HIV AIDS

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.

A recent editorial in The New York Times heralded the conclusion, from 2 large sub-Saharan African studies, that male circumcision dramatically suppresses HIV acquisition rates as the "most important development in AIDS research since the debut of antiretroviral drugs."1 The editorial went on to state that while a "real [AIDS] vaccine is years away . . . we know its near equivalent [now] exists."1But Anthony Fauci, director of the National Institute for Allergy and Infectious Disease, was more circumspect. "These results could be negated by a small decrease in condom use or the addition of more sexual partners," he cautioned.2

SEATTLE -- For women, infection with a common sexually transmitted disease sharply increases the risk of contracting HIV, according to researchers here.

BOSTON -- For women in developing countries who are HIV-positive, a dose of Viramune (nevirapine) during labor to prevent mother-to-child viral transmission does not preclude the safe renewed use of Viramune-based antiretroviral therapy after a six-month delay.

SEATTLE -- Persons newly released from prison, within their first two weeks of freedom, have a nearly 13-fold higher risk of death than those in the general population.

LOS ANGELES -- Older patients admitted to a large academic medical center on busy shifts may have a greater mortality risk than those who come to the hospital on less frenetic days, suggested investigators here.

The introduction of effective antiretroviral therapy has resulted in dramatic clinical benefits for those persons who have access to it. Adherence to such therapy has emerged as both the major determinant and the Achilles' heel of this success. Many patients have levels of adherence too low for durable virologic control.

The first issue of the year 2007 marks thestart of 2 changes for The AIDS Reader. Thefirst is obvious-it’s in front of your noseright now: each month, I will provide a few editorialnotes on what you can expect in the issue.The second change is less conspicuous but moreimportant: a statement of any potential conflictof interest will now appear with each publishedarticle.

The elimination of perinatal HIV transmission in the United States is within reach. When antiretroviral therapy is effective in controlling maternal viremia during pregnancy, the risk of perinatal transmission is less than 1%.

HIV can be transmitted from an infected mother to her child during pregnancy or labor and postnatally through breast milk. Nearly 25 years after the first documented case of HIV infection, the decrease in perinatal HIV infections in the United States represents a major success in public health.

Liver disease, particularly hepatitis C, has emerged as a major cause of morbidity and mortality for people with HIV/AIDS in the era of potent antiretroviral therapy. Mortality is increased in patients with HIV–hepatitis C virus (HCV) coinfection compared with that in patients with HIV alone.1,2

The title of this column is the slogan from World AIDS Day 2006, and as we look to 2007 and a new Congress, a more appropriate slogan could not have been chosen. However, rather than keeping the promise, we are only slightly farther ahead than we were 1, 5, 10, or even 20 years ago and at some risk of going backward, as evinced by the sobering information made available through the World Health Organization (WHO) and the CDC.

Salivary gland enlargement, most commonly involving one or both parotid glands, is sometimes seen in association with HIV infection. Enlargement of the parotid gland may be due to diffuse infiltrative lymphocytosis syndrome; lymphoepithelial cysts; or malignant tumors, such as squamous cell carcinoma, Kaposi sarcoma, and Hodgkin and non-Hodgkin lymphomas.1,2 Non–HIV-related causes of parotid enlargement include acute and chronic viral infection, granulomatous disease, malnutrition, alcoholism, and diabetes mellitus.3,4 Here we report the case of a 41-year-old HIV-infected man with fat maldistribution syndrome associated with type 2 diabetes and hyperlipidemia. Sialadenosis developed presumably as a result of HIV infection and hypertriglyceridemia.