Letter Sender 2: positiveqc

I've been exchanging messages with positiveqc and he said reading my blog was like déjà vu because almost the same things happened to him. I asked if he would like to share his story, and he was very kind to oblige:

Hi there.

Well, sometime in December 2011, I wasn’t my usual self I felt I was feeling weak all the time and when I’m in the mall I get tired from walking easily. Thought it was just age catching up on me or my lack of sleep. But then I started getting low grade fevers which I didn’t mid since once I take paracetamol the fever usually goes away. 

In January 2012, I started getting high grade fevers and felt really weak. I went to see a doctor, got an x-ray since my cough was so bad. Everything was fine and I was given antibiotics. At the same time I had pimple breakouts on my face and back. I even had to see a dermatologist so I can them injected so they would dry up and go away. My face cleared up but the fever was still there. That’s when I decided to go to the hospital. It was a late weekday afternoon I went to the ER of Med city. To cut the ER story short I was confined in the hospital. Then the tests came.

Blood was extracted, sputum was tested and cultured. New set of X-rays and more blood extraction. Was there for 2 weeks and they couldn’t find anything wrong with me. They tested me for Dengue, malaria and were even asked if I went to South Africa or some exotic country in the last few months.

Then one night an infectious disease doctor came in and asked me about my lifestyle. That’s when it all dawned on me. Ito nay un baka nga meron na ako. She asked if I was ok to take an HIV test and whole bunch of other tests related to it. 

A few days later, the CD4 results came in 1st, they were way below normal. That’s when she told me I may be positive for HIV. She asked me to stick out my tongue and saw I already hat oral thrush. I was given a new set of meds and after a few days was discharged.

I went back after a few days for the test results. It was positive. I wasn’t surprised since I was already expecting this due to low cd4 and oral thrush. I then started on my ARV’s one of which gave me anemia. And during my follow up check up my doctor saw me and told me she needs to confine me since I look terrible. 

During my confinement more blood was taken and the results I had low RBC. They almost gave me a transfusion but decided to give me iron supplements instead. During this time the fever was still there.

My doctor changed my ARV cocktail and for months I felt like throwing up all the time. Para akong buntis. I still have occasional fevers mainly because I was also diagnosed to have TB of the lymph nodes. My oral thrush is gone but once a day around 5pm, I feel feverish and weak until about 9pm.

Last august I took my 2nd cd4 test and from a low of 11 it’s now at 81. Hopefully by December it has gone up to more than a hundred.

And that’s my story.

Manila Social Hygiene Clinic

I went back to the Manila Social Hygiene Clinic Wednesday last week to accompany a a friend I met online. Let's call him K. He's from Pasig and he doesn't know where to get tested, so I suggested we go to MSHC.

We met at LRT Roosevelt Station and took the train going to Tayuman. (As a sidenote, there's a social hygiene clinic in Project 7 that's walking distance from LRT Roosevelt. I've had my first ever test there on September 13, 2011. The result was non-reactive. But i prefer MSHC because I had a much more pleasurable experience there.) The ride to Tayuman was quick. I engaged K in a casual conversation to relax the atmosphere. I didn't feel any sign of worry or anxiety from him, but I made sure he's comfortable nonetheless.

We arrived Tayuman and walked southbound. We passed by the Department of Health (DOH) compound, which is where I presume my dad took my blood bags from during my previous transfusions, and after that passed by Jose R. Reyes Memorial Hospital (JRMH), and turned right at Quiricada Street. Just 50meters away from the intersection is San Lazaro Hospital (SLH), which is really just behind JRMH. SLH is one of the three treatment hubs for HIV patients in Metro Manila, but it is more popular as a hospital for treating animal bites and rabies. The other two are the Philippine General Hospital (PGH) in Padre Faura, Manila, and Research Institute for Tropical Medicine (RITM) in Alabang, Muntinlupa.

