to understand and analyze the behaviour of human beings in a more abstract way.

The HIV transmission rates in the developing areas of the world are astounding. In addition to education and prevention efforts, these areas need access to condoms, medical care, HIV testing, and HIV treatment. Much is being done in all of these areas, and much remains to be done. This pandemic is here to stay for a while, and the responsibility lies with each one of us to educate ourselves and others as much as possible and to be compassionate to those who are affected.

WHERE DID HIV COME FROM?

Scientists have developed many different theories about the origin of HIV, but none of them have been proven. HIV is a human virus that is closely related to simian immunodeficiency virus (SIV), a virus that infects chimpanzees and monkeys. SIV has been a known virus in monkeys for thousands of years and does not cause illness in these primates. Studies about the evolution of HIV have estimated that SIV passed from monkeys to humans approximately 80 years ago in the 1930's. It is speculated that human hunters first became infected with the virus after coming into contact with the blood of the monkeys that they had killed for food. In 1999, an international team of scientists confirmed that a chimpanzee native to west equatorial Africa carried a form of SIV which was nearly identical to an aggressive form of HIV. It appears that chimpanzees were the source of HIV, and that the virus somehow crossed species from the chimpanzees to humans. It is not clear when this happened, but there have been reports of HIV infection since the middle of the twentieth century. The earliest known case of HIV in a human was a man in Kinshasa, Democratic Republic of China. Analysis of his blood sample suggested that HIV may have developed from a single virus in the late 1940's or early 1950's.

HIV has existed in the United States since the mid-to late 1970's, when men who had sex with other men were being diagnosed with rare types of pneumonia, cancers, and other unusual illnesses which did not normally occur in people with healthy and intact immune systems in Los Angeles and New York City. In 1982, public health officials began to call this syndrome of opportunistic infections, Kaposi's sarcoma, and Pneumocystis carinii pneumonia in previously healthy men "acquired immunodeficiency syndrome", or AIDS. Formal surveillance of AIDS cases by the U.S. government began in 1982.

HIV, the virus that is known to cause AIDS, was isolated in humans by scientists in 1983; the virus was initially named LTLV-III/LAV. The name was later changed to human immunodeficiency virus (HIV).

HIV started to infect humans and quickly became an epidemic in the middle of the twentieth century. International travel is a key factor that facilitated the movement of HIV from epidemic to pandemic. Even today, the debate over the exact origin of HIV continues. Perhaps it would be more beneficial to the millions of people worldwide who are infected to put that energy and research into how we can better treat existing cases of HIV and AIDS and prevent new infections from occurring.

GREAT RESOURCES FOR COPING WITH NEUROPATHY

John A. Senneff's books have been mentioned in many articles that I have been reading about peripheral neuropathy. His books offer useful insight into coping with the sometimes disabling symptoms of peripheral neuropathy; they are written from a patient's perspective in a down-to-earth and easy to understand way. He discusses traditional as well as complimentary, alternative and experimental therapies to treat neuropathy.

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HIV PERIPHERAL NEUROPATHY

Peripheral neuropathy is a painful condition that is caused by damage to the nerves in the peripheral nervous system, which includes the nerves that run from the brain and the spinal cord to the arms, hands, legs, and feet. The damaged nerves alter sensations and feelings such as pain, temperature, and touch. Peripheral neuropathy occurs frequently with HIV disease and can result in a great deal of pain. It greatly impacts the quality of life of an HIV positive person, often leading to isolation and depression. It is reported in approximately 1/3 of patients who are AIDS diagnosed, but it can occur at any stage of HIV disease including the acute seroconversion stage and the latent (asymptomatic) period.

Causes of peripheral neuropathy:
Peripheral neuropathy is often a side effect of the medications used to treat HIV, but can also be caused by HIV infection itself. Neuropathy can also be caused by vitamin deficiencies (vitamin B12, folate), diabetes, or thyroid abnormalities. Alcohol abuse, older age (greater than 50), and low CD4+cell counts are also assosiated with an increased incidence of peripheral neuropathy.

