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This Week in JAMA
July 14, 2004

This Week in JAMA

JAMA. 2004;292(2):143. doi:10.1001/jama.292.2.143

Edited by Jeanette M. Smith, MD, and Richard M. Glass, MD

Reducing HIV Risk in African American Adolescent Girls

DiClemente and colleagues report that sexually experienced, African American adolescent girls who were randomized to an HIV-prevention program emphasizing ethnic and gender pride, HIV knowledge, communication and condom-use skills, and healthy relationships were more likely to report consistent condom use and less likely to engage in sexual risk behaviors than girls receiving an intervention emphasizing exercise and nutrition.

Combination Therapies for Antiretroviral-Naive Patients

Two articles in this issue of JAMA report outcomes of new therapeutic regimens for antiretroviral-naive patients. Saag and colleaguesArticlerandomized patients to either emtricitabine, a once-daily nucleoside reverse transcriptase inhibitor (NRTI), or the NRTI stavudine, both in combination with didanosine and efavirenz. After 48 weeks, patients receiving emtricitabine were more likely to have an undetectable viral load below the limit of assay quantification than patients taking stavudine. In the second article, Gallant and colleaguesArticlereport that a treatment regimen of tenofovir disoproxil fumarate, a nucleoside analogue reverse transcriptase inhibitor, in combination with lamivudine and efavirenz was highly effective and comparable with a regimen of stavudine, lamivudine, and efavirenz, with less lipodystrophy and better lipid profiles through 144 weeks of treatment.

Reducing Perinatal HIV Transmission

The efficacy of an antiretroviral regimen to prevent perinatal transmission of HIV and the feasibility of HIV-antibody testing in the peripartum period were evaluated in 2 studies reported in this issue. Taha and colleaguesArticleinvestigated whether infants in Malawi who received zidovudine plus nevirapine would have a lower risk of perinatal HIV acquisition than infants who received the standard therapy of nevirapine alone. The authors found no additional reduction in HIV transmission with the combination therapy. Bulterys and colleaguesArticleinvestigated maternal acceptance of HIV testing during labor and the sensitivity, specificity, and time course of the rapid HIV test used. They found that rapid HIV testing was feasible, with accurate and timely results.

Treatment of Lipodystrophy

Koutkia and colleagues found that HIV-positive men randomized to receive twice-daily injections of growth hormone-releasing hormone had significantly less truncal and visceral fat and increased lean body mass compared with men receiving placebo injections.

Association of HAART With Sexual Risk Behaviors

Crepaz and colleagues meta-analyzed data from studies assessing whether receiving highly active antiretroviral therapy (HAART) is associated with unprotected sexual intercourse and sexually transmitted infections. They found that patients receiving HAART were not more likely to engage in sexual risk behaviors, even when their viral load was undetectable. However, believing that HAART or an undetectable viral load protects against HIV transmission was associated with unprotected sex.

Standards of Care in Clinical Trials

Concerns about the ethics of clinical trials conducted in developing nations have led to conflicting recommendations about the standard of care that should be provided to participants. Kent and colleagues reviewed clinical trials of HIV and tuberculosis treatment and malaria prophylaxis conducted in sub-Saharan Africa to determine if trial participants were provided care consistent with the best current clinical standards. They found that only 12 of the 73 trials evaluated conformed to established clinical guidelines.

A Piece of My Mind

"Where did the ‘system' break down for this child?" From "Baby Mo: A Letter From Vietnam."

Medical News & Perspectives

An innovative partnership between medical schools in the United States and Kenya is bringing comprehensive health care and other kinds of assistance to HIV-infected patients.

Hepatotoxicity and HIV Infection

Kottilil and colleagues review the diagnostic and treatment challenges posed by asymptomatic liver enzyme elevations in patients with HIV infection.


Recommendations from the International AIDS Society-USA Panel.


Strategies for patients with HIV and bringing effective HIV care to resource-poor countries are discussed by Sande and RonaldArticle and Brewer and Heymann.Article

JAMA Patient Page

For your patients: Information about HIV infection.