By S. Tizgar. Mount Marty College.

The most frequently reported events (those occurring in at least 5% of patients) were respiratory infection order glucotrol xl 10mg online diabetes insipidus gfr, pharyngitis discount 10 mg glucotrol xl diabetes mellitus glycosuria, rhinitis, bronchitis, sinusitis and headache. There were no major qualitative differences between treatments for occurrence of those events, nor were there major qualitative differences in reports of tremor, palpitation, tachycardia, candidiasis or dysphonia, reports of which were rare. In the subset of children within that trial, there was a trend favoring BUD/FM MART for occurrences of serious adverse events, fractures, and pneumonia. Budesonide/formoterol for maintenance and relief (BUD/FM MART) compared with fluticasone/salmeterol (FP/SM) for maintenance and Short-Acting Beta-Agonist (SABA) for relief 98, 100, Three trials compared BUD/FM MART to FP/SM for maintenance with a SABA for relief. Rate of withdrawal due to adverse events was numerically higher in the FP/SM+SABA 104, 106 arms of two of the three trials. One trial reported withdrawals due to “class effect,” a composite measure that included dysphonia, oral candidiasis, oral fungal infection, tremor, tachycardia, palpitations and headache. Fewer patients in the BUD/FM for maintenance and relief arm withdrew due to class effects compared with those receiving FP/SM+SABA, although 106 the rate was <1% in each. In the third trial, the difference in withdrawals due to adverse event was 0. Deaths were reported in all three trials, though occurrence was rare. A total of 2 patients treated with BUD/FM MART and three patients receiving FP/SM+SABA treatment died during the trials. In the BUD/FM arms, one death was from severe typhoid fever and the other was due to respiratory failure. One of the patients receiving FP/SM died from cardiac failure; causes of the other two deaths were not specified. Inhaled Corticosteroids (ICSs) compared with Leukotriene modifiers (LMs) Summary of findings 107, 109 110, 112-117, 119-127, 132 We found two systematic reviews with meta-analyses and 15 RCTs (Evidence Tables A and B). These were described in the Key Question 1 section of this report. Overall, data from two good quality systematic reviews and numerous fair-rated head-to- head RCTs provides no evidence of a difference in tolerability or overall adverse events between ICSs and leukotriene modifiers. Of note, trials were generally not designed to compare tolerability and adverse events. Indirect evidence suggests that ICSs may increase the risk of cataracts and may decrease short term growth velocity and bone mineral density, none of which have been identified with LMs. Detailed Assessment Most studies that examined the efficacy of ICSs compared to leukotriene modifiers (described in Key Question 1) also reported tolerability and adverse events. Methods of adverse events assessment differed greatly. Few studies used objective scales such as the adverse reaction terminology from the World Health Organization (WHO). Most studies combined patient-reported adverse events with a regular clinical examination by an investigator. Often it was difficult to determine if assessment methods were unbiased and adequate; many trials reported only those adverse events considered to be related to treatment. Rarely were adverse events prespecified and defined. Direct Evidence 107 One good quality systematic review with meta-analysis provides the best evidence for overall adverse events and tolerability. The meta-analysis found no significant difference in the risk of experiencing any adverse effects (N = 15 trials, RR 0.

