Hepatitis C virus (HCV) infection is common in patients also infected
with human immunodeficiency virus (HIV), but effective HCV treatment is lacking.
Carrat and colleaguesArticle report results of a randomized
trial comparing safety and efficacy of peginterferon alfa-2b plus ribavirin
vs standard interferon alfa-2b plus ribavirin in HIV-HCV coinfected patients
treated for 48 weeks. They found that significantly more patients in the peginterferon
plus ribavirin group had undetectable serum HCV-RNA at a 72-week follow-up
examination than patients who had received standard interferon alfa-2b. Tolerability
was similar for both regimens. In an editorial, Manns and WedemeyerArticle discuss results from 3 clinical trials comparing these treatment regimens
and the need for new therapies.
Options for antihypertensive therapy are many, but there are limited
data addressing the superiority of certain combination therapies vs monotherapies
to prevent hypertension-related cardiovascular disease (CVD) complications.
Wassertheil-Smoller and colleagues assessed CVD morbidity and mortality in
women aged 50 to 79 years and with no prior history of CVD disease at baseline
in relation to their antihypertensive therapy. During 5.6 years of follow-up,
monotherapy with diuretics was superior to monotherapy with other agents in
preventing CVD complications. Combination therapy with a calcium channel blocker
plus diuretic was associated with a higher risk of CVD mortality than the
combination of a β-blocker plus diuretic. Risks were similar for combined
therapy with either an angiotensin-converting enzyme inhibitor plus diuretic
or a β-blocker plus diuretic.
Adopting a sedentary lifestyle and poor dietary habits may increase
the risk of obesity in immigrants to the United States, but few studies have
addressed acculturation and obesity in immigrants. Goel and colleagues used
national data to assess the prevalence of obesity in immigrants vs US-born
adults, the association of obesity with duration of US residence, and the
likelihood of diet and exercise counseling by clinicians. The authors found
a lower overall prevalence of obese immigrants vs US-born adults; however,
the prevalence of obesity in immigrants approached that of US-born adults
after 15 years of living in the United States. Immigrants reported receiving
significantly less diet and exercise counseling.
Heavy metal intoxication has been documented in association with Ayurvedic
herbal medicine products (HMPs). Saper and colleagues determined the prevalence
and concentration of heavy metals in Ayurvedic HMPs sold in Boston-area South
Asian grocery stores and computed the estimated daily ingestion of the heavy
metals relative to regulatory standards. Lead, arsenic, and mercury were found
in 20% of the products tested. If the products were taken as recommended,
users would consume potentially toxic levels of these metals.
Implantable cardioverter defibrillator (ICD) therapy prevents sudden
cardiac death in patients with prior myocardial infarction and depressed ejection
fraction, but convincing evidence of a survival benefit in patients with nonischemic
cardiomyopathy (NICM) is lacking. In a meta-analysis of data derived from
randomized trials of therapies to prevent mortality in NICM, Desai and colleagues
found a significant reduction in mortality with ICD therapy compared with
New research suggests that deficits in mitochondrial genes may be a
common underlying cause of traits associated with the metabolic syndrome.
Residents report high levels of burnout, but the causes are not clear.
In an editorial, Lim and Golub discuss the need for scientific rigor in research
in graduate medical education.
See Article and Article
The Rational Clinical Examination
Simple examination maneuvers identify women with low bone mineral density or occult vertebral
Clinical ReviewDiagnosis, pathophysiology,
and pharmacotherapy of mixed dementia.
For your patients: Information about cardiomyopathy.
This Week in JAMA . JAMA. 2004;292(23):2809. doi:10.1001/jama.292.23.2809