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JAMA. 2005;293:2187.

Pediatric HIV Infection Treatment and Trends
Pediatric human immunodeficiency virus (HIV) infection is the subject of 2 articles in this issue of JAMA. Brogly and colleagues (SEE ARTICLE) examined pediatric HIV treatment from 1987 through 2003 and assessed concordance with expert guidelines. They found a short lag time between identification of novel therapies and their use in children and that treatment was consistent with expert guidelines in 78% of cases. Switching to a new regimen was associated with failure to use guideline-recommended therapy. In a second article, Berk and colleagues (SEE ARTICLE) examined disease progression and survival in a cohort of children with perinatal HIV infection in relation to year of birth and use of antiretroviral therapy (ART). They found less disease progression and improved survival at 3 years in children treated with ART compared with those who were not and in children treated in the first few months of age vs later. Recency of birth and more advanced therapy were associated with improved survival. In an editorial, Yogev (SEE ARTICLE) discusses the benefits and risks of ART in children.

Follow-up of Elevated Screening Lead Levels
Prompt follow-up testing of children with abnormal screening blood levels is recommended, but estimates of the number of children who receive follow-up testing and factors associated with failure to do so are lacking. Kemper and colleagues (SEE ARTICLE) reviewed Medicaid program files for children with documented elevated screening blood levels to assess the proportion of children with follow-up testing. They found only 53.9% of children with an elevated screening lead level had a follow-up test. Factors associated with a lower likelihood of follow-up were nonwhite race/ethnicity and living in urban, high-risk lead exposure areas. In an editorial, Lanphear (SEE ARTICLE) outlines the shortcomings of current childhood lead poisoning prevention efforts.

Test Characteristics of Phonocardiographic S₃ and S₄
Presence of the third (S₃) and fourth (S₄) heart sounds on phonocardiography has been considered a marker for left ventricular dysfunction, but whether phonocardiographic S₃ and S₄ correlate with objective markers of left ventricular function is not clear. In a prospective study of patients having left-sided heart catheterization, Marcus and colleagues found that absence of a phonocardiographic S₃ or S₄ was insufficient evidence to exclude ventricular dysfunction and, if present, S₃ was superior to S₄ in identifying patients with left ventricular dysfunction.

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Modifying a Genetic Risk for Myocardial Infarction
Hakonarson and colleagues (SEE ARTICLE) previously identified a variant in the gene encoding the 5-lipoxygenase–activating protein (FLAP), which is associated with an increased risk of myocardial infarction (MI). In this issue of JAMA they report results of a randomized clinical trial involving patients with variants of the FLAP gene or another gene in the leukotriene pathway, which assessed the effect of a FLAP inhibitor, DG-031, on biomarkers associated with MI risk. They found that DG-031 produced significant and dose-dependent suppression of biomarkers associated with arterial inflammation and MI. In an editorial, O’Donnell (SEE ARTICLE) discusses both the promise and limitations of these findings for MI risk modification.

A Piece of My Mind
"This is what I do for my patients. There is no billing code for this, no extra modifier that captures the history we have together." From "Satisfaction?"

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Medical News & Perspectives
Researchers have identified particular gene variants that may help explain the wide variation in the doses of common antiepileptic drugs required to prevent individual patients’ seizures.

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Vitamin D and Fracture Risk
Meta-analysis of clinical trial data reveals that 700 to 800 IU/d of vitamin D reduces fracture risk in older adults.

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CLINICIAN’S CORNER
Palliative Care
Perspectives on Care at the Close of Life
Achieving optimal symptom palliation and supporting family members when a patient is in the final days of life.

(SEE ARTICLE)

JAMA Patient Page
For your patients: Information about lead poisoning.

(SEE ARTICLE)

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