In this month's main article, Dr. Peter Piliero discusses mitochondrial toxicity, which is responsible for many of the long-term complications of antiretroviral therapy. These complications, along with the development of viral resistance, are the primary reasons for delaying the initiation of antiretroviral therapy in HIV-infected patients. This delay provides the opportunity and time to establish an effective provider-patient relationship and to educate patients about the risks and benefits of antiretroviral therapy. Such an approach will lead to improved acceptance of and adherence to antiretroviral therapy, as well as earlier recognition of complications that can be addressed by appropriate changes in antiretroviral therapy.

In this month's spotlight, Drs. Bhupinder Mann and Joseph Bick describe the sudden appearance of SARS and its effect on an unprepared public and health care system. Although fear may be the first response to life-threatening emerging infectious diseases, rational plans of response that are informed by facts are the only ways to respond to and contain emerging pathogens. It is unclear what the magnitude of the SARS problem will be in the United States. But it is clear that all heath care facilities, including prisons and jails, should develop a plan to contain and treat this infection if and when it appears at our doorsteps.

After reading this issue, you should be familiar with toxicities associated with antiretroviral therapies, including common toxicities across drug classes and with specific agents. You should also be familiar with issues relating to the SARS virus, including how it is transmitted, symptoms, making a diagnosis, and what to think about when implementing a plan in a correctional facility.

As always, please contact us with your suggestions and comments.

Sincerely yours,
David Paar

Back to the HEPP Report June 2003 contents page.