The official site of The Project Red Ribbon Care Management Foundation, Inc. (TRR).

  • TRR LOVE FUND

    TRR Love Fund is the arm of the foundation which provides medical assistance to the financially challenged PLHIV.

  • Care assistance for HIV Test

    The Care Assistant Program involves assistance to HIV testing and HIV and AIDS Treatment hubs in the Philippines. Our volunteers schedule the client to the clinic or hub, assist with the procedure in the clinic or hub and conduct peer counseling

  • HOTLINE ASSISTANCE

    With the TRR Hotline Numbers, our volunteers answer concerns and inquiries about HIV and AIDS, do counselling, refers clients to nearest HIV Testing facility, HIV and AIDS Treatment Hub and government and NGO organizations for support

  • PEER COUNSELING

    The foundation volunteers conduct one-on-one counseling either on the phone or in person. They also conduct group counseling

  • SUPPORT GROUP TALK

    The support group talk (SGT) is a program that involves giving HIV lectures by guest speakers, discuss topics about HIV, care, treatment and support, discussion issues related to HIV

  • OUTREACH PROGRAM

    The foundation's outreach program is geared towards providing support to our fellow PLHIV's in the HIV and AIDS Treatment Hubs. Volunteers hand out of donations of medicines and special gifts to PLHIV, give inspirational talks by invited guests to a group of PLHIV, bonding over snacks or meal, visit the sick who are confined in the hospital

  • Referral System

    As part of treatment, the foundation's referral program involves our volunteers referring clients to specialized doctors who are HIV friendly. The foundation has it's own list of specialty doctors of low cost for the indigent PLHIV.

  • Online Support Group

    The foundation has a private Online Support Group in facebook. This group of advocates, supporters, counselors, health Workers and PLHIV

  • Home Health

    Aside from client counselling, the foundation volunteers also do family counselling and home visitation for awareness and continuance of care.

  • Health Fitness

    The foundation believes in holistic approach to treatment and care, thus inclusion of these programs: yoga, dance, swimming, jogging and running, boot camp workouts

  • EVENTS

    As part of awareness and education program, the foundation organizes its own national events to coincide with the international AIDS events: World AIDS Day and International AIDS Candlelight Memorial

Sunday, April 29, 2012

The Youngest


Dra. Ditangco texted me last Monday, that our youngest beneficiary of the Love Fund is 2 year old orphan boy being raised by his aunt from Bicol. I crossed my fingers that he doesn't have HIV but unfortunately Dra. D. confirmed that he is positive. Through love fund, we were able to support him with formula milk and antibiotics. I asked her if we need to solicit more funds for him but Dr. D. said we still have sufficient fund.

I was saddened that this 2 year old kid is suffering already. It would be hard for him, not understanding what he has. It is hard for his aunt who I definitely know is struggling too with his illness.

Most of us got our disease by not being careful. This kid is suffering without even knowing how he got it in the first place. It is sad but though I am quite gladdened by the fact that through the Love Fund, through the help of my friends, he is somewhat being assisted. It would be a longer road for him but I know, there are millions of people out there who are more than willing to extend their hearts to him.





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Tuesday, April 24, 2012

Medical Assistance: April Report


Here is an update on the beneficiaries of the Love Fund and the PCSO assistance.

From Ms. Maram Bartolome:

“We we were able to help quite a number of patients especially those lab tests that are expensive and for patient’s medicines. Thank you so much. The Love Fund was able to give a lot of assistance.”

From Dr. Ditangco:

 “The Love Fund is a big help. We could feel how it has been helping our patients! Thanks to you and your friends!”

Here are some of the cases that have been helped wherein Ms. Maram has attached receipts. She said that they are waiting for the other receipts.

Love Fund Assistance:

1.Breast cancer: UTZ, Medicine, OR supply, x-ray

2.Pregnant woman with complication in heart. She is confined now in te ward. She was given assistance with her medicines, laboratory like UTZ and 2d echo and food for companion since usband is unemployed. 

3. One patient was assisted for his medicine

4. Ophtha patient and asked for assistance for consultation and for laboratory.

Last week Dr. Ditangco and I were able to send  two patients to PCSO for financial assistance for their medical condition. We have a contact person there who assisted these patients. Today I asked Dr. Ditangco for an update.

Fr Dr. Ditangco: 

“Just got a word from them that the wife for chemo with breast cancer will go back to submit prescription for chemo while the other patient already got the pledge letter on that same day. That was really very fast action. We will refer more patients for assistance.”

It is really a privilege to help. I told Dr. Ditangco that ever since I got well, I promised myself that I will give back. I am so blessed that I am doing it right now.

To everybody out there, please help us in giving assistance to our friends. They need you!





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Monday, April 23, 2012

Email 12



I received another email. Here it goes.

"Hi,

I would like to inquire where to avail the BEST health care service for people living with HIV, of course I want it to be private and confidential to prevent discrimination and horror experience. I'm afraid I already have the virus but still crossing my fingers to have a negative result. What are the things I have to prepare? with regards to financial obligations how much should I prepare for the preliminary laboratory examinations? if my CD4 count is below 300 can I avail the free ARV meds? Mind to share me their contact numbers? 

Just bump on your blog site this morning and realized why wait if I can have myself tested before it's too late.

Regards,
XXX"


Pozziepinoy’s Reply:

Hi.

I salute you for being proactive about your health status. You are absolutely right. Why ait when you can have yourself tested now to know your status. Why wait, like me, who was stupid to ignore the fact that I was having unprotected sex and not even thought of having myself tested. Trust me. You are doing the right thing. Do it now.

Let’s answer your questions one by one.

1. On where to avail of the best health care service for people living with HIV where there is privacy and confidentiality to prevent discrimination and “horror” experience, I believe that all the government hubs provide the best health care service.

I was once a patient of a private doctor in a private hospital and I wasn’t given the best advice there. Later on, I was referred to a government hub, because they have more experience in dealing with HIV/AIDS patients, with  opportunistic infections and ARV’s. Don’t worry, the hubs will protect your identity and you will feel the concern of the staff there for you.

