AIDS Reader

Physicians are failing to diagnose HIV infection among older patients,

The 16th Conference on Retroviruses and Opportunistic Infections (CROI) was held in Montreal from February 8 to 11, 2009. This conference provided significant new insights into HIV therapeutics. Here we summarize new findings presented on the effect of antiretroviral therapy on cardiovascular disease (CVD) risk; new pharmacokinetic data, notably, the progress in developing pharmacokinetic boosters as alternatives to low-dose ritonavir; and the lack of clinical benefit with interleukin (IL)-2.

The manifestations of HIV infection are known to involve every organ system and aspect of pathophysiology. The bone marrow is particularly susceptible to the ravages of HIV infection; in addition to non-Hodgkin lymphoma, myelodysplasia and acute leukemia have been associated with HIV infection, although they are not considered to be AIDS-defining illnesses.1-5 Here we report the case of a 58-year-old man who presented with myelodysplasia as a primary manifestation of his HIV infection.

The death rate for HIV-infected patients who miss scheduled clinic appointments during their first year of treatment is more than double that for patients with perfect attendance, according to a recent study (Douglas D. Reuters Health. February 11, 2009).

In 2005, members of the Group of Eight (G8)-an international forum for the governments of Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, the United States, and the European Union-along with the African Union and the heads of state attending the 2005 United Nations World Summit, joined with the UNAIDS Secretariat in committing themselves to providing universal access to HIV care, prevention, and treatment for all those in need by 2010.

A 37-year-old white woman, previously in excellent health, presented to a local emergency department for evaluation of evolving left-sided weakness and a slight left facial droop.

New data from UNAIDS show that several African countries with a high HIV prevalence have made significant gains in preventing new infections.

Although highly effective with a high benefit-to-risk ratio, highly active antiretroviral therapy has a variety of adverse effects, including metabolic, lipid, and bone toxicities. Importantly, renal toxicity has been associated with some of the more widely used agents, specifically from the NRTI and protease inhibitor classes.

The availability of highly active antiretroviral therapy has improved the survival and quality of life of patients infected with HIV. Clinicians are now focusing on the management of metabolic complications and previously unrecognized drug toxicities. The incidence and prevalence of kidney disease are increasing in older HIV-infected patients because of the widespread use of antiretroviral therapy.

Herpes simplex virus (HSV) is an enveloped double-stranded DNA virus that is a common pathogen in humans. There are 2 subtypes, HSV-1 and HSV-2,

One of the most highly discussed and publicized HIV-related presentations at the recent Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Diseases Society of America (ICAAC/IDSA)

The combined 48th Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Infectious Diseases Society of America Annual Meeting (ICAAC/IDSA) was held in Washington, DC, from October 24 to 28, 2008.

Many clinicians are not screening patients for HIV as a routine part of health care because they perceive testing takes too much time and because many insurers are reluctant to reimburse for the procedure.

Lymphoma is a well-known complication of HIV infection. Such AIDS-defining lymphomas are usually aggressive B-cell lymphomas. However, epidemiological data have also linked HIV infection with an increased risk of T-cell lymphoma.

Every think tank and every policy wonk in the country is working on white papers, analyses, proposals, critiques, and plans in the hope that their ideas will be placed before the new president and the new Congress.

Debate over the optimal time to initiate antiretroviral therapy for HIV infection is as old as the availability of effective anti-HIV treatment.1 As I've noted in several past editorials, there were cogent arguments on both sides,

A new study presented at the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington, DC, suggests that persons infected with HIV should begin antiretroviral treatment sooner than guidelines currently recommend (Marchione M. Associated Press. October 26, 2008). The large study finds that delaying antiretroviral therapy until patients’ T-cell counts fall below 350/µL nearly doubles the risk of death in the next few years of their lives when compared with the risk of death in patients whose treatment was started earlier.

In September 2008, data from what is purported to be the largest sexual health survey ever conducted in the United States, cataloging more than 1.2 million Internet responses to an “anonymous” questionnaire, were released.1 There were the expected admissions from respondents concerning frequent use of behavioral disinhibitors-alcohol being the most popular-to manage anxiety and “have an excuse” to do what they wanted to do anyway, ie, have sex:

Injection drug use (IDU) has been a route for HIV transmission since the beginning of the epidemic.

As discussed by Mitty and colleagues,1 the proportion of HIV infections associated with injection drug use (IDU) has dropped dramatically across the United States, including the northeastern portion of the country.

Change is in the air. By the time this column is published, the nation will know who will next occupy the White House; many appointees of the departing administration will most likely have already moved on to new positions; and potential appointees will be polishing their résumés and pressing the wrinkles out of their good interview suit.

New research suggests that AIDS among humans occurred at least 3 decades earlier than previously thought. Rapid urbanization in west-central Africa “was the turning point that allowed the pandemic to start,” said Michael Worobey, an evolutionary biologist at the University of Arizona, Tucson, and the study’s lead author (Avasthi A. National Geographic News. October 1, 2008).

One fun thing to do at an International AIDS Conference-aside from the social aspects and the presentations, protests, and theatre found in the Global Village-is to match your wisdom and art in the selection of antiretroviral drug regimens to that of a large audience of HIV-treating physicians and expert panel members. In this sense, the 17th International AIDS Conference, held this year in Mexico City, did not disappoint.

That opening tells more about the book than the author may have intended. The decision to read and review this book was triggered by reading a short announcement of its publication, noting that the wife of one of the most prominent evangelical Christian preachers active in the United States today had come to recognize the challenges of HIV and AIDS and to speak out about the issues. This seemed like a “conversion experience” worthy of exploration.

This month’s Managing Managed Care reviews just a few of the many presentations from the International AIDS Conference that have some relevance to patient care today. One of the highlights was a discussion of the current status of HIV eradication.

As the 2008 election draws closer, the questions of candidates and campaign issues occupy more and more space in print media, minutes on radio and television, and bandwidth in the ubiquitous blogs and spam messages that have become the modern equivalent of brochures hung on the doorknob.

A 14-year-old boy of African origin with HIV infection presented to the emergency department complaining of sore, swollen eyes and a sore throat. His antiretroviral treatment at that time consisted of lopinavir/ ritonavir and abacavir/lamivudine fixed-dose combination.

An assessment of rapid HIV testing offered in emer­-gency department (ED) settings found the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test produced a high rate of false-positives (Reuters. August 5, 2008).

A 42-year-old white woman with AIDS presented to the emergency department (ED) with a 5-day history of persistent, high-grade fever (temperature of 38.3°C to 40.0°C [101°F to 104°F]); generalized weakness; malaise; and mild headache. The previous night she noted the onset of nausea, emesis, and loss of appetite.

The skin is the most common organ to manifest immune reconstitution syndrome (IRS).1-3 While many viral dermatoses are described in the context of antiretroviral-induced immune recovery (eg, herpesvirus infections, molluscum, genital condylomata, verruca vulgaris),4,5 the case report by Iarikov and colleagues6 is the first report of verruca plana in this setting.