HIV and ID Observations

November 6th, 2013

SINGLE Study Underscores Waning of the Efavirenz Era — But Probably Just in the USA

In today’s New England Journal of Medicine, the SINGLE study finally makes its appearance “in print.”  (The study results were first presented over a year ago.) The highlights: SINGLE was a double-blind, randomized clinical trial comparing abacavir/lamivudine plus dolutegravir to tenofovir/FTC/efavirenz in 833 treatment-naive study subjects. That’s right, three different drugs in each arm — […]

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November 5th, 2013

Sofosbuvir and Ledipasvir Phase II, and When Small Studies Make a Big Impact

Imagine for a moment the ideal medical future … there’s a vaccine that prevents the common cold … colon cancer screening no longer requires that horrendous “prep” … electronic medical records are easily accessible, intuitive, secure, and all communicate effortlessly with one another … your doctor’s office has an actual person who answers the phone […]

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October 25th, 2013

GARDEL Two-Active-Drug Study Not a Game-Changer, but Might Be a Paradigm-Shifter

Don’t look now, but a two-drug lamivudine (3TC) + LPV/r strategy did just as well as a standard three-drug regimen of two NRTIs + LPV/r. Better, actually, since virologic outcomes were the same and the two-drug regimen had fewer side effects. Here are the key details about the GARDEL study, presented just this week by […]

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October 18th, 2013

Back to School: Top Questions from “ID in Primary Care”

We hold an annual post-graduate course entitled “Infectious Diseases in Primary Care”. In this 2.5 day course, we ID doctors do our best to address the concerns of clinicians on the front lines — those doing primary care. And each year, we get some great questions. Like these: Question: I work at a university health […]

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October 14th, 2013

MODERN Study Stopped: An NRTI-Sparing, Two-Drug Initial Regimen Disappoints Again

In case you didn’t know, “MODERN” is the clever name for the “Maraviroc Once-daily with Darunavir Enhanced by Ritonavir in a New regimen” trial, which compared TDF/FTC to maraviroc, both with boosted darunavir. And once again, the NRTI-sparing two-drug regimen comes up short, this time in a fully powered, double-blind noninferiority study. From a PDF […]

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October 7th, 2013

CD4 Cell Count at Presentation: A Figure with a Depressingly Small Upward Slope

You know how to make an ID/HIV specialist angry? Frustrated? Sigh loudly? Tell a clinical anecdote that involves “late” presentation of HIV diagnosis, in particular someone who has been seeking medical care for various ailments for months or even years without getting tested. You know — it goes something like this: “He was seen 3 […]

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September 20th, 2013

CROI Abstract Submissions Now Open, and Old CROI Website Still “Lost” in Cyberspace

HIV researchers can now submit their abstracts to the 2014 Conference on Retroviruses and Opportunistic Infections — or “CROI”. (It rhymes with “soy”, as in “soy sauce”; or, if you prefer, “oy”, as in “oy vey”.) Further details here. General submission for abstracts closes on October 8. Meanwhile, people continue to wonder what happened to the now […]

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September 13th, 2013

Clindamycin vs. TMP/SMX for Soft Tissue Infections: A Clinical Trial That Needs Some Marketing

At ICAAC this week — the ID conference with the most inscrutable acronym out there — Loren Miller from UCLA presented a clinical trial on treatment of skin and soft tissue infections that has widespread clinical applications, yet may receive little if any attention. And why is that? Simply because the drugs (clindamycin and trimethoprim/sulfamethoxazole) have […]

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September 7th, 2013

FAX machines, and the Special Power of the MD Degree

Everyone hates mindless paperwork. But certain types are particularly annoying, seemingly designed to send you screaming into the night, dragging a broken fax machine behind you as your brain explodes. Too strong? Take a look at this fax cover sheet I recently received about a patient who had been receiving IV antibiotics at home: To […]

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August 28th, 2013

Poll: At $14,105/year, Is Dolutegravir Fairly Priced?

The recently approved once-daily integrase inhibitor dolutegravir is now in pharmacies and, like every new HIV drug, the price — around $14k/year — has generated some controversy. For the record, here are the per-year wholesale acquisition costs of the three FDA-approved integrase inhibitors. Raltegravir:  $12,976 Elvitegravir:  $13,428 (once disentangled from the price of TDF/FTC) Dolutegravir: […]

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