2. What are the things to prepare for? Just yourself. Brace yourself. Be prepared emotionally and physically. Knowledge is power so study and learn. Read all about HIV/AIDS. Learn also from the experiences of others who have been living with the disease. 

3. How much should one prepare for the preliminary laboratory examinations? Most hubs would require you to have blood workout done which usually will cost more or less P4,000.  They would also require you to have the CD4 count test which range from P2,500 to P4,000 in the government hubs. You can also prepare for the cost of the initial viral load count which is around P6,000 to P7,500.

4. If the CD4 is below 300 can one avail of the free ARV’s? Absolutely as long as you accomplish the required tests and the counseling provided by the hubs.
   
5. Contact numbers of the HIV/AIDS Hubs:

a. Ilocos Training and Regional Medical Center (ITRMC)
San Fernando, La Union
Dr. Jeisela B. Gaerlan
Medical Specialist II/HACT Leader
Clinic: (072) 700-3808

b. Baguio General Hospital and Medical Center (BGHMC)
Baguio City 
Dr. Maria Lorena L. Santos
HACT Leader / Medical Officer II

c. San Lazaro Hospital (SLH)
Quiricada St., Sta. Cruz, Manila
Dr. Rosario Jessica Tactacan-Abrenica
Medical Specialist II/HACT Leader
Head, HIV/AIDS Pavilion
Tel: 309-9529/28; 740-8301 loc 6000

d. Research Institute for Tropical Medicine (RITM)
Filinvest Corporate City, Alabang, Muntinlupa City
Dr. Rossana A. Ditangco, Head, HIV Research Unit
Tel: 5261705; 8072628/38 local 801/208

e. Philippine General Hospital (PGH)
Taft Avenue, Ermita, Manila
Dr. Jodor Lim / Ms. Dominga C. Gomez
HACT, SAGIP/ PGH
Telefax: 5261705

f. Bicol Regional Training & Teaching Hospital 
Legaspi City, Albay
Dr. Rogelio G. Rivera
Chief of Hospital III
Tel: (052) 483-0016 / 483-0086 / 483-0017

g. Western Visayas Medical Center (WVMC)
Q. Abeto St., Mandurriao, 5000 Iloilo City
Dr. Ray Celis
HACT Leader/Medical Specialist III
Tel: (033) 321-2841 to 50

h. Corazon Locsin Montelibano Memorial Regional Hosp
Lacson St., Bacolod City, Negros Occidental
Dr. Candido Alam
HACT Leader/Medical Specialist
Tel: (034) 435-1591; (034) 433-2697

i. Vicente Sotto, Sr. Memorial Medical Center (VSSMC)
B. Rodriguez St., Cebu City 6000
Dr. Maria Consuelo B. Malaga, 
HACT Leader
Tel: (032) 253-7564; (032) 253-7564 / 9882

j. Zamboanga City Medical Center (ZCMC)
Evangelista St., 7000 Zamboanga City
Dr. Jejunee Rivera
HACT Leader/Medical Officer III
Tel: (062) 991-0573

k. Davao Medical Center (DMC)
J.P. Laurel St., Bajada, 8000 Davao City
Dr. Alicia Layug, HACT Leader
Tel: (081) 227-2731

l. Cagayan Valley Medical Center
Tuguegarao City, Cagayn Valley

m. Jose B. Lingad Memorial Medical Center
San Fernando, Pampanga

n. Or visit/inquire at:
Nearest Social Hygiene Clinics (Special STI Clinics); City/Municipal Health Offices NGO Partners at the local level 

I hope I was able to answer your questions. Feel free to email me again.

Stay strong,
Pozziepinoy




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Wednesday, April 18, 2012

PCSO


Dra Ditangco and I have been communicating for a month now, helping patients ease the financial burden of hospitalizations, lab exams and workout and cost of medicines. Aside from The Love Fund, we have also linked up with The Philippine Charity Sweepstakes Office for their IMAP or Individual Medical Assistance Program.

The PSCO can be tapped if the financial burden is great especially for hospitalizations brought about by opportunistic infections.


Under the IMAP, medical assistance is given to individual patients through the issuance of guarantee letters to hospitals where the patients are confined. A guarantee letter is a certification issued to hospitals for a particular charity patient under the PCSO medical assistance program where the agency assumes the obligation of settling the cost of hospitalization, including the medicines, medical, surgical or blood supplies, and diagnostic procedures.

OBJECTIVES
  • General : Restoration of social functioning (Physical recovery) through medical assistance
  • Specific : Provide assistance for hospitalization expenses, laboratory procedures and purchase of medicines, chemo drugs, dialysis solutions, antibiotics, implants, devices and other medical needs.
DOCUMENTATION REQUIREMENTS
  • Letter Request to Chairman/General Manager
  • Medical Abstract
  • Bill/Quotation/Costing from Hospital Pharmacy/Supplies
  • Laboratory Request/Medicine Prescription
  • Endorsement/Acceptance letter from Hospital Social Services/Credit Collection Office


So far we have helped 3 patients already through PCSO. Another patient will be assisted tomorrow through it.

I know a lot of people with HIV/AIDS are really worried about the financial burden of the disease. Always remember that the channel of help is always open. One really has to look for it.


Credit:
http://www.pcso.gov.ph/imap.html




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Tuesday, April 17, 2012

STAY STRONG!

I always tell the pozzies that I am counseling that it is important to fight the the ill effects of the virus especially when the immune system is already weakened by it. I always advice that having a positive attitude is not enough. One really has to fight back by staying as strong as possible physically. 

I remembered when I was in the hospital, when I was almost at the brink of death because of pneumonia, I told myself that I have to fight back. I was physically fit before because of years of working out but since my body is failing me because I wasn't breathing good and wasn't able to do anything physical, I told myself that the only way that I can fight back is by eating. I ate 6 to 7 times a day even while I was bed ridden. I knew then that my body can recuperate fast if I eat more. 

The rest is history.

