{"title":"Occupational postexposure prophylaxis for HIV: The PEPline perspective.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Transmission of HIV through occupational exposure in healthcare personnel is rare. Risk of transmission from an HIV-infected source person is estimated at 0.3% for percutaneous exposures and 0.09% for mucous membrane or nonintact skin exposures, with risk modulated by exposure and source-patient characteristics. Counseling on risk assessment, postexposure prophylaxis (PEP), and baseline and follow-up testing after exposure is provided through PEPline, the National Clinicians' Post-Exposure Prophylaxis Hotline. PEPline receives approximately 900 calls per month, most from treating clinicians. HIV PEP consists of a 28-day course of a basic or an expanded regimen, depending on the severity or volume of exposure and HIV infection characteristics of the source person. An update to the 2005 US Department of Health PEP drug recommendations is expected in 2011. This article summarizes a lecture given by Ronald H. Goldschmidt, MD, at the 13th Annual Ryan White HIV-AIDS Program Clinical Conference held in August 2010 in Washington, DC.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"18 5","pages":"174-7"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29608776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluating and managing cardiovascular disease risk factors in HIV-infected patients.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The primary risk factors for cardiovascular disease (CVD) in patients with HIV infection are the same as those for the general population. Some antiretroviral drugs are associated with a small increase in short-term risk of CVD that may become greater over longer periods of exposure. However, the absolute risk associated with use of these drugs is of greatest importance for patients already at moderate or high risk of CVD. The guiding principle in managing CVD risk for HIV-infected patients is to maintain control of the HIV infection while addressing the metabolic abnormalities that increase CVD risk. Lipid-lowering therapy with statins is very effective in reducing CVD risk, with levels of low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol constituting the primary treatment targets for most patients with dyslipidemia. This article summarizes a lecture by James H. Stein, MD, at the International AIDS Society-USA continuing medical education program held in Washington, DC, in June 2010.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"18 5","pages":"164-8"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29608774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Recalcitrant giant molluscum contagiosum in a patient with advanced HIV disease - eradication of disease with paclitaxel.","authors":"Silver Cree Sisneros","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"18 5","pages":"169-72"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29608775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victoria A Johnson, Françoise Brun-Vézinet, Bonaventura Clotet, Huldrych F Günthard, Daniel R Kuritzkes, Deenan Pillay, Jonathan M Schapiro, Douglas D Richman
{"title":"Update of the drug resistance mutations in HIV-1: December 2010.","authors":"Victoria A Johnson, Françoise Brun-Vézinet, Bonaventura Clotet, Huldrych F Günthard, Daniel R Kuritzkes, Deenan Pillay, Jonathan M Schapiro, Douglas D Richman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This December 2010 version of the International AIDS Society-USA (IAS-USA) drug resistance mutations list updates the figures last published in December 2009 (Johnson VA et al, Top HIV Med, 2009;17:138-145). This update includes 9 new mutations- E138G and E138K for etravirine (Haddad M et al, CROI, 2010; Abstract 574, and Vingerhoets J et al, Antivir Ther, 2010;15 [Suppl 2]:A125); E92Q for raltegravir (Geretti AM et al, Antivir Ther, 2010;15 [Suppl 2]:A62; Cooper et al, N Engl J Med, 2008;359:355-365; and Malet I et al, Antimicrob Agents Chemother, 2008;52:1351-1358); and M36L, M36V, H69R, L89I, L89M, and L89V for tipranavir/ritonavir. In addition, the tipranavir/ritonavir N83D mutation designation was changed to boldface to indicate its recognition as a major mutation rather than a minor mutation. The mutations I13V, K20M/R, E35G, and L90M were removed from the tipranavir/ritonavir bar, reflecting new understanding. For etravirine, L100I*, K101P*, and Y181C*/I*/V* are denoted with asterisks (instead of bolded) to reflect that these individual mutations each have the greatest impact (ie, highest weighting scores) on reduced phenotypic susceptibility and impaired clinical response when compared with other etravirine mutations (Haddad M et al, CROI, 2010; Abstract 574). In addition, user notes d, n, r, w, and z were revised.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"18 5","pages":"156-63"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29608773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Current issues in the diagnosis and management of tuberculosis and HIV coinfection in the United States.","authors":"Anne F Luetkemeyer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Approximately 10% of new cases of tuberculosis (TB) in the United States occur in HIV-infected persons. HIV infection dramatically increases the risk of TB, and this increased risk is present throughout the course of HIV infection. TB and HIV coinfection complicates the course and treatment of both diseases. Isoniazid preventive therapy and antiretroviral therapy both substantially reduce the risk of developing active disease in persons with latent TB infection. Antiretroviral therapy should be given during treatment for active TB, as mortality was reduced by 56% with initiation of antiretroviral therapy before the completion of TB therapy. In addition, for patients with low CD4+ cell counts (less than 200/microm3), starting antiretroviral therapy during the intensive phase of TB treatment reduced mortality by 34% compared with delaying antiretroviral therapy until 8 weeks after TB treatment initiation.