Archive for the ‘HIV’ Category

HIV: PROBLEMS OF THE DIGESTIVE SYSTEM

Sunday, May 8th, 2011
The digestive system includes the mouth; the tube through which food passes after being swallowed, called the esophagus; the stomach; the small intestine, where food is broken down and absorbed; the large intestine or colon, where unabsorbed material is stored for elimination; and the anus. The whole system, taken together, is responsible for digestion of food and elimination of waste. This section will discuss all parts of the digestive system except the mouth: the mouth, which is a common site of problems, has been given its own section.
HIV infection can affect any part of the digestive system, and does so commonly in the later stages. The symptoms are often a clue to which part of digestive system is being affected. Painful or difficult swallowing is usually a symptom of problems with the esophagus. Pain in the abdomen, nausea, and vomiting are usually symptoms of problems with the stomach. Diarrhea, pain, and malnutrition from the failure to absorb nutrients are all symptoms of problems with the small intestine. And pain, diarrhea, or constipation are symptoms of problems with the colon.
Many of the problems in the digestive system also interfere with nutrition. Anything that interferes with nutrition is especially important to someone with HIV infection, because HIV infection itself causes weight loss and nutritional deficiencies. Severe malnutrition also seems to further weaken the immune system. Anyone with HIV infection and such problems with the digestive system should be under the care of a physician.
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UNDERSTANDING TESTS FOR HIV

Monday, January 17th, 2011
In 1983, the virus that came to be called the human immunodeficiency virus (HIV) was discovered in human blood samples. Two years later, researchers developed a test to detect HIV in the blood. At that time, the best use of the test was to screen people who wanted to donate blood so that blood transfusions and the blood supply would be free of HIV.
Medical researchers, however, were reluctant to use the screening test to identify people with HIV infection. First, although the test was one of the most accurate tests of its kind, occasional errors in its results created a lot of anxiety. Someone whose test result was positive might not have HIV, while someone whose test result was negative couldn’t be certain that HIV was not present. Second, at that time, the public was not ready to accept people with HIV infection, and the newspapers were full of stories of discrimination against these people. This public response was partly due to fear and partly to our uncertainty about how the virus was transmitted. The third reason, and the most important, was that physicians had little to offer anyone who tested positive. As a result, recommendations from the medical profession and from others concerned with the epidemic about whether to get tested for HIV were ambiguous. That is, no one knew whether testing for HIV made sense or not.
Since these early times, the accuracy of the test has improved substantially, public understanding has progressed somewhat, and medical research has made a gigantic leap forward in the treatment of HIV infection. Recommendations have changed accordingly. The purpose of this article is to discuss the tests themselves and their accuracy, make recommendations about who should be tested, discuss the confidentiality of the tests, and help interpret the results.
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UNDERSTANDING TESTS FOR HIVIn 1983, the virus that came to be called the human immunodeficiency virus (HIV) was discovered in human blood samples. Two years later, researchers developed a test to detect HIV in the blood. At that time, the best use of the test was to screen people who wanted to donate blood so that blood transfusions and the blood supply would be free of HIV.     Medical researchers, however, were reluctant to use the screening test to identify people with HIV infection. First, although the test was one of the most accurate tests of its kind, occasional errors in its results created a lot of anxiety. Someone whose test result was positive might not have HIV, while someone whose test result was negative couldn’t be certain that HIV was not present. Second, at that time, the public was not ready to accept people with HIV infection, and the newspapers were full of stories of discrimination against these people. This public response was partly due to fear and partly to our uncertainty about how the virus was transmitted. The third reason, and the most important, was that physicians had little to offer anyone who tested positive. As a result, recommendations from the medical profession and from others concerned with the epidemic about whether to get tested for HIV were ambiguous. That is, no one knew whether testing for HIV made sense or not.     Since these early times, the accuracy of the test has improved substantially, public understanding has progressed somewhat, and medical research has made a gigantic leap forward in the treatment of HIV infection. Recommendations have changed accordingly. The purpose of this article is to discuss the tests themselves and their accuracy, make recommendations about who should be tested, discuss the confidentiality of the tests, and help interpret the results.*252\191\2*

