What is AIDS

http://www.aidsmap.com/Tales-of-the-late-diagnosed/page/2572026/#item2572042

A Pricey Problem

“Late diagnosis is dangerous – and expensive to manage,” says Dr Ian Cormack, HIV consultant at Croydon University Hospital in south London.

“A year on antiretroviral therapy currently costs about £6000. The care bill for a recent patient who spent six weeks in our intensive care unit was well over £200,000, which would have been avoided if they’d tested a year before.”

In his experience, for some groups, late diagnosis remains the rule rather than the exception. “I’d say at least two-thirds of my current patients here had a CD4 count below the treatment-initiation limit of 350 cells/mm³ at diagnosis.

“My patient group here is two-thirds black African and I do know people from that group who have tested late either because they think HIV is still a death sentence, or are worried about their immigration status.”

But, he says, the people who really do scrape through – and the hospital had no avoidable HIV-related deaths last year, so scrape through they do – are the people who don’t fit the typical ‘high risk’ demographic, the 13% of his patients who aren’t openly gay men or black African people.

“The white heterosexuals are the most likely to turn up actually with AIDS-related symptoms. Them, and black Caribbeans, though we see a number of Asians too. They are often very ill and often have difficulties adjusting to their diagnosis, feeling especially isolated and stigmatised.”

The Bisexual Man

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HIV TESTING

Tales of the late diagnosed

Gus Cairns

Published: 14 February 2013

The bisexual man: Brian

One such person is Brian*. The north Londoner, diagnosed at Christmas in 2007, runs his own business as a wholesaler.

He started to worry “because I was looking too healthy. I tend to lose weight in the summer and pile it on again in the autumn. That year, though, I hadn’t had to go on my usual October diet and at first was pleased.

“But something started to scratch at the back of my mind. I didn’t feel ill, exactly. It was more that I felt vulnerable – as if I needed wrapping up and looking after. I started having dark thoughts too, not specifically suicidal but morbid. ‘If I accidentally stepped in the garden pond it would be all over’ – that sort of thing.

“I went back and forth to the GP a few times and they did tests for diabetes, liver function, cancers. All came back blank. Then I started losing my appetite and my GP became concerned: he could see I had unusual weight loss. Looking back, I’m wondering why he didn’t just test for HIV too.

“Just after Christmas, I got a chest infection. The GP took one listen at my chest and said ‘Right, we have to do something’: the next thing, I was in the local A&E department.

“The moment I was there I felt better psychologically; I was being looked after, as I’d wanted. The hospital doctor said ‘We need to broach the subject of your private life’, and I said ‘Go for it’. I realised it was important not to hold back.”

And so he found himself talking for the first time about his bisexuality and his late-night cruising on London commons. He was married with two teenage children, a school governor, well known in the local community. He emphasises that he made a conscious decision not to let fear of gossip stop him telling the truth.

“The doctor was the daughter-in-law of one of my customers. I decided to trust that she’d be professional. I didn’t want a stranger telling my wife, though. So I said ‘Take the day off work’ and told her. I considered saying I’d had a drug problem but decided there was no point in lying. She was devastated, but with the help of counselling at the Terrence Higgins Trust, we pulled through.”

If there’s a message he’d like to give to others, it’s to update their knowledge about HIV. “In my line of business there are quite a lot of bi guys and they’re the ones I always hear myths from. ‘HIV is still a death sentence’, ‘it’s mutating and is resistant to all the drugs’, and so on. It’s these kinds of myths that stop people from testing.”

Coffee Drinkers

Coffee consumption reduces the risk of liver cancer by approximately 50%, the results of a meta-analysis published in the online journal BMC Gastroenterology show. A total of 16 studies published before May 2012 were included in the analysis. Closer examination of the results suggested that the magnitude of the protective effective of drinking coffee was higher among men than women and also differed between patients of Asian and European origin. However, the authors do not believe their results are definitive and call for further research.

Liver cancer is an increasingly important cause of illness and death in both men and women. Infection with hepatitis B or C and excessive alcohol consumption are known risk factors for the malignancy. Factors protective against the development of liver cancer are uncertain, and the impact of coffee consumption is especially controversial.

A team of Chinese investigators therefore performed a meta-analysis of case-controlled and cohort studies examining the impact of coffee consumption and the risk of liver cancer.

Nine case-controlled and seven cohort studies met the investigators’ inclusion criteria. A total of eleven studies were conducted in Asia (nine in Japan) and five in Europe. All the studies provided data on the risk of liver cancer according to coffee consumption. However, there was little heterogeneity between the design of the studies. In particular, the level of coffee consumption against which the risk of liver cancer was assessed varied considerably, from as little as one cup each day to as many as eight or more daily cups.

Overall, the investigators found that a high coffee intake reduced the risk of liver cancer by 50% (OR = 0.50; 95% CI, 0.42-0.59). The protective effect of coffee consumption was similar in the case control studies (OR = 0.50; 95% CI, 0.40-0.63) and the cohort studies (OR = 0.48; 95% CI, 0.398-0.62).

Adjusting the results to take account of liver disease status provided similar results (OR = 0.54; 95% CI, 0.46-0.66).

“The results of the current meta-analysis…suggest that there is an inverse association between coffee consumption and liver cancer among different groups according to consumption level,” comment the investigators. “There were significant reductions of 50% in the risk of liver cancer with the highest consumption of coffee compared with non/almost never consumption.”

Stratifying the results by region suggested that the degree of protection provided by coffee consumption was higher in Asia (OR = 0.45; 95% CI, 0.36-0.56) than Europe (OR = 0.57; 95% CI, 0.44-0.75).

“The different results may be explained by racial differences,” suggest the authors. “Differences in coffee drinking habits may be a partial explanation for the discrepancy.”

Analysis according to sex showed that drinking coffee reduced the risk of liver cancer by 62% in men (OR = 0.38; 95% CI, 0.25-0.56) and by 40% in women (OR = 0.60; 95% CI, 0.33-1.10).

The authors note that caffeine has antioxidant properties, possibly explaining the protective effect of coffee consumption. However, the meta-analysis was unable to show the level of coffee consumption needed to provide protection against liver cancer.

“The results of this meta-analysis suggested that coffee consumption may be associated with a reduced risk of liver cancer,” the authors conclude. “However, because of potential confounding, this finding should be treated with caution. Further better-controlled studies are needed to confirm this finding.”