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The political science of salmon non-recovery, 101
If the 13 endangered salmon runs on the Columbia and Snake rivers go the way of the dodo on our watch, the responsibility for this denouement cannot be laid at the feet of the five Columbia River Indian tribes or their allies in the biological and aquatic sciences.
For two decades, in courtrooms and at hatcheries, tribal councils and marine biologists have waged a tireless battle against an unmovable foe: time. Their chief institutional adversary has been the Bonneville Power Administration, a semi-autonomous federal agency that distributes energy generated by a gantlet of fish-killing hydroelectric dams in the Columbia River Basin, a geographic area the size of France.
When billions of federal salmon recovery dollars flowed into Idaho, Oregon, Washington, Montana and Wyoming in the 1990s, politicians such as Sen. Slade Gorton, R-Wash., and Sen. Gordon Smith, R-Ore., rushed to protect industries whose profits are subsidized by cheap transportation, cheap electricity and free water. Overnight, the icon of the Pacific Northwest morphed from an ocean-going fish into a political football with gills and fins.
Attempts to reconcile the irreconcilable interests of science and politics in the federal government's salmon recovery plans of 1995 and 2000 relied heavily on "the best available science." Yet, 10 years later, the barges still haul salmon to the sea, a handful of industrial farms still irrigate at taxpayer expense, and the extinction trajectories for Columbia River salmon are right on schedule: 2017.
Now, responding to a 2003 court order to fish or cut bait, NOAA Fisheries has unveiled yet another recovery blueprint. Regrettably, this draft biological opinion nudges aquatic biology one step closer to complete irrelevance while winding the spring on the extinction clock tighter.
"We've known all along that the Bush administration was determined to politicize science," says Charles Hudson, spokesman for the Columbia River Tribal Fish Commission. "We never imagined they'd be this brazen."
NOAA Fisheries, for examples, says all it needs to do is to keep salmon from declining any faster than they already are. As Brian Gorman, a spokesman for NOAA Fisheries, put it, "The Endangered Species Act does not mandate recovery; it mandates a recovery plan."
Up to now, the purpose of a recovery plan for endangered species was to establish a biological baseline as a benchmark for recovery strategies. In addition to including 10,000 years of native fishing as an integral feature of that baseline, earlier versions of the plan identified hydroelectric dams as "impacts" to salmon's natural habitat.
The Bush administration never cared for the political consequences of that assessment. The 2004 Salmon Recovery Plan simply declares that the dams pose "no jeopardy" to salmon, as if they have been natural features of the river environment since the last Ice Age. Conversely, native fishing on these rivers is now listed as an "impact."
"This thing doesn't even meet the straight-face test," says Rob Masonis, regional director for the national nonprofit group American Rivers. "What will they say next, that the future of the passenger pigeon looks bright?"
Officials at NOAA Fisheries, who wrote the plan, argue that advancements in the design of removable weirs have made dams more fish-friendly by directing them away from intakes that flush fish through turbines. Conservationists counter that the limited data gathered on these newfangled contraptions tell a different story. Costing tens of millions of dollars, the new weirs have increased fish counts at spawning grounds by less than 1 percent — in good years.
At a hearing in federal court in Portland, Ore., Sept. 28, U.S. District Court Judge James Redden issued a warning to the Bush administration. Addressing a crowded courtroom, the judge predicted that the federal government's new recovery plan was headed for "a train wreck."
So, in the coming months, as the extinction clock continues ticking, and as we reach into our pockets to pony up another $10 million to separate politics from science in yet another salmon recovery plan, we might recall Mark Twain's verdict on politicians: If they started out dead, we'd all be better off, because they'd begin being honest that much sooner.
Paul VanDevelder is a contributor to Writers on the Range, a service of High Country News (hcn.org). He lives in Corvallis, Oregon, and is the author of the new book, Coyote Warrior, a six-generation chronicle of a Mandan-Hidatsa family.
Note: the opinions expressed in this column are those of the writer and do not necessarily reflect those of High Country News, its board or staff. If you'd like to share an opinion piece of your own, please write Betsy Marston at [email protected].


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Science Friday® is produced by the Science Friday Initiative, a 501(c)(3) nonprofit organization.
Science Friday® and SciFri® are registered service marks of Science Friday, Inc. Site design by Pentagram; engineering by Mediapolis.
|How big a role does concrete manufacture play in greenhouse gas emissions? Current estimates say that concrete manufacture could account for as much as five percent of the global carbon footprint. Writing in the Journal of Environmental Engineering, however, researchers say that concrete may actually act as more of a carbon sink that than previously thought, absorbing carbon dioxide and forming chemical compounds inside the porous structure of the building material. We'll talk with one of the authors of the paper about her work.

subset: commoncrawl


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Barry Eisler here. Joe, thanks as always for the guest slot. I was going to mock this Wall Street Journal article somewhere, and there's no better place than A Newbie's Guide for that…
So okay, today the Wall Street Journal ran a piece headlined, "E-Book Sales Fall After New Amazon Contracts: Prices Rise, but Revenue Takes a Hit." The article is behind a paywall, but you can access it by cutting and pasting the headline into your browser and clicking on the result of the search.
I just want to make sure I'm the first to congratulate the Wall Street Journal on its shocking discovery of a correlation between higher prices and lower demand. And, while I'm no economist, I'd like to humbly propose that the WSJ call its discovery something like, "The Demand Curve." If this doesn't win the newspaper a Pulitzer, I have one more suggestion: an even more radically new article on how a round object fastened to an axle can work as something called… a wheel.
Apologies for the snark, but where else but in publishing could a notion like "higher prices lead to lower revenues" even be controversial, let alone newsworthy? But the publishing industry is notoriously special, and Joe has been beating this drum for years. Five years ago, he wrote:
Naturally, people would rather pay less for something than more. And in a digital world, like we're rapidly becoming, consumers have shown consistently in other forms of media that they place less value on downloads than on physical products.
When companies price digital content too high, consumers respond by pirating that content. That's the ultimate in "devaluing."
So what is truly the value of ebooks? Is it free? Or is it the publisher's price, which seems inflated, and which in the agency model gives them 52.5% of the list price of an ebook for doing nothing more than providing a cover, editing, and putting it up on Amazon?
If an ebook is free, the author gets screwed.
If an ebook is priced high, it won't sell a lot of copies, and the author gets screwed.
If an ebook sells for a small amount of money, the author makes 17.5% of the list price. That also seems like the author is getting screwed.
Publishers are currently talking about going 50/50 with authors [BE note: hah, this was five years ago, the talk never ends does it?], so an author will make 35% of the list price. But it's still the price the publisher sets, which is inflated, which will lead to piracy.
By setting the price, the publisher is pricing ebooks so they won't sell well, and then taking 35% of what little money will come in.
Joe has also pointed out many times that authors will be the ones who kill legacy publishing, because they'll go elsewhere as they figure out the New York Big Five's pricing strategy is costing them money. Though whether this is Big-Five-Death-By-Authors or Big-Five-Death-By-Suicide is an interesting philosophical question.
Anyway, back to the Wall Street Journal's big discovery. The headline itself—again, E-Book Sales Fall After New Amazon Contracts: Prices Rise, but Revenue Takes a Hit—is interesting. The way it's written, you might think it was Amazon that caused the high prices that produced that shocking revenue hit. In fact, Amazon has consistently tried to price ebook prices lower, even publicly explaining last year why everyone—authors, publishers, and retailers—makes more money from lower ebook prices. Higher so-called "agency" prices have been forced on Amazon by the Big Five, and were at the heart of the price-fixing conspiracy New York and Apple engaged in to keep ebook prices high.
And that subtitle is amusing, too. Prices rise, BUT revenue takes a hit? How about AND takes a hit? Or THEREFORE takes a hit?
I can't help it. It's too much. The Wall Street Journal—one of the world's leading business newspapers—doesn't seem to understand, or even know the existence of, an Econ 101 concept as basic as this:
In economics, the demand curve is the graph depicting the relationship between the price of a certain commodity and the amount of it that consumers are willing and able to purchase at that given price.
What is it about publishing that makes otherwise intelligent, educated people lose sight of even the most axiomatic things? One day, someone's going to write a dissertation on that topic.
