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Mr D is a 38-year-old African American man in whom AIDS had been diagnosed in 2001; he had responded well to antiretroviral therapy, with a recent CD4+ cell count of 376/µL and an HIV RNA level less than 50 copies/mL. He presented to our clinic complaining of a mildly tender "lump" on the left side of his neck, which he first noticed a week ago. He denied fever, chills, sweats, cough, anorexia, weight loss, and urinary symptoms but had a sore throat for 2 days.

An 8-week-old boy is brought for evaluation of gradually worsening yellow skin discoloration of about 1 week's duration. His parents report that he has had constipation for the past several days; before that, he had green diarrhea and occasionally spit up after breast-feeding.

Study Finds Antiretroviral Drugs May Prevent HIV Infection A study involving monkeys found that the use of 2 antiretroviral drugs, emtricitabine (FTC) and tenofovir, prevented transmission of a primate version of HIV (Berman J. Voice of America. February 5, 2008).

Little of promise in terms of HIV prevention science was reported at the 15th annual Conference on Retroviruses and Opportunistic Infections (CROI), held from February 3 to 6, 2008, in Boston. Coupled with several other pieces of disappointing news related to early HIV diagnosis and efficacy of vaginal microbicides, most hope continued to relate to disease treatment.

A 71-year-old man complains of left elbow pain that increases with movement and has worsened over the past 12 hours. He has also had a cough with sputum production for the past several days.

Currently, an estimated 26 million persons in the United States have a urological disorder, according to a newly released government-funded report. Bladder, prostate, and other urinary tract diseases in US adults cost almost $11 billion annually (2000 data), with Medicare's share exceeding $5.4 billion, according to the study by Litwin and colleagues funded by the NIH.

Complete insurance coverage of cardiovascular medications may lower health care costs as well as increase adherence and improve patient outcomes. Researchers led by Niteesh K. Choudhry, MD, PhD, assistant professor at Harvard University and in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital, Boston, analyzed the cost-effectiveness of providing full prescription drug coverage for post-myocardial infarction (MI) Medicare beneficiaries 65 years and older enrolled in the Part D program. Study results were published in the March 11 issue of Circulation.

The practice of academic detailing is gaining interest and momentum in some health care circles. The primary aim of academic detailing is to prevent the overuse and misuse of certain medications. This is done by educating prescribers on the therapies that are clinically appropriate as well as the costs of therapeutically similar choices. It is less an issue of switching to generics than it is of favoring step therapy or moving toward cost-effective therapeutically equivalent options. A well-designed program should maintain prescriber autonomy and quality of care while helping manage drug costs for both health plans and patients.

A report from the Government Accountability Office (GAO) has led to new questions about the way health care for seniors covered under Medicare Advantage (MA) plans is paid for-and has prompted Centers for Medicare & Medicaid Services (CMS) acting administrator Kerry N. Weems to promise to collect more data from plans.

Last month I wrote about how patients-or rather consumers-were taking on greater responsibility for decisions affecting their own health, largely because of the Internet and the ability to research and form opinions about individual treatments. That was only scratching the surface of how the Internet is revolutionizing health care.

Once a person reaches age 65 years, his or her prescription drug costs typically increase dramatically, according to results of a meta-analysis published in the March issue of the British Journal of Clinical Pharmacology. Researchers from the faculty of pharmacy at the University of Barcelona, Spain, led by Eduardo L. Marino, PharmD, PhD, examined the computerized pharmacy dispensing records of 5.47 million patients in Catalonia from January 1, 2002, to December 31, 2002. The team established 20 age-sex categories and analyzed the participants' use of 15 therapeutic classes of prescription drugs.

A new FDA policy requires pharmaceutical manufacturers to examine whether study participants become suicidal during clinical trials of new medications.1 The policy derives from the belated recognition that antidepressants seem to slightly increase suicidality in children, adolescents, and young adults early in the course of treatment. This is not the only news about medications linked to possible increases in suicidal ideation or behavior.

As dermatologists' use of biologic drugs for psoriasis grows, MCOs must take an increasingly active role in managing the near-term utilization of these high-cost agents while also taking into account that some of the "payback" for these drugs comes in the form of long-term costs avoided. Meanwhile, physicians, insurers, and employers continue to wrestle with issues such as step-down dosing; step therapy; patient-administration versus physician-administration; and whether biologic drugs should be covered under a plan's pharmacy benefit, medical benefit, or some combination. (Drug Benefit Trends. 2008;20:143-147).

With the increasing managed care restrictions on health care coverage, a look into the efficacy of some of these procedures is needed. This study examines the cost burden of implementing prior authorization (PA) for prescription drugs. Seventy-five prescriptions dispensed by 2 Philadelphia pharmacies requiring PA were tracked and the savings analyzed. Requiring PA proved to be financially beneficial to MCOs but resulted in an increase in uncompensated time for physicians and pharmacies. Two classes of drugs, antihistamines and proton pump inhibitors, accounted for 48% of the medications requiring PA. By educating plan members in advance concerning coverage limits for these medications, MCOs could decrease the use of PA and reduce the amount of time spent by physicians, pharmacists, and patients in dealing with this procedure. (Drug Benefit Trends. 2008;20:136-139)

Prescription drug sales in the United States grew at a modest 3.8% rate in 2007 (Cover Figure), to total $286.5 billion, according to an annual IMS Health report, US Pharmaceutical Market Performance Review, based on findings of the IMS National Sales Perspectives and the IMS National Prescription Audit. This compares with a growth rate of 8.3% for 2006. Slower sales growth was attributed by IMS Health to brand-name patent expirations, fewer new products approved, and drug safety issues.

Complete insurance coverage of cardiovascular medications may lower health care costs as well as increase adherence and improve patient outcomes. Researchers led by Niteesh K. Choudhry, MD, PhD, assistant professor at Harvard University and in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital, Boston, analyzed the cost-effectiveness of providing full prescription drug coverage for post–myocardial infarction (MI) Medicare beneficiaries 65 years and older enrolled in the Part D program. Study results were published in the March 11 issue of Circulation.

CARRIAGE OF A STRAIN of methicillin-resistant Staphylococcus aureus(MRSA) was shown to be prevalentin men who have sex with men. Thefinding was based on epidemiologicalstudies conducted in San Franciscoand Boston. In addition to beingresistant to methicillin, the S aureusstrain isolated from the study populationalso appears to be resistant toclindamycin, tetracycline, and mupirocin.The research appears in theJanuary 14 and February 19 issues ofAnnals of Internal Medicine.

The biomechanical complexities of the foot and the circumstances that cause infections can make foot infections difficult to manage.1 When an otherwise healthy patient presents with a foot infection, a traumatic process usually is involved and treatment is relatively straightforward. Sometimes a more serious condition is the cause. The more common presentation, however, is a patient who is immunosuppressed or who has a metabolic or peripheral vascular defect that complicates treatment of the infection.