This Week in JAMA

A JAMA THEME ISSUE

Edited by Jeanette M. Smith, MD, and Gianna Zuccotti, MD, MPH

Antibodies induced by HIV vaccination may confound interpretation of HIV screening tests. Cooper and colleagues assessed the risk of vaccine-induced seropositivity/reactivity in an analysis of end-of-study HIV test results from 2176 HIV vaccine trial participants who were HIV-seronegative at study enrollment. The authors found that 908 of the 2176 vaccine trial participants had vaccine-induced seropositivity/reactivity, which varied across different HIV vaccine products and was associated with the immunogenicity of the vaccine and the antibody immunoassay used.

Routine opt-out HIV screening in health care settings, recommended by the US Centers for Disease Control and Prevention in 2006, is the topic of 2 articles in this issue. Haukoos and colleagues Article assessed whether opt-out HIV screening in an urban public hospital emergency department would identify more new HIV cases than physician-directed diagnostic testing and found that opt-out HIV screening was associated with a small increase in the number of patients with newly diagnosed HIV infection. A rationale for and the evidence supporting opt-out HIV testing as part of routine care for cancer patients is presented by Chiao and colleagues Article. An editorial by Merchant and Waxman Article discusses the need for effective and efficient models for HIV screening in health care settings.

In an analysis of data from mother-infant pairs who received care at 43 randomly selected facilities in Cameroon, Côte d’Ivoire, South Africa, and Zambia, Stringer and colleagues determined the proportion of HIV-exposed infants for whom both mother and child received at least a single dose of nevirapine for prevention of mother-to-child HIV transmission. The authors found that only 51% of HIV-exposed infants received a minimum prophylactic course of single-dose nevirapine.

In a review of 2005 to 2008 data on antiretroviral drugs purchased for use in 16 countries by organizations receiving the US President's Emergency Plan for AIDS Relief funding, Holmes and colleagues found that the availability of generic antiretroviral drugs was associated with substantial expansion in the procurement of antiretroviral therapies and cumulative cost savings of more than $320 million.

Long-term use of antiretroviral therapy is associated with increasing numbers of patients requiring second-line therapy. To assess the efficacy of second-line antiretroviral therapy in resource-limited countries, Pujades-Rodríguez and colleagues determined failure rates of second-line therapy and factors associated with treatment failure and death in a multicohort study of 632 adults who received second-line therapy for more than 6 months in Africa and Asia. The authors report that treatment failure was associated with low CD4 cell counts at initiation of second-line therapy, use of suboptimal second-line regimens, and poor adherence to medication.

The International AIDS Society–USA Panel 2010 recommendations for the use of antiretroviral therapy and laboratory monitoring in adult HIV infection.

“This lack of standing for women contributes to the spread of HIV in this region on the shores of Lake Victoria in Nyanza province.” From “Vaccine, Please.”

Three news features focus on an influential long-term study of HIV in women, the effect of the global economic crisis on HIV/AIDS programs, and treating patients with both HIV infection and opioid addiction.

Caring for long-term HIV survivors

Provider-initiated HIV testing and counseling: WHO/UNAIDS guidance

HIV and human trafficking

Couple-centered HIV prevention strategies

Controlling and ending the HIV/AIDS pandemic

How would you manage a 29-year-old woman with flu-like symptoms? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is August 8.

For your patients: Information about HIV infection: the basics.