Many people with HIV infection have decided to combine the traditional therapies provided by Western medicine (described in detail later in this section) with alternative therapies, such as herbal therapy, acupuncture, dietary changes, and vitamins. Asking your primary health care provider which of these options have been proven useful, and which alternative therapies may be harmful, is a good idea. On the other hand, though your provider may be well versed in Western medicine, he or she may not have any knowledge (or only limited knowledge) of these other options. Many people with HIV infection therefore seek the advice of alternative practitioners to complement the care provided by their primary providers. Many books offer descriptions of the alternative therapies offered for people with HIV infection or AIDS.
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The other two-thirds of those who are carriers have what is called chronic persistent hepatitis; they exhibit less severe symptoms and in fact are frequently symptom free, with only mild inflammation of the liver. They are less likely to progress to the more worrisome complications of cirrhosis and liver cancer, although this is still possible.
They are also less likely to be infectious to others, although this too remains a possibility.
Even carriers can occasionally clear the virus from their systems and cure themselves of hepatitis B.
How and why some people clear the infection while others do not is not clear. For those who remain carriers, routine monitoring by a health care provider for complications from the disease is essential.
People with chronic hepatitis B infection may sustain damage to organs other than the liver, similar to that seen with hepatitis C infection (discussed subsequently). Such symptoms include disorders of the skin (polyarteritis nodosa), kidneys [glomerulonephritis), and blood cells (cryoglobulinemias).
People who become infected with hepatitis B are contagious to others during the weeks before they become symptomatic and for up to several months following infection. Those who become chronically infected are potentially infectious to others throughout their lifetimes. Those with chronic active hepatitis are more infectious to others than those who are only carriers (who have chronic persistent hepatitis). People with acute hepatitis B infection should be considered infectious to others until their blood work shows they have cleared the infection, which may take up to three to six months after infection.
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HOW COMMON IS IT?
In the United States, Chancroid is not a common STD. It is more common in the tropical and subtropical developing world, such as Africa, where it is the most common cause of genital ulcer disease (in the United States the most common cause of genital ulcer disease is herpes). The late 1980s saw an increase in the incidence of Chancroid in the United States, with about 5000 people diagnosed a year. Since then there has been a slight decline in the number infected each year.
Given the low incidence of chancroid in this country, who is at risk for contracting the infection? It’s important to know, first of all, that people who continue to have sex when they have Chancroid sores—most often sex workers and those who visit them, especially in urban areas in the East and South—easily spread the disease. Having sex with someone who has sores increases your chances of contracting this infection. In addition, individuals who use crack cocaine or abuse other mind-altering substances, including alcohol, are less likely to use good judgment and more likely to have unprotected sex with high-risk partners. Men are more commonly infected than women; not being circumcised increases the risk of acquiring this infection. Finally, anyone living in the United States who travels to other areas of the world where infection is common and engage in unprotected genital or anal sex with high-risk persons is at risk.
The incidence of chancroid in this country may be higher than statistics indicate. The diagnosis may be missed because the symptoms are very similar to those caused by herpes and syphilis (which are more common STDs in the United States), and because the bacterium that causes Chancroid is hard to culture.
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Clinical Stage versus Pathologic Stage
This can be pretty confusing. Clinical stage is an estimate, what a doctor believes a man’s prostate cancer to be, based on factors such as the digital rectal exam, PSA, transrectal ultrasound and needle biopsy. Pathologic stage is much more certain—and, for predicting the likelihood for cure, it’s essential— because a pathologist has been able to examine actual prostate tissue and, often, tissue from the lymph nodes, not just make guesses about it based on a few cells and test results. Until recently, knowing pathologic stage was only possible when the prostate was removed. Now, however, based on table 3.3, doctors have a much better way of estimating a man’s pathologic stage of cancer before surgery.
More on the Digital Rectal Exam and Staging
Like transrectal ultrasound, the digital rectal exam is not able to pick up microscopic cancer spread to the prostate wall and beyond. Because of this, the digital rectal exam tends to underestimate the stage of cancer. Studies have found that a significant number of cancers initially staged as T2b (Bi) end up being classified as higher because of cancer that has invaded the capsule of the prostate or the seminal vesicles. For cancer with an initial clinical evaluation of T2c (B2), this degree of “understaging” ranges from 39 percent to 66 percent. One reason for this is that the digital rectal exam is subjective; it depends on the experience and perceptiveness of the doctor performing it. Another is that the digital rectal exam can only give information about the prostate gland itself— and not even all of it, at that. And it certainly can’t tell anything about the nearby pelvic lymph nodes or bones. Also, if a man has had other treatment of a prostate disorder—a TUR, for instance, for BPH—this can cause the prostate to feel different on an exam, and it can throw off the digital rectal exam.
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The prostate is affected from up close—by the testes—and from long-distance—by the brain. Let’s begin at the top: The hypothalamus, located in the brain, makes a chemical messenger called LHRH, which is dispatched in signal pulses—like Morse code or flashes of light—to the nearby pituitary gland. These pulses tell the pituitary to transmit yet another chemical signal, called LH, which motivates the testes to make the male hormone testosterone.
Among other things, testosterone is responsible for secondary sex characteristics like post-puberty body hair and deepening of the voice, and for fertility. It is a major hormone that regulates the prostate. The adrenals also make some weak androgens; however, it’s questionable whether these adrenal androgens have a significant influence on the adult prostate.
Testosterone is important to the prostate, but not in its original form; it must be transformed to an active form. It turns out that testosterone is converted by an enzyme called 5-alpha-reductase to DHT. And DHT is the major androgen, or male hormone, inside the prostate cell.
Here’s how it works: Testosterone circulates in the blood. It enters cells in the prostate by diffusion, like water through a tea bag, and soon is transformed into DHT. DHT hooks up chemically with a specific protein, moves to the cellular seat of power—the nucleus—and quickly becomes a powerful force in the transmission of genetic information (DNA) from prostate cells.
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