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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic illness and its treatments can have a negative impact on sexual functioning. The mechanism of interference may be neurologic, vascular, endocrinologic, musculoskeletal, or psychologic. Patients may mistakenly perceive a medical prohibition to the resumption of sexual activity, or they may need advice on changes in sexual activity to allow satisfactory sexual functioning. Family physicians must be proactive in diagnosing and managing the alterations in sexual functioning that can occur with chronic illness. Patient education and reassurance are essential. Before sexual activity is resumed, patients with cardiovascular disease should be stratified according to risk. Patients with musculoskeletal disease should be educated about positional changes that may improve comfort during sexual activity. Psychosocial concerns should be addressed in patients with human immunodeficiency virus infection or acquired immunodeficiency syndrome. In patients with cancer, it is important to discuss sexual problems that may arise because of negative body image and the effects of chemotherapy. Patients who have disabilities can benefit from the use of muscle relaxants, technical adaptations, and expansion of their sexual repertoire.
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PMID:Chronic illness and sexual functioning. 1256 56

Significant health disparities exist between ethnic groups in the United States. The authors reviewed literature examining the epidemiology of health disparities in Hawaii's multiethnic population. One of the primary goals of the Healthy People 2010 initiative is to eliminate health disparities, specifically cancer, cardiovascular disease, diabetes, infant mortality, child and adult immunizations and HIV/AIDS. However, the research on ethnic health disparities is fragmented, especially in Asian/Pacific Islanders. Unclear definitions of ethnicity (i.e., self-report, mixed ethnicity, etc) and aggregated study populations (i.e., combining multiple ethnic groups into one category) obscure the true health status of ethnic minorities in Hawaii. This paper presents an overview of the state of the literature on Hawaii ethnic health disparities.
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PMID:Healthy people in Hawaii?: an overview of ethnic health disparities in Hawaii for the Healthy People 2010 initiative targeted health concerns. 1259 43

Lipodystrophy (LD) associated with HIV infection is a syndrome of abnormal fat distribution observed in HIV-infected patients treated with various antiretroviral agents. In addition, insulin resistance and dyslipidemia can occur in HIV-infected patients with or without LD. The demonstration of the latter metabolic disorders in normal subjects using protease inhibitors suggests that these agents could play a causative role in their development independently of HIV status. Possible mechanisms whereby protease inhibitors can hinder insulin actions include inhibition of glucose transporter isoform Glut 4, and altered expression of leptin and tumor necrosis factor-a in adipose tissue. The presence of insulin resistance and dyslipidemia can potentially increase the risk of diabetes, cardiovascular disease, and death. However, short-term data in this regard are inconsistent. Treatment of HIV-related LD with metformin may ameliorate insulin resistance, but its impact on fat redistribution requires additional studies. Temporary cessation of antiretroviral therapy does not appear to reverse body fat changes or insulin resistance, but may partially improve the lipid profile. Further investigations are urgently needed to define the mechanisms and cardiovascular consequences of insulin resistance in HIV-related LD, and to find an effective treatment for this complex syndrome.
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PMID:Insulin resistance in HIV-related lipodystrophy. 1264 10

HIV-infected individuals taking antiretroviral medications may experience changes in body shape and metabolism, commonly known as HIV-associated lipodystrophy (HIVLD). In vitro and in vivo research have revealed numerous effects of both protease inhibitors and nucleoside reverse transcriptase inhibitors on the function of various organs--most importantly adipose tissue, liver, and muscle. The metabolic abnormalities could result in an increased risk of cardiovascular disease in this vulnerable and relatively young population. Treatment strategies, normally successful in the general population, have generally been less effective in this group of people, in which the detrimental effects of the antiretroviral medications are ongoing.
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PMID:HIV-associated lipodystrophy: description, pathogenesis, and molecular pathways. 1264 31

The advent of HAART has increased the lifespan of and enhanced the quality of life for patients with HIV infection. However, the gains achieved with HAART may be lost if all known risk factors for cardiovascular disease are not effectively managed in this population. This article reviews recent information on the contributions of insulin resistance, infection and inflammation, and psychiatric and psychological conditions associated with cardiovascular risk. It also summarizes available data on treatments of these risk factors.
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PMID:New concept in the pathogenesis of cardiovascular disease. 1276 90

Highly active antiretroviral therapy (HAART) has prolonged many patients' lives, but many cardiac sequelae of HIV are not affected by HAART and continue to develop even with treatment. In addition, HAART itself causes in a high proportion of patients a metabolic syndrome, characterized by lipodystrophy/ lipoatrophy, dyslipidemia and insulin resistance that may be associated with an increase in peripheral artery and coronary artery diseases. Careful cardiovascular evaluation in the course of HIV disease can identify cardiac complications early enough to treat. All HIV-infected patients who are either candidates to antiretroviral therapy or who are already under treatment should undergo an assessment that includes the evaluation of the cardiovascular risk with the available guidelines and the interactions between antiretrovirals and drugs commonly used to treat cardiovascular disease.
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PMID:Highly active antiretroviral therapy and cardiovascular complications in HIV-infected patients. 1276 27

