Avoiding an outbreak of HIV infection
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.
Answer: 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 welldescribed 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 has mutated — not so that 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 engaging in 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: My doctor tells me I have multiple spurs in my neck and upper back. He also says that the spurs are touching my spine. Is using neck traction dangerous? They also want me to get an injection in my neck. — C.T.
Answer: Bone spurs, called osteophytes, are a common manifestation of osteoarthritis. Most often, the spurs themselves cause no problems, but occasionally they can press on important structures. In the spine, they can press against the spinal cord or on the openings in the spinal column where the nerve roots come out. This can cause pain, numbness or weakness.
Traction is the application of force to pull apart the vertebral bodies. If it is done correctly, it is safe, but not particularly effective. Traction should not be performed without understanding the anatomy of the spine, usually with a CT or MRI scan.
Injections can provide both diagnostic information as well as effective treatment in some people. An injection of anti-inflammatory steroid can help with the pressure on the nerve or nerve root. Studies estimate that about half of people who get injections will get some relief, and my own clinical experience supports that.
Surgery is the most definitive treatment for osteoarthritis of the spine that is causing nerve damage. It is reserved for people with serious symptoms — bad enough to impair their quality of life. It should never be entered into lightly, as it has potential for harm and is not a permanent solution. It doesn’t stop the osteoarthritis from progressing nor the osteophytes from regrowing.