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A JAMA THEME ISSUE
Edited by Jeanette M. Smith, MD, and Gianna Zuccotti, MD, MPH
Antiretroviral therapy can be associated with visceral adiposity and metabolic complications, possibly caused by growth hormone (GH) deficiency. In a randomized trial, Lo and colleagues assessed the effects of low-dose GH vs placebo on body composition and cardiovascular disease markers among patients with HIV-associated abdominal obesity. The authors found that patients receiving GH experienced significant reductions in visceral fat, truncal obesity, triglycerides, and diastolic blood pressure but experienced an increase in 2-hour postchallenge glucose levels.
To assess the incidence of HIV infection in the United States, Hall and colleagues applied an algorithm that combines HIV-antibody testing and the BED HIV-1 capture enzyme immunoassay—which distinguishes recent from long-standing infections—to serum specimens from patients 13 years or older, who resided in 22 states and who were diagnosed in 2006. The authors estimate that there were 56 300 (95% confidence interval, 48 200-64 500) new HIV infections in 2006, which were disproportionately concentrated among men who have sex with men and among African Americans.
Rifampicin-based antitubercular therapy reduces plasma concentrations of nevirapine and efavirenz. Few studies have addressed the virological consequences of this effect. In an analysis of prospective clinical data from South African patients with and without concurrent tuberculosis (TB) who initiated antiretroviral therapy (ART) that was either efavirenz-based or nevirapine-based, Boulle and colleagues found that coadministration of rifampicin-based antitubercular therapy at initiation of ART was associated with higher probabilities of a raised viral load or virological failure in the first 2 years of therapy among patients taking nevirapine-based ART but not in patients who initiated treatment with an efavirenz-based treatment.
To assess demographic, biological, and behavioral risk factors for recent HIV infection in Uganda, Mermin and colleagues analyzed data from the Uganda HIV/AIDS Sero-Behavioral Survey, a nationally representative household survey of Ugandan men and women aged 15 to 59 years. Among the factors found to be associated with a recent HIV infection were female sex, marital status, geographic region, 2 or more sex partners in the past year, positive herpes simplex virus type 2 serology, a sexually transmitted disease in the past year, and being an uncircumcised man.
Some studies have suggested that HIV-infected injection drug users derive less benefit from highly active antiretroviral therapy (HAART) than patients without a history of injection drug use. In a population-based prospective cohort study of antiretroviral-naive HIV-infected patients who had access to free HIV/AIDS care, Wood and colleagues assessed survival rates for patients after initiation of HAART. The authors found no significant difference in mortality rates for users than for nonusers of injection drugs.
The International AIDS Society–USA 2008 recommendations for the use of antiretroviral therapy and laboratory monitoring in adult HIV infection.
“I had lectured patient after patient on how important it is ‘to know for sure.’ The reality is much different when the patient is you.” From “A Person of Status.”
Health leaders are sounding a warning about the global threat posed by a collision between multidrug-resistant tuberculosis and HIV infection.
The Mississippi State Department of Health
Mexico's evolving HIV epidemic
Universal access to treatment for HIV infection
Disclosure and assent for research in pediatric HIV infection
Criminalization of HIV transmission
The past, present, and future of HIV/AIDS
For your patients: HIV infection: the basics
This Week in JAMA . JAMA. 2008;300(5):475. doi:10.1001/jama.300.5.475