Anemia in HIV-infected patients receiv- ing highly active antiretroviral therapy buy 10mg glucotrol xl overnight delivery blood sugar under 100. The etiology of anemia in HIV is complex and multifactorial glucotrol xl 10 mg generic diabetic diet mayo clinic. Anemia and growth However, emerging evidence suggests that not only is anemia an failure among HIV-infected children in India: a retrospective important and independent prognostic indicator in HIV, but it may analysis. Immuno-virologic increased inflammation and aberrant cytokine regulation seen in outcomes and immuno-virologic discordance among adults other clinical contexts such as aging. Increased expression of alive and on anti-retroviral therapy at 12 months in Nigeria. A better understanding of the adolescent spectrum of HIV disease surveillance project. HIV population will be critical in not only improving quality of 13. Haemoglobin and albumin as life, but also in suggesting ways to reduce mortality in these markers of HIV disease progression in the highly active vulnerable populations. Because cART therapy has allowed more antiretroviral therapy era: relationships with gender. Conflict-of-interest disclosure: The authors declare no competing 15. Nancy Berliner, Hematology, Mid-Campus 3, Brigham and Wom- 16. Esan MO, Jonker FA, Hensbroek MB, Calis JC, Phiri KS. Iron en’s Hospital, Boston, MA 02115; Phone: 617-732-5840; Fax: deficiency in children with HIV-associated anaemia: a system- 617-264-5215; e-mail: nberliner@partners. Prevalence and outcomes of anemia in of anemia and underlying iron status in naive antiretroviral individuals with human immunodeficiency virus: a systematic therapy HIV-infected children with moderate immune suppres- review of the literature. Tsiakalos A, Routsias JG, Kordossis T, Moutsopoulos HM, 380 American Society of Hematology Tzioufas AG, Sipsas NV. Fine epitope specificity of anti- transcription inhibited by ferroportin. Masaisa F, Breman C, Gahutu JB, Mukiibi J, Delanghe J, anemia. Severe in vitro inhibition of erythro- ated with lower circulating serum hepcidin levels in Rwandese poiesis and transient stimulation of granulopoiesis after bone- HIV-positive women. Erythro- and uninfected Malawian children with severe anemia. Costantini A, Giuliodoro S, Butini L, Silvestri G, Leoni P, 35. Abnormalities of erythropoiesis during HIV-1 leptin gene promoter is associated with anemia in patients with disease: a longitudinal analysis. Hematopoietic soluble CD14, and other inflammation biomarker levels differ precursor cells isolated from patients on long-term suppressive between obese and nonobese HIV-infected adults on antiretro- HIV therapy did not contain HIV-1 DNA. Serum erythropoietin ficiency virus type 1 resistance of hematopoietic stem cells and aging: a longitudinal analysis.

Handberg J purchase glucotrol xl 10mg without a prescription diabete 0 90, Wessel V discount 10 mg glucotrol xl with amex diabetes type 2 uk statistics, Larsen L, Herrstedt J, Hansen HH. Randomized, double-blind comparison of granisetron versus granisetron plus prednisolone 2 as antiemetic prophylaxis during multiple-day cisplatin- based chemotherapy. Ondansetron versus primperan in treating nausea and vomiting for chemotherapy coordinated with cisplatin or 2 doxorubicin: 311 phase II clinical randomized controlled trial. Stability of cisplatin and ondansetron hydrochloride in admixtures for continuous infusion. Single-agent oral granisetron for the prevention of acute cisplatin- induced emesis: A double-blind, randomized comparison with granisetron 2 plus dexamethasone and high-dose metoclopramide plus dexamethasone. Heron JF, Goedhals L, Jordaan JP, Cunningham J, Cedar E. Oral granisetron alone and in combination with dexamethasone: A double-blind randomized comparison against high-dose metoclopramide plus 2 dexamethasone in prevention of cisplatin-induced emesis. Granisetron oral phase III clinical trial - Study on the inhibitory effect of granisetron for nausea/vomiting induced by 4 chemotherapy for tumors in the hematopoietic organs. The antiemetic efficacy and safety of granisetron compared with metoclopramide plus dexamethasone in patients receiving fractionated chemotherapy over 5 days. Antiemetic efficacy of granisetron compared with high-dose metoclopramide plus dexamethasone in patients 2 with primary lung cancer receiving chemotherapy: A randomized crossover trial. Antiemetics Page 98 of 136 Final Report Update 1 Drug Effectiveness Review Project Exclusion Excluded Studies code # Jacobson SJ, Leclerc JM, Cohn RJ, Pinkerton CR, Nishimura L, Spielberg S. Intravenous granisetron in children receiving highly emetogenic 6 chemotherapy: a double blind, dose-ranging study. Jantunen IT, Flander MK, Heikkinen MI, Kuoppala TA, Teerenhovi L, Kataja VV. Comparison of ondansetron with customary treatment in the prophylaxis 2 of nausea and emesis induced by non-cisplatin containing chemotherapy. Ondansetron and tropisetron with dexamethasone in the prophylaxis of acute vomiting induced by non- 2 cisplatin-containing chemotherapy. Johansson S, Steineck G, Hursti T, Fredrikson M, Furst CJ, Peterson C. Effects of ondansetron on chemotherapy-induced acute and delayed emesis 2 - A pilot study. Jokela RM, Kangas-Saarela TA, Valanne JVI, Koivuranta MK, Ranta PO, Alahuhta SM. Postoperative nausea and vomiting after sevoflurane with or 2 without Ondansetron compared with propofol in female patients undergoing breast surgery. Dexamethasone is as effective as Ondansetron in the prophylaxis of emesis induced by moderately 2 emetogenic chemotherapy. Comparison of dexamethasone and ondansetron in the prophylaxis of emesis induced by moderately emetogenic 2 chemotherapy. Antiemetic efficacy of ondansetron and metoclopramide, both combined with corticosteroid, in malignant lymphoma 2 patients receiving non-cisplatin chemotherapy. A comparison of ondansetron with metoclopramide in the prophylaxis of chemotherapy-induced nausea and 2 vomiting: A randomized, double-blind study. Patient-tailored antiemetic treatment with 5-hydroxytryptamine type 3 receptor antagonists according to cytochrome P- 2 450 2D6 genotypes. Effect of schedule and maintenance on the antiemetic efficacy of ondansetron combined with dexamethasone in acute and delayed nausea and emesis in patients receiving moderately 2 emetogenic chemotherapy: A phase III trial by the National Cancer Institute of Canada Clinical Trials Group.

