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What’s New in HIV/AIDS: 6 Things You Need to Know


As the number of patients with HIV who are treated effectively continues to rise, so too will the number of these patients seen for routine primary care. Here, 6 studies to help PCPs offer optimal treatment for this population.

At the end of 2012, 35.3 million people were living with HIV, according to the World Health Organization. Later this month, the 20th International AIDS Conference will convene in Melbourne, Australia, under the theme of "Stepping up the Pace," recognizing a critical time in the global response to HIV. Data show a steady decrease in new HIV infections worldwide and increasing numbers of people receiving treatment, but much work still needs to be done to reverse the epidemic.

Recent studies have uncovered important new information about HIV/AIDS. Here are 6 things you need to know:

1. The timing of initiation of combination antiretroviral therapy has a significant impact on life expectancy for HIV-infected patients. Shorter life spans are recorded for patients who receive a late diagnosis and a delayed introduction to this therapy.

2. Patients with HIV infection are at higher risk for both AIDS-defining cancers-such as Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer-and non–AIDS-defining cancers. Study results strongly suggest that the availability of highly active antiretroviral therapy has contributed to the declining incidence of many virus-related cancers.

3. The potential etiologies of mediastinal lymphadenopathy in HIV-infected patients are numerous, including infectious and malignant causes. Malignancy remains in the differential diagnosis of mediastinal lymphadenopathy, even in patients receiving combination antiretroviral therapy.

4. Human papillomavirus infections can cause anal and cervical intraepithelial neoplasia and subsequently cancer, and HIV-infected women are at higher risk for these conditions. One prevention strategy is vaccination against HPV. A multicenter trial has shown that the quadrivalent HPV vaccine against types 6, 11, 16, and 18 is safe and induced immunogenicity in HIV-infected women.

5. HIV infection is associated with a spectrum of neurocognitive disorders, ranging from severe HIV-associated dementia to mild neurocognitive disorder and asymptomatic neurocognitive impairment. Physicians caring for HIV-infected patients should be aware of the prognostic value of early ANI, the most common HIV-associated neurocognitive disorder.

6. The risk of fractures in HIV-infected patients is increased almost 3-fold independent of potential confounders (eg, fracture history, alcohol abuse, and medication use). The odds of hip and spine fractures in this population are 9-fold higher, suggesting heightened vigilance among clinicians.

For more on each study, see links below:

1. Antiretroviral Therapy Response and Life Expectancy

2. Trends in Cancer Incidence in HIV-Infected Patients

3. Mediastinal Lymphadenopathy in HIV-Infected Patients: Malignancy Still Common

4. HPV Vaccination in HIV-Infected Women Found Safe and Effective

5. HIV Infection Still Hastens Neurocognitive Decline

6. HIV Infection Associated With Three-Fold Increase in Fracture Risk

Original study reviews written for Consultantlive.com by Bishoy Faltas, MD.


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