HIV: QUICK FACTSIntroductionThe human immunodeficiency virus (HIV) is a subgroup of retrovirus (lentivirus) that causes HIV infection. After a period of time, this infection leads to what is called acquired immunodeficiency syndrome (AIDS).

Epidemiology

According to the Centers for Disease Control and Prevention (CDC), from 2010-2015, the estimated rate of HIV infection in all 50 US states decreased from 14.2 per 100,000 population in 2010 to 12.3 per 100,000 population in 2015. In 2015, 39,513 individuals were diagnosed with HIV infection. From 2010 to 2014, the annual number of new HIV infections decreased by 9%.

Virology HIV-1 and HIV-2 are retroviruses in the Retroviridae family, Lentivirus genus. They are enveloped, diploid, single-stranded RNA viruses with a DNA intermediate.Upon entry into the target cell, the viral RNA genome is converted into double-stranded DNA by an enzyme, reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded enzyme, integrase. HIV contains three retroviral genes, namely gag, pol, and env.

Gag gene: Encodes group-specific antigen; the inner structural proteins
Pol gene: Encodes polymerase; it also contains integrase and protease
Env gene: Encodes the viral envelope, the outer structural proteins responsible for cell-type specificity. Glycoprotein 120, the viral envelope protein, binds to the host CD4+molecule
Pathophysiology

HIV infects vital cells in the human immune system, such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells and leads to cellular immune deficiency. This results in the development of opportunistic infections and neoplastic processes.

Mode of Transmission
Sexual intercourse: Unprotected sexual intercourse; especially receptive anal intercourse and different sexual partnersContact with or transfer of blood, pre-ejaculate, semen, and vaginal fluids infected with the virus.Spread from an infected mother to her infant through breast milk. An HIV-positive mother can transmit HIV to her baby both during pregnancy and childbirth due to exposure to her blood or vaginal fluid.

Signs and Symptoms There are 3 categories of infection 

Category A: Asymptomatic HIV infection without a history of symptoms or AIDS-defining conditions
Category B: HIV infection with symptoms that are directly attributable to HIV infection
Category C: HIV infection with AIDS-defining opportunistic infections
Investigation

A high-sensitivity enzyme-linked immunosorbent assay (ELISA) should be used for screening.

Management

Start with antiretroviral therapy (ART) in all HIV-infected adults ready to start therapy. 
CD4 count is no longer a criterion for starting the therapy.
Use of nucleoside reverse transcriptase inhibitors and protease inhibitors.
For refractory cases, during the failing treatment regimen and before switching therapy, use rapid confirmation, perform resistance testing and reevaluate.

HIV - Quick Facts Need To Know!

The contraceptive pill, or simply 'the pill', is a type of hormonal contraception taken by women to prevent pregnancy. Now, even though the birth control pill is extremely effective in preventing unplanned pregnancy, it is not without some side effects. The common side effects of birth control pill include:

1. Intermenstrual spotting: Some women experience intermenstrual spotting or bleeding in the time between their menstrual cycles. This is very common in the first three months of you taking the pill. Most of the times, intermenstrual bleeding resolves itself.

2. Nausea: Some women might experience mild nausea when they take the pill for the first time. The nausea will resolve on its own after some time, but if it gets critical or persists, seek medical help. Taking your pill at bedtime or with food can aid in countering the nausea.

3. Breast tenderness: Breasts can become tender or enlarge as a result of birth control pills. Reducing salt and caffeine intake, and wearing a support bra can be beneficial.

4. Headaches: The development of migraines and headaches are the effects of the sex hormones. Different pills with varied doses and types of hormones may lead to different symptoms of headaches. Studies suggest that pills with low hormone doses are usually linked with headaches.

5. Weight gain: There is no logical link between weight fluctuations and contraceptive pills, but fluid retention (specifically in the hip and breast areas) and enlarged fat cells are common side-effects.

6. Mood changes: Women who may have suffered from depression should consult their doctors when taking the pill. A study discovered that taking pills usually leads to the thickening of the cortexes (outermost layers of the brain involved with analysing incoming stimuli and reward response). However, there is more research pending on this issue.

7. Missed periods: Skipping or missing a period is very common when you are on the pill. Factors such as stress, travel, illness and thyroid or hormonal abnormalities can influence this.

8. Decreased libido: The pills contain hormones that can lower your sex drive or libido.

9. Vaginal discharge: Some women experience differences in their vaginal discharge when they are on the pill. Vaginal lubrication can dip, which causes discomfort during sex.

10. Visual changes: Fluid retention is a side-effect of the pill, which even ends up affecting the cornea; they change shape or swell up.

Birth Control Pills - 10 Common Side Effects!

HIV or the human immunodeficiency virus is a retroviral agent that causes the immune system of the body to weaken and lead to cause the acquired immune deficiency syndrome (AIDS). It is now treatable. Research is being conducted all over the world to formulate a targeted drug therapy for combating this life-threatening disease. No vaccine is available, which renders the world population highly susceptible to contract the infection.