Q uality scores ofreviewed h otflash /flush trials Eligibility B linding:outcom e M aintenance of Study A llocation criteria assessors order 10 mg glucotrol xl mastercard diabetes 97,care Intention-to-treat com parable Y ear R andom assignm ent? Al-Az z awi order glucotrol xl 10 mg line blood sugar is high, Yes Yes M oreoophorectom y invaginal Yes Yes Yes Yes 2003 ring group (25% vs21%) Buckler,2003 G elfand2003 Yes N otreported M oresm okersinPrefestgroup Yes Yes N otclear-num ber N otclear (10. Saure,2000 Yes;m ethodsN R N R Yes Yes D ouble-blind N R U nclear G ood,1999 Yes;m ethodsN R N R Yes Yes D ouble-blind N R U nclear Hormone therapy Page 81 of 110 Final Report Update 3 Drug Effectiveness Review Project A ppendix E. Q uality scores ofreviewed h otflash /flush trials Study R eporting ofattrition, Differentialloss to followupor Y ear contam ination,etc? Q uality Score F unding source Externalvalidity Al-Az z awi,2003 Attritiony es 34/159(21%)withdrew (by 12 G ood Sponsoredby G alen F air Buckler,2003 weeks):20. F air reportedby group group notgiven Speroff,2003 Attritiony es 16% withdrew:12. Saure,2000 Som e 15% E 2;16% E 2V F air N R F air G ood,1999 Som e 15% overall F air TheraTech Inc. F air Hormone therapy Page 82 of 110 Final Report Update 3 Drug Effectiveness Review Project A ppendix E. Q uality scores ofreviewed h otflash /flush trials Eligibility B linding:outcom e M aintenance of Study A llocation criteria assessors,care Intention-to-treat com parable Y ear R andom assignm ent? G ordon,1995 Yes;m ethodsN R N R Yes Yes D ouble-blind U nclear U nclear Studd,1995 Yes;m ethodsN R N R Yes Yes D ouble-blind Yes U nclear F reedm an, Yes;m ethodsN R N R Yes Yes D ouble-blind N R U nclear 2002 J irapiny oet Yes;m ethodsN R M ethodN R M eanG reenescoreslightly Yes D ouble-blind;m ethods N o; U nclear al,2003 higherinE 2thanplacebo N R PP analy sisex cludes (20. Q uality scores ofreviewed h otflash /flush trials Study R eporting ofattrition, Differentialloss to followupor Y ear contam ination,etc? Q uality Score F unding source Externalvalidity G ordon,1995 Som e 13-26% R x ;30% placebo F air 3M F air Studd,1995 Som e 16% overall F air N R F air F reedm an,2002 N R N R F air N IH F air J irapiny oetal, Attritiony es 16. HR T-naïvewom en only N otelovitz ,2000a Som e R x groups11-21%;placebo17% F air N ovoN ordisk F air N otelovitz ,2000b Som e 16% overall F air N R F air U tian,2001 Som e 19% overall;23% placebo;30% F air W y eth-Ay erst F air 0. Hormone therapy Page 84 of 110 Final Report Update 3 Drug Effectiveness Review Project A ppendix E. Q uality scores ofreviewed h otflash /flush trials Eligibility B linding:outcom e M aintenance of Study A llocation criteria assessors,care Intention-to-treat com parable Y ear R andom assignm ent? Bacchi- Yes;m ethodsN