How To Calculate Your Risk For Breast Cancer

Using known risk factors for breast cancer, mathematical models can be developed to help answer important questions. These mathematical models are useful tools for researchers and for patients as follows:

1. Research on risk factors – The Claus risk assessment model was used to discover the subpopulation of people who had an autosomal dominant genetic allele that increased their risk from 10% to 92%. This led to the discovery of the BRCA genes associated with breast, ovarian, and prostate cancer.
2. Clinical trial eligibility – The Gail risk assessment model was developed to help researchers determine who to enroll in the NSAPB Breast Cancer Prevention Trials
where chemoprevention was shown to reduce breast cancer risk.
3. Guidelines for doing BRCA testing – BRCA testing is very expensive and practically worthless if done on everyone (because it is so rare to be homozygous for BRCA1 or BRCA2). Mathematical models such as the BRCAPRO, BOADICEA, and Tyrer-Cuzick models can help determine what patients should undergo BRCA testing. The decision for testing is usually made when one of these models predicts a 10% or greater chance that there is a mutation of the BRCA1, BRCA2, or both genes.
4. Guidelines for doing MRI screening for breast cancer - MRI screening for breast cancer is not a cost effective screening test for the general population, but in specific groups, there are clear cut reasons to do so. In general, screening MRI is recommended for women with 20-25% or greater lifetime risk of breast cancer. The BRCAPRO and Tyrer-Cuzick models have been used to help make clinical decisions about ordering MRIs for breast cancer screening.
5. Guidelines for breast cancer therapy – The Gail model is used clinically to help
determine who should be put on tamoxifen or raloxifene for chemoprevention. Other models have been used to help make decisions about breast cancer risk reduction with prophylactic mastectomy.

For these reasons, it is important to understand these models. These models are collectively refered to as “risk assessment tools”. The following paragraphs summarize the most popular and most widely used risk assessment tools. Keep in mind that none of these risk assessment tools apply to breast cancer survivors. No mathematical model has been widely accepted to determine cancer risk in cancer survivors.

General Risk Assessment Tools

Gail Model: The Gail model is a validated risk-assessment model that focuses primarily on nonhereditary risk factors, with limited information on family history. It was developed by scientists at the National Cancer Institute and the National Surgical Adjuvant Breast and Bowel Project (NSABP) to assist health care providers in discussing breast cancer risk to determine their eligibility for the Breast Cancer Prevention Trial. The tool allows one to project a woman's individual estimate of breast cancer risk over a five-year period of time and over her lifetime. It also compares the woman's risk calculation with the average risk for a woman of the same age. The Gail Model is an on-line quiz that has 13 questions and is interactive. This calculator is based on published risk statistics and methods gathered from peer-reviewed journals, and has been extensively tested for its validity.

The major limitation of the Gail model is the inclusion of only first-degree relatives, which results in underestimating risk in the 50% of families with cancer in the paternal lineage and also takes no account of the age of onset of breast cancer. It may underestimate risk in certain groups, such as obese patients.

National Cancer Institute Model: The NCI risk assessment tool is essentially a simplified Gail Model that also factors in race. Race is a factor in determining breast cancer risk but is excluded when determining eligibility for clinical trials. This tool is probably the most popular risk assessment tool available to the public as an on-line, interactive risk calculator. The on-line quiz is a shorter, nine-point questionnaire that includes multiple factors, giving a woman her future five-year risk of breast cancer and her lifetime risk of breast cancer.

The NCI tool does not account for a lot of risk factors that can be modified. For this reason, it is difficult to use this test as a motivation tool to show people how lifestyle can alter their risk of breast cancer. It also cannot be used in breast cancer survivors, in patients with DCIS, LCIS, or people who carry one of the BRCA genes.

BRCAPRO model: This is a statistical model available as a computer program that uses two different algorithms to evaluate family history and helps a doctor determine the likelihood of finding either a BRCA1 mutation or a BRCA2 mutation in a family. The results of this can be used to determine if BRCA testing is indicated. This is very useful in light of the high cost of BRCA testing ($3,000). None of the nonhereditary risk factors can yet be incorporated into the model, however. In a comparison of four different methods for estimating breast cancer risk in patients with a family history of breast cancer, the BRCAPRO model was the least accurate. It predicted only 49% of the breast cancers that actually occurred in the screened group of patients with a family history of breast cancer.
Harvard Center for Cancer Prevention Risk Assessment Tool: This is another breast cancer risk assessment tool that includes more lifestyle factors than the NCI or Gail Model tools. It has not been studied as extensively as the Gail Model or the simplified NCI model, but it is promising in that it includes many lifestyle factors that people can do to modify their risk of developing cancer. It is also an on-line questionnaire that can be used by both women and men to estimate their breast cancer risk.

Making all this practical

Now after a thorough and confusing discussion of all these statistical models, it’s time to make all this information practical. What is the best way to help a patient accurately assess her risk of breast cancer and if possible, show her what positive factors are reducing her risk and what negative factors can be changed to reduce her risk? If possible, it would also be great to show the patient the value and indications for testing, imaging, chemoprevention, and in some cases surgery. A discussion of the practical aspect of each of these is addressed in a Q & A format below:

Q: What (free) online programs can be used to help a patient assess their risk of breast cancer?

A: Several of the risk assessment tools mentioned above can be accessed for free by the public. Here are the tests and their websites:

1. Your Disease Risk – English version: http://www.diseaseriskindex.harvard.edu
Spanish version: http://www.diseaseriskindex.harvard.edu/spanish
This is a great interactive questionnaire that calculates five-year and lifetime risk of breast cancer developed by the Harvard Center for Cancer Prevention and made public online in 2000. In 2005, they launched the Spanish version of the site, “Cuidar de su Salud”. The risk calculator includes lifestyle factors such as weight, dietary vegetables, alcohol intake, as well as Jewish ethnicity. It does not include other ethnicities, however, and is not accurate for BRCA mutation carriers or breast cancer survivors. Despite these issues, this is by far the best free online risk calculator since it is very interactive and gives you a personalized description of your risk in the form of a colored bar graph, which they can electronically manipulate to experience "virtual" risk reduction. The bar graph is a seven-level scale that compares users to a typical man or woman your age. Users learn where to focus their prevention efforts and how to make lifestyle changes by "clicking on" personalized strategies. With each click, the bar graph shrinks, and the user watches his/her predicted risk drop. This is a great concept to motivate people to participate and comply with lifestyle modification measures.

2. The NCI Risk Assessment Tool –regular web: http://www.cancer.gov/bcrisktool
Mobile web: http://www.cancer.gov/bcrisktoolmobile
This is the easy to use, on-line questionnaire based on a modified Gail model that also includes ethnicity. It does not factor in a personal history of breast cancer, DCIS, or LCIS. It does not account for other factors such as BRCA status, hormonal replacement therapy, lifestyle factors, breast feeding, menopause, or mammographic density. Despite these issues, it is a very useful tool that gives a woman her five-year and lifetime risk of breast cancer. It is the only risk assessment tool that can be used via mobile handheld devices (any type). A version of this can be downloaded for PDAs with Windows Pocket PC operating system as well.

Q: What programs can be used to help a doctor make decisions about ordering a breast MRI?

A: The American Cancer Society has developed some very good guidelines for breast cancer screening with MRI. It should be emphasized that MRI is an adjunct to mammography, not a replacement. Four programs can be used to help in clinical decision making. They are as follows:

1. A Cancer Journal for Clinicians – http://caonline.amcancersoc.org/cgi/content/full/57/2/75

2. BRCPRO – ver.4.3 available @ http://www4.utsouthwestern.edu/breasthealth/cagene/default.asp

3. Claus Model – available as a palm based software product version 1.0 at
http://www.palmgear.com/index.cfm?fuseaction=software.showsoftware&prodID=29820

4. IBIS - Breast Cancer Risk Evaluation Tool, RiskFileCalc version 1.0. This is the Tyrer-Cuzick model that includes hereditary and nonhereditary risk factors. Contact: ibis@cancer.org.uk

Mushrooms, Green tea cut breast cancer risk

SYDNEY: Chinese women who ate mushrooms and drank green tea significantly cut their risk of breast cancer and the severity of the cancer in those who did develop it, an Australian researcher said Wednesday.

Min Zhang, from the University of Western Australia, studied the diets of 2,018 women from the southeastern Chinese city of Hangzhou — half of whom had breast cancer — between July 2004 and September 2005.

While breast cancer was the most common type of cancer for women worldwide, Min said the rate in China was four to five times lower than that typically found in developed countries.