Publishing industry analyst Mike Shatzkin provides this helpful quote: "Unfortunately, it may be that consumers aren't happy with the higher prices." Okay, I admit that my first thought was, "Those pesky consumers, always insisting on decent value for their money! If we could just figure out a way to keep 'em happy about coughing up $25 a book, we'd all be in clover!"
And then I thought, "Unfortunate for whom?" Because there's demonstrably more money for everyone in lower priced ebooks. But wait, here's a clue:
"Publishers said the current pricing model involves some sacrifice but they felt it was worth it to keep Amazon in check."
Always interesting when someone casually reveals his true motives. Though this one might have been stated more clearly as, "Publishers said sodomizing readers was worth it to keep Amazon in check. A Big Five spokesman added, 'Sorry, readers, we know it hurts but it's for the greater good. And by 'greater good,' I mean the good of the Big Five, who are above all else intent on preserving the problem for which we are the solution.'"
And here's another clue: "What's more, they have noticed a bump in sales of physical books that is possibly related to the higher price of digital books."
I've been saying for years: the prime imperative of the Big Five is to preserve the position of paper and retard the growth of digital. They're willing to lose money to accomplish this. They even just described it as good news.
I also love how the cripplingly high prices the Big Five has fought for are now described as "the Amazon deals" and "the Amazon pacts" ("pact" is such a great word. The west has a North Atlantic Treaty Organization. Only Communists have things like a Warsaw Pact. We have factions, they have tribes; we have detention centers, they have gulags; we might build a security fence but never a Berlin Wall...wait, sorry, I know I'm digressing but propagandistic language is endlessly fascinating to me. Remember, It's Just a Leak!).
Why is the Wall Street Journal trying to hang around Amazon's neck a money-losing price structure dictated by the Big Five? Because it's bad. And if it's bad, and it's happening in publishing, it must be Amazon's fault. Quod erat demonstrandum.
A paragraph later: "Publishers succeeded in preventing Amazon from lowballing prices…"
Lowballing: "a per unit price that maximizes overall revenue." I guess it's time to update the dictionary.
"Hachette cited fewer hot titles and the implementation of its Amazon deal as reasons that e-books fell to 24% of its U.S. net trade sales in the first half of 2015, from 29% a year earlier."
I think this would read a little more clearly as "Hachette cited fewer hot titles and the implementation of THE PRICING STRUCTURE THE BIG FIVE INSISTED ON as reasons that e-books fell to 24% of its U.S. net trade sales in the first half of 2015, from 29% a year earlier."
Nah, that's crazy talk. If there's a problem, it must be The Amazon Deal Pact that caused it.
And this: "Pricing e-books is a Goldilocks problem for the book giants: For years they worried that consumer prices were too low, and now they are seeing the disadvantages of bumped-up prices."
"To figure out how to set prices, a team of data specialists at Macmillan's Manhattan offices in the Flat Iron building sifts through a database of 74 million transactions looking for trends."
Oooh, sounds impressive. But it occurs to me the crack Macmillan Team of Data Specialists could have saved themselves some time, and Macmillan some badly needed revenue lost due to high ebook prices, if they had just read Amazon's announcement about this a year or so ago, or Joe's post from five years ago, or if they had at any point just used the Google to search for something called the Demand Curve…
"Amazon was willing to buy a title for $14.99 and sell it for $9.99, taking a loss to grab market share and encourage adoption of its Kindle e-reader."
It's amazing that someone could write this article and describe the strategy as "grab" market share, rather than as, I don't know, "grow" market share. Is Jeff Trachtenberg psychic? Was he in the meeting rooms where Amazon devised its "grab" strategy? Serious question, Jeff: on what are you basing this assertion? And why do you not at least consider the entirely logical—and substantially better supported by common sense and data—possibility that lower prices don't necessarily cannibalize a market for the benefit of one, but might instead grow that market to the benefit of all?
"Publishers worried that such discounting kept Apple Inc. and Google Inc. from emerging as competitors, as those companies might not want to lose money on e-books."
This would read better as "The Big Five didn't think everyone would agree to subsidize the Big Five's high-price, low-volume, paper-first strategy."
"Apple, which denies wrongdoing, was found liable in a civil case and subsequently lost an appeal in June."
Ah, the little professional courtesies oligarchs extend each other. After all, it's always relevant to note that the convicted defendant continues to deny wrongdoing. Plus it was just a "civil" case (I'm not even sure this terminology is accurate. Does the government bring civil cases prosecuted under US criminal laws?), which doesn't sound all that bad.
In other Wall Street Journal news, "Chester Frot, who denies wrongdoing, was found guilty of burglary and arson and subsequently lost an appeal in June. You can reach him by mail for the next twenty years at San Quentin Correctional Facility."
"Publisher e-book sales have been stagnating since 2013, when they fell 2.5%…"
It's journalistically negligent, or willfully propagandistic, to say this without clarifying that you're talking specifically about legacy publishers. And without pointing out that in the same timeframe self-published ebook sales have been exploding. If you don't understand this point, you can't understand what's really going on in publishing. Which means either that Trachtenberg himself—the guy who writes these articles—doesn't understand what's going on in publishing, or that he doesn't want his readers to.
"One high-level publishing executive disputed that the Amazon pacts are behind the e-book sales decline. 'This is a title-driven business,' he added. 'If you have a good book, price isn't an issue.'"
Did Trachtenberg grant this publishing exec pernicious anonymity because the executive didn't want to be ridiculed for saying something so stupid? Did Trachtenberg ask for anything like, I don't know, supporting data before agreeing to publish an anonymous quote that violates the laws of Econ 101, all available data, and even common sense?
If a book is "good," whatever that means, price isn't an issue? Okay, anonymous publishing executive, why aren't you charging a hundred dollars for your "good" books? You'd be making bank! Could it be that books are a little more fungible than all that? That consumers find books fungible not just with each other, but with other forms of entertainment, as well, meaning that you can very easily suppress sales of a book with a non-issue high price? In fact, it seems you can even suppress sales of an entire market. Bravo!
And then, almost as an aside, in the second-to-last paragraph: "Amazon says e-book sales in its Kindle store—which encompasses a host of titles that aren't published by the five major houses—are up in 2015 in both units and revenue."
A tiny note of insight and relevance! But no analysis of why that is and what it means. Wait a minute, are you saying lower priced book sales are growing in both volume and revenue, while higher priced ones are shrinking by both measures? Is something going on here? What might it mean for the industry?
Nah, why discuss any of that? We know legacy publishes are having a hard time because of the Amazon reason. Anything else goes in the second-to-last paragraph and merits no discussion at all.
I'm not sure why Amazon declined to comment on the article. They could have just said, "Um, we told you so."
As a commenter over at The Passive Voice puts it:
The Big Five really painted themselves and their authors into a corner with agency. They've screwed their authors royally for at least the next two years, just like they've screwed themselves.
1) If they keep their ebook prices high:
– Their ebook revenues (and market share) continue to shrink fast.
– Unable to discount Big Five ebooks, Amazon discounts Big Five print books even more steeply (as they are now), hastening the demise of chain brick-and-mortar bookstores that can't compete at those prices. The Big Five ends up more reliant on Amazon for the Big Five's (less-profitable) paper sales, while the far more profitable ebook market passes them by.
2) But if they lower ebook prices back to where they were in 2014, during the pre-agency days:
– Maybe the erosion of their ebook sales slows. But NOW, under agency, those discounts come out of their own pockets (and those of their authors), instead of Amazon's. The average discount Amazon was underwriting on Big Five books was 20-25% pre-agency—that's a hell of a subsidy, and it's gone now. So under agency, the same discounted 2014 ebook consumer prices and sales will mean 20-25% less revenue for the Big Five than it did in 2015.
– And those lowered consumer ebook prices will once again accelerate the nationwide reader migration from print to ebooks, hastening the demise of chain brick-and-mortar bookstores.
What did Schopenhauer say? "All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."
Although if the Big Five continues to adhere to a high-priced ebook strategy, and continues to rely on insights as fresh and useful as those in this Wall Street Journal article, the more relevant rubric might be Elisabeth Kübler-Ross's anger, denial, bargaining, depression, acceptance.
Although if the Big Five continues to adhere to a high-priced ebook strategy, and continues to rely on insights as fresh and useful as those in this Wall Street Journal article, the more relevant rubric might be Elisabeth Kübler-Ross's anger, denial, bargaining, depression, acceptance.


