HIV AIDS

From the Editor's Desk: In This Month's Issue

A 34-year-old woman who was coinfected with HIV and hepatitis C virus complained of acute abdominal pain and generalized pruritus of 3 weeks' duration. She was noncompliant with her antiretroviral medications.

This infection is caused by reactivationof varicella-zoster virus (VZV),which may remain latent in thedorsal root and cranial nerve gangliafor decades. Reactivation oftenoccurs for no apparent reason, althoughstress and immunosuppressionmay increase the risk.

ABSTRACT: A 4-pronged approach that includes patient education, skin and nail care, appropriate footwear, and proactive surgeries can effectively prevent diabetic foot problems. Teach patients with diabetes to examine their feet daily to detect new onset of redness, swelling, breaks in the integrity of the skin, blisters, calluses, and macerated areas. Have them follow a daily foot care regimen that includes warm water soaks and lubrication, and have them keep toenails properly trimmed. Recommend that patients select shoes that fit properly and have sufficient padding and toe box space; have them use inserts, lifts, orthoses, or braces--as recommended-to correct abnormal gait patterns. Finally, if deformities develop, simple proactive surgical procedures can correct these problems before they result in the development of wounds.

Images in HIV/AIDS: HIV-Associated Lymphogranuloma Venereum Proctitis

LOS ANGELES -- An investigational anti-HIV drug called maraviroc, the first CCR5 inhibitor, significantly outperformed placebo in patients who were failing anti-retroviral therapy, according to interim results from two major phase III trials.

LOS ANGELES -- Like the traditional HIV-associated opportunistic infections, the toll of conditions such as heart and liver disease is affected by the immune status of a patient, researchers reported here.

LOS ANGELES -- Raltegravir (MK-0518), an investigational anti-retroviral drug that targets the HIV enzyme integrase, seems highly effective in patients resistant to existing classes of drugs.

LOS ANGELES -- An investigational synthetic hormone significantly reduces visceral fat in patients treated for HIV, researchers reported here.

LOS ANGELES -- Interrupting antiretroviral therapy for HIV patients increases the risk of cardiovascular disease by more than 50% over four years, a British researcher said here.

LOS ANGELES -- Extensively drug-resistant tuberculosis -- or XDR-TB -- is appearing in more countries and is estimated to have caused 16,000 deaths in 2005.

HOMBURG, Germany -- There is a quick, reliable way to assess sepsis and overall prognosis in secondary peritonitis, according to researchers here.

CHICAGO -- The verdict on male circumcision and HIV transmission has been validated. Now the question is how to implement the finding that male circumcision cuts the risk of HIV infection by more than 50%.

LONDON -- Treating herpes simplex with valacylovir (Valtrex) reduces the levels of HIV in women who are infected with both viruses, according to researchers here.

BETHESDA, Md. -- An atomic-level snapshot of a key HIV protein as it binds to a neutralizing antibody, a feat accomplished here, may be a step toward an effective vaccine, the researchers said.

SAN FRANCISCO -- Smoking marijuana significantly reduces nerve pain associated with HIV infection, according to researchers here.

SAN FRANCISCO -- A transcutaneous electrical nerve stimulation (TENS) device used in stroke rehabilitation clinics may be effective for home use as well, researchers said here.

TOTTORI, Japan -- A third of patients with hepatitis C infections and hepatic fibrosis could be spared liver biopsies by the use of a new index that predicts significant fibrosis with three blood tests, according to researchers here.

ARLINGTON, Va. -- For the second time, efforts to create a topical microbicide that would protect against HIV transmission during sex have ended in failure.

Herpes zoster occurs in 10% to 20% of the general population as a result of reactivation of the varicella-zoster virus (VZV) and is generally benign. It occurs more frequently in persons with cellular immunodeficiency and older age. The association between herpes zoster and HIV was confirmed early in the course of the HIV epidemic by numerous studies. Zoster was noted to precede AIDS in high-risk groups. Both the incidence and complication rate of herpes zoster are increased in HIVinfected patients.

Fanconi syndrome is generally characterized by evidence of proximal renal tubulopathy (ie, decreased renal reabsorption and increased urinary excretion of filtered proteins, potassium, glucose, phosphate, amino acids, and calcium).

The CDC estimates that more than 850,000 people are living with HIV/AIDS in the United States today,1 with African Americans and Latinos being disproportionately affected.2 Over the past decade, the Latino population in the United States has been growing. In fact, in 2002 for the first time, Latinos surpassed African Americans as the largest US minority group. However, the term "Latino" is applied to a very heterogeneous group from different countries and different cultures.3 In addition, a large proportion of Latinos is undocumented in the United States and thus marginalized from the health care system.

A 49-year-old white man, in whom HIV infection had been newly diagnosed (CD4+ cell count, 25/µL; HIV-1 RNA level, 274,000 copies/mL), was transferred to our hospital for further workup and treatment of multiple neurologic deficits. He had presented to another hospital with a 4-day history of left-sided weakness and numbness, left-sided facial droop, dysphonia, and dysphagia that led to the initial diagnosis of an acute stroke.

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.

The investigators employed the HIV Epidemiological Research Study, a longitudinal prospective cohort study, along with semiannual interview, physical examination, and laboratory assays. They recruited 773 HIV-positive women aged 16 to 55 years from 4 academic medical facilities in Baltimore; Bronx, New York; Providence, RI; and Detroit.

Tenofovir disoproxil fumarate is approved to treat HIV infection in combination with other antiretroviral agents. Although tenofovir is generally well tolerated, the potential for nephrotoxicity exists based on preclinical data, case reports, and observational studies.

Although the observations of del Rio and colleagues1 stemming from their study of foreign-born, HIV-infected Latinos are limited to a certain geographic area, their findings should stimulate further research to better understand and provide better health care to ethnic and minority groups living with HIV/AIDS in the United States.

Blastoschizomyces capitatus is an emerging pathogen that causes infection primarily in patients who have immune system dysfunction. The author reports a case of pulmonary blastoschizomycosis in an immunocompetent man who was successfully treated with voriconazole.

If you are looking for answers to such clinical questions, we invite you to log on to our Web site www.ConsultantLive.com.

For a week, a 39-year-old woman with a history of intravenous heroin use had generalized pain, fever, chills, and a nonproductive cough. She rated the pain at 10 on a scale of 1 to 10; it was sharp, constant, and unrelieved by heroin. She also reported dyspnea at rest, pleuritic chest pain, and a 15-lb weight loss over the past month. She had no significant medical history or drug allergies, smoked a half pack of cigarettes per day, and denied alcohol use.