What happened on these forums on August 06 2008?

[karry]

Forgive my curiosity...but in the stats section of this forum, I see that the highest activity on the forums was on August 6 2008. I have been curiouse for a while now and just can't help asking.
 
Karry

[Dachshund]

Miss P came out.

[karry]

lol

[anniebc]

Miss P came out.

It was spectacular, they had a parade and everything..the forums were  buzzing that day.

Aroha
Jan

[tednlou2]

Was that the suicide crisis of a member?  I remember reading that thread a while back.  I can't remember why.  Perhaps someone referenced it?  It was 2007 or 2008.  Now, I am curious. 

[Ann]

It was most likely a field day for bots from search engines like Yahoo or Google. Yes, we get them. That's why you get results from the forums when you google hiv questions.

[karry]

Thanks Ann. That kind of make sense to me. This little curious cat will stop wondering.
K.

[harleymc]

Miss P is out?

[Rev. Moon]

It was most likely a field day for bots from search engines like Yahoo or Google. Yes, we get them. That's why you get results from the forums when you google hiv questions.

I think it had something to do with some episode on CSI N.Y. that mentioned the forums or sumthin' sumthin'. 

Miss P came out.

That makes more sense than Ann's response 

[anniebc]

I think it had something to do with some episode on CSI N.Y. that mentioned the forums or sumthin' sumthin'. 


That makes more sense than Ann's response 

You could be right Rev, the episode when Stella learns of her HIV status..and boy did they get that all wrong.

Maybe Ann was right too, lots of people Googling HIV to see what the hell it was all about.

Aroha
Jan

[Growler]

http://www.poz.com/articles/1_11282.shtml

feb 7not8

[Ann]

I think it had something to do with some episode on CSI N.Y. that mentioned the forums or sumthin' sumthin'. 

Good guess, but wrong.

In 2007, CSI:NY ran four episodes with a running sub-plot on February 14th and 21st, and on April 11th and 25th. We were approached by CBS and asked to host a CSI:NY forum for the general public to discuss the story.

While the CSI forum is no longer available to view, it's still online and I can still access it. Tim Horn created a new thread for each episode to discuss the Hollywood fantasy vs the reality. I'll post four posts (one for each episode), quoting Tim's posts.

Just because I can and just because some folks may be interested.

[Ann]

Episode 1: The FACTS vs. the stuff of T.V.

Hi Everyone:

I just wanted to chime in after watching last night's episode, speaking with colleagues here at AIDSmeds and POZ, and -- above all -- reading the comments of others in this Forum.  While the show got it right in some respects, it got it wrong with others... and all of this MUST be kept in the context of the fact that this was an occupational risk of HIV transmission, which differs in its variables and approach from non-occupational HIV risk (e.g., sexual contact), which is by far the most common concern among the overwhelming majority of POZ and AIDSmeds readers and Forums participants. 

The glass

We see that Stella picks up the glass from a pool of blood.  The piece of glass then snaps in two and results in a deep wound in her arm.  Yes, this is a risk for HIV transmission, given that Stella's own blood supply came into contact with blood from someone with known HIV infection.  The important thing to remember here is that there are varying degrees of risk: 

As soon as HIV in blood is exposed to air and temperatures below that of the human body, it begins to loose its infectiousness.  Yes, the blood on the glass appeared fresh -- the dripping-off-the-glass leaves us wit this impression -- but, as is documented in the scientific literature, HIV is an incredibly fragile virus and its infectivity strength and ability would be significantly compromised by its exposure to air, cooler temperatures, and dilution via aquarium water. 

We discover that the victim was on antiretroviral therapy.  It is well established that HIV-positive people receiving antiretroviral therapy are less likely to transmit the virus to others, especially if the drug regimen being used has been successful at reducing the amount of virus -- viral load -- in the person's bloodstream. 

The test

Blood was drawn for an HIV antibody test. Here's where things get murky.

In a situation such as this, in which a healthcare provider is consulted immediately after a potential exposure (whether it be occupational or non-occupational), a PCR test is the standard diagnostic tool, as it is the only assay capable of detecting HIV infection within hours of exposure (even then it can take up to 72 hours for HIV to become detectable, with 28 days post-exposure providing the most reliable results using this assay).  While it is possible that Stella may return in a future episode for PCR tesing, the test offered to her last night was an HIV antibody test.

