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JAMA. 2006;296:1437.

Gene Mutations and Risk of Lynch Syndrome
Lynch syndrome—also called hereditary nonpolyposis colorectal cancer—is the most common hereditary familial colorectal cancer syndrome and is associated with specific mutations in the mismatch repair genes MLH1, MSH2, and MSH6. Two articles in this issue of JAMA reported by Balmaña and colleagues (SEE ARTICLE) and Chen and colleagues (SEE ARTICLE) describe the development and validation of 2 unique clinical prediction models to identify persons at risk of carrying these mutations. Both prediction models incorporate personal and family history characteristics to predict the likelihood of mutation carrier status. In an editorial, Ford and Whittemore (SEE ARTICLE) compare and contrast characteristics of these 2 models with a third model proposed by other investigators and discuss the models' utility to identify at-risk individuals for whom gene analysis would be appropriate.

Targeted Azithromycin Treatment for Trachoma
Antibiotics are one component of the World Health Organization's SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvement) strategy for elimination of blinding trachoma by the year 2020. Atik and colleagues report results of a randomized trial that assessed the effects of 2 doses of oral azithromycin treatment—at baseline and 12 months—on active trachoma and Chlamydia trachomatis infection rates among school-aged children and their household contacts in 3 communes in Vietnam. During 3 years of follow-up, the authors found that reinfection rates were significantly higher in communes randomly assigned to the SAFE or surgery plus antibiotics (SA) strategies than in the commune assigned to surgery alone (S-only).

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Plasma HIV RNA Level and CD4 T-Cell Decline
Plasma human immunodeficiency virus (HIV) RNA levels predict HIV disease progression, but the relationship of HIV RNA level to CD4 T-cell depletion is not clear. To explore this question, Rodríguez and colleagues (SEE ARTICLE) assessed the extent to which baseline plasma HIV RNA levels could predict the rate of CD4 cell decline in 3 cohorts of antiretroviral treatment–naive, HIV-infected persons. The authors found that higher baseline HIV RNA levels were associated with greater subsequent CD4 cell decline. However, only a small proportion of interindividual CD4 cell loss variability could be explained by baseline HIV RNA level. In an editorial, Henry and colleagues (SEE ARTICLE) discuss patient-level genetic and immunological factors that may modify the rate of CD4 cell depletion and the implications of these findings for current and future treatment of HIV-infected patients.

CLINICIAN'S CORNER
Care of Individuals With Lynch Syndrome
Clinical Review
Lindor and colleagues review cancer risks in patients with Lynch syndrome, screening test efficacy, and evidence supporting preventive interventions.

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A Piece of My Mind
"To the task of raising her youngest daughter, my mother brought love, vision, and determination. She also brought assorted demons. Some I can name; some I can only wonder about." From "Raising a Woman."

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Medical News & Perspectives
The 2006 Lasker Awards honor a group of cell biologists who discovered a chromosome-stabilizing enzyme called telomerase, the psychiatrist who developed cognitive therapy, and one of the founders of modern cell biology.

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Chemotherapy and Chemical Warfare
Marking the 60-year anniversary of the first report of nitrogen mustard for cancer therapy, Hirsch reflects on the development of chemical agents for use in warfare.

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Author in the Room Teleconference
Join David Spiro, MD, MPH, Wednesday, October 18, from 2 to 3 PM eastern time to discuss wait-and-see prescription for otitis media. To register, go to http://www.ihi.org/AuthorintheRoom.

Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

JAMA Patient Page
For your patients: Information about colon cancer.

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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Molecular Genetics and Hereditary Colorectal Cancer: Resolution of the Diagnostic Dilemma of Hereditary Nonpolyposis Colorectal Cancer, Lynch Syndrome, Familial Colorectal Cancer Type X, and Multiple Polyposis Syndromes
Lynch et al.
Am Soc Clin Oncol Ed Book 2009;2009:221-226.
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