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Brief Synopsis
An anthropologist investigates a devil worshipper who commands a deadly demon.
One night, professor Henry Harrington, a scientist investigating a devil cult run by Dr. Julian Karswell, drives to Karswell's country estate outside London to beg him to retract a curse he has invoked on the professor. After Harrington promises to recant his exposé, Karswell asks him to return a piece of parchment he was given that contains runic symbols. Harrington responds that the parchment flew out of his hands into the blazing fireplace at his house where it was incinerated. Later, as Harrington pulls into his garage, a demonic figure emerges from a stand of trees. Panicked, Harrington backs his car into an electrical pole and is electrocuted by the fallen lines. The next day, John Holden, an American authority on paranormal psychology, arrives in London to address a conference of his peers. Holden is met by Harrington's aide, Lloyd Williamson, who informs him that Harrington was found dead that morning. At Holden's hotel room, Williamson introduces the other participants of the conference¿Professor Mark O'Brien, an expert in devil worship and Kumar, a psychologist from India. When O'Brien shows Holden several sketches of demons drawn by Rand Hobart, a member of Karswell's cult who has been jailed for murder, and then suggests that the sketches prove Hobart was acting under forces of evil, the skeptical Holden scoffs at his theory. After Karswell phones to ask Holden to call off his investigation into the cult, however, Holden changes his mind about O'Brien's theory and decides to question Hobart. The next day at the British Museum, Holden retraces Harrington's research and discovers that a critical manuscript about witches and demons is missing. Karswell then unexpectedly appears and invites Holden to his estate to peruse his personal copy of the manuscript. After "accidentally" pushing Holden's papers off the table and onto the floor, Karswell picks them up, then hands Holden his business card. Once Karswell departs, Holden examines the card on which the handwritten message "In memoriam Henry Harrington, allowed two weeks" has been inscribed. When Holden shows the card to the librarian, however, the handwriting has vanished. At Harrington's funeral, Holden meets the professor's niece, Joanna who asks to talk with him later that night at his hotel. There, she warns of danger and reads an entry from her uncle's diary concerning the parchment given to him by Karswell. When the parchment flew out of his hands and into the fire, the professor was convinced that he had been put under a witch's spell. Although Holden ridicules the idea of witchcraft, his curiosity has been piqued by the disappearing ink on Karswell's card, so he asks Joanna to drive him to the Karswell estate the next day. While strolling the estate grounds with Holden, Karswell demonstrates his powers by calling down a violent wind storm. After lightning strikes a tree next to Holden, Karswell predicts that he will die on the 28th of that month at 10 p.m. Karswell then agrees to rescind the curse if Holden terminates his investigation. Unperturbed by the death threat, Holden makes a date with Joanna for dinner the next evening. Back in his hotel room, Holden whistles a melody that begins running through his head and O'Brien and Kumar identify it as a folk tune associated with the devil. When O'Brien examines Holden's schedule book, he is puzzled by the fact that all the pages past the 28th are missing. Over dinner the following evening at the Harrington house, Joanna reads Holden an entry from her uncle's diary that notes all the pages from his calendar beyond the 22nd, the day he died, had been torn out. As Joanna warns that the parchment sealed her uncle's death, Holden finds a parchment of runic characters among his papers. The parchment flies out of his hands toward the fireplace, but gets caught in the grate and falls to the ground. The next day, Hobart obtains permission from Mrs. Hobart to hypnotize her son, then returns to the hotel to find Joanna waiting for him there. Joanna asks Holden to accompany her to meet Dr. Karswell's mother, who has arranged a séance with the medium Mr. Meek. At the séance, after going into a trance, Meek begins to speak in Harrington's voice. When Harrington, through Meek, tells Holden that he must seek out the manuscript that Karswell has translated, Joanna insists on driving to Karswell's estate to search for the translation. Holden sneaks into the library and locates the translation, but is prevented from examining it when Karswell's house cat transforms himself into a jaguar and attacks. When Karswell enters the room, the jaguar changes back into a cat. After exchanging hostile words with Karswell, Holden angrily departs. As he crosses the woods on the way to Joanna's car, a ball of smoke suddenly materializes, expands into a cloud and then disappears. Joanna drives Holden to Scotland Yard to report the sighting, but once there, he debunks the cloud as "just a trick gadget rigged by Karswell." Insulted by Holden's insinuation that she has "stampeded him into hysteria," Joanna leaves in a huff. On the 28th, Holden proceeds to the conference where he is scheduled to discuss hypnosis. Using Hobart as his subject, Holden puts him into a trance and shows him the sliver of parchment. Hobart admonishes that to save his life, Holden "must pass the parchment back to the one who gave it to him, who will then be taken by the demon." Then, overwrought by the incantation, Hobart runs to a window and plunges to his death. Now realizing that to save himself, he must hand the parchment to Karswell before 10 p.m. that night, Holden tracks the doctor to the train station where he is scheduled to leave on the 9:45 train to Southampton. After jumping aboard the departing train, Holden locates Karswell's compartment. Joanna, who has been hypnotized by Karswell, is also there. After Karswell releases Joanna from her trance, Holden offers him a note of apology and a cigarette, all rejected by Karswell, who fears they may contain the parchment. As Karswell nervously rushes for the door, Holden hands him his coat, the parchment stuffed into a pocket. As the parchment flies out of the pocket and out the stopped train, Karswell chases it along the tracks. Some distance away,the parchment transforms into a demon, then snatches Karswell off the tracks, crushes him and throws him into the path on an onrushing train. When the police find Karswell's mutilated body, they conclude that his death was caused by the impact of the train. Holden then turns to Joanna and states "sometimes it is better not to know."
Cast & Crew
Additional Details
|MPAA Ratings:
|Premiere Info:
|not available
|Release Date:
|Production Date:
UCLA has VHS P-VA8249M - U.S. version - 81mins.(U.
|Black and White
|Distributions Co:
|Columbia Pictures Corp.
|Mono (RCA Sound System)
|Production Co:
|Sabre Films, Ltd.
|Great Britain and United States
|not available
|not available
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Half a loaf...
Thomas DiMaggio 2018-08-22
This is one of the truly great fantasy films, ranking with "The Haunting" (1960s version ONLY) and "I Walked With A Zombie": but why on... MORE>
The curse of the Demon
malcolm 2017-10-24
That was a heck of a horror movie back then in 1957. I remember seeing it at home and it sure keep a lot of us up at night. Black and white horror movies... MORE>


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Our classic New England campus is less than 10 miles away from the heart of the city, making it easy for you to get in on the action. It's the best of both worlds.
Getting There
Its easy to get from campus to the heart of Harvard Square in Cambridge by bus. From there, hop onto the subway (also known as "the T") to head to downtown Boston, or stick around the area to enjoy the shops and restaurants.
Things to Do
From world-class sporting events to cultural attractions to shopping, there's plenty to see and do in our beloved Beantown. Here are some of our favorites:
- Shopping in the Prudential Center, Faneuil Hall, and on Newbury Street
- Eating at one of the many delicious Italian restaurants in the North End (save room for a cannoli from Mike's Pastry)
- Visiting Museums like the Isabella Stewart Gardener Museum, Museum of Fine Arts and New England Aquarium
- Watching Championship sports with the Boston Bruins, Celtics and Red Sox, and the New England Patriots
Doing Business in Boston
As one of the country's innovation frontiers, it's no surprise that the city and surrounding areas are great places to look for internships and full-time jobs. Dunkin' Donuts, EMC, Gillette, Reebok, Staples and State Street are just some the international companies headquartered locally; many leading tech companies and start-ups also make their home here.


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Should I start treatment? Pros/cons of two suggested treatments
Dear Dr. I have been living with HIV for almost a year. I am sure I got infected last summer, and I have been monitoring my CD4/viral load level since January. I am currently living in the US, but I am not a resident and I may eventually need to go back to South American where I am originally from. Last month I was advised to start treatment in the US because my DC4 were 335. Since December, my DC4 counts have been 408, 412 (January), 335 (April) and I took a test this week to start treatment and the results were 440 (June). My viral loads have been respectively 6828, 5700, 5300, and 4134. I think I should wait, but I would like your opinion. Finally, I would like to know the difference between being treated with Atripla and with a combination of Abacavir, Lamiduvine and Efavirenz, the treatments available in the US and South America respectively.