Right across SLH is the Manila Social Hygiene Clinic. We arrived there 11:50am, and it was lunchbreak, so I just gave him a tour around. Upon entering the gate, we went straight to a door at the side of the building with stairs going up. The second floor is where Dra. Mendoza holds office. I showed K the doctor's office and showed him the way to the laboratory where his blood will be taken later. The lab is at the first floor.


View Social Hygiene Clinics in a larger map

After the tour, we walked to SM Tayuman to kill some time before the clinic reopens. I told him about my experiences when I was having my tests and told him not to worry because Dra. Mendoza is a very pleasant lady. I told him her interview is quick and informal, in contrast with the one I had in Project 7 which was very thorough and took me half an hour to finish.

Around 1pm, we decided to go back to the clinic. Reaching the gate, I told him I'd wait for him at Jollibee in LRT Tayuman and wished him goodluck.

I had lunch while waiting for him. I craved for burger so I had a Champ meal, and had an extra Chicken and Mushroom pasta. While I was eating, he texted me the doctor was still not in. I felt sorry for him because although he doesn't admit it, the extra waiting time is a killer. I already finished my meal and he said the doctor is still not in because she went somewhere but will be back at 2pm. He said he'll wait.

I texted him again after several minutes and he said he's just waiting for the result. I thought, the interview was quick! I was composing my next message to him when he tapped me at the back. He showed me the result: Non-Reactive! :)

To K, I'm happy for you. I hope you take the result as a blessing that should not be taken for granted. Health is wealth, and i hope you stay healthy all through your life. :)

Manila Social Hygiene Clinic is open for free screening of HIV and other sexually transmitted infections on Mondays thru Thursdays, 8-11am and 1-3pm, and Fridays 8-11am only.

Home.

Finally discharged yesterday afternoon after finishing my fourth bag in the morning. My post-BT hemoglobin count is 98. (Ugh, when will it reach 3-digits? Hehe.)

My next visit to RITM will be on December 10, which coincides with my ARV refill schedule. S, who also got a CBC last Tuesday with me and was finally normal after 3 months of anemia, told me to rest. That's what he did, so I will. I promise I won't be stubborn anymore and will follow everyone's advise, the sane ones at least. I don't want to get a third booking at the hospital.

Letter Sender 1: #28

My own survival story

Hello there! Just call me #28. I'm an HIV+ since January 12, 2012.

I first saw you on Planet Romeo and I got interested and amazed about you looking for same who are HIV+ which in my case, although I heart-warmingly accepted my condition, wouldn't want to flaunt it over social sites. I also followed your blog link and I've read your articles from October to now.

What I've read brought me back all the feelings I also had then. Please allow me to share my own survival story.

The Symptoms

I got the virus through heterosexual encounter. the first symptom that I got wash allergy-like rashes on my skin, that was in July 2011. While I was about to go home from work, I felt this itching sensation at my back, I thought some mosquitoes bit me but I doubt coz our office is very strict on pest and insect killing activities. On the fx I just felt im hot and just ignored it. We I came at our rented unit, I took off my barong and shirt and was surprised about these map-like reddish rashes all over my body. I got frightened and immediately called my friend to accompany me for a consultation at UST Hospital. We went there like 8:00pm and the nurse advised me to take an anti-histamine for 5 days, 3x a day. I did it but only for a day since I noticed that the rashes are gone.

October 2011, I got a flu-like illness that went for 3 days. But what frightened me is that I couldn't breathe normally. I felt that each day, I easily get tired walking and easily catching my breath even for only a two meter walk. My colleague also noticed that I can no longer laugh out laud and get tired easily. She told me to file a sick-leave and have a check-up which I did.

I called my sister to accompany me to UST for a check-up. They did the x-ray and they have diagnosed that I have TB! then I went to their cardio and told him about my fast heart-beat, he said I have Arrythmia (irregular heart beat). My sister and I decided to have a second opinion at St. Luke's. The next morning we went to St. Lukes and had some consultation. On that day, my skin is turning from fair to purple color. My finger nail went so dark and I can even step a foot cause Im catching my breath and I get tired immediately. The cardio wanted me to have a 2D Echo and ECG and be back the next day but I refused. I told him to admit me immediately coz I feel like Im not gonna make it the next day so he admitted me and had me confined.

