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Medical Forum / Diseases and Disorders / AIDS / October 2005Former Surgeon General Urges Congress to Renew Expiring Ryan White Act
In an op-ed appearing in today's edition of "The Hill," Former Surgeon General David Satcher called on Congress to reauthorize a stronger and expanded version of the Ryan White CARE Act, which expires Sept. 30. --- September 28, 2005 http://thehill.com/thehill/export/TheHill/Comment/OpEd/092905.html AIDS is still a threat here By Dr. David Satcher The Ryan White CARE Act, the federal program that funds lifesaving treatment and services for more than a half-million uninsured or underinsured people with HIV/AIDS in the United States each year, is due to expire tomorrow. It is critical that Congress not only renew this program but strengthen and expand it as well. Just as the death of Ryan White in 1990 led the nation to reconsider its view of HIV/AIDS, today's leaders must reassess the legislation that bears Ryan's name to make sure it addresses the changes that have taken place in both the nature and the spread of this epidemic. Most people know Ryan's story. He contracted HIV at age 13 at a time when an AIDS diagnosis was a virtual death sentence. The revolutionary antiretroviral drugs that have transformed the disease into a more manageable chronic condition were still years away. His public struggle with AIDS and against AIDS-related discrimination helped educate our nation about the needs of people living with AIDS. A few months after his death, Congress enacted the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act to provide care, treatment and support services for people who are poor and do not have health insurance or other resources. It has been extended twice since then - both times by wide bipartisan margins in the Congress. President Bush recently announced principles to guide Congress in its deliberations on the latest version of the bill, which should now begin in earnest on Capitol Hill. There are serious concerns that must be kept in mind as modifications to the law are crafted. The Ryan White program will not suddenly end if Congress fails to meet the Sept. 30 deadline but would continue operating in its current form. However, states and cities are already straining under a growing caseload. The Centers for Disease Control and Prevention estimates there are 211,000 people with HIV/AIDS in the United States who are not receiving drug treatment but should be. While the majority of AIDS cases are still in urban areas, more and more people in rural areas, particularly in the South, are being infected. As a result, they are facing additional hardships. Because of funding restraints, nine states have instituted waiting lists for people in need of drugs. In states such as Mississippi and Tennessee, and others around the country, people with AIDS are losing their drug coverage completely due to state Medicaid cutbacks. Another concern is that we cannot continue to approach HIV/AIDS care based on outmoded assumptions about the epidemic. The CARE program has been essentially "flat-funded" for many years now, even though there have been major changes in the nature of the epidemic itself. Today, thanks to remarkable advancements in drug therapies and medical care, people are living longer and deaths attributed to AIDS in the United States have decreased, but about 40,000 new infections are still occurring each year. Present-day healthcare systems cannot support the ever-increasing numbers of people living with HIV/AIDS who are now entering these systems. That has left many of them with inadequate access to healthcare, especially those for whom private health insurance is entirely out of reach. Newly infected people are increasingly likely to be poor, to be members of a minority community and to have inadequate access to healthcare. As a result, nearly half of the estimated 1.1 million people in the United States who are currently infected with HIV/AIDS are not receiving adequate care or treatment. Continued "flat funding" for CARE Act programs will do little to help eliminate current waiting lists and nothing to extend care and treatment to people who aren't even on those lists. Instead, it will only serve to pit city against city and state against state for the limited dollars available. A person's ability to receive treatment should not depend upon where in the country they live. Americans in recent years have responded nobly and generously to the HIV/AIDS pandemic worldwide. We must not let complacency allow us to lose sight of the serious threat that the virus still poses at home. Satcher, a former U.S. surgeon general, is the interim president of the Morehouse School of Medicine in Atlanta. Ben Goddard's column will return. "buzz" <damon_t@hotmail.com> wrote in message > AIDS is still a threat here > By Dr. David Satcher [quoted text clipped - 4 lines] > due to expire tomorrow. It is critical that Congress not only renew > this program but strengthen and expand it as well. By David Snyder Congressional Correspondent WASHINGTON - Millions of dollars of federal money meant for AIDS prevention and research instead have been spent on activities that some are calling "frivolous." So far, no one knows how much money has been thrown away, but a growing number of critics are calling it an epidemic of waste. Nearly $11 billion a year is spent by the federal government - mostly by the Department of Health and Human Services - for AIDS research, treatment, and prevention. But it appears that a significant amount of this money is spent on activities solely meant to celebrate or teach homosexuality. A drag queen pageant in San Francisco last month was partially funded by the Centers for Disease Control and Prevention, through a local AIDS clinic. There was a brochure available at the event promoting HIV testing, but most of the literature and the event itself had little to do with ending the AIDS epidemic or providing care to HIV positive victims. Rep. Dave Weldon (R-FL) said, "It's almost like they're thumbing their noses at us essentially and saying we're going to take your money that's intended for preventing the spread of AIDS and use it for whatever the heck we want to use it for." Congressman Dave Weldon is a physician who has treated victims of HIV and AIDS. "Outrageous. That they would be funding a drag, homosexual drag queen pageant. What does that have to do with preventing the spread of AIDS?" Weldon queried. Last month's drag queen show was hardly the only questionable activity partially supported by taxpayer money. In the last couple of years there have been dating classes, an HIV positive prom, a masturbation workshop, flirting classes, and tango dance lessons. But that isn't all. Wayne Turner of ACT UP said, "We know in Puerto Rico for example, $2.5 million was embezzled, and spent - AIDS money for doctors visits and for medicine - and that money was spent on Jaguars, jet skis and personal maids for executives of AIDS service organizations." Turner, a longtime AIDS activist, is breaking from some of his colleagues to draw attention to the waste. He is afraid that he has helped to create a monster. "I've worked for over ten years now trying to get these resources to help real people with AIDS, to help the patients, help keep them alive with a reasonable quality of life. And when I turn around and see these resources going to pay for these six figure salaries, these bizarre balls and parties and flirting classes in places like San Francisco, I find it absolutely disgusting," Turner said. It is money that could have been spent helping people dying of AIDS, or people with other illnesses. "For every one dollar we spend on AIDS research - we need money for AIDS research, I'm not criticizing AIDS research - we spend 7 cents for autism research," Weldon said. After years of throwing money at AIDS, the federal government is finally acknowledging that there may be a problem. New Health and Human Services Secretary Tommy Thompson last week ordered an internal audit into federal AIDS funding. But for now, it appears the party goes on. "They think of this as their money. Their money. It's not their money, this is taxpayer money," Turner said. "These are the hard-earned dollars of U.S. taxpayers intended to help patients, AIDS patients, sick people." CDC funds are not the same as Ryan White CARE Act funds. "buzz" <damon_t@hotmail.com> wrote in message > CDC funds are not the same as Ryan White CARE Act funds. The House Appropriations Subcommittee on Labor, Health and Human Services on Thursday voted to hold almost all programs under the Ryan White CARE Act -- the federal law that authorizes spending for HIV/AIDS treatment and prevention programs... http://www.thebody.com/kaiser/2004/jul12_04/ryanwhite_funding.html?m55o