Clinical Review Recent advances

General medicine

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7161.792 (Published 19 September 1998) Cite this as: BMJ 1998;317:792
  1. Laura A Petersen, assistant professor of medicine
  1. Health Services Research and Development, Department of Veteran's Affairs Medical Centre, Houston, TX 77030, USA
  • Accepted 22 January 1998

One review could not encompass all the noteworthy recent advances in general medicine, but research findings relevant to the treatment of HIV, congestive heart failure, prostatic hypertrophy, hypertension, hypercholesterolaemia, oestrogen replacement, osteoporosis, cancer screening, and symptoms of the common cold have generated particular interest.

Methods

For this review, I defined advances in general medicine as research that might change the management of chronic disease or the strategies to prevent disease. Given the breadth of the subject, I asked colleagues to nominate the three to five articles published in the previous 18 months that they believed had been most important to the practice of general medicine.

HIV infection

Advances in understanding of the pathogenesis and treatment of HIV related illness have resulted in new recommendations for antiretroviral treatment and disease monitoring. Plasma HIV RNA concentrations are now thought to be the most important predictor of outcome,13 and reductions in the viral load are associated with a reduced risk of disease progression.4 Concerns that treatment with only one agent is associated with rapid selection of resistant virus variants have led to the current recommendation of a regimen incorporating three drugs—two nucleoside analogue reverse transcriptase inhibitors and a protease inhibitor. All patients with plasma HIV RNA concentrations >5000 to 10 000 copies/ml should be given triple therapy, regardless of their CD4+ cell count. Triple therapy is also recommended for patients with symptomatic HIV disease or with CD4+ cell counts below 0.50 × 109/l.5 Unfortunately, these regimens are costly, complicated, and require great commitment on the part of both patients and health care providers. Lack of diligence in adhering to the complex drug regimen may result in emergence of drug resistant strains.

Recent advances

  • New recommendations for antiretroviral therapy and disease monitoring in HIV related illness have been drawn up

  • Blockade may be effective in selected …

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