In This Issue of Archives of Internal Medicine

The incidence of coronary heart disease (CHD) is very high among individuals older than 65 years. Kuller et al have shown in the Cardiovascular Health Study that an index of subclinical disease is a strong and independent predictor of clinical CHD in men and women and black and white individuals. Practically all men have subclinical cardiovascular disease, accounting for their very high risk of CHD compared with women. Among older women, identification of subclinical disease improves prediction of CHD and likely leads to better use of preventive therapies such as lipid-lowering drug therapy.

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Accurate identification of the microorganisms involved in chronic bone infection conveys great importance because prognosis depends on proper surgical debridement and prolonged but specific antimicrobial therapy. Recent studies suggest that specimens taken from soft tissues surrounding the infected bone predict the cause of chronic osteomyelitis, but such an approach could miss infecting pathogens and lead to treatment of colonizing flora. To prevent cross-contamination, samples from the infected bone and surrounding soft tissues were taken from 100 patients with chronic osteomyelitis and subjected to parallel microbiological study. Nonbone specimens identified the cause in only 30% of patients; statistical analysis indicated that such concordance was not better than what would be expected by chance alone.

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Concato et al evaluated the effectiveness of prostate cancer screening by conducting a case-control analysis of 1002 men nested within a cohort of 71 661 veterans receiving ambulatory care. The study addressed potential methodological problems related to the baseline characteristics of patients (ie, confounding), the definition of screening, and the assessment of outcomes. In multivariable analyses, associations were quantitatively and statistically nonsignificant for prostate-specific antigen screening and overall mortality, as well as for prostate-specific antigen or digital rectal examination screening and cause-specific mortality.

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In a randomized, double-blind study of patients with chronic hepatitis B infection given emtricitabine (200 mg once daily) vs placebo for 48 weeks, emtricitabine produced a histologic response (2-point reduction in Knodell necroinflammation with no worsening in fibrosis) in 103 (62%) of 167 patients vs 20 (25%) of 81 patients receiving placebo (P<.001). Significance was demonstrated in hepatitis B antigen (HBeAg)-positive (P<.001) and HBeAg-negative subgroups (P = .002). Serum hepatitis B virus DNA was less than 400 copies/mL in 54% (emtricitabine) vs 2% (placebo) (P<.001) and alanine aminotransferase level was normal in 65% vs 25%, respectively (P<.001). At week 48, 13% of patients receiving emtricitabine were viremic with resistance mutations. The rate of seroconversion to anti-HBe (12%) and HBeAg loss were not different between arms. The safety profile of emtricitabine during treatment was similar to placebo; posttreatment exacerbation of hepatitis B developed in 23% of emtricitabine-treated patients.

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Lau et al demonstrate that C-reactive protein (CRP) levels are correlated with both CD4 lymphocyte counts and log₁₀ human immunodeficiency virus (HIV) RNA levels using data from the Multicenter AIDS Cohort Study. The goal of this study was to examine the association between the levels of CRP with (1) degree of immune suppression and level of HIV RNA and (2) with HIV disease progression. In addition to the correlation between CRP and immune marker and viral load, CRP was found to be predictive for progression to clinical AIDS. Furthermore, CRP levels were found to increase over time whether or not progression to AIDS occurred. However, CRP levels increased at a faster rate among individuals progressing to AIDS compared with individuals who did not progress.

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