Editor
David H. Spach, MD
Professor of Medicine
Clinical Director, Northwest AETC
Division of Infectious Diseases
University of Washington
Associate Editor
Joel E. Gallant, MD, MPH
Professor of Medicine and Epidemiology
Associate Director, AIDS Service
Division of Infectious Diseases
Johns Hopkins University
Interactive
Tutorial
Routine
HIV Screening in Health Care Settings
In 2006, the CDC issued new recommendations on routine HIV screening in health care settings. Click
here to start our new interactive tutorial that provides an in-depth look at multiple aspects of routine HIV
screening. This tutorial provides 1.5 hours of free CME and CNE credit.
New Cases
Methicillin-Resistant Staphylococcus aureus (MRSA) Skin and Soft Tissue Infections
In the past decade, MRSA has emerged as a prominent cause of community-acquired skin and soft tissue infections. This case discussed the mechanisms of antimicrobial resistance, clinical manifestations and approach to different types of skin and soft tissue infections in which MRSA may be involved. New IDSA guidelines for the management and decontamination of MRSA are reviewed.
Cryptosporidiosis
in a Patient with AIDS
Cryptosporidium infection in HIV-infected persons with advanced immunuosuppression can cause debilitating
diarrhea. This case provides an overview of the clinical manifestations, appropriate diagnostic tests, and
management of HIV-infected patients with cryptosporidiosis.
Discordant
CD4 Cell Count and Viral Load Responses to Antiretroviral Therapy
Some patients unfortunately have persistently low CD4 cell counts despite achieving sustained HIV RNA suppression.
This case reviews the normal immunologic recovery with different antiretroviral regimens, the potential
causes of poor immunologic recovery, and data from the recently published ESPRIT and SILCAAT trials.
Unusual
Changes in Physical Appearance in a Patient with AIDS
Body shape changes in HIV-infected patients can result from different causes. This case describes a 44-year-old
man on multiple medications who developed a multitude of body shape changes. The cause for these body shape
changes was discovered.
Cyanosis
in a Patient with AIDS
A 37-year-old man with advanced HIV disease and a history of pulmonary Kaposi’s sarcoma presented with shortness
of breath and cyanosis. Clues to the diagnosis of this uncommon problem are given in the clinical history
and by examining the result of the arterial blood gas.
A
43-Year-Old with a Persistent Skin Rash
Evaluation of skin rashes can prove very difficult in HIV-infected persons with advanced immunosuppression.
In this case, the diagnosis of these hyperkeratotic, scaling lesions was made on a skin scraping when viewed
under a microscope. Test your skills in diagnosis and management in this challenging unknown.
Efavirenz-Associated
Central Nervous System Adverse Effects
Efavirenz (Sustiva) is one of the most frequently used antiretroviral medications. The concern
for neuropsychiatric adverse effects often plays a role in the decision of whether to include efavirenz
as part of an antiretroviral regimen. This case includes a discussion of available data related to efavirenz-related
neuropsychiatric manifestations. In addition, this case provides practical recommendations for the prevention
and management of these symptoms.
A
27-Year-Old with Disseminated Histoplasmosis
Disseminated histoplasmosis in HIV-infected persons is a potentially life-threatening infection. Clinical
manifestations are often non-specific. Diagnostic testing often involves using a combination of tests, including
antigen tests and culture. Preferred initial treatment of progressive disseminated infection consists of
liposomal amphotericin B (AmBisome), followed by maintenance therapy with oral itraconazole (Sporanox).
A
43-Year-Old with New Visual Symptoms
Cytomegalovirus retinitis remains an important clinical problem with patients with advance immunosuppression.
Symptoms of cytomegalovirus retinitis usually include one or more of the four “F’s”: floaters, flashes,
field deficits, or failing vision. Oral valganciclovir (Valcyte), with or without a ganciclovir
intraocular implant, is generally recommended for initial therapy.
African
Americans with HIV: Epidemiology and Risk Factors
The HIV epidemic has disproportionately affected African Americans and in recent years more new diagnoses
of HIV (with or without AIDS) involve African Americans than any other racial/ethnic population. This case
includes a review of the epidemiology and factors related to the explosion of the HIV epidemic in African
Americans.