Background-Human immunodeficiency virus protease inhibitors (HIV PIs) are associated with hyperlipidemia, hyperglycemia, and obesity; however, it is not known whether they increase risk of atherosclerotic vascular disease. The purposes of this study were to characterize the lipoprotein abnormalities associated with use of HIV PIs in individuals with HIV infection and to determine the pathophysiological significance of these changes by assessing their effect on endothelial dysfunction. Methods and Results-This was a cross-sectional study of 37 adults with HIV-1 infection who were receiving antiretroviral therapy. Twenty-two were taking HIV PIs (group 1); 15 were not (group 2). Lipids and lipoproteins were measured by enzymatic techniques and nuclear magnetic resonance spectroscopic analysis. Flow-mediated vasodilation (FMD) of the brachial artery was measured by high-resolution ultrasound. Subjects in both groups were similar in regard to age, time since diagnosis of HIV infection, and CD4 cell count.

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A longitudinal study of demographic and behavioural characteristics associated with risky sexual behaviours of young men after release from prison. One hundred and six men were interviewed in prison and at one week and six months after release. Overall, 37% reported a previous sexually transmitted disease (STD) diagnosis. In the 30 days before incarceration, 33% had had sex with a risky partner, and 59% had had multiple female sex partners. After release, 38 (36%) men reported having had risky sex (>or=2 female sex partners and unprotected vaginal sex): 12 (13%) at one week and 31 (34%) at six months. The only factor independently associated with risky sex was the use of alcohol/drugs before sex: one-week odds ratio (OR)=6.11 (95% confidence interval [CI]: 1.42-26.40), six-month OR=3.05 (95% CI: 1.30-9.42). Behavioural intervention programmes for incarcerated men should address drug and alcohol use and its contribution to higher risk for HIV and STDs.

The Centers for Disease Control and Prevention (CDC) recommends routine HIV screening in primary care but little is known about general internists' views of this practice. We conducted a national, cross-sectional, Internet-based survey of 446 general internists in 2009 regarding their HIV screening behaviors, beliefs, and perceived barriers to routine HIV screening in outpatient internal medicine practices. Internists' awareness of revised CDC guidelines was high (88%), but only 52% had increased HIV testing, 61% offered HIV screening regardless of risk, and a median 2% (range 0-67%) of their patients were tested in the past month. Internists practicing in perceived higher risk communities reported greater HIV screening. Consent requirements were a barrier to screening, particularly for VA providers and those practicing in states with HIV consent statutes inconsistent with CDC guidelines. Interventions that promote HIV screening regardless of risk and streamlined consent requirements will likely increase adoption of routine HIV screening in general medicine practices.

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