Who Should Get a Resistance Test

In people who are infected with drug-resistant HIV, the majority of the HIV in their bodies will be mutated. One or more of these mutations will prevent HIV meds from working as well as they should.

How is it possible to be resistant to HIV medications before you've even taken them? Unfortunately, it's easier than you might think. In the United States, an average of 7% to 19% of newly infected people have mutations that are associated with drug resistance to at least one drug -- and, in some cases, to a whole class of medications.

How does this happen? The person you got HIV from may have been on HIV treatment, and his or her virus became resistant to one or more medications. Transmitted along with HIV was their resistance to certain drugs. If you were infected within the last several years, taking a resistance test before beginning HIV treatment will reveal whether you have HIV that is resistant to any HIV medications.

However, if you were infected more than a few years ago, or if you are not sure when you were infected, current resistance tests may not be able to provide a completely accurate result. This is because, after a few years, without HIV treatment, wild-type HIV will reproduce more than the drug-resistant virus you were originally infected with, and that wild-type HIV will once again become the most common type of HIV in your body.

Currently available resistance tests are not sensitive enough to detect mutations when they are present in small numbers in your body; they are most likely still there, but in low numbers.

So, for example, if you got HIV from a person who had resistance to Sustiva (this drug is one of the three drugs in Atripla), and a few years went by before you started taking HIV medications, a resistance test may not note that you have any mutations to Sustiva. But if you then start to take Sustiva, the Sustiva-resistant virus in your body will once again thrive.

While these tests may not detect resistance in people who were infected several years ago, it's still best to get one as soon as possible after you're diagnosed. If the test does find resistance, this information will be extremely helpful when it comes time to choose your first treatment regimen.

People Whose Viral Load Rises While on Treatment
If you're currently receiving HIV treatment and your viral load rises sharply, this could indicate that you're experiencing what your doctor might call "treatment failure." Although it sounds worse than it actually is, it could mean that your HIV has grown resistant to one or more of the medications you're taking.

However, a rising viral load can signify other things as well. Your body could be reacting to a recent vaccination or an infection. Or, a new HIV drug you just started taking could be interacting with other drugs you're taking, making your treatment less powerful.

Once your doctor rules out all these other possibilities, and before you stop or change treatment, it's critical to immediately get a resistance test. This way you can learn which drug is failing to keep your HIV under control and switch medications if necessary.

Quick timing is essential because once you stop or change medications, your drug-resistant HIV may become harder to detect, since many mutations thrive only when you're taking the medication they're resistant to. When not taking medications, wild-type HIV will become the most numerous type of HIV in your body and mutated HIV will be more difficult to measure.

People Who Need to Change Medications Due to Side Effects
Let's say you've been on HIV medications and, due to side effects, you need to change one or more drugs. If your viral load is above 1,000 copies, you should get a resistance test. Once again, make sure you get the test before you stop or change treatment. The test may help you be sure that a new medication will work at its full power.

If you have a viral load below 1,000 at the time you decide to switch medications, though, a resistance test might not be ordered because even though drug resistance mutations may be present, they are more difficult to reliably find when someone's viral load drops below 1,000.

Pregnant Women
To avoid passing HIV to their babies, it's best for pregnant women with HIV to make sure they have an undetectable viral load. If you're pregnant and getting HIV treatment but you have a detectable viral load, resistance testing may help figure out which drugs aren't working and which will have the best chance of preventing your baby from getting HIV.

10
Berries

Let's start with something that at least most people agree tastes good. Just about any food with word "berry" in it is extremely healthy, with the primary exception being Cap'n Crunch's Crunch Berries. Most berries contain ellagic acid and other polyphenol antioxidants that inhibit tumor growth. Don't get too caught up in one kind of berry and the "best" polyphenol with a name you can't pronounce. Focus on a variety of seasonal berries and add them to plain, no-fat yogurt.

9
Chocolate

Chocolate has endured countless studies by scientists determined to prove this can't possibly be healthy. But it is healthy, provided the cocoa-to-candy ratio remains high. Reach for a dark chocolate bar with at least 70-percent cocoa (often spelled cacao), preferably more. The closer to its bitter bean state, the better. One again we see those antioxidants and therapeutic polyphenols at work. In particular there is a class of chemicals in cocoa called catechins, also found in tea, that seem to offer protection against heart disease, stroke and cancer, according to studies of South Americans who consume the cocoa bean generously.

