Jeanette M. Smith, MD
Treatment of hepatitis C virus (HCV) infection in patients coinfected with HIV is challenging. In a multicenter, open-label, and nonrandomized trial that enrolled 223 patients concurrently infected with HCV and HIV, Sulkowski and colleagues found that combination treatment with sofosbuvir and ribavirin was associated with high rates of sustained virologic response. In an Editorial, Saag discusses advances in treating patients with HCV and HIV coinfection.
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Mugo and colleagues assessed pregnancy outcomes in 1785 HIV-serodiscordant heterosexual couples in which the female partner was HIV uninfected and was randomly assigned to receive antiretroviral preexposure prophylaxis or placebo during the periconceptual period. The authors report there were no differences in pregnancy incidence, birth outcomes, or infant growth among women who received HIV preexposure prophylaxis vs placebo at the time of conception.
In a cluster randomized trial that provided 16 660 adults in Malawi with access to HIV self-testing, MacPherson and colleagues found that compared with standard facility-based care, offering optional home initiation of HIV care to participants who reported a positive HIV self-test result prompted a significant increase in the proportion of adults who initiated antiretroviral therapy.
In a randomized placebo-controlled trial that enrolled 50 antiretroviral drug–treated HIV-infected patients with abdominal fat accumulation, Stanley and colleagues found that treatment with tesamorelin—a growth hormone–releasing hormone analog—resulted in significant reductions in measures of visceral adipose tissue and, additionally, modest reductions in liver fat.
Marrazzo and colleagues—members of the International Antiviral Society-USA Panel—report results of a comprehensive and systematic literature review (1996-2014) and consensus development process undertaken to provide updated recommendations for the prevention and treatment of HIV infection in adults and adolescents. The authors emphasize integrated biomedical and behavioral approaches to prevention, provide recommendations for preexposure and postexposure HIV infection prophylaxis, and stress the importance of timely HIV infection diagnosis and treatment. In an Editorial, Mathers and Cooper discuss integration of HIV prevention in routine clinical practice.
Continuing Medical Education
This article by Günthard and colleagues—members of the International Antiviral Society-USA Panel—provides updated treatment recommendations for adults with HIV infection. The recommendations emphasize early initiation of treatment with proven regimens of combination therapy, provide guidance for laboratory monitoring, and consider treatment failure and drug regimen switches for adverse effects and patient burden.
A woman with a history of hepatitis C virus infection had a 2-year history of painful skin and oral lesions, which improved with prednisone but recurred when prednisone was discontinued. The patient had no history of herpes simplex virus (HSV) infection; however, HSV serologies were positive. What would you do next?
This Medical Letter article summarizes results of clinical studies of dolutegravir—an integrase strand transfer inhibitor—recently approved for the treatment of HIV infection.
Highlights. JAMA. 2014;312(4):313–315. doi:10.1001/jama.2013.279627