Here are some ways that can help one with HIV to regain or maintain one's strength:
Five ways to maintain your strength when you are HIV-positive 

1. Eat more and different kinds of foods and drink plenty of fluids. 

To maintain your strength and keep up your weight, every day: 
a. Eat three meals and regular snacks in between.  Adequate meals and snacks include:
    i. Meals:     porridge, or pasta with tomato sauce and bread 
    ii. Snacks:  Bananas, mangos, bread, porridge, and boiled milk 
b.Always eat different types of food:

   i. Vegetables and fruits such as carrot, potato, tomato, banana, oranges,   papaya, avocado, and mango

   ii. bread, and porridge

   iii. beef, chicken, fish,  liver, and eggs

c. Drink at least eight glasses of boiled or treated water and fresh fruit juices.  Avoid soft drinks and packaged juices, as they can reduce appetite.

d. When you don’t feel hungry:

     i. Eat small amounts of food 5-6 times a day
     ii. If you don’t have mouth sores, use mild spices for better test

FOOD HELPS YOU STAY STRONG AGAINST HIV/AIDS.

2. Practice good food hygiene
  1. Improper storage and preparation of food and dirty hands can lead to diarrhea and vomiting, which reduce energy, vitamin, and mineral intake. 
  2. Wash your hands with soap and water before eating or preparing food. 
  3. Wash fruits and vegetables with boiled or treated water before cooking or eating.
  4. Keep food and water covered and stored away from insects, flies, and rodents.
  5. Clean food preparation area and utensils with soap and water after every meal and cooking session.
  6. Avoid raw meat and eggs, spoiled or moldy foods, and juice made from unboiled water.
PREVENTING WATER-BORNE DISEASES IS ESSENTIAL TO MAINTAINING YOUR 
STRENGTH. 

3. Make food a social activity. 

a. Eat together with family or friends.  This will encourage you to eat more and maintain a regular schedule.  Family and friends can also help prepare and clean-up, particularly when you are sick.
b. If possible, help create a garden or raise small livestock with family, friends, neighbors, or a PLWHA association.
c. When you are eating less because you are stressed or depressed, spend time withfamily or friends or talk to a spiritual leader.

4. Maintain a healthy lifestyle. 

a. Walk, jog, or garden to improve blood circulation, stimulate appetite, reduce fat, and maintain muscle tone. 
b. Abstain completely or significantly reduce your consumption of alcohol, cigarettes, and chat.  Alcohol and chat can reduce appetite and make anti-HIV drugs less effective. 
c. Avoid coffee and tea when you are out with friends; instead, drink fruit juices and eat fruits like bananas and oranges.

PHYSICAL EXERCISE HELPS YOU STAY STRONG.

5. Treat symptoms that can prevent you from eating.

a.  If you have mouth sores: 
     i. Clean at least twice daily with cotton and lightly salted warm water.
     ii.Eat cooked and soft foods and avoid acidic ones like lemons and oranges as well as spicy foods.
b. Seek medical advice immediately if: 
    i. Mouth sores do not improve.
    ii. You lose weight or your appetite decrease.
    iii. You have persistent diarrhea.
    iv. You feel discomfort when swallowing.

HAVE YOUR WEIGHT MONITORED REGULARLY.

6. Nutrition and HIV medication (ARVs)

a. Even if you are taking ARVs, practice the five ways to maintain your strength and to maintain the body’s muscles which process the medicine.
b. You may experience vomiting, diarrhea, and loss of appetite caused by ARVs.  However, continue eating and taking the drugs regularly

FOLLOW THE ADVICE OF HEALTH WORKERS TO AVOID NEGATIVE INTERACTIONS 

BETWEEN THE FOOD AND MEDICINE YOU ARE TAKING.


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© Copyright. All Rights Reserved by Pozziepinoy 2012

Credits: 



Friday, April 13, 2012

Email 11: Still Confused


I received his email again.

Sir, I am back again asking for your help. I am still so bothered until now about my condition. 
I have been tested twice and both came back negative. But I was doubtful about the test I took in a government hospital here because I found out they were using Beijing biod biotech rapid test which is not in the list of FDA approved tests.

I tried to contact the PNAC or the DOH but I am not hearing any response from them regarding the matter if they check and monitor for quality control the medical devices used in hospitals especially those used for blood screening like HIV.

Here's my story and the list of symptoms I am having.

I have had unprotected receptive anal sex last August 12, 2011 and I also had unprotected anal sex on October 12, 2011.

On the last week of October, I started to feel chills everyday at night and I have stuffy nose and loose bowel once a day every morning. I can also feel 4 lymph nodes below my jawline and one small nodes(less than 1 cm) at the side of my neck. Later on, the chills are felt already even in daytime. I checked my temp every time I had chills and it ranges from 37.1-37.4 persisting for almost 3 months .These continued until the 2nd week of January and it went away on its own without treatment . After the chills and what I think is low grade fever subsides, burning sensation in my feet and hands starts to develop which worsens at dawn. I also experienced dry mouth and white tongue which i could not scrape. I had 2 episodes of hives all over my body which lasted for days and I don’t have any known allergy. Now, I have 1 ulcer in my lips and once I had it at the back of my throat. I also have feeling of tiredness, dry mouth, and burning sensation in my my hands and feet. The burning sensation is on the dorsal part of the feet, around the ankle, in the calf, in the dorsal area of my hands but not on the sole of the feet and the palms and the toes. It is only lately that the soles feel like tingling at times but not so often and there is no burning sensation in the sole.

I have been tested negative for HIV antibody in December 14, 2011 and January 16, 2012 which turned out non-reactive.I also had my stool checked and found numerous fungus in my stool.
I am still doubtful of my result since i am having all these symptoms.I also have been checked for my blood sugar, my thyroid panel and other STD’s and everything went ok, since the doctor thought I was having thyroid problem.

I am 27, male and has always been healthy before.

Do you know anyone who is positive and is having symptoms the same as mine?

If it's ok sir, since i don't have access with specialists here in our place, can you ask your doctor if my symptoms could possibly be hiv? Since I learned that there is a condition called diffuse infiltrative lymphocytosis syndrome which could possibly occur in early HIV infection and could manifest as parotid gland enlargement, dry eyes and mouth, which could also cause peripheral neuropathy and extraglandular involvement like the lungs (since I also am having occasional back pain). I have all these symptoms except for parotid gland enlargement. I even have my heart pounding when I try to take a nap in the morning.