8
Ginger and turmeric

Ginger and turmeric are about as close as you can get to good-tasting medicine. Ginger has powerful anti-inflammatory properties and can slow cancer growth. Turmeric, the spice that forms the base of most curries, is from a root in the ginger family. The active ingredient is curcumin, which can kill cancer cells quickly, albeit in a test tube. Ginger and turmeric enhance the flavor of most any meal and come with a long list of healthful benefits. Yes, you can get both ginger and turmeric/curcurmin in a pill form. But pill supplements are usually dumb American ideas. Add these to your spice rack, not medicine cabinet.

7
Beans and lentils

Add the aforementioned ginger or turmeric or both, and you're in for some good, healthy eating. Beans and lentils contain numerous phytochemicals, far too cumbersome to read in one sitting, that have been shown in the laboratory to slow or prevent damage to the DNA, the basis of cancer. The added benefit comes with the fiber, associated with lower risk of digestive cancers such as colon cancer. The tricky part, for many Americans, is learning how to cook these properly. Make friends with someone from India who can cook, and you'll be amazed how you can get through much of your week without beef or pork.

6
Green tea

Start drinking up to a half-gallon of green tea a day, cold or hot, caffeine be damned. (Tea only has a third of the caffeine found in most coffee.) Green tea has epigallocatechin gallate (EGCG) and catechins, as tough on cancer cells as they are on the tongue to pronounce. EGCG retards cancer growth; and stomach and lung cancer rates in Japan would likely be even higher considering all the cancer-promoting salty food and tobacco there.

Note that in the United States it is extremely difficult to get real green tea. What you are buying is green tea drink (sugar, water, and someone whispering the words "green tea" over the bottle) or green tea mix (a blend of teas to ease that natural bitterness of green tea). The most potent green tea comes from Japan; and Asian supermarkets carry many varieties, with the best brands being in boxes with letters you can't read. Note also that black teas lose healthy catechins in the fermentation process; and decaffeinated teas lose catechins in the washing process.

5
Vitamin D

Vitamin D isn't a food per se; it is a proto-hormone that seems to interfere with cancer growth. Many studies on humans have shown vitamin D is instrumental in reducing the risk of colon and breast cancer and improving the survival rates of lung cancer. The precise mechanism is not known, but most researchers in recent years have become increasingly convinced that few of us get enough vitamin D through sunlight or diet. There are few vegetarian sources other than eggs and UV-irradiated mushrooms. Your best bet comes from the waterways: catfish, salmon, sardines, or mackerel.

4

Folate

Folate, and the related folic acid or vitamin B9, is part of the vitamin B-complex family, which as a whole has cancer-preventive properties. The cancer-folate relationship is complex. People with diets low in folate seem to have higher rates of cancer. Diets high in folate don't necessarily prevent cancer, but they don't seem to hurt. The lack of folate might enable cancer to get the upper hand, allowing mutations to occur unchecked. Leafy green vegetables, beans, peas and lentils are all generally high in folate.

3
Cruciferous vegetables

Cruciferous vegetables are those in the mustard or cabbage family, and the list is exhaustive. Unfortunately, most U.S. markets only carry a few: cabbage, broccoli, kale and collards. Step into a good Asian market for an entire aisle of offerings. These vegetables, in varying degrees, are rich in anti-cancer properties such as diindolylmethane, sulforaphane and the element selenium. The punch comes with the crunch: Chewing, more so than subsequent digestion, releases these chemicals. Thus, it is important not to overcook these greens. Even tough collards, if fresh, can be chopped thin and pan-fried in a few minutes, as opposed to the traditional southern methods of boiling the hell out of these.

2
Dark green vegetables

This category of vegetables overlaps the cruciferous family and includes chard, spinach and beets (by virtue of the leaves, but the red root is healthy, too). These vegetables contain, among other goodies, beta-carotene, lutein and zeaxanthin -- each of which are powerful antioxidants that can block early cancer development. They are also high in folate. Best yet, Swiss chard in particular is extremely easy to grow in pots. It's the plant that keeps giving: You can clip off leaves for months upon months as new ones keep shooting up. Fresher greens are more tender and tastier.

