What Most People Don’t Know About HIV

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What To Know About HIV This World AIDS Day

Yesterday, we asked 10almonds readers to engage in a hypothetical thought experiment with us, and putting aside for a moment any reason you might feel the scenario wouldn’t apply for you, asked:

❝You have unprotected sex with someone who, afterwards, conversationally mentions their HIV+ status. Do you…❞

…and got the above-depicted, below-described, set of responses. Of those who responded…

  • Just over 60% said “rush to hospital; maybe a treatment is available”
  • Just under 20% said “ask them what meds they’re taking (and perhaps whether they’d like a snack)”
  • Just over 10% said “despair; life is over”
  • Two people said “do the most rigorous washing down there you’ve ever done in your life”

So, what does science say about it?

First, a quick note on terms

  • HIV is the Human Immunodeficiency Virus. It does what it says on the tin; it gives humans immunodeficiency. Like many viruses that have become epidemic in humans, it started off in animals (called SIV, because there was no “H” involved yet), which were then eaten by humans, passing the virus to us when it one day mutated to allow that.
    • It’s technically two viruses, but that’s beyond the scope of today’s article; for our purposes they are the same. HIV-1 is more virulent and infectious than HIV-2, and is the kind more commonly found in most of the world.
  • AIDS is Acquired Immunodeficiency Syndrome, and again, is what it sounds like. When a person is infected with HIV, then without treatment, they will often develop AIDS.
    • Technically AIDS itself doesn’t kill people; it just renders people near-defenseless to opportunistic infections (and immune-related diseases such as cancer), since one no longer has a properly working immune system. Common causes of death in AIDS patients include cancer, influenza, pneumonia, and tuberculosis.

People who contract HIV will usually develop AIDS if untreated. Untreated life expectancy is about 11 years.

HIV/AIDS are only a problem for gay people: True or False?

False, unequivocally. Anyone can get HIV and develop AIDS.

The reason it’s more associated with gay men, aside from homophobia, is that since penetrative sex is more likely to pass it on, then if we go with the statistically most likely arrangements here:

  • If a man penetrates a woman and passes on HIV, that woman will probably not go on to penetrate someone else
  • If a man penetrates a man and passes on HIV, that man could go on to penetrate someone else—and so on
  • This means that without any difference in safety practices or promiscuity, it’s going to spread more between men on average, by simple mathematics.
  • This is why “men who have sex with men” is the generally-designated higher-risk category.

There is medication to cure HIV/AIDS: True or False?

False so far (though there have been individual case studies of gene treatments that may have cured people—time will tell).

But! There are medications that can prevent HIV from being a life-threatening problem:

  • PrEP (Pre-Exposure Prophylaxis) is a medication that one can take in advance of potential exposure to HIV, to guard against it.
    • This is a common choice for people aren’t sure about their partners’ statuses, or people working in risky environments.
  • PEP (Post-Exposure Prophylaxis) is a medication that one can take after potential exposure to HIV, to “nip it in the bud”.
    • Those of you who were rushing to hospital in our poll, this is what you’re rushing there for.
  • ARVs (Anti-RetroVirals) are a class of medications (there are different options; we don’t have room to distinguish them) that reduce an HIV+ person’s viral load to undetectable levels.
    • Those of you who were asking what meds your partner was taking, these will be those meds. Also, most of them are to be taken in the morning with food, so that’s what the snack was for.

If someone is HIV+, the risk of transmission in unprotected sex is high: True or False?

True or False, with false being the far more likely. It depends on their medications, and this is why you were asking. If someone is on ARVs and their viral load is undetectable (as is usual once someone has been on ARVs for 6 months), they cannot transmit HIV to you.

U=U is not a fancy new emoticon, it means “undetectable = untransmittable”, which is a mathematically true statement in the case of HIV viral loads.

See: NIH | HIV Undetectable=Untransmittable (U=U)

If you’re thinking “still sounds risky to me”, then consider this:

You are safer having unprotected sex with someone who is HIV+ and on ARVs with an undetectable viral load, than you are with someone you are merely assuming is HIV- (perhaps you assume it because “surely this polite blushing young virgin of a straight man won’t give me cooties” etc)

Note that even your monogamous partner of many decades could accidentally contract HIV due to blood contamination in a hospital or an accident at work etc, so it’s good practice to also get tested after things that involve getting stabbed with needles, cut in a risky environment, etc.