There are two types of antibody tests: rapid assays, which provide results within 20 minutes and standard antibody tests, which can take two days to two weeks to produce results.  First, Stella really should have gotten the rapid assay, and then only to confirm the absence of pre-existing HIV infection that she didn't know about... an antibody test, within hours of exposure, is absolutely meaningless.  Most people produce detectable antibodies within six weeks of infection, with the overwhelming majority producing detectable antibodies within three months of infection.  When discussing the window period, Stella is told that it "could take longer," which was really bad advice.   Yes, the U.S. Centers for Disease Control, in their testing guidelines, say that testing out to six months may be necessary in some cases... but these guidelines are quite old and do not reflect the heightened sensitivity of currently available assays.  If I had my way, I would have had the nurse saying: "Three months is conclusive, but if you're still not satisfied with those results we can test you again for your peace of mind." 

Post-exposure prophylaxis (PEP)

Stella is given PEP to help prevent HIV infection if, in fact, she was exposed to the virus.  She is told: "To lower your risk of infection, we'll start you on an antiviral regimin. Side effects can include..."  No length of time was discussed at all.

On the CBS website synopsis of the show, it curently states that she is put on a three-month drug regimen.  This is incorrect.  The standard PEP regimen is 28 days, with antibody testing conducted again three months after PEP is concluded. 

Occupational vs. non-occupational risk

The risk of HIV infection via occupational exposure to HIV -- meaning exposure to potentially infectious blood or other bodily fluids through a work-related situation, including a police investigation -- is, statistically, very low.

Let's take a look a the example of healthcare workers, considered to be at the highest risk of occupational HIV exposure. Approximately 600,000 to 800,000 needle-stick injuries occur in the United States annually. Yet, as of September 2000 (according to CDC documentation), only 97 cases of occupationally acquired HIV infection had been documented worldwide, with 52 of these occurring in the United States.

What we specialize in here, at AIDSmeds and POZ, is education surrounding non-occupational risk factors and, even more importantly, living long and well with the virus.  The fact of the matter is, the overwhelming majority of CSI: NY viewers -- other than health care providers and "fellow" police personnel -- will never face this particular transmission risk scenario in their lifetime. 

The differences between occupational and non-occupational risks and exposures, as well as testing and PEP guidelines, are significant enough that the CDC really does treat them separately.  As T.V. viewers, we immediately want to find some sort of connection with the character... the problem is the "story of Stella" simply doesn't reflect the risks that many present (and, unfortunately, future) Forums members are forced to contend with. 

Hopefully, as this story line progresses, we will see details that will be unifying for HIV-positive viewers and more applicable to HIV-negative viewers (e.g., a glimpse at what it means to be living with HIV, not just the anxiety associated with the fear of infection).  If the writers are effective in this way, the shroud of doubt surrounding the transmission and testing facts will be replaced by something much more meaningful and thoughtful. Fingers crossed.

Tim Horn

[Ann]

Episode 2: The FACTS

Another AIDSmeds.com take on Stella's foray into testing an HIV awareness (CSI:NY 317 / The Ride-In):

Disclosure to Mac

Stella tells Mac, head of the crime lab and her colleague and friend, what happened at the Emery Gable crime scene.  It was nice to see that Mac was immediately supportive and was attentive to her fears and concerns.  While Stella acknowledges that she’s aware that her “risk was low,” she also expresses that she’s still worried and doesn’t have the strength to wait out the testing window.  Mac counters with extremely encouraging words.  I think this was nicely handled, actually. 

Stella reports that her first HIV test – the one taken immediately after the exposure – has come back negative and that “she has ten weeks to go before she can be tested again” and find out for sure.  While there’s nothing incorrect here, there’s still a big piece of “modern medicine” missing from Stella’s post-exposure care: access to a PCR test. 

Not only is one type of PCR testing approved by the FDA for aiding in the diagnosis HIV infection soon after exposure, it is a standardized test for those dealing with potential occupational exposure.  In the “real world,” Stella most likely would have been given a PCR test at the time she presented for medical care and then soon after her 28-day PEP regimen – which wasn’t discussed – was completed.  While a confirmatory antibody test would still be necessary, PCR testing is useful in terms of alleviating fears, one way or another.       