During my confinement, the tests results revealed that I have ONLY pneumonia not TB, but, i also was diagnosed of viral Cardiomyocarditis or viral Cardiomyopathy (weak heart muscle) which causes me to have shortened breath and fatigue. They took care of me and after a week, i was discharged.

November 2011, I had fever and what looks like red dots on my skin. I submitted a sick leave request and told my boss that maybe my Cardio-related illness is coming back. My mom and I went to my aunt in Cavite to rest so they can take care of me while im sick. Two days gone-by and the red dots spread so fast and were map-like on my neck, then chest, then on my tummy and lastly on my legs. My aunt asked my mom to take me to the nearby hospital and have me checked. When we are at the hospital, I don’t feel hot but my temperature wa 41 degrees celcius so the doctor requested for my confinement. I was then diagnosed with German Measles and Typhoid fever. I stayed there until the second week of December.

Two days after my discharge, I felt something wet and sticky on my anus. I took off my underwear and saw a greenish-like sticky liquid. I ignored it until it felt itchy. We went back to St. Luke’s and have it checked. The surgeon said I have fistula-in-ano, an anal infection which requires surgery. But I was requested to get a clearance first from my cardio since I have a heart disease. So I went to my cardio and talked to him. He was surprised to see me cause I lost weight a lot. My record shows Im 60Kg in October, my first consultation with him and now I’m 54kg in just two months. I told him about my fever, the measles and now my fistula-in-ano. Then suddenly he asked me one thing, “are you gay?”. I felt different but I honestly answered him “yes, I am”. The next think he requested me before clearing me out for my surgery is to go to an Infectious disease specialist which I did without worry or with quite a hint of what he wants me to know.

I went to my first Infectious Disease doctor at St. Luke’s. The first thing he asked me is about my gender preference and my sexual activities. I told her all about it and then she asked me to open my mouth for her to see if I have some sores. She found that I have sores but only the sores of persons infected with a dreaded virus. She politely advised me to have an HIV screening but she also told me that I’m more likely to be positive. At that instance I felt nothing, it’s just like a normal check up. She was surprised I did not took the news surprisingly. I told her that in my self, I already know what’s this will come about. I told her I already have the hint that I am infected. She said only few accept that news calmly and with acceptance so she continued with her advise. I also met with a Hematologist for blood clearance and my cardio has cleared me. My HIV screening is scheduled on the 12th of January 2012 and the surgery on the 19th of the same month.

The News

January 12, 2012 morning, I went to St. Luke’s Pathology Department and had my blood screened for HIV. In the afternoon, I got the results and no surprise it’s reactive. I met with a counselor and he told me not to be afraid, I have to disclose my case with my family as much as possible and more of consoling words. My sister which is my best friend also knew what to expect. On January 17, I got myself admitted and be prepared for the operation of my fistula on the 19th.

The operation went for about an hour. They gave me a general anesthesia but made me sleep before they injected it on my spine. From my waist to my feet, their numb for two hours after the surgery coz of the anesthesia. I was advised to stay confined for three days but I got fever with overflowing sweaty nights the days after. And then there it was my attending physician was no longer the surgeon but my Infectious Disease doctor. I was treated with anti-soar meds for seven days until my fever went down to 37.5 degrees and I was discharged. They informed my company about what happened and I was approved for a Leave Without Pay case. I rested with my family in Pampanga while recovering from the operation but just days after my discharge, the fever regularly comes back. Only I and my sister knows my real case. My mom and other siblings took me to as many as 3 “albularyos” to “cure” my fever but none of them succeeded. Until I went so weak and so pale that my Infectious Disease doctor from St. Luke’s referred me to her colleague here in Pampanga. We went to his clinic and the moment he knew my case, he instructed me to get myself confined in a near-by hospital.

