HIV and ID Observations

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 years ago for […]

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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 defunct CROI website, […]

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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:  $14,105 If […]

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August 12th, 2013

Dolutegravir Approval Signals a Beginning and the End of Something Very Special

As anticipated, the FDA approved dolutegravir today for HIV treatment, the third integrase inhibitor now available. This was about as surprising as the arrival of Royal Baby Prince George. We knew dolutegravir was coming soon, just not exactly when or what it would be named. Here’s a short list of the data we have thus far on this drug […]

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August 7th, 2013

Occupational Post-Exposure Prophylaxis (PEP) Guidelines Updated — And They Are Clear and Sensible

Good news here — the United States Public Health Service has issued new national guidelines for management of occupational exposure to HIV. Authored by an expert panel, these updated occupational PEP guidelines replace the (woefully outdated, sorry, had to write that) previous version, which dates back to 2005. On a quick read-through, despite the density of print, the […]

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August 1st, 2013

Poll: Will There Be A Shortage of HIV Providers?

Over on NEJM Journal Watch — love that new name — I reviewed a paper on the demographics of people living with AIDS in San Francisco. Bottom line — more than half are now older than 50. Implication — that’s so old! First, it really isn’t, unless you compare it to the dismal era 20+ years ago, when […]

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July 14th, 2013

Will Dolutegravir Instantly Become the Integrase Inhibitor of Choice in Patients with Treatment Failure?

Here’s the short answer : Yes. Probably. And here’s why. In a randomized, double blind clinical trial just published in the Lancet — it’s called SAILING — once-daily dolutegravir was compared to twice daily raltegravir in treatment-experienced patients. The site investigators could choose one or two other fully active agents to develop an optimized background regimen (OBR). […]

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July 7th, 2013

Almost Annual Whine About No CROI Dates, and a New Temporary (I Hope) CROI Website

Believe or not, sometimes we know a year in advance the dates of the Conference on Retroviruses and Opportunistic Infections (CROI). For example, we learned at the beginning of CROI 2010 that in 2011, it would take place February 27-March 3 — in Boston no less. Yay! (The meeting was a bit shorter, but it did in fact […]

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June 27th, 2013

Testing Out the New Website with an ID Link-o-Rama

Hey, new website is live! Interested to hear what you think about our new-ish look. In celebration, here are some quick ID/HIV tidbits that have recently crossed my path, or have been sitting in my inbox for a while, dying to get out: Doxycycline shortage. Hardly anything more frightening to a New England ID doc than a shortage […]

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June 20th, 2013

Let’s Move the HIV Testing Algorithm Into the 21st Century

As I’ve written before, the most widely used testing algorithm for HIV — enzyme immunoassay followed, if positive, by Western blot confirmation — is long overdue for an update. A brief review why this is the case, and also why sticking with it is so problematic: Immunoassays have become progressively more sensitive, especially when paired with p24 […]

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