The AIDS Reader: From the Editor's Desk

February 1, 2007

From the Editor's Desk: In This Month's IssueThis month, you will find a report of the results of a clinical trial evaluating HIV infection in our Latino population. Although clinical trial write-ups are rarely published in The AIDS Reader–which instead prefers to provide reviews that help explain the relevance of clinical research to practice–an article drawing attention to the problem of HIV infection and its management in this ethnic minority is of increasing importance in clinical care.

This month, you will find a report of the results of a clinical trial evaluating HIV infection in our Latino population. Although clinical trial write-ups are rarely published in The AIDS Reader–which instead prefers to provide reviews that help explain the relevance of clinical research to practice–an article drawing attention to the problem of HIV infection and its management in this ethnic minority is of increasing importance in clinical care. Last month, the National Health and Nutrition Examination Survey announced that it was shifting its focus to include a wider variety of Hispanic populations. And for good reason: Latinos represent the largest and fastest-growing ethnic minority group in the United States. The results of the clinical investigation reported by Dr Colleen Kelley and colleagues underscore the disproportionate impact of HIV infection on the US Latino community and the need not only for earlier intervention but also for diagnostic and therapeutic approaches tailored to this heterogeneous ethnic group. The need to account for the "many vibrant cultures" and differing views of health care within this group in order to provide better medical care to Latinos is the underlying theme of the commentary by Dr Roberto Corales, which appears with the clinical report.

Understanding the risk of adverse effects associated with standard-of-care medications is critical in making informed and appropriate decisions when initiating or changing treatment, and in our other feature article, Dr Paul Sax and colleagues set their sights on the moving target of tenofovir-associated renotoxicity. Since tenofovir is one of several agents recommended for first-line use in the current IAS-USA and DHHS treatment guidelines, this review has important information for practicing HIV clinicians. Sax and colleagues review the tenofovir-associated renal data reported in the medical literature, including data not only from prospective controlled studies but also from observational cohort studies and case reports. There has been much "shooting from the hip" from stakeholders interested in the treatment of persons with HIV/AIDS on the likelihood of worsening renal function with tenofovir use, so I am pleased that The AIDS Reader is able to publish a review on tenofovir-associated renal effects in the hope that the information will help HIV care providers better understand the true drug-related risk with this widely used agent. Also, donÕt miss the Editorial Comment, which accompanies this review article, by Dr Samir Gupta, who provides insights into the types of patients at risk for tenofovir-related renotoxicity.

You need to be cautioned, however, about a potential bias in this review. We did not become aware until after the paper had been accepted for publication that the authors had received commercial support related to manuscript preparation. Although this is a violation of The AIDS Reader's editorial policy, we chose not to pull the paper. Since tenofovir is a common and recommended component of current antiretroviral therapies and because of the continuing questions about the renal safety of tenofovir, we felt that the independently peer-reviewed information provided in the review by Sax and colleagues, paired with the independent commentary of Dr Gupta, is of sufficient importance and interest to our readers to justify this exception.

In the remainder of the issue, I would like to call your attention to 2 articles on viral opportunistic infections–a Case Report presented by Dr Regina Osih and colleagues and our Clinical Challenge column provided this month by Dr Sophia Archuleta–which point out the need for a careful evaluation of patients showing CNS involvement, including cerebrospinal fluid PCR testing, before reaching a diagnosis.

Take care and be well.
John Hawes, Editor
jhawes@cmp.com