1
Wine

Wine -- and, in particular, red wine with its high concentration of the chemical resveratrol from the grape skin -- is anti-cancer and pro-heart, at least in moderation. Alcohol can be toxic and is associated with liver, breast and stomach cancers. Somewhere there is a balance, though, with resveratrol contributing in some unknown way to suppress metabolites associated with cancer growth. More and more researchers have become comfortable in recent years in recommending a glass of wine a day to prevent cancer and promote a healthier circulatory system. If the concept of wine seems too radical to include on a list of anti-cancer foods, consider having that wine with an Italian pasta meal with tomato sauce (high in lycopene, somewhat associated with cancer prevention), sardines and a dark leafy green salad (high on the anti-cancer food list).

This top-10 list goes to 11. Try mixing most of the items mentioned in this anti-cancer food list into a smoothie with non-fat yogurt or silken tofu. You'll be amazed the amount of healthy junk you can cram into a smoothie -- flaxseed, wheat germ, and even bitter vegetables -- and still come up with something tasty as long as you include berries, kiwis, overripe bananas or peeled carrots or any combination thereof.

Baked salmon with Southeast Asian marinade

Dietitian's tip:
Salmon works well on the grill. After you've wrapped the fish in aluminum foil, grill until firm and opaque throughout, about 10 minutes on each side. Serve on couscous with steamed green beans on the side.

Serves 2
Ingredients
1/2 cup pineapple juice
2 garlic cloves, minced
1 teaspoon low-sodium soy sauce
1/4 teaspoon ground ginger
2 salmon fillets, each 4 ounces
1/4 teaspoon sesame oil
Freshly ground black pepper, to taste
1 cup diced fresh fruit, such as pineapple, mango and papaya


Directions
In a small bowl, add the pineapple juice, garlic, soy sauce and ginger. Stir to mix evenly.

Arrange the salmon fillets in a small baking dish. Pour the pineapple juice mixture over the top. Put in the refrigerator and marinate for 1 hour. Turn the salmon periodically as needed.

Preheat the oven to 375 F. Lightly coat 2 squares of aluminum foil with cooking spray. Place the marinated salmon fillets on the aluminum foil. Drizzle each with 1/8 teaspoon sesame oil. Sprinkle with pepper and top each with 1/2 cup diced fruit.

Wrap the foil around the salmon, folding the edges down to seal. Bake until the fish is opaque throughout when tested with the tip of a knife, about 10 minutes on each side. Transfer the salmon to warmed individual plates and serve immediately.

As a nation, we're living longer and healthier lives because of improved medical care and better social conditions. As an individual, how long you live is often down to your genes. But there are things you can do to boost your chances of making your old age a healthy, happy and long one.

No matter what age you are now, here are a few tips that'll hopefully have you living to a grand old age.

Tip number one: be positive!

Are you a glass half-empty or a glass half-full kind of a person? The answer may literally be life and death. Researchers at the Mayo Clinic in Minnesota found that optimists decreased their risk of early death by 50 percent compared to pessimists.

Tony Broe is professor of geriatric medicine at the University of New South Wales Research Institute he says that "optimism correlates with self-esteem so I think succeeding in life leads to more optimism and probably a better outcome, but it's hard to know what's the chicken and what's the egg," he says.

So we don't know whether being optimistic makes you more successful, or being successful makes you optimistic.

Just in case — start smiling! Positive thinking lowers the stress hormone cortisol which reduces the effectiveness of your immune system. So, managing stress is also important to a long life. "Stress in young animals, in young children, leads to actual death of brain cells," says professor Broe. You can learn ways to chill out, meditation is a well-known one.

Try this for ten minutes every morning:

Sit comfortably, close your eyes and listen to your breathing.
With each breath out, repeat a calming word and empty your mind.
If that doesn't do it for you, how about a little tai chi? All those fit and elderly Chinese can't be wrong. Even just taking a deep breath can help. Whatever you choose, always look on the bright side of life.

Tip number two: keep active!

Exercising regularly keeps you fit and keeps your weight down.

Growing older is no excuse for growing lazy:

Margaret Dickson: I'm up at six o' clock and walk the dog for half-an-hour to three-quarters of an hour every morning.
Doug Thomas: I enjoy my golf, my fishing, my gardening.
Joan Edwards: I walk every day, I do aquarobics, I do the heart moves exercises and I found that I just feel so much better.

