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Doc: Avoiding an outbreak of HIV infection

October 3, 2018

Dear Dr. Roach: My local news outlet here in Saskatchewan published a story on mutated strains of HIV present in my province being a concern to the medical community. As a sexually active adult, but not a user of injectable recreational drugs, what does this mean for me and other citizens in my area? How are these strains different from regular HIV? Are they easier to catch? The article states that my province has the highest rate of HIV in North America! Should I be including HIV testing in my annual physical with my doctor?

N.E.

Dear N.E.: HIV, the virus that causes acquired immune deficiency syndrome, remains of critical importance worldwide. As you suggest, it may be spread both through sexual behavior and by sharing needles or other materials used in injecting drugs.

There are many different strains of HIV. It is constantly evolving, and there have been well-described episodes in different communities where rates of infectivity of the virus from sexual contact were much higher than expected. In the case of Saskatchewan in 2018, the virus mutated — not so it is easier to be transmitted, but so that it is more likely to destroy the body’s immune system more quickly once acquired.

Every sexually active adult should take steps to protect him- or herself against HIV, but it’s particularly important for people in this area during this outbreak (even though most of this particular outbreak has been spread through injection drug use, according to public health officials).

Abstinence from sex is the only completely effective way to prevent sexually transmitted HIV. However, using a condom for any sexual activity, choosing partners wisely, getting yourself and your partner tested before sexual activity and taking medication prior to sexual activity (called “pre-exposure prophylaxis”) all are effective ways to reduce risk. Obviously, avoiding injection drugs is a good idea for many reasons: Needle exchange programs are a way to eliminate the HIV risk.

Dear Dr. Roach: I’m an adult with Type 2 diabetes and now get eye injections. In exercising with weights, I wonder if muscle tension is causing any stress on my eyes. The health trainers give conflicting information.

B.A.

Dear B.A.: Injections in the eye for diabetics usually are given as a treatment for proliferative diabetic retinopathy or for diabetic macular edema. The injections, any of three different inhibitors of vascular endothelial growth factor, work by blocking the growth of new blood vessels, which is an important part of the underlying reason for these eye diseases.

Muscle tension, whether in the body in general or of the eye, is not associated with these eye diseases, so you should feel free to use weights in your exercise program. However, I would use lighter weights; heavier weights can increase the pressure transiently inside the blood vessels of the whole body, including the eye, which can worsen the problem.

A good exercise program can help bring down blood sugar, which is important for reducing risk of complications of diabetes. Don’t stop your exercise program completely for fear of muscle stress: adjust it if necessary.

Email questions to ToYourGoodHealth@med.cornell.edu.

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