HIV AIDS

SAN FRANCISCO -- A standard six-month course of treatment for tuberculosis may not be sufficient to cure patients co-infected with HIV, researchers here say.

We present a case of a 35-year-old man with fever and pancytopenia, who had rapid progression to acute respiratory distress syndrome (ARDS), multiorgan failure, and disseminated intravascular coagulopathy secondary to disseminated tuberculosis (TB). Although both sputum and bronchoalveolar lavage (BAL) fluid smears were negative for acid-fast bacilli, the polymerase chain reaction (PCR) assay on the BAL fluid was positive for Mycobacterium tuberculosis. This case emphasizes the need to include TB in the differential for ARDS and the value of PCR testing of BAL fluid, especially in high-risk patients.

abstract: The use of fiberoptic bronchoscopy (FOB) in HIV- infected patients has sharply declined since the availability of highly active antiretroviral therapy and the resulting decrease in the incidence of opportunistic infections. Nevertheless, FOB continues to be an important diagnostic tool in this patient population. For example, FOB is useful in evaluating for Pneumocystis jiroveci (formerly carinii) pneumonia (PCP) in patients with CD4+ cell counts of less than 200/µL who have diffuse pulmonary infiltrates and in whom sputum induction has not been performed or is nondiagnostic. It is also useful for evaluating patients who have not responded adequately to empiric therapy for bacterial pneumonia or PCP. Other applications include the visual diagnosis of endobronchial Kaposi sarcoma or the assessment of suspected lung cancer. (J Respir Dis. 2007;28(6): 244-252)

SAN DIEGO -- When talking about antipsychotic agents for schizophrenia, it's important to distinguish efficacy from effectiveness.

WASHINGTON -- The FDA should be given the authority to regulate tobacco as an addictive drug, including marketing, advertising, and, eventually, the right to regulate nicotine content, said an Institute of Medicine report issued today.

BETHESDA, Md. -- The bumpy road to an HIV vaccine is leading researchers to try non-traditional avenues and to consider vaccines that -- unlike the classic paradigm -- would offer only partial protection.

LOS ANGELES -- A peptide that protects rhesus monkeys from HIV-1 infection does just the opposite when its structure is reversed, researchers here say.

SILVER SPRING, Md. -- Although the FDA advised physicians in March to use erythropoiesis-stimulating agents at the lowest possible dose to preclude a transfusion, an advisory committee has urged the agency to develop still stricter standards.

OXFORD, England -- A moderately high daily dose of aspirin taken long term may reduce colorectal cancer risk, but gastroenterologists should be cautious about recommending it, researchers said.

HOUSTON -- Patients with hepatitis C virus infection may have a 20% to 30% increased risk of developing non-Hodgkin's lymphoma, researchers here reported.

SEATTLE -- Only 16% of sedating antihistamine use among older patients at VA medical centers was for an appropriate indication, researchers reported here.

SEATTLE -- Light, physical activity and other non-drug therapies may be as effective against insomnia in the elderly as pharmacologic interventions, researchers said here.

LONDON -- More than a third of the HIV-positive gay men in England may be HIV-positive and not know it, according to researchers here.

Patients with congenital heart disease and pulmonary arterial hypertension (PAH) are at risk for severe deterioration during pregnancy and delivery. We discuss the case of a 38-year-old woman who presented to the emergency department complaining of dyspnea 6 days after giving birth to her first child via cesare- an section. When PAH is untreated, maternal mortality may exceed 50%, but aggressive PAH treatment offers improved outcomes. Moreover, initial improvement in functional status made with parenteral prostanoids can be maintained with combination oral therapy.

An obese 52-year-old woman with a 5-year history of type 2 diabetes mellitus had odynophagia and dysphagia for several days. She described the sensation as food "sticking" in her chest. She also complained of vaginal itching, polyuria, and polydipsia. The only remarkable finding on physical examination was candidal vaginitis. The patient did not smoke cigarettes or drink alcoholic beverages, and there was no history of recent weight loss.

Methicillin-resistant Staphylococcus aureus (MRSA) became a "bug" to be reckoned with nearly 50 years ago. At that time, however, it targeted only patients who were exposed to infection in the hospital.In recent years, the epidemiology of MRSA has significantly changed. The pathogen is now a major culprit in community-acquired infections.

I read with interest the case of lymphogranuloma venereum (LGV) featured in Dr Henry Schneiderman's recent "What's Your Diagnosis?" column (CONSULTANT, February 2007, page 187). As one who has had a career-long interest in sexually transmitted disease, I feel compelled to make a few remarks regarding this case.

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

Frightened but lucid man who appears stated age. Vital signs are normal. No mass palpable in abdomen, though there is a faint suggestion of upper-abdominal distension. No supraclavicular lymphadenopathy, umbilical nodules, or upper-abdominal vascular bruit.

SILVER SPRING, Md. -- An FDA advisory panel has unanimously recommended accelerated approval of a novel antiretroviral drug as an add-on treatment for adult infected with CCR5-tropic HIV-1.

COPENHAGEN -- The use of protease inhibitors to treat HIV is associated with an increased risk of a heart attack, according to a large observational study.

SAN FRANCISCO -- A significant number of patients with major depression also suffer from chronic insomnia that hampers recovery, and treating the insomnia may improve both conditions.

BOSTON -- Girls perinatally infected with HIV early in the AIDS epidemic have reached adolescence and a mixed picture is emerging on their reproductive health, researchers here reported.

ATLANTA -- After a decade of decline, syphilis rates rose by 19% from 2000 through 2003, largely because of cases among men who have sex with men, according to a CDC study.

BRADFORD, England -- Well-meaning physicians may unwittingly induce delirium in older patients when they prescribe medications such as antihistamines or sleep aids, according to a literature review.