When you get the time explain how you got CDC from HHS By David Snyder Congressional Correspondent WASHINGTON - Millions of dollars of federal money meant for AIDS prevention and research instead have been spent on activities that some are calling "frivolous." So far, no one knows how much money has been thrown away, but a growing number of critics are calling it an epidemic of waste. Nearly $11 billion a year is spent by the federal government - mostly by the Department of Health and Human Services - for AIDS research,... Don't let the fact that the AIDS theory predictions are not panning out stop us from putting more $$ into it. "Fondoo" <dale601@hotmail.com> wrote... > Don't let the fact that the AIDS theory predictions are not panning out > stop us from putting more $$ into it. I'm not sure what you're getting it, I'll take the standard position that the HIV virus causes AIDS and that very expensive drugs do supress the virus. But my argument is that the money is wasted, the focus should not be on spending ever-increasing amounts of money on treating those with HIV, rather that the money should be directed towards preventing as many new infections as possible. It makes no sense to spend $20,000 a year to keep an HIV patient alive just so he can infect hundreds of more people each year, each of whom costs $20,000 to keep alive. We can be compassionate and treat each HIV patient for the rest of his life, but why do we allow him to continue to infect others? The solution has been to continue to increase the HIV budget every year, but it has gotten us nowhere. It would be much more efficient to contain the spread of the virus, though definitely politically-incorrect. ------------------------------------------------------------------------ "As he watched the eyeless face with the jaw moving rapidly up and down, Winston had a curious feeling that this was not a real human being but some kind of dummy. It was not the man's brain that was speaking; it was his larynx. The stuff that was coming out of him consisted of words, but it was not speech in the true sense: it was a noise uttered in unconsciousness, like the quacking of a duck." -- 1984 ------------------------------------------------------------------------ snip >But my argument is that the money is wasted, the focus should not be on >spending ever-increasing amounts of money on treating those with HIV, >rather that the money should be directed towards preventing as many new >infections as possible. It makes no sense to spend $20,000 a year to >keep an HIV patient alive just so he can infect hundreds of more people >each year, Ah--first, treatment can be as little as $150 per year. $20,000 is the price which pharma screws the world. Second, prevention and treatment are strongly intertwined. Why get tested if you can't get treatment? "Yes, you're HIV+ but you can't afford the drugs so have a nice death." BOTH prevention and treatment are critical to provide. Bush wants to destroy both through PEPFAR by shoveling money at psycho religious fundies who want people to be "abstinent only" (a lovely idea but it simply isn't realistic) and withholding condoms. And then making sure treatment is stymied unless the big bucks go into his funders at pharma. NOT for generics that bring the costs down dramatically. George M. Carter "GMCarter" <fiar@verizon.net> wrote... > Ah--first, treatment can be as little as $150 per year. $20,000 is the > price which pharma screws the world. But you ignore the intellectual property rights that the pharmaceutical companies own, plus the cost of development. $150 is simply the manufacturing cost (if it's true), it does not include the BILLIONS of dollars in research and testing that went into the drugs. You could break the patents and manufacture the current drugs cheaply, but the virus will eventually mutate and no new drugs will have been developed because the companies are not going to invest billions of dollars just to have the new patents broken. > Bush wants to destroy both through PEPFAR by shoveling money at psycho > religious fundies who want people to be "abstinent only" (a lovely > idea but it simply isn't realistic) and withholding condoms. And then > making sure treatment is stymied unless the big bucks go into his > funders at pharma. NOT for generics that bring the costs down > dramatically. I was raving recently about the condom shortage in Uganda. As it turns out, U.S. policy is nicknamed "ABC" for Abstinence, Be faithful, and Condoms - it is not abstinence-only as some claim. And I asked why it was America's responsibility to provide condoms for Uganda or the rest of Africa or the world. Why isn't the EU sending condoms to Africa, and why should they? I calculated the cost of providing the number of condoms Uganda was short and it was negligible, mere pocket change in Western terms, yet the Ugandan government couldn't even afford that, presumably because the millions or billions of dollars in aid we've sent them is sitting in Swiss bank accounts. Oh, and the Uganda story was funny because the Ugandan condoms were recalled because of defects, and the government responded to that shortage by increasing the tax on imported condoms. --------------------------------------------------------------------- "[Uruguay and Brazil] are important friends and allies of the United States, and principally they need to put in place policies that will assure that as assistance money comes, that it does some good, and it doesn't just go out of the country to Swiss bank accounts." -- (Former) U.S. Secretary of Treasury Paul O'Neill; July 28, 2002 --------------------------------------------------------------------- >"GMCarter" <fiar@verizon.net> wrote... >> Ah--first, treatment can be as little as $150 per year. $20,000 is the >> price which pharma screws the world. > >But you ignore the intellectual property rights that the pharmaceutical >companies own, plus the cost of development. To the contrary. First, IP rights do NOT trump human life in my book. Second, a GREAT deal of the cost of development comes from public funding (almost entirely public for the nuke class, for example). Third, development costs are horrifically inflated by Pharma to justify this persistent lie. Indeed, the dense thicket of patents has STYMIED research and development. > $150 is simply the >manufacturing cost (if it's true), it does not include the BILLIONS of [quoted text clipped - 3 lines] >because the companies are not going to invest billions of dollars just >to have the new patents broken. I dispute the notion that the companies need to spend so many billions. They don't. Public funded research could do it more cheaply. The $150 cost was negotiated by the Clinton Foundation, among others. The patents are already broken--and indeed, there is NO reason that there cannot be some form of (more reasonable) tiered pricing where wealthier nations pay more and developing nations pay cost or less. The rights of humans to treatment and care is a global movement. It is ethically sound and can be indeed fiscally far more responsible than allowing economies to collapse due to AIDS and other diseases. As to the rest, ABC in and of itself is not a bad idea. But the religious right are pressing the "abstinence only" position in many places and that is just absurd. And indeed, EVERY wealthy nation should be giving about 0.7% of its GDP toward aid to our fellow humans in more dire straits. There are reasons that go beyond just alleviating suffering. Improving lives can help reduce birth rates, in the long run, for example. I would MUCH rather see the US and EU and others send condoms than perpetuate horrific, multi-billions of dollars wars that are based on outright lies and misinformation, causing horrific suffering and death for thousands of people, creating greater animosity and ultimately a hot spot center for the training of Al Qaeda terrorists. The world is a FAR more dangerous place with Bush and his crew of liars, thieves and murderers--his administration represents the biggest form of terrorism this planet has ever seen, with their naked lust for oil, power, enriching the rich and screwing everybody else. George M. Carter Want to save money on AIDS? OUTLAW the unspecific supposed HIV test that’s really a possible test for STD's, the flu or flu vaccine, pregnancy, drug use, alcoholism, poverty, bacterial infection, ect ,ect, ect. Why is the country with the highest possible chance for cross reactions have the most stringent test?