text: Home > Medical > HIV/Aids > About HIV/Aids Updated 24 June 2014 HIV/AIDS - from Natural Standard The human immunodeficiency virus (HIV) is the virus that potentially causes AIDS (acquired immune deficiency syndrome). 0 iStock BACKGROUND The human immunodeficiency virus (HIV) is the virus that potentially causes AIDS (acquired immune deficiency syndrome). HIV primarily attacks the immune defense system, making the patient extremely vulnerable to opportunistic infections, which are infections that occur in people who have weakened immune systems. HIV primarily infects and destroys immune cells with the CD4 receptor protein on their cell surfaces (also called CD4-positive or CD4+ T-cells). Healthy individuals have a CD4 cell count between 600 and 1,200 cells per microliter of blood. HIV patients have less than 600 CD4 cells per microliter of blood. Patients progress to AIDS when/if their CD4 cell counts drop to lower than 200 cells per microliter (one-one millionth of a liter) of blood. This may happen if a person does not receive adequate treatment or if he/she develops a serious infection or illness. Individuals with a CD4 cell counts lower than 200 have the greatest risk of developing potentially fatal opportunistic infections, such as Mycobacterium avium complex (MAC) infections, because their immune systems are very weak. HIV is transmitted from person to person via bodily fluids, including blood, semen, vaginal secretions, and breast milk. Therefore, it can be transmitted through sexual contact with an infected person, by sharing needles/syringes with someone who is infected, through breastfeeding, during vaginal birth, or, less commonly, through transfusions with infected blood. However, in countries where blood is screened for HIV antibodies, HIV infection is rarely transmitted through blood transfusions. Very low amounts of HIV have been found in saliva and tears in some AIDS patients. However, contact with saliva, tears, or sweat has not been shown to result in HIV transmission. The most common type of HIV worldwide is called HIV-1. It is easily transmitted and is the cause of most HIV/AIDS infections around the world. HIV-1 has several subtypes (A through H and O), which are more common in certain parts of the world but produce AIDS similarly. The second type, called HIV-2, is much less common and less virulent or infectious. Since 1981, when the first case of AIDS was reported in the United States, the disease has become a global pandemic, causing an estimated 65 million infections and 25 million deaths worldwide. During the mid-to-late 1990s, advances in HIV treatment slowed the progression of HIV infection to AIDS. This consequently led to decreases in AIDS-related deaths. According to the U.S. Centers for Disease Control and Prevention (CDC), the number of AIDS-related deaths continues to decline, with an eight percent decrease from 2000 through 2004. However, the number of AIDS diagnoses increased eight percent during that period as well. From 2000 to 2004, the estimated number of people living with AIDS increased from 320,177 to 415,193, according to the CDC. This 30% increase can partially be attributed to advanced treatments that have helped HIV/AIDS patients to live longer lives, as well as increased access to testing and information about the disease. According to the CDC, an estimated 2.8 million patients died from AIDS, 4.1 million people became infected with HIV, and 38.6 million were living with HIV worldwide in 2005. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO) 2006 AIDS Epidemic Update, an estimated 39.5 million people are currently living with HIV worldwide. It is also estimated that 4.3 million people became newly infected in 2006, with 2.8 million (65%) of these cases occurring in Sub-Saharan Africa. In 2006, 2.9 million people died from AIDS-related illnesses. Certain geographic regions, such as Sub-Saharan Africa and the Caribbean, have much higher rates of infection than others. Certain populations, such as Sub-Saharan women, men who have sex with men (MSM), prostitutes, and injection-drug users, are also at increased risk for HIV infection. Currently, there is no cure for HIV/AIDS. However, treatment with anti-HIV drugs, called antiretrovirals, may suppress the virus, which subsequently helps boost the immune system. Although these drugs may help patients live longer lives, they do not reduce the risk of transmitting the disease to someone else. PATHOLOGY General: HIV is transmitted from person to person via bodily fluids including blood, semen, vaginal secretions, and breast milk. Individuals who have other sexually transmitted diseases are more susceptible to the virus. This is because some STDs, such as syphilis, cause breaks in the skin or sores that make it easy for HIV to enter the body. HIV is particularly difficult to treat because it reproduces very quickly and has a high mutation rate. When HIV reproduces, different strains (types) of the virus emerge. Mutations (changes in genetic information) occur almost every time a new copy of the virus is produced. Therefore, many types of HIV can be produced in a single person in one day. For this reason, HIV patients receive different combinations of antiretrovirals to suppress the virus. HIV primary targets immune cells called CD4 T-cells. The CD4 T-cells are white blood cells that help coordinate the immune system's response to infection and disease. These cells have a molecule called CD4 on their surfaces, which allows the cells to detect foreign substances, including viruses that enter the body. This process then triggers the immune system to destroy the foreign substance. When HIV enters the body, the virus recognizes this protein, binds to the receptors on the CD4 cell wall, and enters the cell. Once inside the cell, HIV replicates and eventually kills the cell. Primary, or acute, infection: Patients can transmit the virus to others during all stages of infection. The first stage of HIV, known as the primary or acute infection, is the most infectious stage of the disease, and it typically lasts several weeks. During this phase, the virus replicates rapidly, which leads to an abundance of the virus in the bloodstream and a drastic decline in the number of CD4 T-cells. The CD8 T-cells, which kill abnormal or infected body cells, are then activated to destroy HIV-infected body cells and antibodies are produced. Clinical latency: The next stage, called clinical latency, may last anywhere from two weeks to 20 years. During this phase, HIV is not considered dormant. Instead, it is active in the lymph nodes where large amounts of the virus become trapped. The surrounding tissues, which contain high levels of CD4 T-cells, may also become infected. The virus accumulates in infected cells and in the blood as free virus. Patients generally do not experience symptoms during this stage until the CD4 cell count drops to 600 microliters of blood or lower. Symptomatic stage: As the virus continues to weaken the immune system, patients eventually become more susceptible to infections. The next stage is the symptomatic stage, in which the person experiences symptoms associated with a weakened immune system. AIDS: The term AIDS (acquired immune deficiency syndrome) refers to the most advanced stage of HIV infection. This stage happens when HIV multiplies rapidly and severely affects the immune system. Individuals have AIDS when they have fewer than 200 CD4 T-cells per microliter of blood. This low CD4 T-cell count makes them extremely vulnerable to potentially fatal opportunistic infections such as pneumonia or tuberculosis. Several infections, including Pneumocystis jiroveci pneumonia (formerly called Pneumocystis carinii pneumonia, PCP) and Kaposi's sarcoma (KS), are considered AIDS-defining illnesses. This means that once a patient develops one of these infections, their condition has progressed to AIDS. DEMOGRAPHICS General: Race and ethnicity by themselves do not increase or decrease a person's risk of acquiring HIV infection. However, certain people are more likely to face challenges associated with the risk for HIV infection, such as lack of awareness of HIV status, substance abuse, or socioeconomic issues. African Americans: In 2004, African Americans accounted for 20,965 (49%) of the 42,514 estimated AIDS cases (not HIV) diagnosed in the United States. The rate of AIDS diagnoses among African American adults and adolescents was 10 times higher than the rate of Caucasians and almost three times higher than the rate of Latinos. In addition, 23 times more African American women were diagnosed with AIDS than Caucasian women. Eight times more African American men were diagnosed with AIDS than Caucasian men, according to the CDC. Latinos: In 2004, Latinos accounted for 20% (8,672) of the 42,514 new diagnoses in the United States, according to the CDC. The top causes of infection in most Latino men were infections after HIV exposure through sexual contact with other men, injection drug use, and heterosexual contact. The top causes of infection in Latino women were HIV exposure through heterosexual contact and injection drug use. Latinos were shown to get tested for HIV more often than any other race or ethnicity except African Americans. According to the CDC, in 2004, about 50% of Hispanics between the ages of 15 and 44 were tested, and 18% had been tested during the past year. Women: After the initial outbreak of HIV, few women were diagnosed with the virus. Today, women account for more than 25% of all new HIV/AIDS diagnoses in the United States. In 2004, an estimated 93,566 women were living with AIDS, making up 23% of the estimated 415,193 people living with AIDS in the United States. Youth (13-24 years old): In the United States, it is estimated that 50% of the 40,000 new HIV infections each year occur in people younger than age 25 and 25% of infections occur in people younger than 21. HIV/AIDS ranks as the sixth-leading cause of death among individuals ages 15-24 in the United States, with the number of AIDS cases reported each year in that age group increasing by 417% from 1981 through 1994. Injection-drug users: Since the AIDS epidemic began, injection drug use (IDU) with illegal drugs has directly and indirectly (drug use clouds judgment, leading people to engage in high-risk behaviors) accounted for more than one-third of AIDS cases in the United States. In the year 2000, out of the 42,156 new cases of AIDS reported, 11,635 were linked to IDU. Injection drug use is more common among racial and ethnic minorities in the United States, which makes them more likely to acquire HIV through IDU. In 2000, IDU accounted for 26% of all AIDS cases among African American adults and 31% among Hispanic adults and adolescents, compared to 19% of all cases among Caucasian adults and adolescents. Homosexuals: Men who have sex with men (MSM) accounted for 70% of all estimated HIV infections among male adults and adolescents in 2004 in the United States, according to the CDC. Although the number of HIV diagnoses for MSM decreased during the 1980s and 1990s, the number increased by eight percent from 2003 through 2004. According to the CDC, it is unknown whether this increase is because more people are getting tested for HIV or because more patients are becoming infected with HIV. Healthcare workers: Although healthcare workers are exposed to the virus at work, it is unlikely that they will acquire the virus from a patient, especially if they follow universal precautions, which should be taken with all patients. For healthcare workers, HIV transmission is most likely to occur through accidental injuries from needles or other sharp medical instruments that may be contaminated with the virus. However, this risk is small. Researchers estimate that about 0.3-1% of healthcare workers exposed to the virus by an accidental needle stick or puncture develop HIV. Since December 2001, there have been 57 documented reports of healthcare workers acquiring HIV from a patient. To prevent transmission of HIV to healthcare personnel in the workplace, the U.S. Centers for Disease Control and Prevention (CDC) offers precautionary guidelines. TRANSMISSION Bodily fluids: HIV is transmitted from person to person via bodily fluids because the virus is present in varying concentrations in the blood, semen, vaginal fluid, and breast milk. It can be spread by sexual contact with an infected person, by sharing needles/syringes with someone who is infected, or, less commonly, through transfusions with infected blood. HIV infection through blood transfusion