HIV/AIDS and the Flu "Questions & Answers"

HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immune deficiency syndrome). HIV kills or damages cells in the body’s immune system, gradually destroying the body’s ability to fight infection and certain cancers. CDC estimates that 1.1 million people are living with HIV/AIDS in the United States.

People with HIV/AIDS are considered at increased risk from serious influenza-related complications. Studies have shown an increased risk for heart- and lung-related hospitalizations in people infected with HIV during influenza season as opposed to other times of the year, and a higher risk of influenza-related death in HIV-infected people. Other studies have indicated that influenza symptoms might be prolonged and the risk of influenza-related complications is higher for certain HIV-infected people.  Vaccination with a flu shot has been shown to produce an immune response against influenza viruses in certain people infected with HIV.

Because influenza can result in serious illness, HIV-infected persons are recommended for vaccination. To help you prepare for the flu this season, this fact sheet provides Questions & Answers to guide the administration of both flu shots and antiviral medications to people with HIV/AIDS.

Should people with HIV/AIDS receive the inactivated influenza vaccine?

People with HIV/AIDS are considered at increased risk from serious influenza-related complication and should receive inactivated influenza vaccine (the flu shot). Persons with advanced HIV disease may have a poor immune response to vaccination. Therefore, pre-exposure chemoprophylaxis (use of antiviral medications to prevent influenza) may be considered for these patients if they are likely to be exposed to people with influenza.

Are there people with HIV/AIDS who should NOT receive the inactivated influenza vaccine?

Contraindications to the use of inactivated influenza vaccine (the flu shot) in persons with HIV/AIDS are the same as those for persons without HIV/AIDS. 
There are some people who should not get a flu vaccine without first consulting a physician. These include:

• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an influenza vaccination.
• People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine.
• Children less than 6 months of age (influenza vaccine is not approved for this age group), and
• People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)

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Should people with HIV/AIDS receive the nasal-spray flu vaccine (Live Attenuated Influenza Vaccine [LAIV] (FluMist®))?

No. Persons with HIV/AIDS and persons with other medical conditions (such as asthma, diabetes, or heart disease) are not recommended to receive the LAIV (FluMist®). LAIV (FluMist®) contains a weakened form of the live influenza virus. LAIV (FluMist®) is approved for use only among healthy* people 2-49 years of age† who are not pregnant.

Should people with HIV/AIDS receive influenza antiviral medications for treatment of influenza?

It’s very important that antiviral drugs be used early to treat flu in people who are very sick with flu (for example people who are in the hospital) and people who are sick with flu and who have a greater chance of getting serious flu complications, such as people with HIV/AIDS.

Studies have shown that flu antiviral drugs work best for treatment if they are started within 2 days of getting sick. There may still be benefit in treating people with antiviral drugs even after two days have gone by, especially if the sick person has a greater change of serious flu complications (see box) or if the person has certain symptoms (such as shortness of breath, chest pain/pressure, dizziness, or confusion) or is in the hospital because of the flu.

When should people with HIV/AIDS receive antiviral medications for chemoprophylaxis (prevention of influenza)?

People with HIV/AIDS should be prescribed antiviral medications to prevent infection with influenza when they cannot otherwise be protected during times when there is a high risk for exposure to influenza. Use should be in accordance with current recommendations from CDC or local public health authorities. Current CDC guidance on use of chemoprophylaxis should be consulted, and updated recommendations from CDC can be found on the Seasonal Influenza (Flu) and 2009 H1N1 web sites.

There are no published data on interactions between anti-influenza agents such as amantidine and rimantidine and drugs used in the management of HIV infected persons. Patients should be observed for adverse drug reactions to anti-influenza chemoprophylaxis agents, especially when neurologic conditions or renal insufficiency is present.

Should health care workers who have contact with HIV/AIDS patients be vaccinated?

Influenza vaccination is recommended for healthcare workers, including those who are involved in direct care of HIV-infected patients. More information about vaccination of health-care workers can be found in “Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (ACIP)”. Health-care workers who are healthy*, less than 50 years of age, and are not pregnant may receive the nasal-spray flu vaccine (LAIV/FluMist).

Source : cdc.gov

Achieving Iron Balance with Diet

If a person is iron deficient he or she will want to incorporate substances or foods that increase or improve iron absorption and avoid foods or substances that impair absorption. If a person has abnormally high body iron levels, he or she will want to consume foods or substances that lower the amount of iron absorbed.  People with complicated iron balance issues associated with sickle cell disease, thalassemia, blood diseases and cancers will need to work out an individual diet plan starting with the Diet for Iron Balance.