( Two bands on the western blot.) Have HIV in Africa just move to Australia (4 bands for western blot) you then have a great chance of being cured!! It's a miracle "International travel found to cure HIV infection" Weeee!! And the survey said? Bullshit! > Want to save money on AIDS? OUTLAW the unspecific supposed HIV test thats >really a possible test for STD's, the flu or flu vaccine, pregnancy, drug >use, alcoholism, poverty, bacterial infection, ect ,ect, ect. ALL tests have limitations. But this is a gross mischaracterization based on lies spewed forth by the denialist community. HIV antibody tests, ELISA+Western blot, are highly specific and sensitive. Compared to a lot of other diagnostic tests, it's pretty damned accurate. NOTHING in medicine is 100%, any more than life. > Why is the country with the highest possible chance for cross reactions >have the most stringent test?( Two bands on the western blot.) Have HIV in >Africa just move to Australia (4 bands for western blot) you then have a >great chance of being cured!! It's a miracle "International travel found >to cure HIV infection" Weeee!! And the survey said? Bullshit! This is also just complete and utter bullshit, dear. The tests may have some slight differences--but there is also the clinical outcome. And the numbers of people who might fall under this situation are VERY few--indeed...any? Again, given how the "cross-reactions" paper was shown to be frequently distorting, lying and exagerrating the literature, I don't buy this either. HIV doesn't care what some whack job writes. George M. Carter "HIV antibody tests, ELISA+Western blot, are highly specific and sensitive. Compared to a lot of other diagnostic tests, it's pretty damned accurate." Yes, and you can see how "pretty darned accurate" the HIV tests are by reading their disclaimers: ELISA Test "At present there is no recognized standard for establishing the presence or absence of HIV-1 antibody in human blood." (Abbott Laboratories, ELISA HIV Antibody Test Insert, section "Sensitivity and Specificity") "EIA testing cannot be used to diagnose AIDS... The risk of an asymptomatic person with a repeatedly reactive serum developing AIDS or an AIDS-related condition is not known." (Abbott Laboratories, ELISA HIV Antibody Test Insert, section "Limitations of the Procedure") "Clinical studies continue to clarify and refine the interpretation and medical significance of the presence of antibodies to HIV-1." (Abbott Laboratories, ELSA HIV Antibody Test Insert, section "Limitations of the Procedure") Western Blot Test "Do not use this kit as the sole basis of diagnosis of HIV-1 infection." (Eptope, Inc., Western Blot HIV Antibody Test Insert, section "Limitations of the Procedure") “The clinical implications of antibodies to HIV-1 in an asymptomatic person are not known.” (Calypte, Cambridge Biotech HIV-1 Western Blot Kit, section “Limitations of the Serum and Plasma Procedure”) >"HIV antibody tests, ELISA+Western blot, are highly specific and sensitive. >Compared to a lot of other diagnostic tests, it's pretty damned [quoted text clipped - 8 lines] >or absence of HIV-1 antibody in human blood." (Abbott Laboratories, ELISA >HIV Antibody Test Insert, section "Sensitivity and Specificity") And read on: http://www.musc.edu/dc/icrebm/sensitivity.html they note: "The positive predictive value is how many of the test-positives truly have the disease. In the first example with a 1% sero-positive rate, the ELISA has a positive predictive value of 0.91 (91%). When looking at the blood donor pool with a 0.1% sero-prevalence, the positive predictive value is only 0.5 (50%), whereas in the high- prevalence population of intravenous drug users, the positive predictive value is 0.99 (99%). Although the sensitivity of the ELISA does not change between populations, the positive predictive value changes drastically from only half the people that tested positive being truly positive in a low- incidence population to 99% of the people testing positive being truly positive in the high- prevalence population. The negative predictive value of the ELISA also changes depending on the prevalence of the disease." see also: http://www.sfaf.org/aids101/hiv_testing.html They note: "The CDC states that the combined accuracy of the ELISA plus either the WB or IFA is greater than 99%." Compare this to syphilis or parasitic infections. Notoriously difficult to diagnose in some cases. Does that mean these diseases don't exist? Or cause AIDS? Or culturing for bacteria. As tests go, use of ELISA and Western Blot are pretty effective. George M. Carter "Although the sensitivity of the ELISA does not change between populations, the positive predictive value changes drastically from only half the people that tested positive being truly positive in a low- incidence population to 99% of the people testing positive being truly positive in the high-prevalence population." And do tell us, George, if someone's HIV tests come back positive, what is the deciding factor in determining if they are a *true* positive, as in the case of a "high-prevalence population," or a *false* positive, as in case of a "low- incidence population"? In other words, how does the doctor, or clinician, make an official "HIV-positive" diagnosis, once the Elisa and Western Blot tests come back positive from the lab? How do they separate out the wheat (true positive) from the chaff (false positive) when making their final decision whether, or not, to tell this person they have “HIV?” >"Although the sensitivity of the ELISA does not change between populations, >the positive predictive value changes drastically from only half the [quoted text clipped - 6 lines] >the case of a "high-prevalence population," or a *false* positive, as in >case of a "low- incidence population"? Watch the CD4 count. It tends to drop precipitously over a course of a few years. Indeed, many people are diagnosed after an OI. Hey, a "false positive" can arise in a "high-prevalence population" and a true positive in a low-incidence one. George M. Carter "Watch the CD4 count. It tends to drop precipitously over a course of a few years. Indeed, many people are diagnosed after an OI." This is *prior* to there being CD4 counts taken, George. I am talking about the patient's *initial* diagnosis of "HIV" infection... "Hey, a 'false positive' can arise in a 'high-prevalence population' and a true positive in a low-incidence one." Okay, so what the *hell* do "high prevelence" and "low-incidence" populations have to do with the diagnosis of someone as "HIV-positive," once their Elisa and Western Blot tests come back positive from the lab? In other words, how does the doctor, or clinician, determine if the person is *truly* "HIV-positive," or if their test result is simply a "false positive?" On what basis are someone's test results *intrepreted* to determine their "true" status? Why don't you explain how that little trick works to all the "HIV-positives" out there. I am sure they'd just LOVE to know how they made the "final cut" for Club HIV... -Paul Whiting Good point Paul but nobody seems to care about people with false positives dying of AIDS Chemotherapy. Any thoughts of educating the public about this are thrown out based on the fear of legal liability and the even sadder excuse of "What if a person with HIV does not get tested because he does not have enough faith in the test" > Good point Paul but nobody seems to care about people with false >positives dying of AIDS Chemotherapy. Of course, that's inflammatory rhetoric typical of the brain dead that can't argue cogently. Most people don't want to see people treated unnecessarily, first of all. I certainly don't. Second, it is pretty rare that it happens. It has happened, no question. But I don't know of ANY cases of people inaccurately diagnosed with HIV infection who were treated subsequently and then died. Do you have evidence to support that claim? George M. Carter How do you know how many false positives there are or have been treated George? The media and our doctors sure do not pass out information on this. I don't remember my Doc asking me if I had a flu shot the week I tested, and he never told me I should retest if I did. Hell I have seen the smart guys here say that "Well the tests are better now" Good God man I was tested 15 years ago how great were they then?? Maybe there is another reason why my body likes being off Chemo??? Why do "I" have to come up with these ideas when I have been paying doctors for years to tell me this stuff??? I ask because I have been a victim of HIV for 15 years and had to stumble on a dissident site to even learn a false positive is even possible. Heck I believed them when they told me my viral load test measured viruses. I thought they could "See" viruses bahhhhh!! I can say this because this is my story. > How do you know how many false positives there are or have been treated >George? The media and our doctors sure do not pass out information on >this. Nonsense. The media have worked every case of a false diagnosis to death. It's a good story, especially if it happens to a white person. > I