Drugs that cause peripheral neuropathy:

• Videx (didanisone, ddi), antiretroviral medication used to treat HIV
  
• Zerit (stavudine, d4t), antiretroviral medication used to treat HIV
• Dapsone, used to treat or prevent PCP pneumonia
• Metronidazole (flagyl), antibiotic
• Isoniazid (INH), antibiotic used to treat tuberculosis
  
• Pyridoxine (vitamin B6)
• Ethambutol (used to treat MAC infection)
• Vincristine (chemotherapy to treat Kaposi's sarcoma)
• Hydroxyurea
  
• ALCOHOL
  

Symptoms of peripheral neuropathy:
The earliest symptoms of peripheral neuropathy are pain, numbness, and tingling in the hands and feet in the classic "sock and glove" distribution. The pain is often described as burning, shooting, electric-shock like, throbbing, or aching. Some people describe an altered sensation when picking up objects, as if their fingers are "made of plastic", or feelings of their hands and feet falling asleep. The patient may complain of their feet throbbing or cramping at night or of stumbling when they try to walk. The symptoms are generally symmetric (occur on both sides of the body), although they may be more severe on one side. If the neuropathy is severe, touching the affected extremity can feel like an open wound is being touched. In the most severe cases, severe pain and dysfunction of the nerves can result in difficulty walking and disability.

Diagnosis of peripheral neuropathy:
The diagnosis of peripheral neuropathy can generally be made by a healthcare provider who is experienced in the treatment of HIV disease based on a history of the symptoms and a comprehensive physical examination which includes testing of the reflexes and evaluation of the sense of vibration,touch, pressure, and pain in the extremities. Bloodwork will be done to check CD4+ cell count, HIV viral load, blood glucose (sugar), thyroid function, Vitamin B1, B6, and B12 levels, folate levels, Vitamin E levels, and Magnesium levels. The HIV specialist may refer the patient to a neurologist for an evaluation and treatment recommendations, and nerve-conduction studies (electromyography, or EMG) may be scheduled.

Treatment of peripheral neuropathy:
Unfortunately, there iss no cure for peripheral neuropathy. They key to treatment is to remove the underlying cause and to control the pain.

• If a vitamin deficiency is the cause of the neuropathy, restoring the nutritional balance with vitamin supplementation will often reverse the process.
• In cases of medication-induced neuropathy, reducing the dosage of the offending drug or discontinuing it will oftentimes reverse the neuropathy, although this may take 2-4 months.
• If heavy alcohol consumption has been determined to be a contributing factor, all use of alcohol must be stopped. Substance abuse counselling services may be needed.
  
• Metabolic conditions such as diabetes and thyroid disorders need to be stabilized.
• HIV needs to be well-controlled, with an undetectable HIV viral load.

Medications used to treat peripheral neuropathy:

• Certain anticonvulsants (Tegretol, Lamictal, Neurontin, or Dilantin) have been used with some success in treating HIV related peripheral neuropathy. These medications can change the levels of HIV medications in your body, so be sure to tell your HIV specialist if another healthcare provider prescribes these for you.
• Antidepressants (Elavil, Cymbalta) have shown to have some effect on decreasing the pain associated with neuropathy.
• Topical anesthetics such as lidocaine cream patches or Capsaicin cream may provide some pain relief.
• If Tylenol or Motrin do not provide pain relief, you may need narcotic (opiate-based) pain medications in addition to some of the other medications listed. Narcotics are started at a low dose and are increased gradually until the pain is controlled, as long as there are no side effects.

Other things to try:

• Be sure to keep your healthcare provider informed about how your symptoms are, especially if they are worsening. Report any medication side effects.
• Inspect your feet carefully every morning and every night, including between the toes and the bottoms of the feet. You may hurt your foot and have an infection, but may fail to feel pain due to the neuropathy. Always were socks and properly fitted shoes; do not go barefoot.
• Massaging your hands and feet or soaking them in cold water may provide temporary pain relief.
• Keep your hands and feet cool; many people report feeling more comfortable sleeping without sheets or blankets on their feet.
• Click here for some refernces about experimental treatments that you may wish to consider.
• Some people report good pain relief with accupuncture. Many AIDS Service Organizations offer accupuncture to patients free of charge.
• Get up and walk around!
  

DISCLOSING YOUR HIV STATUS TO OTHERS

If you recently found out that you are HIV positive, you will need to notify any sexual partners or people with whom you have shared needles of your status so that they can get tested. If you are unable to do this yourself, the local Health Department in your area will notify people that they might have been exposed to HIV without mentioning your name.

