La mirada del tigre: acerca de la transferencia en pacientes adictos 1 Observaba la marcha bamboleante y, casi con asombro, esa convicción corporal de superioridad cuando entró al consulto-rio. Su relato se extendía alrededor de las bondades de un estadoespecial cercano al éxtasis al que nunca podría acceder con miconocimiento intelectual exento de experiencia. Como muchasotras
Pmsnewsfall2006FOCUS GROUPS SHED LIGHT ON CLIENT
RECENT RESEARCH – B CELLS AND HIV
As much as we LOVE to stick needles into our guys and ask them dirty questions, there’s an actual reason why we continually collect this info from our partipants.
groups with PMS volunteers to learnabout their experiences at the clinic.
Just down the way from the PMS clinic is Pitt’s Department of Infectious Diseases and Microbiology, where much of the research involving the data we collect from our volunteers is conducted. Research information to increase the satisfaction of volunteers, performed there often leads to papers published in to improve the quality of services we provide, and to medical journals, which can hopefully lead to new ways strengthen our ability to keep volunteers in the study.
of understanding how to fight and eventually cure HIV.
The groups were lead by Mark Friedman, a trained One of the most interesting recent findings from our focus group facilitator who is not affiliated with the researchers involves the role B cells play in spreading PMS. Below are some of the questions we asked and HIV infection throughout the body*. B cells are a lot the major findings we got from the groups.
like T cells - they are the cells responsible for producingantibodies in response to infections. When a virus What are the main reasons why guys first come
invades the body, B cells and T cells spring into action.
to the Men’s Study? a) to get tested to determine
their HIV status, b) to take care of their own health, c)
Although B cells do not become infected with HIV the their concern for their community, and d) the perception way that T cells do, our research found that B cells that their involvement will be safe and confidential.
play an important role as an accomplice in HIV’stakeover of T cells.
What are the major reasons why guys stay in the
study? a) this is a way to stay healthy (e.g., health
B cells internalize HIV, carrying it around in the body and transmitting HIV to T cells. Our research foundthat a particular protein (called DC-SIGN) carried by the B cells acts as a “bridge” that HIV uses to reach the surface of T cells. Without this protein, HIV had a We hope that this study can open new areas of Charles R. Rinaldo, PhD, Principal Investigator Anthony J. Silvestre, PhD, LSW, Co-Investigator research on the role played by B cells on spreading HIV in people who have the virus and can assist in William G. Buchanan, MM, Contributing Editor coming up with new drugs or forms of therapy aimed Bridget C. Calhoun, MPH, PA-C, Contributing Editor Marcy Holloway, MPAS, PA-C, Contributing Editor at exploiting this path of HIV transmission from one Ashley G. Woodson, Production Assistant NEWS AND NOTES is published by the Pitt Men’s Study. All information and opinions are the sole responsibility of *Info for the article referenced in this story is as follows: the the Study and do not necessarily reflect the policies or Rappocciolo, G., Piazza, P., Fuller, C.L. Reinhart, T.A., Watkins, views of the University of Pittsburgh or the National S.C., Rowe, D.T., Jais, M., Gupta, P., and Rinaldo, C.R., Jr. DC-SIGN on B lymphocytes is required for transmission of HIV-1 to Tlymphocytes. PloS Pathogens 2:e70, 2006.
THE PITT MEN’S STUDY PICKS YOUR
GONORRHEA DRUGS BECOMING LESS
The CDC recently announced that gonorrhea, the 2nd most common STD in the United States, is now resistant to the class of antibiotics known as fluoroquinolones Multicenter AIDS CohortStudy (MACS for short).
The only class of drugs left to combat this infection arecephalosporins. Experts fear that gonorrhea will eventually become resistant to those too because of sites continually conduct studies based on data and the overuse of antibiotics in humans and animals, thus leaving doctors with no antibiotics to treat the disease.
Drug companies have been slow to develop new PMS is now leading a MACS-wide study of the antibiotics since they are not as profitable as drugs for relationship between the structure of the brain and the ability of study participants to perform tests of memory,learning, problem solving and other measures of brain The CDC reports that in 2005 there were 350,000 reported cases of gonorrhea in the USA and estimatesthat there are probably at least twice as many people Under the direction of James T. Becker, Ph.D., who infected. Since 2000 the incidence of resistant has led the neuropsychological study at PMS since its gonorrhea has jumped from less than 1% of the reported beginning, the four MACS sites will enroll 160 men in this study of brain structure and thinking.