I am so anxious now and could not understand how I am feeling.

I would want to get tested again but i am already very scared. And it would be hard for me to have access on Elisa or Western Blot. Only rapid test is available in our provincial hospital. Could I rely on the result of my rapid test? 

The nearest hub or social hygiene clinic from our place is 10 hours away.

Thank you po. Pasensya na po sa abala. Hope matulungan nyo po ako sa mga tanong ko.

God bless!

Paranoia Freak





Hi Paranoid Freak!

Thanks for writing me again.

I asked Dr. Ditangco about your symptoms but she said it really is best that you go to a specialist (preferably an infectious disease doctor) so your condition can really be diagnosed. She said it could be anything but it is better to get facts from blood work and other laboratory tests to get a proper diagnosis. 

The only tests that can be done to know if you have HIV are the ELISA,Western Blot and the rapid tests . I researched about the testing areas in Mindanao and I found these areas that you can try again if you are doubtful:

1. Butuan City: Social Hygiene Clinic
    Dr. Jesus Chin-Chui
    Add; City Health Office, Butuan City
    Tels: (085) 3423432; 8151111 loc 1039

2. Davao City: Social Hygiene Clinic
    Dr. Jordana Ramitere, Social Hygiene Clinic Physician
    Add: City Health Office. Magallenes St., Davao City
    Tels: (222) 4187
    Mobile: 09209102718

3. Davao City: Southern Philippines Medical Center (SPMC), formerly Davao Medical Center (DMC)
    Dr. Leopoldo J. Vega, Chief of Hospital
    Dr. Alicia Layug- HIV AIDS core Team Leader
    Add: JP Laurel St., Bajada, Davao City
    Tels: (227)2731
    Mobile: 09204241721

4. Davao City: Davao Regional Hospital
    Ms. Telesfora A. Hinay
    Add: Apokon. Tagum City
    Tels: (082) 221 8593; 227 9536; 400 3653

5. General Santos City: Social Hygiene Clinic
    Dr. Mely Lastimosos, Social Hygiene Clinic Physician
    Add: General Santos City Hospital
    Tels: (083) 305 1510
    Mobile: 09088877512; 09198483116

6. Zamboanga: Social Hygiene Clinic
    Dr. Kibtiya Uddin, Social Hygiene Clinic Physician
    Add: Petit Barracks, Zone 4C, City Health Office, Zamboanga City
    Mobile: 09274836672

7. Zamboanga City: Zamboanga City Medical Center (ZCMC)
    Dr. Romeo A. Ong, Chief of Hospital
    Dr. Jejunee Rivera, HIV AIDS Core Team Leader
    Add: Zamboanga City
    Tels: (062) 9910573; 9912934; 9920154
    Mobile: 0920 4241721

I also asked about the Beijing biod rapid test that you are asking for and Dr. Ditangco said that you can rely on it’s accuracy. However, if you are still doubtful on the procedure your testing center used, just go to the testing centers that I posted above. If you can, just come to Manila and I can direct you where you can get yourself tested again to calm down your nerves. Also by coming to Manila, I can also help you to seek help from the best doctors I know.

I do hope that I was able to answer your questions. I posted your letter here in case somebody with the same symptoms can post a comment about it.

I wish you well and always remember that you will always be in my prayer’s list.



Pozziepinoy




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Philippine HIV Testing Centers

Thursday, April 12, 2012

PP Prayer List 5


I will be sending the PozziePinoy's Prayer List again to the heads of churches here in the country and in two church organizations in the United States this Friday evening. Three new pozzies have been added to this list. I also indicated a priority list for those who are in need of immediate prayer!

Please email me fast or just ask for a name inclusion in the comment box if you want your name or your friend's name to be included here.

In need of prayers: to watch over their health, to help them keep a positive outlook in life despite HIV, to help them face all health fears, to guard them against possible infections.

Priority Prayers:
  1. RobHIV- He has bilateral pneumonia now and is confined. He is on oxygen and antibiotics now.
  2. FBfriend- He has pneumonia with symptoms of persistent coughing, chest pain and difficulty of breathing. He is confined now.
  3. PositHive- He may have urinary tract infection and is undergoing OPD treatment.
  4. FBguy- He has pneumonia and undergoing an OPD treatment.
  5. worriedabouthiv - he will get his HIV test this Friday or next week. may the test turn out negative to calm down his nerves.
Daily Prayers:

1. Poz Angel
2. PositHive
3. PozzieBoy23
4. GeekPozzie
5. Ryan HIV
6. Iamhivpositive
7. PozJerry
8. Casually
9. Bohemian
10. Chris HIV
11. Mike HIV
12. Kien HIV
13. Mark HIV
14. Panga HIV
15. Rob HIV
16. Albert HIV
17. Turvey HIV
18. Mao Hiv
19. Jersey
20. Jayjay HIV
21. 2ndLease
21. FB guy
22. Kiev
23. Spongie
24. iampositive25
25. Paranoid Freak
26. Marky
27. Sam HIV
28. Carlo HIV
29. Rob 2WL
30. Tipsyheaven1
31. Aqua HIV
32. SG HIV\
33. RenalCB HIV
34. FBguy
35. FBfriend
35. worriedabouthiv




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FB Acquaintance

I always add people in facebook because I advertise my business in it. Everyday, I post my daily activities and what I do while I am working.

Unfortunately, in FB, there is another "friend" who seems like having the same symptoms I had 8 months ago. He posted in his timeline that he has persistent dry cough, difficulty of breathing and chest pain. He posted pictures of his IV and een a video of blood being drawn from his arm. What's good about facebook is that people were very supportive of him and even praying for him.

His symptoms brought back memories when I was first brought to the emergency room. Same procedures as him were done plus a chest x-ray. After an hour, they found out that I had pneumonia and was given IV prophylaxis and azithromycin. The rest was history.

