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management
Joseph McGowan, MD and Sanjiv Shah, MD

Understanding HIV Tropism

The ability of HIV to bond to different coreceptors for cell entry is known as tropism. After attaching to CD4, HIV must also bind to one of two additional coreceptors. The predominant coreceptor is CCR5, especially early in the course of infection; alternately HIV may be able to bind to CXCR4, either instead of or in addition to CCR5. Viral and host cell factors determine viral tropism and the dynamics of viral attachment prior to cell entry. Tropism has critical implications for HIV care. This article explains tropism and explores how it may influence decisions regarding the use of CCR5 antagonists for disease management.

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coinfections
Jason Bratcher, MD, MBA and Joel Palefsky, MD

Anogenital Human Papillomavirus Coinfection and Associated Neoplasia in HIV-positive Men and Women

The incidence of anal intraepithelial neoplasia (AIN) and anal cancer, caused by human papillomavirus (HPV), is much higher in HIV-positive women and HIV-positive men who have sex with men (MSM) than in the general population, and highly active antiretroviral therapy (HAART) for HIV disease has had little or no impact on this trend. There is a growing need for definitive guidelines to assess for AIN in HIV-positive individuals, and with better treatment options available, it is even more crucial to identify these patients at an earlier stage. New York is the first state to institute recommendations for anal cytology screening in HIV-positive patients.

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management
Teresa H. Evering, MD and Martin Markowitz, MD

HIV-1 Integrase Inhibitors

The integrase inhibitors are a welcome addition to the treatment armamentarium for HIV/AIDS in treatment-experienced patients failing available antiretroviral regimens. The promising efficacy and tolerability profile of the integrase inhibitors, absence of cross-resistance with other antiretroviral classes, and demonstrated synergism of the integrase inhibitors in combination with approved antiretroviral agents place them in a position to become important components of effective combination antiretroviral regimens in individuals living with HIV/AIDS.

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complications
Todd T. Brown, MD, PhD

Selected Endocrine Topics in HIV: Osteoporosis and Adrenal Insufficiency

The care of HIV-infected patients has become increasingly complex. Endocrine problems, such as osteoporosis and AI, have been frequently reported in the HAART era. Additional considerations may be required regarding the etiologies, diagnosis, and treatment compared with the general population. Further research is required to understand the intricacies of these problems in HIV-infected patients in order to provide optimal care.

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management
Athe Tsibris, MD

Update On CCR5 Inhibitors: Scientific Rationale, Clinical Evidence, and Anticipated Uses

The CCR5 antagonists are a welcome addition to the therapeutic armamentarium available for antiretroviral-experienced patients. Currently, their use in antiretroviral-naive patients should be restricted to enrollment in ongoing or planned clinical trials. The CCR5 antagonist maraviroc is FDA-approved for treatment-experienced patients with R5 virus (only), and no patient should receive maraviroc without first undergoing a tropism assay.

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progression
Saurabh Mehandru, MD

The Gastrointestinal Tract in HIV-1 Infection: Questions, Answers, and More Questions!

The GI tract is targeted during all stages of HIV disease, and this is especially so during acute and early HIV infection. CD4 cells are preferentially lost from the GI tract within weeks of HIV infection. Despite long-term antiretroviral therapy, CD4+T-cell reconstitution remains deficient in the GI tract in spite of the reconstitution seen in the peripheral blood.

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PRN is pleased to offer this new CME opportunity designed for physicians, nurse practitioners and physician assistants caring for patients with or at risk for HIV disease and its many complications. Based on content from The PRN Notebook, credit for each course will be available for a limited period of time noted on each activity.

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