The Lancet Infectious Disease
Jul 2010  Volume 10 Number 7  Pages 441 – 504
http://www.thelancet.com/journals/laninf/issue/current

Leading Edge
The deadly synergy of HIV and tuberculosis
The Lancet Infectious Diseases
To coincide with the International AIDS Conference being held this month in Vienna, Austria, we publish in this issue of the journal six Review and Personal View papers on a diversity of subjects related to HIV/AIDS. In addition, page 446 features a profile of Gottfried Hirnschall, the newly appointed Director of WHO’s HIV/AIDS Department.

Review
Effect of treating co-infections on HIV-1 viral load: a systematic review
Kayvon Modjarrad, Sten H Vermund

Co-infections contribute to HIV-related pathogenesis and often increase viral load in HIV-infected people. We did a systematic review to assess the effect of treating key co-infections on plasma HIV-1-RNA concentrations in low-income countries. We identified 18 eligible studies for review: two on tuberculosis, two on malaria, six on helminths, and eight on sexually transmitted infections, excluding untreatable or non-pathogenic infections. Standardised mean plasma viral load decreased after the treatment of co-infecting pathogens in all 18 studies.

Risk of resistance to highly active antiretroviral therapy among HIV-positive injecting drug users: a meta-analysis
Daniel Werb, Edward J Mills, Julio SG Montaner, Evan Wood

Although highly active antiretroviral therapy (HAART) is an effective treatment for HIV, many physicians withhold this treatment from HIV-positive injecting drug users (IDUs) because of fears of non-adherence and consequent development of antiretroviral resistance. Little is known, however, about whether the rates of resistance differ between IDUs and non-IDUs. We did a meta-analysis of studies that compared antiretroviral resistance rates in IDUs (current or previous) with those in HIV-positive patients infected by other routes and who had never injected drugs.

HIV-associated psoriasis: pathogenesis, clinical features, and management
Nilesh Morar, Saffron A Willis-Owen, Toby Maurer, Christopher B Bunker

Psoriasis is a chronic papulosquamous skin disease that is thought to be a T-cell-mediated autoimmune disorder of keratinocyte proliferation. The association between psoriasis and HIV infection seems paradoxical, but insights into the role of T-cell subsets, autoimmunity, genetic susceptibility, and infections associated with immune dysregulation might clarify our understanding of the pathogenesis of psoriasis with HIV in general. HIV-associated psoriasis can be clinically confusing because several comorbid skin disorders in patients with HIV can mimic psoriasis.

Central Asia: hotspot in the worldwide HIV epidemic
Claire Thorne, Nina Ferencic, Ruslan Malyuta, Jadranka Mimica, Tomasz Niemiec

The HIV epidemic in central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan) has accelerated since 2000. This expansion in the epidemic is largely attributable to escalating injection drug use, reflecting central Asia’s geographic position along major drug trafficking routes. Although up to 75% of cumulative HIV cases have been among injection drug users (IDUs) so far, HIV infections are increasing in other population groups, including female sex workers and their clients, prisoners, and migrants.