Back to this guy, I messaged him privately and asked him how he was. He said that the doctors are doing a lot of blood tests and they suspect that he has HIV. He said that he was tested that day and it showed negative. He said that they saw something in his heart though, which to me is not really related to his coughing, which I maybe wrong since I am not a doctor. He also added that he is worried about the costs of the hospitalizations and I told him just to tell me if he needs help.

While I was messaging him on FB, I texted him too and asked him how he was. He texted back that he is undergoing a general checkup only. Hmmm... conflicting stories.

Anyway, I just wished him the best and I told him that I will be there for him, and will surely pray for him.

I hope I am wrong again. I just wish it is nothing serious, like what we have. Oh I just really wish.





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Wednesday, April 11, 2012

Think Positive 3

Think Positive 2

Think Positive

Don't Lose Hope

Don’t lose hope. Everything will be fine. I assure you.

Here are the things that you need to know about HIV/AIDS that may calm your heart and mind.
  1. There are FREE testing centers all over the country. Everything is confidential.
  2. The HIV/AIDS treatment hubs provide:
          a. FREE consultation with Infectious Disease doctors
          b. FREE ARV’s
          c. FREE prophylaxis (when available)
          d. FREE counselling

     3. PhilHealth provides 
         a. FREE CD4 test and laboratory tests after 6 months of application in any hub
         b. financing of all ARV’s starting 2013
         c. for other information, see my entry on PhilHealth at PhilHealth OHAT Package

    4. HIV/AIDS Law provides
        a. protection against discrimination in the work place
        b. protection against disclosure of HIV status
        c. protection against mandatory testing in work places

Don’t lose hope. Everything will be fine. I assure you. 

I’ll tell this to you over and over again. Just TRUST your doctor, TRUST the medicines and have a HEALTHY lifestyle (eat right, exercise, have a happy disposition in life) and everything will be fine.




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Pneumonia


I would like to discuss this topic because not only it is an opportunistic infection (OI) especially if it recurs within a year, but also one poz is now confined because of it. Yesterday he texted me and told me that he was in a bad condition. He said that he has difficulty in breathing and he can hardly walk. He also has high grade fever. He was thinking he has a lung problem. I told him to get himself checked by a doctor (in that case, a lung specialist). The following afternoon, he told me that his pulmo doctor said that he has pneumonia and he needs to be confined. I told him to do what the doctor tells him to do no matter what.

To all my readers, please help pray for him so that he can recover fast and regain his life back.


Please, if you have the symptoms being discussed here, don't think twice. Go and seek consult immediately. Go to a pulmo doctor fast! If you need a good pulmonologist, I know one. Just email me at pozziepinoy@yahoo.com.


Pneumonia can be cured if treated fast!





WHAT IS PNEUMONIA?

Pneumonia is an infection of one or both lungs which is usually caused by bacteria, viruses, or fungi. Prior to the discovery of antibiotics, one-third of all people who developed pneumonia subsequently died from the infection. Currently, over 3 million people develop pneumonia each year in the United States. Over a half a million of these people are admitted to a hospital for treatment. Although most of these people recover, approximately 5% will die from pneumonia. Pneumonia is the sixth leading cause of death in the United States.


HOW DO PEOPLE "CATCH" PNEUMONIA?

Some cases of pneumonia are contracted by breathing in small droplets that contain the organisms that can cause pneumonia. These droplets get into the air when a person infected with these germs coughs or sneezes. In other cases, pneumonia is caused when bacteria or viruses that are normally present in the mouth, throat, or nose inadvertently enter the lung. During sleep, it is quite common for people to aspirate secretions from the mouth, throat, or nose. Normally, the body's reflex response (coughing back up the secretions) and their immune system will prevent the aspirated organisms from causing pneumonia. 
However, if a person is in a weakened condition from another illness, a severe pneumonia can develop. People with recent viral infections, lung disease, heart disease, and  swallowing problems , as well as alcoholics, drug users, and those who have suffered a stroke or seizure are at higher risk for developing pneumonia than the general population. As we age, our swallowing mechanism can become impaired as does our immune system. These factors, along with some of the negative side effects of medications, increase the risk for pneumonia in the elderly.

Once organisms enter the lungs, they usually settle in the air sacs and passages of the lung where they rapidly grow in number. This area of the lung then becomes filled with fluid and pus (the body's inflammatory cells) as the body attempts to fight off the infection.



WHAT ARE THE SIGNS AND SYMPTOMS OF PNEUMONIA?

Most people who develop pneumonia initially have symptoms of a cold ( upper respiratory infection , for example, sneezing, sore throat, cough), which are then followed by a high fever (sometimes as high as 104 F), shaking chills, and a cough with sputum production. The sputum is usually discolored and sometimes bloody. Depending on the location of the infection, certain symptoms are more likely to develop. When the infection settles in the air passages, cough and sputum tend to predominate the symptoms. In some, the spongy tissue of the lungs that contain the air sacs is more involved. In this case, oxygenation of the blood can be impaired, along with stiffening of the lung, which results in shortness of breath. At times, the individual's skin color may change and become dusky or purplish (a condition known as "cyanosis") due to their blood being poorly oxygenated.

The only pain fibers in the lung are on the surface of the lung, in the area known as the pleura. Chest pain may develop if the outer aspects of the lung close to the pleura are involved in the infection. This pain is usually sharp and worsens when taking a deep breath and is known as pleuritic pain or pleurisy. In other cases of pneumonia, depending on the causative organism, there can be a slow onset of symptoms. A worsening cough, headaches, and muscle aches may be the only symptoms.

Children and babies who develop pneumonia often do not have any specific signs of a chest infection but develop a fever, appear quite ill, and can become lethargic. Elderly people may also have few symptoms with pneumonia.


HOW IS PNEUMONIA DIAGNOSED?

Pneumonia may be suspected when the doctor examines the patient and hears coarse breathing or crackling sounds when listening to a portion of the chest with a stethoscope. There may be wheezing or the sounds of breathing may be faint in a particular area of the chest. A chest X-ray is usually ordered to confirm the diagnosis of pneumonia. The lungs have several segments referred to as lobes, usually two on the left and three on the right. When the pneumonia affects one of these lobes, it is often referred to as lobar pneumonia. Some pneumonias have a more patchy distribution that does not involve specific lobes. In the past, when both lungs were involved in the infection, the term "double pneumonia" was used. This term is rarely used today.