is extremely rare in countries where blood is screened for HIV antibodies. Environment: HIV does not survive well in the environment outside of the body. According to studies performed by the U.S. Centers for Disease Control and Prevention (CDC), drying HIV reduces the amount of viral particles by 90-99% within several hours. The virus also cannot reproduce when it is outside of the body. Therefore, it is highly unlikely that the disease can be transmitted through contact with the environment, such as public toilet seats. Kissing: Casual contact through closed-mouth or "social" kissing does not put an individual at risk for HIV. However, there is the potential for blood contact with open-mouth kissing. The risk for acquiring the virus from open-mouth kissing is low, and the CDC has only investigated one case in which HIV transmission may have been caused by blood contact during open-mouth kissing. The CDC recommends that individuals avoid open-mouth kissing with an infected person. Biting: There have been medical reports that found that HIV transmission resulted after a human bite. Severe trauma and extensive tissue tearing were reported in each of these cases. However, biting is not a common way of transmitting the disease. Saliva, tears, and sweat: Very low amounts of HIV have been found in the saliva and tears of some AIDS patients. However, a small amount of HIV in body fluid does not necessarily mean that the fluid can transmit the virus. Contact with saliva, tears, or sweat has not been shown to result in transmission of HIV. Insects: According to numerous studies, there is no evidence to suggest that HIV has been transmitted through insects, even in areas such as Africa, that have high numbers of AIDS patients and mosquito populations. HIV can only live for a short time inside an insect and does not reproduce inside insects. Effectiveness of condoms: If a condom is used properly during sexual intercourse, an individual may reduce the risk of acquiring or transmitting STDs, including HIV. Several studies show that using condoms correctly and consistently may reduce the breakage rates of latex condoms to less than two percent. There are many types and brands of condoms, but only latex or polyurethane condoms have been shown to effectively prevent HIV transmission when used appropriately. According to the CDC, natural membrane condoms, such as those made with lambskin, have natural pores that can possibly transmit diseases. Therefore, lambskin condoms are not considered to be effective in preventing HIV transmission. Recent evidence has suggested that condom use by high-risk populations increases, rather than decreases the infection rate. According to the latest studies, condom promotion is only effective in lowering the rate of AIDS in concentrated, high-risk groups; condoms have never been shown to reduce HIV infection rates and AIDS deaths in general-population epidemics like those in sub-Saharan Africa. In on study, researchers asserted that of the three interventions scientifically shown to prevent AIDS - abstinence, being faithful, and using condoms - they argue that the use of condoms clearly comes last and should be promoted as a first-line defense only to those in extremely high-risk groups, such as commercial sex workers. One prospective study showed that for 'receptive' men during anal sex, it made little or no difference whether their partners used a condom or not. Researchers suggested that condoms are less effective in anal sex than in vaginal sex. SIGNS AND SYMPTOMS Early symptoms: Many patients are asymptomatic (experience no symptoms) when they first become infected with HIV. After one or two months, an estimated 80-90% of HIV patients develops flu-like symptoms, including, headache, fever, fatigue, and enlarged lymph nodes. These symptoms usually last about one week to one month and are often mistaken for another viral infection, such as the flu. Despite having minimal or no symptoms during this stage, individuals are very infectious because the virus is present in large quantities in bodily fluids. The most obvious sign of HIV infection is a decrease in the number of CD4 cells in the blood. These cells help fight against infection. HIV slowly kills these cells without causing symptoms. Even when the infected individual is asymptomatic, the virus is multiplying, infecting, and destroying cells in the immune system. Clinical latency symptoms: After the initial infection with HIV, more serious symptoms develop. This next stage of infection is called clinical latency. Once infected with HIV, it may take 10 or more years for more severe symptoms to appear in adults or up to two years in children who are born with HIV infection. The length of this asymptomatic period varies among individuals. Some people may start to experience more serious symptoms within a few weeks, while others may have no symptoms for several years. The virus can also hide within infected cells. Patients can transmit the virus to others during all stages of the disease. As the immune system continues to weaken, many symptoms appear, including inflamed lymph nodes (swollen glands) that may be enlarged for longer than three months. Other symptoms may include fatigue, weight loss, frequent fevers and sweats, persistent or frequent yeast infections (oral or vaginal), persistent skin rashes or flaky skin, pelvic inflammatory disease (PID) in women that does not respond well to treatment, and short-term memory loss. In addition, some individuals develop a painful nerve disease called shingles or frequent and severe herpes infections that cause sores to develop on the mouth, genitals, or anus. Infected children may be sick often or grow slowly (failure to thrive) because their immune systems are still developing. AIDS symptoms: Once the patient's CD4 T-cell count is less than 200 cells per microliter of blood, their condition has progressed to AIDS, the final stage of the disease. The first symptoms often include moderate and unexplained weight loss, frequent lung infections, and oral ulcerations (sores). Patients are vulnerable to opportunistic infections and tumors. Opportunistic infections and tumors may include tuberculosis, thrush, herpes viruses, shingles, Epstein-Barr virus, pneumonia, and a type of cancer called Kaposi's sarcoma (KS). In the last stages of AIDS, it is common for individuals to have cytomegalovirus or Mycobacterium avium complex (MAC) infections. COMPLICATIONS Opportunistic infections: General: Opportunistic infections are conditions that occur in individuals who have weakened immune systems. The organisms (bacteria, fungi, or viruses) that cause these infections do not cause illnesses in patients who have healthy immune systems because they are able to fight off the infection. The most common opportunistic infections associated with HIV and AIDS are Pneumocystis jiroveci pneumonia, Mycobacterium avium complex (MAC), toxoplasmosis, and tuberculosis. Patients at risk of developing these infections typically receive medication to prevent infections. Pneumocystis jiroveci pneumonia: Pneumocystis jiroveci pneumonia (formerly called Pneumocystis carinii or PCP) is the most common opportunistic infection among HIV patients. Before antiretroviral therapy and preventative treatment was available, about 70-80% of people with HIV developed PCP. However, this number has been declining significantly over the years. Originally, researchers thought a one-cell organism called Pneumocystis carinii caused the infection. However, recent research suggests that a fungus called Pneumocystis jiroveci is the cause. The condition is still commonly referred to as Pneumocystis carinii pneumonia (PCP). According to the U.S. Centers for Disease Control and Prevention (CDC), PCP is classified as an AIDS-defining illness. This means that when HIV-infected patients develop PCP, their condition has progressed to AIDS. Individuals with a CD4 cell (helper T-cells that help fight against disease and infection) count lower than 200 cells per microliter of blood have the greatest risk of developing PCP. In addition, people who have CD4 cell counts lower than 300 who have already had another opportunistic infection have an increased risk of developing PCP. This infection almost always affects the lungs causing a type of pneumonia. The first signs of PCP are difficulty breathing, fever, and a dry cough. Other common symptoms include chest discomfort, weight loss, chills, tachypnea (rapid breathing), tachycardia (fast heart rate), mild crackles (bubbling or rattling sounds that occur when air moves through fluid-filled airways), cyanosis (bluish discoloration of the skin), nasal flaring, and intercostal retractions (visible use of muscles between the ribs, which indicates labored breathing). The patient may also cough up blood, although this is considered a rare symptom. Historically, mortality ranged from 20-40%, depending on the severity of the disease when it was diagnosed. Today, however, mortality rates range between 10-20%. Today, PCP is almost entirely preventable, and it can be treated effectively with medications. Unfortunately, PCP is still common in patients who are infected with HIV for a long time before they begin antiretroviral therapy (ART). In fact, 30-40% of HIV patients develop PCP if they begin treatment when their CD4 cell counts are very low (around 50 cells per microliter of blood). Mycobacterium avium complex (MAC): Mycobacterium avium complex (MAC), or mycobacterium avium intracellulare (MAI), is a bacterial infection that is caused by either Mycobacterium avium or Mycobacterium intracellulare. These bacteria are commonly found in water, soil, dust, and food. In fact, these bacteria are present in almost every human. However, a healthy immune system prevents the bacteria from causing an infection. HIV/AIDS patients are at risk of developing MAC. According to the CDC, MAC is considered an AIDS-defining illness. It is estimated that up to 50% of individuals with HIV/AIDS develop MAC, especially if their CD4 count is lower than 50 cells per microliter of blood. MAC rarely causes infections in patients who have CD4 cell counts higher than 100 cells per microliter of blood. MAC infections may be localized (limited to one part of the body) or disseminated (spread throughout the entire body, sometimes called DMAC). MAC infection often occurs in the lungs, intestines, bone marrow, liver, and spleen. Common symptoms of MAC include weight loss, fever, chills, night sweats, swollen glands, abdominal pain, diarrhea, inflammation, and an overall feeling of weakness. MAC usually affects the intestines and inner organs first. The most common complication of DMAC is anemia (low levels of red blood cells), which may require a blood transfusion. If the infection involves many organs, it may lead to respiratory failure and death. Patients who have localized infections that have not spread to other parts of the body have a low mortality rate because they are easier to treat. Toxoplasmosis: Toxoplasmosis (toxo) is a parasitic infection that is caused by a single-celled parasite called Toxoplasma gondii. Toxoplasma gondii is one of the most common parasites, found all over the world. Individuals may be exposed to the parasite in soil, cat feces, or in raw or undercooked meat (especially lamb, pork, or venison). There have also been rare reports of toxoplasmosis infection as a result of organ transplantation or blood transfusion. It is estimated that more than 60 million Americans carry the parasite. However, 80-90% of infected patients are carriers (experience no symptoms) because the body's immune system prevents the parasite from causing illness. Toxoplasmosis is considered an AIDS-defining illness, according to the CDC. HIV patients often experience symptoms such as headache, confusion, poor coordination, seizures, and ocular toxoplasmosis (severe inflammation of the retina) as well as lung problems that are similar to tuberculosis or pneumocystis pneumonia. Tuberculosis: Tuberculosis (TB) is a bacterial infection of the lungs, which is caused by the bacterium Mycobacterium tuberculosis. Symptoms may include cough, shortness of breath, pleurisy (pain with breathing or coughing), fever, weight loss, night sweats, chills, and loss of appetite. The disease can cause serious breathing problems, which can be life threatening, especially if left untreated. Tuberculosis is highly contagious. The disease is transmitted through airborne droplets when a person with the infection coughs, talks, or sneezes. About 10-15 million Americans have