HIV AIDS

SILVER SPRING, Md. -- Although the FDA advised physicians in March to use erythropoiesis-stimulating agents at the lowest possible dose to preclude a transfusion, an advisory committee has urged the agency to develop still stricter standards.

OXFORD, England -- A moderately high daily dose of aspirin taken long term may reduce colorectal cancer risk, but gastroenterologists should be cautious about recommending it, researchers said.

HOUSTON -- Patients with hepatitis C virus infection may have a 20% to 30% increased risk of developing non-Hodgkin's lymphoma, researchers here reported.

SEATTLE -- Only 16% of sedating antihistamine use among older patients at VA medical centers was for an appropriate indication, researchers reported here.

SEATTLE -- Light, physical activity and other non-drug therapies may be as effective against insomnia in the elderly as pharmacologic interventions, researchers said here.

LONDON -- More than a third of the HIV-positive gay men in England may be HIV-positive and not know it, according to researchers here.

Patients with congenital heart disease and pulmonary arterial hypertension (PAH) are at risk for severe deterioration during pregnancy and delivery. We discuss the case of a 38-year-old woman who presented to the emergency department complaining of dyspnea 6 days after giving birth to her first child via cesare- an section. When PAH is untreated, maternal mortality may exceed 50%, but aggressive PAH treatment offers improved outcomes. Moreover, initial improvement in functional status made with parenteral prostanoids can be maintained with combination oral therapy.

An obese 52-year-old woman with a 5-year history of type 2 diabetes mellitus had odynophagia and dysphagia for several days. She described the sensation as food "sticking" in her chest. She also complained of vaginal itching, polyuria, and polydipsia. The only remarkable finding on physical examination was candidal vaginitis. The patient did not smoke cigarettes or drink alcoholic beverages, and there was no history of recent weight loss.

Methicillin-resistant Staphylococcus aureus (MRSA) became a "bug" to be reckoned with nearly 50 years ago. At that time, however, it targeted only patients who were exposed to infection in the hospital.In recent years, the epidemiology of MRSA has significantly changed. The pathogen is now a major culprit in community-acquired infections.

I read with interest the case of lymphogranuloma venereum (LGV) featured in Dr Henry Schneiderman's recent "What's Your Diagnosis?" column (CONSULTANT, February 2007, page 187). As one who has had a career-long interest in sexually transmitted disease, I feel compelled to make a few remarks regarding this case.

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

Frightened but lucid man who appears stated age. Vital signs are normal. No mass palpable in abdomen, though there is a faint suggestion of upper-abdominal distension. No supraclavicular lymphadenopathy, umbilical nodules, or upper-abdominal vascular bruit.

SILVER SPRING, Md. -- An FDA advisory panel has unanimously recommended accelerated approval of a novel antiretroviral drug as an add-on treatment for adult infected with CCR5-tropic HIV-1.

COPENHAGEN -- The use of protease inhibitors to treat HIV is associated with an increased risk of a heart attack, according to a large observational study.

SAN FRANCISCO -- A significant number of patients with major depression also suffer from chronic insomnia that hampers recovery, and treating the insomnia may improve both conditions.

BOSTON -- Girls perinatally infected with HIV early in the AIDS epidemic have reached adolescence and a mixed picture is emerging on their reproductive health, researchers here reported.

ATLANTA -- After a decade of decline, syphilis rates rose by 19% from 2000 through 2003, largely because of cases among men who have sex with men, according to a CDC study.

BRADFORD, England -- Well-meaning physicians may unwittingly induce delirium in older patients when they prescribe medications such as antihistamines or sleep aids, according to a literature review.

A middle-aged man hospitalized for intensive pulmonary toilet and topical and systemic treatment of a refractory skin disorder. Cough and moderate dyspnea with even mild exertion. Complains of scaling, uncomfortable dermopathy that he finds deeply cosmetically disfiguring and emotionally distressing.

BOSTON -- Hefty user fees from pharmaceutical companies account for some 40% of the FDA?s budget for new-drug reviews, but this scheme that spurs speedier approvals worries safety watchdogs.

BIRMINGHAM, England -- A cluster of six matching cases of tuberculosis here in 2005 originated from one person's exposure to bovine TB, strongly suggesting human-to-human spread, British researchers reported.

RIO DE JANEIRO -- The novel investigational drug raltegravir was highly effective at reducing the level of virus in their blood of extremely sick HIV patients, many of them with AIDS, according to researchers here.

BARCELONA, Spain -- Patients with hepatitis C virus infection who achieve a sustained virologic response to therapy should be considered cured, said investigators today.

ROCKVILLE, Md. -- The FDA and GlaxoSmithKline have warned pharmacies about a drug-tampering incident that resulted in misbranding of two drugs used to treat HIV.

RIBEIRÃO PRETO, Brazil -- In a pilot study of stem cell therapy for newly diagnosed type 1 diabetes, nearly all patients remained free of exogenous insulin for extended periods , one for as long as three years, researchers here reported.

BOSTON -- Co-infection with HIV and either hepatitis B or C remains a clinical challenge, but new therapies appear to have increased the opportunities for effective treatment.

BARCELONA, Spain -- The third-generation protease inhibitor darunavir (Prezista) is highly effective in combating highly resistant HIV, according to researchers here.

abstract: Hemoptysis has many causes, including bronchiectasis, lung cancer, and bronchitis. The initial goals of the history and physical examination are to differentiate hemoptysis from epistaxis and hematemesis and then to establish its severity. A variety of signs and symptoms may suggest the underlying cause. For example, hematuria suggests vasculitis or an immunologically mediated disease, such as Wegener granulomatosis or systemic lupus erythematosus. The workup includes chest radiography and measurement of hemoglobin and hematocrit levels, platelet count, international normalized ratio, activated partial thromboplastin time, and creatinine level. Chest CT scanning often identifies sources of bleeding that are not apparent on radiographs and sometimes can be used in conjunction with bronchoscopy. Patients with massive hemoptysis should be hospitalized for rapid evaluation and intervention; treatment may include interventional bronchoscopy, angiography, or embolization. (J Respir Dis. 2007;28(4):139-148)

Structured treatment interruption (STI) before initiating a new antiretroviral regimen is one strategy for improving virological response in patients with multidrug-resistant HIV-1 infection. However, there are conflicting data concerning the effectiveness of STI, and its role has not been established. The results of several recent studies, described below, are noteworthy (Table).

DURBAN. South Africa -- When women with HIV exclusively breastfeed their infants for the first six months, the chance of passing on the virus is only about 4%, researchers here said.