For folks with counts similar to yours, there are no absolute rules for when to begin combination antiretroviral therapy. Many factors come into play: published guidelines; the potential benefit of decreasing HIV replication (viral load) and improving immune functor (CD4 counts); the risk of short- and long-term drug side effects and toxicities; and the HIVer's readiness to begin lifelong antiretroviral therapy. The current published U.S. Guidelines would recommend you being treatment now. Personally I recommend early intervention (even earlier than most published guidelines) to preserve immune function and decrease damaging immune activation. (See below.)
The two regimens you list are similar in that they are based on a common non-nucleoside reverse transcriptase inhibitor drug (efavirenz) plus two reverse transcriptase inhibitors. Atripla contains efavirenz, emtricitabine and tenofovir in a single three-in-one combination pill that is conveniently taken just once per day. The other regimen uses older antiretrovirals (abacavir and lamivudine), which must be taken separately. There are potential side effects associated with abacavir, including a potentially severe hypersensitivity reaction. You can read much more about the individual components of the two regimens in the archives and elsewhere on this site. Have a look!
Good luck. Be well.
Dr. Bob
when to start (WHEN TO START TREATMENT, 2009) Jul 12, 2009
as of my last blood work i have a cd4 count of 326 and a viral load of 12,600 and a cd4 percentage of 25% i have been positive for 3 years and this is the first time the cd4 has dropped below 350 and at the time of the bloodwork i was positive for chlamydia, besides that i am very healthy. What should i do? Sincerely, Leery of starting therapy
Response from Dr. Frascino
Hi Leery of Starting Therapy,
I would suggest you have a discussion with your HIV specialist to thoroughly discuss the pros and cons of beginning treatment. I would certainly encourage you to consider starting. However, not until the reasons for your leeriness have been completely cleared up.
I'll reprint below some information from the archives about when to consider starting treatment.
Good luck.
Dr. Bob
should i wait? (WHEN TO START TREATMENT, 2009) Jul 11, 2009
i was diagonised in aug 08. my last risk behaviour was eight months before diagnosis. this was unprotected oral and protected vaginal intercourse outside monogamous relationship. i had unprotected intercourse with my wife since the risk behaviour and until i was diagonised. she became pregnant but remained uninfected (and the baby too). my bloods say that my VL has remained high (>100 000). My CD4 count has been going up from 280 at diagnosis to 520 currently. The doctor says to hold off treatment for now. He also says I should be very careful as I am highly infectious. I dont understand why my partner could not get infected after eight months of unprotected sex. Is it normal for one partner not to pick the infection in such circumstances? Is there any benefit in delaying treatment?
Response from Dr. Frascino
I'm sorry to hear about your recent diagnosis.
Regarding your wife, yes it is indeed possible that she escaped becoming HIV-infected despite having unprotected sex with you for eight months. The main reason is that not every HIV exposure leads to HIV transmission. The CDC estimates that the per-act statistical risk for receptive penile-vaginal sex with a male partner confirmed to be HIV positive is 10 per 10,000 exposures! However, please note this statistical risk is the same for every exposure. Consequently HIV transmission could occur with a single exposure. It's a bit like playing the lottery. Or perhaps a more accurate analogy would be sexual Russian roulette, because the consequences of "winning" can be catastrophic. I should also mention your wife will need follow-up HIV testing at the three- and six-month marks from the date of her last exposure (unprotected sex) to confirm her HIV-negative status.
As for when to begin antiretroviral therapy, this is a personal decision that has many variables to consider, including your degree of immune deterioration, viral load, desire to begin treatment, risk of medication side effects/toxicities, etc. The guidelines for beginning treatment are always in flux as we learn more about the pathogenesis of HIV and as new less toxic, more effective anti-HIV medications become available. I'll reprint below some information concerning when to consider beginning treatment below. I should also point out one potential extenuating circumstance for you. Your wife is (at least so far) HIV negative and you have an extremely high HIV plasma viral load, which means you are highly infectious. If you were to begin antiretroviral therapy now and drive your viral load to undetectable levels, the chance of HIV transmission would decrease significantly. I would suggest both you and your wife read through the chapters in the archives devoted to magnetic couples (one poz, one neggie) and HIV sexual prevention. I'll also report below some information from the archives on harm-reduction strategies for magnetic couples.
Good luck to you both.
Dr. Bob
hiv , no meds and babies (WHEN TO START THERAPY) May 30, 2009
i was diagnosed with hiv a few weeks ago and my viral load is around 10 000ish and my cd4 count is 500-600 (i had tonsilitis at the time of blood test) and my doctor has said that its not neccesary for me to take the meds yet untill my cd4 cell count drops unless however i can choose to start them now. im confused becuase most of the information i can find tells me that the earlier you start meds the better your chances at living longer. its all new to me and i researched my ass off so much so that my doctor didnt have enough time to answer all my tech questions! so if you could fill me in...
the reason that i found out i was hiv +ive was due to being pregnant but i lost the baby due to stress from the results and my partner and i want to try again as we are aware that there is less than 2% chance of the baby being hiv +ive and my doctor is unsure whether if i should start meds before we try to get pregnant again or whether to wait until after the first crucial three month period of pregnancy.
thirdly if my partner has hiv, which is highly likely if i have it, are we still able to procreate the regular way? hanky panky or sperm washing and ivf etc etc. can a hiv + sperm lead to +ive babies. becuase im guessing they are all out of our price range and we really want a bub
thankyou for your time dr
Response from Dr. Frascino
I'm sorry to learn of your recent HIV diagnosis and miscarriage. The questions you raise are complex and are best handled via a conversation with your HIV specialist. I encourage you to discuss your questions and concerns with your HIV physician, as the information I can provide via this format cannot substitute for an in-depth face-to-face discussion.
As for the optimal time to begin combination antiretroviral medication, the truth is we don't know. The current guidelines recommend starting when CD4 counts drop into the 350 range. You are correct: More recent evidence suggests that starting earlier may be beneficial (decreased immune activation, preserved immune function, etc.). However, these potential benefits must always be weighed against the potential of drug side effects and toxicities. Personally I would encourage early intervention with antiretroviral therapy if the HIVer is ready, willing and motivated to begin. I'll reprint below some information from the archives that addresses this topic.
As for whether to take antiretroviral medications during the first trimester (first three months) of pregnancy, this depends on what your CD4 count and viral load are at the time of conception. If you have a reasonably low HIV plasma viral load and preserved CD4 count, I would support waiting until the second trimester after the period of organogenesis (period when the baby's organs are being formed). However, if your CD4 count was low and viral load sky high, I'd start treatment without delay. There is additional information in the archives of this forum in the chapter devoted to pregnancy. Check it out!
Regarding starting a family when one or both partners are HIV infected, yes it is possible. If the guy is "positively charged" (so to speak), sperm washing and IVF would be safest to avoid infecting a negative partner (or decreasing the risk of superinfection/dual infection in a positive partner). Hanky-panky is a bit riskier but there are some harm-reduction strategies that can be employed, including using antiretroviral drugs to drive the viral loads to undetectable levels. This would significantly decrease the risk of viral transmission. Also you should time your unprotected nookies to the period in your menstrual cycle when you are most likely to conceive. Before going into additional detail, I recommend you first determine if your partner is HIV positive or not. That should be your next step, along with an in-depth discussion of these topics with your HIV specialist.
Good luck.
Dr. Bob
Early Initiation of Antiretroviral Therapy Improves HIV Survival Rates, Study Says
April 30, 2009
The New York Times on Thursday examined a study that found asymptomatic HIV-positive people who delayed antiretroviral treatment until their disease reached an advanced stage faced higher mortality rates than those who initiated treatment earlier. According to the Times, current national guidelines recommend starting HIV-positive people on antiretroviral treatment when CD4+ T cell counts fall below 350; however, the recent study suggests that initiating treatment earlier could reduce the risk of death. The study, as well as a related editorial, appeared online in the New England Journal of Medicine earlier this month and both will appear in the April 30 edition of the journal. In addition, a separate study published online earlier this month in the journal Lancet developed similar conclusions about the benefits of earlier antiretroviral therapy initiation, the Times reports.
