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Establishing an Anal Dysplasia Clinic for HIV-Infected Men: Initial ExperienceProlonged exposure to high-risk strains of human papillomavirus (HPV) and the dysplastic effects that HPV exerts on cells of the squamocolumnar transitional junction of the anal canal lead to anal intraepithelial neoplasia (AIN), which is a precursor to squamous cell carcinoma of the anus (SCCA).1 Anal HPV infection is present in 93% of HIV-positive men who have anoreceptive intercourse.2 Furthermore, anal dysplasia of any grade has been reported in 56% of HIV-infected men who participate in anoreceptive intercourse.3,4
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An HIV-Infected Patient With Nocardia asteroides Bilateral PneumoniaPneumonia remains a concern for persons with long-standing HIV infection. We present a case of a 43-year-old HIV-infected woman with bilateral pneumonia whose presentation suggested the cause was a bacterial pathogen.
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The Changing Face of Anal CancerCancer of the anal canal is a relatively uncommon disease in the United States. It accounts for about 2% of the cancers of the GI tract; about 5000 cases will be diagnosed this year. Squamous cell carcinoma of the anus (anal SCC) is of particular interest to the infectious disease specialist because it is one of the cancers associated with HIV infection in men who have sex with men (MSM).
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Conquering the HIV+ Patient's Special Challenges With Smoking CessationThere are many reasons why people infected with HIV are more likely to be smokers, and the condition makes it a challenge to quit. But many do want to stop smoking, and a new program shows how to tailor the effort for them.
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Antiretroviral Therapy: Short-Term, Earlier Interventions Show PromiseNew guidelines on the use of antiretroviral therapy, together with recently published studies, highlight the benefits of early, short-term treatment on outcomes, clinical signs of the disease, morbidity and mortality, and secondary transmission.
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An HIV-Infected Patient With Nocardia asteroides Bilateral PneumoniaPneumonia remains a concern for persons with long-standing HIV infection. We present a case of a 43-year-old HIV-infected woman with bilateral pneumonia whose presentation suggested the cause was a bacterial pathogen.
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Extensive Development of Flat Warts as a Cutaneous Manifestation of Immune Reconstitution SyndromeCutaneous manifestations of immune recovery in response to highly active antiretroviral therapy may account for up to 54% to 78% of the clinical presentations of the immune reconstitution syndrome (IRS)
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HIV-Associated Pseudotumor Cerebri: A Case Report and Literature ReviewIdiopathic intracranial hypertension is a cause of vision loss in HIV-positive patients. In many patients with controlled HIV disease, idiopathic intracranial hypertension develops without any other apparent cause.
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Treatment of Acute Hepatitis C in an HIV-Positive Man With Pegylated Interferon and Ribavirin for 24 WeeksAn epidemic of acute hepatitis C is emerging among HIV-infected men who have sex with men (MSM), with a growing number of cases reported in the MSM population in the United States and Europe.
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A Really Big Pain: Acute EpididymitisA 24-year-old man with a history of HIV infection (CD4+ cell count, 746/µL [32%]; HIV RNA level, 980 copies/mL; nadir CD4+ cell count, 482/µL [29%]), secondary syphilis, major depression, and intermittent crystal methamphetamine use presented to the emergency department with a 1-week history of gradually increasing pain and swelling in the left side of his scrotum, 2 days of fever (temperature to 38.6°C [101.5°F]), and chills.
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Schistosoma mansoni Colitis in an AIDS PatientA 33-year-old man from the Ivory Coast (who had been living in the United States for the past 8 years) received a diagnosis of AIDS when he presented with Pneumocystis jiroveci pneumonia. His CD4+ cell count was 6/µL, and his HIV RNA level was 575,000 copies/mL. He also presented with altered sensorium and seizure activity and was found to have obstructive hydrocephalus and ring-enhancing lesions in both cerebellar hemispheres and basal ganglia. Results of polymerase chain reaction testing of cerebrospinal fluid for Toxoplasma gondii were positive, and treatment for toxoplasmosis was started. A ventricular-peritoneal shunt was placed.
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Subacute Onset of Paralysis in a Person With AIDSThe pathogen Toxoplasma gondii is an intracellular protozoan that most commonly presents in persons with AIDS as reactivation of latent infection.
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Psychiatric Aspects of HIV/AIDSIn the era of rapid transmittal of health information and frequent educational updates via the Internet, hardcover medical texts still have a place. A worthy newcomer in this regard is Psychiatric Aspects of HIV/AIDS, edited by Fernandez and Ruiz, a comprehensive sourcebook with contributions by a panel of experts.
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Schistosoma mansoni Colitis in an AIDS PatientA 33-year-old man from the Ivory Coast (who had been living in the United States for the past 8 years) received a diagnosis of AIDS when he presented with Pneumocystis jiroveci pneumonia. His CD4+ cell count was 6/µL, and his HIV RNA level was 575,000 copies/mL. He also presented with altered sensorium and seizure activity and was found to have obstructive hydrocephalus and ring-enhancing lesions in both cerebellar hemispheres and basal ganglia. Results of polymerase chain reaction testing of cerebrospinal fluid for Toxoplasma gondii were positive, and treatment for toxoplasmosis was started. A ventricular-peritoneal shunt was placed.