don't remember my Doc asking me if I had a flu shot the week I tested, What makes you think a flu shot causes a significant risk of a false positive? If you're concerned, you can get tested again. Anyone can. George M. Carter "I don't remember my Doc asking me if I had a flu shot the week I tested What makes you think a flu shot causes a significant risk of a false positive? If you're concerned, you can get tested again. Anyone can." Yes, George, anyone who's been diagnosed HIV+ can get retested but, even if you come up negative, it *won't ever* change your status in the eyes of the medical establishment. All memberships in Club HIV are for a lifetime. In otherwords, you can never have your positive status expunged from you medical records. -Paul Whiting snip >Yes, George, anyone who's been diagnosed HIV+ can get retested but, even >if you come up negative, it *won't ever* change your status in the eyes of >the medical establishment. Oh horseshit. "Yes, George, anyone who's been diagnosed HIV+ can get retested but, even if you come up negative, it *won't ever* change your status in the eyes of the medical establishment. Oh horseshit." George, how did Christine fair after her positive, then indeterminate, then positive, then negative, then positive test results? Is she considered "HIV negative" after all of those contradictory results? "pauleewhiting" <pauleewhiting@nospam.hotmail.com> wrote... > "Yes, George, anyone who's been diagnosed HIV+ can get retested but, even > if you come up negative, it *won't ever* change your status in the eyes of [quoted text clipped - 7 lines] > Is she considered "HIV negative" after all of those contradictory > results? Does it matter? There are no legal implications to having HIV, it doesn't matter if you test positive then later test negative and then later test positive again, your legal status never changes. If you want to believe the negative result and not take medication and f.ck whoever you please, no one will stop you. If anything, you have more legal protections with HIV then without; for example you are guaranteed disability checks and if you choose to work employers can't refuse to hire you and you can never be fired. >Does it matter? There are no legal implications to having HIV, it >doesn't matter if you test positive then later test negative and [quoted text clipped - 4 lines] >you are guaranteed disability checks and if you choose to work >employers can't refuse to hire you and you can never be fired. How about the legal custody of your child if you refuse to give them the "life saving" meds as an "HIV-positive" parent? -Paul Whiting >"Yes, George, anyone who's been diagnosed HIV+ can get retested but, even >if you come up negative, it *won't ever* change your status in the eyes of [quoted text clipped - 4 lines] >George, how did Christine fair after her positive, then indeterminate, >then positive, then negative, then positive test results? If that's the accurate order of events, I'd say she is most likely HIV+. >Is she considered "HIV negative" after all of those contradictory >results? Is she considered by whom? Her physician? Her ID doc? Or is somehow the aggregate "medical establishment" weighing in on her condition at whim? George M. Carter "Nonsense. The media have worked every case of a false diagnosis to death. It's a good story, especially if it happens to a white person." Oh now you are just being silly What makes you think a flu shot causes a significant risk of a false positive? First off I mentiond Flu shots because they are very common and a published risk. Also why should I trust a stranger or group of strangers on the definition of "significant" I WANT TO BE INFORMED BY THE F***ING DOCTORS ON MY PAYROL. >"Nonsense. The media have worked every case of a false diagnosis to >death. It's a good story, especially if it happens to a white person." [quoted text clipped - 6 lines] > First off I mentiond Flu shots because they are very common and a >published risk. What risk? >"Watch the CD4 count. It tends to drop precipitously over a course of a few >years. Indeed, many people are diagnosed after an OI." > >This is *prior* to there being CD4 counts taken, George. I am talking >about the patient's *initial* diagnosis of "HIV" infection... Yes, and I've provided the evidence supporting HIV testing as pretty damned good, even in low-incidence populations. False results may arise with ANY test. Has no effect on the fact HIV exists and, in the majority of infected individuals, AIDS develops. There are no "tricks" here--just how diagnostic tests of ANY kind are defined and their limitations. Do you think that all tests are 100% perfect? Except, somehow, HIV? George M. Carter "Yes, and I've provided the evidence supporting HIV testing as pretty damned good, even in low-incidence populations. False results may arise with ANY test. Has no effect on the fact HIV exists and, in the majority of infected individuals, AIDS develops. There are no 'tricks' here--just how diagnostic tests of ANY kind are defined and their limitations. Do you think that all tests are 100% perfect? Except, somehow, HIV?" Okay, Geoge, but how do the doctors and clinicians make the final diagnosis of "HIV-positivity" when both the Elisa and Western Blots come back positive from the lab? Like you said, the HIV tests are known to have "false-positive" results, so in order to prevent somone who's *not really* HIV-positive from being told they are, how is the final determination made by the doctor or clinician? Paul, look at this link from Max Planck Institut of Berlin : http://www.mpib-berlin.mpg.de/dok/full/gg/ggacfac__/ggacfac__.html You can see that even the mainstream statisticians vilify the aids counsellors. "Paul, look at this link from Max Planck Institut of Berlin: http://www.mpib-berlin.mpg.de/dok/full/gg/ggacfac__/ggacfac__.html You can see that even the mainstream statisticians vilify the aids counsellors." Thanks for posting this article! For those reading this debate, please compare the Positive Predictive Value (the probability of being infected with HIV if a client tests positive) between the two risks groups: heterosexual men (50%) and homosexual men (99.3%). Abstract This study addresses the counselling of heterosexual men with low-risk behaviour who, voluntarily or involuntarily, take an HIV test. If such a man tests positive, the chance that he is infected can be as low as 50%. We study what information counsellors communicate to clients concerning the meaning of a positive test and whether they communicate this information in a way the client can understand. To get realistic data, one of us visited as a client 20 public health centers in Germany to take 20 counselling sessions and HIV tests. A majority of the counsellors explained that false positives do not occur, and half of the counsellors told the client that if he tests positive, it is 100% certain that he is infected with the virus. Counsellors communicated numerical information in terms of probabilities rather than absolute frequencies, became confused, and were inconsistent. Based on experimental evidence, we propose a simple method that counsellors can learn to communicate risks in a more effective way. Former Senator Lawton Chiles of Florida reported at an AIDS conference in 1987 that of 22 blood donors in Florida who were notified that they tested HIV-positive with the ELISA test, 7 committed suicide. In the same medical text that reported this tragedy, the reader is informed that "even if the results of both AIDS tests, the ELISA and WB [Western blot], are positive, the chances are only 50-50 that the individual is infected" (Stine, 1996, pp. 333, 338). Situations like this can occur when people with low-risk behaviour, such as blood donors, test positive. The discrepancy between what clients believe a positive HIV-test means and what it actually does mean seems to have cost human lives in addition to the toll the disease itself has taken. One of the goals of AIDS counselling is to explain the actual risk to the client. This article deals with pre-test HIV counselling of low-risk clients concerning the meaning of a positive HIV test in German public AIDS counselling centers. We address three questions: What information do counsellors communicate to the client concerning the chances of an HIV infection given a positive test? Is this information communicated in a way the client can understand? How can the communication and the accuracy of the information be improved? Positive Predictive Value What the client needs to understand is the probability of being infected with HIV if he or she tests positive. The predictive value of a positive test (PPV) can be calculated from the prevalence p(HIV), the sensitivity p(pos|HIV), and the false positive rate p(pos|no HIV): PPV= p(HIV)p(pos | HIV) p(HIV) p(pos | HIV) + p(no HIV) p(pos | no HIV) where p(no HIV) equals 1 - p(HIV). Equation 1 is known as Bayes's rule. This rule expresses the important fact that the smaller the prevalence, the smaller the probability that a client is infected if the test is positive. What is the predictive value of a positive test for a 20- to 30-year-old heterosexual German man who does not engage inpractice risky behaviour? Inserting the previous estimates - a prevalence of .01%, a sensitivity of 99.8%, and a specificity of 99.99% (repeated ELISA and Western blot) - into Bayes's rule, the PPV results in .50, or 50%. An estimated PPV of about 50% for heterosexual men who do not engage inpractice risky behaviour is consistent with the report of the Enquete Committee of the German Bundestag, which. estimatedIn this report the PPVprobability for low-risk people (rather than just men) is even estimated as "less than 50%" (Deutscher Bundestag, 1990, p. 121). How to Communicate the Positive Predictive Value Even if a counsellor understands this formula, ordinary people rarely do (Gigerenzer & Hoffrage, 1995). Moreover, we know from paper-and-pencil studies in the United States and in Germany that even experienced physicians have great difficulties when asked to infer the PPV from probability information (Casscells et al., 1978; Dawes, 1988; Eddy, 1982; Gigerenzer & Hoffrage, 1996; Windeler & Köbberling, 1986). But we also know from a recent study with 48 physicians in Munich that physicians' performance can be substantially improved, by a factor of more than four, if the information is presented in natural frequencies rather than in terms of probabilities or percentages (Gigerenzer, 1996; Hoffrage & Gigerenzer, 1996). By natural frequencies we mean information represented in terms of absolute (not relative) frequencies, that is, in the way a physician would have actually experienced the frequencies if she had sampled the individual cases herself (Gigerenzer & Hoffrage, 1995). More precisely, natural frequencies are frequencies which have not been normalized with respect to the base rate (prevalence) of the disease. Normalized frequencies, such as probabilities and percentages, have only emerged in the last few centuries as tools to represent degrees of uncertainty (Gigerenzer et al., 1989), whereas through most of human history and evolution, minds had to deal only with natural frequencies. How would a counsellor communicate information in natural frequencies? She might explain to the patient the meaning of a positive test in the following way: "Imagine 10,000 heterosexual men like you being tested. One has the virus and he will with practical certainty test positive. Of the remaining non-infected men, one will also test positive [the false positive rate of 0.01%]. Thus we expect that two men will test positive, and only one of them has HIV. This is the situation you are in if you test positive; the chance of having the virus is one out of two, or 50%." This simple method can be applied whatever the relevant numbers are assumed to be. If the prevalence is 2 in 10,000, the PPV would be 2 out of 3, or 67%. The numbers can be adjusted; the point is that clients can understand more easily if the counsellor communicates in natural frequencies than in probabilities. With a frequency representation the client can "see" how the PPV depends on the prevalence. If the prevalence of HIV among German homosexuals is about 1.5%, then the counsellor might explain: "Think of 10,000 homosexual men like you. About 150 have the virus and they all will likely test positive. Of the remaining non-infected men, one will also test positive. Thus, we expect that 151 men will test positive, and 150 of them have HIV. This is the situation you are in if you test positive; the chance of having the virus is 150 out of 151, or 99.3%." http://www.mpib-berlin.mpg.de/dok/full/gg/ggacfac__/ggacfac__.html >"Yes, and I've provided the evidence supporting HIV testing as pretty >damned good, even in low-incidence populations. False results may arise [quoted text clipped - 11 lines] >diagnosis of "HIV-positivity" when both the Elisa and Western Blots come >back positive from the lab? When the ELISA and Western Blot come back positive from the lab, that is considered diagnostic of HIV infection. You don't like the results? Get another test. But it doesn't STOP there, of course. That's what I'm saying. A diagnosis doesn't mean everything is locked in amber or something. One goes on to do other tests, etc. >Like you said, the HIV tests are known to have "false-positive" results, >so in order to prevent somone who's *not really* HIV-positive from being >told they are, how is the final determination made by the doctor or >clinician? Darling, after ELISA and Western Blot come back positive, the chances are VERY strong that the person is infected with HIV. The data are enormously strong on this point. It's just f.cking frothing idiocy to claim otherwise...and if it ain't, then we might as well throw out ALL diagnostic tests and pretend no diseases exist at all! Wheee!! Wonderland!!!! Then you FOLLOW the person, looking at viral load and CD4 count. You look to see if there are symptoms. There may be things like thrush or a nasty zoster outbreak if early. IF the test is 'indeterminate' - then more testing is undertaken. IF a person is uncertain, they can go get another test. George M. Carter Paul also wants to imply that a positive test result means the patient is immediately advised to start ARV. When of course that is not the standard of care nor has it ever been. Paul also seems to be under the misconception that the majority of people who's only AIDS symptom is a low CD4 T-Cell count are on ARV. Even during the heady early days of HAART that was not the case (in that the AIDS population under a doctors care at that time was already very ill). The majority of people taking ARV have progressed to symptomatic AIDS including having experienced an opportunistic infection prior to being started on ARV. Sadly this is due to the fact that many people do not know there HIV status until there first hospital admission with an OI and thus do not start ARV at the optimum stage in AIDS progression. Which the standard of care defines as CD4 count bellow 300 and above 200 (this is not a bright line but requires clinical judgment as the spread of 100 implies) depending on viral load numbers and/or opportunistic infections preferably before the first opportunistic infection. Gary Stein "Paul also wants to imply that a positive test result means the patient is immediately advised to start ARV. When of course that is not the standard of care nor has it ever been. Paul also seems to be under the misconception that the majority of people who's only AIDS symptom is a low CD4 T-Cell count are on ARV." When, exaclty, did I imply that a positive test result means the patient is immediately advised to start ARV or suggest that the majority of people who's only AIDS symptom is a low CD4 T-Cell count are on ARV? "Paul also wants to imply that a positive test result means the patient is immediately advised to start ARV. When of course that is not the standard of care nor has it ever been. Paul also seems to be under the misconception that the majority of people who's only AIDS symptom is a low CD4 T-Cell count are on ARV." When, exactly, did I imply that a positive test result means the patient is immediately advised to start ARV or suggest that the majority of people who's only AIDS symptom is a low CD4 T-Cell count are on ARV? Unless the patient is a baby of course "Hit it hard hit it early" Ignore T-Cell counts or perfect health. More long term chain terminators for babies’ yay!! At least by the IHO's 2005 standards It seems the chances of a false positive are outweighed by the chance of not hitting HIV early. Am I wrong in this? It did seem to be the agenda of the hospital my daughter was born in. Two positive PCR's = DNA chain terminators for my healthy little girl, and if she dies well hey it's AIDS not the F***ing Chemo, and treatment health benefits being based on a study made up of pregnant IV drug using mommies I defy you Ghouls to tell me this kind of thinking is good for my baby, Yes I believe Doctors that read studies (if they even bother looking past protocol)and feel they can do this crap without thinking twice when common sense screams this is wrong are Ghouls "Darling, after ELISA and Western Blot come back positive, the chances are VERY strong that the person is infected with HIV. The data are enormously strong on this point. It's just f.cking frothing idiocy to claim otherwise...and if it ain't, then we might as well throw out ALL diagnostic tests and pretend no diseases exist at all! Wheee!! Wonderland!!!! Then you FOLLOW the person, looking at viral load and CD4 count. You