For the NEJM study, researchers led by Mari Kitahata, director of clinical epidemiology at the Center for AIDS and Sexually Transmitted Infections at the University of Washington, tracked survival rates for 17,517 asymptomatic HIV-positive people in the U.S. and Canada who received care from 1996 to 2005 and who had never previously taken antiretroviral therapy. For their first analysis, the researchers examined a group of 8,362 patients, 2,084 of whom started therapy when CD4+ counts were between 351 and 500. They also examined 6,278 participants with similar CD4+ counts who delayed therapy until their counts declined below 350. According to the study, the patients who delayed treatment had a 69% higher risk of death compared with those who initiated treatment earlier. For the researchers' second analysis, they examined 9,155 HIV-positive people with CD4+ counts of more than 500. Of those, 2,220 started therapy within six months, while 6,935 delayed therapy. Among those who postponed treatment, 3,881 experienced a decline in CD4+ levels and 539 started antiretroviral treatment within six months of having a CD4+ count of 500 or less. In addition, the researchers found that those who deferred therapy had a 94% greater mortality risk than those who initiated treatment earlier.
According to Kitahata, the study examined "one of the most important questions in the last decade: what the optimal timing is for starting therapy." She added that the recent research "provides evidence that patients would live longer if antiretroviral treatment was begun when their CD4+ count was above 500." According to the Times, the study is "not the final word on the matter" (Rabin, New York Times, 4/30).
Delaying HAART Might Prevent Complete Immune System Recuperation, Study Says
April 9, 2009
People living with HIV who do not start highly active antiretroviral treatment until their CD4+ T cell counts drop below 200 might not be able to reach a normal CD4 cell count, even after 10 years of otherwise effective treatment, according to a study in the March 15 issue of Clinical Infectious Diseases, Reuters reports. According to Reuters, an HIV-positive person is considered to have a normalized immune status after CD4 counts are maintained above 500.
For the study, researchers examined 366 HIV-positive people who had maintained plasma HIV RNA levels of no more than 1,000 copies per milliliter of blood for at least four years after starting therapy. About 25% of the study's participants were followed for more than 10 years, with a median follow-up of 7.5 years. Reuters reports that 95% of the participants who started therapy with a CD4 cell count of at least 300 were able to reach a normalized CD4 cell count of at least 500. The researchers reported that 44% of participants who began treatment with a CD4 cell count of less than 100 -- as well as 25% who began treatment with a CD4 cell count of between 100 and 200 -- were not able to reach a CD4 cell count higher than 500.
Lead author Steven Deeks of the University of California-San Francisco and colleagues wrote that a "persistently low CD4 cell count during treatment is associated with increased risk of both AIDS and non-AIDS related events," such as liver disease, cardiovascular disease and cancer. They added that "novel immune-based therapeutic approaches may be necessary to restore immunocompetence in these individuals." In a related editorial, Boris Julg and Bruce Walker, both of Massachusetts General Hospital, wrote that major treatment guidelines recommend beginning antiretroviral therapy when CD4 cell counts drop below 350, adding that it can be difficult for developing and low-income countries to follow such advice. Julg and Walker wrote that "adequate early therapy, leading to more-complete immune reconstitution, may save resources because of the resulting lower incidence of opportunistic infections and reduced need for medical care" (Reuters, 4/7).
Study Supports Earlier Antiretroviral Treatment, Researchers Call for Amended Recommendations
April 9, 2009
In in the journal Lancet on Thursday, researchers published findings that they say support calls for starting antiretroviral treatment earlier than some current recommendations, AFP/Yahoo! News reports. According to AFP/Yahoo! News, there are no universal guidelines for when HIV-positive people should begin highly active antiretroviral therapy, but a common recommendation is to begin the treatment when CD4+ T cell counts decline below 200 to 250. Some researchers argue that this recommendation is too low and that more lives could be saved if the treatment was started sooner, according to AFP/Yahoo! News.
For the study, Jonathan Sterne of the University of Bristol and colleagues compared previous studies that followed more than 45,000 HIV-positive people in Europe and North America (AFP/Yahoo! News, 4/8). The data for the study included 21,247 HIV-positive people followed from 1989 to 1995 -- before antiretroviral treatments were developed -- and 24,444 HIV-positive people since 1998, according to Reuters. All of the participants had not progressed to AIDS and had CD4 cell counts of less than 550. In addition, none of the participants reported a history of injection drug use (Reuters, 4/8). According to the study, people who began antiretroviral treatment when their CD4 counts were less than 350 were 28% more likely to develop AIDS or die prematurely than those who began treatment with CD4 counts of 351 to 450. The study also said that the findings support earlier HIV treatment initiation, particularly as new antiretrovirals have fewer side effects than earlier treatments. The study said, "In view of diminished concerns about toxic effects and resistance, our results suggest that 350 cells per microliter should be the minimum threshold at which antiretroviral therapy is started" (AFP/Yahoo! News, 4/8). According to the researchers, the beneficial effects of earlier treatment initiation were especially significant during the first two years of treatment.
The researchers also conducted a repeat analysis among 4,605 HIV-positive injection drug users, which showed similar results. The authors said the results "should be applicable to many patients starting or considering starting combination therapy in developed countries." In a related commentary also published in Lancet, Robin Wood and Stephen Lawn -- both of the University of Cape Town in South Africa -- said that the "question of when to start [antiretroviral treatment] might have more than one right answer." Wood and Lawn noted that the risk-to-benefit ratio of early antiretroviral treatment initiation remains uncertain in developed countries, adding that in low-income settings, the prevalence of AIDS and AIDS-related deaths are typically higher both before and after starting treatment. In the commentary, the authors suggested randomized trials that take into consideration such issues in both types of settings (Reuters, 4/8).
Earlier Antiretroviral Treatment Could Reduce Risk of Death in HIV-Positive People, Study Finds
April 2, 2009
A study published Wednesday in the New England Journal of Medicine suggests that starting HIV-positive people on antiretroviral treatment earlier than what current guidelines recommend could reduce the risk of death, the Wall Street Journal's "Health Blog" reports (Goldstein, "Health Blog," Wall Street Journal, 4/1). Researchers in two separate analyses examined the medical records of about 17,000 HIV-positive people (Waters, Bloomberg, 4/1). They looked at participants' CD4+ T cell count, starting with 8,000 participants in the first analysis. The researchers compared patients who began antiretroviral treatment within six months of receiving a CD4 count between 351 and 500 with those who delayed starting treatment until after their CD4 count was 350 or less. The patients that delayed treatment had a 69% higher risk of death during the follow-up period.
For the second analysis, the researchers studied 9,000 patients, comparing those who began treatment six months within receiving a CD4 count of 500 or greater with those who delayed starting treatment until their CD4 count was below 500. The researchers found that there was a 94% higher risk of death among patients who delayed treatment ("Health Blog," Wall Street Journal, 4/1). Bloomberg reports that the study adds to growing support for changing current guidelines, which recommend starting HIV-positive people on antiretroviral treatment when CD4 counts fall below 350. Current guidelines also say that doctors can decide on an individual basis whether patients with CD4 counts above 350 should begin treatment. For several years, doctors and patients have struggled with when to begin antiretroviral treatment, which can have significant side effects such as nausea, stomach issues, changes in blood fat levels and altered mental processes, Bloomberg reports.
Reaction The study adds "weight to a growing body of research that suggests treating HIV at earlier stages can help save lives," Bloomberg reports. "The drugs are now safer and the evidence mounting from our data and other data suggests it makes sense to start therapy earlier," Richard Moore, study author and professor of medicine at Johns Hopkins Bloomberg School of Public Health, said. Jason Kantor -- an analyst with RBC Capital Markets in San Francisco -- said the study's findings are already known to many doctors but that they still are likely to spark increased use of antiretroviral treatment. Brad Hare, medical director of the University of California-San Francisco's Positive Health Program at San Francisco General Hospital, said the study provides "a scientific foundation for a practice that a lot of patients and doctors have already been doing, namely starting medications earlier."