“We concluded that higher dietary intake of mushrooms decreased breast cancer risk in pre- and post-menopausal Chinese women, and an additional decreased risk of breast cancer from the joint effect of mushrooms and green tea was observed,” Min told French news agency.

“The risk of breast cancer significantly declined with the highest intake of dietary mushrooms,” she said, adding that fresh and dried mushrooms were equally effective.

Eating as little as 10 grams, or less than one button mushroom daily, would have a beneficial effect, Min found, with the women who consumed the most fresh mushrooms around two-thirds less likely to develop breast cancer compared with those who did not eat mushrooms.

In addition to lowering the cancer risk, green tea and mushrooms also cut the malignancy of any cancer which did form, Min found.

The fact that the combination of green tea and mushrooms was more effective than just mushrooms alone could partially explain the lower incidence of breast cancer amongst Chinese women, she said.

“To our knowledge, this is the first human study to evaluate the joint effect of mushrooms and green tea on breast cancer,” she said.

“Our findings, if confirmed consistently in other research, have potential implications for protection against breast cancer development using an inexpensive dietary intervention.”

The study was published in the most recent issue of the International Journal of Cancer, and is one in a series of Asian studies by Min and her team on the anti-carcinogenic effects of phytochemicals.

Breast Cancer Facts

• Breast cancer is 100 times more common among women than men.
• A woman's risk of developing breast cancer increases with age.
• Only 5% to 10% of breast cancer cases are hereditary.
• Breast cancer risk is higher among women whose close blood relatives have this disease, or who themselves had previous bouts of breast cancer.
• Women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk.
• Long time use of Hormone Replacement Therapy, after menopause, may slightly increase the risk of breast cancer.
• Regular consumption of alcohol, cigarette smoking, and a diet high in polyunsaturated fats increases your risk of developing breast cancer.
• Breast cancer is the leading cause of cancer deaths for women aged 40-59.
• Every three minutes a woman is diagnosed with breast cancer.
• Every thirteen minute a woman dies from breast cancer.
• One in every eight women are at risk of developing breast cancer in her lifetime.
• During 2000, it is estimated that 182,800 women and 1,400 men will be diagnosed with breast cancer.
• Approximately 40,800 women and 400 men will die with breast cancer this year.
• During the 1990s, approximately 1.8 million women and 12,000 men were diagnosed with invasive brease cancer.
• When breast cancer is confined to the breast, the five-year survival rate is over 95 percent.

Yoga Benefits Women with Breast Cancer

In a study just published in the journal Psycho-Oncology, researchers conclude they've found a treatment that resulted in a 50% reduction in depression and a 12% increase in feelings of peace and meaning in women with breast cancer. The successful treatment isn't a new type of anti-depressant or anti-anxiety drug. In fact, it isn't a drug at all -- it's the ancient healing and exercise system known as yoga.

Wake Forest University School of Medicine scientists conducted a randomized study of 44 women, all with breast cancer; 34% were actively undergoing cancer treatment such as chemotherapy while the rest of the majority had already completed therapy. Half took a ten week program of 75 minute Restorative Yoga (RY) classes and half were in the waitlist control group. RY is a gentle type of yoga similar to other forms of yoga classes that gently moves the spine in all directions. Blankets, cushions, bolsters, and any other needed props provide support that results in deep relaxation with minimal physical exertion, allowing people at virtually any level of health to practice yoga more easily.

The women in both groups completed a questionnaire to assess the quality of their lives at the beginning and end of the ten week program. According to the Wake Forest research team, the results showed that the women who had been given the RY classes experienced significantly more benefits than the control group (who were later all invited to participate in identical RY classes).

Specifically, the yoga group was found to have improvements in mental health including depression, positive emotions, and spirituality (defined as feeling calm and peaceful) compared to the control group. In fact, the scientists found that women who started the yoga classes with higher negative emotions and lower emotional well-being experienced the most benefits from the gentle yoga exercises compared to the control group. In addition, while women in the control group did not report a change in their fatigue levels, the women taking yoga classes demonstrated a significant improvement in fatigue symptoms.

"Evidence from systematic reviews of randomized trials is quite strong that mind-body therapies improve mood, quality of life, and treatment-related symptoms in people with cancer. Yoga is one mind-body therapy that is widely available and involves relatively reasonable costs," Suzanne Danhauer, Ph.D., who headed the Wake Forest University School of Medicine research team, said in a statement to the media. "Given the high levels of stress and distress that many women with breast cancer experience, the opportunity to experience feeling more peaceful and calm in the midst of breast cancer is a significant benefit."

What is the screening process for breast cancer?

Screening for breast cancer before there are symptoms can be important. Screening can help doctors find and treat cancer early. Treatment is more likely to work well when cancer is found early.

Your doctor may suggest the following screening tests for breast cancer:

* Screening mammogram
* Clinical breast exam
* Breast self-exam

You should ask your doctor about when to start and how often to check for breast cancer.

Screening mammogram

To find breast cancer early, NCI recommends that:

* Women in their 40s and older should have mammograms every 1 to 2 years. A mammogram is a picture of the breast made with x-rays.

* Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.

Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.

If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present.

Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect:

* A mammogram may miss some cancers. (The result is called a "false negative.")

* A mammogram may show things that turn out not to be cancer. (The result is called a "false positive.")

* Some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them.

Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.

Clinical breast exam

During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.

Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.

Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.

A thorough clinical breast exam may take about 10 minutes.

Breast self-exam

You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period.

You should contact your health care provider if you notice any unusual changes in your breasts.

Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.

General Info about Breast Cancer

Other than skin cancer, breast cancer is the most common type of cancer among women. Breast cancer mostly occurs in women over the age of 50, and the risk is especially high for women over age 60. Breast cancer is also found to occur more often in white women than African American or Asian women.

Each breast has 15 to 20 sections called lobes. Within each lobe are many smaller lobules (milk producing glands). Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules and bulbs are all linked by thin tubes called ducts (milk passages that connect the lobules and the nipple). Fat surrounds the lobules and ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola.There are no muscles in the breast, but muscles lie under each breast and cover the ribs.Each breast also contains blood vessels and lymph vessels. The lymph vessels carry colorless fluid called lymph, and lead to small bean-shaped organs called lymph nodes. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest. Lymph nodes are also found in many other parts of the body.

Cancer cells may enter lymph vessels and spread out along these vessels to reach lymph nodes. Cancer cells may also enter blood vessels and spread through the blood stream to other parts of the body, bypassing lymph nodes. When breast cancer cells reach the lymph nodes, they continue to grow, often causing swelling of the lymph nodes. These swollen lymph nodes sometimes can be felt, especially in the armpit. If breast cancer cells have spread to the lymph nodes in the arm pit, there is a greater chance that cancer cells have spread to other organs of the body as well.

The Stages of Breast Cancer

Your doctor will look at a number of factors, including the size of the tumor, the role of lymph nodes, and how far the cancer has spread, to determine the stage of your breast cancer. There are early stages of breast cancer (0, I, II, and IIIA) and advanced stages (IIIB/C and IV).

Early stages of breast cancer

Stage 0

Cancer cells are present in either the lining of a breast lobule or a duct, but they have not spread to the surrounding fatty tissue. This stage is also called ductal carcinoma in situ, or DCIS.

Stage I

Cancer has spread from the lobules or ducts to nearby tissue in the breast. At this stage and beyond, breast cancer is considered to be invasive. The tumor is 2 cm or less in diameter (approximately 1 inch or less); the cancer has not spread to the lymph nodes.

Stage II

In this stage, the tumor can range from 2 cm to less than 5 cm in diameter (approximately 1 to 2 inches); sometimes cancer may have spread to the lymph nodes.

Stage IIIA

In this stage, the tumor is 5 cm or greater in diameter (approximately 2 inches or greater); or the tumor may be of any size where cancer cells have grown extensively into the axillary (underarm) lymph nodes.

Advanced stages of breast cancer

Stage IIIB/C

Known as locally advanced cancer; tumor may be of any size but has spread into the skin of the breast or tissues of the chest wall.

Stage IV

Known as metastatic; cancer has spread from the breast to other parts of the body, such as the bones, liver, lungs, or brain.

Breast cancer recurrence — the return of cancer following primary (initial) treatment — can occur at the same site as the original tumor or somewhere else in the body.

