GIN INC JOURNAL

Too many Americans with HIV are diagnosed late in the course of their disease and miss out on the optimal benefit of effective treatments, U.S. health officials reported Thursday.

As many as 1 million Americans are infected with HIV, but up to a third don't know they have the disease because they haven't been tested for it, according to the U.S. Centers for Disease Control and Prevention. That's why the agency recommends that HIV testing be a routine part of any medical examination.

"People are learning about their HIV infection several years after being infected," explained lead researcher Dr. R. Luke Shouse, from the CDC's Division of HIV/AIDS Prevention in the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

"This means that they may have unknowingly transmitted HIV," Shouse said. "It also means that there is a time when they had HIV when they were not under appropriate medical care, so there are missed opportunities for prevention and care."

The new report on HIV testing appears in the June 26 issue of the CDC's Morbidity and Mortality Weekly Report, to coincide with National HIV Testing Day on June 27. The day promotes testing as an important strategy to prevent and control transmission of HIV in the United States, according to the CDC.

According to the report, which collected data on people diagnosed with HIV/AIDS in 34 states from 1996 to 2005, 38.3 percent of those diagnosed with HIV were diagnosed with AIDS within a year, and 6.7 percent were diagnosed with AIDS over the next two years.

Since progression from HIV to AIDS typically takes about 10 years without treatment, these findings highlight the importance of testing for HIV early, when antiretroviral treatments can deliver maximum benefit, Shouse said.

Minorities were more likely to be diagnosed late, compared with whites, and more minorities than whites progressed to AIDS within three years, the researchers found.

In addition, people whose initial HIV diagnosis occurred when they were older were more likely to progress to AIDS within three years. Men diagnosed with HIV were also more likely to develop AIDS within three years, the researchers noted.

"It's important to be tested for HIV -- routine screening for folks 13 years and above with regular medical visits, and at-risk populations should be screened annually," Shouse said.

Another report in the same issue of the CDC journal showed that too few high school students have been tested for HIV. In fact, only 12.9 percent of all students, and 22.3 percent of students who have had sex, have been tested, researchers found.

"When you look at the younger age groups, we estimate, a little under half of people 13-to-24 who are HIV-positive know they are infected," said lead researcher Andrew C. Voetsch, also from CDC's Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

That's about 50,000 people, Voetsch noted.

Voetsch said that to get more people tested, the message has to be reinforced with health-care providers, so public health agencies must educate health-care providers on the importance of testing. Also, people need to be educated about identifying HIV early, to get them into treatment and make them aware of how to protect their partners, he said.

A. David Paltiel, professor and acting division head of the Division of Health Policy and Administration at Yale University School of Medicine, said late testing is a problem that has been around for a long time.

"All of those people who are tested late have been unable to access drugs that would prolong their life," Paltiel said. "They are at much higher risk of the complications that actually kill people. This means a lot of mortality that could have been prevented."

Paltiel agreed that HIV testing should be a routine screening procedure. "There should be routine HIV testing for all sexually active adults and teenagers in all health-care settings," he said.

Routine HIV testing has been opposed because it stigmatizes people, Paltiel said.

"But now we've got these magnificent drugs that really do save lives, that really can reduce the transmission," he said. "So to the extent you make HIV screening routine, without singling people out, you may not only help save lives [and] reduce transmission, but you may destigmatize HIV testing."

A complex mix of factors related to environment, lifestyle, and heredity plays a role in the causation of cancer. For example, 80 percent of all cancers are related to the use of tobacco products, to what we eat and drink, and to our exposure to radiation, asbestos, and some of the other cancer-causing agents. There’s not much you can do about your genes, but several other key risk factors are under your control.

If you identify them and make the necessary changes in your lifestyle early enough, you can substantially decrease your chances of developing a malignancy. Here are some of the risk factors you can do something about:

1. Tobacco

Tobacco is the most preventable cause of mortality in this country. Regardless of whether you chew it, snuff it, smoke it, or inhale someone else’s exhaust, tobacco is a killer. In the United States, it is responsible for 85 to 90 percent of all lung cancers, and for one-third of all deaths related to other cancers. The magnitude of the risk depends on the number and kind of cigarettes you have smoked and for how long. A pack-a-day smoker is ten times more vulnerable than a non-smoker. It is never too late to quit. After you do, your cancer risk declines gradually each year.

2. Chronic alcohol abuse

This type of abuse can cause cancer of the liver, as well as of the mouth, throat, and larynx, especially in combination with tobacco. It may also raise the risk of breast cancer. If you are going to imbibe, limit yourself to the equivalent of two drinks a day – and stop smoking.