look to see if there are symptoms. There may be things like thrush or a nasty zoster outbreak if early. IF the test is 'indeterminate' - then more testing is undertaken. IF a person is uncertain, they can go get another test." I am not asking if the *person* is uncertain, dearest, I am asking how the doctor or clinician knows whether someone is truly HIV+, or not, whose Elisa and Western Blot tests both come back positive from the lab. The HIV tests are known to have false-positives, so the doctor, or clinician, must have *some kind of criteria* for making the final determination as to whether the "HIV-positive" status they are looking at is real, or if it is false. In other words, how does the doctor, or clinician, ***interpret the results*** of each and every positive test result that passes through their very capable hands, since there are many, many known conditions that can cause a *false positive* result on the HIV tests? They have to have *some criteria* for determining which of the positive results are real and which are simply cross-reactions to antibodies caused by another condition... What the criteria do doctors and clinicians use to determine what someone's actual status is? -Paul Whiting snip... >I am not asking if the *person* is uncertain, dearest, I am asking how the >doctor or clinician knows whether someone is truly HIV+, or not, whose >Elisa and Western Blot tests both come back positive from the lab. The chances are very strong the person is HIV+ in that case. Do you think at that point everything stops? >The HIV tests are known to have false-positives, so the doctor, or >clinician, must have *some kind of criteria* for making the final >determination as to whether the "HIV-positive" status they are looking at >is real, or if it is false. The false positives come with more likelihood with a SINGLE ELISA. That's why it is usually repeated. And followed up with a WB. >In other words, how does the doctor, or clinician, ***interpret the >results*** of each and every positive test result that passes through >their very capable hands, since there are many, many known conditions that >can cause a *false positive* result on the HIV tests? They look further. If they see the CD4 count declining, have a PCR viral load, hear reports of thrush, fatigue, diarrhea, wasting, night sweats....time doesn't stop after the HIV+ result comes in, dearie sweetie poopkins. >They have to have *some criteria* for determining which of the positive >results are real and which are simply cross-reactions to antibodies caused >by another condition... > >What the criteria do doctors and clinicians use to determine what >someone's actual status is? By getting a test result that is strongly positive on ELISA and at least 2 bands of WB. See http://www.hivguidelines.org/public_html/a-tests/a-tests.htm George M. Carter >>In other words, how does the doctor, or clinician, ***interpret the >>results*** of each and every positive test result that passes through [quoted text clipped - 5 lines] >sweats....time doesn't stop after the HIV+ result comes in, dearie >sweetie poopkins. I am talking about the initial diagnosis, Butter Muffin, LONG before there are CD4 and viral load test done. Most people are diagnosed as "HIV-positive" based on their initial antibody tests, not on "reports of thrush, fatigue, diarrhea, wasting, night sweats." >>They have to have *some criteria* for determining which of the positive >>results are real and which are simply cross-reactions to antibodies caused [quoted text clipped - 6 lines] >least 2 bands of WB. See >http://www.hivguidelines.org/public_html/a-tests/a-tests.htm Yes, George, but what if someone tests positive on both the Elisa and Western Blot tests, but it's been determined that he has *never* been exposed to HIV, which was established by the fact he's *never* engaged in any "risk behaviours" and, thus, does *not* belong to any of the "risk groups" who are known to have a "high prevalence of HIV-infection"? How does the doctor, or clinician, then determine whether he is *truly* "HIV-positive" or whether his test results were simply a "false positive"? Now, keep in mind that he continually comes up positive, but has no known exposure to HIV whatsoever, since he's, say, a married Caucasian male with a dozen children (so he's obviously not gay), who gets regular drug tests at work (so he's not using drugs), but who's trying to get life insurance... -Paul Whiting snip >I am talking about the initial diagnosis, Butter Muffin, LONG before >there are CD4 and viral load test done. Most people are diagnosed as >"HIV-positive" based on their initial antibody tests, not on "reports of >thrush, fatigue, diarrhea, wasting, night sweats." You may be right--I don't know how many people get tested because of symptoms. A fair percentage do because of a risk exposure and subsequent fever or rash. >Yes, George, but what if someone tests positive on both the Elisa and >Western Blot tests, but it's been determined that he has *never* been >exposed to HIV, which was established by the fact he's *never* engaged >in any "risk behaviours" and, thus, does *not* belong to any of the >"risk groups" who are known to have a "high prevalence of >HIV-infection"? What if the moon were made of green cheese? I suppose such a scenario may happen. That individual MAY have been misdiagnosed. This is just you, though, grasping at straws again. It doesn't apply on a population level. George M. Carter "You may be right--I don't know how many people get tested because of symptoms." "I suppose such a scenario may happen. That individual MAY have been misdiagnosed." "It doesn't apply on a population level." >"You may be right--I don't know how many people get tested because of >symptoms." [quoted text clipped - 3 lines] > >"It doesn't apply on a population level." Quotes taken out of context! How Rovian.... George M. Carter ** snip >I am talking about the initial diagnosis, Butter Muffin, LONG before >there are CD4 and viral load test done. Most people are diagnosed as >"HIV-positive" based on their initial antibody tests, not on "reports of >thrush, fatigue, diarrhea, wasting, night sweats." You may be right--I don't know how many people get tested because of symptoms. A fair percentage do because of a risk exposure and subsequent fever or rash. >Yes, George, but what if someone tests positive on both the Elisa and >Western Blot tests, but it's been determined that he has *never* been >exposed to HIV, which was established by the fact he's *never* engaged >in any "risk behaviours" and, thus, does *not* belong to any of the >"risk groups" who are known to have a "high prevalence of >HIV-infection"? What if the moon were made of green cheese? I suppose such a scenario may happen. That individual MAY have been misdiagnosed. This is just you, though, grasping at straws again. It doesn't apply on a population level. George M. Carter >>"You may be right--I don't know how many people get tested because of >>symptoms." [quoted text clipped - 5 lines] > > Quotes taken out of context! How Rovian.... Well, ya know... eventually the radical fringes meet each other with much the same technique of empty and meaningless rhetoric. Poor dead David Pasquarilli, selling a drug to cure a disease he didn't believe existed, that kind of thing. B/ ... >Well, ya know... eventually the radical fringes meet each other with >much the same technique of empty and meaningless rhetoric. Poor dead >David Pasquarilli, selling a drug to cure a disease he didn't believe >existed, that kind of thing. What's that, Madge, dncb? You're soaking in it! and it's non toxic to boot... now for a word from our sponsor... http://www.badmash.org/videos/videos_flv.php?v=george_bush_512K_Stream.flv&a > .... >>Well, ya know... eventually the radical fringes meet each other with [quoted text clipped - 5 lines] > > and it's non toxic to boot... I meant marijuana.... the ACT-UP SF pot club. > now for a word from our sponsor... > http://www.badmash.org/videos/videos_flv.php?v=george_bush_512K_Stream.flv&a LOL "Quotes taken out of context! How Rovian...." Well, hey, at least I didn't reveal your secret identity as a pharmaceutical industry lackey... >"Quotes taken out of context! How Rovian...." > >Well, hey, at least I didn't reveal your secret identity as a >pharmaceutical industry lackey... Gosh! Here's the guy that says we should be nice to each other! Ain't you a big old hypocrite? "Gosh! Here's the guy that says we should be nice to each other! Ain't you a big old hypocrite?" George, how many times have you use the word f.ck (and it's many colorful derivatives) when describing the dissidents? How many times have you used that word to describe me? Have I *ever* used that word to describe you? >"Gosh! Here's the guy that says we should be nice to each other! > >Ain't