A special thank-you goes out to the pharmacists, physicians, educators, and researchers who took the time to review manuscripts for Drug Benefit Trends in 2007.

When you start to examine the thyroid, patients frequently react instinctively by raising their head, thereby stretching the neck. Actually, such a reaction impedes precise palpation of the gland. Tell patients to keep their neck flexed forward, so as to ensure that the infrahyoid muscles of the neck are relaxed.

Patients who have had a cholecystectomy may have loose stools for several weeks or months. Over-the-counter and prescription antidiarrheals can provide temporary relief but can be costly and may produce constipation. Instead, try prescribing fiber therapy with methylcellulose (two 500-mg tablets daily or bid).

Doxycycline and potassium tablets can cause ulceration and severe burning of the esophagus if they get stuck and dissolve in that location. Gelatin capsules pose a heightened risk because they can adhere to the wall of the esophagus. To prevent this significant adverse effect, try the following:

A study published in the November issue of the Journal of Adolescent Health shows that young persons with asthma are twice as likely to have anxiety and depressive disorders than youths without asthma. Researchers at the University of Washington School of Medicine, Seattle; Group Health Cooperative (GHC); and Seattle Children’s Hospital Research Institute interviewed 1379 youths aged 11 to 17 years enrolled in the GHC HMO. Of the study participants, 781 had received a diagnosis of asthma or had been treated for asthma; 598 participants were randomly selected youths with no history of asthma.

Given the risk of skin cancer and the benefit of vitamin D production, what should I tell my patients about sun exposure?

London-based GlaxoSmithKline (GSK) plc and New York–based Pfizer Inc have announced they will combine their HIV drug divisions into a new company (Kelley T. Bloomberg News. April 16, 2009). GSK will hold an 85% share of the joint venture; Pfizer will hold 15%. According to a filing with the US Securities and Exchange Commission, GSK Senior Vice President Dominique Limet, a physician, is CEO-designate of the new company.

The lifetime cumulative risk of at least 1 abnormal ocular lesion for an HIV-positive person ranges from 52% to 100%. Ophthalmic involvement can occur during the early phase of HIV infection, and ocular lesions are mainly noted in the posterior segment.1,2

A 58-year-old man with type 2 diabetes, nephrolithiasis, and benign prostatic hyperplasia presented with bilateral periorbital ecchymoses and left subconjunctival hemorrhage. The ecchymoses had spontaneously appeared 3 days earlier; the patient had no history of trauma or falls. He also had difficulty in voiding, characterized by increased frequency, hesitancy, and diminished urine stream.

Persons with HIV infection frequently present with anemia from different causes, including use of antiretroviral therapy (typically zidovudine), iron deficiency, vitamin B12 deficiency, opportunistic infections (such as mycobacterial and fungal infections), chronic disease, AIDS-associated malignancies, autoimmune hemolysis, and direct effects of HIV infection itself. A frequently overlooked cause of chronic anemia in HIV-infected persons is parvovirus B19 coinfection.1-3 We present an illustrative case of unsuspected treatable parvovirus B19 infection in an HIV-positive person with chronic transfusion-dependent anemia initially attributed solely to zidovudine therapy.

Scrub typhus, which is caused by Orientia tsutsugamushi, has various systemic manifestations, including GI symptoms. We describe one patient with scrub typhus who presented with symptoms that suggested acute appendicitis and another who presented with symptoms of acute cholecystitis.

The human papilloma viruses (HPVs) are among the widespread sexually transmitted pathogens infecting women. Like HIV, HPV–s

Clostridium difficile infections account for most cases of antibiotic-associated colitis.1 However, there is increasing evidence that Klebsiella oxytoca infection contributes to the development of C difficile–negative antibiotic-associated hemorrhagic colitis. Most cases have been reported in France,2-12

A TOPICAL TREATMENT THAT KILLS herpes simplex virus type 2 (HSV-2) and that has long staying power may be available in the future. The experimental microbicidal solution, consisting of cholesterol-conjugated small interfering RNA (chol-siRNA), was tested in female mice that were given a lethal dose of the virus. The solution, delivered intravaginally, had a remarkably protective effect.

With the FDA approval of a new small-molecule drug to treat HIV infection by blocking the CCR5 chemokine receptor and with several other drugs of this class in development for this and other indications, there is an increased interest in determining the potential influence on tumor promotion or suppression that blocking this receptor may have. Large, long-term clinical studies would be the ideal method for evaluating the potential increase in cancer risk, and at least one such study is under way (see http://clinicaltrials.gov/show/NCT00665561?order=49).

Disseminated echinococcal disease can present complex management issues that require a multidisciplinary approach to care. We describe a patient with hydatid disease who had multiple cysts in the liver, lungs, and pulmonary artery that were caused by Echinococcus granulosus infection.

Should ART be deferred in patients at risk for nonadherence?Since nonadherence to antiretroviral therapy (ART) may hasten the development of resistance, it may seem reasonable to defer ART in HIV-infected patients who have risk factors for nonadherence, such as substance abuse.

A milestone has been reached in the treatment of sepsis—the institution of protocolized management that starts in the emergency department. Early goal-directed therapy, with targeted fluid resuscitation and measures of oxygen delivery, has been shown to improve survival in patients with septic shock. Although initiating aggressive fluid resuscitation is the first priority, it is also essential to rapidly obtain cultures and infuse broad-spectrum antibiotics. Norepinephrine is a more potent vasoconstrictor than dopamine and may be more effective in treating hypotension in patients with septic shock. Vasopressin is an effective second-line agent. Treatment with recombinant human activated protein C at 24 µg/kg/h for 96 hours has been shown to reduce mortality in patients with sepsis; its benefit is greatest in the most acutely ill patients. (J Respir Dis. 2009;30(1-2))

A 30-year-old white man with HIV infection since September 2004 presented to his infectious disease physician in January 2007 to restart his antiretroviral therapy. Three months earlier, he had discontinued all of his antiretroviral medications because of his loss of health insurance. He remained asymptomatic during this period, with the exception of some mild oral candidiasis. At the time of restarting his antiretroviral therapy, his CD4+ cell count was 264/µL and test results were positive for syphilis (rapid plasma reagent [RPR] titer of 1:128, confirmed with a fluorescent treponemal antibody absorption test).

Tenofovir disoproxil fumarate is extensively used for treatment of HIV infection. In addition, tenofovir has recently obtained FDA approval for treatment of hepatitis B, and it can therefore be assumed that this drug will be increasingly used in non–HIV-infected persons as well. Although the risk for nephrotoxicity with this agent is low, its widespread use will no doubt lead to more episodes of renal impairment in patients worldwide. It is important to identify those patients for whom tenofovir should not be used or, at the least, identify those patients, both HIV-infected and non–HIV-infected, for whom renal function should be more closely monitored during tenofovir use.