Gonorrhea is a sexually transmitted infection that can A select group of participants, both HIV-infected and infect the penis, vagina, mouth, or anus. Ejaculation does uninfected, will be contacted at each site based on such not have to occur for gonorrhea to be transmitted or factors as their participation in MACS, age, medical acquired. The incubation period can range from 1 week to 1 month. The initial symptoms include discomfort inthe penis, a thick white, yellow or green discharge from Because PMS has more uninfected participants than the tip of the penis, and pain or burning sensation when the other three MACS sites (Baltimore, Chicago, and urinating. Gonorrhea infection following anal sex can Los Angeles), Pittsburgh will have an especially result in anal discharge, anal itching, anal soreness, important role since we have the most men who can bleeding, and/or painful bowel movements. Infections serve as “controls” for the other sites.
in the throat may cause a sore throat but usually causesno symptoms.
Participants will undergo approximately one hour ofMRI scanning to take very detailed pictures of the brain.
Although many men have signs and symptoms with In addition, each participant will complete a series of this infection, some do not. If you suspect that you tests of memory, learning, problem solving, etc.
may have been exposed to gonorrhea, please discuss Participants will, as always, be compensated for their testing and treatment options with your doctor or visit Pittsburgh will analyze all the data, the results of which Using condoms during anal and vaginal sex to prevent will be presented at scientific meetings and in scholarly HIV infection should also protect one from gonorrhea.
However, the infection can be transmitted throughunprotected oral sex as well.
This is very important work that may lead to newresearch endeavors that will also be led by PMS.
(Information used in this article was reported by NPRin April 2007).
KNOW YOUR MEDS !
Here at the Pitt Men’s Study, we love to ask a lot of questions about our participants’use of prescription drugs, those that are HIV-related as well as those that are not.
To facilitate this, we include a sheet with your appointment letter on which youcan record any medications used since the last visit. We hope our men will fill outand bring this with them to their appointments. It’s surprising how many mencannot recall their medications, even those for conditions such as HIV, heart disease,diabetes, etc. Our study is most effective when we collect detailed and accurateinformation, and we ask all of our men in the MACS study to please make theeffort to do this – it makes our data stronger, and can lead to new findings.
But there’s another good reason for knowing what meds you take: the unlikely but real likelihood of suddenlybeing taken ill or being involved in an accident. Anyone who is taking medications routinely for a specificmedical condition should carry a list of them in his wallet including the drug name, the dose and the frequencytaken. In case you require emergency medical care, such a list alerts doctors to medical conditions you have thatcould influence exactly how they treat you. You should also list the name and phone number of your primarycare physician as well as any doctors treating you for any chronic conditions. This knowledge could make yourrecovery easier and possibly save your life.
It’s another bothersome task (and perhaps a reminder of something you’d just as soon not dwell on), but it surehelps us, and most importantly, it might help you.
FOCUS GROUPS continued from page 1
screenings), b) altruism (wanting to help fight HIV/ What are some things that PMS could do to
AIDS; maybe help create a breakthrough; being increase the likelihood that volunteers will keep
supportive of other men; wanting to simply make the coming back? a) staying in contact with individuals
world a better place), c) the warm, friendly, caring, who stop coming, b) greatly increasing communication dedicated, knowledgeable, and professional staff, and concerning the impact of the study (state the d) the confidentiality of the PMS and how safe it feels difference that volunteers are making; continually communicate the purpose and accomplishments ofthe study), c) provide volunteers with more health- What are the major reasons why guys drop out of
related information such as information about current the study, or lapse from time to time? a) personal
treatments and their possible side effects, and what factors such as depression, addiction, and lack of people can do to take better care of themselves, d) motivation, b) AIDS fatigue or the feeling of being make communications with volunteers more “user- burned out by such a devastating epidemic, c) moving friendly” (briefer, in non-scientific terms).
out of the Pittsburgh area, d) sometimes having anotherpriority in life that must come first.
We are using this information to improve our study.
Specifically, we are going to gear our newsletter There was a unique theme among many African- toward giving more information as to the impact of American PMS volunteers. Several of these men had the study and the research that has come out of it.
experienced what they described to be hardship (abuse, We’re also getting ready to offer regular health alerts discrimination and/or poverty) in the past. Most of these - via both email and snail mail - to interested men men had overcome this hardship. These volunteers who wish to stay informed of current health concerns strongly felt that volunteering for PMS was a way to stay healthy and to keep fighting adversity.