Breast Anatomy

The breast has no muscle tissue. A layer of fat surrounds the glands and extends throughout the breast. The breast is responsive to a complex interplay of hormones that cause the tissue to develop, enlarge and produce milk. The three major hormones affecting the breast are estrogen, progesterone and prolactin, which cause glandular tissue in the breast and the uterus to change during the menstrual cycle. Each breast contains 15 to 20 lobes arranged in a circular fashion. The fat (subcutaneous adipose tissue) that covers the lobes gives the breast its size and shape. Each lobe is comprised of many lobules, at the end of which are tiny bulb like glands, or sacs, where milk is produced in response to hormonal signals. Blood and lymph vessels form a network throughout each breast. Breast tissue is drained by lymphatic vessels that lead to axillary nodes (which lie in the axilla) and internal mammary nodes (which lie along each side of the breast bone). When breast cancer spreads, it is frequently to these nodes.

During pregnancy and the period of breast-feeding, the breasts become larger and elastic fibres in the skin tear, this shows as red irregular marks on the skin surface. By regular massage with a moisturizing cream the elasticity of the skin is increased and the breast skin becomes soft and supple. The women in our families use a collagen rich cream with a little natural progesterone added to it and it appears to work extremely well. It is really important to wear a good sports bra when exercising regardless of the size of your bust. It will help to reduce breast pain and minimise 'sagging' in the future! But many women don't know how to choose the right style or size. Here are our tips for finding the right sports bra.Breasts have no muscles of their own and are only held up by the pectoral muscles the muscles of the chest on which they lie. Extra support can be given by wearing a good bra. Most of the support that well-fitting bra gives to the breast should come from beneath and not from the straps. You can check this by slipping off the straps to see if the bra will stay in place without them. The back piece and the sides of a good bra should be in level with the front.

What is Breast Cancer?

Also called: Breast carcinoma

Breast cancer is a cancer that starts in the cells of the breast in women and men. Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% of all cancer incidence, both sexes counted) and the fifth most common cause of cancer death. In 2005, breast cancer caused 502,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).
Breast cancer is about 100 times as frequent among women as among men, but survival rates are equal in both sexes.

WHO Clinical Staging for HIV Infection

Symptoms of the Four Stages of HIV

In 2006, the World Health Organization (WHO) released revised criteria for clinical staging of HIV disease in adults and adolescents. These criteria allow physicians in resource poor countries to determine the appropriate time to begin antiretroviral treatment. In many areas of the world, physicians do not have access to labs where they can perform CD4 and viral load tests, which are used in developed countries to determine an individual’s disease progression.

Criteria for Stage I
During the first stage of HIV, an individual generally has flu like symptoms which last for a week or two. WHO provides the following criteria for placing a patient in this stage:

• Asymptomatic
• Persistent generalized lymphadenopathy (the swelling or enlargment of the lymph nodes).

Criteria for Stage II
In stage II, many people are completely asymptomatic, but others demonstrate a number of physical symptoms that healthcare providers can use to stage the patient. WHO criteria for this stage include the following:

• Moderate unexplained weight loss
• Recurring respiratory tract infections
• Herpes Zoster (shingles)
• Angular cheilitis (lesions at the corner of the mouth)
• Recurring oral ulceration
• Papular pruritic eruptions (skin rash possibly related to insect bites)
• Seborrhoeic dermatitis (a skin disorder that causes scaly, itchy, flaky skin)
• Fungal nail infections.

Criteria for Stage III
In stage III, HIV patients begin to exhibit more serious symptoms. This is also when opportunistic infections begin to take advantage of the weakened immune system. WHO criteria for placing a patient in this stage include the following:

• Unexplained severe weight loss
• Unexplained chronic diarrhea lasting for longer than one month
• Unexplained persistent fever, either intermittent or constant
• Persistant oral candidiasis (yeast infection of the mouth)
• Oral hairy leukoplakia (a white patch on the side of the tongue with a hairy appearance)
• Pulmonary tuberculosis
• Severe bacterial infections (for example, pneumonia, meningitis, and empyema)
• Acute necrotizing ulcerative stomatitis (inflammation of the stomach mucous lining), gingivitis (inflammation of the gums), or periodontitis (inflammation of the tissue that supports the teath)
• Unexplained anemia (lack of hemoglobin the blood cells), neutropenia (low number of a certain type of white blood cell called neutrophil), and/or chronic thrombocytopenia (low platelet count).

Criteria for Stage IV (AIDS)
In stage IV, a patient is considered to have progressed from HIV to AIDS. This stage is characterized by more severe symptoms and an even greater number of opportunistic infections. WHO criteria for this stage include the following:

• HIV wasting syndrome
• Pneumocystis pneumonia (pneumonia caused by a yeast-like fungus)
• Recurrent severe bacterial pneumonia
• Chronic herpes simplex infection
• Esophageal candidiasis (yeast-like infection of the esophagus)
• Extrapulmonary tuberculosis
• Kaposi sarcoma (a tumor caused by human herpesvirus 8)
• Cytomegalovirus infection (an infection caused by human herpesvirus 5)
• Central nervous system toxoplasmosis (a parasite affecting the central nervous system, including brain)
• HIV encephalopathy (a brain disorder)
• Extrapulmonary cryptococcosis including meningitis (fungal diseases)
• Disseminated non-tuberculous mycrobacteria infection
• Progressive multifocal leukoencephalopathy (the reactivation of a common virus in the central nervous system)
• Chronic cryptosporidiosis (a parasitic disease)
• Chronic isosporiasis (a parasitic intestinal disease)
• Disseminated mycosis (a fungus that causes infection)
• Recurrent septicemia (also known as blood poisoning)
• Lymphoma (cerebral or B cell non-Hodgkin)
• Invasive cervical carcinoma
• Atypical disseminated leishmaniasis (a parasite transmitted by the sand fly)
• Symptomatic HIV-associated nephropathy or HIV-associated cardiomyopathy.
  

HIV-1 and HIV-2 (Diffrence)

Many people have seen references made to two different strains of the HIV virus, HIV-1 and HIV-2, but the similarities and differences are rarely explained. Both forms of HIV are spread through sexual contact, blood, and mother-to-child transmission. There is no known cure for either form of HIV and both will eventually progress to AIDS. The symptoms of HIV-1 and HIV-2 are exactly the same and individuals cannot know which type they have without tests performed by a physician.

These two strains of the same virus were both discovered by Dr. Montagnier and his colleagues in 1983. While HIV news sources typically use the blanket term “HIV”, they are usually referring to HIV-1, since the majority of news on research, treatment, and statistics relate only to HIV-1. HIV-2, found mainly in a small area of Africa, is much rarer than HIV-1 and has special consideration for research.

Geographic Spread of HIV-1 and HIV-2
HIV-1 is found around the world, while HIV-2 is restricted to a very small portion of West Africa. Countries where HIV-2 is common include Senegal, Nigeria, Ghana, and the Ivory Coast. Outside of West Africa, HIV-2 is extremely rare. Places where it is most common are countries with strong ties to West Africa like Portugal, Angola, and France. In the United States, only about 100 confirmed cases of HIV-2 have been reported. These cases have mostly occurred in people who have traveled to West Africa.

Spread of HIV-1 and HIV-2
HIV-2 has been found to be harder to spread to others than HIV-1, though HIV-2 becomes much more infectious in the later periods of the disease progression. HIV-2 also has a longer period between when a person becomes initially infected and when they begin showing symptoms of illness. HIV-2 is slower than HIV-1 to advance to AIDS, though researchers do not yet know why this occurs. It is possible for individuals infected with one strain of HIV to become infected with the other strain.

HIV Testing and Treatment Issues
While many HIV test only test for HIV-1, newer versions of rapid HIV tests are sensitive to both HIV-1 and HIV-2. These tests are not regularly used in areas where HIV-2 is rare. Individuals who believe they may have been exposed to HIV-2 are encouraged to discuss their testing options with a physician.

HIV treatments are not as effective for treating HIV-2 as they are for HIV-1. The development of HIV treatments has mainly been done with the intention of treating HIV-1, since it affects a larger number of people. Further research is required to develop treatment targeted for HIV-2.
It is also more difficult for physicians to monitor the progression of HIV-2 since there is currently no FDA-licensed viral load test. The viral load tests that have been developed for HIV-1 are not reliable tools for monitoring the viral load progression of HIV-2 infected individuals. New tests are being developed to better monitor the viral load of HIV-2 infected individuals.

History of World AIDS Day

Remembering Those with HIV/AIDS on December 1

Every year on December 1, organizations, groups, and individuals around the world plan events to participate in World AIDS Day. These events highlight the overwhelming number of individuals suffering from HIV/AIDS and honor those who have passed away. Many organizations also use this time to focus on prevention efforts.

