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JAMA. 1998;280:3.

HIV/AIDS Theme Issue
Include a Protease Inhibitor in Multidrug Regimen
State-of-the-art treatment dictates that physicians strongly consider including a protease inhibitor in a multidrug regimen when initiating treatment for HIV infection. In this study of simultaneous vs sequential treatment in patients followed for at least 100 weeks, Dr Gulick and colleagues found that those who received a regimen with a simultaneously initiated protease inhibitor showed better immunologic status and virologic profile.

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New Test Could Mean Improved Treatment Planning
Discussing prognosis and treatment options with a patient newly diagnosed with HIV infection would benefit from an accurate estimate of infection duration. The modified ELISA test described by Dr Janssen and colleagues may provide more precision in defining disease history in an individual, allowing physicians to plan more appropriate treatment strategies.

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Heterosexual Spread of HIV in Southeast Asia
The spread of HIV in Southeast Asia often appears to involve transmission to spouses from men having sex with infected female sex workers. However, in this study of HIV prevalence and risk factors in Thai women in the prenatal care setting, Dr Siriwasin and colleagues found that about one fourth of the sex partners of seropositive women were not HIV-infected.

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Delivery Method and Perinatal HIV Transmission
Even though prophylaxis with zidovudine significantly reduces the rate of perinatal HIV transmission, there remains a substantial risk for transmitting HIV to the infant. In this study of pregnant women with HIV infection who received zidovudine prophylaxis, Dr Mandelbrot and colleagues observed an attenuated risk of perinatal HIV transmission with elective cesarean delivery.

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Why a Genital Lesion Increases HIV Transmission Risk
The presence of a genital lesion increases the risk of transmitting HIV to a sex partner. Dr Schacker and colleagues evaluated 12 HIV-1–seropositive men with genital herpes lesions. HIV-1 was recovered from lesions in 25 of 26 episodes of genital herpes and on 67% of days, and was more likely to be recovered from lesions on days when HSV-2 also was recovered.

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Latest Recommendations for Antiretroviral Therapy
In this consensus statement, the International AIDS Society–USA Panel provides state-of-the-art recommendations for potent antiretroviral therapy, including considerations for changing or modifying therapy and strategies for such special circumstances as HIV infection in pregnancy.

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The Cover
A Cover Without Art.

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Medical News & Perspectives
The FDA has approved the first wide-scale testing of a vaccine to prevent AIDS, although some scientists remain skeptical about its prospects for success.

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Contempo 1998
Most pediatric HIV-1 infections are acquired perinatally. Effective strategies for prevention of vertical transmission of HIV-1 are emerging.

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A Piece of My Mind
"Often we do not acknowledge the gift our patients offer when they become involved in research." From "Success and Sadness."

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Controversies
Treat now or later? Early and aggressive vs delayed and conservative therapy in early HIV infection.

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JAMA Patient Page
For your patients: drug treatment options for HIV infection.

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