CHANTIX: A NEW SMOKING-CESSATION
help you. The pharmaceutical company Pfizer hasdeveloped varenicline (Chantix), which was approved by the Food and Drug Administration in May 2006 onan expedited basis (fast tracked). The expedited Smoking cigarettes is bad for your health — bad for approval was due to results of studies showing your heart, bad for your brain, and bad for every other impressive rates of smoking cessation among more than organ that keeps you alive. Yet, many people still do it; the Centers for Disease Control and Prevention (CDC)estimate 44.5 million Americans smoke cigarettes.
Chantix has two important benefits. First, it reduces Why? Because tobacco companies have invested an nicotine withdrawal symptoms; and secondly, it blocks unbelievable amount of time, effort and money in receptors in the brain from absorbing nicotine, making making sure that once you start, you can’t stop! smoking less enjoyable. No other medications used forsmoking cessation (Zyban, Wellbutrin, etc.) have both There are tiny receptors in the brain for nicotinic acid, or nicotine, which is the addictive chemical in cigarettes.
The nicotine stimulates the brain to release dopamine, Chantix is prescribed for a period of 12 weeks during a hormone that makes people feel good. Over time, which the dosage slowly increases. The most common the brain becomes dependent on the nicotine, making it side effect of Chantix is nausea. Many patients are very difficult to stop smoking, even when experiencing able to continue taking the medication if they stay at shortness of breath or difficulty breathing.
the lower dosages and by taking the pills with food.
Chantix should not be used by women who are pregnant,or by women trying to get pregnant.
Chantix can be used safely in people with HIV infectionand those taking medications for HIV infection.
Healthcare providers frequently monitor kidney functionin patients taking Chantix, but that is done easily with aroutine blood test.
The cost of Chantix can range from $100-$140 per monthand may be comparable to what is spent on cigarettesper month depending on the number and brand ofcigarettes smoked. Unfortunately, the cost of Chantixis not currently covered by most insurance companies.
However, check with your individual insurance companysince some provide coverage if other methods ofsmoking cessation (such as antidepressants or nicotine For those determined to quit, the method of “cold turkey” may be effective, but only if they can overcomethe common symptoms of withdrawal (which include If you are interested in quitting smoking, please discuss jittery feelings, frequent headaches and cravings for all your options with your healthcare providers, and cigarettes). For others, use of nicotine gum, nicotine remember, the best results are obtained by using patches, hypnosis or antidepressants may be helpful.
pharmacologic therapies (such as Chantix) along with It has been estimated that most people need 3 or 4 smoking-cessation counseling and support from people attempts before they are successful at finally kicking If you have not been able to quit, it’s never too late totry again! And now, there is another option that may HIV FORUM PROVIDES INFO ABOUT
positive patient advocates. The goal of the project is NEW DRUG TREATMENTS
“not for people to have less sex but more sex and healthier sex,” said Fisk. “By assessing risky behaviors,counselors help people change their behaviors to meet The Pitt Men’s Study, along with co-sponsors Pittsburgh AIDS Center for Treatment (PACT), PittsburghTreatment Evaluation Unit, Allegheny General Fisk pointed to studies that show that 25% of the 1.1 Hospital’s Positive Health Clinic, and GlaxoSmithKline, million Americans infected with HIV are not aware presented the first of a series of HIV Educational that they carry the virus, and that this group is most likely to transmit the virus. Another 25% know theyhave HIV but are not in care, and they are also more “For over 23 years, the Pitt Men’s Study has been at likely to transmit HIV. Fisk’s goal is to “get people the forefront in educating our community on prevention tested and into care and help them have a healthy sex of HIV infection,” said Dr. Charles Rinaldo, Pitt Men’s life and good drug [taking] habits in order to reduce Study principle investigator. “We are here to serve the community by addressing your needs and conveyingthe latest information related to your health.” A panel of experts that included Dr. Riddler, Mr. Fisk,Dr. Piontkowsky of the Positive Health Clinic and Dr.
PACT physician and PMS medical director Dr. Sharon Deborah McMahon of PACT then answered questions Riddler, who spoke about advances in HIV treatment, first discussed a new formulation of Kaletra that doesnot need to be refrigerated, making it more useful in Reprinted from Out, May 2007, with the permission countries where refrigeration is a luxury.
Dr. Riddler then turned her attention to the recentlyapproved combination drugs Epzicom, Truvada and PARTY HONORING THE STUDY’S CAB
Atripla that are new formulations of existing drugs.