Sputum samples can be collected and examined under the microscope. Pneumonia caused by bacteria or fungi can be detected by this examination. A sample of the sputum can be grown in special incubators, and the offending organism can be subsequently identified. It is important to understand that the sputum specimen must contain little saliva from the mouth and be delivered to the laboratory fairly quickly. Otherwise, overgrowth of noninfecting bacteria from the mouth may predominate. As we have used antibiotics in a broader uncontrolled fashion, more organisms are becoming resistant to the commonly used antibiotics. These types of cultures can help in directing more appropriate therapy.

A blood test that measures white blood cell count (WBC) may be performed. An individual's white blood cell count can often give a hint as to the severity of the pneumonia and whether it is caused by bacteria or a virus. An increased number of neutrophils, one type of WBC, is seen in most bacterial infections, whereas an increase in lymphocytes, another type of WBC, is seen in viral infections, fungal infections, and some bacterial infections (like tuberculosis).

A bronchoscopy is a procedure in which a thin, flexible, lighted viewing tube is inserted into the nose or mouth after a local anesthetic is administered. Using this device, the doctor can directly examine the breathing passages (trachea and bronchi). Simultaneously, samples of sputum or tissue from the infected part of the lung can be obtained.

Sometimes, fluid collects in the pleural space around the lung as a result of the inflammation from pneumonia. This fluid is called a pleural effusion. If a significant amount of fluid develops, it can be removed. After numbing the skin with local anesthetic a needle is inserted into the chest cavity and fluid can be withdrawn and examined under the microscope. This procedure is called a thoracentesis. Often ultrasound is used to prevent complications from this procedure. In some cases, this fluid can become severely inflamed (parapneumonic effusion) or infected (empyema) and may need to be removed by more aggressive surgical procedures. Today, most often, this involves surgery through a tube or thoracoscope. This is referred to as video-assisted thoracoscopic surgery or VATS.


PNEUMONIA AND HIV

Pneumonia in the immunocompromised host involves infection and inflammation of the lower respiratory tract. Regardless of the reason for altered immune function, pneumonia carries a high mortality rate in immunocompromised patients. 
Immunocompromise, and, consequently, a high risk of pneumonia, is associated with the presence of the following factors:
  • Malignancy
  • Human immunodeficiency virus (HIV) infection
  • Primary immunodeficiencies
  • Transplant immunosuppression
  • Pregnancy
  • Alcoholism
  • Cystic fibrosis
  • Autoimmune disease
  • Neuromuscular disease
  • Cognitive dysfunction
  • Spinal cord injury
  • Burns
  • Leukemia
  • Lymphoma
  • Extreme old or young age
  • Solid organ malignancy chemotherapy
  • Chronic steroids
  • Asplenia
  • Diabetes
Complications

Complications of pneumonia in immunocompromised persons can include the following:
  • Pneumothorax
  • Hypoglycemia (may occur with pentamidine)
  • Respiratory failure/ventilatory dependence
  • Acute respiratory distress syndrome
  • Superinfection
  • Pleural effusion
  • Empyema
  • Death
Causes of Pneumonia

Many pulmonary pathogens reliably plague a host who has a dysfunctional immune system. Others are encountered more frequently with certain causes of immune suppression. Therefore, the pathophysiology can be appreciated in general and more specific contexts.

Conceptually, pneumonia susceptibility due to immunosuppression stems from neutrophil defects, immunoglobulin defects, or T-cell defects. The underlying reason for immune suppression may suggest certain pulmonary pathology.

The etiologic agents responsible for pneumonias in immunocompromised patients are often different from those found in immunocompetent patients.

Infectious causes of pneumonia in immunocompromised patients include the following:
  • Bacterial organisms
  • Coccidioides species
  • Cytomegalovirus (CMV)
  • Tuberculosis (TB)
  • Histoplasma species
  • Aspergillus species
  • Mycobacterium avium complex (MAC)
  • Pneumocystis (carinii) jiroveci (PCP)
  • Influenza
  • Herpes simplex virus (HSV)
  • Varicella-zoster virus (VZV)
  • Legionella species
  • Nocardia species
  • Cryptococcus neoformans
  • Mucoraceae species
  • Strongyloides species
  • Toxoplasma species
  • Capnocytophaga species
Noninfectious causes of pneumonia in immunocompromised patients include the following:
  • Pulmonary hemorrhage
  • Pneumonitis
  • Congestive heart failure
  • Pulmonary embolism
  • Myocardial infarction
  • Pneumothorax
  • Drug-induced injury
  • Radiation-induced injury
Patients with human immunodeficiency virus (HIV) are at risk for a number of pulmonary infections. Pneumocystis jiroveci remains the most common opportunistic infection in this group; however, the epidemiology of pulmonary infections among patients with HIV is changing.

HIV causes dysfunction of cell-mediated, as well as humoral, immunity. CD4 T cells principally help other cells achieve their effector function. As such, at low CD4 levels, a disruption of B-cell differentiation occurs. Impaired B-cell functions, particularly of memory cells, are postulated to account for increased risk of infection.[3] Even after the initiation of highly active antiretroviral therapy (HAART), patients with HIV have reduced marginal zone B-cell percentages.

Tuberculosis

HIV is considered to be the greatest risk factor for TB. Patients with HIV are more likely to develop active tuberculosis (TB) once infected, and they have a higher risk of death from TB. HIV is the most important recognized risk factor for progression from latent to active tuberculosis.

Bacterial pneumonia

The most common bacterial pathogen causing illness in patients with HIV isStreptococcus pneumoniae. Patients infected with this organism develop pneumonia more frequently than do their non-HIV–infected counterparts, and they have a more severe clinical course when they are infected.

Pneumocystis (carinii) jiroveci pneumonia (PCP)

Pneumocystis (carinii) jiroveci infection remains the most common opportunistic infection among patients with HIV; however, its epidemiology is changing. Adoption of HAART has resulted in lower frequency of this infection.

