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Two years ago, while revisiting the quality and durability of highly active antiretroviral therapy-linked immune reconstitution, I noted that the incidence of certain non-AIDS-defining malignancies associated with sexually transmitted viruses in immunosuppressed persons, including penile, oral, and anal cancers, have continued to increase among HIV-infected persons despite the use of highly active antiretroviral therapy

Oral Plasmablastic Lymphoma

A previously healthy 43-year-old man was referred to the hospital for the diagnosis of a nodular lesion in the mandibular gingiva.

Oral cavity lymphoma occurs frequently in HIV-positive patients, often with a poor prognosis.1 Ortega and colleagues2 present an enlightening case of a destructive oral plasmablastic lymphoma in a 43-year-old HIV-positive man. Similar to another recently reported case,3 this lymphoma was their patient's first manifestation of his underlying HIV infection.

Treatment of HIV infection reduces the risk of transmission and can significantly improve patients’ quality of life. For these reasons, the CDC has recommended routine screening for HIV in all health care settings.1 HIV testing access in correctional facilities is the weakest link in the fight against HIV infection in the United States; increasing access to testing would improve the identification of HIV-positive inmates as they pass through prisons and jails, providing an opportunity to integrate them into the public health infrastructure of HIV care. However, numerous logistical and cost-related barriers to such testing must be addressed when determining how and when it should be conducted.

Miller1 reports the results of a 3-month program of progressive resistance and aerobic exercise training in 2 perinatally HIV-infected girls: a normal-weight 10-year-old and an overweight 17-year-old. By the end of the program, both had decreases in body mass index (BMI); lost fat, including visceral fat, by at least some measures; and gained significant muscle strength. One had improved cardiovascular fitness, and both showed further improvements after completing a home-based program after the initial 12-week program.

In a phase 2 study, the new echinocandin anidulafungin was demon-strated to be effective in the treatment of invasive candidiasis. Additional encouraging findings have recently been reported by Reboli and coworkers, who compared anidulafungin with fluconazole in a randomized, double-blind, noninferiority trial. The study included patients 16 years or older who had invasive candidiasis; 89% had candidemia only. They were randomly assigned to receive either intravenous anidulafungin or intravenous fluconazole. After 10 days of intravenous therapy, the patients could receive oral fluconazole.

Common eye diseases such as glaucoma, cataract, and age-related macular degeneration (ARMD) (Figure) can have significant systemic ramifications. Recent studies have found that these eye diseases may herald the onset of various types of physical and mental impairment, especially in elderly persons.

A number of factors heighten the risk of parasitic infections in elderly persons, who often live in communal settings (eg, nursing homes), where they are more likely to encounter parasites, such as the scabies mite.

Ask About the Animals

I work with frail, elderly patients who generally have few--if any-- living relatives. During their initial physical evaluation, I always ask them if they have any pets.