If you’re concerned about potential stigma associated with HIV testing, you can get kits online:

CDC | How do I find an HIV self-test?

(these are usually fingerprick blood tests, and you can either see the results yourself at home immediately, or send it in for analysis, depending on the kit)

If I get HIV, I will get AIDS and die: True or False?

False, assuming you get treatment promptly and keep taking it. So those of you who were at “despair; life is over” can breathe a sigh of relief now.

However, if you get HIV, it does currently mean you will have to take those meds every day for the rest of your (no reason it shouldn’t be long and happy) life.

So, HIV is definitely still something to avoid, because it’s not great to have to take a life-saving medication every day. For a little insight as to what that might be like:

HIV.gov | Taking HIV Medication Every Day: Tips & Challenges

(as you’ll see there, there are also longer-lasting injections available instead of daily pulls, but those are much less widely available)

Summary

Some quick take-away notes-in-a-nutshell:

  • Getting HIV may have been a death sentence in the 1980s, but nowadays it’s been relegated to the level of “serious inconvenience”.
  • Happily, it is very preventable, with PrEP, PEP, and viral loads so low that they can’t transmit HIV, thanks to ARVs.
  • Washing will not help, by the way. Safe sex will, though!
    • As will celibacy and/or sexual exclusivity in seroconcordant relationships, e.g. you have the same (known! That means actually tested recently! Not just assumed!) HIV status as each other.
  • If you do get it, it is very manageable with ARVs, but prevention is better than treatment
  • There is no certain cure—yet. Some people (small number of case studies) may have been cured already with gene therapy, but we can’t know for sure yet.

Want to know more? Check out:

CDC | Let’s Stop HIV Together

Take care!

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  • Vodka vs Beer – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing vodka to beer, we picked the vodka.

    Why?

    As you might have guessed, neither are exactly healthy. But one of them is relatively, and we stress relatively, less bad than the other.

    In the category of nutrients, vodka is devoid of nutrients, and beer has small amounts of some vitamins and minerals—but the amounts are so small, that you would need to drink yourself to death before benefiting from them meaningfully. And while beer gets touted as “liquid bread”, it really isn’t. A thousand years ago it will have been a lot less alcoholic and more carby, but even then, it wasn’t a health product aside from that it provided a way of making potentially contaminated water safer to drink.

    In the category of carbohydrates, vodka nominally has none, due to the distillation process, and beer has some. Glycemic index websites often advise that the GI of beers, wines, and spirits can’t be measured as their carb content is not sufficient to get a meaningful sample, but diabetes research tells a more useful story:

    Any alcoholic drink will generally cause a brief drop in blood sugars, followed by a spike. This happens because the liver prioritises metabolizing alcohol over producing glycogen, so it hits pause on the sugar metabolism and then has a backlog to catch up on. In the case of alcoholic drinks that have alcohol and carbs, this will be more pronounced—so this means that the functional glycemic load of beer is higher.

    That’s a point in favor of vodka.

    Additionally, in terms of the alcohol content, correctly-distilled vodka’s alcohol is pure ethanol, while beer will contain an amount of methanol that will vary per beer, but an illustrative nominal figure could be about 16mg/L. Methanol is more harmful than ethanol.

    So that’s another point in favor of vodka.

    Once again, neither drink is healthy; both are distinctly unhealthy. But unit for unit, beer is the least healthy of the two, making vodka the lesser of two evils.

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    You might like to read:

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  • Just Be Well – by Dr. Thomas Sult

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Firstly, what this is not: a “think yourself well” book. It’s not about just deciding to be well.

    Rather, it’s about ensuring the foundations of wellness, from which the rest of good health can spring, and notably, an absence of chronic illness. In essence: enjoying chronic good health.