Transmission of and infection from P (carinii) jiroveci is incompletely understood. Traditionally, infection in a patient with HIV has been thought to represent the reactivation latent colonization. Now, however, some evidence exists that the epidemiology of this infection is defined on a more local geographic level. As molecular analysis of P (carinii) jiroveci improves, so will the understanding of the transmission and epidemiology of this opportunistic infection. 

Histoplasmosis

For the immunocompetent host, histoplasmosis is frequently asymptomatic. In the setting of HIV, this infection is much more common and frequently progresses to disseminated disease. Immunocompromised persons living in endemic areas are at increased risk of disease.

Spores of the mold phase are inhaled and cause a localized or patchy bronchopneumonia. CD4 lymphocytes normally activate macrophages to control the infection. In patients with HIV and low CD4 counts, the likelihood of developing pulmonary and disseminated histoplasmosis is increased.

Coccidiomycosis

Coccidiomycosis also can lead to pneumonia. This fungal infection is caused byCoccidioides immitis, an organism endemic to large parts of the southwestern United States.

Spores are inhaled and then ingested by pulmonary macrophages. Impaired cell-mediated immunity in persons with HIV accounts for an increased risk of infection in these patients. Life-threatening infections have been described in patients both with HIV and impaired cellular immunity.

Cryptococcus

Cryptococcal pneumonia is more severe in patients with HIV. Patients with pulmonary disease frequently progress to disseminated disease.

Most cases are the result of the reactivation of a latent infection. Recognition and treatment are important, because pulmonary cryptococcus is thought to herald the onset of disseminated disease.

Herpes simplex virus and varicella-zoster virus

The pathophysiology of HSV and VZV infections in the setting of HIV is not well understood. Varicella pneumonia is not a common infection in patients with HIV. Few cases have been reported; these have included primary and reactivation disease.

Mycobacterium avium complex

Mycobacterium avium complex (MAC) infection refers to infection with either of two nontuberculous mycobacterial species, either M avium or M intracellulare. These infections can occur in non-HIV–infected patients; however, MAC is much more frequently encountered in the setting of HIV.

This infection is thought to represent a recent acquisition of organisms rather than the reactivation of a latent infection.

Staging of HIV-associated pneumonia

A staging system specifically for predicting mortality in HIV-associated pneumonia has been described. This model was developed by using classification tree analysis, and it relies on 3 commonly available clinical variables: neurologic symptoms, respiratory rate more than 25, and serum creatinine level. However, this study has not been subsequently validated in the era of HAART.

Malignancy

Neutrophil defects, immunoglobulin defects, and T-cell defects are all seen in patients with cancer.
Underlying malignancy itself is a risk factor for subsequent infections, while leukopenia and lymphopenia are common adverse reactions to chemotherapy.

Primary immunodeficiencies

Patients with primary immunodeficiencies are challenged by a number of pulmonary infections. The spectrum of illnesses they face is largely determined by their underlying immune dysfunction: humoral deficiencies, cellular deficiencies, or combined deficiencies.

Patients with defects of humoral immunity are unable to create functional antibodies. Their complications are characterized by severe, recurrent upper and lower respiratory tract infections.

Cellular deficiencies are rare conditions that affect T-cell development and function. Dysfunction of T cells invariably has an impact on B-cell activity; therefore, most of these conditions manifest as combined deficiencies.

In combined deficiencies, T-cell and B-cell function is disturbed. These patients present not only with recurrent episodes of respiratory syncytial virus (RSV), HSV, VZV, influenza, and other viral respiratory infections, but also with chronic diarrhea and chronic mucocutaneous candidiasis.

Transplant immunosuppression

Solid-organ and bone-marrow transplant patients have a heightened risk of pulmonary infection. Timing since transplantation, use of immunosuppressive medications, and the type of transplant are all important in predicting these complications.

For solid-organ and bone-marrow transplant patients, the time since transplant is a major predictor of infectious complications. Induction regimens are used in the early posttransplant period, while maintenance therapies are later, long-term medication strategies.

In addition, the depth and duration of neutropenia are risk factors for infection in transplant patients. Risk factors for pulmonary nocardial disease reportedly include the receipt of high-dose steroids, CMV disease in the previous 6 months, and high median calcineurin inhibitor level.

A variety of antilymphoproliferative agents are used commonly in solid-organ transplantation patients, including cyclosporine, azathioprine, and tacrolimus. Additionally, monoclonal and polyclonal antibodies to hematopoietic antigens are increasingly being used. The full medication history should be available through the patient’s transplant coordinator.

Like solid-organ transplant patients, various antilymphoproliferative agents are used commonly in bone-marrow transplantation patients. Distinguishing between CMV, idiopathic pneumonia syndrome, and graft-versus-host disease is challenging.

PCP can occur even in patients who are on prophylactic treatment with trimethoprim-sulfamethoxazole.

Pregnancy

Pregnancy results in immunologic changes, including a decrease in helper-T-cell numbers, a reduction in the activity of natural killer cells, and a decrease in cell-mediated immune function, that predispose patients to infections. In addition, the elevated serum concentrations of progesterone and 17beta-estradiol observed in the latter half of pregnancy can stimulate the growth and maturation ofCoccidioides immitis.

Cardiopulmonary changes that occur as a part of normal pregnancy may result in a diminished capacity to compensate for the effects of respiratory disease.

Further, a reluctance to perform imaging studies in pregnant patients may lead to delayed detection of pneumonias.

The etiologic agent is not identified in approximately half of cases of community-acquired pneumonia in pregnancy. S pneumoniae and Haemophilus influenzae are the most frequently identified bacterial agents.

Alcohol consumption

Alcohol consumption affects systemic and pulmonary immune function. Current alcohol use is an independent risk factor for severe community-acquired pneumonia. Additionally, patients who are alcoholics are frequently also smokers. The negative effect of these risk factors for pulmonary infections are additive. Chronic alcohol drinkers also have decreased saliva production, an important component of mucosal defense.

Patients who are receiving treatment with corticosteroids for alcoholic hepatitis are at increased risk of developing Pneumocystis pneumonia.

