HIV/AIDS A JAMA THEME ISSUE Edited
by Jeanette M. Smith, MD, and Richard M. Glass, MD
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.
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.
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.
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.
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.
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.
"Where did the ‘system' break down for this child?" From "Baby
Mo: A Letter From Vietnam."
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.
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
For your patients: Information about HIV infection.
This Week in JAMA. JAMA. 2004;292(2):143. doi:10.1001/jama.292.2.143