The First World AIDS Day
The first World AIDS Day was organized by the World Health Organization on December 1, 1988. Originally, the day was organized by UNAIDS. UNAIDS chose a new theme each year after consulting with other HIV/AIDS organizations to determine the most pressing topics. In 2005, UNAIDS officially gave responsibility of World AIDS Day to The World AIDS Campaign (WAC), an independent HIV/AIDS organization.

Since WAC took over the campaign, the theme has been “Stop AIDS: Keep the Promise.” This theme is meant to target policy makers and health authorities to encourage them to meet the targets that have been set on the way to providing universal access to HIV treatment, care, support, and prevention services by 2010. The theme “Stop AIDS: Keep the Promise” will continue until 2010, with sub-themes chosen each year.

Past World AIDS Day Themes
The following have been the themes of World AIDS Day for the past 20 years:

• 2008 - Stop AIDS; Keep the Promise – Lead- Empower- Deliver
• 2007 - Stop AIDS; Keep the Promise - Leadership
• 2006 - Stop AIDS; Keep the Promise - Accountability
• 2005 - Stop AIDS; Keep the Promise
• 2004 - Women, Girls, HIV and AIDS
• 2003 - Stigma & Discrimination
• 2002 - Stigma & Discrimination
• 2001 - I care. Do you?
• 2000 - AIDS : Men make a difference
• 1999 - Listen, Learn, Live: World AIDS Campaign with Children & Young People
• 1998 - Force for Change: World AIDS Campaign With Young People
• 1997 - Children Living in a World with AIDS
• 1996 - One World, One Hope
• 1995 - Shared Rights, Shared Responsibilities
• 1994 - AIDS & the Family
• 1993 - Act
• 1992 - Community Commitment
• 1991 - Sharing the Challenge
• 1990 - Women & AIDS
• 1989 - Youth
• 1988 - Communication

World AIDS Day 2008
For World AIDS Day 2008, the sub-theme is “Lead- Empower- Deliver”. This is the second year that the theme has focused on the topic of leadership. This theme is meant to highlight the fact that many individuals and organization have already offered up their leadership skills, and now policy makers need to find the resources to deliver on their promises. The campaign is calling on everyone, including families, communities, civil society organizations, and governments to take the initiative in helping meet the target goals.

Drugs For Treating Aids May Prevent People From Catching Aids

In one of the most promising developments in more than 20 years, scientists claim that drugs used to control HIV/AIDS in patients may also be effective in preventing the disease in the first place.

The drugs in question are tenofovir (Viread) and emtricitabine, or FTC (Emtriva), sold in combination as Truvada by Gilead Sciences Inc. Gilead is the California company best known for inventing Tamiflu.

Previous research has been aimed at finding a vaccine against HIV/AIDS, with the intention of conditioning the immune system against the disease. But these drugs work differently. They simply keep the virus from reproducing, and have already been used successfuly by health care workers to prevent them from being infected by the virus carried by patients.

This approach to fighting HIV/AIDS has been tempting researchers for many years, but has only recently become feasible as preventative drugs have been developed that are safe for non-infected persons to take. Previous drugs had unreasonable effects for uninfected persons.

That situation changed when Tenofovir came on the market in 2001. Tenofovir is powerful and safe, and it only has to be taken once a day. It also does not interact with other medicines or birth control pills, and manifests less drug resistance than other AIDS medications.

Monkey studies show exciting results
A major study by the CDC (Centers for Disease Control and Prevention) in Atlanta, Georgia involved six macaques. The monkeys were given a combination of Tenofovir and FTC and then administered a deadly combination of monkey and human AIDS viruses. They were given the viruses in rectal doses to simulate contact between gay men.

Each was given 14 weekly exposures of the virus, and none of the monkeys became infected. In a control group which did not receive the drugs, all but one got the disease, normally after just two exposures.

The scientists then stopped giving the drugs to the test group to see if the prevention was only temporary. The results were equally impressive. None of the monkeys contracted the disease. "We're now four months following the animals with no drug, no virus. They're uninfected and healthy," reported a CDC researcher.

Now other research teams are pushing to have this drug combination tested on humans. A $29 million CDC study of drug users in Botswana will now be switched to this new drug combination.
Another study of 400 heterosexual women in Ghana by the Family Health Initiative, and funded by the Bill and Melinda Gates Foundation, is studying the effects of tenofovir alone.

But several other studies have failed to materialize because studies of this nature immediately raise suspicions that scientists are using local people as guinea pigs. The fear is that they will intentionally expose the test subjects to the virus.

The cost of tenofovir and Truvada also make testing difficult. In African countries condoms are now liberally donated by companies, aid groups, UN agencies, and western governments. While the drugs are relatively cheap, the cost remains an impediment.

Nevertheless researchers have been reinvigorated by the stunning results out of Atlanta, and new tests are going ahead in pockets of interest around the world.

CDC Recommends HIV Tests, Puts Less Stress on Condom Use

In a significant shift in strategy in the fight against HIV/AIDS, the Centers for Disease Control recently recommended that tests for HIV be extended to all patients entering hospitals and clinics in the U.S. The CDC also recommended that doctors begin offering routine voluntary HIV tests to patients between 13 and 64.

It is estimated that of the more than 1 million people in the U.S. with HIV and AIDS, about 25% are unaware they have HIV. The new strategy is aimed at discovering these cases before HIV develops into AIDS. It is also hoped these measures will curb the spread of the disease since these 250,000 people are carriers who unknowingly infect others.

This marks a departure from the previously followed strategy of testing only people in high risk categories.

This policy change will also involve a shift away from the promotion of abstinence and condom use to prevent the spread of the disease, towards more emphasis being placed on testing for HIV status and early treatment.

According to a spokesperson for the CDC, what explains this change in policy is that drugs now exist that can prevent the development of AIDS from HIV. Early detection can therefore result in early treatment. In the past early detection did not necessarily mean much since there was very little that could be done for someone infected with HIV.

It is also hoped that early detection will result in less transmission of the disease. A recent CDC survey found that sexually-active adults altered their sexual behavior patterns after they were diagnosed with HIV. They were less likely to engage in unprotected sexual activity, in many cases opting for a condom or for not engaging in sex at all.

Drug companies and makers of oral tests stand to benefit significantly from this change of emphasis. It is expected that tests which are now administered at hospitals and clinics will soon be available over the counter. People interested in testing themselves will be able to do it at home. This should result in a significant increase in sales of HIV testing kits.

There should also be a rise in HIV treatment drugs as hundreds of thousands of people learn they have HIV and begin treatment with anti-HIV drugs. Currently anti-HIV drugs account for about $6-billion in sales in the U.S. That number should increase dramatically if the new testing procedures prove to be effective.

Some argue that as in so many areas within the health industry, efforts aimed at prevention will be replaced by promises of a quick cure brought to us compliments of the incredibly influential and increasingly invasive drug companies.

What are AIDS and HIV?

AIDS stands for acquired immunodeficiency syndrome, a condition first reported in the United States in 1981, that has since become a major worldwide epidemic.

AIDS is caused by HIV (human immunodeficiency virus). By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. The term AIDS applies to the most advanced stages of HIV infection.

How is HIV spread?
There are several common ways that HIV can be passed from person to person, including:

• Having unprotected sex with someone who is infected
• Using needles or syringes that have been used by people who are infected
• Receiving infected blood products or transplanted organs (Since 1985, the United States actively tests all donated blood for HIV; therefore, the risk of getting HIV in this way in the United States is now extremely low.)
• Transmission from mother to child – An infected mother may pass the virus to her developing fetus during pregnancy, during birth, or through breastfeeding.

If you have a sexually transmitted disease, you may be at higher risk for getting infected with HIV during sex with an HIV-infected partner.

There is no evidence that HIV is spread by contact with saliva or through casual contact, such as shaking hands or hugging, or the sharing of food utensils, towels and bedding, swimming pools, telephones, or toilet seats. HIV is not spread by biting insects such as mosquitoes or bedbugs.

What is the treatment for HIV/AIDS?
Although when AIDS first appeared there were few treatments, researchers have now developed drugs that can help fight both HIV and the related infections and cancers that come with it. Treatment advances have improved the survival rates and decreased progression of HIV disease in developed countries like the United States, where antiretroviral drugs are available.
Additional treatment information is available from the National Institute of Allergy and Infection Diseases at NIH. The NIH is currently conducting many clinical trials related to HIV/AIDS to test treatments and therapies. These trials are sponsored and co-sponsored by various Institutes, including the NICHD.