    The prescription here is functional medicine, which stands on the shoulders of lifestyle medicine. This latter is thus briefly covered and the basics presented, but most of the book is about identifying the root causes of disease and eliminating them one by one, by taking into account the functions of the body’s processes, both in terms of pathogenesis (and thus, seeking to undermine that) and in terms of correct functioning (i.e., good health).

    While the main focus of the book is on health rather than disease, he does cover a number of very common chronic illnesses, and how even in those cases where they cannot yet be outright cured, there’s a lot more that can be done for them than “take two of these and call your insurance company in the morning”, when the goal is less about management of symptoms (though that is also covered) and more about undercutting causes, and ensuring that even if one thing goes wrong, it doesn’t bring the entire rest of the system down with it (something that often happens without functional medicine).

    The style is clear, simple, and written for the layperson without unduly dumbing things down.

    Bottom line: if you would like glowingly good health regardless of any potential setbacks, this book can help your body do what it needs to for you.

    Click here to check out Just Be Well, and just be well!

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  • Long-acting contraceptives seem to be as safe as the pill when it comes to cancer risk

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Many women worry hormonal contraceptives have dangerous side-effects including increased cancer risk. But this perception is often out of proportion with the actual risks.

    So, what does the research actually say about cancer risk for contraceptive users?

    And is your cancer risk different if, instead of the pill, you use long-acting reversible contraceptives? These include intrauterine devices or IUDs (such as Mirena), implants under the skin (such as Implanon), and injections (such as Depo Provera).

    Our new study, conducted by the University of Queensland and QIMR Berghofer Medical Research Institute and published by the Journal of the National Cancer Institute, looked at this question.

    We found long-acting contraceptives seem to be as safe as the pill when it comes to cancer risk (which is good news) but not necessarily any safer than the pill.

    Peakstock/Shutterstock
    A woman gets a hormonal birth control product implant
    Some hormonal contraceptives take the form of implants under the skin. WiP-Studio/Shutterstock

    How does the contraceptive pill affect cancer risk?

    The International Agency for Research on Cancer, which compiles evidence on cancer causes, has concluded that oral contraceptives have mixed effects on cancer risk.

    Using the oral contraceptive pill:

    • slightly increases your risk of breast and cervical cancer in the short term, but
    • substantially reduces your risk of cancers of the uterus and ovaries in the longer term.

    Our earlier work showed the pill was responsible for preventing far more cancers overall than it contributed to.

    In previous research we estimated that in 2010, oral contraceptive pill use prevented over 1,300 cases of endometrial and ovarian cancers in Australian women.

    It also prevented almost 500 deaths from these cancers in 2013. This is a reduction of around 25% in the deaths that could have occurred that year if women hadn’t taken the pill.

    In contrast, we calculated the pill may have contributed to around 15 deaths from breast cancer in 2013, which is less than 0.5% of all breast cancer deaths in that year.

    A woman pops contraceptive pills from a pill pack.
    Previous work showed the pill was responsible for preventing far more cancers overall than it contributed to. Image Point Fr

    What about long-acting reversible contraceptives and cancer risk?

    Long-acting reversible contraceptives – which include intrauterine devices or IUDs, implants under the skin, and injections – release progesterone-like hormones.

    These are very effective contraceptives that can last from a few months (injections) up to seven years (intrauterine devices).

    Notably, they don’t contain the hormone oestrogen, which may be responsible for some of the side-effects of the pill (including perhaps contributing to a higher risk of breast cancer).

    Use of these long-acting contraceptives has doubled over the past decade, while the use of the pill has declined. So it’s important to know whether this change could affect cancer risk for Australian women.

    Our new study of more than 1 million Australian women investigated whether long-acting, reversible contraceptives affect risk of invasive cancers. We compared the results to the oral contraceptive pill.

    We used de-identified health records for Australian women aged 55 and under in 2002.

    Among this group, about 176,000 were diagnosed with cancer between 2004 and 2013 when the oldest women were aged 67. We compared hormonal contraceptive use among these women who got cancer to women without cancer.

    We found that long-term users of all types of hormonal contraception had around a 70% lower risk of developing endometrial cancer in the years after use. In other words, the risk of developing endometrial cancer is substantially lower among women who took hormonal contraception compared to those who didn’t.