latent TB infection, which means they are not sick, but they carry the bacterium that causes the disease. Only 10% of individuals with latent TB ever develop the infection. While tuberculosis is not considered an AIDS-defining illness, HIV patients have an increased risk of developing TB because they have weakened immune systems. The risk of developing active TB increases 7-10% in HIV patients who have latent TB. HIV patients are more likely to experience symptoms in areas of the body other than the lungs. This is called extrapulmonary TB. The disease may affect the bones, joints, nervous system, or urinary tract. Also, TB appears to make HIV infection worse; researchers have observed faster HIV replication when tuberculosis is also present. HIV and pregnancy: Babies born to HIV-infected mothers may become infected during pregnancy, delivery, or breastfeeding. Therefore, the U.S. Centers for Disease Control and Prevention (CDC) recommend that all pregnant women get tested for HIV. Antiretroviral therapy can significantly reduce the likelihood of an HIV-infected pregnant mother passing the virus to her baby. Patients who were taking antiretroviral medication before becoming pregnant should talk to their healthcare providers to determine the safest and most effective treatment option. In general, efavirenz (Sustiva©), stavudine (Zerit©), hydroxyurea (Droxia© or Hydrea©), and the oral liquid formulation of amprenavir (Agenerase©) should not be taken during pregnancy because they may cause harm to the fetus. Because a baby may become infected though exposure to the mother's blood and vaginal secretions during delivery, the risk of infection increases with delivery time. Mothers with high levels of the virus in their blood might reduce their risk if they deliver their babies by cesarean section (surgical delivery of an infant), also called c-section. While c-sections may reduce the risk of transmission during birth, it is not typically necessary in patients taking antiretroviral therapy. HIV infection rates of babies shortly before or after birth have been shown to drop to as low as 1-2% if their mothers take combination antiretroviral therapy during pregnancy, as well as zidovudine or nevirapine (Viramune©) preventative therapy during labor and after birth. HIV-infected mothers should not breastfeed their babies because the virus may be transmitted via the breast milk. Instead, baby formulas should be used. DIAGNOSIS General: HIV is diagnosed after HIV antibodies or HIV itself is detected in the patient's body. As soon as the virus enters the body, the immune system produces antibodies, which are proteins that detect foreign substances in the body, including infectious agents like HIV. The presence of HIV antibodies in the blood, oral fluid, or urine can be used to determine whether HIV is in the body. Blood tests are the most commonly used HIV tests. It may take some time for the immune system to produce enough antibodies for the antibody test to detect them. This time period, known as the "window period," varies among patients. Most people will develop detectable antibodies two to eight weeks after exposure, with the average being 25 days. However, some individuals might take longer to develop detectable antibodies. Of those infected with HIV, 97% develop antibodies within the first three months of infection. In very rare cases, it can take up to six months to develop antibodies to HIV. Therefore, if a patient tests negative for HIV in the first three months after possible exposure, repeat testing should be considered at least three months after the exposure. In the United States, the test results must remain confidential. Individuals who are younger than 18 years old can consent to or refuse to be tested for HIV, without the involvement of their legal guardians. Test results may not be released to the patient's legal guardian(s) without his/her consent. Who should get tested: The U.S. Centers for Disease Control (CDC) recommends that the following individuals get tested for HIV: Individuals between the ages of 13 and 64 should be tested annually. Individuals who have injected illegal drugs. Individuals who have had unprotected vaginal, anal, or oral sex. Individuals who have multiple or anonymous sexual partners. Individuals who have exchanged sex for drugs or money. Individuals who been diagnosed with or treated for hepatitis, tuberculosis (TB), or a sexually transmitted disease (STD), such as syphilis, gonorrhea, or chlamydia. Individuals who have come in direct contact with an HIV-infected person's blood. Individuals who have had unprotected sex with someone who meets any of the above stipulations. Pregnant women should be screened for HIV as part of regular prenatal tests. Pre-test counseling: According to the U.S. Centers for Disease Control and Prevention's (CDC) new guidelines for HIV testing, HIV prevention counseling is not required to accompany HIV screening. However, the CDC still recommends that patients receive information about HIV infection, transmission, and prevention. Patients should receive information about HIV testing and the meaning of test results. Healthcare providers should also tell the patient when to expect results and that confirmatory testing is necessary if the test result is positive. This is because it is possible for a false positive test result. The patient may receive information through a pamphlet, brochure, video, or a one-on-one meeting with a certified counselor. Patients who are tested with a rapid HIV test should have equal access to the same types of information. Prevention counseling: Prevention counseling is not mandatory, but it should be offered to all patients when they receive their test results. Counseling focuses on reducing the risks of HIV infection or transmission. The counselor makes a personalized detailed risk assessment of the patient. The counselor should also suggest behavior changes that may help reduce the patient's risk of developing or transmitting HIV. The counseling session is a chance to clear up any misconceptions or questions the patient may have about the disease. Enzyme-linked immunosorbent assay (ELISA): The most common HIV tests use blood to detect HIV infection. The enzyme-linked immunosorbent assay (ELISA) tests a patient's blood sample for antibodies. Oral fluid (not saliva), collected from the cheeks and gums, may also be used to perform an ELISA. Oral fluid ELISA tests are considered as sensitive as a blood test. A urine sample may also be used during an ELISA, but this is considered less accurate than a blood or oral fluid test. A positive (reactive) ELISA for all samples must be used with a follow-up (confirmatory) test, such as the Western blot test, to make a positive diagnosis. Although false negative or false positive results are extremely rare, they may occur if the patient has not yet developed antibodies to HIV or if a mistake was made at the laboratory. When used in combination with the confirmatory Western blot test, ELISA tests are 99.9% accurate. Western blot test: A Western blot test is typically used to confirm a positive HIV diagnosis. During the test, a small sample of blood is taken and it is used to detect HIV antibodies, not the HIV virus itself. The Western blot test separates the blood proteins and detects the specific proteins (called HIV antibodies) that indicate an HIV infection. The Western blot is used to confirm a positive ELISA, and the combined tests are 99.9% accurate. Polymerase chain reaction (PCR): Polymerase chain reaction (PCR) tests are used to detect HIV's genetic material, called RNA. These tests can be used to screen the donated blood supply and to detect very early infections before antibodies have been developed. This test may be performed just days or weeks after exposure to HIV. Although these tests are the most accurate, they are not performed as often as the other HIV tests because they are expensive and also time- and labor-intensive. Rapid test: A rapid test produces results in about 20 minutes. Rapid tests use a sample of blood or oral fluid to detect HIV antibodies. The patient's sample is placed on a test strip that contains HIV antigens. If the patient has developed HIV antibodies, the strip will change colors, indicating a positive result. A positive HIV test should be confirmed with a follow-up confirmatory test before a final HIV diagnosis can be made. These tests have similar accuracy rates as traditional ELISA screening tests. Home-testing kit: Consumer-controlled test kits, also called home-testing kits, were first licensed in 1997. The Home Access HIV-1 Test System™ is a home kit that is approved by the U.S. Food and Drug Administration (FDA). The Home Access HIV-1 Test System™ is available at most local pharmacies. The individual pricks a finger with a special device and places drops of blood on a specially treated card. The card is then mailed to a licensed laboratory for testing. Home testing kits are confidential, and patients do not need to provide any personal information (such as name or address) when submitting samples. Instead, they call for results using a personal identification number (PIN). Callers may speak to a counselor any time before, during, or after the test. All individuals with positive test results are given referrals for follow-up confirmatory tests, as well as information and resources on treatment and support services. FDA-approved tests are equally as accurate as the tests performed in a doctor's office when performed correctly. HIV drug resistance testing: Drug resistance testing is used to determine whether a patient with HIV has a mutated form of the virus that does not respond to antiretroviral therapy (ART). If an HIV-infected patient becomes resistant to a drug and continues to take the same medication, HIV is able to multiply faster because the drug cannot stop it from replicating. When the new, mutated form is favored, it is called selective pressure. If the resistant virus makes enough copies of itself, it may eventually become the dominant type of HIV in the body. Once this happens, the medication is ineffective, and the patient will be resistant to the specific medication. The FDA has approved the drug resistance test TrueGene™. The sensitivity, specificity, and reproducibility for many other tests have not been well established. However, several tests are available, and many health insurance plans cover them. There are two main types of drug resistance tests: genotypic and phenotypic resistance tests. Genotypic resistance testing examines the genetic structure (genotype) of a patient's HIV. A blood sample is taken from the patient, and the HIV is analyzed for the presence of specific genetic mutations that are known to cause resistance to specific drugs. For instance, researchers have determined that lamivudine (Epivir©) and emtricitabine (Emtriva©) are not effective against forms of HIV that contain the mutation "M184V" in its reverse transcriptase gene. If a patient tests positive for this mutation, it is highly likely that he or she is resistant to both drugs, and different drugs should be prescribed. Phenotypic testing directly measures the sensitivity (phenotype) of a patient's HIV in response to specific antiretrovirals. Many experts believe that these tests are more accurate and comprehensive than genotypic tests. These tests can help a physician determine the amount or concentration of a drug that is needed to stop a specific strain of HIV from replicating in a patient. Genetic testing: Genetic testing can be done on several genes that affect HIV and the course of the infection. For example, a genetic mutation causing a protein defect called CCR5 delta 32 has been shown to be resistant to the HIV virus. Mutations in the major histocompatibility complex, class I, B (HLA-B) gene is also linked to the HIV virus. There are several variations in HLA-B that can either slow the progression of HIV to AIDS or speed it up. Mutations in the killer cell immunoglobulin-like receptor, three domains, long cytoplasmic tail, 1(KIR3DL1) gene and the chemokine (C-C motif) ligand 3-like 1 (CCL3L1) gene have also been associated with varying rates of AIDS progression. TREATMENT General: Although current antiretroviral drugs cannot cure HIV/AIDS, they may suppress the virus, even to undetectable levels. The guidelines for antiretroviral treatment are the same for adolescents and adults. In emergency situations, or if parental involvement is impossible or could cause harm, and if the patient can adhere to treatment regimens, a minor can consent to