Just thirty minutes of moderate intensity exercise every day is ideal — especially as you age.

What's moderate? Well you don't need to hit the gym: a spot of gentle gardening and a good stroll with the dog are great exercise — and good for your stress levels too.

According to psychology professor Mary Luszcz from Flinders University in Adelaide, giving your brain a workout is also just as important as working out your body.

"Practice in different kinds of cognitive activity does seem to be beneficial to ageing well," she says.

Stimulate your brain with games that involve problem solving, like crosswords and cribbage.

Professor Broe says it's vital to have an interest in life: "I think the key brain mental activities or brain exercise as you get older are things that challenge your skills, things that interest you. It is the involvement in it using what we call your frontal lobes to plan and program and carry out what you do rather than just absorbing information in what we call the back half of the brain where knowledge sits."

For Jeff and Margaret, painting and quilting fit the bill because, like learning a new language or making music, they involve coordinating multiple regions of the brain. But you'd be surprised at what else is good for you — one is shopping. Yes, that's right — go ahead and shop 'til you drop, because retail therapy uses several cognitive functions. It might not be great for the bank balance, but it is good for your brain.

Tip number three: eat well, live well!

Another key to staying young is eating a well balanced diet. The so-called Mediterranean diet — pasta, fish and olive oil with plenty of fruit and veggies — has been associated with longevity in many studies.

That's because the Mediterranean diet is rich in anti-oxidants which mop up free radicals in the body which accelerate ageing. Good natural sources are berries, capsicums, spinach and surprisingly, red wine.

If you watched What's Good For You last year, you might remember that family doctor Philip Norrie has written several books on the health benefits of red wine.

"The thing that's unique about wine is not only has it got alcohol like other alcoholic beverages beer and spirits, but it's got the most potent antioxidants in nature — resveratrol, quercetin and epicacatin and they should put it on the NHS and fund it with Medicare," says Dr Norrie.

But if your glass of wine goes hand-in-hand with a cigarette — the cigarettes have got to go. We've all heard the stories about the person who smoked 60 a day all their life and lived to be 100, but the reality is that smoking kills 50 Australians every day. Your chance of heart attack increases by two to six times if you smoke. Your risk of stroke is increased by three times, and then there's cancer: "Smoking is a big killer and it's a big cause of disability, but you can give it up any time and there are marked health benefits from stopping smoking," says professor Broe.

Quit now and within a few years your chances of getting a heart attack will be the same as a non-smoker's.

Tip number four: stay connected

When we retire we have a lot more time on our hands to do the things we want to do and that includes having a good time with friends. Of course, most of us also have our families, but which group will actually help prolong our lives — friends or family?

"Our own research has shown that friends relative to family are actually more important to longevity — to how long you actually live," says Professor Luszcz.

Why friends beat family is less clear, but researchers say a strong friend can really prolong your life.

And it seems to work both ways — researchers at the University of Michigan found that old people who volunteer to help others reduce their chance of dying by 60 percent.

Families are still important, of course. In fact, another study at Adelaide's Flinders University showed family ties can stave off disability among the elderly.

So cherish your friends and family — they could be your life line.

Tip number five: get married

If you're a man and you want a long life — get married. Studies show it can add seven years to the male lifespan.

Why?

Because, traditionally it's women who care for the men.

Prof Luszcz says it's because "they're used to having, essentially, a woman take care of them and so that enhances the chances that they're going to be well fed, that they're going to be looked after, that they're going to have someone who they can confide in if they want to do that."

But what about women, is marriage good for them too?

"For women, they can gain a sense of accomplishment by doing these sorts of things, but they can also seek someone outside the marriage so the marriage per se is not the only source of benefit for women in terms of longevity," says Prof Luszcz.

In fact, single women live longer than married ones — all that running around after your husband isn't good for your health.

Fast facts

If you're a man, women really are good for your health. Research published in the American Journal of Human Biology shows that having a daughter increases a man's lifespan by 74 weeks. If you're a woman it doesn't matter if it's a girl or a boy — each child takes 95 weeks off your life.
 

5 Drinks That Help You Calm Down.

Stressful day? Don't reach for a candy bar. Try one of these soothing liquids instead.