The NICHD supports and conducts research related to HIV/AIDS in specific groups of people, including pregnant and non-pregnant women, infants and children, and adolescents and young adults. The information below applies to those groups.

How does HIV/AIDS affect women?
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), 19.2 million women are living with HIV/AIDS throughout the world. In many countries, the rate of HIV infection in women is rising faster than in any other group.

Worldwide, more than 80 percent of HIV infections are spread by heterosexual sex (vaginal intercourse); women are particularly at risk of contracting HIV through this type of contact. HIV is increasing most dramatically among African American and Hispanic women.

Although most of the signs and symptoms of HIV infection are similar in men and women, some are more specific to females. For example:

• Vaginal yeast infections may be chronic, more severe, and difficult to treat in women with HIV infection than in women who are uninfected.
• Pelvic inflammatory disease, an infection of the female reproductive organs, may also be more frequent and severe in women with HIV infection.
• Human papillomavirus (HPV) infections, which cause genital warts, may occur more frequently in HIV-infected women, and can lead to pre-cancerous lesions of the cervix or cancer of the cervix.

The NICHD, along with other Institutes, supports studies to determine what aspects of HIV are specific to women and the best treatments for these symptoms.

How does HIV affect pregnant women and infants?
Women can give HIV to their babies during pregnancy, while giving birth, or through breastfeeding.

But, there are effective ways to prevent the spread of mother-to-infant transmission of HIV:

• Taking anti-HIV drugs during pregnancy—either a drug called zidovudine or AZT alone or in combination with other drugs called highly active antiretroviral therapy (HAART)—a mother can significantly reduce the chances that her baby will get infected with HIV.
• Delivering the baby by cesarean section, and doing so before the mother’s uterine membranes rupture naturally, reduces transmission that may occur during the birth process. Use of anti-HIV drugs during pregnancy and delivery, combined with a cesarean section in women with certain levels of HIV in their blood, can reduce the chance that the baby will be infected to less than 2 percent.
• Avoidance of breastfeeding by an HIV-infected mother. HIV can be spread to babies through the breast milk of mothers infected with the virus. The American Academy of Pediatrics recommends that, in countries such as the United States, where infant formula is safe and is often available and affordable, HIV-infected women feed their infants commercially available formula instead of breastfeeding.

Approximately one-fourth to one-half of all untreated pregnant women infected with HIV will pass the infection to their babies. HIV infection of newborns is very rare in the United States because women are tested for HIV during pregnancy, and women with HIV infection receive anti-HIV drugs during pregnancy, cesarean delivery if their HIV blood levels are high, and are advised not to breastfeed their infants.

How does HIV affect children and adolescents?
It is estimated that approximately 10,000 children are living with HIV infection in the United States. In the United States, the number of infants born with HIV infection has dramatically decreased from about 2,000 a year to fewer than 200 a year due to identification of HIV infection in pregnant women and use of anti-HIV drugs during pregnancy, cesarean delivery, and avoidance of breastfeeding.

In contrast to the United States, mother-to-child transmission in developing countries remains a major problem; about 700,000 infants are newly infected with HIV each year because most women are not screened for HIV during pregnancy, anti-HIV drugs are not available, and safe alternatives to breastfeeding are not available.

Prior to 1985, when screening of the nation's blood supply for HIV began, some children as well as adults were infected through transfusions with blood or blood products contaminated with HIV, but this is now rare in the United States.

In contrast to the dramatic decrease in mother-to-child transmission of HIV infection, the number of cases of HIV infection in adolescents and young adults continues to increase in the United States. About one-third to one-half of new HIV infections in the United States are among adolescents and young adults.

Most HIV-infected adolescents and young adults are exposed to the virus through unprotected sex; some teens and young adults are also infected through injection drug use. In addition, an increasing number of children who were infected as infants are now surviving to adolescence.

AIDS-The Fear Epidemic

By any measure, AIDS is a frightening disease. It is physically devastating, incurable, and lethal. And it is spreading at a menacing pace. Fear and misconceptions about AIDS, however, have spread faster than the disease itself.

Federal health officials stress that the AIDS virus has spread almost exclusively by three routes: by sexual intercourse, through blood contact (contamination with or transfusion of infected blood or blood products), and from an infected pregnant woman to her fetus or newborn. The only other known instances in which the virus was transmitted, say officials, involved artificial insemination or organ transplants from infected donors.

But many people remain unconvinced. They fear that casual personal contact with an AIDS victim—a handshake, a sneeze, a drink from the same glass—might lead to infection. A child with AIDS attempting to attend school can throw a community into a frenzy. An AIDS patient returning to work may find coworkers deserting the job in protest.

In short, anxiety about AIDS has itself become epidemic. Part of the problem is that AIDS is a new disease—mysterious in its origin and initially baffling in its symptoms and cause. But the impression that scientists are groping amid a welter of unresolved questions is misleading. A vast amount of critical knowledge has already been gained about AIDS, and more is being learned all the time.

The epidemic first surfaced in the late 1970s, when rare cancers and uncommon infections began appearing in a number of gay (homosexual) men. Those illnesses were linked with a severe deficiency in the body's immune-defense system—a disorder initially called GRID, for Gay-Related Immune Deficiency. As late as mid-1981, gay men were still the only known victims in the United States, creating the impression that AIDS arose from something exclusive to that group.

By 1982, when the name became AIDS, for "acquired immune deficiency syndrome," the first currents of fear jolted the health-care community. The number of AIDS cases was rising geometrically, and the disease had appeared in two more groups—intravenous drug users and hemophiliacs. Not only did the pattern imply an infectious agent, but the disease was now affecting three of the principal groups vulnerable to hepatitis B infection—a viral illness that's also an occupational hazard among health workers.

AIDS would subsequently prove to be much less contagious than hepatitis B, partly because the number of hepatitis B virus particles in blood is up to a billion times greater than the number of AIDS virus particles. But no one knew that in 1982. Nor was it known that the AIDS virus doesn't penetrate intact skin or the linings of the respiratory and digestive tracts—and thus could not be transmitted by such things as a kiss on the lips, a cough, or food prepared by a person with AIDS.

With the number of cases doubling every six months, medical personnel on the front line became increasingly fearful for their own safety. That fear soon became evident to the public at large, helping to confirm impressions that a virulent plague was loose in the land. As public fear of the threat grew, scientific understanding of the disease advanced rapidly.

By mid-1984, three independent research teams in the United States and France had conclusively identified the virus that causes AIDS. Discovery of the virus—now designated "human immunodeficiency virus," or HIV—immediately opened new avenues of research into every aspect of the disease. Investigators have already deciphered the genetic code of the virus in search of ways to attack it. Others probing for clues to therapy have explored its crippling effect on the immune system.

For epidemiologists, who investigate the incidence, transmission, and patterns of disease, identification of the virus was the indispensable handle for a powerful new tool. It meant that a test could now be developed to detect individual exposure to the virus, information vital for deeper insight into the epidemic and its spread.

Elisa: Testing for Exposure to Aids
By 1985, a simple, inexpensive blood test for detecting exposure to the AIDS virus had been developed and approved for use. Called ELISA (for enzyme-linked immunosorbent assay), the test detects antibodies produced by white blood cells in response to the presence of the virus. Developed primarily to screen potential blood donors, ELISA has also served as a versatile research tool, greatly facilitating analysis of the epidemic's path.

Before ELISA, it was difficult to trace the spread of the virus. There was no practical way to detect it in people without symptoms, who represent the largest number of those infected. By mid-1988, about 65,000 cases of AIDS had been reported to the U.S. Centers for Disease Control (CDC). An estimated 325,000 people had AIDS-related complex (ARC), a term used to describe a condition that includes (in addition to laboratory evidence of immunodeficiency) swollen glands, recurrent fever, weight loss, or a combination of those symptoms. When persons with ARC develop any one of a number of opportunistic infections (or Kaposi's sarcoma), they are considered to have developed AIDS.

An estimated 1.6 million to 3.2 million additional people may be infected with the virus but have no symptoms of illness. Although their blood reveals antibodies to the virus—as determined by two consistently positive ELISA tests and a more sophisticated (and costly) confirming test called Western blot analysis—they may have no other laboratory or clinical signs of disease. Most public-health officials estimate that 30 to 50 percent of those people will ultimately develop full-blown AIDS.

With a practical means of detection in hand, researchers began probing areas previously obscure. For example, how fast was the virus spreading to the general population—or among intravenous-drug users, or gay men? Was it infecting family members who had no sexual contact with a victim in the home? Were some sexual practices riskier than others? Since 1985, a wealth of new information has become available to address those questions and others.