treatment without parental involvement. However, communication with legal guardians should be encouraged in all patients who are younger than 18 years old and need to make healthcare decisions. Patients who were taking antiretroviral medication before becoming pregnant should talk to their healthcare providers to determine the safest and most effective treatment options. In general, efavirenz (Sustiva©), stavudine (Zerit©), hydroxyurea (Droxia© or Hydrea©), and the oral liquid formulation of amprenavir (Agenerase©) should not be taken during pregnancy because they may cause harm to the fetus. Highly active antiretroviral therapy (HAART): HIV patients typically receive a combination of antiretroviral drugs because a single patient may have several different strains (types) of the virus circulating in the blood. The different strains of the virus may respond differently to specific types of drugs. Therefore, highly active antiretroviral therapy (HAART), which is a combination of drugs from at least two different drug classes, is recommended. There are five major classes of antiretrovirals: fusion inhibitors, nucleoside/neucleotide reverse transcriptase inhibitors (NRTIs/NtRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors, and integrase inhibitors. Each drug class disrupts different stages of HIV's life cycle. Fusion inhibitors prevent the virus from entering and infecting human cells. The U.S. Food and Drug Administration (FDA) has approved the fusion inhibitor, enfuvirtide (Fuzeon©), also called T-20. Clinical trials have demonstrated that enfuvirtide-based therapy is an effective treatment for patients who have taken other types of antiretrovirals in the past. Enfuvirtide should not be taken in patients who have never received antiretroviral drugs before because it is only recommended when other drugs have not worked. Nucleoside reverse transcriptase inhibitors (NRTIs) and nucleotide reverse transcriptase inhibitors (NtRTIs), also called nukes, inhibit HIV replication. HIV replicates by converting the viral RNA into complementary DNA (cDNA), which then integrates into the host DNA. A viral enzyme called reverse transcriptase (RT) converts the viral RNA into cDNA using host nucleotides, which are the building blocks of DNA. NRTIs are nucleoside analogs, or fake versions of nucleosides (which are the precursors to nucleotides), and the resulting DNA cannot be incorporated into the host DNA. NtRTIs are neucleotide analogs and do not need to be converted. Therefore, NtRTIs may have fewer side effects than NRTIs. The FDA has approved the following NRTIs: lamivudine/zidovudine (Combivir©), emtricitabine (Emtriva©), lamivudine (Epivir©), abacavir sulfate/lamivudine (Epzicom©), zalcitabine (Hivid©), zidovudine (Retrovir©), abacavir sulfate/lamivudine/zidovudine (Trizivir©), emtricitabine/tenofovir disoproxil fumarate (Truvada©), didanosine (Videx©, Videx EC©), stavudine (Zerit©), and abacavir sulfate (Ziagen©). Tenofovir disoproxil fumarate (Viread©) is an FDA-approved NtRTI. Non-nucleoside reverse transcriptase inhibitors (NNRTIs), also called non-nucleoside analogs, interfere with viral replication. HIV replication requires the enzyme reverse transcriptase (RT), which is targeted by NNRTIs. When patients take non-nucleoside reverse transcriptase inhibitors (NNRTIs), the drug attaches to HIV's enzyme before it can use the patient's nucleic acid to multiply. NNRTIs significantly reduce the ability of HIV to multiply and infect new cells. The FDA has approved several NNRTIs, including delavirdine (Rescriptor©), efavirenz (Sustiva©), and nevirapine (Viramune©). Also, in July 2006, the FDA approved the multi-class combination drug efavirenz/emtricitabine/tenofovir disoproxil fumarate (Atripla©), which includes one NNRTI and two NRTIs. Protease inhibitors (PIs) also interfere with HIV replication, they prevent the production of viral proteins that require an enzyme called protease. When protease is blocked, the new copies of HIV do not form properly and cannot infect new cells. The FDA has approved several protease inhibitors including: amprenavir (Agenerase©), tipranavir (Aptivus©), indinavir (Crixivan©), saquinavir mesylate (Invirase©), opinavir/ritonavir (Kaletra©), fosamprenavir calcium (Lexiva©), ritonavir (Norvir©), darunavir (Prezista©), atazanavir sulfate (Reyataz©), and nelfinavir mesylate (Viracept©). In October 2007, the FDA approved an integrase inhibitor, called raltegravir (Isentress©), for the treatment of HIV in combination with other antiretrovirals. Integrase inhibitors are a new class of antiretrovirals that block the integrase enzyme that HIV uses to incorporate cDNA into host DNA. Antiretroviral side effects: Individuals taking antiretroviral drugs often find it difficult to follow complicated drug plans. Current treatments involve taking at least two different classes of antiretroviral drugs daily. Also, some of the drugs may cause nausea or vomiting, some pills should be taken on an empty stomach, and others should be taken with food. Specific side effects depend on the specific drugs. In general, common side effects include changes in body fat distribution and blood lipid levels. Glucose metabolism (the breakdown of carbohydrates to produce energy) is also affected, which may lead to the onset or worsening of diabetes. It is estimated that about 2-10% of people taking antiretrovirals have diabetes. The National Institute of Allergy and Infectious Diseases is among many research organizations that is investigating simpler, less toxic, and more effective drug plans. Synergistic enhancers: Another group of medications, called synergistic enhancers, may also be used in combination with other antiretroviral drugs to treat HIV. These medications do not act as antiretrovirals when taken alone, but they have been shown to improve the antiretrovirals effects of other drugs, including ritonavir. Very small doses of synergistic enhancers may also be used to reduce the liver metabolism of other antiretroviral drugs. Surgery: Patients infected with the human immunodeficiency virus (HIV) may require surgery to treat infections and diseases associated with the condition. With the introduction of HAART, HIV patients are able to live longer lives. As a result, it is possible that surgical interventions may be needed to diagnoses and/or treat long-term conditions. For example, lung infections, which may be caused by Pneumocystis jiroveci pneumonia (formerly called Pneumocystis carinii pneumonia, PCP), Mycobacterium avium complex (MAC), and tuberculosis often require invasive diagnostic procedures, such as bronchoalveolar lavage or an open lung biopsy. Like any surgical procedure, there are potential health risks. It remains unclear whether HIV patients are more likely to develop complications than HIV-negative patients. Common complications of surgery include bleeding, infections, and nerve damage. It has been suggested that HIV patients may have an increased risk of surgical complications (especially infections) because they have weakened immune systems. However, there is currently no scientific data on the prevalence of surgical complications among HIV patients compared to non-infected patients. Researchers believe that the risks of surgical complications for HIV patients can be predicted in a way similar to the method used in HIV-negative patients. Prior to surgery, healthcare providers should perform a physical examination, detailed medical history, and laboratory testing to determine the patient's overall health. Healthcare providers must also consider possible interactions between the patient's anti-HIV drugs (antiretrovirals) and medications, such as pain relievers, that are used before, during, and after surgical procedures. It remains unclear whether a patient's CD4 cell count influences their risk of surgical complications. Healthy individuals have a CD4 cell count between 600 and 1,200 cells per microliter of blood. The lower the CD4 count, the weaker the patient's immune system. Some studies have found no correlation between low CD4 cell counts and surgical complications, while others have found an increase in complications with lower CD4 counts. Further research is needed before a firm conclusion can be made. Organ transplants: As mentioned above, HAART enables HIV/AIDS patients to live longer lives. Today, most patients with HIV/AIDS are dying from end-stage organ disease and organ failure rather than AIDS-associated opportunistic infections. Since HAART prolongs the lives of HIV patients, it is possible for chronic conditions to progress to organ failure. For instance, HIV patients may experience end-stage liver disease as a complication of chronic hepatitis C virus. Glomeruli diseases are also common among HIV patients, and they may lead to kidney failure. In advanced stages of liver or kidney damage, organ transplants may be the patient's only chance of survival. Until recently, people who had HIV were not considered good candidates for organ transplantations. Many patients were denied transplants under the assumption that they had shorter life expectancies and less favorable survival rates than other patients in need of transplants. However, now that patients are living longer lives, many groups are re-considering whether HIV patients should be transplant candidates. Although the United Network for Organ Sharing (UNOS) does not consider HIV infection a contraindication for organ transplantation, individual transplant centers are in charge of deciding whether or not to perform surgery in an HIV-positive patient. Some centers will not provide organ transplants to HIV-positive patients, even if they are good candidates based on their physical and mental health. Some health insurance companies are reluctant to cover transplantation in HIV-positive candidates because they consider it to be an experimental procedure. Currently, only a few medical centers worldwide perform organ transplants in HIV-positive patients. However, health insurance companies and doctors consider organ transplantations in HIV-negative patients to be a well-established, reimbursable procedure. Recent legislation in California and a ruling in Arizona may help increase HIV patients' access to transplant surgery. In October 2005, an administrative law judge declared that Medicaid had to pay for a liver transplant for an Arizona woman who was HIV-positive. In the same month, California Governor Arnold Schwarzenegger signed a law that prohibits health insurance companies from denying coverage for organ transplants in HIV patients solely on the basis of their HIV-status. The law is the first of its kind to target such denials. The limited number of transplants that have been performed in HIV patients have produced encouraging results. However, organ transplants for people with HIV/AIDS have not gained widespread medical support, and there are still concerns regarding the long-term prognosis for HIV-positive transplant recipients. Treatment adherence: In order for anti-HIV drugs to work correctly, they must be taken exactly as prescribed. Skipping doses or not taking the medications correctly can cause the amount of an antiretroviral drug to decrease in the bloodstream. If the drug level becomes too low, HIV can begin reproducing more quickly. The faster HIV reproduces, the more mutations occur, including those that may be resistant to drugs. When a patient becomes resistant to a drug, the medication is no longer effective, even if it is taken in the future. As a result, patients have fewer treatment options. According to several studies, HIV patients must be more than 95% adherent to their treatment plans in order for them to remain effective. This means that missing more than one dose per month may reduce the drugs' effectiveness. Healthcare providers evaluate treatment effectiveness by measuring CD4 cell counts in the patient's blood. These immune cells are the primary targets of HIV. If the CD4 cell count is maintained, the likelihood of the virus mutating into resistant strains is decreased. HIV patients who are otherwise healthy and symptom-free should have their CD4 cell count and viral load tested about 2-4 times a year. However, symptomatic patients should be tested more frequently to evaluate both the risk of opportunistic infections and the response to HIV drug treatments. INTEGRATIVE THERAPIES Note: Integrative therapies should not replace antiretroviral therapy (ART) in HIV patients. Patients should consult their healthcare providers before taking any herbs or supplements because they may interact with treatment. In particular, patients should not take St. John's wort because it may interact with HIV treatment. Unclear or conflicting scientific evidence: Aloe vera: Clear gel from the pulp of Aloe vera leaves has been used on the skin for thousands of years to treat wounds, skin infections, minor burns, and other skin conditions. Although aloe has been suggested as a possible treatment for HIV infection, further research is needed before a firm conclusion can be made. Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, and tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds, or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools, or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease, or kidney disease. Avoid taking by mouth if pregnant or breastfeeding. Alizarin: Limited available evidence suggests that alizarin may be of benefit in the treatment of viral infections. Additional research is needed in this area. Avoid if allergic or hypersensitive to alizarin or any plants in the Rubiaceae family. Alizarin may be toxic and should not be handled for long periods of time, rubbed in the eyes, or eaten. Avoid if pregnant or breastfeeding. Antineoplastons: Antineoplastons are substances found in human blood and urine. Preliminary study reported increased energy and weight in patients with HIV who were treated with antineoplaston AS2-1, as well as a decreased number of opportunistic infections and increased CD4 cell counts. However, this evidence cannot be considered conclusive. Currently, there are drug therapy regimens available for HIV with clearly demonstrated effects (highly active anti-retroviral therapy), and patients with HIV are recommended to consult with their physicians about treatment options. Avoid if allergic or hypersensitive to antineoplastons. Use cautiously with high medical or psychiatric risk. Use cautiously with an active infection due to a possible decrease in white blood cells. Use cautiously with high blood pressure, heart conditions, chronic obstructive pulmonary disease, liver disease/damage, or kidney disease/damage. Avoid if pregnant or breastfeeding. Astragalus: Antiviral effects have been reported in early studies for HIV. Additional research is warranted. Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplant or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding. Beta sitosterol: Beta-sitosterol is found in plant-based foods, such as fruits, vegetables, soybeans, breads, peanuts, and peanut products. It is also found in bourbon and oils (such as olive oil, flaxseed, and tuna). Due to data that suggest immune modulating effects of beta-sitosterol and beta-sitosterol glucoside, these sterols have been studied in combination in the treatment of HIV. Larger populations of patients with HIV should be evaluated in randomized controlled trials to draw any conclusions. Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (like Parkinson's disease or Alzheimer's disease), diverticular disease (bulging of the colon), short bowel syndrome, celiac disease, and sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding. Bitter melon: Laboratory studies have shown that a protein in bitter melon called MAP30 may have antiviral activity against HIV. However, this has not been studied in humans. Further research is needed before a firm conclusion can be made. Avoid if allergic to bitter melon or members of the Curcurbitaceae (gourd or melon) family. Avoid ingesting bitter melon seeds. Avoid with glucose-6-phosphate dehydrogenase deficiency. Use cautiously with diabetes, glucose intolerance, or with hypoglycemic agents due to the risk of hypoglycemia (low blood sugar). Avoid if pregnant or breastfeeding. Blessed thistle: Laboratory studies report no activity of blessed thistle against herpes viruses, influenza, or poliovirus. Effects of blessed thistle (or chemicals in blessed thistle called lignans) against HIV are not clear. Human research of blessed thistle as a treatment for viral infections is lacking. Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding. Boxwood: Trials have been conducted for SPV30 (extract of boxwood, Arkopharma, France) to evaluate its potential effectiveness for HIV/AIDS. Rigorous clinical study is needed to confirm these early study results. Avoid if allergic or hypersensitive to boxwood, its constituents, or any plants in the Buxaceae family. Use cautiously with HIV or AIDS. Avoid if pregnant or breastfeeding. Carrageenan: Carrageenan-based gels may reduce HIV transmission during sexual intercourse and have been investigated for safety and acceptability in published studies involving healthy females. Overall, studies suggest that carrageenan is not associated with abnormal genital clinical findings or severe side effects, and is considered acceptable for use by females and their male partners. Additional research is needed to better determine the role of carrageenan for HIV infection prevention. Use oral carrageenan cautiously in infants. Use cautiously in patients with, or at risk for, cancer. Use cautiously in patients treated with azoxymethane or nitrosomethylurea. Use cautiously in patients with gastrointestinal, immune, inflammatory, or bleeding disorders, or in patients with low blood pressure or diabetes. Use cautiously intravaginally. Use cautiously in patients using antilipemic agents. Use cautiously in combination with any oral medication, as the fiber in carrageenan may impair the absorption of oral medications. PREVENTION Ways to prevent acquiring and/or transmitting HIV: Individuals who are either at risk for acquiring HIV or are 13-64 should be tested for HIV annually. This is because this age group is most likely to be sexually active. Needles or syringes should be avoided. Unprotected sexual contact, including vaginal, anal, or oral sex, should be avoided with an infected person. Unprotected sexual contact with someone with unknown HIV status should also be avoided. Behavioral modification may help prevent HIV/AIDS infection. In Uganda, there has been a dramatic decline in HIV prevalence as well as a decline in multi-partner sexual behavior. The decrease in HIV/AIDS infection came after the launch of behavior change programs largely developed by the Ugandan government and local NGOs. The 'ABC' initiative (Abstain, Be faithful, or for those who refuse to do either, use Condoms) resulted in a significant decrease in HIV infections in generalized epidemics. Researchers explained that once the ABC program was launched, rates of 13- to 16-year-olds having sex in one district of Uganda dropped from nearly 60% in 1994 to less than five percent in 2001. Uganda's message for the majority of the population focused on mutual fidelity; the reduction in casual sex, not the elimination of all sex, seems to have led to Uganda's falling HIV rates. Uganda has shown a 70% decline in HIV prevalence since the early 1990s, linked to a 60% reduction in casual sex. Gloves should be worn when in contact with blood or other body fluids that could possibly contain blood, such as urine, feces, or vomit. Cuts, scrapes, sores, or breaks on the exposed skin of both the caregiver and patient should be covered with bandages. Any body area that comes into contact with blood or other body fluids should be thoroughly washed. Surfaces that have been tainted with blood should be disinfected with antibacterial soap. Practices that increase the likelihood of blood contact, such as the sharing of razors, toothbrushes, and nail clippers, should be avoided. Needles and other sharp instruments should be used only when medically necessary and handled appropriately. In 1985, the U.S. Centers for Disease Control and Prevention (CDC) issued a list of routine precautions for all personal-service workers, such as hairdressers, barbers, cosmetologists, and massage therapists, to take. Instruments that penetrate the skin, such as tattoo and acupuncture needles or ear piercing guns, should either be used once and disposed of or thoroughly sterilized. Instruments that are not meant to penetrate the skin, but may come in contact with blood (such as razors), should not be shared unless thoroughly sterilized. Antiviral therapy during pregnancy can significantly lower the chance that the virus will be passed to the infant before, during, or after birth. The treatment is most effective if it is started as early as possible during pregnancy. However, there are still health benefits if treatment is begun during labor or shortly after the baby is born. Delivering the baby by cesarean section has been shown to reduce the risk of transmission to the newborn. However, this is not the standard preventative care for HIV-infected pregnant women. It should only be considered in certain clinical circumstances (such as for patients who have a very high viral load or for patients who do not adhere to antiretroviral therapy). Copyright © 2011 Natural Standard (www.naturalstandard.com) What to Read Next {{item.title}} Read Health24's Comments Policy Comment on this story 0 comments Comments have been closed for this article. Logout Comment 0 characters remaining Share on Facebook Loading comments... Ask the Expert HIV/Aids expert Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg. Ask a question Questions posted to HIV/Aids expert questions answered by the expert Q: My doctor has given up on me, help me please! posted on 23/07/2017 Q: HIV testing. posted on 23/07/2017 Q: HIV infection. posted on 23/07/2017 Q: Was I infected 9 years ago? posted on 22/07/2017 Q: Unprotected sex. posted on 22/07/2017 Q: Biological views on HIV/AIDS. posted on 22/07/2017 Q: Test reading time. posted on 20/07/2017 Q: My partner has HIV. posted on 20/07/2017 Q: HIV testing after oral sex. posted on 20/07/2017 Q: HIV detected on HIV test posted on 19/07/2017 Q: Medical check posted on 19/07/2017 Q: Diarrhoea and infection. posted on 18/07/2017 Q: Unprotected sex harm to baby? posted on 18/07/2017 Q: Is HIV spread by blood in mouth? posted on 18/07/2017 Q: Loosing weight after stating ARVs posted on 18/07/2017 load more × Still have a question? 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text:
Epidemiology of Cardiotoxicity in Children With Cancer
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
|Cardiovascular Diseases Heart Diseases Heart Failure, Congestive Death, Sudden, Cardiac Heart Failure
|Study Type:
|Study Start Date:
|April 1992
|Study Completion Date:
|March 1994
The data were analyzed to estimate the incidence of clinical cardiotoxicity as measured by sudden death, congestive heart failure, or discontinuation of therapy based on cardiac function. Evaluation of patient characteristics (age, anemia) and treatment factors such as drug, dose level, dosing schedule, exposure to irradiation and/or cyclophosphamide identified groups at particularly high risk for development of clinical cardiotoxicity and provided estimates of this risk for future treatment planning. Such estimates of high risk groups should make possible future trials to test the feasibility of using cardioprotectors or alternate dosing schedules to prevent cardiotoxicity. The incidence of clinical cardiotoxicity was calculated using Kaplan- Meier estimates as a function of total cumulative anthracycline dose and also as a function of the time since the end of treatment stratified by dose levels. The estimates were stratified by exposure to cyclophosphamide and radiation therapy. Multivariate methods were used to evaluate the prognostic significance of selected patient characteristics and treatment parameters and to provide estimates of the relative risk of each variable. The method of recursive partitioning was used to identify subpopulations at elevated risk for clinical cardiotoxicity. The data and analytic techniques were accessible through SAS data sets and procedures available to the study at the Pediatric Oncology Group (POG) Statistical Office.
The study completion date listed in this record was obtained from the "End Date" entered in the Protocol Registration and Results System (PRS) record.
|Ages Eligible for Study:
|up to 100 Years (Child, Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
No Contacts or Locations Provided
|ClinicalTrials.gov Identifier:
|NCT00005418 History of Changes
|Other Study ID Numbers:
R03HL048020 ( U.S. NIH Grant/Contract )
|Study First Received:
|May 25, 2000
|Last Updated:
|March 15, 2016
Additional relevant MeSH terms:
Heart Failure
Cardiovascular Diseases
Heart Diseases
Death, Sudden
Death, Sudden, Cardiac
Pathologic Processes
Heart Arrest
ClinicalTrials.gov processed this record on July 27, 2017

