State-of-the-art treatment dictates that physicians strongly consider
including a protease inhibitor in a multidrug regimen when initiating treatment
for HIV infection. In this study of simultaneous vs sequential treatment in
patients followed for at least 100 weeks, Dr Gulick and colleagues found that
those who received a regimen with a simultaneously initiated protease inhibitor
showed better immunologic status and virologic profile.
Discussing prognosis and treatment options with a patient newly diagnosed
with HIV infection would benefit from an accurate estimate of infection duration.
The modified ELISA test described by Dr Janssen and colleagues may provide
more precision in defining disease history in an individual, allowing physicians
to plan more appropriate treatment strategies.
The spread of HIV in Southeast Asia often appears to involve transmission
to spouses from men having sex with infected female sex workers. However,
in this study of HIV prevalence and risk factors in Thai women in the prenatal
care setting, Dr Siriwasin and colleagues found that about one fourth of the
sex partners of seropositive women were not HIV-infected.
Even though prophylaxis with zidovudine significantly reduces the rate
of perinatal HIV transmission, there remains a substantial risk for transmitting
HIV to the infant. In this study of pregnant women with HIV infection who
received zidovudine prophylaxis, Dr Mandelbrot and colleagues observed an
attenuated risk of perinatal HIV transmission with elective cesarean delivery.
The presence of a genital lesion increases the risk of transmitting
HIV to a sex partner. Dr Schacker and colleagues evaluated 12 HIV-1–seropositive
men with genital herpes lesions. HIV-1 was recovered from lesions in 25 of
26 episodes of genital herpes and on 67% of days, and was more likely to be
recovered from lesions on days when HSV-2 also was recovered.
In this consensus statement, the International AIDS Society–USA
Panel provides state-of-the-art recommendations for potent antiretroviral
therapy, including considerations for changing or modifying therapy and strategies
for such special circumstances as HIV infection in pregnancy.
A Cover Without Art.
The FDA has approved the first wide-scale testing of a vaccine to prevent
AIDS, although some scientists remain skeptical about its prospects for success.
Most pediatric HIV-1 infections are acquired perinatally. Effective
strategies for prevention of vertical transmission of HIV-1 are emerging.
"Often we do not acknowledge the gift our patients offer when they become
involved in research." From "Success and Sadness."
Treat now or later? Early and aggressive vs delayed and conservative
therapy in early HIV infection.
For your patients: drug treatment options for HIV infection.
This Week in JAMA. JAMA. 1998;280(1):3. doi:10.1001/jama.280.1.3