1. Drink a glass of milk. It contains tryptophan, which as it is metabolized is converted to mood-boosting serotonin. Plus, its calcium, magnesium and potassium content may help keep blood pressure down.

2. Drink hot cocoa. Warm drinks raise your body temperature—a feeling we associate with comfort, so it triggers a similar response in our brains.

3. Order black tea instead of coffee. A study by University College London shows that drinking black tea four times a day for six weeks lowered the stress hormone cortisol after a stressful event.
 

4. Drink green tea—packed with theanine, which increases the brain’s output of relaxation-inducing alpha waves and reduces the output of tension-making beta waves.
 

5. Drink a glass of cold water, then go for a walk outside. The water gets your blood moving and the air invigorates by stimulating the endorphins that de-stress you.

The Reality of Married Lovemaking

When writer Miriam Arond and her husband, psychiatrist Samuel L. Pauker, M.D., surveyed hundreds of newlywed couples across the nation, they discovered that 85 percent had made love before tying the knot, yet the frequency and quality of unmarried sex had little to do with the reality of married lovemaking. Nearly half said that after marriage, they didn't have sex as often as they'd like; 20 percent of new wives reported low sexual desire. For a fourth of the wives, sex meant painful intercourse or elusive orgasms, while 1 in 10 husbands experienced premature ejaculation, and 1 in 20 had erection problems.

What ever happened to athletic, swinging-from-the-chandeliers, "did-the-earth-move-for-you-too?" prenuptial lovemaking? The deep, mystical, Tantric communing of two spirits? Hours of Hollywood sex complete with mood music, flickering candlelight, and satin sheets?


Balancing a sense of intimacy and safety and security with a sense of unpredictability."The excitement of getting married gives couples a hit of dopamine -- a feel-good brain chemical that increases sex drive. For a few months after marriage, things may stay hot," says marriage and sex therapist Pat Love, Ed.D. "And while you still love each other and feel passionate about each other, the dopamine does settle down. You're back to real life. Your normal sex-drive set point kicks back in. Your expectations about married sex take over. It's the perfect time to do the delicious work of deepening your sexual bond."


"The challenge for couples is balancing a sense of intimacy and safety and security with a sense of unpredictability and creativity and eroticism," says Barry McCarthy, Ph.D., a psychology professor at American University in Washington, D.C. "When sexual intimacy is strong, making love plays a healthy 15 to 20 percent role in energizing your marriage. The paradox is that when sex is problematic, it plays an inordinately powerful, negative role in new marriages."

Understanding the real sexual issues that newlyweds face can help you keep sex fun and fulfilling -- now and for the rest of your lives. Experts say these hidden concerns can cool the hottest love life in the early days of marriage:

Mismatched sex drives. "When your sex drive returns to its normal level in the months after you get married, couples start to notice a frustrating desire discrepancy," Dr. Love says. "It's perfectly normal. You've just got to work it out."

Testosterone, the hormone of desire, fuels sex drive in men and women. But, Dr. Love says, relatively low levels of natural testosterone mean that two-thirds of all women don't walk around thinking about sex all the time. "For these women -- and I'm one of them -- you don't feel like having sex until you're already having it," she says. "That's perfectly normal. It just means you have to approach sex a little differently. You have to make time for touching, time for sex. You can't rely on being aroused to get things started. You have to start with relaxed touching and kissing to raise your arousal level."


Clashing sex-pectations. On the last night of a romantic two-week honeymoon, Priscilla and Greg Hunt bumped up against a radical difference in expectations and desire. "We had been making love three times a day on our honeymoon," Priscilla recalls. "It was wonderful, but we were about to go back to real life. To work and school and doing the dishes and responsibilities. I had to say, it's time to talk about moderation." Says Greg, "Sexuality was a real issue. We were both learning about it in our college courses, but experiencing it firsthand was strikingly different. My testosterone levels were extremely high. We were not evenly matched for libido. We had to work hard to communicate. Sexuality is a very sensitive issue -- you have all sorts of feelings and insecurities wrapped up in it."

Their solution? A fluid, flexible compromise: "There were times he wanted sex when we didn't have it and times I didn't want sex but we did. Thankfully, there were more times when we both wanted to make love. There's been a natural ebb and flow. It's something we still have to talk about," Priscilla says. "This is the reality for every couple: You're wired differently. If you have enough sexual experiences together that are positive for both of you, you'll be able to work out the differences."

