HIV AIDS

For 2 days, a 45-year-old woman has had a painful rash on her left upper chest,upper back, neck, shoulder, and upper arm; she has also had pain around herleft ear. She describes the pain as burning, needlelike, and so severe that it hasprevented sleep; it is unrelieved by topical emollients. The rash was precededby 24 hours of a similar burning pain in the same area. No neurologic deficitsare associated with the rash. She has no history of rashes; no pain or rashesoccur elsewhere on her body.

For about 3 to 4 months, a 53-year-old man has had gradually worsening footdiscomfort. He describes the discomfort as a burning sensation accompaniedby numbness and tingling. Initially, these symptoms were present only in hisfeet, but for several weeks they have involved both ankles as well. Althoughthe discomfort is always present, it is occasionally aggravated by the bed coversor by heavy woollen socks. The patient has no skin lesions, motor symptoms,or other abnormalities of his legs or feet.

The patient is a 4-year-old boy who hasbeen coughing persistently for the past 2months. The mother reports that aboutthe time the coughing began, the childhad a “cold” with nasal congestion andfever. These symptoms resolved, but acough ensued. The mother tried usingover-the-counter medications, includingcough suppressants, but the cough hasnot abated. It occurs during the day andat night. It is disrupting the child’s sleep,and the teachers at his day-care centerare concerned that he may be infectingother children.

A 55-year-old woman has had a lump under her right jaw for thepast 24 hours. She has difficulty in swallowing because of neck discomfort, andher voice is raspy. Both of these symptoms have progressed rapidly during thepast 12 hours. The patient has no difficulty in breathing, sore throat, or historyof recent illness. Her temperature is 38.5°C (101.5°F).

A 64-year-old woman presentsto the emergency department withworsening crampy abdominal painthat began the night before. Afterthe pain started, she had a bowelmovement containing a significantamount of blood; since then she hashad episodes of diarrhea. She hadbeen previously healthy, denies traumaand fever, and knows no one withsimilar symptoms. She reports norecent enema, endoscopy, or otherabdominal procedure.

A 36-year-old womanhas had a rash on her hands and feetfor the past week. She denies recentillness, pruritus, fever, chills, sorethroat, and abdominal discomfort.She is currently in a monogamousrelationship with her fiancé.

A 54-year-old Hispanic housewife presents to the emergencydepartment with a 3-week history of moderatelysevere, progressive, generalized, pulsating headache.The headache, which is partially relieved by propoxyphenenapsylate, is associated with weakness, vomiting of recentonset, and intermittent bilateral blurred vision. The symptomsbegan after an incident in which the patient’s sonwas stabbed.

For 3 days, a 60-year-old woman hashad a tender rash on her forehead. Thelesions erupted 2 days after she sustainedminor trauma to the left side ofthe forehead (Figure 1); no scratchesor bleeding were associated with theinjury. She noted a burning sensationand mild tenderness at the site shortlybefore the lesions arose.

Rifampin is associated with numerousclinically significantdrug interactions.1-4 New interactionswith rifampin-aswell as rifabutin-continue tobe reported in studies and clinical observations.Here we present highlightsof our recent update on the interactionsthat are most relevant toprimary care practice.5

During a routine skin examination,periungual erythema and increasedcurvature of the nail plate are notedin a 78-year-old man. The patient hasemphysema and a smoking historyof more than 50 pack-years. Currently,he requires oxygen support forregular daily activity.

A 41-year-old woman with a 4-yearhistory of polymyositis with lupus featureshas had constant rectal pain for4 months. She has not noticed any factorsthat either aggravate or relievethe pain. The patient complains of intermittentconstipation (but no dischargeor rectal bleeding), generalizedweakness and malaise for the past 2months, a low-grade fever for the pastmonth, and a 4.1-kg (9-lb) weight lossover the past 6 weeks. She denies nightsweats or chills, anorexia, vision problems,drug allergies, and tobacco oralcohol use.

