New Cases

A 43-Year-Old with a Persistent Skin Rash
Evaluation of skin rashes can prove very difficult in HIV-infected persons with advanced immunosuppression. In this case, the diagnosis of these hyperkeratotic, scaling lesions was made on a skin scraping when viewed under a microscope. Test your skills in diagnosis and management in this challenging unknown.

Efavirenz-Associated Central Nervous System Adverse Effects
Efavirenz (Sustiva) is one of the most frequently used antiretroviral medications. The concern for neuropsychiatric adverse effects often plays a role in the decision of whether to include efavirenz as part of an antiretroviral regimen. This case includes a discussion of available data related to efavirenz-related neuropsychiatric manifestations. In addition, this case provides practical recommendations for the prevention and management of these symptoms.

A 27-Year-Old with Disseminated Histoplasmosis
Disseminated histoplasmosis in HIV-infected persons is a potentially life-threatening infection. Clinical manifestations are often non-specific. Diagnostic testing often involves using a combination of tests, including antigen tests and culture. Preferred initial treatment of progressive disseminated infection consists of liposomal amphotericin B (AmBisome), followed by maintenance therapy with oral itraconazole (Sporanox).

A 43-Year-Old with New Visual Symptoms
Cytomegalovirus retinitis remains an important clinical problem with patients with advance immunosuppression. Symptoms of cytomegalovirus retinitis usually include one or more of the four “F’s”: floaters, flashes, field deficits, or failing vision. Oral valganciclovir (Valcyte), with or without a ganciclovir intraocular implant, is generally recommended for initial therapy.

African Americans with HIV: Epidemiology and Risk Factors
The HIV epidemic has disproportionately affected African Americans and in recent years more new diagnoses of HIV (with or without AIDS) involve African Americans than any other racial/ethnic population. This case includes a review of the epidemiology and factors related to the explosion of the HIV epidemic in African Americans.

Protease Inhibitor-Associated Hyperbilirubinemia
Isolated unconjugated hyperbilirubinemia is a known adverse effect that can develop while taking atazanavir. This case includes a review of the natural history, mechanism, genetic predisposition, and management of protease-inhibitor associated hyperbilirubinemia.