Paul E. Sax, MD is the Editor-in-Chief, Journal Watch HIV/AIDS Clinical Care, Clinical Director of the Division of Infectious Diseases at Brigham and Women's Hospital, and Professor of Medicine at Harvard Medical School.
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(3 votes, average: 5.00 out of 5)Got this challenging curbside consult from a colleague, and it has a interesting wrinkle: I have a longstanding patient with HIV who had many failed regimens in the 1990′s with resultant following mutations on a genotype done in 2003: NRTI (M184V, Q151M mutations); PI (A71, I54V, K20M, L10I, L90M, V82A mutations); no NNRTI resistance. She has been undetectable since [...]
(7 votes, average: 4.57 out of 5)Every time I cover HIV prevention in a lecture, it’s always kind of embarrassing to cite the “official” post-exposure prophylaxis (PEP) guidelines, which are here (non-occupational) and here (occupational). That’s right, they were last updated in 2005, the year of Hurricane Katrina. Yes — more than six years ago. The alternative choices seem particularly curious (read: [...]
(1 votes, average: 4.00 out of 5)Over on Journal Watch AIDS Clinical Care, we periodically publish a tricky case — always drawn from clinical practice — then ask some experts how they would manage it, and why. The most recent case pretty much has it all: Multiple prior regimens Multi-class drug resistance Metabolic complications Bad allergy history, one event nearly requiring [...]
(3 votes, average: 4.67 out of 5)Since the publication of iPrEx, the hypothetical decision about whether to prescribe pre-exposure prophylaxis (PrEP) has become a practical reality. As a result, we’ve posted a case on the Journal Watch/AIDS Clinical Care site, describing someone who requests intermittent pre-exposure prophylaxis to prevent HIV. It’s a high-risk, HIV-negative man who’s been treated several times with post-exposure prophylaxis. [...]
(1 votes, average: 5.00 out of 5)Over in Journal of Infectious Diseases, the MERIT study was recently published (with Chuck Hicks’ Journal Watch summary here), demonstrating that maraviroc is non-inferior to efavirenz — provided that the enhanced-sensitivity tropism test is used to select appropriate candidates. (The MERIT study began in 2004-5. Don’t think I’ll ever forget that, since the investigator meeting [...]
(1 votes, average: 5.00 out of 5)Here’s a case over in our Journal Watch: AIDS Clinical Care site: a man with suspected PCP develops rapidly progressive renal failure after being starting on both empiric PCP treatment with TMP-SMX and ART with TDF/FTC plus darunavir/ritonavir. The specific questions at the end of the case were: What do you think is causing the [...]
(No Ratings Yet)A couple of months ago, I presented these three clinically stable, virologically suppressed patients — and asked if they should switch treatment: 50 year old man on ABC/3TC, EFV since 2000. No renal disease. Hyperlipidemia, on atorvastatin 80 mg a day. Father died of an MI age 48. 63 year old man, on EFV + [...]
(No Ratings Yet)A couple of years ago, an ID-colleague of mine told me about a tough case: While working in the ICU, an anesthesiologist sustained a pretty severe needle stick. Approached for HIV testing, the source of the exposure felt threatened by the providers in the ICU, and refused to sign the consent. The patient then deteriorated [...]
(No Ratings Yet)With first-line therapy for HIV being so astonishingly successful, much of what we do in practice is tweak regimens that are by virologic and immunologic standards, working just fine: Viral load undetectable, CD4 stable. But not so fast — while one of my colleagues said that if he didn’t change his patients’ regimens, then he’d [...]
(No Ratings Yet)Both here and on the AIDS Clinical Care site, we posted a case of a 50-year-old HIV+ man in need of a screening colonoscopy. What sedation could he receive while on tenofovir/FTC and ritonavir-boosted atazanavir? Specifically, would midazolam and fentanyl (“contraindicated” in the ritonavir package insert) be ok? (Same issue for efavirenz, by the way.) [...]