Substances that increase iron absorption:

Ascorbic acid or vitamin C occurs naturally in vegetables and fruits, especially citrus. Ascorbic acid can also be synthesized for use in supplements. Ascorbic acid enhances the absorption of nutrients such as iron.    In studies about effects of ascorbic acid on iron absorption, 100 milligrams of ascorbic acid increased iron absorption from a specific meal by 4.14 times.

Alcohol

Although alcohol can enhance the absorption of iron, no one is encouraged to drink alcohol as a means of improving iron status.  Moderate consumption of alcohol has known health benefits but heavy or abusive drinking, especially when in combination with high body iron levels increases the risk for liver damage, liver cancer and blood cell production. Approximately 20-30% of those who are heavy consumers of alcohol acquire up to twice the amount of dietary iron as do moderate or light drinkers, but alcohol abuse increased the risk of liver disease such as cirrhosis. A standard drink is defined as 13.5 grams of alcohol: or 12oz beer, 5oz wine, 1.5oz distilled spirits.  Moderate consumption is defined as two drinks per day for an adult male; one drink per day for females or those older than 65 regardless of gender. 
 

Beta-Carotene

is one of more than 100 carotenoids that occur naturally in plants and animals. Carotenoids are yellow to red pigments that are contained in foods such as apricots, beets and beet greens, carrots, collard greens, corn, red grapes, oranges, peaches, prunes, red peppers, spinach, sweet potatoes, tomatoes, turnip greens and yellow squash. Beta-carotene enables the body to produce vitamin A. In studies of the effects of vitamin A and beta-carotene on absorption of iron, vitamin A did not significantly increase iron absorption under the experimental conditions employed. However, beta-carotene significantly increased absorption of the metal. Moreover, in the presence of phytates or tannic acid, beta-carotene generally overcame the inhibitory effects of both compounds depending on their concentrations. Like vitamin E, beta-carotene is an excellent anti-oxidant, but one should take any of these judiciously.  Studies have shown that taking vitamin A habitually in amounts of 25,000 IU can cause liver problems, and that taking supplemental beta-carotene can enhance the progression of some cancers. The best source of these nutrients is whole foods.

Additive iron:

EDTA+fe and Ferrochel?are additive iron compounds and are emerging as candidates for fortification by major food manufacturers. Both additives were found to exceed absorption capabilities of the commonly used fortificant ferrous sulfate.

Hydrochloric acid

Hydrochloric acid (HCI) present in the stomach, frees nutrients from foods so that they can be absorbed.

Meat

Especially red meat increases the absorption of nonheme iron. Beef, lamb and venison contain the highest amounts of heme as compared to pork or chicken which contains low amounts of heme. It has been calculated that one gram of meat (about 20 percent protein) has an enhancing effect on nonheme iron absorption equivalent to that of 1 milligram of ascorbic acid.  A Latin American-type meal (maize, rice, and black beans) with a low iron bioavailability had the same improved bioavailability when either 75 g meat or 50 mg of ascorbic acid was added

"Tips For Parent" Antidepressant Medication and Children

To help parents better understand and make decisions about the use of SSRI antidepressant medication for their children, Mental Health America has prepared this fact sheet.

Childhood depression is a very serious health problem that affects one in 8 adolescents and one in 33 children. Left untreated, depression can lead to significant problems at home, in school and with peers — as well as to life-threatening problems such as substance abuse and suicide. The good news is that depression in children is very treatable, with psychotherapy, medication, or a combination of the two.

In October, 2004 the U.S. Food and Drug Administration ordered that SSRIs prescribed for children carry a “black box” label — the strongest warning the agency puts forth — regarding the potential risk for suicide.

In light of this warning, Mental Health America offers the following tips for parents on how best to approach their child’s care.

• Seek help if your child shows signs of depression or other mental health problems. Discuss all available treatment options with your child’s doctor, and carefully weigh all the risks and benefits associated with each treatment. (If your child is already being treated, express any concerns that you have to your child’s doctor.)
• If your child is prescribed an antidepressant medication, watch him or her closely and make sure s/he receives a thorough evaluation, continual follow-up and careful monitoring – particularly in the first several weeks – by a qualified doctor.
• Educate yourself about the warning signs of suicide and act quickly if you are concerned. Many people are afraid to discuss the issue of suicide for fear of “planting” the idea, but it is actually better to be open and direct.
• If your child is taking an antidepressant, do not abruptly discontinue use. Doing so can lead to significant side effects.
• Separate “fact from fiction” by using credible sources with information based on sound medical science rather than rumor or opinion. Beware of extreme claims, such as antidepressants are “always dangerous” or “never effective.” Medical research has demonstrated that such statements are misleading and dangerous.
• Remember that the worst possible situation for a child with a mental health problem is to go without any treatment at all.