Cystic fibrosis

Patients with cystic fibrosis experience progressive lung disease, which leads to respiratory insufficiency and failure.

In cystic fibrosis, abnormal chloride and sodium transport in the respiratory epithelium results in the development of thick, viscous secretions. Chronic airway obstruction leads to colonization by pathogenic bacteria, including Pseudomonas aeruginosa.

Autoimmune diseases

Patients with autoimmune diseases, either primary ones or those resulting from immunosuppressive therapies, are at higher risk of infectious pulmonary complications.

In systemic lupus erythematosus (SLE), distinguishing infection from an autoimmune flare is important. Treatment with steroids in the setting of infection could be deleterious. Susceptibility to infections derives from therapeutic and disease-related factors.

Complement deficiencies and elevated Fc gamma III and granulocyte-macrophage colony-stimulating factor (GM-CSF) levels may contribute to increased susceptibility to infection in patients with SLE. Deficiencies of functional mannose-binding lectin do not appear to be the reason for increased infection burden.

Low complement, the use of more than 20 mg prednisone daily, and the use of cyclophosphamide in patients with SLE were important risk factors in multivariate analyses.

Severe manifestations of disease are treated with immunosuppressive therapies.

In connective tissue diseases, the primary condition and the use of immunosuppressive medications place patients at increased risk. Of 5,411 cases reviewed, 29% of patients developed a serious infection; 24% died from this infection—most reported as bacteremia or pneumonia.

Neuromuscular disease

Poorly managed secretions and frequent aspiration are risk factors for pneumonitis and pneumonias. Reasons for a breakdown in this component of pulmonary defense can be functional, resulting in an overwhelmed immune system.

Pneumonia is a leading cause of death in persons with neuromuscular disease. Impairment of cough and swallowing mechanisms contributes to an increased risk of pneumonia. Gastroesophageal reflux is more common, persistent, and severe in patients with cerebral palsy. Kyphoscoliosis secondary to unequal muscle tone leads to restrictive lung function and predisposes to atelectasis.

Cognitive dysfunction

Drooling, feeding problems, and aspiration place patients with cognitive dysfunction at higher risk of pulmonary infections.

Spinal cord injury

Muscular weakness from spinal cord injury may contribute to a dysfunctional cough reflex.

Extremes of age

Older patients may complain of fewer symptoms than younger patients, making the diagnosis more challenging.

Children and infants at risk of RSV infection include those younger than 24 months with chronic lung disease who have required medical therapy within 6 months of RSV season onset, preterm infants born prior to 32 weeks’ gestation, preterm infants born at 32-35 weeks’ gestation with at least 2 additional risk factors, and those with hemodynamically significant heart disease.

Burn

Complications arise from direct lung injury and from indirect pulmonary effects (eg, decreased lung expansion secondary to circumferential burns).

Bacterial clearance is impaired in patients with inhalational injury. This can result from a variety of causes, including impaired cough, impaired mucociliary action, airway plugging, and impaired alveolar macrophage function.

Selective oral decontamination in burn patients has been advocated in some burn centers. Reduced oral carriage of organisms responsible for pulmonary infections is speculated to account for a lower frequency of pneumonias in these patients.

Leukemia

Leukemia itself (primarily chronic lymphocytic leukemia) is characterized by frequent infectious episodes. Patients who are undergoing chemotherapy are additionally at risk for severe neutropenia and subsequent pulmonary infections.

Lymphoma

When lymphoma compromises airway lumen, secondary postobstructive pneumonias can develop. Patients with lymphoma are often taking steroids, which increase their risk of pulmonary infections.

Solid-organ malignancy chemotherapy

Patients who are undergoing chemotherapy for solid-organ tumors are at increased risk of infections. Pulmonary infections are common.

Steroids

Patients who are taking steroids long term are at higher risk for pulmonary infections.This includes patients who are taking steroids long term for sarcoidosis; they have the same risk for pulmonary infections as do other chronic steroid users, and they are also at risk for complications from postobstructive infections secondary to compressive granulomas.

The dose and duration of use are predictive of increased risk of pneumonia. Low-dose and short-term use carry minimal additional risk of pneumonia; dosages more than 10 mg/d or cumulatively 700 mg of prednisone increased patients' risk of pulmonary infection.

Asplenic patients

These patients are at particularly high risk for acquiring infections from encapsulated organisms.They also have a higher rate of infection from pneumonias overall.

Hyperglycemia and diabetes

Hyperglycemia and diabetes cause neutrophil dysfunction and are independent predictors of poor outcomes in patients with pneumonia.



RATE OF PNEUMONIA IN HIV

In patients with HIV who are infected with S pneumoniae, the risk of pneumonia is 10-100 times greater than non-HIV infected persons.

In patients with PCP, risk of infection is strongly correlated with CD4 count. In patients with a CD4 count between 201 and 350, the incidence was 0.5%.



MORTALITY AND MORBIDITY RATES FOR HIV-ASSOCIATED PNEUMONIA

From 1999-2000, the leading cause of death was from PCP. More than 50% of patients who died were not on or were not adherent to HAART.

The case-fatality rate in patients with TB is higher in patients co-infected with HIV.
For community-acquired pneumonia, the in-patient mortality rate is 9.1%. The clinical staging system predicts mortality: neurologic symptoms, elevated respiratory rate, and elevated creatinine.

CLINICAL PRESENTATION

Patient history

The underlying cause of immunosuppression is a crucial aspect of the history.
Nonspecific findings may include the following:
  • Fever
  • Exertional dyspnea, followed by dyspnea at rest with progression of disease
  • Cough, most often nonproductive in patients with acquired immunodeficiency disease (AIDS)
  • Pleuritic chest pain
  • Anorexia and weight loss
  • Abdominal pain
Physical examination
Pulmonary findings may be nonspecific or nonexistent in immunocompromised patients.
Findings at physical examination may include the following:
  • Fever
  • Tachypnea
  • Tachycardia or bradycardia
  • Rales or crackles
  • Rhonchi
  • Decreased breath sounds
  • Dullness to percussion
  • Egophony