Some of the findings are uncompromisingly bleak. Among high-risk groups, the AIDS virus is cutting a widening swath of infection, particularly in areas that have already borne the brunt of the epidemic, such as metropolitan New York and San Francisco. The infection is also spreading among young adults in inner-city minority groups, especially black and Hispanic intravenous-drug users and their sexual partners. One analysis of blood tests administered to some 300,000 military recruits found the rate of infection in blacks to be four times that in whites.

Federal health officials have predicted that the cumulative total of AIDS cases could reach 270,000 by 1991, with 179,000 deaths. Most of those will be people who are already infected with the virus, the officials said.

The grim projections of unfolding tragedy have overshadowed all other emerging information about the epidemic. But there has been another side to the news. An increasing number of epidemiological studies now point to an unmistakable conclusion: The reassurances from health officials about casual contact with AIDS patients are well founded. As CDC director James O. Mason, M.D., put it, "This is a very difficult disease to catch."

Transmission appears to require not only direct insertion of the virus into the bloodstream but also a substantial dose of the virus—much more than could be transmitted by casual contact. Indeed, a consistent pattern in people who become infected is frequent or severe exposure to the virus.

Even in sexual intercourse—the primary route of infection—the virus does not appear to spread easily. Like most sexually transmitted diseases, AIDS is strongly associated with a highly active sex life and multiple partners.

Homosexual Transmission
Among gay and bisexual men, the disease first appeared in those with extremely large numbers of sexual partners—a lifetime average of over 1000 partners, according to one early epidemiologic study. It's not known whether multiple sexual contacts raise the risk simply by raising the odds that a person will encounter the AIDS virus once, or by some process in which the body's defenses are worn down (perhaps through exposure to other sexually transmitted diseases), or both. All that's known for sure is that having a large number of sexual partners raises the risk.

Now that the virus is more prevalent—and the odds of catching it (among people at risk) are higher—the average number of sexual partners reported by people who contract the disease would be far less than 1000. No precise numbers, however, are available.

A key factor in the rapid spread of the virus among gay and bisexual men is the practice of anal intercourse, probably because the surface membranes and blood vessels of the anal canal are vulnerable to small fissures or tears during intercourse. Such tears may allow virus carried in semen to gain entry into the bloodstream of the receiving partner. The risk of viral transmission is especially high for the partner accepting penetration (receptive anal intercourse). In one six-month study examining transmission of the virus in gay men, a University of Pittsburgh research team found receptive anal intercourse to be the major risk factor in infection. At the outset, none of the men showed any evidence of AIDS virus in their blood. After six months, however, antibodies to the virus were found in a number of the subjects, especially among men who had had two or more sexual partners. In that group, men engaging in receptive anal intercourse had 16 times the infection rate as those having no anal intercourse.

As yet, there's no scientific evidence that sexual practices other than anal-related sex lead to AIDS-virus transmission in gay men. However, only a few large studies have compared the effects of different sexual practices.

One such study was conducted by University of California researchers over a two-year period for the San Francisco Men's Health Study. The California investigators examined infection rates among some 800 gay or bisexual men with different sexual histories. No difference in infection rates was found between those who engaged solely in oral-genital sex and those who had no sexual partners at all.

The California researchers concluded that the risk of AIDS-virus transmission by oral-genital contact was minimal. But they cautioned—as did the Pittsburgh group—that their findings did not prove that sexual activity other than anal intercourse posed no risk among gay men. They pointed out that their results were based on a relatively small number of observations and could not completely exclude the possibility of transmission by oral-genital sex.

Indeed, caution has been the watchword among public-health officials offering preventive advice. Since more than 90 percent of AIDS cases have occurred in gay or bisexual men and intravenous-drug users, the message to those high-risk groups has stressed avoiding any possible risk. One drawback of that approach, however, is that it makes AIDS appear easier to catch than it actually is. Some public-health workers, for example, warn against deep kissing involving exchange of saliva. But there's no evidence that the virus is transmitted that way.

Heterosexual Transmission
In contrast to oral sex or deep kissing, vaginal intercourse is clearly an important route of infection. The AIDS virus can be spread by either a man or a woman during intercourse.

On a relative scale, vaginal intercourse appears to be less effective in spreading the virus than anal intercourse, and less contagious from female to male than the reverse. As yet, the risk of transmission in a single act of vaginal intercourse is unknown. But current evidence suggests that frequent or long-term sexual exposure with an infected partner or partners is an important factor in transmission.

As of mid-1988, about 4 percent of newly diagnosed AIDS cases in the U.S. can be traced to heterosexual transmission. A large number of the victims are spouses or long-term sexual partners of AIDS patients or other high-risk individuals, particularly intravenous-drug users. Another large segment includes immigrants from Haiti and central Africa, where the virus spreads mainly by heterosexual intercourse.

Some confusion initially surrounded the status of Haitians, who were once listed as a separate risk group for AIDS. Epidemiologists have since found that the infection rate is not high among Haitians who are longterm U.S. residents. It's high, though, among recent immigrants with a history of venereal disease or sexual contact with prostitutes. In both Haiti and central Africa, infected prostitutes are an important factor in the spread of the virus among heterosexuals.

Reports from central Africa also show that AIDS is concentrated among urban people who are very sexually active. The average AIDS patient had more than 30 sex partners a year, including frequent contacts with prostitutes.

Overall, heterosexual spread of the infection often involves multiple sexual exposures to the virus. Even under these circumstances, however, infection is far from automatic. In a number of studies based on antibody tests, 50 to 65 percent of the regular heterosexual partners of patients with AIDS or advanced AIDS-related illness have shown no evidence of the virus in their blood. And among the wives or regular sex partners of hemophiliacs with AIDS, 90 to 95 percent were not infected.

The fact that such prolonged sexual exposure often fails to cause infection certainly argues against fears that a bathtub, toilet seat, or the air around an AIDS patient could pose a threat.

Public-health officials generally recommend using condoms during anal or vaginal intercourse and oral-genital sex to reduce the risk of AIDS-virus transmission. CDC investigators, after evaluating many studies from around the world, concluded that barrier contraceptives—condoms, spermicides, and diaphragms used with spermicides—are effective in reducing the risk of sexually transmitted diseases, including AIDS. Lubricants, if used, should be water-based; petroleum products can damage latex.

One lab experiment demonstrated that the AIDS virus can't penetrate an intact latex condom. Another showed that a common spermicide, nonoxynol-9, inactivates the virus and kills the white blood cells that carry it. (Nonoxynol-9 is the spermicide in many contraceptive jellies and foams, and the active ingredient in the contraceptive sponge Today.)

Blood-to-Blood Contact
The rapid spread of the AIDS virus among intravenous-drug users fosters the impression that the virus is highly infectious. Actually, some common practices among addicts who use needles are what make them especially vulnerable. And while there is some evidence that gay people have modified their risk behavior, drug abusers have not.

In addition to the frequency of injections—at least daily in many users—intravenous-drug addicts often share their needles and syringes. Indiscriminate sharing of injection paraphernalia has become common at drug "shooting galleries," where addicts go to rent or share equipment. "Often, the same needle will be used for up to 50 injections until it is no longer usable," reports Peter Selwyn, M.D., medical director of a drug-treatment program for addicts at Montefiore Medical Center in the Bronx, New York.

The risk of contamination is multiplied by another practice—drawing blood back into the syringe so that any remaining drug can be flushed out of the syringe and into the vein. If an addict is infected with the virus, a significant dose of it may be transmitted to the next sharer. In short, intravenous-drug use is an extremely effective way of acquiring a blood-borne disease—even one as difficult to contract as AIDS.

Some people have proposed that government agencies should make sterile needles and syringes available to intravenous-drug users, either free or at cost. Facing the threat of an AIDS epidemic in 1984, the Amsterdam (Netherlands) Municipal Health Service adopted such a plan. It appears to be working. The number of addicts using intravenous drugs has not increased, and more addicts than ever have been motivated to enter treatment for their addiction. Similar programs have since been initiated in Sweden, Great Britain, France, Italy, and Australia.

Such proposals in the United States have generally met with strong opposition. In 1988, the first attempt at a free-needle program was made in Portland, Oregon; it stalled when insurance coverage was refused. New York City began a similar program the same year. Yet even advocates of the idea recognize it as a stopgap measure. They emphasize the need for more drug-treatment centers and a multifaceted approach to the problem. But an epidemic often demands swift action. Cheap, clean needles and syringes would at least reach the inner-city battleground where AIDS has hit hardest and where the real war on drugs is being fought—and lost.