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Oral HistoplasmosisA 39-year-old woman complained of excruciating pain that radiated from a chronic lesion on the left upper lip to the entire left side of the face. She had AIDS (CD4+ cell count, 68/µL; HIV RNA level, greater than 750,000 copies/mL) but was not receiving antiretroviral therapy. The lesion first appeared as a blister, which ruptured after it was struck by a toy thrown by her son. It enlarged and became more painful despite antibiotic therapy and a 1-month course of valacyclovir. During this period, she had no fever. She used marijuana and alcohol for pain control.
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Unusual Cause of Bilateral Optic Neuritis in a Patient With AIDSBilateral retrobulbar optic neuritis developed in a 38-year-old woman with advanced HIV infection. This was secondary to varicella-zoster virus (VZV) infection, confirmed by polymerase chain reaction detection of VZV in the patient's cerebrospinal fluid. There was no evidence of retinitis, and the ocular symptoms preceded the rash. This case illustrates that a new onset of unexplained visual loss resulting from optic neuritis in an HIV-positive patient may be caused by VZV infection. Clinicians should be aware of this unusual manifestation of VZV infection. Prompt recognition and early intervention with antivirals are needed, but it is unclear how much vision can be preserved.
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Pre-exposure HIV Prophylaxis WorksFurther hope for prevention of transmission as the search for a cure continues.
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Public Health and Human Rights: Evidence-Based ApproachesThe words HIV or AIDS do not appear in the title of this book, and at first glance, this book appears to be about something else. On the contrary, it is about HIV and much more.
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HIV-Associated Intestinal SpirochetosisA 33-year-old, sexually active homosexual HIV-positive man, with a CD4+ T-lymphocyte count of 258/µL and HIV-1 RNA level of 7079 copies/mL, presented to his primary care physician with left upper quadrant pain, urgency to defecate, and non-bloody watery diarrhea.
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Ryan White: An Unintentional Home BuilderAs Indiana native John Mellencamp might say, “Ryan White was born in a small town.” Kokomo, Ind, in 1971 indeed was a thriving, relatively small community in America’s Heartland. A town founded on family values, hard work, and a full belief in the American Dream,
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Oral HistoplasmosisA 39-year-old woman complained of excruciating pain that radiated from a chronic lesion on the left upper lip to the entire left side of the face. She had AIDS (CD4+ cell count, 68/µL; HIV RNA level, greater than 750,000 copies/mL) but was not receiving antiretroviral therapy. The lesion first appeared as a blister, which ruptured after it was struck by a toy thrown by her son. It enlarged and became more painful despite antibiotic therapy and a 1-month course of valacyclovir. During this period, she had no fever. She used marijuana and alcohol for pain control.
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Pharmacokinetic Interactions Between Ritonavir-Boosted Darunavir and NNRTIs: A Report of 3 CasesManagement of treatment-experienced patients with multidrug resistance can be challenging. Fortunately, since 2006, 4 new antiretroviral agents-darunavir, maraviroc, raltegravir, and etravirine-with activity against drug-resistant HIV have been approved.
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Non–AIDS-Defining Cancers: Should Antiretroviral Therapy Be Initiated Earlier?Much has been written about the increase in non–AIDS-defining cancers in HIV-infected persons over the past decade.
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Substance Abuse and HIV: Treatment ChallengesSubstance abuse, especially injection drug abuse, is often associated with chronic infectious diseases, including HIV infection, hepatitis B, hepatitis C, and tuberculosis. Delivery of effective treatment for these chronic conditions can be very challenging in patients who continue to abuse substances.
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Mycobacterium avium-intracellulare Complex Immune Reconstitution Inflammatory Syndrome in HIV/AIDS Presenting as OsteomyelitisWe report a case of osteomyelitis due to Mycobacterium avium-intracellulare complex (MAC) in an AIDS patient shortly after the initiation of antiretroviral therapy with subsequent immune reconstitution inflammatory syndrome (IRIS).
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Severe Psoriasis in Advanced HIV InfectionA 50-year-old African American man with HIV infection had a CD4+ T-cell count of 18/μL (1%), CD8+ cell count of 1035/μL (69%), and CD4:CD8 ratio of 0.01 at the time of diagnosis. He had multiple erythematosquamous skin lesions over his forehead, face, chest, back, and extremities
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Routine HIV Screening, Part 2: Beyond Testing and ReferralJake” was a 17-year-old high school student who came to see me with his supportive but anxious mother. Four months earlier, Jake’s pediatrician, having read the CDC recommendations for routine testing of all patients aged 13 to 64,
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An HIV-Infected Patient With Nocardia asteroides Bilateral PneumoniaPneumonia remains a concern for persons with long-standing HIV infection. We present a case of a 43-year-old HIV-infected woman with bilateral pneumonia whose presentation suggested the cause was a bacterial pathogen.
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HSV-1 Encephalitis Complicated by Cerebral Hemorrhage in an HIV-Positive PersonHerpes simplex virus type 1 (HSV-1) is the most common cause of sporadic encephalitis worldwide. In the California Encephalitis Project, 24% of the cases of viral encephalitis were caused by HSV-1 and 3% were caused by HSV-2.1
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Severe Psoriasis in Advanced HIV InfectionA 50-year-old African American man with HIV infection had a CD4+ T-cell count of 18/μL (1%), CD8+ cell count of 1035/μL (69%), and CD4:CD8 ratio of 0.01 at the time of diagnosis. He had multiple erythematosquamous skin lesions over his forehead, face, chest, back, and extremities