HIV Transmission via CPR

While one can’t really blame Stella for feeling jumpy and, perhaps, a bit insecure about her risk of transmitting HIV to Sid, here’s what I would have told her (and, no, Mac’s “considered very low risk” commentary doesn’t quite cut it):

1) Studies, dating back to the early and mid-1980s, have consistently demonstrated that HIV can be detected in saliva, tears, and urine.  However – and this is a key factor – HIV in these fluids is only found in extremely low concentrations.

2) The most important evidence is, well, a complete lack of evidence.  More than 25 years into the HIV/AIDS epidemic, not a single case of HIV transmission via mouth-to-mouth contact or CPR has been reported to the U.S. Centers for Disease Control or in the medical literature. 

There have been a handful of cases of bacterial infections – such as tuberculosis, meningococcus, salmonella, and gonorrhea (along with a few cases of the viral infection herpes) – but not a single HIV case.  In fact, viruses that are even easier to spread compared to HIV – hepatitis B virus (HBV) and cytomegalovirus (CMV) to name a few -- have never been documented to have been spread via mouth-to-mouth contact or CPR either. 

According to an article published in Annals of Internal Medicine in 1998, there have only been 15 cases of any infectious disease – notably the bacterial infections listed above – being transmitted via CPR over the preceding thirty years… and not one of them involved HIV.  And there’s another important statistic to consider as well: studies have consistently demonstrated that prompt performance of CPR can save the life of the person in cardiac arrest 10% to 15% of the time.   In turn, it seems pretty clear that the benefit to society of administering CPR to a patient in cardiac arrest – 10,000 to 15,000 lives saves per year in the U.S. alone – vastly outweighs whatever (nonexistent) risk of HIV transmission via this sort of contact.

Perhaps the most important words of all were uttered by Sid to Stella once he’s back on his feet: “I can’t get the virus from saliva, I know that.”  As for the “bleeding gums” Stella speaks of, there’s no evidence to suggest that her morning teeth brushing – several hours earlier – necessarily increased her risk any higher.  Once again, there’s been no evidence of HIV being spread via mouth-to-mouth CPR, “bleeding gums” or not. 

As for the "less than 0.1%" statistic cited by Stella, well, this simply isn't based on any sort of concrete science.  According to the Annals of Internal Medicine article cited abobe, the risk for infection with any infectious disease via mouth-to-mouth CPR is less than 1 in 200,000 (that's a 0.0005% risk).  And where would HIV transmission fit within this?  Well, it doesn't... simply put, it is impossible to put a number, percentage, or calculation on an undocumented risk. 

Tim Horn

[Ann]

EPISODE 3 (4/11/07): THE FACTS

Okay, folks, I'm back again with a review of the third installation in the CSI:NY story arc dealing with Stella's potential HIV exposure.

I suppose I should preface this with with an expression of my own befuddlement.  Earlier today, Peter and I learned that tonight's episode would bring Stella's possible HIV exposure back up to the surface.  So I watched.  But as the plotline unfolded, I couldn't envision how Stella's situation was going to make its way back in. 

An investigation of attempted murder involving some handsome young men with a cloning lab (one being a city councilman's son, no less) -- I just loved the genetically altered rat designed to produce a human ear on its back -- experimenting with "human hibernation?" 

A bunch of attractive, well-to-do young adults engaging in "fantasy suicides" -- a "knight in shining armor" commits Hari Kari with a jousting lance; mid-coital death-by-ice-pick in a posh $40,000 hotel suite; a woman acting out Marilyn Monroe's overdose scene, the blonde tresses, satin sheets, and all -- that were planned while participating in a support group for people with terminal illnesses run by a botanically gifted psychiatrist? 

It wasn't until the very last scene that I was reminded as to why I watched the show in the first place.  It seems as if Stella has somehow managed to internalize the almost comical suicide investigations:

MAC: Stella. What are you doing here this late?
STELLA: Mac, there's a DNA test for detecting HIV. The window period is much shorter. Which means I can get an immediate answer. I was wondering if you could authorize getting the PCR kit needed for the test.
MAC: You want to do it here in the lab?
STELLA: We have the equipment. Adam's graduate degree --
MAC: Top of his class. I know. Okay.
STELLA: (relieved) Thanks.
MAC: What if you're positive, Stella?
STELLA: Whatever the outcome, I am bound and determined to live every day to the fullest."

I just have a few technical issues to note. 

