Some mental health professionals—psychiatrists, psychologists, social workers, psychiatric nurses, counselors—deal primarily with people affected by HIV infection. Psychiatrists are physicians who have specialized in psychiatry—that is, in disorders of mood and thinking; psychiatrists can prescribe medication. Psychologists have doctoral degrees, either a Ph.D. or an Ed.D., in psychology; psychologists can test and diagnose. Social workers have master’s degrees plus supervised training. Psychiatric nurses have master’s degrees plus supervised training. And counselors can be pastors or others who counsel people. All these professionals should be certified by the certifying boards of their respective professions. The certifying boards for counselors are variable, some good, some not so good, and as a result, counselors are not as tightly monitored as the other mental health professionals. To overgeneralize, these professionals offer two kinds of therapy—talk therapy and medical therapy. All of them offer talk therapy. They can help you express and understand and resolve painful feelings, analyze and solve problems with other people, gain a sense of who you are as a whole person. They will work with problems that range from the specific and practical to the fundamental and philosophical. You can say anything to them. Psychiatrists alone can also offer medical therapy, drugs that restore sleep, appetite, and mood. Probably the best advice is to begin with talk therapy, but you will want to ask the professional to refer you for medical therapy if necessary. The professional who is unwilling to do this is best avoided. If you do not know who the mental health professionals are, begin by asking the medical professionals—doctors, nurses, physician’s assistants—you do know. If they cannot help, they will surely refer you to someone who can. Local AIDS-advocacy groups, the gay community, local mental health associations, and state mental health agencies all have lists of qualified, experienced mental health professionals.*235\191\2*
Blisters are small, fluid-filled bubbles that often break, becoming open sores filled with clear fluid or pus. Blisters can occur in groups in one specific area of the skin, or they can be distributed all over the skin.
Like red rashes, blistering rashes can be caused by adverse reactions to drugs. The most common causes of blistering rash in people with HIV infection, however, are two related viruses, herpes simplex and herpes zoster.
Herpes zoster, or shingles-Herpes zoster is caused by the same virus that causes chickenpox. Like herpes simplex, the herpes zoster virus stays dormant in the nerve cells. The virus recurs many years or decades after the original bout with chickenpox, causing a disease galled shingles. Shingles is common not only in people with HIV infection, but in the elderly and in others as well.
The symptoms of shingles are blisters that are identical to those seen with chickenpox. The blisters are small and filled with a watery fluid; later, the blisters break, the fluid becomes pus, scabs form, and the skin heals. Unlike the blisters of chickenpox, however, the blisters of shingles are often extremely painful. In addition, they are not spread all over the body, but instead are distributed in bands or lines on the chest, the abdomen, down the leg, on the arm, or on the face. In all cases, the blisters occur on only one side of the body and stop abruptly at the middle of the body. The blisters follow this pattern because they are following the path of the nerve in which the virus is living, and each nerve serves only one side of the body.
The worst complication of this infection is pain. The pain may come before the blisters appear, or it may accompany the blisters. The pain may also occur once the blisters are gone and the skin is healed; this pain is called post-herpetic neuralgia. Fortunately, people with HIV infection who get shingles simply do not often develop post-herpetic neuralgia.
A note about transmission: the blisters contain the virus that causes herpes zoster. Adults who have had chickenpox already have this virus, have antibodies to it, and are not susceptible when exposed to someone with chickenpox or shingles. However, young children and the rare adult who has escaped chickenpox could become infected with the virus that causes herpes zoster. These people may acquire chickenpox by contact with the blisters or by inhaling it. To prevent transmission, people who have not had chickenpox should carefully avoid contact and should even avoid being present in the same room. People who are hospitalized should expect strict isolation precautions—gloves, mask, and gowns—to be taken, to prevent transmission to the health care workers.
Shingles is not life-threatening and inevitably cures itself. But it can be especially severe in people with HIV, so treatment is generally recommended. Shingles can be treated with acyclovir, and other drugs may be given to control the pain. Acyclovir may be given by mouth, but the doses required are unusually large, and hospitalization for intravenous treatment is sometimes advocated.
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