Source : nmha.org

Kawasaki Disease

What is Kawasaki disease?
Kawasaki disease is a sudden and time-limited (acute) illness that affects infants and young children. Affected children develop a prolonged fever lasting several days, a skin rash, and swollen lymph nodes in the neck (cervical lymphadenopathy). They also develop redness in the whites of the eyes (conjunctivitis) and redness (erythema) of the lips, lining of the mouth (oral mucosa), tongue, palms of the hands, and soles of the feet.

Without treatment, 15 to 25 percent of individuals with Kawasaki disease develop bulging and thinning of the walls of the arteries that supply blood to the heart muscle (coronary artery aneurysms) or other damage to the coronary arteries, which can be life-threatening.

How common is Kawasaki disease?
In the United States and other Western countries, Kawasaki disease occurs in approximately 1 in 10,000 children under 5 each year. The condition is 10 to 20 times more common in East Asia, including Japan, Korea, and Taiwan.

What genes are related to Kawasaki disease?
The causes of Kawasaki disease are not well understood. The disorder is generally regarded as being the result of an abnormal immune system activation, but the triggers of this abnormal response are unknown. Because cases of the disorder tend to cluster geographically and by season, researchers have suggested that an infection may be involved. However, no infectious agent (such as a virus or bacteria) has been identified.

A variation in the ITPKC gene has been associated with an increased risk of Kawasaki disease. The ITPKC gene provides instructions for making an enzyme called inositol 1,4,5-trisphosphate 3-kinase C. This enzyme helps limit the activity of immune system cells called T cells. T cells identify foreign substances and defend the body against infection. Reducing the activity of T cells when appropriate prevents the overproduction of immune proteins called cytokines that lead to inflammation and which, in excess, cause tissue damage. Researchers suggest that the ITPKC gene variation may interfere with the body's ability to reduce T cell activity, leading to inflammation that damages blood vessels and results in the signs and symptoms of Kawasaki disease.

It appears likely that other factors, including changes in other genes, also influence the development of this complex disorder.
Read more about the ITPKC gene.

How do people inherit Kawasaki disease?
A predisposition to Kawasaki disease appears to be passed through generations in families, but the inheritance pattern is unknown. Children of parents who have had Kawasaki disease have twice the risk of developing the disorder compared to the general population. Children with affected siblings have a tenfold higher risk.

 

Source : ghr.nlm.nih.gov

Heart Disease Overview

The heart is a large muscle that pumps blood through the body, carrying oxygen and nutrients to tissues and vital organs. Heart disease is a blanket term used for several different conditions that affect the heart and the large blood vessels connected to it. Heart disease is common yet serious condition; about 12 percent of American adults suffer from it, and it kills more than half a million people every year in the United States, making it the number one cause of death.

Coronary Artery Disease
Coronary artery disease (CAD) and heart disease are often used interchangeably because CAD is the most common type of heart disease. It affects the coronary arteries—blood vessels that supply the heart with oxygen and nutrients. Deposits of fatty material called plaque build up inside the arteries, narrowing them and restricting blood flow or even blocking them completely, which can lead to a heart attack.

Congenital Heart Disease
A congenital heart defect is a malformation of the heart that's present from birth. The defect can hinder the heart’s ability to pump blood effectively. Some of these defects cause serious problems in infancy, but others may not be detected until later in life.

Cardiomyopathy
Cardiomyopathy is an abnormal thickening or enlarging of the heart muscle. This affects the heart’s ability to pump blood effectively, leading to symptoms of heart failure.

Valvular Disease
Valvular disease causes a problem with one of the four valves in the heart. The heart is divided into four sections, with valves ensuring blood flows one way in the right direction. When one of these valves begins to leak or narrow, the heart does not work as effectively.

Heart Infection and Inflammation
Infection and inflammation can affect the sac of tissue around the outside of the heart (pericarditis), the heart muscle tissue (myocarditis), or the inner membrane of the heart (endocarditis). Each of these can damage the heart and interfere with its function.

 

Source : healthline.com