    For ovarian cancer, we saw a 50% reduced risk (compared to those who took no hormonal contraception) for women who were long-term users of the hormone-containing IUD.

    The risk reduction was not as marked for the implants or injections, however few long-term users of these products developed these cancers in our study.

    As the risk of endometrial and ovarian cancers increases with age, it will be important to look at cancer risk in these women as they get older.

    What about breast cancer risk?

    Our findings suggest that the risk of breast cancer for current users of long-acting contraceptives is similar to users of the pill.

    However, the contraceptive injection was only associated with an increase in breast cancer risk after five years of use and there was no longer a higher risk once women stopped using them.

    Our results suggested that the risk of breast cancer also reduces after stopping use of the contraceptive implants.

    We will need to follow-up the women for longer to determine whether this is also the case for the IUD.

    It is worth emphasising that the breast cancer risk associated with all hormonal contraceptives is very small.

    About 30 in every 100,000 women aged 20 to 39 years develop breast cancer each year, and any hormonal contraceptive use would only increase this to around 36 cases per 100,000.

    What about other cancers?

    Our study did not show any consistent relationships between contraceptive use and other cancers types. However, we only at looked at invasive cancers (meaning those that start at a primary site but have the potential to spread to other parts of the body).

    A recent French study found that prolonged use of the contraceptive injection increased the risk of meningioma (a type of benign brain tumour).

    However, meningiomas are rare, especially in young women. There are around two cases in every 100,000 in women aged 20–39, so the extra number of cases linked to contraceptive injection use was small.

    The French study found the hormonal IUD did not increase meningioma risk (and they did not investigate contraceptive implants).

    Benefits and side-effects

    There are benefits and side-effects for all medicines, including contraceptives, but it is important to know most very serious side-effects are rare.

    A conversation with your doctor about the balance of benefits and side-effects for you is always a good place to start.

    Susan Jordan, Professor of Epidemiology, The University of Queensland; Karen Tuesley, Postdoctoral Research Fellow, School of Public Health, The University of Queensland, and Penny Webb, Distinguished Scientist, Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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    4. Incorporate “movement snacks”: this is about when we are going about our daily life, we should move more while doing everyday tasks. Get in some shoulder stretches while waiting for the kettle to boil, deep squat while petting the dog, etc. These are very important, because mobility is very much a “use it or lose it” thing, and so moving in many different ways, frequently, is the only way to ensure full coverage (no stretching regimen is going to be able to cover the many compound movements that we do in everyday life).

    *That article also covers how to avoid the damage of sitting even if you cannot physically stand!

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  • If I’m diagnosed with one cancer, am I likely to get another?

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    Receiving a cancer diagnosis is life-changing and can cause a range of concerns about ongoing health.

    Fear of cancer returning is one of the top health concerns. And managing this fear is an important part of cancer treatment.

    But how likely is it to get cancer for a second time?

    Why can cancer return?

    While initial cancer treatment may seem successful, sometimes a few cancer cells remain dormant. Over time, these cancer cells can grow again and may start to cause symptoms.

    This is known as cancer recurrence: when a cancer returns after a period of remission. This period could be days, months or even years. The new cancer is the same type as the original cancer, but can sometimes grow in a new location through a process called metastasis.

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    The exact reason why cancer returns differs depending on the cancer type and the treatment received. Research is ongoing to identify genes associated with cancers returning. This may eventually allow doctors to tailor treatments for high-risk people.

    What are the chances of cancer returning?

    The risk of cancer returning differs between cancers, and between sub-types of the same cancer.

    New screening and treatment options have seen reductions in recurrence rates for many types of cancer. For example, between 2004 and 2019, the risk of colon cancer recurring dropped by 31-68%. It is important to remember that only someone’s treatment team can assess an individual’s personal risk of cancer returning.

    For most types of cancer, the highest risk of cancer returning is within the first three years after entering remission. This is because any leftover cancer cells not killed by treatment are likely to start growing again sooner rather than later. Three years after entering remission, recurrence rates for most cancers decrease, meaning that every day that passes lowers the risk of the cancer returning.

