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The timing of the initiation of antiretroviral therapy in asymptomatic patients with HIV infection is unclear. In this retrospective study involving patients in North America from 1996 through 2005, the deferral of therapy until the patient's CD4+ count had fallen below one of the two thresholds of interest (a range of 351 to 500 cells or >500 cells per cubic millimeter) was associated with a relative hazard of death of 1.69 and 1.94, respectively.
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In this randomized, controlled trial involving patients with chronic infection with hepatitis C virus (HCV) genotype 1, the addition of the HCV-specific protease inhibitor telaprevir to therapy with peginterferon and ribavirin improved the rate of sustained virologic response. Patients treated with telaprevir were more likely than those treated with peginterferon and ribavirin alone to stop treatment because of adverse events, and severe rash was the most common reason for discontinuation.
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In this phase 2 trial in patients infected with HCV genotype 1, three regimens including telaprevir, a specific inhibitor of the HCV serine protease, were tested. One such regimen (telaprevir for 12 weeks and peginterferon and ribavirin for 24 weeks) resulted in a higher rate of sustained virologic response than the control regimen (48 weeks of peginterferon and ribavirin). Telaprevir caused severe rash in some patients.
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A 23-year-old nonsmoking woman (gravida 1, para 0) presents at 11 weeks' gestation with an 8-year history of asthma, which has worsened over the past year. She reports symptoms requiring albuterol two or three times per day and interfering with sleep. Her forced expiratory volume in 1 second is 75% of the predicted value; it increases to 88% after administration of albuterol. How should her case be managed?
A 36-year-old man was admitted to the hospital because of chest pain, dysphagia, and pleural and mediastinal calcifications. He had had intermittent chest pain for 6 years after an athletic injury; dysphagia, dyspnea, and weight loss had developed over the past 2 years. Imaging studies showed pleural and mediastinal calcifications, with an esophageal stricture. Surgical procedures were performed to relieve esophageal stricture and obtain tissue for diagnosis, but symptoms recurred and biopsy specimens disclosed bony tissue with no malignant cells.
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