Recent reports have indicated that norepinephrine (NE) enhances HIV replication in infected monocytes and promotes increased expression of select matrix metalloproteinases associated with dilated cardiomyopathy (DCM) in vitro in co-cultures of HIV-infected leukocytes and human cardiac microvascular endothelial cells (HMVEC-C). The influence of NE on HIV infection and leukocyte-endothelial interactions suggests a pathogenic role in AIDS-related cardiovascular disease. This study examined the effects of norepinephrine (NE) and HIV-1 infection on leukocyte adhesion to HMVEC-C. Both flow and static conditions were examined and the expression of selected adhesion molecules and cytokines were monitored in parallel. NE pretreatment resulted in a detectable, dose-dependent increase of leukocyte-endothelial adhesion (LEA) with both HIV-1-infected and -uninfected peripheral blood mononuclear cells (PBMCs) relative to media controls after 48 hr in co-culture with HMVEC-C in vitro. However, the combination of NE plus HIV infection resulted in a significant (P < 0.0001) 18-fold increase in LEA over uninfected media controls. Increased levels in both cell-associated and -soluble ICAM-1 and E-Selectin but not VCAM-1 correlated with increased LEA and with HIV-1 infection or NE pretreatment. Blocking antibodies specific for ICAM-1 or E-Selectin inhibited HIV-NE-induced LEA. These data suggest a model in which NE primes HIV-1-infected leukocytes for enhanced adhesion and localization in HMVEC-C where they can initiate and participate in vascular injury associated with AIDS-related cardiomyopathy.
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PMID:Norepinephrine enhances adhesion of HIV-1-infected leukocytes to cardiac microvascular endothelial cells. 1277 6

Although federal initiatives have mandated broader inclusion of minorities in clinical research on diseases that have disparities in health by race and ethnicity, it is not clear whether these initiatives have affected reporting of trial results. The objective of this study was to examine the reporting of race/ethnicity in clinical trials reports in areas of known disparities in health (i.e., diabetes, cardiovascular disease, HIV/AIDS, and cancer) and to determine what factors were associated with reporting of race/ethnicity in results. We performed a Medline search covering the period January 1989 to Oct 2000 to identify clinical trials of diabetes, cardiovascular disease, HIV/AIDS, and cancer published in the Annals of Internal Medicine, JAMA, and New England Journal of Medicine. The main outcome measure was the reporting of participation and of results by race/ethnicity of trial participants. Of 253 eligible trials, 40% (n=102) were non race-focused yet did not report race, while 2% (n=4) were non gender-focused and did not report gender. Forty-six percent of trials that reported the race/ethnicity of the sample reported only one or two racial/ethnic categories, and in 43% of these trials the total number of individuals reported in each race/ethnicity category did not equal the total reported sample size. Analysis of results by race/ethnicity was reported in only two trials, and by gender in only three trials. In diseases with known racial and ethnic disparities, many clinical trials do not report the race/ethnicity of the study participants, and almost none report analyses by race/ethnicity. Although federal initiatives mandate inclusion of minority groups in research, that inclusion has not translated to reporting of results that might guide therapeutic decisions.
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PMID:Adequacy of reporting race/ethnicity in clinical trials in areas of health disparities. 1281 14

During the past decade, a large number of new drugs for treating HIV and its complications have been developed. The increasingly sophisticated use of these drugs in combination has led to a marked reduction in HIV-related morbidity and mortality in countries where they are available. HIV/AIDS patients receiving treatment are now expected to live into old age. The beneficial effect of HIV treatment has resulted in an expanding population of persons living with HIV/AIDS who will need the care of an HIV specialist because of the complexity of the treatment regimens and the rapidly changing HIV/AIDS knowledge base. However, this growing and aging population will also benefit from the care of a primary care physician. The primary care generalist is in the best position to recognize and diagnose HIV infection, evaluate HIV risk in his or her patient population, and help prevent HIV infection in persons at risk. In patients known to be infected, the primary care generalist will be best able to manage hyperlipidemia, diabetes, cardiovascular disease, and other disorders of an aging population with an increased risk of these and other conditions. Patients with HIV infection frequently accumulate a large number of specialist physicians, and the unique ability of the primary care physician to monitor their care and act as a knowledgeable patient advocate is a great benefit to the patient.
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PMID:HIV disease in primary care. 1282 57

Antiretroviral-induced hyperlipidaemia is observed frequently and has raised concern about an increase in cardiovascular risk. However, HIV infection itself induces pro-atherogenic lipid changes, which may lead to an increased cardiovascular risk but are partly reversed by some antiretroviral regimens. Recent cohort studies have reported conflicting data on the change in the incidence of cardiovascular disease and the associated risk factors in HIV-positive patients. Switching patients with high low-density lipoprotein-cholesterol or very high triglyceride levels to antiretrovirals with a less pronounced effect on lipids is an option. Patients who are not eligible for this strategy should be considered for treatment with lipid-lowering agents. However, to date, no controlled studies showing a clinical benefit for the treatment of antiretroviral-induced hyperlipidaemia with lipid-lowering agents are available; for patients with several cardiovascular risk factors and pronounced hyperlipidaemia the use of a statin or fibrate is justified. In general, hyperlipidaemia due to antiretroviral therapy should not lead to undertreatment with antiretrovirals or overtreatment with statins or fibrates. Given the overall low number of cardiovascular events, an individualised approach seems adequate.
J HIV Ther 2003 May
PMID:HIV-associated and antiretroviral-induced hyperlipidaemia: an update. 1283 61


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