HIV: PRACTICAL MATTERS-PUTTING YOUR AFFAIRS IN ORDER: LIVING WILLS

Saturday, January 8th, 2011
A living will is a legal document outlining your decisions about treatment to sustain your life should you be unconscious or incompetent. The living will is somewhat different from the durable power of attorney for health care: the person with your durable power of attorney for health care, when faced with the decision of whether to prolong your life, will usually decide to prolong life. The living will provides that person with your specific instructions for making this decision. The person with your durable power of attorney for health care can also make decisions that may not have been foreseen in your living will.
Living wills, unlike regular wills, apply only to medical treatments. The actual form and scope of a living will is established by state laws. In general, living wills specify which types of treatment you wish to have or wish not to have. Living wills also specify the physical and mental states in which you do or do not want these treatments. These treatments include transfusions, support on a respirator, operations, and resuscitation. Some states have no provision for living wills. Other states that do provide for living wills do not allow any restrictions on food and water. In any case, a living will applies only after the person becomes incompetent and has a terminal condition.
A living will might be written as follows:
In the event that I have an incurable disease that is certified to be a terminal condition by two physicians who have personally examined me—including one who shall be my attending physician—and these physicians have determined that my death is imminent and will occur whether or not life-sustaining procedures are used; and where application of such procedures would serve only to artificially prolong the dying process, I direct that these procedures be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication, food, and water, and any additional procedure necessary to give comfort and alleviate pain. In the absence of my ability to give directions regarding the use of such
life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physicians as the final expression of my right to control my medical care and treatment.
To make a living will, obtain a sample document from your lawyer, from a hospital legal office, or from a social worker. The content of the living will may be discussed with your physician to assure the use of proper terms and to include likely decisions. The living will must be dated and signed by you and by two witnesses. You must be at least eighteen years old and competent. The witnesses must be at least eighteen years old, must not be related to you, must not be financially responsible for your care, and may not be your health care provider or connected with the facility providing your care. You or your representative should give your physician a copy of the living will. You may revoke the will at any time, preferably by a written statement, but also by destroying the living will and notifying any persons—including the physician—who retain copies.
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HIV: PRACTICAL MATTERS-PUTTING YOUR AFFAIRS IN ORDER: LIVING WILLSA living will is a legal document outlining your decisions about treatment to sustain your life should you be unconscious or incompetent. The living will is somewhat different from the durable power of attorney for health care: the person with your durable power of attorney for health care, when faced with the decision of whether to prolong your life, will usually decide to prolong life. The living will provides that person with your specific instructions for making this decision. The person with your durable power of attorney for health care can also make decisions that may not have been foreseen in your living will.     Living wills, unlike regular wills, apply only to medical treatments. The actual form and scope of a living will is established by state laws. In general, living wills specify which types of treatment you wish to have or wish not to have. Living wills also specify the physical and mental states in which you do or do not want these treatments. These treatments include transfusions, support on a respirator, operations, and resuscitation. Some states have no provision for living wills. Other states that do provide for living wills do not allow any restrictions on food and water. In any case, a living will applies only after the person becomes incompetent and has a terminal condition.     A living will might be written as follows:     In the event that I have an incurable disease that is certified to be a terminal condition by two physicians who have personally examined me—including one who shall be my attending physician—and these physicians have determined that my death is imminent and will occur whether or not life-sustaining procedures are used; and where application of such procedures would serve only to artificially prolong the dying process, I direct that these procedures be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication, food, and water, and any additional procedure necessary to give comfort and alleviate pain. In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physicians as the final expression of my right to control my medical care and treatment.     To make a living will, obtain a sample document from your lawyer, from a hospital legal office, or from a social worker. The content of the living will may be discussed with your physician to assure the use of proper terms and to include likely decisions. The living will must be dated and signed by you and by two witnesses. You must be at least eighteen years old and competent. The witnesses must be at least eighteen years old, must not be related to you, must not be financially responsible for your care, and may not be your health care provider or connected with the facility providing your care. You or your representative should give your physician a copy of the living will. You may revoke the will at any time, preferably by a written statement, but also by destroying the living will and notifying any persons—including the physician—who retain copies.*218\191\2*