This Week in JAMA

A JAMA THEME ISSUE

Edited by Jeanette M. Smith, MD

Two articles in this issue report findings relating to immune activation and inflammation in individuals with HIV infection. In a randomized trial involving 83 patients with asymptomatic HIV infection, Paton and colleagues investigated the effect of oral hydroxychloroquine on immune activation, inflammation, and disease progression. The authors report that compared with placebo, hydroxychloroquine did not decrease immune activation and was associated with a greater decline in CD4 cell count and increased HIV viral load. Subramanian and colleagues assessed aortic wall inflammation in 81 individuals with HIV infection and 54 uninfected control participants who had similar cardiac risk factors. They found that HIV-infected individuals had increased arterial inflammation compared with controls. In an editorial, Stein and Hsue discuss inflammation, immune activation, and cardiac risk in individuals with HIV infection.

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Keller and colleagues assessed the risk of cervical precancer or cancer in a prospective cohort of 420 HIV-infected women and 279 HIV-uninfected women who at baseline had normal cervical cytology and were oncogenic human papillomavirus negative. The authors found that cervical precancer and cancer risks were similar among HIV-infected and uninfected women through 5 years of follow-up.

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Limketkai and colleagues examined the effect of hepatic fibrosis stage on the incidence of a composite outcome of end-stage liver disease, hepatocellular carcinoma, or death in a prospective cohort of 638 patients who were coinfected with HIV and hepatitis C virus (HCV). The authors report that hepatic fibrosis stage at baseline was independently associated with the composite outcome during a median follow-up of 5.8 years.

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Thompson and colleagues report the 2012 recommendations of the International Antiviral Society–USA Panel for treatment of adult HIV infection, which reflect a systematic review of recent data (July 2010 to May 2012) and panel consensus. Among the new recommendations is that all patients should be offered antiretroviral therapy regardless of CD4 cell count.

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A healthy heterosexual man presents with a crusted plaque on his nipple, which formed after a bite during sexual intercourse and has persisted for 1 month, and a generalized macular rash. What would you do next?

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Researchers hope to find ways to eradicate latent reservoirs of HIV.

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Toward an AIDS-free generation

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AIDS: 1990 and 2012

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HIV prevention in the United States

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Aging and HIV-related cognitive loss

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“There is nothing more you can do for me here. I just want to go home.” From “Forever Young.”

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HIV/AIDS: increasing evidence, advancing ahead

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Dr Smith summarizes and comments on this week's issue. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly.

How would you manage a patient with probable nonalcoholic fatty liver disease? Read the case at www.jama.com and submit your response by August 5.

Join Melanie A. Thompson, MD, and Paul A. Volberding, MD, Wednesday, August 15, from 2 to 3 PM eastern time to discuss updated recommendations for treatment of HIV infection. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about HIV infection.

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