A 22-year-old man presents to theemergency department with a2-week history of a worsening nonproductive,irritating dry cough andexertional dyspnea. The patient hasbeen otherwise healthy. He deniesfever, rigors, night sweats, hemoptysis,chest pain, palpitations, orthopnea,paroxysmal nocturnal dyspnea,ankle edema, and lymphadenopathy.

For 3 days, a 42-year-old man has had episodic dullchest pain. The anterior precordial and retrosternalpain intensifies with inspiration and movement. He has nohistory of recent viral infection, hypertension, coronaryartery disease, cardiac surgery, diabetes mellitus, or hyperlipidemia.There is no family history of cardiovasculardisease.

TORONTO, Dec. 27 - Researchers and clinicians descended en masse on this city this year for the World AIDS Conference -- the first time in a decade the meeting has been held in North America.

ATLANTA -- Tuberculosis remained at relatively low rates in the U.S., despite more reported cases of multi-drug resistant TB (MDR TB). But a new alarm was sounded in 2006 ? extensively drug resistant TB (XTR TB).

HOUSTON -- After a plaque of scary headlines, the news of a potential pandemic avian flu has dropped off the front pages. But virologists believe the threat is waiting in the wings.

OAKLAND, Calif. -- HIV-infected patients having surgery were more likely to develop post-op pneumonia or to die within 12 months than matched non-infected patients, researchers here reported.

OAKLAND, Calif. -- HIV-infected patients having surgery were more likely to develop post-op pneumonia or to die within 12 months than matched non-infected patients, researchers here reported.

ROCKVILLE, Md. -- Two patients treated with the immune modulator Rituxan (rituximab) for systemic lupus erythmatosus have died of progressive multifocal leukoencephalopathy (PML), the FDA warned physicians.

SAN ANTONIO -- Evidence is mounting that the so-called human mammary tumor virus (HMTV) can actually causes breast cancer, a New York researcher said.

SAN ANTONIO -- Evidence is mounting that the so-called human mammary tumor virus (HMTV) can actually causes breast cancer, a New York researcher said.

BETHESDA, Md. -- Two U.S.-led trials of men in sub-Saharan Africa were halted early when interim analyses of results confirmed that circumcision can significantly reduce heterosexual transmission of HIV.

BETHESDA, Md. -- Two U.S.-led trials of men in sub-Saharan Africa were halted early when interim analyses of results confirmed that circumcision can significantly reduce heterosexual transmission of HIV.

A 73-year-old woman presents with apainless, nonpruritic rash of recent onseton her right lower ankle. She has nofever, chills, nausea, vomiting, malaise,or other systemic complaints. Her medicalhistory includes fibromyalgia, osteoarthritis,stable angina, and anxiety;there is no history of connective tissuedisease.

RESEARCH TRIANGLE PARK, N.C. -- Major hormonal contraception methods appear to have little or no effect on HIV susceptibility for women at moderate risk, according to a study of more than 4,000 African women.

ORLANDO -- A novel approach to Burkitt's lymphoma, using a regimen designed for large B-cell lymphomas, led to complete remissions in all patients in a small study, investigators reported here.

SEATTLE -- In a spiral of infection and susceptibility, the African epidemics of HIV and malaria may be fueling each other, according to researchers here. The interplay of the two diseases heightens their effect in regions where both are found.

Primary care physicians' implementation of routine screening is crucial to reducing the incidence of and mortality from HIV. Here's how to implement routine testing in your practice.

NEW HAVEN, Conn. -- All adults in the U.S. should be routinely given a rapid test for HIV unless there's evidence that the local prevalence of undiagnosed infection is less than 0.2%, suggest researchers here.

NEW YORK -- Even while HIV is well controlled in the bloodstream, the gut is suffering a fierce assault on immune cells, according to researchers here. While the attack isn't clinically obvious, it may have long-term effects, especially as people with HIV age.