Whether you have just recently tested positive for HIV or have known your status for a while, it can be difficult to know who to tell about it, when to tell them, and how to go about telling them. Other than notifying sexual partners or people with whom you have shared needles that they may have been exposed, the decision to disclose your HIV status is entirely up to you. You don't have to tell anybody. Once you tell somebody that you are infected with HIV, they will never forget it, so it is important that you take your time to decide if you are ready to do this.

The Benefits of Telling Others:

• You can choose to tell people who you trust and who you feel will be able to offer you love and support. The support and understanding of close family members and friends will help you to deal with the diagnosis of HIV and with the physical and mental health challenges that you will face living with this chronic disease. Having someone to talk with will help as you deal with the emotions that you undoubtedly are feeling; anxiety, fear, anger, disbelief, and depression are all very common.
  
• You will not have to hide your HIV status; keeping a secret of this magnitude from those you are close to can be extremely stressful. By disclosing your status, it will be easier for you to go to appointments for health care and to take medications if needed. You will also have the option of having someone come with you to medical appointments in order to help you to understand and deal with your health issues. In addition, your family will benefit from knowing that you are receiving good health care.
  
• You will reduce the chances of transmitting the virus to others. You will be able to educate yourself and others about how the virus is spread and dispel any myths about casual household contact resulting in infection. You will learn how to protect yourself and your sexual partners. It is important to note that in many states in the U.S. not telling a sexual partner that you are HIV positive before having intimate contact is considered to be a felony.Whether
• Whether or not you disclose your HIV status to other health care providers is your decision, but they will be able to provide better and more appropriate care to you if they are aware of your stHealthcarelthcare providers are knowledgeable about how to protect themselves against HIV.
  

The Downside to Telling Others:

• People may discriminate against you because you have HIV. This is largely due to fear of the disease and the lack of understanding in the general population about HIV and how the infection is spread. There are also issues of stigma relating to sexual preferences or even drug use that many people have to deal with. You may face uncomfortable questions from people about how you became infected.
• Others may have a difficult time accepting your status; they may back away from you because they do not know what to say or do, or they may be overly-concerned and overprotective. Again, educating people oftentimes helps those close to you to accept and deal with an HIV diagnosis.
• You may be rejected in dating situations and find it difficult to become indiagnosis.Youew relationship due to the fear of rejection once you disclose your status. Every situation is different, and you don't have to tell everyone that you date that you are HIV positive. However, if the relationship evolves to a point where you will be in an intimate situation where HIV could be transmitted, you will need to discuss your HIV status. The longer you wait, the more difficult it can be for both you and your potential sexual partner.
• It is illegal for employers to inquire about your health or any disabilities partner.Itay have, however they may legally ask you if you have any conditions that would result in you being unable to perform essential functions of the job. All HIV positive Americans are protected from job discrimination under the Americans with Disabilities Act (ADA). As long as you are able to perform the essential duties of the job, your employer cannot discriminate against you because of your HIV status. If your illness or the side effects of medications interfere with your performance, or if you require time away from work frequently for medical appointments, you may want to consider discussing your HIV status with your employers and presenting them with a letter from your healthcare provider verifying your disability. Most employers will gladly make any accomodations necessary for an employee who wants to continue working. Be sure to inform them if you want to keep your HIV status confidential; they are prohibited by law from disclosing your status to anybody else.
  

When you are considering telling someone else that you are HIV positive, try to anticipate and prepare for their reaction. Be ready to answer questions about your health and about HIV disease itself. You may want to have some brochures or written information available to help the person to understand. Above all else, realize that you cannot control how other people will react to or feel about the news that you are infected with HIV. Have someone available who can support you and help you to accept the reaction that you get.

THE NEWBORN OF AN HIV POSITVE WOMAN

Despite careful pre-pregnancy planning, close prenatal monitoring and excellent HIV specialist care, there is still that minute (less than 2%) chance that an HIV positive mother will deliver a baby who has been infected with the virus. It is natural to want to know immediately whether or not the baby is infected with HIV, but it takes at least 3 months and sometimes as long as 18 months to definitively determine the HIV status of the baby. During this time, the baby will receive a number of blood tests and will be given medication.