First, Stella requests a DNA test.  Polymerase chain reaction (PCR) testing can be used to test a blood sample for virus particles, not HIV antibodies.  Given that the virus can often be detected within days post-infection, as opposed to the six- to 12-week "window period" required for antibody testing, PCR testing can be used to diagnose HIV very early on in the course of infection. 

Technically speaking, an RNA PCR -- not a DNA PCR -- would have been used.  HIV DNA can only be detected inside cells, which is a costly and time-consuming procedure (and only available, for the most part, in laboratories specializing in HIV research).  RNA PCR is capable of detecting "free floating" HIV RNA particles, a less involved and cheaper process.  Hence, this is the assay that would most likely be used. 

However, HIV RNA PCR "kits" are prohibitively expensive -- they require special probes, regents, etc -- so I seriously doubt that one would be "ordered up" for the CSI:NY lab simply to suit Stella's needs (plus, it would be highly illegal for a crime lab to conduct such testing for diagnostic purposes).  In the "real world" -- and this includes healthcare workers, emergency personnel, and CSI staff dealing with potential occupational exposure -- testing such as this is done in concert with a healthcare provider and conducted at a lab where HIV RNA PCR testing is already conducted.  Why Stella is insisting on taking all matters into her own hands, including her own medical care, is beyond me.  In fact, this sends a terrible message... that even professionals, who should know better, are too shamed to seak out diagnostic and medical care through a healthcare provider.

There was no mention of Stella's post-exposure prophylaxis (PEP).  If she's still on it, a PCR wouldn't be conclusive.  She'd need to be off the meds for up to a month for the results to be considered reliable.  Even then, she'd still need a standard antibody test to confirm the results, with blood drawn approximately three months after finishing PEP. If Mac really wanted to be supportive, he should have offered to go with Stella to the doctor -- hold her hand, even -- to work through this correctly.     

Stella, Mac, and their colleagues seem to know an awful lot about the science of human hibernation, the complexities of forensic DNA testing, the intricacies of exotic botany, even the structure of heavy-duty silk strands when viewed under a microscope... but what they don't know about HIV and its diagnosis is a lot... all the more reason for the writers of CSI:NY to stop this do-it-yourself DNA [sic] HIV testing and put Stella in a situation where she belongs... communicating with a healthcare provider familiar with HIV, its spread, and its diagnosis. 

Until the next episode,

Tim Horn 

[Ann]

EPISODE 4 (4/25/07) -- THE FACTS

So, it looks as if we're finally at the end of CSI:NY HIV story arc. 

Taking yet another huge bite of "artistic license," the writers of CSI:NY have Stella offering up a blood sample for PCR testing in the CSI lab. Inaccuracies and message problems aside -- see my EPISODE 3 synopsis (http://forums.poz.com/index.php?topic=11240.0) -- we're now left to accept Adam's lab "conclusion"... that Stella is HIV negative. 

Judging by last night's epilogue, featuring Melina Kanakeredes urging views to learn more about HIV and testing by checking out www.knowhivaids.org (the website linking CSI:NY to the POZ Forums), I'm assuming that Adam's word is final and that this fourth episode concludes Stella's hand wringing and the end of CSI:NY's HIV exposure storyline. 

Of course, in the real world, the "final word" on HIV testing wouldn't end with a negative PCR result and would NEVER end in a CSI lab.  An HIV antibody test is required, approximately three months after exposure (or the completion of post-exposure prophyalxis), would have been necessary... and such testing, as required by law, would have taken been conducted by a healthcare provider or by a diagnostic lab. 

In all honesty, efforts to show what really should have happened in this final episode of CSI:NY's HIV story story arc are a little pointless, given the inaccuracies in the three episodes leading up to Stella's negative finale. Stella's negative... and my only hope is that, in the future, the writers of CSI:NY will really do their homework before so much as thinking about another HIV storyline, especially while working on a show that claims to paint an accurate, behind-the-scenes picture of the fascinating science, work, and procedures of crime scene investigations. 

In conclusion, we should all take note of this reference in a recent CNN article (http://www.cnn.com/2007/HEALTH/04/20/cdc.in.hollywood.ap/index.html) regarding medical accuracy on prime-time television:

Scary thought indeed.

Tim Horn

[Larsen]

Wouldn't the Berlin Patient announcement have been second half of 2008?