The members of the Community Advisory Board Atripla includes three medications and represents a were honored at the Study’s annual holiday party at major advance in treatment – a one-pill-per-day HIV the home of Dr. Anthony Silvestre. Dr. Rinaldo spoke warmly of the Board members dedication to thehealth of our community and their commitment to Additionally two new protease inhibitors were approved the study. His comments were greeted with much in 2007: Aptivus and Prezista. Both drugs must be given enthusiasm by those attending the event. Members with Norvir twice a day and have shown good viral of the Board are Co-Chairs Mr. August Pusateri suppression in a significant number of those taking them (Buzz) and Mr. Bill Kaelin, and members Dr. Paul Alercon (on leave), Ms. Kathi Boyle, Mr. BradleyBurns, Mr. Michael Crawmer, Mr. Chuck Honse, There are two new classes of HIV medications: co- Ms. Cyndee Klemanski, Mr. Floyd Patterson, Mr.
receptor inhibitors (Maraviroc) that target one of the Christopher Taylor, Ms. Chris Tripoli, Dr. Manny two receptors HIV uses to infect T cells and integrase Vergis, and Mr. Richard Vinski. Staff members Jeff inhibitors (Raltegravir) that stop HIV’s genetic material Toth and Ashley Woodson were also thanked for from fusing into the T cell’s DNA. “These are the first new classes of oral HIV antivirals in ten years, “Thishas special significance for those whose HIV strain In the past year, the Board has been working hard to has become resistant to most if not all of the currently support data gathering related to meth use and its impact on unsafe behaviors as well the Study’s workon the impact of HIV medications on heart function.
Stuart Fisk from the Postive Health Clinic then spoke The Board has also been advocating for increased about “prevention for positives.” Patients at Allegheny funding from the Governor for HIV prevention and General Hospital’s Positive Health Clinic are offered anti-bullying programs in the schools.
individual and group counseling by one of two HIV- SUMMER FOOD SAFETY - DON’T LET BAD POTATO SALAD RUIN YOUR DAY
Planning on picnicking this summer? There’s more to look out for than just ants! While enjoying the warm weather, picnics, and barbecues, be sure to protect yourself from getting sick. Foodpoisoning is caused by eating foods contaminated with harmful bacteria and usually causes diarrhea, abdominalcramping, nausea, and vomiting. Summer outdoor eating may increase your chances of eating foods that canmake you ill. In order to decrease your risk of food poisoning, follow these simple recommendations: DON’TS
• Always wash hands before eating – use • Never eat raw meat or fish – This includes warm soapy water and vigorously rub hands popular dishes such as sushi, raw oysters, together for at least 30-45 seconds.
• Be sure to rinse all fruits and vegetables to • Don’t thaw meat at room temperature – remove pesticides and bacteria – Even fruit Instead, thaw in the refrigerator ensuring and vegetables that don’t look dirty may that the drippings won’t come in contact • Always cook red meat to 165 degrees – • Never use any item past the expiration date – Before buying any perishable items check sure to check the color of the inside before the expiration date and make sure you plan serving. Keep cooking until it’s no longer periodically inventory items in therefrigerator to make sure nothing has • Always cook poultry to 180 degrees – It’s always a good idea to use a meatthermometer to be certain safe temperatures • Don’t eat cheese that has mold on it – When buying cheese of any kind read the labeland make sure it has been pasteurized.
• Never eat fruits with soft spots that show refrigerated – Dairy products should not signs of mold – When buying fruit, choose pieces that are not quite ripe so that if they the fridge right before they’re needed and aren’t eaten for a few days they don’t spoil.
• Never use raw eggs in mayonnaise or ice cream – Always substitute frozen eggproducts that have been pasteurized inrecipes that call for raw eggs. When eatingfood prepared by someone else ask if raweggs were used in the preparation.
• Never eat soft-boiled or sunny-side-up eggs – Runny eggs are undercooked and cancause food poisoning.
As always, eat well-balanced meals that include food from all food groups, and limit your intake of alcohol.
Remember, foods contaminated with harmful bacteria don’t always look or smell spoiled.
When in doubt, throw it out! DON’T FORGET THE SUNSCREEN!
