HIV update: Which single-tablet regimens, and when.

With the approval of single-tablet regimens that contain 3 or 4 drugs, many patients take just one pill a day. So what are the options and what's on the horizon?

Does your patient really need testosterone replacement?

Or has he been made to think so by direct-to-consumer advertising? Here's how to properly screen patients and when to recommend treatment.

HIV: 3 cases that hid in plain sight.

Having a high index of suspicion is key to recognizing the signs of HIV infection in patients without classic risk factors. How quickly would you have spotted these 3 cases?

Resolution of renal failure after initiation of HAART: 3 cases and a discussion of the literature.

Renal failure is a known complication of HIV infection. The most common form is HIV-associated nephropathy, or HIVAN. It is characterized by high-grade proteinuria with rapid progression to end-stage renal disease. The kidneys of affected patients appear enlarged on ultrasonography. Histopathologically, there is focal segmental glomerulosclerosis with glomerular collapse. Before the era of HAART, patients with HIVAN had limited survival, although in some cases this was prolonged if dialysis was instituted. Over the past few years, isolated case reports have shown that patients with HIVAN will recover renal function following initiation of HAART. We report 3 patients believed to have HIVAN who exhibited marked improvement in renal function after treatment with a regimen comprising 2 nucleoside reverse transcriptase inhibitors and a protease inhibitor.

Identifying exercise-induced bronchospasm. Treatment hinges on distinguishing it from chronic asthma.

Exercise-induced bronchospasm (EIB) is an often-undiagnosed but common problem affecting both recreational and elite athletes. Although exercise can trigger exacerbation of chronic asthma, EIB should not be confused with the chronic inflammatory disease. In this article, Drs Hermansen and Kirchner review the incidence, diagnosis, and treatment of EIB and explain how to distinguish EIB from chronic asthma.

Clinical management considerations for dyslipidemia in HIV-infected individuals.

Dyslipidemia is common in patients with human immunodeficiency virus (HIV) and may result in significant morbidity, including coronary heart disease (CHD). Treatment of dyslipidemia in these patients is generally based on the National Cholesterol Education Program Adult Treatment Panel III goals for individuals without HIV. For individuals with ≥ 2 cardiovascular risk factors, the risk of CHD should be evaluated using the Framingham risk calculator and managed accordingly. Switching to an antiretroviral regimen with a favorable lipid profile should be considered before pharmacologic management if virologic suppression can be maintained. Statins are the first-choice therapy for elevated low-density lipoprotein cholesterol, but in HIV-infected individuals, special consideration must be given to drug-drug interactions, specifically those between protease inhibitors and statins. Management of dyslipidemia in HIV-infected individuals is a challenging but important aspect of chronic disease management. Additional research, specifically related to the role of chronic inflammation, is needed to better define the relationship between HIV infection and cardiovascular disease.

Tdap vaccine: current indications for adolescent and adult patients in the United States.

Despite the availability of a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in the United States since 2005, the vaccine remains underutilized and perhaps misunderstood by many physicians. Pertussis continues to be a major public health problem, with adults being the primary source of infectious transmission to unprotected infants. Consequently, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices has expanded the indications for the Tdap vaccine. In addition, the vaccine can be safely administered regardless of the time since the patient's last tetanus-diphtheria booster. Widespread use of the Tdap vaccine-especially in health-care workers, adolescents, and adults aged 19 to 64 years-should greatly reduce the incidence of Bordetella pertussis infection in the United States. The recent Food and Drug Administration approval of the Tdap vaccine for individuals aged 65 years or older should increase the use of this vaccine.

Reiter's syndrome.

Preview Reiter's syndrome is an often overlooked and misdiagnosed complex of symptoms. Patients may not present with the classic triad of symptoms, or they may forget to mention other pertinent manifestations. How can you make an accurate diagnosis? And what is an effective approach to management? Dr Kirchner reviews studies on the epidemiology, causes, and pathogenesis of the syndrome and discusses key factors in clinical evaluation and treatment.

Opportunistic fungal infections in patients with HIV disease.

Preview The increasing number of patients surviving with advanced HIV infection presents new challenges to physicians who care for them. As a patient's CD4+ T-lymphocyte count declines, susceptibility to opportunistic fungal infections increases. In this article, Dr Kirchner discusses two commonly encountered pathogens, Cryptococcus neoformans and Histoplasma capsulatum.

Hepatitis B.

Hepatitis B causes significant morbidity and mortality worldwide. More than 400 million persons, including 1.25 million Americans, have chronic hepatitis B. In the United States, chronic hepatitis B virus infection is responsible for about 5,000 annual deaths from cirrhosis and hepatocellular carcinoma. Hepatitis B virus is found in body fluids and secretions; in developed countries, the virus is most commonly transmitted sexually or via intravenous drug use. Occupational exposure and perinatal transmission do occur but are rare in the United States. Effective vaccines for hepatitis B virus have been available since 1982; infant and childhood vaccination programs introduced in the 1990s have resulted in a marked decrease in new infections. Risk factors for progression to chronic infection include age at the time of infection and impaired immunity. From 15 to 30 percent of patients with acute hepatitis B infection progress to chronic infection. Medical therapies for chronic hepatitis B include interferon alfa-2b, lamivudine, and the nucleotide analog adefovir dipivoxil.

The clinical management of recurrent genital herpes: current issues and future prospects.

This article reports the proceedings of an expert panel discussion on current clinical management practices for the treatment of recurrent genital herpes. The panel reviewed the effectiveness of primary and specialist care settings in the UK and USA and identified the principal clinical needs of patients with recurrent genital herpes. The ideal alternative to daily suppressive nucleoside analogue therapy is a treatment with long-term impact on the natural history and prognosis of recurrent genital herpes. The potential of resiquimod, an immune response modifier, to resolve this unmet need was examined. Resiquimod is reported to delay the onset of recurrent genital herpes symptoms in patients in a Phase II clinical trial. While awaiting clinical confirmation of this new development in immunotherapy, the panel concluded with two recommendations: a reassessment of recurrent genital herpes management in terms of physician education of patients, and the promotion of a positive patient-physician relationship in the approach to treatment.