R N R Yes Yes D ouble-blind Yes U nclear M odena, 1997 D eAloy sio, Yes;m ethodsN R N R Slightvariation Yes D ouble-blind Yes U nclear 2000 deVrijer, Yes;m ethodsN R N R Yes Yes D ouble-blind Yes U nclear 1999 N otelovitz , Yes;m ethodsN R N R Yes Yes D ouble-blind Yes U nclear 2000c Shulm an, Yes Yes Yesex ceptforsm oking Yes Yes Yes U nclear 2002 Speroff,1996 Yes;m ethodsN R Yes D escribed,dataN R Yes Yes U nclear U nclear vanHolst, Yes;m ethodsN R N R D escribed,dataN R Yes D ouble-blind Yes U nclear 2000 vanHolst, Yes;m ethodsN R N R Slightvariation Yes D ouble-blind Yes U nclear 2002 U tian,1999 Yes;m ethodsN R Yes Slightvariation Yes D ouble-blind Yes,dataN R U nclear W iklund, Yes;m ethodsN R N R Yes Yes U nclearif double-blind Yes Yes,dataN R 1993 Hormone therapy Page 85 of 110 Final Report Update 3 Drug Effectiveness Review Project A ppendix E. Q uality scores ofreviewed h otflash /flush trials Study R eporting ofattrition, Differentialloss to followupor Y ear contam ination,etc? Q uality Score F unding source Externalvalidity Bacchi-M odena, Som e 6% R x ;15% placebo F air N R F air 1997 D eAloy sio,2000 Som e 7% R x ;25% placebo F air N R F air deVrijer,1999 Som e 11% overall F air N R F air N otelovitz ,2000c Som e 5% overall(11R x ,1placebo) F air R hone-Poulenc R orer F air Shulm an,2002 Som e 3% overall F air Berlex L abs F air Speroff,1996 Som e <20% R x ;31% placebo F air ParkD avis F air vanHolst,2000 Som e 7% overall F air N R F air vanHolst,2002 Som e 17% overall F air N R F air U tian,1999 Som e 10% overall(12R X ;8placebo) F air L ab F ournierSA F air W iklund,1993 Som e 4% R x ;8% placebo F air N R F air Hormone therapy Page 86 of 110 Final Report Update 3 Drug Effectiveness Review Project AppendixF. Qualityscoresof reviewedbonedensityandfracturetrials Blinding:outcome Maintenanceof Study Random Allocation G roupssimilarat Eligibilitycriteria assessors,care Intention-to-treat comparable Year assignment? R ubinacci, M ethodnot N otreported M eanF SH values Yes Yes N o N otclear 2003 reported slightly higherinE 2 group;duem ainly to very high valueinone participant. N otelovitz , M ethodnot N otreported Yes Yes Yes Yes N otclear 2002 reported Civitelli,2002 M ethodnot N otreported W om eninHR T arm 2 Yes Yes N otclear N otclear reported y earsolderthanplacebo; num berof y earssince m enopausesim ilar. Cauley ,2003 Yes Yes Yes Yes Yes Yes Yes (W HI) Hormone therapy Page 87 of 110 Final Report Update 3 Drug Effectiveness Review Project AppendixF. Qualityscoresof reviewedbonedensityandfracturetrials Differentiallossto Study Reportingof attrition, followup oroverallhigh Year contamination,etc? QualityScore Fundingsource Externalvalidity R ubinacci, Attritiony es 26% withdrew:30% inE 2 Poor-high followup, Supportedby F air 2003 and22% inplacebo.

