Use of dual-energy x-ray absorptiometry (DXA) scans in HIV-infected patients.

Multiple studies have demonstrated increased rates of osteopenia and osteoporosis in HIV-infected patients but there have been no published studies on current screening practices. We conducted a retrospective chart review of 2924 patients attending an urban HIV clinic. Thirty patients (1%) had dual-energy x-ray absorptiometry (DXA) scans. Patients undergoing DXA scans were more likely to be older, women, and have nondetectable HIV viral load and CD4 count ≥200. The most frequently cited indications for screening were perimenopausal or postmenopausal status and HIV infection. Of the patients screened, 96% had osteopenia or osteoporosis with a median T-score of -1.9 and a median of 3.8 osteoporosis risk factors in addition to HIV.  Of the 20 practitioners in the clinic, only 7 had patients with screening DXA scans. DXA scans are underutilized in the HIV population given the high rate of osteopenia and osteoporosis detected in this study.

HHV-6 infection in patients with HIV-1 infection and disease.

Human herpesvirus 6 (HHV-6) is among the most widespread of the human herpesviruses. In immunocompetent children, it causes exanthem subitum, febrile episodes without skin rash, and non-Epstein-Barr and non-cytomegalovirus infectious mononucleosis. HHV-6 has also been associated with clinical disease in bone marrow and solid organ transplant recipients. Its potential role in HIV-1-associated clinical syndromes is now being recognized and evaluated. In this review, we describe the virus, the pathogenesis of HHV-6-associated disease, and the diagnostic tests used to differentiate active from latent infection. We then discuss possible clinical manifestations of HHV-6 in HIV-1-infected patients, how to evaluate the need for treatment, and which pharmacologic agents are potentially useful. There is no consensus on these issues in the medical community, and HHV-6 is not now included among indicator infections for the diagnosis of AIDS.