HIV infection spreads from an infected person through contact with certain bodily fluids like blood and semen. Spread from one human being to another is called as transmission of HIV. Mother to child transmission, i.e. perinatal transmission is also common. Healthcare and hospital staff are at a great risk of occupational transmission. Other causes of transmission include sharing intravenous drug equipment, needle prick injury, organ transplantation and artificial insemination. Since vaccination and targeted drug therapy for remission are not available, prevention strategies play an important role in curbing the spread of infection.

A three-level prevention strategy is implemented for HIV infection.

Primary prevention- Activities that focus on prevention of uninfected people being infected.
Secondary prevention- Aimed at the provision of proper health care and behavioral facilities for HIV infected people like lifestyle changes, welfare rights advice, anti-discrimination measures.
Tertiary prevention- Aimed at minimizing the symptoms of an infected person; includes the provision of prophylactic drugs and complementary therapies.
The risk avoidance approach for transmission of HIV infection includes certain measures like practicing mutual monogamy & delayed sexual activity in the young population. Safe and appropriate use of syringes and needles is advised. Unnecessary blood transfusions should be completely avoided. Routine screening of HIV antibody should be done.

Risk reduction approach propagates the mandatory use of condoms during sexual intercourse. Sexually transmitted diseases should be treated to avoid the risk of transmitting infection. Sterile syringes should be used. If blood transfusion is necessary, then blood transfused should be evaluated well to meet the quality standards.

If HIV infection is suspected, anti-retroviral drug therapy should be started.
The only universally approved method of HIV transmission during sexual activity is the use of condoms.
Pharmaceutical methods for prevention and treatment include antibiotic drug therapy for sexually transmitted diseases, anti-retroviral drugs for infected individuals, pre and post-exposure prophylaxis and use of low space dead syringes.
Pre-exposure prophylaxis is advised for people who are at a higher than average risk of contracting the infection.
Drug therapy consisting of a combination of Tenofovir and Emtricitabine is prescribed, one per day.
Visit the physician at regular intervals and routine screening is done. Post-exposure prophylaxis is considered to be effective if the treatment is started within an hour of exposure, to effectively reduce the risk of seroconversion. A drug combination of Emtricitabine, Tenofovir and Raltegravir is given.
Social initiatives are undertaken to spread awareness and educate people regarding AIDS. Behavioral change and acceptance of social message is necessary to benefit from the social initiatives. Sex education, LGBT sex education and awareness, safe injection use programs, needle exchange programs, safe sex practice education are some social strategies implemented.
Prevention of transmission of HIV from mothers to children involves anti-retroviral drug therapy during pregnancy and post birth in the newborn child. Breastfeeding is avoided and bottle feeding is advised.

HIV Transmission - How Can It Be Prevented?

In some cases, psychological factors rather than physical incapability plays a vital role in causing Erectile Dysfunction (ED). Child abuse or any instance of sexual trauma is considered as one of the root causes of Erectile Dysfunction. Other than this, there are numerous factors like a person s emotional health and well-being can also be a direct reason behind Erectile Dysfunction.

The psychological causes of Erectile Dysfunction are

Pressure: Constant exposure to stress due to work load, difficulties in married life, parenting issues, financial issues can be a major reason behind erectile dysfunction.
Guilt: The pressure of satisfying a new sexual partner may become so overpowering that it may result in poor sexual performance. This may lay seeds of guilt in a person and hamper his emotional health.
Anxiety: If a person erectile droop at any instance, fear may creep in that it can occur again. This situation opens door for  performance anxiety  and may cause erectile dysfunction in the long run.
State of Depression: Even a person who performs normally during sexual intercourse can suffer from erectile dysfunction if he is in depression. Depression poorly hinders a person s emotional health and cause a series of psychological as well as physical problems. The drugs taken during depression may even facilitate erectile dysfunction.
Loss of interest in sex: Reasons behind this can be growing age, disputes with partner, any kind of stress or certain medications.
Loss of Self-confidence: Failure in previous attempts for sexual intercourse, feeling of insufficiency in sex life may lead to loss of self-confidence. This can be one of the deciding factors behind erectile dysfunction.
Remedy 

Occurrence of erectile droop once or twice is quite common among men. There is nothing to be worried about. But if this problem persists, one shall consult a sexologist. Few tips to prevent and cure erectile dysfunction are as follows: 

One needs to open up and discuss such issues with his partner as well as his physician. If the cause of erectile dysfunction is poor emotional health, then he can undergo some therapy. Some stress releasing exercises or meditation can help you gain control over your mind.
One can take some pills like Viagra and prevail over psychological impediments. It helps to boost up one s confidence while performing any sexual act.
Try to remain fit and fine. Exercise daily to shed any extra weight. Avoid drinking and smoking and take a healthy diet. Take adequate sleep (about 7 hours in night) and get your blood pressure and cholesterol levels checked regularly.
All the above tips help in maintaining your physical as well as psychological health. Follow them and get cured of erectile dysfunction.

