The principle of directly observed therapy (DOT) has its roots in the treatment of tuberculosis (TB), for which DOT programs have improved cure rates in hard-to-reach populations. Human immunodeficiency virus (HIV) and TB affect similar populations, and there are concerns about both regarding the development of drug resistance associated with poor adherence to therapy. Accordingly, DOT may benefit certain HIV-infected people who have difficulty adhering to highly active antiretroviral therapy. However, important differences exist in the treatment of these diseases that raise questions about how DOT can be adapted to HIV therapy. DOT for management of HIV infection has been effective among prisoners and in pilot programs in Haiti, Rhode Island, and Florida. Although DOT can successfully treat HIV infection in marginalized populations in the short term, a multitude of questions remain. This review provides an account of the preliminary development of DOT programs for the treatment of HIV-infected individuals.
Hispanic and non-Hispanic whites with NIDDM have similar risks of DSN. Current cigarette smoking and a history of myocardial infarction may represent independent risk factors for DSN in addition to glycemic control.
A 30-year-old bisexual man who was infected with human immunodeficiency virus (HIV) and had a history of anaphylaxis to penicillin developed lues maligna, or ulceronodular secondary syphilis. Therapy with parenteral erythromycin failed, and he was subsequently treated with ceftriaxone following penicillin desensitization. A review of the English-language literature identified 14 cases of lues maligna reported between the early 1900s and 1988. From 1989 to 1994, an additional 12 cases (including the current case) were reported. Of those 12 cases, 11 occurred in patients who either were infected with HIV or were at high risk for HIV infection. Patients infected with HIV may be at increased risk of developing this severe form of secondary syphilis. Lues maligna should be considered in the differential diagnosis of HIV-infected patients who present with ulceronodular lesions.
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