Pelvic operations can cause adhesions • Adenomyosis (endometrial cells growing within or lead to infections which in turn can cause the uterine wall in the muscle layer called PID order glucotrol xl 10 mg mastercard diabetic diet popcorn. D&Cs carried out under unsterile condi- myometrium) cheap 10mg glucotrol xl with mastercard diabetes diet information spanish. In most of these conditions, menstrual pain is re- • Stress or a family history of dysmenorrhea: primary lated to pressure of the impaired tissue (fibroids, dysmenorrhea can be psychosomatic. The way 80 Painful Menstrual Period: Dysmenorrhea older female relatives deal with their menstrual Speculum examination period can influence the perception of girls During a speculum examination you can find signs about womanhood and menstruation and the of cervical cancer (bleeding, ulcers, erosions, way they deal with painful periods. Stress in masses) or for STI (abnormal vaginal discharge, a school or around issues of adolescence and reddish cervical surface, discharge from the cervical growing up can lead to a change in pain percep- os) and for vaginal endometriosis (dark-red or tion and primary dysmenorrhea as well. The cervix can be distorted Please bear in mind that a menstrual period is to one side by fibroids, tubo-ovarian masses or the inevitable sign that a pregnancy did not endometriosis, or shortened by cervical or intra- work out. So, for women with difficulties in cavitary fibroid growth. Wet mount The wet mount can show signs of vaginal or cervi- cal infections including STI (pus cells, clue cells, PHYSICAL EXAMINATION Trichomonas). Most of the time you can make the diagnosis with- out many investigations in your facility. Primary Vaginal examination dysmenorrhea is a diagnosis of exclusion, but your During bimanual palpation you can find signs of history with onset of symptoms and menarche can adenomyosis (enlarged, soft, often tender uterus) or already help you to establish the diagnosis. In pri- fibroids (enlarged, firm uterus, bulky uterus with mary dysmenorrhea your examination outside humps, mobile or immobile) and ovarian masses menstruation will be normal as there is no under- such as benign or malignant ovarian tumors and lying cause for it. Most women come when they tubo-ovarian abscesses as a sign of PID (masses are having pain, so it might be wise to re-examine right, left or behind the uterus, mobile or im- them once their period is over to see the difference. Cervical tenderness can be a sign of acute Be aware of possible congenital malformations like or chronic infection (STI, PID) but also for endo- a rudimentary uterine horn that can cause the pain. A painful palpation Keep in mind: a woman can start with primary of the posterior fornix can be a sign of endometrio- dysmenorrhea and with time experience additional sis of Douglas’ space or infiltration of the tissue secondary symptoms due to new underlying causes. So ask every woman if the pain changed with time, especially concerning onset and duration. You Rectal examination must do a full gynecological examination on all patients with dysmenorrhea to establish or rule A rectal examination can reveal blood or anal pain out underlying causes. Special considerations for which can be signs of endometriosis and sometimes examination of young girls or virgins are given in endometriosis in recto-vaginal septum can be pal- Chapter 1 on gynecological examination and pated by recto-vaginal examination. You can find a description on each examination method or Further investigations investigation in Chapter 1. Vaginal/abdominal ultrasound Abdominal palpation If your clinical diagnosis is secondary dysmenor- rhea look for the following pathology: By doing an abdominal examination you can assess abdominal masses (fibroids, cancer) or points of Uterine fibroids Their echogenicity in ultrasound is a pain-related resistance (PID, adhesions). They usually should look for scars and assess their healing. An have well-defined borders to the myometrium and ugly broad scar might be a sign of secondary heal- a capsule. Don’t forget to do abdominal ultrasound ing with the likelihood of infection or adhesions. This is due to Adenomyosis Adenomyosis is difficult to see with their mode of action: NSAIDs stop prosta- ultrasound and the diagnosis is often one of exclu- glandin production, something which paraceta- sion. The posterior wall of the uterus might be mol or Buscopan cannot do. They do not reduce the effect of pros- ten enlarged. Patients with adenomyosis often taglandin on the uterus.

