Pediatric human immunodeficiency virus (HIV) infection is the subject
of 2 articles in this issue of JAMA. Brogly and colleaguesArticle examined pediatric HIV treatment from 1987 through
2003 and assessed concordance with expert guidelines. They found a short lag
time between identification of novel therapies and their use in children and
that treatment was consistent with expert guidelines in 78% of cases. Switching
to a new regimen was associated with failure to use guideline-recommended
therapy. In a second article, Berk and colleaguesArticle examined
disease progression and survival in a cohort of children with perinatal HIV
infection in relation to year of birth and use of antiretroviral therapy (ART).
They found less disease progression and improved survival at 3 years in children
treated with ART compared with those who were not and in children treated
in the first few months of age vs later. Recency of birth and more advanced
therapy were associated with improved survival. In an editorial, YogevArticle discusses the benefits and risks of ART in children.
Prompt follow-up testing of children with abnormal screening blood levels
is recommended, but estimates of the number of children who receive follow-up
testing and factors associated with failure to do so are lacking. Kemper and
colleaguesArticle reviewed Medicaid program files for
children with documented elevated screening blood levels to assess the proportion
of children with follow-up testing. They found only 53.9% of children with
an elevated screening lead level had a follow-up test. Factors associated
with a lower likelihood of follow-up were nonwhite race/ethnicity and living
in urban, high-risk lead exposure areas. In an editorial, LanphearArticle outlines
the shortcomings of current childhood lead poisoning prevention efforts.
Presence of the third (S3) and fourth (S4) heart
sounds on phonocardiography has been considered a marker for left ventricular
dysfunction, but whether phonocardiographic S3 and S4 correlate
with objective markers of left ventricular function is not clear. In a prospective
study of patients having left-sided heart catheterization, Marcus and colleagues
found that absence of a phonocardiographic S3 or S4 was
insufficient evidence to exclude ventricular dysfunction and, if present,
S3 was superior to S4 in identifying patients with left
Hakonarson and colleaguesArticle previously identified
a variant in the gene encoding the 5-lipoxygenase–activating protein
(FLAP), which is associated with an increased risk of myocardial infarction
(MI). In this issue of JAMA they report results of
a randomized clinical trial involving patients with variants of the FLAP gene
or another gene in the leukotriene pathway, which assessed the effect of a
FLAP inhibitor, DG-031, on biomarkers associated with MI risk. They found
that DG-031 produced significant and dose-dependent suppression of biomarkers
associated with arterial inflammation and MI. In an editorial, O’DonnellArticle discusses both the promise and limitations of these findings for MI risk modification.
“This is what I do for my patients. There is no billing code for
this, no extra modifier that captures the history we have together.”
Researchers have identified particular gene variants that may help explain
the wide variation in the doses of common antiepileptic drugs required to
prevent individual patients’ seizures.
Meta-analysis of clinical trial data reveals that 700 to 800 IU/d of
vitamin D reduces fracture risk in older adults.
Achieving optimal symptom palliation and supporting family members when
a patient is in the final days of life.
For your patients: Information about lead poisoning.
This Week in JAMA . JAMA. 2005;293(18):2187. doi:10.1001/jama.293.18.2187