Harvard Medical School researchers Paul Sax and Lindsey Baden write in an accompanying editorial that the findings cannot be considered conclusive because researchers did not randomly assign patients to begin treatment at different stages but analyzed patient records, Bloomberg reports. The editorial says, "The supportive evidence for the benefits of earlier therapy continues to increase," although the study did not "provide definitive proof that we should start antiretroviral therapy in all" HIV-positive patients (Bloomberg, 4/1). Sax and Baden also write that the participants who began treatment earlier might have differed from those who waited in ways that improved survival rates and were independent of when they initiated therapy. To address this, researchers should randomly assign patients to begin therapy earlier or later and determine which group fares better, the editorial says, noting that at least three such studies are ongoing or planned ("Health Blog," Wall Street Journal, 4/1). Hare said that the study will spark a discussion into changing current guidelines on when to begin treatment and whether the government should fund a randomized clinical trial. The study was sponsored by two federal agencies, including NIH (Bloomberg, 4/1).
Tired (WHEN TO START TREATMENT, 2009) May 31, 2009
Hi Dr Bob. 2 weeks ago i had a routine blood test whch gave low neutrophile counts 1.200 X mm3 an d low Hb 11 and Hematocrit of 34 I got concerned and had an HIV test, this came back positive. My viral load is 6.000 and my CD4 257, the Dr says I must start treatment, is this correct? Besides feeling a bit tired sometimes, I feel fine. Thank you Paco
Response from Dr. Frascino
Hello Paco,
I'm sorry to hear about your recent diagnosis. If indeed your CD4 count is in the middle-250 range, I would strongly suggest you begin combination antiretroviral therapy without delay. Since this was your first test, if possible I would recommend repeating your CD4 count and HIV plasma viral load and also obtaining a resistance test (genotype). This will allow for confirmation that there was no laboratory or clerical error. Plus, the resistance test will help in selecting the best medications to include in your first regimen. I'll reprint some information from the archives that discusses beginning treatment. I would also suggest you read the information in the chapter "Just Diagnosed" that can be easily accessed on The Body's homepage. From there you can proceed to review the wealth of other information on this site.
Good luck. I'm here if you need me, OK?
Dr. Bob
Should meds be NOW considered? (WHEN TO BEGIN TREATMENT) Dec 26, 2008
Hello Dr. Bob.. Happy Holidays.. and may your coming year be as bright as a shining star.. I recently did my labs on received my results..CD4..453 and viral load 44,000. I have some minor discomfort such as swollen lymph nodes in the groin area and infrequent joint pains in elbow and knees. Do u recommend and consider the start of ARV treatment? Please give me your feedback because I am getting worried whether my immune system is rapidly degenerating.
Response from Dr. Frascino
The optimal time to begin antiretroviral therapy remains a hotly debated topic as we learn more about HIV pathogenesis and natural history and develop new, more potent, less toxic medications. I'll try to give you an update on where things stand at the moment, but I would strongly suggest you discuss your situation with your HIV physician specialist, as there are many variables that must be taken into consideration for each individual situation. There is no one right answer for everyone. When it comes to beginning antiretroviral therapy it's a case of "one size fits one!"
A new study presented at the recent AIDS meetings in Washington, D.C. suggested HIV-positive folks should begin antiretroviral therapy sooner than the guidelines currently recommend (CD4 count of 350). The large study found that delaying the start of treatment until the CD4 count falls to 350 nearly doubles the risk of death during the next few years when compared to the risk of death in patients who began treatment earlier (CD4 count under 500). The survival benefit, however, must be weighed against the chances of drug toxicities and side effects. There is also the risk that poor regimen adherence could breed a drug-resistant strain of virus. There are, however, now three recent studies all showing that HIV-positive folks who begin antiretrovirals while CD4 counts are above 350 have a better chance of their counts returning to the normal range (600-1,200) than those who delay treatment until the CD4 count falls below 350.
Personally, as an immunologist, I strongly recommend early intervention with antiretrovirals if the person is ready, willing and motivated to begin taking the medications.
I should also mention there are situations in which we currently start antiretroviral therapy immediately despite CD4 cell counts. These conditions include patients with concurrent hepatitis and certain types of kidney disease and those who are pregnant.
Ultimately, I'm confident there will come a day when any HIV positive patient diagnosed will be advised to begin antiretroviral therapy as soon as they are diagnosed. This year we've seen treatment guidelines for beginning antiretrovirals increase from a CD4 count of 200 to 350. I think it's likely that this trend will continue with a formal recommendation to consider treatment at a CD4 count of 500 in the near future. Stay tuned to The Body. We'll keep you posted as the guidelines are revised. My personal recommendation is to begin antiretroviral therapy as early as possible in most situations, being fully cognizant that there are risks involved and that our scientific knowledge is still incomplete.
Hope that helps.
Dr. Bob
Shingles Starting Treatment & Queen Issues (SHINGLES AND HIV, 2009) (WHEN TO START ANTIRETROVIRAL TREATMENT, 2009) Feb 18, 2009
Hi Dr Bob, Three weeks ago I came down with Shingles. A small patch on the back of my neck and a little across my chest all on the left side. I went to my local GP and he gave me Valtrex ( the 7 day shingle pack)Since then the pain has gone and the Shingles have crusted over ...yet are still present albeit not as visible. Ive been POZ since 20th july 2007 and am NOT ON HAART....do you think having Shingles is a sign that my CD4T cells have fallen below 500??? I have a meeting with my HIV Dr in 1 months time for my usual LABS (cd4 & viral load) Do you think if my CD4 T cells have fallen below 500( even though experts say below 350) i should start treatment?
Also im seeing dark circles appear under my eyes...Im 33 yrs old ..is this simply age related or Low CD4 T cells and high viral load?? I drink plenty of water and have no family background of "dark circles /bags " under eyes...maybe its AGE ..aaarrrggghh And Mardi Gras is only a few weeks away...HELP!?!?!
Thanks, Drew (Sydney, Australia)
Response from Dr. Frascino
G'day Aussie Drew,
Relax mate! Approximately 95% of healthy adults are seropositive for varicella zoster virus (VZV), the virus that causes shingles. Of this 95%, about 5% of healthy adults develop zoster (shingles). The risk for those of us with HIV is between 15 and 25 times greater. However, getting shingles (unlike many opportunistic infections) does not correlate with CD4 counts.
As for what your next CD4 count and/or HIV plasma viral load will be, I really have no way of predicting. (I don't know what your previous counts have been.) It's a good idea to wait a month or so after an intercurrent infection (like shingles) before checking your counts, because viral loads may well rise transiently and CD4 counts fall transiently as a consequence of any infection.
As for the optimal time to begin antiretrovirals, having just returned from the HIV/AIDS meetings in Montreal, I can advise you this topic continues to stimulate lively debate among HIV specialists. Recent studies, such as the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), which included more than 8,000 patients from 22 North American prospective clinical cohorts, are designed to answer the question of when to start therapy. The investigators in this study found a 70% greater mortality in patients who deferred beginning treatment until their counts dropped to 350 compared to those who started treatment with counts between 350 and 500. This study was an "observational" cohort study and therefore there is the possibility of selection bias, etc. However, the results are certainly intriguing. It's also worth noting there are now several other studies that have also found lower mortality, morbidity, drug toxicity and/or improved CD4 counts with initiation of antiretroviral therapy at CD4 counts above 350. Current guidelines, as you mention, recommend treatment for all patients with CD4 counts below 350. However, with results of large studies suggesting earlier treatment is better coupled with the recent approval of new and novel antiretroviral therapies which appear to be better tolerated, less toxic, more convenient and less risky if adherence is not perfect, the treatment pendulum certainly seems to be swinging back in the direction of early intervention. Personally, I encourage earlier intervention if the HIVer is willing and motivated to begin. Ultimately, I think we'll be discussing "when not to start" rather than "when to start" treatment.
Would I recommend treatment if your counts are 500 or less at your next blood draw? I certainly would discuss the option of starting with you to ascertain if indeed you were ready, willing and motivated to do so. If so, yes, I'd recommend you start.
As for the dark circles, no, that's not HIV related. You've just probably had too many Fosters at the pub plus too many late nights at the Midnight Shift.
Enjoy Mardi Gras, Drew. I've got plenty of fond memories of the many Sydney Mardi Gras that I attended! I've even toyed with the idea of heading to Oz for this year's party as well. (Save me a dance, OK?)