subset: commoncrawl


text: ...more are worth renting. For example: Raving Rabbids, Wario Ware, Resident Evil UC are worth renting...IMO. Any others to add to the list? These days you can rent games for quite a while (two weeks or so). While you're renting it just play it quite often and you will beat it in a few days. What do you guys think? I can see buying these games: Mario Kart Wii Smash Bros (when it comes out) SMG Zelda Metroid Strikers online multi-player games Of course, if you play games over and over again than this concept does not apply. You can always just rent it again too.


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How to Apply
That's right: Proposal time!
The Shared Beringian Heritage Program announces the 2015 Request for Proposals
Due September 14, 2015
The Shared Beringian Heritage Program funds cooperative efforts that link people, organizations, institutions, and local governments across the Bering Strait. Projects funded under this program may be either scientific research projects or local, community-based educational, cultural or conservation projects that fulfill some or all of the goals of the Beringia program.
For more information, please see the
To be eligible to apply:
- A duration of 1 to 3 years and funding not to exceed $150,000 for three years.
- Cooperator must be a non-profit organization, which Includes non-governmental organizations, academic institutions, tribal governments, and representative indigenous groups from the region
- Project has to meet one or more of the goals of the Beringia Program
- Proposal includes a "meaningful" Russian component
- Submitted applications must be received electronically by midnight on the 14th of September and if mailed in, must be postmarked by the 9th of September.
If you need paper copies of the application, please provide an address and we will be happy to mail as many copies as you need.
If you are having issues with any part of the application, or have questions about any step in the proposal process, please call the Program Specialist Ian Buvit at 907-644-3691 or e-mail at firstname.lastname@example.com.


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As Mitt Romney tries to become the first Republican since Ronald Reagan to win Wisconsin, a new CNN/ORC poll shows the presidential race is in a dead heat in that battleground state.
The CNN survey shows President Obama leading Romney, 49% to 45%, among registered voters. The difference is within the poll's margin of error.
STORY: No sure thing for GOP ticket
CNN has now moved the battleground state to "tossup" on its 2012 elections map.
The poll was taken Monday-Tuesday, a couple of days after Romney tapped Wisconsin congressman Paul Ryan to be his running mate.
Ryan, chairman of the House Budget Committee, has higher favorable ratings in his home state than Romney, according to the CNN poll. The seven-term lawmaker is viewed positively by 50% of Wisconsin adults, compared with 45% for the GOP presidential contender. More than half, or 54%, of Wisconsinites have a favorable view of Obama.
Wisconsin has 10 electoral votes up for grabs in November. Gov. Scott Walker, a rising GOP star, recently survived a tough recall election this spring.
CNN surveyed 1,005 adults, including 920 registered voters. The poll has a margin of error of +/-3 percentage points.
Catalina Camia leads the OnPolitics online community and has been at USA TODAY since 2005. She has been a reporter or editor covering politics and Congress for two decades, including stints at The Dallas Morning News and Congressional Quarterly. Follow her at @USATOnPolitics.
USA TODAY's Jackie Kucinich (@jfkucinich) and Fredreka Schouten (@fschouten) also contribute to the OnPolitics blog.


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We are delighted to announce that we took home not one, but two awards for 'Supplier of the Year' and 'Marketing Campaign of the Year' in the prestigious UK Watch and Jewellery Awards 2014.
We were joined by the industry's finest at the London Hilton on Park Lane, on Wednesday 2 July 2014, to celebrate the incredible talent and best in business, amongst of which we are delighted to be counted.
Every year the industry gathers at the UK Watch and Jewellery Awards to acknowledge the brands that have had a notable and commendable year, each striving to better the Watch and Jewellery industry. We are proud to be at the forefront of the business and for two consecutive years, taking home the same accolade of 'Supplier of the Year', proving our dedication to excellence year in year out.
The rigorous judging process for the awards which includes mystery shopping and official editorial visits proves that we really are dedicated and we look set for an equally successful 2014/15.


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Reader: Government has no business telling us what beers we can drink
The news that Corona Light qualifies as heavy-enough to be sold in Colorado bars and restaurants -- just in time for Cinco de Mayo! -- inspired this from mtnrunner2:
Bless you, o omnipotent state government, for permitting us do something we should have been able to do all along without your interference.
I certainly hope SB 60 passes, along with any other bill that truly frees up the market, for example letting other stores sell any strength beer (unfortunately that one died last time). The state has no right to prevent such sales, or to prevent consumers like me from buying it.
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After a legal fight, Rep. Charles Rangel's top challenger in a Democratic primary conceded defeat to the veteran New York congressman.
Ballots were cast two weeks ago, but State Sen. Adriano Espaillat challenged the vote in court because some absentee ballots had not been counted.
The New York City Board of Elections announced Saturday that Rangel, who has been in office since 1970, received 18,940 votes to 17,950 for Espaillat.
Espaillat, seeking to become the first person born in the Dominican Republic elected to Congress, issued the following statement after conceding again to Rangel:
After a historic campaign where we engaged voters in Manhattan and the Bronx about the bold, new ideas needed to move our city and our country forward, it is clear that we have fallen just a little bit short. We are proud of the tremendous show of support we received at the polls and even prouder of the fact that our campaign fought for every single vote to be counted. We congratulate Representative Rangel and thank our many supporters for their strong and ongoing support.
Rangel, 82, was censured by the House in 2010 for ethics violations. He had said during this campaign -- one of his toughest in years -- that voters had moved past his ethics woes as he emphasized his experience in Congress.
Espaillat was one of several challengers to Rangel, who is running in a redrawn district that now has more Hispanic voters. The 13th Congressional District, centered in Harlem, has long been dominated by blacks.
The district is predominantly Democratic, and winning the primary has usually been tantamount to winning election outright.
(Contributing: Susan Davis)
Catalina Camia leads the OnPolitics online community and has been at USA TODAY since 2005. She has been a reporter or editor covering politics and Congress for two decades, including stints at The Dallas Morning News and Congressional Quarterly. Follow her at @USATOnPolitics.
USA TODAY's Jackie Kucinich (@jfkucinich) and Fredreka Schouten (@fschouten) also contribute to the OnPolitics blog.