you a big old hypocrite?" > >George, how many times have you use the word f.ck (and it's many colorful >derivatives) when describing the dissidents? I dunno. You bothered to count? >How many times have you used that word to describe me? "f.ck" to describe you? Nah. a.shole? Idiot? Occasionally, I suppose. >Have I *ever* used that word to describe you? Do I care? There's a difference. You accuse me of being a pharma puppet. What a goddamned joke. Actually, more like libel. It would be like me saying you were a crypto-fascist out to kill gay men by instilling a false notion of HIV's role in AIDS. So--I will state outright, I don't think that's who you are. And don't you play on that level either. Call me an idiot if you l ike. I don't care. Or maintain the high road and hold your tongue from the occasional insult. But obviously--you're free to do whatever you want. I never claimed to be nice. I am increasingly disagreeable and nasty, I find, in my old age--and much less tolerant of bullshit. George M. Carter >>>In other words, how does the doctor, or clinician, ***interpret the >>>results*** of each and every positive test result that passes through [quoted text clipped - 11 lines] > "HIV-positive" based on their initial antibody tests, not on "reports of > thrush, fatigue, diarrhea, wasting, night sweats." Again if you would pay attention to the facts you would understand that that is simply not the case. Close to 50% of new HIV diagnosis occur in people who have allready progressed to AIDS and are experiencing an OI. There first HIV test occurs during the course of hospitalization for the treatment of the OI or during a doctors visit for the treatment of the OI. >>>They have to have *some criteria* for determining which of the > positive [quoted text clipped - 15 lines] > "risk groups" who are known to have a "high prevalence of > HIV-infection"? It is assumed that due to the stigma attached to being a member of a risk group that the person is not being truthful about there exposure risks. They are deemed HIV+ and closely followed to see if treatment is appropriate, this is done by the use of Viral Load testing and CD4 count testing and the doctor keeping a close eye on the patient for symptoms of OI's. If the PCR shows a viral load above 1,000 on more then one test they are unquestionably HIV+. PCR's use as a diagnostic test is widely accepted by the medical community. As George explained to you it is only when the Viral Load on the Ultra-sensitive version of the test is close to the undetectable range say 100 or lower that the anti-body tests are more accurate, once viral load is repeatedly over 100 there simply is no question as to it's accuracy in diagnosising HIV infection. The reason for repeating a PCR is to avoid any quality control error in the lab not a problem with the PCR test it's self. > How does the doctor, or clinician, then determine whether he is *truly* > "HIV-positive" or whether his test results were simply a "false [quoted text clipped - 3 lines] > gets regular drug tests at work (so he's not using drugs), but who's > trying to get life insurance... As I've said above. Gary Stein "It is assumed that due to the stigma attached to being a member of a risk group that the person is not being truthful about there exposure risks. They are deemed HIV+ and closely followed to see if treatment is appropriate, this is done by the use of Viral Load testing and CD4 count testing and the doctor keeping a close eye on the patient for symptoms of OI's. If the PCR shows a viral load above 1,000 on more then one test they are unquestionably HIV+. PCR's use as a diagnostic test is widely accepted by the medical community. As George explained to you it is only when the Viral Load on the Ultra-sensitive version of the test is close to the undetectable range say 100 or lower that the anti-body tests are more accurate, once viral load is repeatedly over 100 there simply is no question as to it's accuracy in diagnosising HIV infection. The reason for repeating a PCR is to avoid any quality control error in the lab not a problem with the PCR test it's self." So, Gary/George, are there ever times when the HIV tests are considered to have "false positive" results? And how are "false positive" results determined? -Paul Whiting snip >So, Gary/George, are there ever times when the HIV tests are considered to >have "false positive" results? And how are "false positive" results >determined? Hey, you dumb f.ck. You CLEALY didn't read ANY of the references or info provided on the URLs. EVERY SINGLE TEST ON THE PLANET can cause false positives. It does happen. But it is pretty darn rare. Simply because it happens does NOT render HIV nonexistent or the cause of AIDS. f.ck, you're really being incredibly dense. George M. Carter Hey George, how long can a false positive be on Chemo before his T-Cells drop? How do you tell between a Chemo drop and an HIV drop in T-Cells? If you are using the T-Cell drop = HIV theory anyways These questions gotta suck because how many studies are about “Why people should not take drugs” > Hey George, how long can a false positive be on Chemo before his T-Cells >drop? How do you tell between a Chemo drop and an HIV drop in T-Cells? If >you are using the T-Cell drop = HIV theory anyways Chemo does NOT cause CD4 cells to drop. They may cause other problems, like anemia. But that ain't a drop in CD4 count, etc. And HIV-negative people have taken ARV in a variety of settings. From pk studies to PEP. No decline in CD4. Other toxicities? You bet. But that ain't one of them. >These questions gotta suck because how many studies are about Why people >should not take drugs These questions gotta suck honey cause they're f.cking stupid and just based on your belief in nonsense. Not on ANY data. George M. Carter "Chemo does NOT cause CD4 cells to drop. They may cause other problems, like anemia. But that ain't a drop in CD4 count, etc." Chemotherapy and You: A Guide to Self-Help During Cancer Treatment Coping with Side Effects What Causes Side Effects? Because cancer cells may grow and divide more rapidly than normal cells, many anticancer drugs are made to kill growing cells. But certain normal, healthy cells also multiply quickly, and chemotherapy can affect these cells, too. This damage to normal cells causes side effects. The fast-growing, normal cells most likely to be affected are ***blood cells forming in t >"Chemo does NOT cause CD4 cells to drop. They may cause other problems, >like anemia. But that ain't a drop in CD4 count, etc." I have no idea where you got the following from. Cyclosporing is a drug that can cause CD4 counts to decline (used in transplant recipients). The CD4 count recovers if drug is stopped. That's about IT. Other chemo drugs CAN cause neutropenia, anemia, etc., etc. They do NOT result in a selective depletion of CD4+ T lymphocytes. And nor do ANY of the chemotherapy drugs used to treat HIV infection. Whether its vitamins or AZT or efavirenz. George M. Carter >Chemotherapy and You: A Guide to Self-Help During Cancer Treatment > [quoted text clipped - 8 lines] >fast-growing, normal cells most likely to be affected are ***blood cells >forming in t >Other chemo drugs CAN cause neutropenia, anemia, etc., etc. They do >NOT result in a selective depletion of CD4+ T lymphocytes. And nor do >ANY of the chemotherapy drugs used to treat HIV infection. Whether its >vitamins or AZT or efavirenz. The efficacy and toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex (ARC): an open uncontrolled treatment study. Stambuk D, Youle M, Hawkins D, Farthing C, Shanson D, Farmer R, Lawrence A, Gazzard B. St Stephens Hospital, London. "Thirty-two per cent of patients treated with azidothymidine became anaemic. **Neutropenia** occurred in 3 per cent of patients. Platelets increased initially after treatment but subsequently fell to thrombocytopenic levels in eight patients. Nine of 12 patients with thrombocytopenia before azidothymidine was commenced responded with an increased platelet count." http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&lis t_uids=2512592&dopt=Abstract -------------- Definitions of **neutropenia** on the Web: An abnormal decrease in the number of neutrophils (the most common type of white blood cells) in the blood. The decrease may be relative or absolute. Neutropenia may also be associated with HIV infection or may be drug-induced. www.amfar.org/cgi-bin/iowa/bridge.html Neutropenia indicates decreased numbers of circulating neutrophils. It may be due to insufficient production or increased destruction of neutrophils. Conditions that cause neutropenia include endotoxemia, viral infections, overwhelming bacterial infections, and administration of drugs that cause bone marrow suppression. [ back to top ] www.anjotech.co.za/glossary2.htm a