Fifty-one thousand Ameri-cans will be diagnosed this The Southwestern Pennsylvania Healing Weekend (SPHW) has been scheduled for June 8-10, and will be held at a peaceful mountain retreat center. The primary goal of the Weekend is to provide relaxation, information and camaraderie for those infected and/or affected by The SPHW is funded by a combination of local AIDS The incidence of melanoma is increasing by nearly 4% service organizations, churches and businesses willing a year, and melanoma is the most prevalent cancer to support the on-going battle against HIV and AIDS.
among the 25-29 year age group. Decreasing your sun The SPHW continues to grow and is known for providing exposure, using sunscreen, checking your skin monthly, fun-filled opportunities for meeting new people, sharing and being checked yearly by your doctor are ways to personal experiences, and personal growth. Special activities include workshops, massage, bingo,motivational speakers, bonfire, and a variety of stress When going outside, always use a waterproof sunscreen reduction activities. A series of 12-step meetings will of SPF 30 or higher (rated for both UVA and UVB), also be planned for those who are interested. The cost apply it heavily 30 minutes before going out in the sun, of the weekend is $250.00 and includes 2 nights of and reapply every 90 minutes. Make sure you cover double occupancy lodging, all meals, evening snacks, every area that is exposed including the ears. Don’t admission to all workshops/activities and entertainment.
stay out in the sun any longer with sunscreen than you A limited number of partial scholarships (ranging from $175 - $225) are available for those who complete anapplication and are in need of financial assistance. The Don’t forget to use sunscreen when taking a trip and deadline for registration is April 30, 2007. Those make sure to protect those parts of you that will be completing a registration form after the deadline will exposed to the sun while inside the car (like your face and neck and that arm and hand you like to hang outthe window!). There are also shirts that filter UV rays.
Brochures for the SPHW are available at local HIV/AIDS service organizations and treatment centers.
With early diagnosis, similar to many other cancers, Additional information and the scholarship application melanoma is treatable in the early stages. Go to <http:/ can be found within the brochures. For more information /www.skincheck.org> for more information on how you please contact Bridget Calhoun at the Pitt Men’s Study (412) 624-2008 or Don Finch at Persad Center (412)441-9786, Ext #303. We hope to see you there! COME AND SEE US THIS SUMMER!
The Pitt Men’s Study will be out and about this summer. Youshould come and hang out with us! First off, we’ll be at the Memorial Day Festival on May 28 in South Park. We’ll alsobe manning a table at PrideFest, which is held on June 16, 2007 on the North Shore.
At both events we’ll be handing out informational materials, condoms, and lube as wellas answering any questions you might have.
Gay and bisexual men are still being infected with HIV. The Pitt Men’s Study wishes to remind youabout the possibility of becoming infected by alerting you to the most common reasons given by menwho become infected.
• Some men have become infected because they believe that their partner is HIV negative.
But we know that some men who claim to be HIV negative are simply wrong about their
status; some deliberately mislead or rely on old information that is no longer valid. Some men
think that sexual partners who appear to be healthy are not infected, but this is not necessarily
so. One should treat every sexual partner as if he is HIV positive and only engage
in those activities that he would perform with someone he knew to be HIV positive.
• Depression and alcohol/drug use - especially meth and cocaine - lead otherwise
cautious men to engage in risky sexual behaviors. It is important to be especially
cautious during sex when you are feeling down or are under the influence of alcohol and
drugs. Those who may have mental health, alcohol or drug problems should consider seeking
professional assistance through the Persad Center or a private therapist who has experience
dealing with problems related to maintaining safer sex behaviors.
• Not using a condom during anal sex is the most significant risk factor for HIV infection among gay and bisexual men. Those who engage in anal sex should use a latex condom
with a water-based lubricant every time they have anal sex. Insertive partners should
consider withdrawing prior to ejaculation to provide even greater protection to their partners.
Each person needs to assess the risk that he is willing to take. It is important that a long history ofnegative HIV status not create a false sense of security. No one should use a negative result tocondone unsafe behavior. As we all cope with living with HIV, we need to support each other andnot let our guard down.
If you have not been to the Pitt Men’s Study within the last six months, you are encouraged to call
412-624-2008 (or toll-free at 1-800-987-1963) to schedule an appointment. We also continue to
enroll new volunteers for free and confidential HIV screening; please encourage your friends to call
the above numbers for information on joining. Volunteers who wish to attend our educational sessions
for a second time also may call to schedule. Members of our clinical staff can offer you advice on
safer sex and HIV prevention.
Remember: Prevention is still the best way to combat HIV
La cambiale di matrimonio FARSA GIOCOSA IN UN ATTO DI G. Interpreti: ROSA MORANDI , NICOLA (Tobia Mill in veste da camera, berretto Personaggi da notte, che porta con una mano un mappamondo e nell'altra tiene una TOBIA MILL, negoziante: basso comico (prende la lettera e, riconoscendo SLOOK, negoziante americano: basso CLARINA, cameriera di Fanny: soprano.