text:
Rockthegear.org relaunch promotes gearing up
SAN DIEGO, Calif. – Safe riding gear ambassador Brittany Morrow has relaunched the website rockthegear.org, which promotes gearing up while riding and shares news about the latest motorcycle gear and protective gear technology.
Morrow started the site in 2008 with funding from the Motorcycle Safety Foundation. Her inspiration came after a crash while she was a passenger on a sportbike. Morrow was not wearing gear, and she had to receive skin grafts on more than 50 percent of her body. Since then, she has been an advocate for always wearing a full complement of safety gear.
With the relaunched version of Rock the Gear, visitors can take the "I Rock the Gear" pledge to sign up for future notifications.
Morrow said, "I'm not trying to sell anything, but I do hope that riders 'buy into' an idea that wearing gear is a smart choice for individuals, their family and friends, their wallets and the community as a whole."
Rock the Gear relaunched March 2, and word has quickly spread. "I've been relying solely on social media to spread the word about the relaunch since Sunday," Morrow said. "Motorcyclists who value the message and quality of information have been extremely supportive by reposting, retweeting and reblogging in great numbers."
Morrow will also be doing some live promotions with gear fittings and presentations at two upcoming Icon Freestyle events in California. She will be at South Bay Motorsports in Chula Vista on April 5, from 12:30-5 p.m. On June 4, she will be at Chaparral Motorsports in San Bernardino from 5-8 p.m.


text: [Federal Register: June 6, 2007 (Volume 72, Number 108)] [Notices] [Page 31332-31333] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr06jn07-100] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. 2007N-0215] Joint Meeting of the Endocrinologic and Metabolic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. ----------------------------------------------------------------------- This notice announces a forthcoming meeting of a public advisory committee of the Food and Drug Administration (FDA). The meeting will be open to the public. Name of Committees: Endocrinologic and Metabolic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee. General Function of the Committees: To provide advice and recommendations to the agency on FDA's regulatory issues. Date and Time: The meeting will be held on July 30, 2007, from 8 a.m. to 5 p.m. Addresses: Electronic comments should be submitted to http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=http://www.fda.gov/dockets/ecomments. Select ``2007N-0215--Thiazolidinedione'' and follow the prompts to submit your statement. Written comments should be submitted to the Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852, by close of business on July 23, 2007. All comments will be posted without change, including any personal information provided. Comments received on or before July 23, 2007, will be provided to the committee before the meeting. Location: Holiday Inn Gaithersburg, Two Montgomery Village Ave., Gaithersburg, MD 20879. The hotel telephone number is 301-948-8900. Contact Person: Cathy A. Miller, Center for Drug Evaluation and Research (HFD-21), Food and Drug Administration, 5600 Fishers Lane (for express delivery, 5630 Fishers Lane, rm. 1099), Rockville, MD 20857, 301-827-7001, FAX: 301-827-6776, e-mail: email@example.com, or FDA Advisory Committee Information Line, 1-800-741-8138 (301-443-0572 in the Washington, DC area), codes 3014512536 and 3014512535. Please call the Information Line for up-to-date information on this meeting. A notice in the Federal Register about last minute modifications that impact a previously [[Page 31333]] announced advisory committee meeting cannot always be published quickly enough to provide timely notice. Therefore, you should always check the agency's Web site and call the appropriate advisory committee hot line/ phone line to learn about possible modifications before coming to the meeting. Agenda: The Endocrinologic and Metabolic Drugs and the Drug Safety and Risk Management Advisory Committees will meet in joint session to discuss the cardiovascular ischemic/thrombotic risks of the thiazolidinediones, with focus on rosiglitazone, as presented by FDA and GlaxoSmithKline. FDA intends to make background material available to the public no later than 2 business days before the meeting. If FDA is unable to post the background material on its Web site prior to the meeting, the background material will be made publicly available at the location of the advisory committee meeting, and the background material will be posted on FDA's Web site after the meeting. Background material is available at http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=http://www.fda.gov/ohrms/dockets/ac/acmenu.htm, click on the year 2007 and scroll down to the appropriate advisory committee link. Procedure: Interested persons may present data, information, or views, orally or in writing, on issues pending before the committee. Written submissions may be made to the contact person on or before July 6, 2007. Oral presentations from the public will be scheduled between approximately 1 p.m. and 2:30 p.m. Those desiring to make formal oral presentations should notify the contact person and submit a brief statement of the general nature of the evidence or arguments they wish to present, the names and addresses of proposed participants, and an indication of the approximate time requested to make their presentation on or before June 28, 2007. Time allotted for each presentation may be limited. If the number of registrants requesting to speak is greater than can be reasonably accommodated during the scheduled open public hearing session, FDA may conduct a lottery to determine the speakers for the scheduled open public hearing session. The contact person will notify interested persons regarding their request to speak by June 29, 2007. Persons attending FDA's advisory committee meetings are advised that the agency is not responsible for providing access to electrical outlets. FDA welcomes the attendance of the public at its advisory committee meetings and will make every effort to accommodate persons with physical disabilities or special needs. If you require special accommodations due to a disability, please contact John Lauttman, 301- 827-7001, at least 7 days in advance of the meeting. Notice of this meeting is given under the Federal Advisory Committee Act (5 U.S.C. app. 2). Dated: May 31, 2007. Randall W. Lutter, Associate Commissioner for Policy and Planning. [FR Doc. E7-10850 Filed 6-5-07; 8:45 am] BILLING CODE 4160-01-S


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Maybe Accepting Guests
- Last login over 1 year ago
Join Couchsurfing to see Lluis's full profile. It's free!
About Me
Try to make this world better. Do you help me?
I love sport... quite a sport freak! I try to enjoy the nature with all kind of sport from trekking to kanoeing, biking, running... I try to be away as long as the sun shines. On the other hand I love cooking, chating. I hope I am not the typical engineer! Another debility... animals, specially dogs. Animals only have good feelings.
Do the others what you want to get. We are all humans, we are all the same. A good smile helps for everything. Mens sana in corpore sano. And... we have only one life!
Why I'm on Couchsurfing
I think this is a very good initiative... departing that we all have good feelings towards the other. We should trust and help ourselves. I hope I will be able to particpate offering a couch and meeting new people by couching abroad!
Just starting... but looks very interesting!
After 3 experiences... couchsurfings shows the best way to get to know a country from inside... with its own inhabitants, which know much better about the culture, traditions and possibilities around.
Sports, cooking, music, nature, animals.
- animals
- dogs
- culture
- cooking
- running
- traveling
- music
- cycling
- sports
- engineering
Music, Movies, and Books
All in general. Not easy movies of action and no message. Alternative movies. Books... I do not read much... Only when I feel intrigued by the book... but sometimes I get bored before ;-( Any recomendation that will stick me to the book? Last novels that kept me interested were the Millenium's trilogy by S.Larsson and some of Kenn Follet. Reading as well on healthy life and food.
One Amazing Thing I've Done
Travel is always a nice experience. Working and living abroad let's us grow.
Teach, Learn, Share
Positive people with good feelings. Nice and supportive. I like the people that put themselves in other's place to be empathic and helpful. Smiling faces are as well a good attitude.
Countries I've Visited
Argentina, Australia, Chile, Costa Rica, Cuba, France, New Zealand, Réunion, United States, Venezuela
Countries I've Lived In
Germany, Netherlands, United Kingdom


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The gifts keep on coming for the Michigan State Spartans. After landing a commitment from 2015 shooting guard Kyle Ahrens two weeks ago, Spartans landed West Virginia transfer Eron Harris, who was considered to be the nation's best transfer on market.
MUST READ: Former Detroit Southeastern Jungaleer and Iowa State Cyclone Percy Gibson Transfers to Oakland
Now the Spartans have landed Cleveland State transfer and Michigan native, Bryn Forbes. The news was first announced by the Michigan State Spartans on Twitter and Forbes confirmed minutes with tweet of his own on Twitter.
Forbes is a Lansing native and will have two years of eligibility remaining. Under NCAA regulations, he is expected to have to sit out the 2014-15 season, unless he receives a hardship waiver from the NCAA, due to reported medical issues with his sister.
Although, he may have to sit out for year, this is still a solid grab for the Spartans. The former Lansing Sexton Big Red, was great player at Lansing Sexton where he played alongside current Spartan Denzel Valentine. During his time at Lansing Sexton, Forbes helped to lead his team to back-to-back state titles (2011, 2012) and three straight appearances in state title game (2010, 2011, 2012). As a senior he averaged 19 points per game with five rebounds and three assists, his consistent production, earned him a two-time all-state selection and all-area selection.
Forbes was just as productive during his time with Cleveland State. During the 2012-2013 season, he was voted the 2012-13 Horizon League Newcomer of the Year, and he led the Vikings with 15 points per game while shooting 42 percent from three-point range.
Coming in, Forbes should be able to provide more consistent shooting and overall scoring for the Spartans. At 6-foot-3, Forbes is what I consider to be a pure shooter, he can shoot and score efficiently from three-point range and mid range. He can put the ball on the deck and pull up for a shot or you can put him in a catch-and-shoot situation. At the end of the day, Forbes is a scorer and he always has been a scorer.
Now according to MLive.com, Forbes's signing fills Michigan State's last available scholarship, although one more could become available if Alex Gauna opts not to play his senior season.
Overall, this is a good signing for the Spartans and it Forbes will prove to be a consistent weapon in this Spartan arsenal. If you think I'm over exaggerating, think about the roster Michigan State will have in 2015-16. With the addition of Forbes, Harris and the commitments of power forward Deyonta Davis and shooting guard Kyle Ahrens, the Spartans have the potential to be very scary in 2015-2016.
Written by LBeasley (Lauren Beasley), Sports Contributor for Radio One Detroit