Dr. Bob
condom failed (HARM REDUCTION STRATEGIES FOR MAGNETIC COUPLES, 2009) May 27, 2009
I am an hiv neg. female, my boyfriend has been hiv pos. for 20 years.and his viral load has always been undetectable.3 nights ago,after sex, we realized the condom had come off and was still inside me,it took some digging, but he got it out.and it was evident that he had come inside me.. afterwards, i started spotting, and started my period the next day. wich has me concerned.i get tested every 4 to 6 months, and had just been tested a week before..i am not going to get all stressed out about it,i know nothing is ever 100% safe,and it can only make things harder. but, the fact that i was bleeding a little has me worried.. how likely is it i've been infected ?, and how long should i wait to get tested again?.this is the first, and hopefuly the last accident we have had.!!
Response from Dr. Frascino
Condom failure does place you at some degree of risk for HIV. That your positive boyfriend has an undetectable HIV plasma viral load would significantly decrease the risk of HIV transmission. However, your spotting may increase the HIV-transmission risk. In situations where there has been a significant HIV exposure, post-exposure prophylaxis (PEP) would be warranted if it can be started soon and no later than 72 hours after the exposure. Your exposure was three nights ago; consequently, this is no longer an option for you. But I would encourage you and your boyfriend to review the information about harm-reduction strategies for magnetic couples in the archives of this forum. We have an entire chapter devoted to magnetic couples. I'll reprint below a sample of what can be found there. At this point we would recommend you have an HIV-antibody test at the three- and six-month marks. The six-month test is recommended by the CDC because you had a significant HIV exposure from a partner confirmed to be HIV positive.
Good luck. I agree getting all stressed out won't help!
Dr. Bob
Undetectable Viral Load in Semen MAGNETIC COUPLE SEXUAL RISK 2009) May 26, 2009
A "big G'day" from Australia to you, Doctor Bob!
I am an HIV positive male involved in a relationship with an HIV negative female.
I have been on Atripla (or the Aussie equivalent) for a year now, and for 10 of those months been undetectable.
My girlfriend and I always practice safe sex - I wouldn't put her at risk for anything!
However, during sex last night, the condom broke. We were unaware that it broke and probably had vaginal intercourse for about 15 minutes before realising it had snapped.
I did not ejaculate inside her, but (obviously), can't tell you how much pre-cum would have "leaked" during this 10 minute period.
What are the chances she would have contracted HIV from me?
We are both frantically worried about it and it is putting a strain on our (otherwise wonderful) relationship.
I have read that a recent Swiss study found that a consistent undetectable viral load in the blood correlated with the semen, but I have read other reports that say this might now be the case.
I am hoping that being undetectable and not cumming inside her stacks the odds well and truly in her favour. What would be the chances of her contracting something from this one-off incident?
Thanks if you can shed any light on the matter, and good luck to you and your partner in your own magnetic relationship - opposites attract!!
All the best, Oz Boy. xx
Response from Dr. Frascino
Hello Boy from Oz,
Here's what we know:
The HIV plasma viral load usually, but not always, correlates with the HIV viral load in semen (or cervical secretions).
Having an undetectable HIV plasma viral load significantly decreases the chances of HIV transmission.
Not ejaculating in the love canal significantly decreases the chance of HIV transmission.
PEP (post-exposure prophylaxis) taken as soon as possible and no later than 72 hours after an exposure can decrease the chance of HIV transmission. (You can read much more about PEP in the archives.)
To specifically answer your question, the odds are very much in your girlfriend's favor. However, HIV testing is still warranted. I would also recommend you and your gal-pal review the harm-reduction strategies available for magnetic couples (PEP, PrEP, proper condom use, etc.). I'll reprint below some information from the archives. Please note we have an entire chapter devoted to magnetic couples.
Good luck from one magnetic couple to another! Magnetic couples rock!
Dr. Bob
Hiv infection? Magnet couple stress and fear (MAGNETIC COUPLE SEXUAL RISK 2008) Oct 8, 2008
I am negative at the moment and my boyfreind is HIV positive. he is an HIV educator actually.
After I accepted his status, we finally became intimate with each other. I did oral sex on him 3 times that night. Twice on his penis and once with his ass. He precums almost instantly (I don't know if its just with me lol), but I feel like despite the wealth of knowledge about the risk of unprotected oral sex I feel like I may have exposed myself. I didnt not swallow much if any precum. I had a little after taste and I mouthwashed mid session. I only have minor gum bleed after toothbrushing. I am a little concerned about anal oral intercourse too even thought I saw no possible way i could get infected. He penetrated me with a condom and i am not concerned about infection there.
I just want to feel a little assured about my chances for infection here. I love him so much and I find it hard to be intimate with him without thinking about his status. It's a reason why I can't put myself in a condition to penetrate him. And I feel horrible even thinking about talking to him about it because he is an HIV educator and probably know more than most about safe sex practices. Gawd, Just thinking about it and letting my mind run amok about possible infection makes me want to cry becasue I dont want to hurt nor loose him, but I want to trust him with us and our intimacy. And I want to be able to give him my all when we make love without holding myself back.
Given what I said, what were my exposure risks. And what advise do you have for me and the relationship with the one i can see myself with forever?
Response from Dr. Frascino
Your HIV-acquisition risk is extremely low. There have been no documented cases of HIV transmission due to rimming or getting rimmed. Oral sex carries only a very slight risk for HIV acquisition/transmission. You can read much more about this in the archives of this forum. We have entire chapters devoted to oral sex and sexual-HIV transmission risk.
Regarding your concerns about sexual activity within a magnetic relationship, as you might imagine, you are not alone. It's something all magnetic couples must come to terms with. Communication is key and that is what is lacking in your current relationship! That your Mr. Right is an HIV educator should make communication easier, not more difficult! Chances are he's as worried about infecting you as you are about acquiring the virus. The two of you are overdue for a heart-to-heart (note that's heart-to-heart, not hard-to-hard) talk! You need to openly discuss your concerns and together the two of you need to develop sexual rituals based on what is known scientifically about the HIV-transmission risk and on your individual levels of comfort. I suggest both you and your Mr. Wonderful read through the chapter in the archives devoted to magnetic couples. You'll soon see your concerns are shared by many of us in serodiscordant relationships. In addition to taking equal responsibility to make sure HIV is not transmitted, there are a number of other measures the two of you might want to consider to further reduce transmission risk:
Have your poz-partner take antiretrovirals to drive his HIV plasma viral load down to undetectable levels. This will significantly decrease transmission risk.
Get a starter dose of PEP (post-exposure prophylaxis) to have on hand just in case there is an accidental exposure (condom break).
Consider PrEP (pre-exposure prophylaxis). This involves the negative partner taking antiretroviral medication prophylactically on a routine basis. We still don't know if this approach is effective. Clinical trials are underway. Some magnetic couples aren't waiting for the results of the trials, but rather are instituting PrEP as a harm-reduction strategy now.
You can read much more about PEP, PrEP and other risk-reduction strategies in the archives.
Finally, I want to assure you from personal experience that opposites attract and that happily-ever-after can indeed become a reality for magnetic couples. Steve (Dr. Steve, the expert in The Body's Tratamientos forum) is HIV negative. I'm "virally enhanced." We've been happily-ever-aftering for 15 years and yes, that includes toe-curling, wake-the-neighbor, own-name-forgetting fusion sex. My advice to you is to make sure Mr. Right doesn't get away for all the wrong reasons.
Good luck to you both!
Dr. Bob


text:
Location: Arthropod-borne Animal Diseases Research
Project Number: 3020-32000-007-01-I
Project Type: Interagency Reimbursable Agreement
Start Date: Jan 15, 2014
End Date: Jun 30, 2017
Surveillance and vector The main objective of the project is to design and initiate a system for sustainable surveillance of African swine fever virus (ASFV) in the Ukraine. Sub-objectives include: • Minimize the cost of early ASFV detection by determining the necessary sample size of arthropods and feral swine for accurate detection in a local region. Perform small scale surveillance effort in eastern Ukraine to establish methods for a routine, national program. • Train personnel to perform a routine, national program of ASFV surveillance in Ukraine.