This is an issue for many couples who've enjoyed a lusty sexual intimacy before marriage and/or during the honeymoon but who settle into different rhythms during day-to-day married life. The solution? Talk it out so that you don't feel rejected, frustrated, or bored.

Say Hello to Pleasure!
First Base, Revisited Don't wait for all that sexy dopamine to wear off. Using the heat, passion, and "let's jump back into bed now" sexual urgency of your first months together to explore and expand your repertoire of touch. "The first two years of marriage are critical for building a sexual style that includes shared pleasure and deeper intimacy. Aim for that. Otherwise, sex problems can become the focus of your relationship," Dr. McCarthy notes.

The sexual prescription? First, go back to first, second, and third base -- touching for physical pleasure, not necessarily orgasm or intercourse. And get past old-fashioned man/woman sex roles that stand in the way of an emotionally close and erotic sex life. "Men are often socialized to value performance more than intimacy or pleasuring," says Dr. McCarthy. "Women are taught to value relating and to see eroticism as the realm of wild, crazy women -- not wives.

"Not all pleasurable touching can or should lead to intercourse," he notes. "When a couple becomes comfortable touching inside and outside the bedroom, they're building a closer, more solid sensual and sexual bond that will make them feel happier, closer, and even sexier now -- and help protect against sexual problems in the future."

Emphasize pleasure, not just the big O. "Exploration and touch without the expectation of intercourse or orgasm helps couples get to know each other's bodies and needs -- you learn what kinds of touch are pleasurable as a giver and as a recipient," Dr. McCarthy says. Pleasure and affection keep you close even when you don't want sex.

Nurture emotional intimacy too. Feeling understood, supported, and valued will make you both feel closer and therefore more receptive to physical closeness.


Plan ahead. Sex-drive discrepancy? Busy schedule? Put s-e-x on the calendar. It's a fact of life: Most of us married someone who wants sex more often or less often than we do. If you wait to feel turned on before you have sex, you'll miss out on lots of great moments together. Let touching turn you on rather than expecting to feel aroused first. This may seem totally unnecessary during the hot-and-heavy exchanges of the Passion stage, but experts say it's the best way to ensure you'll still be enjoying great sex when your life is complicated by kids, a house, stress, reduced sex drive, and times of conflict.

Low sex drive? Consider saying yes anyway. "People freak out when I say this," Dr. Love confides. "But if you make time for love and romance and try to say yes when your partner wants to make love -- provided you're not dealing with a compulsive or sex-addicted spouse -- you will have a better sex life. Let your partner's drive get you both into bed, or wherever you'll make love, so that you can be touched and turned on. Why get into the habit of not doing it?"

Think of life as foreplay. "I found out early on that relational issues that seem to have nothing to do with the act of sex itself make a huge difference to my wife and to her interest in intimacy," Greg Hunt says. "I learned to pay attention to things I wasn't naturally good at. If I'm ignoring her and also not paying attention to things like chores around the house, she's not going to feel cozy and intimate at bedtime."

Don't use sex as a bargaining chip. Angry? Say something -- don't grunt or "hmph" and roll over. Withholding lovemaking when you're upset turns this deep, vulnerable connection into a nuclear weapon for power struggles. Adding layers of resentment to your feelings about physical intimacy is a surefire way to make sure neither of you will be in the mood.

Have realistic expectations. And in particular, dial back on multi-orgasmic, transcendental expectations. Even for the most happily married couples, more than 10 percent of sexual encounters aren't even pleasurable for one or both spouses, Dr. McCarthy says. An off night -- maybe the sex is hurried, you're tired or distracted, or simply uncomfortable -- doesn't mean you've got a big problem. It's life. Don't expect perfect sex every time -- or wait for the perfect moment to pounce on your mate. Just connect!

Make it eye-to-eye, soul-to-soul. You'll feel more vulnerable -- but couples report they also feel sexier, more attractive, more in-the-moment, and closer when they look into each other's eyes during sex.

Never underestimate the power of a quickie. You won't always have all the time in the world for making love -- and maybe you don't already. Don't overlook fast sex. It keeps the two of you in the intimacy loop, so you don't jeopardize the compassion, happiness, romance, and understanding that sexual closeness can bring.