The Adversity

The most difficult and challenging part of my life was during my confinement at JBL Hospital. I’ve undergone almost all kinds of laboratory test. My weight went down to 43kg. I had three blood transfusion because I was diagnosed of anemia. Then they are eager to take away all the infectious bacteria by giving me strong doses of anti-biotics like augmentin, co-amoxicalav and very expensive ones. I also had been through the eye-blinding check-up just to find out my eye’s were saved from infection. The scariest part was when my heart stopped beating twice. I had also bid goodbye to my friends and relative coz I felt like I can no longer make it. I have prayed and confessed all my misdeeds and asked for HIS forgiveness.

My heart crushed when my mom knew about my real case. She cried one whole night and went to many churches and prayed for nine consecutive days. My friend’s families requested a pray-over in their chapels for my fast healing. Many colleagues from my former and current company visited me in the ICU. I even remember one nurse told me that I am more than a celebrity because of the many Manilanian visitors who brings food from my favorite restaurants. They also gave us financial aid to cover my expensive anti-biotics.

The Healing

I started taking my ARV’s in February 29th when my lab results showed no more signs of opportunistic infections. My CD4 count in January is 127. My sister estimated that during my confinement in JBL my CD4 went down below 100. I was discharged March 5, 2012.

Only few weeks after my discharge, my hemoglobin count went down from 90 to 80. I needed to be admitted on a nearby private hospital and have a blood transfusion. I was not at ease when close friends and classmates visited me not knowing my real condition. I had two bags of blood transfused within my veins. I even saw one FB friend which I am fond of and well, he’s a doctor in that hospital. After two days, I was discharges.

At home, in April and so on, my sister and sisters-in-law nursed me while I’m weak. I was literally weak. I can’t speak coz I get easily tired. I can’t move my hands and my legs. I can’t exert any effort. I can’t eat more than a spoon of food, I get acidic. Behind my back the neighbors are saying I only have until May to live. Many of my childhood friends and classmates visited me at home. All of them didn’t avoid to shed tears while seeing me bed-ridden, so skinny and dark skinned. I was a living skeleton. I still have my anal wound.

The Apprentice

While I was undergoing ARV treatment, my aunt from Cavite invited two friends she knew, who are faith-healers. At first I was hesitant to meet them coz I have a previous encounters with “albularyos”. Then she took them with her and they visited me in mid April. Tita Inday was the “main healer” as I call her and she have an assistant. She didn’t asked me anything about my condition. The only thing she asked was,”Do you believe that God can heal you?”. I’m not so religious but at that instance of course, I cried and said “Yes, I believe”. Then she started her healing process.

Tita Inday ask my sister to gather specific leaves from different trees. She boiled it and put some ammonia. The she asked me sit down and to covered myself, from head to toe with a blanket and she also put inside the boiling leaves. She asked me to inhale the vapor to the most that I can take it. The vapor is hot, it stings in my nostrils but I felt better. I felt like there’s no more phlegm in my lungs and indeed I felt better breathing. The next day before they left, she instructed my mom and my sister some herbal rituals for 39 days. They have to prepare me a drink consisting of a galss of pure ampalaya juice (literally the juice extracted from ampalaya leasves) with three calamansi and a teaspoon of sugar. I will drink it every morning for seven days with empty stomach then a glass of tomato juice everyday for 39 days or until needed.I did that and it’s really not good. But the good thing is, my hyperacidity went gone and my CBC count are remarkably getting to normal after 39 days. She also advised me to drink a glass of milk in the morning and before going to bed. The drink is prepared by putting three scoops of BirchTree powdered full cream milk, added with 2 freshly beaten organic egg and a spoon of sugar. So it’s like drinking a liquid leche-flan. I diligently obeyed and did the routine and for 39 days, I was able to move my hands and legs. I can breathe more comftably but not normal. Then I continued taking my ARVs, heart meds, and those herbal treatments.

