AIDS Reader

HIV testing and prevention were two important, and sometimes controversial, research themes at the 17th International AIDS Conference (IAC) held from August 3 to 8, 2008, in Mexico City. Both topics, usually low-tech activities, saw a renewed interest in an evidence-based approach and pleas for more data.

With an improved life expectancy, HIV-positive patients now face interactions between antiretroviral therapy and medications for chronic medical problems. One example is thromboembolism and its treatment with oral anticoagulants.

Although more than 20 years of antiretroviral therapy use has resulted in the selection of multidrug-resistant (MDR) HIV-1, new drugs in the traditional and newer antiretroviral drug classes provide an increasing range of options for the effective treatment of HIV-1 infection.

A 45-year-old incarcerated man with long-standing AIDS was admitted for management of lower extremity pain secondary to peripheral neuropathy.

In addressing a press conference this summer at the United Nations High-Level Meeting on AIDS, Dr Anthony Fauci of the NIH commented on the “40,000 to 52,000 new infections each year” occurring in the United States.

Since the introduction of highly active retroviral therapy and with the improvement in the survival of persons with HIV/AIDS, the spectrum of renal disease in HIV-infected persons has expanded.

Because widespread use of highly active antiretroviral therapy has made it possible for persons with HIV infection to live longer, the epidemiology of HIV/AIDS has shifted in several ways

On Thursday, July 17, plans to conduct a large-scale test of an experimental therapeutic AIDS vaccine were canceled, the latest setback following last year’s failed Merck AIDS vaccine trial (Russell S. San Francisco Chronicle. July 18, 2008).

In recent years, few breakthroughs in HIV prevention science have been realized. Preexposure prophylaxis (PrEP), involving the use of antiretrovirals just before a potentially risky sexual encounter, is an intriguing concept, although it’s not new.

Many different antiretroviral regimens can be used as initial therapy for infection with HIV.

In the United States, an estimated 150,000 to 300,000 people are infected with both HIV and hepatitis C virus (HCV), representing about 15% to 30% of all persons living with HIV infection1,2 and 70% to 90% of injection drug users

The HIV epidemic was discovered in the early 1980s, and the response from the medical community was remarkable. Health care providers committed their time and careers to the cause of a group of people afflicted with an unknown and fatal illness.

Five years ago, the International Agency for Research on Cancer (IARC) conducted a case-control study in 9 sites (Italy, Spain, Northern Ireland, Poland, India, Cuba, Canada, Australia, and Sudan) of 1415 participants with cancer of the oral cavity and 255 with oropharyngeal carcinoma.1 Markers for human papillomavirus (HPV) infection were evaluated, including antibodies against HPV16 E6 and E7 proteins, which are common in cervical cancer, and HPV DNA in biopsy samples, detected by polymerase chain reaction assay.

Cerebrovascular disease (CVD) in HIV may be associated with multiple concurrent etiologies and with varying presentations, from chronic asymptomatic microvascular calcifications or vascular anomalies to intracerebral hemorrhage to thrombotic stroke.

In September 2006, the CDC recommended that the interpretation of "general consent" for medical care include HIV screening, which eliminated the need for a separate, written consent.

We present the case of an HIV-infected patient with cirrhosis in whom severe neuropsychiatric signs and symptoms developed in the setting of a significantly elevated plasma efavirenz level.

A 40-year-old homosexual man with CDC class B3 HIV infection presented to our clinic complaining of worsening right hip pain. HIV infection had been diagnosed in 1995. His most recent CD4+ cell count was 167/µL, and his HIV RNA level was suppressed while he was receiving antiretroviral therapy consisting of emtricitabine/tenofovir fixed-dose combination, efavirenz, and ritonavir-boosted atazanavir.

A case-control study was conducted that involved a retrospective chart review of 181 HIV-infected women in whom cervical dysplasia had been diagnosed to examine the association between patient adherence to highly active antiretroviral therapy and the regression or stabilization of cervical dysplasia.

Since the introduction of highly active antiretroviral therapy in the mid-1990s, antiretroviral therapy (ART) options have expanded considerably to include simpler, safer, and more tolerable regimens.

Aspergillus species are ubiquitous molds to which humans are commonly exposed. Of approximately 180 species, it is estimated that 34 are medically significant. Most persons who come in contact with the fungus remain asymptomatic.

Kaposi sarcoma (KS), AIDS-related non-Hodgkin lymphoma (AIDS-NHL), and anal squamous cell carcinoma/anal intraepithelial neoplasia (SCC/AIN) are malignancies that commonly involve the GI tract in patients who have HIV/AIDS.1 Oncogenic viruses have been implicated in the etiology of each of these neoplasms-specifically, human herpes virus 8 (HHV8) in KS, Epstein-Barr virus (EBV) in AIDS-NHL, and human papillomavirus in SCC/AIN.

Primary HIV infection refers to the earliest stages of infection, or the interval from initial infection to seroconversion (when antibody to HIV is detectable). During this stage, many patients have symptoms of acute HIV seroconversion illness, are viremic with very high HIV RNA levels, and have negative or indeterminate findings on HIV antibody tests.

UNICEF has reported that there have been some improvements for children facing AIDS, but progress is still far short of goals set for 2010 (Worsnip P. Reuters. April 3, 2008).

Apart from clinical trials that provide highly active antiretroviral therapy shortly after the recognition of an acute seroconversion reaction-an intervention that some believe could be a prelude to eradicating HIV -there has long been debate over the optimal time to initiate antiretroviral therapy.

In the early years of the HIV/AIDS epidemic, the physicians and nurses who provided care to patients with this puzzling and clearly complex infection identified the benefits of specialized knowledge of the virus and management of the symptoms associated with its attack on the immune system.

“It’s a completely different mechanism of action to what we have currently under development and what the field has under development,” said Dr Zeda Rosenberg, IPM’s CEO. “It’s pretty early in the life cycle for HIV. Most of us feel that for a microbicide to be really effective, it has to get at the infection in its earliest time points.”

The 15th Conference on Retroviruses and Opportunistic Infections (15th CROI) was held in Boston from February 3 to 6, 2008. There were more than 1000 oral and poster presentations at this conference and, as is usually the case, some were quite important.

Fusion inhibitors are novel antiretroviral agents, administered as subcutaneous injections, approved for use in treatment-experienced HIV-infected patients.

Lipoatrophy is a noteworthy adverse effect of antiretroviral therapy. A 2-part literature review was conducted to assess the impact of lipoatrophy in HIV-infected persons: the first reviewed the qualitative studies that reported lipoatrophy data, and the second reviewed the clinical studies that recorded patient-reported outcome end points.

Lipoatrophy is an important problem that emerged in 1998 with seminal findings reported by Carr and colleagues.1