The idea that stopping antiviral treatment for HIV for short spells can cut the amount of circulating virus by transiently reawakening the immune system seems to have been firmly knocked on the head. Researchers following a cohort of 97 patients after they underwent a series of structured treatment interruptions found that viral load, far from decreasing, simply returned to pretreatment levels. Treatment interruptions also reduced the killer T cell response to the virus in most people (www.pnas.org/cgi/content/abstract/202372199

In 1999, two cases from New York of encephalitis associated with muscle weakness led to a huge investigation that ultimately identified West Nile virus as the cause of ongoing outbreaks of disease in humans and crows. Severe cases have been described as Guillain-Barré type syndromes, but two further reports in the New England Journal of Medicine (2002;347:1225-6)now say that West Nile virus can cause poliomyelitis, suggesting that the virus can directly attack motor neurones in the spinal cord.

A tenth of patients with dyspepsia present with alarm symptoms. But although alarm symptoms are said to predict a bad prognosis, a three year prospective study found they gave low positive predictive values and high negative predictive values. The authors say this reflects …