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substantially above the threshold for initiation of antiviral therapy (350 cells/mcL) should have counts performed every 6 months Those who have counts near or below 350 cells/ mcL should have counts performed every 3 months This is necessary for evaluating the efficacy of antiviral therapy and for initiating P jiroveci prophylactic therapy when the CD4 count drops below 200 cells/mcL Some studies suggest that the percentage of CD4 lymphocytes is a more reliable indicator of prognosis than the absolute counts because the percentage does not depend on calculating a manual differential While the CD4 count measures immune dysfunction, it does not provide a measure of how actively HIV is replicating in the body HIV viral load tests (discussed below) assess the level of viral replication and provide useful prognostic information that is independent of the information provided by CD4 counts

Chung RT et al; AIDS Clinical Trials Group A5071 Study Team Peginterferon alfa-2a plus ribavirin versus interferon alfa-2a plus ribavirin for chronic hepatitis C in HIV-coinfected persons N Engl J Med 2004 Jul 29;351(5):451 9 [PMID: 15282352] Dominguez S et al Efficacy of early treatment of acute hepatitis C infection with pegylated interferon and ribavirin in HIV-infected patients AIDS 2006 May 12;20(8):1157 61 [PMID: 16691067] Fitch KV et al Effects of a lifestyle modification program in HIV-infected patients with the metabolic syndrome AIDS 2006 Sep 11;20(14):1843 50 [PMID: 16954725] Grubb JR et al The changing spectrum of pulmonary disease in patients with HIV infection on antiretroviral therapy AIDS 2006 May 12;20(8):1095 107 [PMID: 16691060] Kohli R et al; HER Study Group Bacterial pneumonia, HIV therapy, and disease progression among HIV-infected women in the HIV epidemiologic research (HER) study Clin Infect Dis 2006 Jul 1;43(1):90 8 [PMID: 16758423] Lima MA et al New features of progressive multifocal leukoencephalopathy in the era of highly active antiretroviral therapy and natalizumab J Neurovirol 2005;11 (Suppl 3):52 7 [PMID: 16540456]

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As usual, the Boolean expression is any expression that evaluates to true or false. The statement executed within the while statement can of course be a block of statements within braces. Example 5-12 illustrates the use of the while loop.

McArthur JC et al Neurological complications of HIV infection Lancet Neurol 2005 Sep;4(9):543 55 [PMID: 16109361] Manzardo C et al Central nervous system opportunistic infections in developed countries in the highly active antiretroviral therapy era J Neurovirol 2005;11 (Suppl 3):72 82 [PMID: 16540459] Maurer TA Dermatologic manifestations of HIV infection Top HIV Med 2005 Dec 2006 Jan;13(5):149 54 [PMID: 16377853] Nath A et al Influence of highly active antiretroviral therapy on persistence of HIV in the central nervous system Curr Opin Neurol 2006 Aug;19(4):358 61 [PMID: 16914973] Roberts MT AIDS-associated progressive multifocal leukoencephalopathy: current management strategies CNS Drugs 2005;19(8):671 82 [PMID: 16097849] Skiest DJ et al Cryptococcal immune reconstitution inflammatory syndrome: report of four cases in three patients and review of the literature J Infect 2005 Dec;51(5):e289 97 [PMID: 16321643] Stevens DL et al Practice guidelines for the diagnosis and management of skin and soft-tissue infections Clin Infect Dis 2005 Nov 15;41(10):1373 406 [PMID: 16231249] Sullivan PS et al Effect of hepatitis C infection on progression of HIV disease and early response to initial antiretroviral therapy AIDS 2006 May 12;20(8):1171 9 [PMID: 16691069] Weis N et al Impact of hepatitis C virus coinfection on response to highly active antiretroviral therapy and outcome in HIVinfected individuals: a nationwide cohort study Clin Infect Dis 2006 May 15;42(10):1481 7 [PMID: 16619163]

HIV infection may mimic a variety of other medical illnesses Specific differential diagnosis depends on the mode of presentation In patients presenting with constitutional symptoms such as weight loss and fevers, differential considerations include cancer, chronic infections such as tuberculosis and endocarditis, and endocrinologic diseases such as hyperthyroidism When pulmonary processes dominate the presentation, acute and chronic lung infections must be considered as well as other causes of diffuse interstitial pulmonary infiltrates When neurologic disease is the mode of presentation, conditions that cause mental status changes or neuropathy eg, alcoholism, liver disease, renal dysfunction, thyroid disease, and vitamin deficiency should be considered If a patient presents with headache and a cerebrospinal fluid pleocytosis, other causes of chronic meningitis enter the differential When diarrhea is a prominent complaint, infectious enterocolitis, antibiotic-associated colitis, inflammatory bowel disease, and malabsorptive symptoms must be considered

Until vaccination is a reality, prevention of HIV infection will depend on effective precautions regarding sexual practices and injection drug use, use of perinatal HIV prophylaxis, screening of blood products, and infection control practices in the health care setting Primary care clinicians should routinely obtain a sexual history and provide risk factor assessment of their patients Because approximately one-fourth of the HIV-infected persons in the United States do not know they are infected, the CDC recommends all adults be routinely tested for HIV Prior to testing, clinicians should obtain

IEEE Annals of the History of Computing 23, no 1 (2001):22 33 Gamma, Erich Design Patterns: Elements of Reusable Object-Oriented Software Addison-Wesley Professional Computing Series Reading, MA: Addison-Wesley, 1995..

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