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Deadline 3 hours.
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text:
Myths About Tight VaginaAugust 4, 2012
How often have you heard many men tell you that a "tight vagina" is great for sex? Well I have heard this since I was a teenager. In reality, some men don't enjoy a tight vagina sex as much for some reasons below: Tight Vagina doesn't mean better sex Tight Vagina will only be good if the woman knows… Continue Reading »


text:
Reduction of 2,4-D Load in Surface Runoff Down a Grassed Waterway1
- L. E. Asmussen,
- A. W. White Jr.,
- E. W. Hauser and
- J. M. Sheridan2
The effectiveness of a grassed waterway in decreasing 2,4-D [(2,4-dichlorophenoxy) acetic acid] content in surface runoff was investigated. Corn (Zea mays L.) plots were treated with 2,4-D (0.56 kg/ha) and runoff produced by applying simulated rain was directed through a 24.4-m-long grassed waterway. The 2,4-D concentrations were measured under wet and dry antecedent waterway and plot conditions. Reduction in 2,4-D load in waterways results from water loss by infiltration, sediment loss, and by attachment-absorption on vegetative and organic matter. Of the simulated rainfall applied 1 day after application of 2,4-D, 50% of the water ran off the plots under dry antecedent soil conditions, and 78% ran off under wet conditions. Infiltration reduced runoff flowing down the waterway an additional 25% under dry conditions and 2% under wet conditions. Suspended sediment reduction in the waterway was 98 and 94% of the total amount moving from the plot for the dry and wet waterway conditions, respectively. The total loss (on sediment and in solution) of the applied 2,4-D from the plot in the dry and wet states was 2.5 and 10.3%, respectively. Of the 2,4-D lost from the plots and entering the 24.4-m waterway, approximately 30% reached the end of the waterway, regardless of antecedent soil moisture.Please view the pdf by using the Full Text (PDF) link under 'View' to the left.
Copyright © . .


text:
@article {1313, title = {Overview of Current Energy Efficiency Policies in China}, journal = {Energy Policy}, volume = {38}, number = {11}, year = {2010}, month = {2010}, abstract = {
From 1970-2001, China was able to significantly limit energy demand growth throughaggressive energy efficiency programs. Energy use per unit of gross domestic product (GDP)declined by approximately 5\% per year during this period. However, the period 2002-2005 sawenergy use per unit of GDP increase an average of 3.8\% per year. To stem this out-of-controlgrowth in energy demand, in November 2005 the Chinese government enunciated a mandatorygoal of 20\% reduction of energy intensity between 2006 and 2010. The National People{\textquoteright}sCongress passed legislation identifying the National Reform and Development Commission asthe lead agency to design and carry out programs in support of this goal. These policies andprograms, created after almost a decade of decline of the energy efficiency policy apparatus,have had considerable impact. Although initial efforts have not been sufficient to meet theannual declines required to reach the ambitious 20\% energy intensity target, the latest reportsindicate that China may now be on track to meet this goal. The paper provides an assessment ofthese policies and programs to begin to understand issues that will play a critical role in China{\textquoteright}senergy and economic future. Activities undertaken in China will have a significant influence onthe global effort to reduce the growth, and later the absolute quantity, of greenhouse gasemissions.}, keywords = {assessment, China, energy efficiency, energy intensity, policy, target}, attachments = {https://eetd.lbl.gov/sites/all/files/publications/ep-china-ee-policieisnov-2010.pdf}, author = {Nan Zhou and Mark D. Levine and Lynn K. Price} }


text: Atlanta Friday Night Fights View: Atlanta Friday Night Fights - Mixed Martial Arts (MMA) Event on December 16, 2005 in Atlanta, Georgia USA Share: Share on Facebook Share on Twitter Share on Google Plus Post a Comment Fight Winner Loser Method Round Time 1 Charles Nutt Justin Key Unknown 1 2 Bernard Rutherford Shannon Ritch Unknown 1 Charles Nutt vs. Justin Key Charles Nutt 2-4-0 5′ 9″ 145 lbs. WINNER Justin Key 0-5-0 0 lbs. Unknown in the 1st round Bernard Rutherford vs. Shannon Ritch Bernard Rutherford 5-6-0 0 lbs. WINNER Shannon Ritch 61-88-0 5′ 9″ 200 lbs. Unknown in the 1st round


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The St. Louis Cardinals have a finalized a deal to acquire the Cleveland Indians' ace, Justin Masterson, as reported by Peter Gammons. In exchange the Cardinals will send 2012 first round pick, outfielder James Ramsey to the Indians. This trade is interesting because even though only two total players were moved, the Cardinals still have the firepower to get practically anyone on their wish list. Will they make any more moves before Thursday's non-waiver trade deadline? No one really knows but they might want it that way as some reports say that the Cardinals organization is still interested in other top tier pitchers.
While other trades could be in the works, we'll analyze the trade the Cardinals made Wednesday afternoon. At first glance, Masterson's numbers look pretty bad this season. His 5.51 ERA and 1.65 WHIP would be the worst numbers he has put up in those categories. Masterson was a different pitcher last year though when he finished with a record of 14-10, 3.45 ERA and a 1.2 WHIP. The Cardinals are hoping he can return to last year's form to help them reach the playoffs.
With Masterson's numbers fluctuating from last season to this season, a change of scenery, especially to a contending team, might be what the doctor ordered. St. Louis is trying to see it that way at least. Masterson will closely resemble Lance Lynn; a pitcher who will go six to seven innings, strike out a good number of batters and give his team a chance to win the game. They both can be dominant at times as well as give up the one big inning. Look for Masterson to have a winning record and a sub 4.00 ERA during his time in St. Louis.
The Cardinals did have to part with 24 year old centerfield prospect, James Ramesy. The left-handed hitter was St. Louis' first round draft pick in 2012 and is living up to that draft status thus far.
Through 67 games in Double-A, Ramsey has a batting average of .300 with 13 homers, 36 RBI and an impressive .389 on-base percentage.
Ramsey very well could be in the mold of a solid number two outfielder in the big leagues.
This is a fair, solid trade that helps out both ball clubs. The Cleveland Indians received a good prospect who will be in the majors in a couple years, if not sometime next year. Cleveland was able to trade away a pitcher who's contract expires after the season and get a valuable piece in return. Meanwhile, the Cardinals added a pitcher who they believe is capable of pitching like the number two guy in their rotation. The Cardinals are loaded with outfield depth and they didn't even have to give up their best prospect, Oscar Taveras. That's the kicker. If Cleveland would have wanted any more, it would have been too much. This is the perfect alternative to David Price or Cole Hammels who would warrant a lot more in return. St. Louis will now make a push for the NL Central title, while keeping as much young talent as possible.
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Tags: Baseball, Cleveland, Cleveland Indians, James Ramsey, Justin Masterson, Lance Lynn, MLB, Oscar Taveras, St. Louis, St. Louis Cardinals, trade deadline


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was setting in as we pass through the trees
of Akyaka Forest Camp to Maden Iskelesi, where
we were to board the fishing boat Menekse. Hot
tea and a warm welcome awaited us. Then the
lights were extinguished and we set out. The
bright spotlights visible ahead came from a
lightboat 9-10 metres in length. When fishing
the 28 metre Menekse uses two lightboats which
go ahead and attract the fish to their light.
The fishing boat is radioed if the fish are
the right species, and the net is then played
out in a circle around the lightboat. Next the
rope which runs around the bottom of the net
is pulled in, gathering up the net like a bag.
This is winched up and the catch emptied into
tanks on deck. About 2 o'clock in the morning
an announcement over the loudspeaker called
a break. When the captain called the crew back
to work, 10-15 people emerged from the deck
head and began to fold up the nets ready for
a second catch.
Beneath the bright lights they worked swiftly and harmoniously as a team. Another shoal was surrounded, drawn up, and a flickering stream of bonito, mackerel, sardines, anchovies and horse mackerel poured onto the deck. In the first light of dawn the work took on the fantastic appearance of a choreographed show. To the shouts of 'Vira! Vira!' ('Carry on!') the net was hauled in for the last time, and the boat headed back to harbour. The fish had to reach the market as fast as possible and the crew worked at full speed packing the fish into 300 crates. As we followed the hilly shoreline the scent of thyme, rose geranium and resin floated across the water.
Kayaf Ali, a local fisherman who spends most of his time with his wife on their boat, chatted with us on the deck as he carefully went over his nets ready for the next night. Many couples go out fishing together here. As evening came around again we were invited to eat dinner on another fishing boat belonging to Birol Reis. The table was already laid on deck and there were several guests besides ourselves. Later that night when it was time to go fishing we were invited along. The boat carved its way through the black water beneath a star filled sky. When the boat returned at dawn it dropped us in the bay at Akyaka Forest Camp.