Methamphetamine and HIV.

When the New York City Department of Health and Mental Hygiene announced in January 2005 that a gay man in his forties had become infected with a multidrug-resistant "superstrain" of HIV and had progressed to AIDS within a few months, much was made of the man's use of methamphetamine. The case highlighted two important aspects of the intersection of methamphetamine use and HIV. First is the fairly well-established role the drug can play in facilitating new infections by lowering users' inhibitions and encouraging sexual practices that increase the risk of HIV transmission. The second aspect is the idea that methamphetamine somehow speeds up the HIV disease process. There is little evidence of a direct interaction between meth and HIV that accelerates immune decline, but meth use can undermine the general health of the user. There is also a growing body of evidence that meth's harmful effects on the brain may be exacerbated in people with HIV, and that many HIV-related neurological impairments may be worsened by meth use.

Revisiting monotherapy: heresy or revised orthodoxy?

After the widespread introduction of triple combination antiretroviral therapy in 1996 caused AIDS deaths to plummet, the earlier practice of single-drug treatment--or monotherapy--seemed like an embarrassing phase of medical ignorance. By then, it had become all too apparent that monotherapy promoted the rapid development of drug-resistant virus, often leading to treatment failure. Stories still occasionally surface about an isolated doctor prescribing solo AZT (zidovudine, Retrovir), and many long-time HIV physicians with large practices probably have one or two patients still doing well on two drugs and see no reason to change their regimens. But by and large, hitting hard with two nucleoside reverse transcriptase inhibitors (NRTIs) plus either a protease inhibitor (PI) or a non-NRTI (NNRTI) has become dogma, and is now enshrined in all HIV treatment guidelines.