low level of neutrophils (a certain kind of white blood cell) that causes a high risk of infection, particularly in the lungs, mouth and throat, sinuses and skin. May result as a side effect of cancer chemotherapy, since some agents kill neutrophils as well as the cancer cells. saci.uthscsa.edu/PatientServices/glossary.html A blood condition caused by a large decrease in a type of white blood cell called a neutrophil. This decrease can occur when leukemia cells infiltrate and overcrowd the bone marrow, or during the high-dose chemotherapy regimen administered before a bone marrow transplant. www.cancercenter.com/stem-cell/stem-cell-glossary.cfm meaning not enough neutrophils, a type of white blood cell that kills and digests microorganisms such as viruses. The neutrophil has a lifespan of about 3 days. Neutropenia may be seen with viral infections or after radiotherapy and chemotherapy. Being neutropenic lowers the barrier to infection-making a patient very susceptible. Precautions like "no live flowers and mask/gown/ gloving" isolation help to keep potential infections down. www.providence.org/alaska/tchap/glossary/N.htm Neutropenia is a haematological disorder characterised by an abnormally low number of neutrophil granulocytes (a type of white blood cell). Neutrophils usually make up 50-70% of circulating white blood cells and serve as the primary defence against infections by destroying bacteria in the blood. Hence, patients with neutropenia are more susceptible to bacterial infections and without prompt medical attention, the condition may become life-threatening. ... >>Other chemo drugs CAN cause neutropenia, anemia, etc., etc. They do >>NOT result in a selective depletion of CD4+ T lymphocytes. And nor do >>ANY of the chemotherapy drugs used to treat HIV infection. Whether its >>vitamins or AZT or efavirenz. snip >Neutropenia is a haematological disorder characterised by an abnormally >low number of neutrophil granulocytes (a type of white blood cell). Read the stuff you cut and paste. Neutrophils are not the same as CD4+ T lymphocytes. AZT is more likely to cause anemia than neutropenia in any event. The point is--that it doesn't even ALWAYS cause these conditions in every user. AZT best dose is probably 150 mg bid in an adult. As good efficacy for less toxicity. George M. Carter >Yes, George, but what if someone tests positive on both the Elisa and >Western Blot tests, but it's been determined that he has *never* been >exposed to HIV, which was established by the fact he's *never* engaged >in any "risk behaviours" and, thus, does *not* belong to any of the >"risk groups" who are known to have a "high prevalence of >HIV-infection"? What if the moon were made of green cheese? That is my wife?s case bro so blast off to your cheesy moon would you. Or atleast buy a freaking clue >>Yes, George, but what if someone tests positive on both the Elisa and > >Western Blot tests, but it's been determined that he has *never* [quoted text clipped - 11 lines] >That is my wifes case bro so blast off to your cheesy moon would you. > Or atleast buy a freaking clue Ah, excuse me, but if you are HIV+ and were f.cking her without a condom, then dearest poopsie, she was engaging in high risk behavior. George M. Carter "As good efficacy for less ***toxicity.***" >"As good efficacy for less ***toxicity.***" Water is toxic. Toxicity depends on dose. George M. Carter >"As good efficacy for less ***toxicity.***" "Water is toxic. Toxicity depends on dose." I will remember that next time I pick up a bottle of Dasani that says... "TOXIC. Toxic by inhalation, in contact with skin and if swallowed. Target organ(s): Blood bone marrow. If you feel unwell, seek medical advice (show the label where possible). Wear suitable protective clothing." >>"As good efficacy for less ***toxicity.***" > [quoted text clipped - 5 lines] >organ(s): Blood bone marrow. If you feel unwell, seek medical advice (show >the label where possible). Wear suitable protective clothing." A label is not what makes a substance toxic. Nor is a toxicity is necessarily a fatal attribute. But--too nuanced! I'm sure you have another question to ask, eh? "A label is not what makes a substance toxic." No, but a label can indicate toxicity with , say, skull and cross bones on it... "Nor is a toxicity is necessarily a fatal attribute. But--too nuanced! I'm sure you have another question to ask, eh?" No, just a few more definitions... Definitions of toxic on the Web: Poisonous, carcinogenic, or otherwise directly harmful to life. www.buzzardsbay.org/glossary.htm having the characteristic of causing death or damage to humans, animals, or plants; poisonous. www.wef.org/publicinfo/newsroom/wastewater_glossary.jhtml Harmful, destructive or deadly to living things. www.education.melbournewater.com.au/content/glossary/ A chemical that can harm or kill you (like pesticides). www.ci.tacoma.wa.us/envirokids/Glossary/default.htm The ability to have a harmful or deadly effect on individuals, animals, plants, or the environment, in general. www.ecohealth101.org/glossary.html refers to the ability to kill or damage cells. www.ariusresearch.com/glos.html Producing or containing a poisonous substance that may be harmful or deadly. www.pca.state.mn.us/gloss/glossary.cfm Any substance that can cause death, abnormalities, disease, mutations, cancer, deformities, or reproductive malfunctions in an organism. ohioline.osu.edu/b873/b873_8.html harmful, poisonous, deadly www.fws.gov/midwest/mussel/glossary.html Poisonous; having the ability or property to produce harmful or lethal effects on humans or the environment. One of the four hazardous waste characteristics. (See also reactive, corrosive and ignitable.) www.moea.state.mn.us/ee/glossary.cfm Poisonous; for example, cytotoxic*** drugs poison cells www.cancerbacup.org.uk/Cancertype/Childrenscancers/General/Sometermsexplained ***There's that word again! >"A label is not what makes a substance toxic." > >No, but a label can indicate toxicity with , say, skull and cross bones on >it... Of course. So what? Many useful items may be kept in large containers where exposure to relatively large amounts could be fatal. >"Nor is a toxicity is necessarily a fatal attribute. > >But--too nuanced! I'm sure you have another question to ask, eh?" > >No, just a few more definitions... How marvelously and pointlessly pedantic! George M. Carter "Chemo does NOT cause CD4 cells to drop. They may cause other problems, like anemia. But that ain't a drop in CD4 count, etc." Chemotherapy and You: A Guide to Self-Help During Cancer Treatment Coping with Side Effects What Causes Side Effects? Because cancer cells may grow and divide more rapidly than normal cells, many anticancer drugs are made to kill growing cells. But certain normal, healthy cells also multiply quickly, and chemotherapy can affect these cells, too. This damage to normal cells causes side effects. The fast-growing, normal cells most likely to be affected are ***blood cells forming in the bone marrow*** and cells in the digestive tract (mouth, stomach, intestines, esophagus), reproductive system (sexual organs), and hair follicles. Some anticancer drugs may affect cells of vital organs, such as the heart, kidney, bladder, lungs, and nervous system. [Emphasis mine.] You may have none of these side effects or just a few. The kinds of side effects you have and how severe they are, depend on the type and dose of chemotherapy you get and how your body reacts. Before starting chemotherapy, your doctor will discuss the side effects that you are most likely to get with the drugs you will be receiving. Before starting the treatment, you will be asked to sign a consent form. You should be given all the facts about treatment including the drugs you will be given and their side effects before you sign the consent form. Infection Chemotherapy can make you more likely to get infections. This happens because most anticancer drugs affect the ***bone marrow, making it harder to make white blood cells (WBCs),*** the cells that fight many types of infections. Your doctor will check your blood cell count often while you are getting chemotherapy. There are medicines that help speed the recovery of white blood cells, shortening the time when the white blood count is very low. These medicines are called colony stimulating factors (CSF). Raising the white blood cell count greatly lowers the risk of serious infection. [Emphasis mine.] Most infections come from bacteria normally found on your skin and in your mouth, intestines and genital tract. Sometimes, the cause of an infection may not be known. Even if you take extra care, you still may get an infection. But there are some things you can do. http://www.cancer.gov/cancertopics/chemotherapy-and-you/page4 |
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