3. Diet

People who shun fruits and vegetables have roughly twice the incidence of most types of cancer – lung, larynx, oral cavity, stomach, colon, and rectum, bladder, pancreas, cervix, and ovary – than those with the highest intake. Yet only 9 percent of Americans heed the recommendations of the National Cancer Institute and the National Research Council to eat two servings of fruit and three portions of vegetables a day. Seventh-Day Adventists, who don’t drink or eat much meat but do consume a diet rich in fruits and vegetables, have the lowest incidence of cancer in the U.S. population. This protective effect is probably due to the antioxidants and folic acid present in fruits and vegetables, which neutralize damage to chromosomal DNA caused by oxygen-free radicals.

4. A high-fat diet

This type of diet is associated with cancer of the breast, uterus, and prostate. The guilty foods are eggs, fatty meat, high-fat salad dressings and cooking oils, and diary products such as whole milk, butter, and most cheeses.

Blueberries have a higher antioxidant capacity than any other fruit or vegetable. They are said to protect against cancer by virtue of their anthocyanins and other natural phytochemicals.

5. A high consumption of soy-based food

Soy-based food such as tofu, may also protect against cancer because of the genistein content. Genistein suppresses the production of proteins that cancer cells need in order to keep growing. In China and Japan, where people eat lots of soy, there is much less cancer of the breast, colon, and prostate than in this country. Since men with prostate cancer generally have lower blood levels of selenium than their normal counterparts, selenium supplements may protect against this malignancy.

6. Some supplements

Some supplements seem to protect against certain cancers. For instance, colon polyps and cancer do not recur as often in persons who regularly take multivitamins, calcium supplements, and vitamin E. A diet rich in fruits and vegetables is protective against cancer, presumably because of the beta-carotene content. So take your mother’s advice: Eat all the fruits and vegetables you can – and forget the pills.

7. Don’t have X-rays

Don’t have X-rays any more frequently than is absolutely necessary. I no longer take annual routine chest films on myself. Some dentists are too enthusiastic about X rays. Make sure you really need them before acquiescing.

Diabetes becomes more prevalent with age. About half of all the cases are diagnosed over age 60. There are two types of diabetes that can affect seniors. Type I diabetes occurs when the body’s immune system, for some yet undiscovered reason, mistakenly attacks and destroys the cells in the pancreas that are responsible for making insulin. However, 90 percent of the time when an older person gets the disease, it is diabetes II.

If you have Type II, your pancreas is still doing its job. The catch is that it either isn’t producing enough insulin or it is making plenty of insulin but your body has developed what is known as insulin resistance. Although diabetes is a chronic disease that has no cure, here are a few suggestions that can help you.

1. Pay Attention To Your Feet

Inspect your feet and between your toes every day. Diabetes can damage nerve endings in your feet and toes, making it difficult for you to feel sores, blisters, and other injuries. Look for cuts, breaks in the skin, or swollen, red areas. Keep your feet clean and dry. Bathe your feet with warm water and mild soap every day. Dry them carefully, especially between the toes. Apply a thin coat of moisturizing lotion if the skin on your feet feels unusually dry. Wear clean socks and comfortable, well-fitting shoes. Never go barefoot. You are more likely to get injured if you do.

2. Avoid Large Meals

Spread your calories, especially those that come from carbohydrates, throughout the day in order to keep your blood sugar levels at optimal levels. So instead of two large meals, you may want to eat five or six smaller meals like half a sandwich and an orange.

3. Step Lively

Regular exercise is a vital part of any diabetes management plan. Just taking a 15-minute walk every day can help lower blood sugar and can help your body use insulin more efficiently. Some activities such as weight-lifting may not be safe for you, particularly if you have high blood pressure or diabetic eye disease.

4. Consume Fiber

Food high in water-soluble fiber like beans, oat bran, fruits, and nuts can help people with diabetes control their blood sugar. Soluble fiber slows the absorption of carbohydrates, so your blood sugar level may not rise as quickly. Try eating at least 20 grams of fiber a day. You will be well on your way to reaching your goal.

5. Follow The Pyramid

Even if you have a dietary plan specifically designed to control your diabetes, certain basics apply to everyone. It is recommended to take reference to the U.S Department of Agriculture’s Food Guide Pyramid for people who are 50-plus as an excellent starting point for any senior who has diabetes. These guidelines give you a general eating program that balances your consumption of fats, proteins, and carbohydrates in a way that should provide good nutrition.

6. Treat Yourself

In the past, people with diabetes were told that they could not eat certain foods, namely refined carbohydrates like sugar, cookies, or sweets. However, all carbohydrates have similar effects on blood sugar. That means a cookie elevates blood sugar about as much as a slice of bread or piece of fruit. Moderation is the key. Try to keep your simple-sugar intake down to 10 percent of your total calories each day.

7. Know Your Enemy

Learn as much as you can about diabetes. The better you understand the disease, the more likely you are to be able to control it. Ninety-nine percent of the care and management of diabetes is in the patient’s hands. You have to prepare your meals, and monitor your blood sugars. You have to know what to do and when to do it. And you can do it if you don’t have the knowledge and skills.