This project will strategically and systematically determine the most efficient method of surveillance to mitigate the risk for the emergence and establishment of ASFV in wild pig/soft tick populations. The first step involves a survey of parasitic arthropods (insects and ticks) associated with wild boar and feral pigs and an assessment of their infection status for ASFV. We will then determine which of the soft ticks and other arthropods parasitizing wild boar and feral pigs are competent vectors of ASFV by conducting transmission studies in the laboratory. The predicted distribution of wild boar and feral pigs and the suspect ASFV vectors will be generated using global information systems, spatial analysis, and niche modeling. This predicted distribution will provide a prioritized list of locations for field sampling of wild pigs (animals captured for the purpose and hunted animals) and suspect arthropod vectors. A systematic sampling scheme of priority areas will be conducted to validate the spatial model as a predictive tool that can be used accurately for risk assessment and decision making. This work will be completed by leading Ukrainian specialists in collaboration with USDA investigators. It is expected that the international community will benefit from the evidence-based data generated by this project, which will support ASFV surveillance systems and epizootic risk analysis for ASF control. A. SUMMARY. Year #1 Task 1. Surveillance of ticks in the natural habitat of feral swine in Ukraine. 1.1 Assessing the presence of soft ticks in Ukraine. 1.2. Screening of soft ticks for possible ASF virus presence. Year #2 Task 2. Surveillance of hunted feral swine in the regions adjacent to the ASF affected regions of Russia. 2.1 Assessing tick parasitism of wild boar and feral swine in the Ukraine


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2012 Impact Factor: 3.160
News and Events
DCNU in the News December 2013
Publication date: 10 December 2013
Sunday 8 December 2013
Dr Michelle de Haan and Dr Eva Zita Patai from the Developmental Cognitive Neuroscience Unit (DCNU) at UCL Institute of Child Health talk to the Observer on Sunday 8 December 2013.
Go to: http://www.theguardian.com/science/2013/dec/08/newborn-babies-more-developed-cognitive-development
Faraneh Vargha-Khadem on BBC Radio4
Publication date: 19 September 2013
September 2013
Professor Faraneh Vargha-Khadem speaks to Bettany Hughes on BBC Radio 4 in two of a series of five programmes on "The Ideas that Make Us". Listen to "Idea" and "Love" first broadcast on 16th and 18 September 2013.
Go to: http://www.bbc.co.uk/programmes/b03bn7hm/episodes/guide
Helen Cross: Elected Secretary General ILAE
Publication date: 26 June 2013
June 2013
are due to Professor Helen Cross (UCL Institute of Child Health)
who was recently elected Secretary General of the International
League Against Epilepsy. She says:
Sarah-Jayne Blakemore: Mind & Brain Prize
Publication date: 20 February 2013
January 2013
Professor Sarah-Jayne Blakemore has been awarded the Young Mind&Brain prize 2013 from the University of Turin: http://www.mentecervello.it/home/node/53
Open University Publication: April 2012
Publication date: 19 April 2012
Early Childhood in Focus: Developing Brains
Public Service Review Science & Technology
Publication date: 20 March 2012
CDCN article written by David Gadian and Faraneh Vargha-Khadem on behalf of the CDCN Steering Committee
Breakthroughs in children's medicine
Publication date: 8 December 2011
Coverage of Faraneh Vargha-Khadem's work is featured in:
See publication: Breakthroughs in children's medicine – Read at:
UCL Partner's Psychological Interventions Research Centre (PIRC)
Publication date: 8 December 2011
Faraneh Vargha-Khadem accepted the invitation to join UCL Partner's Psychological Interventions Research Centre (PIRC). PIRC aims to harness the collective power of psychological research within UCLP and its partner Trusts by sharing insights and developing avenues for collaboration. She was invited by Professor Alessandra Lemma, PIRC Clinical Lead at Tavistock & Portman NHS Foundation Trust and Professor Steven Pilling, PIRC Research Lead, Centre for Outcomes Research & Effectiveness and National Collaborating Centre for Mental Health. To officially launch the centre and its work, a seminar was held in November 2011. The seminar featured talks by Dr Jonathan Roiser (UCL Institute of Cognitive Neuroscience) and Prof Stephen Scott (Institute of Psychiatry). In addition, Profs Pilling and Lemma will gave an overview of psychological research within UCLP. This was the first in two parallel seminar series that will run once a term throughout the academic year.
'Language gene' speeds learning
Publication date: 5 December 2011
"Mouse study suggests that mutation to FOXP2 gene may have helped humans learn the muscle movements for speech."
Tate Liverpool exhibition inspires pioneering science games
Publication date: 5 December 2011
Tate Liverpool exhibition inspires pioneering science gamesInspired by Tate Liverpool's current exhibition, Alice in Wonderland, an art-science collaborative made up of scientists, led by UCL Institute of Child Health Dr Michelle de Haan, curators, game designers and film-makers, have just launched Wondermind, a series of pioneering interactive games, videos and an online blog to help children learn about the science of the developing human brain. Read more about the game
Talk on changes in the teenage brain at the BBC Free Thinking Festival
Publication date: 5 December 2011
Professor Sarah-Jayne Blakemore gave a talk on changes in the teenage brain at the BBC Free Thinking Festival, broadcast on Radio 3 on 23rd November 2011:
click here to listen.


text:
Thursday, November 08, 2012
Coronation Futurity Preview: 'Birds' is the word or is it His Race to Win?
TORONTO, November 7 – Sam-Son Farm will be represented by two sons of Stormy Atlantic, Up With the Birds and His Race to Win, in Saturday's $250,000 Coronation Futurity Stakes, at Woodbine.
A key race on the calendar for Canadian-bred two-year-olds, the 1 1/8-mile main track event has drawn six starters, including Up With the Birds, who comes into the race off a strong maiden-breaking performance on September 29 and His Race to Win, fourth in the Cup & Saucer Stakes (turf) on October 20.
The end result was a 3 ½-length score under regular rider Eurico Rosa da Silva, an effort that had conditioner Malcolm Pierce beaming.
"He's definitely a nice colt," praised Pierce. "Now we'll just have to see if he can take that next step forward and win this one. He's certainly improving in every aspect and he's coming into the race just how we'd want him to be."
His Race to Win, who has finished second, third and fourth from three starts, broke inward at the start of the 1 1/16-mile Cup & Saucer, which was contested over 'yielding' ground.
"Eurico said he didn't enjoy the ground that day," offered Pierce. "I was a little disappointed because I felt we could have at least been second in that race. Still, I'm happy with the way he's developing and it's nice to be in the position to have two good-looking, talented colts in your barn."
Although Pierce, who has 55 career stakes wins, has never won the Coronation Futurity, Sam-Son has taken five editions of the race.
Dauphin Fabuleux won in 1984. One year later, Grey Classic was victorious. Sam-Son co-owned 1987 winner Regal Classic with Windfields. Three years later, Rainbows For Life took top honours. Their most recent success came courtesy of Dixieland Diamond in 1999.
"It would be nice to get one," admitted Pierce. "At this point, I'd say Up With the Birds is a step ahead, but that said, it's early in both their careers. They are both continuing to learn and even though it's early to think about, we'll hope they are at their best when the Queen's Plate comes around next year. The only thing about this race is that it hasn't been to kind to the winners when it comes to Plate success."
The last horse to win the Coronation Futurity and then the Plate was Norcliffe, who achieved the feat in 1975-76. He also holds the stakes record time, since the race was contested at 1 1/8 miles, of 1:49.20.
Inaugurated in 1902 at Toronto's Old Woodbine Racetrack, the race has been won by some notable names, including Northern Dancer in 1963, who would go on to win the Kentucky Derby and Preakness Stakes, as well as the Queen's Plate. Sunny's Halo won the 1982 edition and then took the Kentucky Derby the following year.
Also on tap Saturday, the Grade 2, $150,000 Autumn Stakes, a 1 1/16-mile event that marks the return of last year's Coronation Futurity champion, Maritimer.
Post / Horse / Jockey / Trainer
1 / His Race to Win / Alex Solis / Malcolm Pierce
2 / Hesa Big Dude / Melanie Pinto / Justin Nixon
3 / Bookies Nightmare / Davy Moran / Carolyn Costigan
4 / Kitten Candy / Luis Contreras / Robert Tiller
5 / Star Contender / Patrick Husbands / Mark Casse
6 / Up With the Birds / Eurico Rosa da Silva / Malcolm Pierce
Read more articles in the Woodbine category.