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"18 4","pages":"143-8"},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29492703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Moving beyond interferon alfa: investigational drugs for hepatitis C virus infection.","authors":"David L Wyles","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Numerous direct-acting drugs to treat hepatitis C virus (HCV) infection are in development, offering the potential for substantial improvement over current interferon alfa-based therapy and the possibility of effective interferon alfa-sparing regimens in achieving cure of HCV infection. Drugs furthest along in clinical development include HCV nonstructural protein 3 (NS3) protease inhibitors (eg, telaprevir, boceprevir), which have potent anti-HCV activity but low barriers to resistance and considerable likelihood of cross-resistance. Nucleoside analogue nonstructural protein 5B (NS5B) polymerase inhibitors exhibit a high barrier to resistance and cross-HCV genotype and subtype activity. Nonnucleoside analogue polymerase inhibitors have a low barrier to resistance and are characterized by a substantial frequency of preexisting resistance mutations. The initial use of direct-acting drugs will be as add-on treatment to interferon alfa and ribavirin regimens. The success of interferon alfa-sparing regimens will depend on presenting a sufficiently high barrier to resistance with direct-acting drugs and whether the immunomodulatory effects of interferon alfa are needed for cure of HCV infection.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"18 4","pages":"132-6"},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29493160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sexually transmitted infections and HIV: epidemiology and interventions.","authors":"Connie L Celum","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although the association of HIV and sexually transmitted infections (STIs) has been well known for 25 years, there is insufficient attention to STIs by many HIV providers, in part because patients are asymptomatic or have nonspecific symptoms and because of provider demands and focus. Optimal patient care requires frequent testing for STIs as well as obtaining an accurate medical history, which requires building trust with patients and asking direct but open-ended questions about risks and symptoms. Increased vigilance will also help practitioners avoid missing these infections. Herpes simplex virus type 2 infection has highly variable clinical manifestations, and diagnosis is needed before considering episodic or suppressive treatment. However, suppressive treatment of herpes simplex virus type 2 infection has not been shown to reduce risk of HIV acquisition. The increase in syphilis rates continues; screening is inexpensive and treatment is highly effective. Quinolone resistance rates in gonorrhea are increasing, complicating treatment in some locales. Cases of proctitis caused by chlamydial infection with lymphogranuloma venereum strains have been observed in the United States and Europe.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"18 4","pages":"138-42"},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29492701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What do we need to do to cure HIV infection.","authors":"Robert F Siliciano","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Finding a cure for HIV infection requires methods to stop ongoing viral replication, to identify all reservoirs in which nonreplicating HIV persists, and to eliminate each of these reservoirs. Current antiretroviral therapy largely stops ongoing viral replication. This is a reflection of the extremely high antiviral activity of some classes of antiretroviral drugs as revealed in a novel index, the inhibitory potential, which incorporates the slope parameter of the dose-response curve. This index may aid in the rational selection of fully suppressive therapy. At least 2 stable reservoirs of latently infected cells have been identified, and attempts are under way to identify compounds that selectively reactivate latent HIV and allow elimination of these reservoirs. This article summarizes a presentation made by Robert F. Siliciano, MD, PhD, at the International AIDS Society-USA continuing medical education program held in Atlanta in March 2010.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"18 3","pages":"104-8"},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29330173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dyslipidemia and its Treatment in HIV Infection.","authors":"Carl Grunfeld","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>HIV-infected patients have metabolic abnormalities that put them at increased risk of cardiovascular disease (CVD), including abnormalities associated with HIV infection itself, antiretroviral treatment, restoration to health, and body composition changes. The 2 major components of dyslipidemia in HIV-infected patients are hypertriglyceridemia and reduction in high-density lipoprotein (HDL) cholesterol (with likely altered function of HDL cholesterol); these abnormalities contribute to increased atherosclerotic risk. Adverse effects of antiretroviral drugs on lipids are not class specific but rather are associated with particular drugs. Thus, practitioners need to be cognizant of the risks of metabolic abnormalities posed by individual drugs. HIV infection increases CVD risk independent of the effects of traditional risk factors. The relative risk of CVD in HIV-infected patients has decreased in recent years with increasing use of lipid-lowering therapy. However, use of lipid-lowering therapy is complicated by numerous potential drug interactions with antiretroviral drugs that practitioners need to consider when prescribing lipid-lowering therapy. This article summarizes a presentation made by Carl Grunfeld, MD, PhD, at the International AIDS Society-USA continuing medical education program in Los Angeles in March 2010. The original presentation is available as a Webcast at www.iasusa.org.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"18 3","pages":"112-8"},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3189481/pdf/nihms319935.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29329394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cervical injection drug use: a pain in the neck.","authors":"James H Tabibian, Mark Sulkowski","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"18 3","pages":"110-1"},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29330175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}