Enfuvirtide and cutaneous injection-site reactions.

Enfuvirtide belongs to a newer class of antiretroviral (ARV) agents called fusion inhibitors for the treatment of human immunodeficiency virus type 1 (HIV-1) infection. Enfuvirtide blocks attachment, binding, and entry of the viral capsid into the host CD4+ cell. Administration is only available subcutaneously in a twice-daily regimen particularly for those patients who have previously failed more than one ARV regimen. Common side effects of enfuvirtide administration include fatigue, insomnia, nausea, and diarrhea; however, injection-site reactions are the most common side effect and present in nearly all individuals undergoing treatment. The spectrum of cutaneous manifestations ranges from little to no reaction to cysts, nodules, induration, or sclerodermalike lesions. These reactions are mostly variants of iatrogenically induced hypersensitivity and are self-limited.

The Capability Gap in Occupational Health Information Management.

The lack of an integrated approach to data capture, information management, and analysis limits the contribution of occupational and environmental medicine to protecting 2.3 million uniformed and civilian DoD workers. Despite an abundance of military information systems that include the terms "Safety" and "Occupational Health" in their names, none of these systems provide capabilities needed to aggregate and analyze the results of occupational medicine exams, use medical surveillance to mitigate exposure incidents, provide enterprise-level management of occupational medicine services, or comply with privacy and recordkeeping law and regulation. Instead, they provide a patchwork of data that meets most regulatory compliance requirements but fails to achieve the true objectives of occupational health programs. Bridging these capability gaps will improve the occupational health care of the DoD workforce, improve the quality of occupational medicine services, increase public trust in the DoD management of exposure incidents, and potentially generate hundreds of millions of dollars through cost-avoidance on workers' compensation claims and through identification and elimination of non-value-added medical certification exams. The ongoing Military Health System transformation represents a unique opportunity to bridge these long-recognized but persistent capability gaps.

The Role of the Professional Supervisor in the Audiometric Testing Component of Hearing Conservation Programs.

: ACOEM believes that the functions of a professional supervisor in hearing conservation programs are part of the "core practice" of occupational medicine. This guidance emphasizes the role occupational medicine clinicians play in the supervision of audiometric surveillance conducted under the auspices of hearing conservation programs and reviews the regulatory and scientific basis and pertinent practices involved in this supervisory role.

The risk of mental health disorders among U.S. military personnel infected with human immunodeficiency virus, active component, U.S. Armed Forces, 2000-2011.

Mental health disorders (MHD) are reportedly more common among soldiers and airmen with HIV than their seronegative counterparts. This report documents the incidence rates of MHD among HIV-positive members of all service branches and compares the rates to those of two HIV-unexposed control groups: an HSV2-infected group and a group without documented HIV or HSV2 infections. Approximately 56 percent of HIV-infected service members received an incident diagnosis of a MHD six months or more after the initial detection of their infections. Cumulative incidence rates in nearly all MHD categories of interest were highest in the HIV group, intermediate in the HSV2 group and lowest in the referent group. The disorders more frequently diagnosed among HIV-infected service members compared to their uninfected counterparts were psychosis/schizophrenia, substance dependence, substance abuse, bipolar disorder, suicide ideation and depression. The findings are consistent with previous studies and reiterate the importance of long-term and comprehensive clinical monitoring of individuals diagnosed with HIV-1 infections.