The experience of health-care workers, meanwhile, provides a striking contrast to the epidemic among intravenous-drug users. Seven separate studies in the United States and England have examined the outcome of needle-stick and other exposures among health workers caring for AIDS patients. Approximately 1500 people—nurses, physicians, medical students, technicians, and laboratory workers—were studied to determine whether their exposures had resulted in infection. Most of the exposures were needle-stick injuries from instruments that had just been used for an AIDS patient. The rest were direct exposures of a mucous membrane, such as a splash of infected blood into the eye or nostrils.

Despite the large number of exposures, only five of the 1500 workers developed AIDS-virus antibodies in their blood. Those five had experienced a severe exposure, such as a deep injection wound or a puncture from a grossly contaminated large-bore biopsy needle. None of the workers who had direct exposure of mucous membrane to blood or other body fluid developed infection.
Hemophilia, a genetic disorder marked by the absence of an important clotting factor, results in repeated bleeds, often into joints. Transfusions of blood products can correct the bleeding temporarily. Before routine screening of blood and blood products for the AIDS virus was initiated in 1985, many hemophiliacs became infected. Since then, the risk has been virtually eliminated.

Casual Contact: How Aids Is Not Transmitted
Detection of the AIDS virus in saliva in 1984, and subsequently in tears, sparked immediate public concern. But further research has shown that the virus is rarely present in either. When it is, the quantity is minute—probably too low, say most public-health experts, to play a role in infection. Nevertheless, as a precaution, they still warn against deep kissing with an infected person and advise special procedures for eye-care and dental personnel, who are constantly exposed to tears or saliva.

No such precautions apply to contact with drinking glasses, eating utensils, eyeglasses, and the like. All evidence shows that the risk from such items is nonexistent. The same is true for a typical friendly kiss.

Some parents of young schoolchildren also fear that a bite from an infected classmate might transmit the virus. Here again, the concern is unwarranted, experts at the CDC say. The amount of virus in saliva—if any—is considered too minuscule to cause infection, especially in a single instance of biting.

There is no evidence that the virus can be transmitted by food or by any variety of insect. Nurses who have administered mouth-to-mouth resuscitation to AIDS patients have not become infected. Nor have children attending school with hemophiliac classmates who were infected. But possibly the strongest evidence that the virus presents no threat in casual contact comes from studies in families.

If AIDS could spread through casual contact, a patient's home would be a likely breeding ground of infection. The close personal environment of a family household would offer ample opportunities for spreading the virus.

It hasn't happened, however. Studies in U.S. households and among families in Europe, Haiti, and central Africa have all produced the same result. No instance of transmission has occurred among anyone who wasn't the sexual partner or newborn infant of an infected person.

The most comprehensive study is an ongoing, long-term investigation being conducted jointly by the CDC, Montefiore, North Central Bronx Hospital, and Albert Einstein College of Medicine. In 1986, the research group reported its evaluation of 101 people living in households with 39 AIDS patients. None of the 101 household members were sexual partners of the patients, but all lived in close personal contact with the infected person for periods ranging from three months to four years.

"Most of the families in this study were poor and lived in crowded conditions," the researchers reported. "A high percentage of household members assisted the patient with bathing, dressing, and eating." There was close personal interaction, and substantial sharing of household facilities and items likely to be soiled with body secretions. Some of the household members used the same razors and toothbrushes as the patient. Many shared the same combs, eating utensils, plates, and drinking glasses. More than 90 percent used the same toilet, bath, and kitchen facilities as the patient, and 37 percent shared the same bed. Most also engaged in affectionate behavior with the patient, including hugging and kissing on the cheek or lips.

Except for one child infected at birth, all of the 101 households examined were found to be free of any sign of AIDS virus in their blood. The researchers concluded that transmission of the virus through ordinary personal contact "appears to be minimal or nonexistent in the household setting."

The research group has continued its investigation since that report. As of the spring of 1988, it had completed examinations of more than 200 family members in more than 75 households, including reexaminations of the original subjects. None (except the one child) showed evidence of infection.

Similar findings were recently reported from central Africa. A research group in Kinshasa, Zaire, investigated whether the same results reported among household members in Europe and North America apply under conditions common in the developing world.

"Unlike living conditions in the United States and Europe," said the report, "living conditions in households in Kinshasa are more likely to include environmental factors favoring person-to-person transmission of infectious agents." Such conditions, the report said, included "crowding, lack of modern sanitary systems, and substantial numbers of mosquitoes and other arthropods."
The study, which evaluated 204 household members of AIDS patients, found no evidence that the virus was spread by ordinary personal contact. The researchers concluded that transmission by nonsexual personal contact "appears to be very rare, if it occurs at all."

The Kinshasa group also suggested what many American and European epidemiologists have come to realize, with profound relief: Since the AIDS virus isn't spreading in the home, transmission by casual contact in workplaces, schools, or similar settings will probably never occur.

AIDS/HIV Information

AIDS is an acronym for Acquired Immunodeficiency Syndrome it causes a destruction of the immune system. It is the most advanced stage of the HIV virus (HIV stands for Human Immunodeficiency Virus). AIDS is defined by the Centers for Disease Control and Prevention (CDC) as the presence of a positive HIV antibody test and one or more of the illnesses known as opportunistic infections.

The HIV virus, type 1 or 2 is widely known to be the cause of AIDS. HIV breaks down and attacks your T cells so your body is unable to defend itself against different infections. The HIV virus also attacks your peripheral nervous system, this causes nerve and muscle pain, especially in the feet, legs, and hands.

HIV is spread through direct contact with semen or blood of an individual that is infected. This can be transferred in many ways the most common is unprotected sexual intercourse. Other means of infection are infected blood transfusions, mother to infant (at time of birth, or through breast milk), sharing needles with an infected person, and rarely a healthcare worker that gets pricked with an infected needle.

Often people who are infected with HIV have few symptoms and in some cases there are none. Other times, symptoms of HIV are confused with other illnesses such as the flu. This may be severe, with swollen glands in the neck and armpits, tiredness, fever and night sweats. This is where as much as 9 out of 10 of the infected individuals will develop AIDS. At this point the person may feel completely healthy and not even know that he/she has the virus. The next stage begins when the immune system starts to break down and the virus becomes more aggressive in damaging white cells. Several glands in the neck and armpits may swell and stay swollen for an extended period of time without any explanation. As this disease progresses boils or warts may spread over the body. They may also feel tremendously tired, night sweats, high fevers, chronic diarrhea, and they may lose a considerable amount of their body weight. Most cases have shown thrush as a symptom as well. At this point the person is in the final stages of HIV--AIDS. Severe chest infections with high fever are common and survival rate is above 70% but decrease with each recurrence.

A person is diagnosed with AIDS when he/she has one or more positive HIV screening and the presence of an AIDS defining condition. Some of the common conditions include but are not limited to: Meningitis, Encephalitis, Dementia, Pneumonia, Kaposi sarcoma, and Lymphoma. There is also a blood test called an Immune Profile that can be done. This test is used to measure the loss of immunity and help decide on the best treatment. There is a test that is rarely used due to its high cost, it is known as a Viral Load: This test detects the virus itself, and also measures the amount of HIV in the blood. It shows how quickly the HIV infection is likely to advance. A high viral load suggests that the person may progress rapidly to AIDS.

Although there is no cure for AIDS there are medical treatments that aide in prolonging, and maintaining the best quality of life possible. These include two nucleoside inhibitors, lamivudine and zidovudine. Actual treatment plans will vary with each patient, along with the physical aspect of this disease. The psychological side has to be addressed in order for a treatment plan to be effective.

The easiest way to escape contracting this disease is to avoid the risk factors that you are in control of. Such as: unprotected sex, not sharing a needle, and if you are in the healthcare field be sure to use all precautions necessary to avoid an accidental prick from a possible infected needle (remember that in this diseases early stages it is common for the person not to even know they are infected). Today AIDS is the fifth leading cause of death among all adults aged 25 to 44 in the United States. Among African-Americans in the 25 to 44 age group, AIDS is the leading cause of death for men and the second leading cause of death for women. Our society needs to become aware that by not protecting ourselves we are killing ourselves and that this has to stop.

Anatomy of the Human Brain

The image on the left is a side view of the outside of the brain, showing the major lobes (frontal, parietal, temporal and occipital) and the brain stem structures (pons, medulla oblongata and cerebellum).

