Annals of Internal Medicine tip sheet for Sept. 19, 2006

1. More People with AIDS Die of "Common" Causes in 2004 than in 1999

Researchers found that of 68,669 New York City residents with AIDS who died between 1999 and 2004, 26.3 percent did not die of HIV-related causes (Article, p. 397). This figure is a 33 percent increase from 19.8 percent in 1999. The principal causes of death were cardiovascular disease, substance abuse, and cancer.

An editorial writer says that as better therapies enable people with HIV to live longer, they develop diseases related to age, particularly cardiovascular disease and cancers (Editorial, p. 463).

Both primary care physicians and HIV care specialists must remember to provide their HIV patients with prevention and screening, treatment and counseling for drug and tobacco abuse and sexually transmitted diseases, and treatment for chronic diseases.

2. In a New Survey, Men Call Themselves Straight but Have Sex with Men

A survey of 4,193 men living in New York City found that nearly 10 percent of all the male participants who identified themselves as straight reported having sex with at least one man during the previous year (Article, p. 416).

Compared to men who identified themselves as gay, these men were more likely to belong to a minority racial or ethnic group, be foreign-born, and have a low educational level. Seventy percent reported being married.

This group also was less likely to have been tested for HIV infection during the previous year and less likely to have used a condom during the last sexual encounter than men who identified themselves as gay.

This study is one of the largest U.S. population-based surveys to report on the contrast between a man's sexual identity and his actual sexual behaviors.

The authors say that "because men who have sex with men do not necesssarily identify as gay, prevention messages should focus on the activities that pose risk (for example, unprotected receptive anal sex) and should not be framed to appeal solely to gay-identified men."

3. Three Imaging Techniques Evaluated for Detecting Artery Disease

Researchers obtained images of the coronary arteries of 108 patients with suspected coronary artery disease using multislice computed tomography (CT), magnetic resonance imaging (MRI), and conventional coronary angiography.

The authors used conventional coronary angiography, in which a small tube is inserted into a blood vessel in the groin or arm and threaded to the heart or arteries supplying the heart, as the reference standard for assessing the sensitivity and specificity of the less-invasive multislice CT and non-invasive MRI (Article, p. 407).

The researchers found that the multislice CT was superior to MRI for ruling out CAD. But multislice CT, while not invasive, does subject the patient to a substantial dose of radiation and an intravenous injection of a contrast agent, which can damage the kidneys.

An editorial writer points out that the probability of CAD can be as high as 50:50 after a negative multi-slice CT (Editorial, p. 466).

Current recommendations are to do invasive coronary angiography when there is a high probability of finding blockages that will require repair. Therefore, the editorial writer says, "multislice CT seems to have little value in most candidates for invasive coronary angiography." The writer, however, thinks that it can be useful in a subset of patients with a relatively low probability of CAD: those with nonspecific chest pain and equivocal results on exercise testing.

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NOTE: Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.


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