HIV AIDS

SYDNEY -- As the long-term prognosis for patients with HIV improves, it becomes more important to assess the patient's risk for cardiovascular disease and other health issues, researchers suggested here.

SYDNEY -- In patients who have both HIV and tuberculosis, doctors can use a relatively low dose of nevirapine (Viramune) in combination with rifampin (Rifadin), researchers said here.

SYDNEY -- The novel integrase inhibitor raltegravir was as effective initial therapy as the standard treatment, a researcher said here.

SYDNEY -- New compounds that seek ways to disrupt mechanisms of the HIV life cycle were outlined here, reflecting an expanding investigative antiviral pipeline

SYDNEY -- A novel HIV drug aimed at barring entry of the virus into the cell was safe and had a long half-life in an early trial, lowering viral load for up to two weeks after treatment stopped, a researcher said here.

SYDNEY -- HIV vaccine research is poised to take a step into the unknown -- the use of live but attenuated viruses to create immunity.

SYDNEY -- Doctors and patients should not be content with keeping human immunodeficiency virus (HIV) at low levels, but should seek to optimize treatment to suppress virus to undetectable levels.

SYDNEY -- Tuberculosis and HIV therapy can take place at the same time without the risk of long-term HIV treatment failure, researchers said here.

SYDNEY -- The pendulum of HIV treatment is starting to swing -- once again -- toward the "hit early, hit hard" theory.

TAIPEI, Taiwan -- Older patients prone to falling can have significantly better lives if they undergo a structured exercise programs, investigators here reported.

abstract: Tuberculous pericarditis, while relatively rare in the United States, is an important cause of pericardial disease in countries where tuberculosis is prevalent. Patients are most likely to present with chronic disease--effusive and/or constrictive. Those with effusive pericarditis often present with tamponade. Patients with constrictive pericarditis exhibit features of systemic and pulmonary venous congestion. An elevated level of adenosine deaminase in pericardial fluid is a good marker for tuberculosis. The presence of granulomas or case-ation necrosis in pericardial tissue confirms the diagnosis. If treatment of effusive tuberculous pericarditis is delayed, constrictive or effusive-constrictive disease usually develops, resulting in a high mortality risk. In addition to a standard antituberculosis regimen, treatment of tuberculous pericarditis may include adjuvant therapy with corticosteroids, pericardiocentesis, and/or pericardiectomy. (J Respir Dis. 2007;28(7):278-282)

Given the dramatic advances in antimicrobials since penicillin was introduced, why has the mortality rate associated with community-acquired pneumonia (CAP) remained essentially unchanged? Inadequate application of practice guidelines may be the chief reason, according to a committee from the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS).1

Acute invasive fungal rhinosinus- itis occurs predominantly in immunocompromised patients, such as those with neutropenia and transplant recipients. The diagnosis requires biopsy, but permanent section can be time-consuming and result in a delay in treatment. Ghadiali and colleagues conducted a study to evaluate the accuracy of frozen-section biopsy in this setting.

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The diagnostic criteria for major depression are anhedonia, depressed mood, feelings of worthlessness or inappropriate guilt, inability to concentrate, fatigue, insomnia or hypersomnia, psychomotor agitation or retardation, significant weight loss or gain, and recurrent thoughts of death or suicide. Five or more of these symptoms must be present for at least 2 weeks, and one of them must be anhedonia or depressed mood. Conditions that can present with depression include dysthymia, bipolar disorder, cyclothymia, and adjustment disorder. Depression may also result from substance abuse or from the physiological conditions associated with a medical disorder, such as spinal or head injury, AIDS, or cancer.

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BALTIMORE -- A needle stick injures more than four of every five surgical residents during their training, researchers here said, and about half of the incidents go unreported.

ATLANTA -- Rapid HIV testing with on-the-spot results during emergency room visits or at community events appears to be a feasible way to identify people who are infected with the virus and don't know it.

INDIANAPOLIS -- More than a third of U.S. adults report problems falling asleep or daytime sleepiness, and lack of sleep is linked to one in five serious motor vehicle accidents.

SEATTLE -- A hand-held echocardiography device can bring cardiac imaging to the outpatient setting, said investigators here.

ATLANTA -- Varicella vaccine should be administered in a two-dose regimen with the first dose at 12 to 15 months and the second dose at age four to six.

BALTIMORE -- When treating hepatitis B and HIV co-infection, physicians should use caution with the antiviral drug entecavir (Baraclude), researchers here said.

TORONTO -- The tests used to evaluate influenza vaccines are so unreliable they can vary up to 700-fold from one lab to another, according to a British researcher.

BALTIMORE -- The old system of targeting high-risk persons for HIV testing is more efficient than screening all patients routinely, according to a researcher here.

SAN FRANCISCO -- A standard six-month course of treatment for tuberculosis may not be sufficient to cure patients co-infected with HIV, researchers here say.

We present a case of a 35-year-old man with fever and pancytopenia, who had rapid progression to acute respiratory distress syndrome (ARDS), multiorgan failure, and disseminated intravascular coagulopathy secondary to disseminated tuberculosis (TB). Although both sputum and bronchoalveolar lavage (BAL) fluid smears were negative for acid-fast bacilli, the polymerase chain reaction (PCR) assay on the BAL fluid was positive for Mycobacterium tuberculosis. This case emphasizes the need to include TB in the differential for ARDS and the value of PCR testing of BAL fluid, especially in high-risk patients.

abstract: The use of fiberoptic bronchoscopy (FOB) in HIV- infected patients has sharply declined since the availability of highly active antiretroviral therapy and the resulting decrease in the incidence of opportunistic infections. Nevertheless, FOB continues to be an important diagnostic tool in this patient population. For example, FOB is useful in evaluating for Pneumocystis jiroveci (formerly carinii) pneumonia (PCP) in patients with CD4+ cell counts of less than 200/µL who have diffuse pulmonary infiltrates and in whom sputum induction has not been performed or is nondiagnostic. It is also useful for evaluating patients who have not responded adequately to empiric therapy for bacterial pneumonia or PCP. Other applications include the visual diagnosis of endobronchial Kaposi sarcoma or the assessment of suspected lung cancer. (J Respir Dis. 2007;28(6): 244-252)

SAN DIEGO -- When talking about antipsychotic agents for schizophrenia, it's important to distinguish efficacy from effectiveness.

WASHINGTON -- The FDA should be given the authority to regulate tobacco as an addictive drug, including marketing, advertising, and, eventually, the right to regulate nicotine content, said an Institute of Medicine report issued today.