The image on the right is a side view showing the location of the limbic system inside the brain. The limbic system consists of a number of structures, including the fornix, hippocampus, cingulate gyrus, amygdala, the parahippocampal gyrus and parts of the thalamus. The hippocampus is one of the first areas affected by Alzheimer's disease. As the disease progresses, damage extends throughout the lobes.

Glossary of Terms for an Anatomy of the Brain

Amygdala – limbic structure involved in many brain functions, including emotion, learning and memory. It is part of a system that processes "reflexive" emotions like fear and anxiety.

Cerebellum – governs movement.

Cingulate gyrus – plays a role in processing conscious emotional experience.

Fornix – an arch-like structure that connects the hippocampus to other parts of the limbic system.

Frontal lobe – helps control skilled muscle movements, mood, planning for the future, setting goals and judging priorities.

Hippocampus – plays a significant role in the formation of long-term memories.

Medulla oblongata – contains centers for the control of vital processes such as heart rate, respiration, blood pressure, and swallowing.

Limbic system – a group of interconnected structures that mediate emotions, learning and memory.

Occipital lobe – helps process visual information.

Parahippocampal gyrus – an important connecting pathway of the limbic system.

Parietal lobe – receives and processes information about temperature, taste, touch, and movement coming from the rest of the body. Reading and arithmetic are also processed in this region.

Pons – contains centers for the control of vital processes, including respiration and cardiovascular functions. It also is involved in the coordination of eye movements and balance.

Temporal lobe – processes hearing, memory and language functions.

Thalamus – a major relay station between the senses and the cortex (the outer layer of the brain consisting of the parietal, occipital, frontal and temporal lobes).

Types of Brain Tumors

There are many different types of brain tumors. They are usually categorized by the type of cell where the tumor begins, or they are also categorized by the area of the brain where they occur. The most common types of brain tumors include the following:

Gliomas
The most common type of primary brain tumor is a glioma. Gliomas begin from glial cells, which are the supportive tissue of the brain. There are several types of gliomas, categorized by where they are found, and the type of cells that originated the tumor. The following are the different types of gliomas:

• Astrocytomas
  Astrocytomas are glial cell tumors that are derived from connective tissue cells called astrocytes. These cells can be found anywhere in the brain or spinal cord. Astrocytomas are the most common type of childhood brain tumor, and the most common type of primary brain tumor in adults. Astrocytomas are generally subdivided into high-grade or low-grade tumors. High-grade astrocytomas are the most malignant of all brain tumors. Astrocytomas are further classified for presenting signs, symptoms, treatment, and prognosis, based on the location of the tumor. The most common location of these tumors in children is in the cerebellum, where they are called cerebellar astrocytomas. These persons usually have symptoms of increased intracranial pressure, headache, and vomiting. There can also be problems with walking and coordination, as well as double vision. In adults, astrocytomas are more common in the cerebral hemispheres (cerebrum), where they commonly cause increased intracranial pressure (ICP), seizures, or changes in behavior.


• Brain stem gliomas
  Brain stem gliomas are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. The child usually does not have increased intracranial pressure (ICP), but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination.


• Ependymomas
  Ependymomas are also glial cell tumors. They usually develop in the lining of the ventricles or in the spinal cord. The most common place they are found in children is near the cerebellum. The tumor often blocks the flow of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing increased intracranial pressure. This type of tumor mostly occurs in children younger than 10 years of age. Ependymomas can be slow growing, compared to other brain tumors, but may recur after treatment is completed. Recurrence of ependymomas results in a more invasive tumor with more resistance to treatment.


• Optic nerve gliomas
  Optic nerve gliomas are found in or around the nerves that send messages from the eyes to the brain. They are frequently found in persons who have neurofibromatosis, a condition a child is born with that makes him/her more likely to develop tumors in the brain. Persons usually experience loss of vision, as well as hormone problems, since these tumors are usually located at the base of the brain where hormonal control is located. These are typically difficult to treat due to the surrounding sensitive brain structures.


• Oligodendrogliomas
  This type of tumor also arises from the supporting cells of the brain. They are found commonly in the cerebral hemispheres (cerebrum). Seizures are a very common symptom of these tumors, as well as headache, weakness, or changes in behavior or sleepiness. This tumor is more common in persons in their 40s and 50s. These tumors have a better prognosis than most other gliomas, but they can become more malignant with time.

Metastatic tumors
In adults, metastatic brain tumors are the most common type of brain tumors. These are tumors that begin to grow in another part of the body, then spread to the brain through the bloodstream. When the tumors spread to the brain, they commonly go to the part of the brain called the cerebral hemispheres, or to the cerebellum. Often, a patient may have multiple metastatic tumors in several different areas of the brain. Lung, breast, and colon cancers frequently travel to the brain, as do certain skin cancers. Metastatic brain tumors may be quite aggressive and may return even after surgery, radiation therapy, and chemotherapy.

Meningiomas
Meningiomas are usually benign tumors that come from the meninges or dura, which is the tough outer covering of the brain just under the skull. This type of tumor accounts for about 15 percent of brain tumors. They are slow growing and may exist for years before being detected. Meningiomas are most common in patients in their 40s and 50s. They are commonly found in the cerebral hemispheres just under the skull. They usually are separate from the brain and can sometimes be removed entirely during surgery. They can, however, recur after surgery and certain types can be malignant.

Schwannomas
Schwannomas are benign tumors, similar to meningiomas. They arise from the supporting cells of the nerves leaving the brain, and are most common on the nerves that control hearing and balance. When schwannomas involve these nerves, they are called vestibular schwannomas or acoustic neuromas. Commonly, they present with loss of hearing, and occasionally loss of balance, or problems with weakness on one side of the face. Surgery can be difficult because of the area of the brain in which they occur, and the vital structures around the tumor. Occasionally, radiation (or a combination of surgery and radiation) is used to treat these tumors.

Pituitary tumors
The pituitary gland is a gland located at the base of the brain. It produces hormones that control many other glands in the body. These glands include the thyroid gland, the adrenal glands, the ovaries and testes, as well as milk production by pregnant women, and fluid balance by the kidney. Tumors that occur in or around the area of the pituitary gland can affect the functioning of the gland, or overproduce hormones that are sent to the other glands. This can lead to problems with thyroid functioning, impotence, milk production from the breasts, irregular menstrual periods, or problems regulating the fluid balance in the body. In addition, due to the closeness of the pituitary to the nerves to the eyes, patients may have decreased vision. Tumors in the pituitary are frequently benign, and total removal makes the tumors less likely to recur. Since the pituitary is at the base of the skull, approaches for removal of a pituitary tumor may involve entry through the nose or the upper gum. Certain types of tumors may be treated with medication, which, in some cases, can shrink the tumor or stop the growth of the tumor.

Primitive neuroectodermal tumors (PNET)
PNET can occur anywhere in the brain, although the most common place is in the back of the brain near the cerebellum. When they occur here, they are called medulloblastomas. The symptoms depend on their location in the brain, but typically the patient experiences increased intracranial pressure. These tumors are fast growing and often malignant, with occasional spreading throughout the brain or spinal cord.

Medulloblastomas
Medulloblastomas are one type of PNET that are found near the midline of the cerebellum. This tumor is rapidly growing and often blocks drainage of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing symptoms associated with increased ICP. Medulloblastoma cells can spread (metastasize) to other areas of the central nervous system, especially around the spinal cord. A combination of surgery, radiation, and chemotherapy is usually necessary to control these tumors.

Craniopharyngioma
Craniopharyngioma are benign tumors that occur at the base of the brain near the nerves from the eyes to the brain, and the hormone centers. Most persons with this type of brain tumor develop symptoms before the age of 20. Symptoms include headaches, as well as problems with vision. Hormonal imbalances are common, including poor growth and short stature. Symptoms of increased intracranial pressure may also be seen. Although these tumors are benign, they are hard to remove due to the sensitive brain structures that surround them.

Pineal region tumors
Many different tumors can arise near the pineal gland, a gland that helps control sleep and wake cycles. Gliomas are common in this region, as are pineal blastomas. In addition, germ cell tumors, another form of malignant tumor, can be found in this area. Tumors in this region are more common in children than adults, and make up 3 to 8 percent of pediatric brain tumors. Benign pineal gland cysts are also seen in this location, which makes the diagnosis difficult between what is malignant and what is benign. Biopsy or removal of the tumor is frequently necessary to tell the different types of tumors apart. Persons with tumors in this region frequently experience headaches or symptoms of increased intracranial pressure. Treatment depends on the tumor type and size.