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in Denmark found that HIV-infected persons at age 25 years without hepatitis C had a life expectancy of 39 additional years Unfortunately, not all HIV-infected persons have access to treatment Studies consistently show less access to treatment for blacks, the homeless, and injection drug users In addition to access to treatment, sustaining lower mortality will require developing new treatments for patients in whom resistance to existing agents develops For patients whose disease progresses even though they are receiving appropriate treatment, meticulous palliative care must be provided (see 5), with attention to pain control, spiritual needs, and family (biologic and chosen) dynamics

El-Sadr WM et al; Strategies for Management of Antiretroviral Therapy (SMART) Study Group CD4+ count-guided interruption of antiretroviral treatment N Engl J Med 2006 Nov 30;355(22):2283 96 [PMID: 17135583] Gallant JE et al; Study 934 Group Tenofovir DF, emtricitabine, and efavirenz vs zidovudine, lamivudine, and efavirenz for HIV N Engl J Med 2006 Jan 19;354(3):251 60 [PMID: 16421366] Grinspoon S et al Cardiovascular risk and body-fat abnormalities in HIV-infected adults N Engl J Med 2005 Jan 6;352(1): 48 62 [PMID: 15635112] Gulick RM et al; AIDS Clinical Trials Group (ACTG) A5095 Study Team Three- vs four-drug antiretroviral regimens for the initial treatment of HIV-1 infection: a randomized controlled trial JAMA 2006 Aug 16;296(7):769 81 [PMID: 16905783] Hammer SM et al Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society-USA panel JAMA 2006 Aug 16;296(7):827 43 [PMID: 16905788] Huang L et al Intensive care of patients with HIV infection N Engl J Med 2006 Jul 13;355(2):173 81 [PMID: 16837681] Lohse N et al Survival of persons with and without HIV infection in Denmark, 1995 2005 Ann Intern Med 2007 Jan 16;146(2): 87 95 [PMID: 17227932] Robbins GK et al; AIDS Clinical Trials Group 384 Team Comparison of sequential three-drug regimens as initial therapy for HIV-1 infection N Engl J Med 2003 Dec 11;349(24): 2293 303 [PMID: 14668455]

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The logic of the for loop is as though you said, For every value of counter, which I initialize to zero, take this action if the test returns true, and after the action, update the value of counter.

Diminished libido and erections Decreased growth of body hair Testes may be small or normal in size Serum testosterone is usually decreased Serum gonadotropins (LH and FSH) are decreased in hypogonadotropic hypogonadism; they are increased in testicular failure (hypergonadotropic hypogonadism)

Male hypogonadism is caused by deficient testosterone secretion by the testes It may be classified according to whether it is due to (1) insufficient gonadotropin secretion by the pituitary (hypogonadotropic) or (2) pathology in the testes themselves (hypergonadotropic) (Table 26 14)

A deficiency in FSH and LH may be isolated or associated with other pituitary hormonal abnormalities (See Hypopituitarism) Patients must be evaluated for signs of Cushing s syndrome or adrenal insufficiency, growth hormone excess or deficiency, and thyroid hormone excess or deficiency Acquired hypogonadotropic hypogonadism may be due to pituitary or hypothalamic factors but may be idiopathic Hyperprolactinemia (see Table 26 2) may also induce hypogonadism Hypogonadotropic hypogonadism can develop in men receiving GnRH agonist therapy for prostate cancer and can persist following cessation of therapy

Remember the modulus operator, which we introduced in 4 and which we said would be useful later Well, it really comes into its own in controlling for loops. When you perform modulus n on a number that is a multiple of n, the result is zero. Thus, 80%10=0 because 80 is an even multiple of 10. This fact allows you to set up loops in which you take an action every nth time through the loop by testing a counter to see whether %n is equal to zero, as illustrated in Example 5-15.

A failure in testicular secretion of testosterone causes a rise in LH If testicular Sertoli cell function is deficient, FSH will be elevated Conditions that can cause testicular failure include viral infection (eg, mumps), irradiation, cancer chemotherapy, autoimmunity, myotonic dystrophy, uremia, XY gonadal dysgenesis, partial 17-ketosteroid reductase deficiency, Klinefelter syndrome, and male climacteric Klinefelter syndrome (seminiferous tubule dysgenesis) is a common cause of male hypogonadism that is due to the expression of an abnormal karyotype, classically 47,XXY Other forms are common, eg, 46,XY/47,XXY mosaicism, 48,XXYY, 48,XXXY, or 46,XX males The manifestations of Klinefelter syndrome are variable Testes feel normal during childhood, but during adolescence they usually become firm, fibrotic, small, and nontender to

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