HIV and ID Observations

April 24th, 2009

Colonoscopy in HIV Patients, Part II: Problem (Mostly) Solved

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.) We solicited […]

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March 1st, 2009

Sedation for Colonoscopies in HIV Patients: Debate Rages

Here’s a problem we’re grappling with: A patient with HIV needs a colonoscopy, but is on either a ritonavir-boosted protease inhibitor or an efavirenz-based regimen. (This must be something like 90% of HIV patients as of March 1, 2009, based on my extremely unscientific gut impression.) For efavirenz, midazolam is contraindicated; for ritonavir, same story — or “consider […]

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February 13th, 2009

CROI 2009: Greatest Hits

Fresh back from lovely Montreal, where the temperature (I’m glad to report) climbed into the balmy 40’s … Here’s a rapid-fire listing of the Greatest Hits.  As I’m sure to be leaving something off this list, happy to accept other suggestions: Interleukin-2 does not work.  The ESPRIT and SILCAAT studies are over. Yes, the CD4’s increase, but […]

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January 29th, 2009

Too Many Options: What Actually Happened

We recently published a case in AIDS Clinical Care entitled “Too Many Options”, describing a patient with longstanding HIV infection, virologic failure, and resistance to NRTIs, NNRTIs, and PIs. Fortunately, resistance and tropism testing gave him several options for a new drug regimen — including darunavir, etravirine, maraviroc, enfuvirtide, and — if one believes phenotypic NRTI […]

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January 13th, 2009

Can We Have “Too Many Options?”

As part of our regular series “Antiretroviral Rounds” in AIDS Clinical Care, today we post a case of a highly treatment-experienced patient with dreaded “triple class” resistance — that is, resistance to NRTIs, NNRTIs, and PIs. The good news now, of course, is that we have more than these three drug classes. The tough part is choosing […]

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October 21st, 2008

Back to School, Day 4: PEP and More PEP

After a lecture on HIV for Primary Care Providers in our course last week, the most controversial topic was, not surprisingly, the use of post-exposure prophylaxis (PEP) for both occupational and non-occupational exposures.  And today, after an entire lecture on PEP to a group of HIV providers in our AIDS course, again the subject drew […]

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July 29th, 2008

Antiretroviral Rounds: Immediate ART After an OI — Are We There Yet?

A few things have been guaranteed to get widely divergent views among HIV specialists — and one of them was when to start antiretroviral therapy in someone presenting with an acute OI.  However, in the latest Antiretroviral Rounds, our two experts (Raphy Landovitz and Phil Grant/Andrew Zolopa) kind of agreed.  They’d start immediately.    At least that’s […]

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July 11th, 2008

M184V: So many options, but does that include TDF/FTC/EFV?

Co-formulated TDF/FTC/EFV (Atripla) is a nifty bit of pharmacologic packaging (ever so much more so since it involves collaboration between two different pharmaceutical companies, ahem) — and our patients have noticed.  All of us who practice HIV medicine have been asked for the “one pill” treatment; often these requests make sense, sometimes they don’t. It’s easy to say […]

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June 29th, 2008

And Now… The “Answer”

Last month, I wrote a post inviting responses to our Antiretroviral Rounds case in AIDS Clinical Care, and inviting you to respond. It was a case of someone with (mostly) undetectable HIV RNA levels, but lots of resistance detected when he had to stop meds due to pancreatitis. I also promised to tell you how the […]

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May 21st, 2008

When Expert Clinicians Disagree

Periodically, in AIDS Clinical Care, we publish a case in the “Antiretroviral Rounds” section and ask two clinical experts in our field how they would manage such a patient. The most recent case elicited responses that were 180 degrees different. (This is exactly what we’re after, by the way — why present a case in which […]

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