All babies born to HIV positive mothers will test positive for HIV antibodies at birth and for many months afterwards, because the baby is born with the mother's antibodies (this is true for HIV positive as well as HIV negative babies). Over a period of months, the baby will lose the mother's antibodies and develop his or her own. HIV antibody testing will be done on the baby at birth and then again at 1 month and at 3 months (also at 6 months if the 3 month result is positive or questionable). Once the HIV antibody test comes back negative, the baby is determined to be HIV negative, and no further testing is required. If the tests remain positive, further tests will be done to determine if the baby is infected with HIV.

After the baby is born, he or she will take an anti-HIV medication, usually AZT in liquid form, once daily for 4-6 weeks. Studies have shown that this may play a role in further decreasing the risk of HIV infection in the baby. Along with AZT, the baby will also take medication to prevent pneumonia. Both of these medications will be stopped after the baby is determined to be HIV negative.

Breastfeeding is a major mode of transmission of HIV; studies have shown an estimated 29% transmission rate from mothers who breastfeed their babies. Therefore, the newborn cannot be breastfed. The healthcare provider will prescribe the right formula for the baby and will monitor his or her tolerance to the food an growth.

After the baby is born, the mom must continue to closely follow all of the recommendations of her HIV treatment specialist and do everything that she can to keep herself healthy. By working closely with her healthcare providers, the HIV positive mom can look forward to raising children and seeing them grow and mature into adulthood. HIV no longer prevents women from fulfilling their dreams to have families, and that is a huge step forward in this epidemic.

PRENATAL CARE FOR THE HIV POSITIVE WOMAN

HIV infection no longer prevents a couple from having children. With the proper planning and medical care and by taking good care of herself during the pregnancy, an HIV+ woman can look forward to a long and healthy life for herself and her child. If an HIV positive woman is pregnant, she has hopefully planned the pregnancy and discussed the appropriate HIV treatment and medical precautions that must be taken to minimize the risk of transmission of HIV to her baby with her HIV specialist and with her obstetrician. By instinct, most women will do whatever it takes to care for their unborn children. Good prenatal care and monitoring is essential for any woman, but especially for the HIV+ woman.

Pregnancy and HIV disease: Pregnancy does not affect the course of HIV disease in any way. It will not make the HIV better or worse. The CD4+ cell count will drop during pregnancy, which is normal for any woman, regardless of HIV status, but this will return to the pre-pregnancy levels after delivery. If the CD4+ cell count drops too low, the woman may need additional medications to prevent opportunistic infections.

Mother-to-Child Transmission of HIV: If a woman is HIV+, the virus can be transmitted to the baby while the baby is in the uterus, during labor and delivery, or through breastfeeding. The factors that can reduce the transmission for each of these situations will be discussed. Overall, with proper medical care, the rate of mother-to-child transmission in the U.S. is less than 2%.

HIV medications and Pregnancy: Certain HIV medications, as well as other medications, can result in birth defects; hopefully the woman has discussed her pregnancy plans with her HIV treatment specialist and is on an appropriate regimen of antiretroviral medications (ARV) before she conceives, if they are needed. If so, she may continue with these medications as long as she is able to be adherent to them consistently throughout the pregnancy, or she may discuss stopping the medications until after the first trimester, when organ development of the baby is complete. If a woman is not on HIV medications, she should be at some point during the pregnancy; an undetectable HIV viral load decreases the risk for transmission to the baby during the pregnancy and during delivery. Most often, the ARV medications will not be started until after the first trimester; morning sickness may make it difficult to adhere to medications initially, and the effects of ARV medications on the development of the baby are not fully known. Click here to view the current U.S. Department of Health and Human Services Guidelines for ARV therapy during pregnancy.

Delivery: Today, HIV+ women who are on effective ARV therapy and whose HIV viral load is undetectable, vaginal delivery is a viable option; under these circumstances, the risk of transmission is about the same as with a C-Section, and the C-Section carries with it the risk of any major surgery. If a woman is not on ARV therapy or if her viral load is >1,000 at the time of delivery, however, a C-Section becomes necessary to reduce the risks of transmission of HIV to the baby. The method of delivery will be decided upon after the woman and her treatment specialists discuss her particular situation and the risks and benefits of each method.

Through careful planning and by following the advice of an experienced HIV treatment specialist, HIV+ women can now fulfill their hopes and dreams of having happy, healthy children.

Future posts will discuss the care of the newborn, including HIV testing.