    Every day that passes also increases the numbers of new discoveries, and cancer drugs being developed.

    What about second, unrelated cancers?

    Earlier this year, we learned Sarah Ferguson, Duchess of York, had been diagnosed with malignant melanoma (a type of skin cancer) shortly after being treated for breast cancer.

    Although details have not been confirmed, this is likely a new cancer that isn’t a recurrence or metastasis of the first one.

    Australian research from Queensland and Tasmania shows adults who have had cancer have around a 6-36% higher risk of developing a second primary cancer compared to the risk of cancer in the general population.

    Who’s at risk of another, unrelated cancer?

    With improvements in cancer diagnosis and treatment, people diagnosed with cancer are living longer than ever. This means they need to consider their long-term health, including their risk of developing another unrelated cancer.

    Reasons for such cancers include different types of cancers sharing the same kind of lifestyle, environmental and genetic risk factors.

    The increased risk is also likely partly due to the effects that some cancer treatments and imaging procedures have on the body. However, this increased risk is relatively small when compared with the (sometimes lifesaving) benefits of these treatment and procedures.

    While a 6-36% greater chance of getting a second, unrelated cancer may seem large, only around 10-12% of participants developed a second cancer in the Australian studies we mentioned. Both had a median follow-up time of around five years.

    Similarly, in a large US study only about one in 12 adult cancer patients developed a second type of cancer in the follow-up period (an average of seven years).

    The kind of first cancer you had also affects your risk of a second, unrelated cancer, as well as the type of second cancer you are at risk of. For example, in the two Australian studies we mentioned, the risk of a second cancer was greater for people with an initial diagnosis of head and neck cancer, or a haematological (blood) cancer.

    People diagnosed with cancer as a child, adolescent or young adult also have a greater risk of a second, unrelated cancer.

    What can I do to lower my risk?

    Regular follow-up examinations can give peace of mind, and ensure any subsequent cancer is caught early, when there’s the best chance of successful treatment.

    Maintenance therapy may be used to reduce the risk of some types of cancer returning. However, despite ongoing research, there are no specific treatments against cancer recurrence or developing a second, unrelated cancer.

    But there are things you can do to help lower your general risk of cancer – not smoking, being physically active, eating well, maintaining a healthy body weight, limiting alcohol intake and being sun safe. These all reduce the chance of cancer returning and getting a second cancer.

    Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute and Terry Boyle, Senior Lecturer in Cancer Epidemiology, University of South Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Omega-3 Mushroom Spaghetti

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    The omega-3 is not the only healthy fat in here; we’re also going to have medium-chain triglycerides, as well as monounsaturates. Add in the ergothioneine from the mushrooms and a stack of polyphenols from, well, most of the ingredients, not to mention the fiber, and this comes together as a very healthy dish. There’s also about 64g protein in the entire recipe, so you do the math for how much that is per serving, depending on how big you want the servings to be.

    You will need

    • 1lb wholewheat spaghetti (or gluten-free equivalent, such as a legume-based pasta, if avoiding gluten/wheat)
    • 12oz mushrooms, sliced (any non-poisonous edible variety)
    • ½ cup coconut milk
    • ½ onion, finely chopped
    • ¼ cup chia seeds
    • ¼ bulb garlic, minced (or more, if you like)
    • 2 tbsp extra virgin olive oil
    • 1 tbsp black pepper, coarse ground
    • 1 tbsp lime juice

    Method

    (we suggest you read everything at least once before doing anything)

    1) Cook the spaghetti according to packet instructions, or your own good sense, aiming for al dente. When it’s done, drain it, and lastly rinse it (with cold water), and set it aside.

    2) Heat the olive oil in a skillet and add the onion, cooking for 5 minutes

    3) Add the garlic, mushrooms, and black pepper, cooking for another 8 minutes.

    4) Add the coconut milk, lime juice, and chia seeds, stirring well and cooking for a further two minutes

    5) Reheat the spaghetti by passing boiling water through it in a colander (the time it spent cold was good for it; it lowered the glycemic index)

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    Enjoy!

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    Take care!

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