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HIV Testing in the Emergency DepartmentIn a recent editorial in The AIDS Reader, the “burden of responsibility for routine HIV testing” was accurately described as now falling on all clinicians, including those in emergency departments (EDs). Routine HIV testing in the ED seems logical because patients who seek health care in the ED are often underinsured and have low incomes, the very populations with a higher prevalence of undiagnosed HIV.
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Ryan White: An Unintentional Home BuilderAs Indiana native John Mellencamp might say, “Ryan White was born in a small town.” Kokomo, Ind, in 1971 indeed was a thriving, relatively small community in America’s Heartland. A town founded on family values, hard work, and a full belief in the American Dream,
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Pill Impaction Mimicking Appendicitis in an HIV-Positive PatientA 45-year-old Hispanic man who acquired HIV infection in April 2003 presented with a 24-hour history of worsening right lower quadrant pain accompanied by fever, decreased appetite, nausea, and vomiting.
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African American Women and HIV/AIDS: A National Call for Targeted Health Communication Strategies to Address a DisparityIn 1998, President Clinton declared HIV/AIDS to be a "severe and ongoing crisis" in the African American community and launched the
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Oral Plasmablastic LymphomaA previously healthy 43-year-old man was referred to the hospital for the diagnosis of a nodular lesion in the mandibular gingiva.
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Nonalcoholic Fatty Liver Disease: An Increasingly Common Cause of Liver Disease Among HIV-Infected Persons?Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized condition in the general population worldwide.
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GSK and Pfizer to Merge HIV Drug Units in New Company, Sixteen States Inconsistent With CDC HIV Testing RecommendationsLondon-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.
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Recurrent Urothelial Bladder Cancer Among HIV-Infected PatientsWe report 4 cases of bladder cancer in an ethnically diverse population of about 2500 HIV-infected patients. These patients were younger than the median age at diagnosis of bladder cancer in the United States.
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Oral Plasmablastic LymphomaA previously healthy 43-year-old man was referred to the hospital for the diagnosis of a nodular lesion in the mandibular gingiva.
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HSV-1 Encephalitis Complicated by Cerebral Hemorrhage in an HIV-Positive PersonHerpes simplex virus type 1 (HSV-1) is the most common cause of sporadic encephalitis worldwide. In the California Encephalitis Project, 24% of the cases of viral encephalitis were caused by HSV-1 and 3% were caused by HSV-2.1
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Psychiatric Aspects of HIV/AIDSIn the era of rapid transmittal of health information and frequent educational updates via the Internet, hardcover medical texts still have a place. A worthy newcomer in this regard is Psychiatric Aspects of HIV/AIDS, edited by Fernandez and Ruiz, a comprehensive sourcebook with contributions by a panel of experts.
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Current Health Disparities in HIV/AIDSThe CDC and other public health organizations have identified numerous disparities in the incidence and outcomes of HIV disease among different population groups
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Ryan White: An Unintentional Home BuilderAs Indiana native John Mellencamp might say, “Ryan White was born in a small town.” Kokomo, Ind, in 1971 indeed was a thriving, relatively small community in America’s Heartland. A town founded on family values, hard work, and a full belief in the American Dream,
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Disseminated Mycobacterium avium-intracellulare Infection in a Person With AIDS With Cutaneous and CNS LesionsWe present the case of a 55-year-old man with AIDS who had disseminated Mycobacterium avium-intracellulare (MAI) infection who was nonadherent to antiretroviral treatment and prophylaxis for opportunistic infections.
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Antiretroviral Treatment Update From the 17th International AIDS ConferenceThe 17th International AIDS Conference was held in Mexico City from August 3 to 8, 2008. This conference attracted more than 20,000 participants and provided some significant new insights into HIV therapeutics.
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An HIV-Infected Patient With Fever, Pancytopenia, and Renal Failure: Is This End-Stage AIDS?Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. Although immunocompetent persons with H capsulatum infections are usually asymptomatic, several clinical syndromes can manifest in immunocompromised patients.
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Disseminated Mycobacterium avium-intracellulare Infection in a Person With AIDS With Cutaneous and CNS LesionsWe present the case of a 55-year-old man with AIDS who had disseminated Mycobacterium avium-intracellulare (MAI) infection who was nonadherent to antiretroviral treatment and prophylaxis for opportunistic infections.
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HIV and Hypertension: The Need to Pay More HeedAbout a third of HIV-positive patients have high blood pressure. Is this a predictable consequence of ordinary aging, or do their history of HIV infection and treatment play a role? Whatever the explanation, many of these patients don't take the problem seriously enough.
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An HIV-Infected Patient With Nocardia asteroides Bilateral PneumoniaPneumonia remains a concern for persons with long-standing HIV infection. We present a case of a 43-year-old HIV-infected woman with bilateral pneumonia whose presentation suggested the cause was a bacterial pathogen.
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Neurosarcoidosis in a Patient With AIDSNeurosarcoidosis has not been reported in patients with HIV infection. We present the case of a patient with AIDS in whom spinal cord sarcoidosis developed years after highly active antiretroviral therapy was initiated and her immune system was reconstituted. Treatment with prednisone resulted in resolution of MRI lesions and symptoms. Since patients with HIV-1 infection who are receiving antiretroviral therapy can survive for many years, physicians should be aware of chronic immune restoration disease involving the CNS.
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HIV Infection in the ElderlyThere is general consensus among public health authorities that the elderly are not being screened for HIV as frequently as are younger persons. But there is compelling reason to do so.
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Subacute Onset of Paralysis in a Person With AIDSThe pathogen Toxoplasma gondii is an intracellular protozoan that most commonly presents in persons with AIDS as reactivation of latent infection.
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Progression of Kaposi Sarcoma Associated With Iatrogenic Cushing Syndrome in a Person With HIV/AIDSThe prevalence of Kaposi sarcoma (KS) in HIV-infected persons in the pre-HAART era has been reported to be as high as 20%. Although AIDS-associated KS has declined by more than 80% since the introduction of highly active antiretroviral regimens, KS remains an important malignancy in the HIV-infected population
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Non–AIDS-Defining Cancers: Should Antiretroviral Therapy Be Initiated Earlier?Much has been written about the increase in non–AIDS-defining cancers in HIV-infected persons over the past decade.
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Legionnaires Disease in a Patient With AIDSLegionella species are among the leading causes of community-acquired pneumonia (CAP) in the general population, and although rare in patients with HIV infection, Legionella pneumonia is associated with significant morbidity and mortality
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Severe Pruritus After Completing Pegylated Interferon for Hepatitis CIn most HIV-infected persons, one or more dermatological conditions develop at some point during their lifetime.1 Among the spectrum of dermatological diseases, those associated with pruritus are among the most common.
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Mycobacterium avium-intracellulare Complex Immune Reconstitution Inflammatory Syndrome in HIV/AIDS Presenting as OsteomyelitisWe report a case of osteomyelitis due to Mycobacterium avium-intracellulare complex (MAC) in an AIDS patient shortly after the initiation of antiretroviral therapy with subsequent immune reconstitution inflammatory syndrome (IRIS).
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A "Usual" Case of SyphilisMr 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.
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Non–AIDS-Defining Cancers: Should Antiretroviral Therapy Be Initiated Earlier?Much has been written about the increase in non–AIDS-defining cancers in HIV-infected persons over the past decade.
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CCR5 Antagonists in the Treatment of HIV-Infected Persons: Is Their Cancer Risk Increased, Decreased, or Unchanged?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).