The Miracle

On August 29, I had my sixth-month general check-up at St. Luke’s. The results were overwhelmingly unbelievable. My 2D Echo says that from a heart-muscle pumping capacity of 39% in April, it went back to normal of 57% (Normal range is 55%-77%) and even the nurse who compared the results wondered if the initial test is really accurate or if I am the same patient who undergone the test. My ECG, went back to normal, my hemoglobin increased from 80 to 110 remarkably and my other whole blood test stabilized. I also had my repeat CD4 test at San Lazaro SACCL and from 127 count it went up to 247 for only 8months (in which when I was in JBL it was estimated to be below 100). The doctor says, the double increase is not normal for HIV stage 4 patients who are under treatment. My Cardiologist was so impressed about my fast recovery. She even said that she should have taken a photo of me when I first came to her and now when I was “ok”. From 39kg in April I gained weight to 50kg end of August. From Nevirapine, LamiZido-vudine, Contrimoxazole, Izoniasid, Lanoxin, Vastarel, and Coralan to Nevirapine, LamiZido-vudine and Carvedilol now.

Since June, my Company let me work at home. They brought here all my office equipments and supplies. And they even gave back my regular salary and benefits. They are expecting me to be back in January 2013.

The Second Life

I consider this year as the greatest turning point of my life. At 25, I almost met death, but by faith and love, I’m still alive. I now consider each day as my last day on earth. I asked for forgiveness and mercy before I go to bed. I tried to do good every day I live. I now know how to love unconditionally. How to share everything generously and how to do all deeds with kindness. This is not my life anymore, it’s His. My dying wish and I pray, to see my mom and siblings blessed and thankful; to see my friends and colleagues and even acquaintances successful on their chosen paths, and to see that my name be remembered in good ways.

Please share my story. Thank you. If you need facts, please contact me at 091x xxx xxxx. (Pls keep this Number confidential)

Sincerely,

#28

P.S. As of today, November 20, 2012, I am 53kg. Hemoglobin of 120 will have my CD4 in March and 2D echo in February.

Not done yet.

I've been confined at the hospital since Wednesday. It's Sunday. I've been transfused with three bags of blood as of Friday morning, and in afternoon I found out I still need one more. That means we have to do the entire process of blood transporting and crossmatching all over again. I guess that means I'd stay here a few more days than expected... And more movies and tv series.

The Big Bang Theory, anyone?

HPV exam.

What's more embarassing than a doctor examining your arse? It's when five of them start peeking and poking at your arse trying to look for signs of HPV.

I don't know how HPV got written on my chart, but one of the doctors referred me to derma on reports of HPV. I'm clueless because to know if one has genital warts, you actually have to see the warts. I don't remember any doctor examining my privates, so how did it get reported?

The report said I had peri-anal warts. So they tried and tried to look for warts in an area of my body so private not even I have seen. It didn't end there. They also examined my other private part. After a careful and thorough search, they gave up and said I probably have none because if I have it, I would definitely know. Genital warts are supposedly hard, cauliflower-like growths that can easily be felt when cleaning.

Not that I'm complaining, it was about time somebody examined my privates for signs of anything, but they sure did it with a bang! :)

(For more info on HPV, you can check this article out.)

Na naman.

It's 730am, and I'm back at my favorite place on earth: RITM. Yeah, you guessed it right, I'm getting another blood transfusion.

I had a checkup yesterday and from 84 last week, my hemoglobin dropped again to 68. I also had my first shot of erythropoietein yesterday, the glycoprotein hormone that controls red blood cell production. I'll have it thrice a week.

I'm waiting for the doctor who will process my admission. Stay tuned. :)

Meetup with a balikbayan friend.

I've been regularly meeting up with people I've become friends with online, pozzies and otherwise. Last friday, I've met up with a friend who was coming home from Abu Dhabi. He gave me pasalubongs: chocolates from the middle east, and a book entitled "Chicken Soup for the Unsinkable Soul".

Inside, I found a short hand-written message:

"Always strive to be happy."

