Little has been written about chiropractic and AIDS. Given the history of the disease, the risk to the doctor and his staff must be considered. Also, the fears of caregivers and especially, patients must be addressed because of the widespread ignorance about the dangers of AIDS. Education of both doctor and patient is the key to keeping this dreaded disease under control.
Any journey begins with the first step, and a brief review of the history of AIDS is in order. Though the disease first appeared in the U.S. in 1981, AIDS was new only to the Western world. It is thought to have originated in Central Africa, caused by a virus that was perhaps an evolutionary descendant of one that had existed in monkeys for thousands of years. There is also the possibility that the virus had existed in humans in Central Africa for hundreds of thousands of years. How the AIDS virus came out of Africa is not known for sure, but it has been suggested that it may have been by way of Haiti. During the 1970s thousands of people participated in cultural exchanges between the French-speaking populations of Zaire and the Caribbean islands. AIDS may have been carried from Haiti to New York by American homosexuals, for whom the island had become a popular vacation spot. It then could have moved quickly from the US to other parts of the world, where it settled in and began its work of infecting the relatively closed homosexual and drug-abusing communities, in which the conditions essential to infection were ideal.
In the initial infected stage of the disease, there are believed to be some 1.5 million Americans,1 most of whom are sexually active homosexual and bisexual males, and men and women who abuse intravenous drugs. A small percentage of the infected population has received transfused blood tainted with the AIDS virus, are the heterosexual partners of someone with AIDS, or are infants born to infected mothers. The others remain unclassified, though most likely these are unaffected members of one of the other high risk groups.
Generally, members of the infected group show laboratory evidence of infection, i.e., antibodies to the virus are seen in blood samples but the patient may or may not be symptomatic at this time. Current estimates suggest that an infected person who is asymptomatic will develop detectable antibodies to the virus two to eight weeks after initial exposure, but in some cases six or more months may pass before there is such evidence of infection. The period of time that an infected individual remains symptom-free varies widely from days to weeks to many years. When symptoms do appear, the individual falls into the next stage, AIDS-related complex.
The intermediate stage of an AIDS virus infection is characterized by a range of symptoms and illnesses that also are found in patients who meet the technical definition of AIDS itself. The symptoms, many of which it must be pointed out may occur in people who are not infected with the AIDS virus, include unexpected and unexplained loss of appetite and weight loss of more than 10 pounds in less than two months; leg weakness; unexplained fever that has lasted for more than a week; night sweats; persistent and unexplained diarrhea; persistent dry coughing; white spots or unusual blemishes in the mouth; hairy leukoplakia, a precancerous condition showing itself with white sores as well as thickening and overgrowth of the mucous membrane of the mouth, on the tongue, or in the vagina; shingles; and lymphoma, a cancer of the lymphatic system. With shingles comes another symptom of special interest to the chiropractor: back pain.
Patients are diagnosed as having full-blown AIDS if they have a positive blood test for the antibodies to the virus, a positive culture or the virus itself and positive lab tests that demonstrate profound immune dysfunction and loss of a specific class of disease-fighting white blood cells called T-4 lymphocytes. They also have one or more of a number of life-threatening opportunities diseases that cannot be explained by any cause other than infection with the AIDS virus. These include:
- pneumocystitis pneumonia, a parasitic infection of the lungs with a 25 to 50 percent fatality rate;
- cytomegalovirus (CMV) infection, which causes blindness, pneumonia, colitis, and esophagitis;
- candidiasis in its esophageal form;
- crytosporidiosis, causing sever diarrhea with danger of death;
- tuberculosis, which appears with a greater than expected frequency in AIDS patients, especially IV drug users, but responds well to treatment;
- Kaposi's sarcoma, a cancer or tumor of the blood or lymphatic vessel walls, which for some as yet unclear reason strikes homosexual men with AIDS far more often than it does other patients with AIDS.
The Center for Disease Control in Atlanta (1993) estimated that one in every 250 people are infected with the AIDS virus.2 The average chiropractor sees between 100-250 patients per week, with some seeing that many patients in a single day. Using these statistics, the risk of exposure is definitely real. AIDS was the leading cause of death in males between 25 and 44 years of age (1992)3 and sixth leading cause of death in females.4
A chiropractor may think, "I practice in a small rural community, so these statistics don't really concern me." The national committee on AIDS reported a 37 percent increase of AIDS and HIV infection in rural cases versus a five percent increase in metropolitan areas.5 The dramatic difference is attributed to several factors: fear, bigotry, lack of education and knowledge. Additional contributing factors include an increase of crack cocaine use, an increased number of sexual partners, and an increase in STD cases.
The ultimate weapon is education. The chiropractor must handle the fear epidemic, which leads otherwise sane people to think and act irrationally and even immorally. Several years have passed since the Kimberly Bergalis incident, in which she accused her dentist, admittedly HIV-positive, of giving her AIDS. The ripples are still being felt across all health care professions. As many of eight percent of health care professionals remain frightened, so much so that primary care physicians and support personnel are making career changes at an alarming rate.
A recent study by McCormack Brown of 225 dental hygienists found that more than 50 percent of the sample was unwilling to treat HIV-positive individuals because of fear of contracting the disease. By complying with OSHA guidelines, environmental planning and good common sense, the chance of getting AIDS from a chiropractic patient is one in several million.6
The relative risk of patient infection from a seropositive care giver is 1 in 263, 000 to 3.8 million cases.7 In stark contrast, the risk of dying from cigarettes is 3.6 in 1,000 and the risk of dying in an auto accident on the way to the chiropractor's office is 1 in 4,167. There are absolutely no published reports of any chiropractor assistants or chiropractors contracting the disease on the job.
The major clinical responsibility for treating persons infected with HIV, today and in the future, falls on the primary care physician and chiropractor, who is used as a portal of entry into the diagnostic arena. More than 140,0008 people in the United States have been diagnosed with HIV and as mentioned earlier, a million more are affected and as yet are asymptomatic. AIDS is no longer a rare disease that will be seen only by the specialist, but a disease that every chiropractor will have to deal with if not on a daily basis at least some time in his or her career.
The chiropractor must become adept at HIV screening, sexual history-taking and counselling both his staff and patients on risk reduction. AIDS prevention is an important preventative health activity for every chiropractic physician.
References
- Roper W, Person H, and Curian J. Condoms and HIV/STD prevention: Clarifying the message: American Journal of Public Health, April 1993, Vol 83(4), p. 501-502.
- CDC, The Scope of HIV/AIDS Epidemic, Nov 1993, p. 1-3.
- Ibid.
- CDC, Facts about the HIV/AIDS Epidemic in the United States, Nov 1993.
- National Commission on AIDS: Report #3, US Government Printing Office, 1990.
- Pugliese, Gina. Complying with OSHA's new pathogen's standard: Health Facilities Management, June 1992, p. 40-46.
- Horowitz, Leonard. Fear of AIDS: RDH, July 1992, p. 35-40.
- National Commission on AIDS: Report #3, US Government Printing Office, 1990.
Carmen Gioia, DC
Clairton, Pennsylvania