The treatment of recurrent aphthosis is based on topical anes- thetics and corticosteroids 10 mg glucotrol xl otc diabetes mellitus uk. Large persistent aphthae can require intralesional corti- costeroids or systemic prednisone buy 10 mg glucotrol xl diabetes ketones. Immunomodulators such as thalidomide are sug- gested for use as prophylaxis in patients with frequent and painful recurrences. Folliculitis: pustular, papular or edematous-papular follicular lesions, involving the proximal limbs and the upper trunk. Possible causes include Staphylococcus, Malassezia furfur, Demodex folliculorum and drugs like indinavir. Treatment depends on the etiologic agent detected by bacterial swabs and histopathology if needed. Antimicrobials against staphylococcus and malassezia or changing the antiretrovi- ral regimen may be required. DADPS, a 10% crotamiton or polidocanol ointment or low-dose UVB 311 nm radiation are effective against severe pruritus in these patients (Holmes 2001, Simpson-Dent 1999). Today, it is well-established that ART-naïve patients with pruritic eosinophilic folliculitis significantly improve with ART. Genital warts (condylomata acuminata): See chapters on STDs (Condylomata acumi- nata) and Cervical and Anal Cancer. Herpes simplex virus / Herpes zoster infections: see chapter on AIDS. Immune reconstitution inflammatory syndrome (IRIS)-related skin reactions: ART supports the TH-1 immune response and the tuberculin test reactivity recovers (Girardi 2002). In association with this immune reconstitution clinical manifesta- 616 Interdisciplinary Medicine tions of herpes zoster, mucocutaneous herpes simplex infections, mycobacterial infections, eosinophilic folliculitis, foreign body granulomas and cutaneous sar- coidosis have been reported (Handa 2001, Hirsch 2004, Beatty 2010). These infec- tious, as well as some non-infectious inflammatory skin diseases occur within a few days to 3 months after the initiation of ART. The therapy depends on the severity of clinical manifestations and consists of specific antibiotics, steroidal and non- steroidal anti-inflammatory drugs (see chapter on IRIS). Kaposi sarcoma: the most frequent malignant tumor of the skin and mucosal mem- branes associated with HIV infection (see chapter on Kaposi’s sarcoma). Lipodystrophy: See chapter on Lipodystrophy syndrome. Malignant cutaneous lymphomas: Malignant B and T cell lymphomas are rare in HIV-infected patients (Beylot-Barry 1999, Biggar 2001). Cutaneous B cell lymphomas usually grow as red to violaceous nodules and are easily mistaken for Kaposi’s sarcoma. They can also look like persistent hematoma or non-specific asymptomatic papules. A biopsy should be performed on any clinically unclear tumor of the skin. Cutaneous T cell lymphomas are rare malignancies in HIV+ patients. The prevalence among 2,149 HIV-infected patients in Frankfurt was 0. The clinical course starts with non-specific eczematous patches (Stage I), which are usually not diagnosed as cutaneous lymphoma even after several biopsies because of the paucity of findings such as cellular atypia. These lesions are usually diagnosed as eczematous dermati- tis.

To exclude sample confusion each first positive test result should be confirmed by examination of a second sample purchase glucotrol xl 10 mg visa diabetes symptoms pictures. If a patient is suspected to have an HIV infection buy glucotrol xl 10mg without prescription diabetes symptoms in children type 1, the result of viral load measurement can be used for confirmation (see chapter 6. In this case, a second serological test is not necessary. HIV PCR In addition to the serological test systems, molecular methods for detection of HIV RNA (nucleic acid amplifications tests, NAT) are available. PCR is the NAT most frequently used for HIV RNA detection. The quantitative detection of HIV RNA (a viral load determination) is one of the essential components of the monitoring of HIV infection (Wittek 2007, Thompson 2010). To increase the safety of blood products the HIV PCR is obliga- tory in the context of blood donation. Other indications for the use of the PCR are the exclusion of an HIV infection of newborns of HIV+ mothers (see below), the clarification of equivocal serological constellations or a suspected acute infection. According to new recommendations, PCR analysis may be used for confirmation of a reactive screening test result instead of a Western Blot. For this purpose, a PCR test is considered positive in case of a viral load above 1000 copies/ml. If the viral load amounts to less than 1000 copies/ml or the PCR is negative subsequent Western Blot analysis is obligatory (DVV/GfV 2015). However, the HIV PCR is not recommended as a screening test. Since false negative results are possible it cannot replace the serological screening test. Possible reasons for false negative results are as follows: 1. Commercially available HIV PCR tests usually do not cover HIV-2 (rare in Europe). HIV is characterized by a high degree of genetic diversity. In case of infection with a new or previously unknown variant sensitivity of the PCR may decrease due to mutations affecting the primer or probe binding sites. Through a so-called “dual target” PCR the risk of false negative test results due to sequence variability may be reduced (Chudy 2012; see also chapter 6. The “dual target” PCR is obligatory for screening blood donations. A small number of HIV+ patients can suppress viral replication in the absence of ART (“elite controllers”, prevalence less than 1%). Thus, despite serologically proven HIV infection a PCR test may be negative in those patients. The aim of the antiretroviral treatment is the reduction of the viral load below the detection limit. As a consequence, the use of a PCR as a HIV screening test in a successfully treated patient would lead to a false-negative testing result. Rapid tests Rapid HIV tests functionally correspond to a screening test, i. Rapid tests can be carried out quickly, easily and without any equipment expense and can therefore be used as so-called “point of care” tests.