Thank you very much, C. Having friends like you around me makes me happy. :)

Going down.

Yesterday I was back in RITM for a follow-up checkup. My CBC is down again to 84 from 97 post-BT.

I'll have another CBC next week. If the trend continues, I might need to see a hematologist, which RITM doesn't have.

Am I worried about my condition? No. S has gone through worse, and he's doing fine. I thank him for showing me that things will be ok. But what I am going through right now is very, very frustrating.

See you again next Monday, RITM.

How is HIV Transmitted? : Specific Sexual Practices: What are the Risks?

How is HIV Transmitted? : Specific Sexual Practices: What are the Risks?

Specific Sexual Practices: What are the Risks?

Studies have repeatedly demonstrated that certain sexual practices are associated with a higher risk of HIV transmission than others.

Vaginal Intercourse:

Unprotected vaginal intercourse is the most common mode of HIV infection worldwide. In the United States and many other developed nations, it is the second most common mode of sexual HIV transmission (after anal intercourse among MSM).

At least five European and American studies have consistently demonstrated that male-to-female HIV transmission during vaginal intercourse is significantly more likely than female-to-male HIV transmission. In other words, HIV-positive men are much more likely to transmit the virus to HIV-negative women through vaginal intercourse than HIV-positive women are to HIV-negative men.

There are a few reasons for this. First, there are more men than women in the United States infected with HIV, meaning that it's much more likely for a female to have sex with an HIV-positive male than for a male to have sex with an HIV-positive female. Second, women have a much larger surface area of mucosal tissue – the lining of the vagina and cervix that can chafe easily and are rich in immune system cells that can be infected by HIV – than men. For men, HIV must enter through a cut or abrasion on the penis, through the lining of the urethra inside the penis.

There has been some research suggesting that men who are uncircumcised have a higher risk of becoming infected with HIV or transmitting the virus if they are already HIV positive. However, it is important to stress that men who are circumcised can still be infected (or transmit the virus) if condoms are not used for vaginal sex.

Men or women who have ulcerative sexually transmitted infections (STIs), such as genital herpes or syphilis, are more likely to spread the virus if they are HIV positive or to become infected with the virus if they are HIV negative.

Anal Intercourse:

Being the receptive partner – the "bottom" – during unprotected anal intercourse is linked to a high risk of HIV infection. The reason for this is that HIV-infected semen can come into contact with mucosal tissues in the anus that can be damaged easily during anal intercourse. And the risk of HIV transmission isn't necessarily reduced if the "top" pulls out before ejaculation – studies have demonstrated that pre-ejaculate (pre-cum) can contain high amounts of HIV and can result in transmission during anal intercourse.

It's important to note that both MSM and heterosexuals have anal intercourse. Many heterosexuals report that it is a pleasurable form of intimacy that eliminates the risk of pregnancy. However, it is still associated with a high risk of HIV infection, if condoms are not used and the insertive partner's HIV status is either positive or not known.

Is the insertive partner (the "top") also at risk during unprotected anal intercourse? At least eight studies conducted over the years were unable to demonstrate a clear link between insertive anal sex and a risk for HIV infection among MSM. However, these studies should not be interpreted to mean that being the top during anal intercourse – and not using a condom – is without risk. We know that men can be infected with HIV through vaginal intercourse – an activity in which they are the insertive partner. Based on this knowledge, it is also believed that the insertive partner during unprotected anal intercourse can also be infected with HIV. Studies, using mathematical estimates, suggest that unprotected insertive anal sex is roughly four to 14 times less risky than unprotected receptive anal sex. However, experts still believe that the risk for transmission is noteworthy.

Penile-Oral Sex

Of the different sex acts, the one that often causes the greatest amount of confusion in terms of risk – and raises the greatest number of questions – is penile-oral sex. The fact is, most experts agree that fellatio, sometimes referred to as "blow jobs," is not an efficient route of HIV transmission. However, this does not mean that it cannot happen.