Erectile Dysfunction - Psychological Causes + Remedies

The prostate is a vital organ that located between the penis and the bladder. The prostate is involved in the release of the prostate fluid that keeps the sperm properly nourished. Prostate cancer, as the term indicates, is characterized by the abnormal and uncontrolled growth of cancerous cells in the prostate. Though the incidences of prostate cancer are low in India, necessary precautions and diagnostic steps should be carried out to prevent the condition from jeopardizing our lives.

Prostate screening includes two tests known as the Digital Rectal Exam (DRE) and Prostate-Specific Antigen test (PSA). PSA combined with DRE helps to identify prostate cancer at a very early stage. If any of the tests show an abnormality, a doctor might prescribe an ultrasound such as MRI Fusion or Prostate Biopsy to confirm the diagnosis.

Immediate treatment may not be necessary
For low-risk prostate cancer, doctors often recommend active surveillance that includes periodic blood tests, rectal exam, and biopsies.
Active surveillance helps a doctor to continuously track the growth of cancer cells and the possibility of their spread to other areas of the body.
Surveillance is fit for those who are already suffering from a serious condition or for those patients who are above the age of 60.
A surgical procedure to remove prostate cancer
Surgery is considered when the cancer has metastasized to surrounding tissue and the lymph nodes. There are two kinds of surgeries that a patient can go through- a Robot-Assisted surgery and a Retropubic surgery.
Radical Prostatectomy might have risks involved. It is, therefore, wise to discuss the pros and cons of the surgery with the doctor well in advance.
Understanding the treatment options

Radiation therapy: Radiation therapy involves the use of high-powered and high-frequency energy beams to kill cancer cells. Radiation therapy is often used to shrink the size of the cancer cells. There could be two types of radiation therapy-Brachytherapy and External beam radiation. Radiation therapy too can have its side effects. Doctors prescribe several medicines during therapy.
Hormone therapy: Hormone therapy helps to stop the production of a male hormone known as testosterone. This treatment option includes medication that completely stops the production of testosterone, the medications may also block the flow of testosterone on the cancer cells, and surgery to remove the testicles. Hormone therapy is used in advanced cancer stages.
Chemotherapy: Chemotherapy is a drug that goes into the body and kills rapidly growing and metastasizing cancer cells. It is administered through IV (intravenous), or orally as pill or both. This treatment option is employed when cancer spreads to a remote body location and does not respond to hormone therapy.
Biological therapy: Biological therapy involves the usage of the body s immune system to fight cancer. A type of biological therapy known as the sipuleucel-t is used to treat patients with advanced cancer stage and recurring cancer as well.

Prostate Cancer - How Biological Therapy Will Help?

A couple of decades ago, medical professionals believed that a lot of females could not climax at all. There are a number of reasons for this. It is easy for the male to know when he has achieved an orgasm, which usually happens with ejaculation, which is quite evident. For the females, on the other hand, it is not so evident. It is a perceived feeling and while the media showcase it in a particular way, reality is far moved from it.
There are various reasons why it is very difficult to pin this down. Orgasms are not just an elusive feeling for the woman, it is an elusive topic for the medical professionals too. Read on to know some of the common causes (more beliefs or notions) about this and some simple but effective ways of managing this.
- Private topic: Girls are very shy compared to boys and both their exposure to sex education and discussion about this is limited compared to boys. We might tend to think of it as common in India alone, but this is true across a vast number of countries. We are not alone! This shyness continues into their later years too, and unless transformed by the partner, it may continue to be a topic that is shunned.
- Purpose: Sex is more deemed as a form of procreation rather than for sex. Therefore, while sex is necessary for conception, orgasm is not. This is one more reason (strange but true) that orgasm is very elusive for a woman.
- Psychological factors: It could be guilt from past relationships or fear of past abuse. It could be fear of losing control or fear of coming across as vulnerable. For any of these reasons, women can have difficulties climaxing during the act.
In men, the causes are more defined and physical in nature and include erectile dysfunction, premature ejaculation, retrograde ejaculation, and delayed ejaculation.
Whatever the cause of the problem, the first step in coping up with the issue is to acknowledge the issue. Being a private topic, this is not something that is going to draw the person towards medical help. However, this needs to be discussed frankly with the partner or with the doctor. Getting the partner involved removes a lot of psychological barriers (guilt, fear, anxiety, etc.) This would result in natural ironing out of issues, improving the performance of both the people involved.
If that does not happen, seeking professional help, be it medical help to correct physical issues or counselling, is the next suggestion. A frank discussion will do wonders, and what was once elusive can be well within your reach.

The Elusive Orgasm - Causes and Coping!

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