Dr Thomas Fekete's recent article on emerging infections (CONSULTANT, October 2007) was timely, given recent evidence that the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection, both hospital-acquired and community-acquired, has assumed pandemic proportions.

 NEARLY A THIRD (31%) of personsliving with tuberculosis (TB) are unawareof their HIV status, accordingto a study highlighted in the CDC'sMorbidity and Mortality Weekly Report(Reported HIV status of tuberculosispatients-United States, 1993-2005.MMWR. 2007;56:1103-1106). Thestudy evaluated retrospective healthdata from 49 states and the Districtof Columbia and found that eventhough reporting status of personswith TB increased from 35% in 1993to 68% in 2003, it has remainedrelatively unchanged since then.

HIV infection continues to exact a devastating toll worldwide.Advances in antiretroviral therapy have helped bring theHIV/AIDS epidemic under control in developed countries.Antiretroviral drugs, however, are not widely available inthose developing countries where HIV poses a catastrophicthreat. Effective strategies for HIV prevention are thereforecrucial to curbing the global epidemic. Vaccination, microbicideuse, and male circumcision are 3 key preventive interventions.Current research is focused on developing effective vaccinesand microbicides and on determining the extent to whichcircumcision helps prevent HIV acquisition and transmission.[Infect Med. 2008;25:63-72]

Critical ViewsinInfectiousDiseaseMedicine A

Several reports have documented an increased incidence of smooth muscle tumors in patients with AIDS and in those with other immunocompromised conditions.

Recently the CDC released a report of a study on coinfection with HIV and Mycobacterium tuberculosis that found that many US patients with tuberculosis (TB) are still not being tested for HIV.

Reviewing just a 2-month interval of HIV/AIDS-related publications and announcements, from mid-September to mid-November of 2007, produced discouraging news in 3 key areas: vaccine development, female-initiated barrier protection, and HIV treatment in the resource-poor world.

We evaluated a cohort of persons with late-stage HIV infection currently enrolled in a longitudinal tracking study to determine whether coinfection with hepatitis C virus (HCV) is associated with a greater prevalence and/or severity of HIV-associated cognitive-motor complex and distal predominantly sensory peripheral polyneuropathy compared with persons with HIV infection alone

Writing a book about the history of anything is an ambitious undertaking, and this book is no different. For those of us who witnessed HIV from the beginning of its re-corded history, Engel does a good job of hitting the highlights and examining the issues.

Imagine yourself living with a chronic infection and-after trying your best to adhere to the recommended course of treatment-being told by your doctor: “You have failed your medication. The most we can do now is salvage therapy.

Much has been written about the increase in non–AIDS-defining cancers in HIV-infected persons over the past decade.

Cinti and colleagues1 call further attention to an increasing concern for people living with HIV infection and those providing their care: the increased risk of cancers that are not considered AIDS-defining events.

The first step in the workup of a patient with a persistent asymptomatic alkaline phosphatase (ALP) elevation is to measure gamma-glutamyltranspeptidase to determine whether the elevation is liver-related or bone-related.

Bipolar disorder (also known as manic-depressive illness) affects nearly 6 million adults in the United States.1 This psychiatric disorder was first described at the time of Hippocrates and is currently one of the most prevalent and severe mental illnesses in our society.

To help answer the question of Mary Ellen Lewis, PA-C, about her patient with a low-density lipoprotein (LDL) cholesterol level of 120 mg/dL and a high-density lipoprotein (HDL) cholesterol level of 100 mg/dL(CONSULTANT, June 2007), I would like to describe my approach to the treatment of dyslipidemia.

Nephropathy develops in about 30% of patients with diabetes. Screen for albuminuria at the time type 2 diabetes is diagnosed and within 5 years of diagnosis of type 1 diabetes.

About 25% of patients seek advice on exercise and physical activity from their physician, according to a recent survey conducted by the American College of Sports Medicine (ACSM). The survey also showed that about 65% of patients would be more interested in exercising to stay healthy if their physician offered recommendations and resources.

Sponsors of Part D plans are pressuring the Centers for Medicare & Medicaid Services (CMS) to shift its stand on e-prescribing, from encouraging physicians to voluntarily adopt the practice to mandating that they adopt it. "The time is now to require e-prescribing in Medicare. The only realistic way to rapidly accelerate adoption of e-prescribing is to require physicians to use the technology in Medicare," according to a statement released by the Pharmaceutical Care Management Association (PCMA). However, the AMA opposes such a mandate unless it includes federal grants or tax credits to help physicians pay for the necessary technology.

Currently, an estimated 20% of the adult US population have irritable bowel syndrome (IBS). Although the disorder affects both sexes, between 60% and 75% of persons who receive a diagnosis of IBS are women. IBS develops before age 35 in approximately 50% of those with the disorder. Between 5% and 20% of children and 6% to 14% of adolescents have symptoms of IBS.

Employers in general are highly satisfied with their PBMs. Employers gave PBMs an average overall service and performance rating of 7.9 on a 10-point scale compared with 7.8 in 2006.