Research attempting to evaluate the risk of fellatio has often faced important limitations. For starters, very few people participating in studies only engaged in penile-oral sex. Many people also had unprotected vaginal or anal intercourse, making it very difficult to determine if unprotected fellatio is an "independent factor" associated with HIV transmission. There are also people who test positive for HIV and claim that unprotected fellatio was their only risky behavior. However, it's virtually impossible to know if these people are always reporting their sexual behavior accurately. (Study volunteers often have a difficult time admitting the truth about potentially embarrassing behavior to healthcare professionals conducting scientific studies.)

Because unprotected fellatio can mean that body fluids from one person can (and do) come into contact with the mucosal tissues or open cuts, sores, or breaks in the skin of another person, there is a "theoretical risk" of HIV transmission. "Theoretical risk" means that passing an infection from one person to another is considered possible, even though there haven't been any (or only a few) documented cases. This term can be used to differentiate from documented risks. Having unprotected receptive anal or vaginal intercourse with an HIV-positive partner is a documented risk, as they have been shown in numerous studies to be an independent risk factor for HIV infection. Having unprotected oral sex is a theoretical risk, as it is considered possible, but has never been shown to be an independent risk factor for HIV infection in studies.

Here's a good way to think about theoretical risk: In theory, it is possible that while walking down the street, a meteor will fall on your head and kill you instantly. This is because meteors do occasionally fall to earth. People live their lives above ground, so there is a theoretical risk of being hit be a meteor. In fact, there have been reports of a few people being hit by meteors. But because the risk is so small, given that few meteors fall to earth and the large number of inhabitants of this planet, the risk is purely theoretical. The same principle holds true with oral sex – millions of people all over the world are believed to engage in unprotected oral sex and there have only been a handful of documented cases of HIV transmission. In turn, fellatio, and other types of oral sex (see below), remains a theoretical risk for HIV infection.

There have been a number of studies that have closely followed MSM and heterosexual couples, in which one partner was HIV positive and the other partner was HIV negative. In all of the studies, couples that used condoms consistently and correctly during every experience of vaginal or anal sex – but didn't use condoms during oral sex – did not see HIV spread from the HIV positive partner to the HIV negative partner.

There have been three case reports and a few studies suggesting that some people have been infected with HIV as a result of unprotected oral sex. However, these case reports and studies all involved MSM – men who were the receptive partners (the person doing the "sucking") during unprotected oral sex with another HIV-positive man. There haven't been any case reports or studies documenting HIV infection among female receptive partners during unprotected oral sex. Even more importantly, there hasn't been a single documented case of HIV transmission to an insertive partner (the person being "sucked") during unprotected oral sex, either among MSM or heterosexuals.

Is insertive oral sex a possible route of HIV transmission? Yes. But is it a documented risk? Absolutely not.

Oral-Vaginal Sex

Like the study of fellatio, evaluating the risk of unprotected oral-vaginal sex (cunnilingus) is difficult, given that most people surveyed in studies did not avoid other types of unsafe sexual activity. However, there have been case reports highlighting one case of female-to-female transmission of HIV via cunnilingus and another case of female-to-male transmission of HIV via cunnilingus. Both of these cases involved transmission from receptive partner (the one receiving oral sex) to the insertive partner (the one performing oral sex). There haven't been any documented cases of HIV transmission from the insertive partner to the receptive partner.

Oral-Anal Sex

Oral-anal sex is often referred to as analingus. Analingus, or "rimming," is not considered to be an independent risk factor for HIV. However, it has been shown to be a route of transmission for hepatitis A and B, as well as parasitic infections like giardiasis and amebiasis.

Digital-Anal or Digital-Vaginal Sex

Digital-anal or digital-vaginal sex is the clinical term for "fingering" either the anus or the female genitals (including the vagina). While it is theoretically possible that someone who has an open cut or fresh abrasion on his or her finger or hand can be infected with HIV if coming into contact with blood in the anus or vagina or vaginal secretions, there has never been a documented case of HIV transmission via fingering.

Source: http://www.aidsmeds.com

Treatment News : Possible Cure in Protein That Starves HIV of Needed Building Blocks

Treatment News : Possible Cure in Protein That Starves HIV of Needed Building Blocks

Possible Cure in Protein That Starves HIV of Needed Building Blocks

Focusing on a protein called SAMHD1, a team of researchers believes it has stumbled upon the mechanism in which some immune system cells keep HIV from hijacking their cellular machinery to produce new virus. The findings, published online ahead of print by the journal Nature Immunology, pave the way for novel methods to treat—and potentially cure—HIV infection.

SAMHD1, the international team of scientists explains, is found in white blood cells known as macrophages and related cells known as dendritic cells. Building upon research published last year, demonstrating that SAMHD1 makes it difficult for HIV to infect macrophages, the scientists have helped close the knowledge gap with the discovery that the protein cuts off the supply line of deoxyribonucleotide triphosphate (dNTP)—the building blocks of DNA—which HIV needs to re-create its genetic contents.

When a virus, like HIV, infects a cell, it hijacks the cell’s dNTP. Once the virus replicates, the resulting DNA molecule contains all the genes of the virus and instructs the cell to make more virus.

SAMHD1, the researchers found, protects the cell from viruses by destroying the pool of dNTPs, leaving the virus without any building blocks to make its genetic information, a process known as nucleotide pool depletion.

“SAMHD1 essentially starves the virus,” explained Nathaniel Landau, PhD, a professor of microbiology at New York University School of Medicine and a lead author of the Nature Immunology paper in an accompanying news announcement. “The virus enters the cell, and then nothing happens. It has nothing to build and replicate with, so no DNA is made.”

As a result, the most common form of HIV—HIV-1—does not readily infect these cells. Instead, the virus has evolved to replicate mainly in CD4 cells, which do not contain SAMHD1 and therefore have a healthy pool of dNTPs.

The virus, the researchers suggest, may have evolved in such a way that it deliberately avoids trying to infect immune cells that have SAMHD1, in order to avoid alerting the greater immune system to activate a variety of antiviral mechanisms to attack the virus.

The team also discovered how a protein in the other form of HIV—HIV-2, which is found mainly in Africa—knocks out SAMHD1. They found that the protein Vpx destroys SAMHD1, clearing the way for HIV-2 to infect macrophages. While scientists have known that HIV-2 needs Vpx to infect macrophages, they hadn’t known precisely why.

Interestingly, while one might think that a virus that is able to replicate itself in crucial cells like macrophages might be more dangerous than one that cannot, that’s not the case with HIV. The researchers note that HIV-2 is generally actually less virulent than HIV-1.

One possible explanation for this is that, like a starving man who becomes increasingly desperate for food, HIV-2—when faced with a shortage of raw materials—puts its mutation capabilities into overdrive, creating the Vpx proteins necessary to circumvent the pathway blocked by SAMHD1.

“Viruses are remarkably clever about evading our immune defenses,” Landau said. “They can evolve quickly and have developed ways to get around the systems we naturally have in place to protect us. It’s a bit of evolutionary warfare, and the viruses, unfortunately, usually win. We want to understand how the enemy fights so that we can outsmart it in the end.”

Understanding the mechanism by which SAMHD1 protects cells may provide a new idea about how to stop or slow the virus’s ability to spread, the researchers explained. Potential future research efforts, for example, might focus on finding a way to increase the amount of SAMHD1 in cells where it does not exist, such as CD4 cells, or to reduce the amount of dNTPs in cells vulnerable to infection.

This could potentially force HIV to remain dormant in all immune system cell lines, unable to replicate—another functional cure strategy.

“Over the past few years, a number of these natural resistance mechanisms have been identified, specifically in HIV,” Landau sad. “This is a very exciting time in HIV research. Many of the virus’s secrets are being revealed through molecular biology, and we’re learning a tremendous amount about how our immune system works through the study of HIV.”

Source: http://www.poz.com