HIV and ID Observations

February 17th, 2013

An Adherence Intervention That Works — But There’s a Catch

In a previous post, we reviewed the various flavors of medication non-adherence, and concluded with this tantalizing line: Next up:  An Adherence Intervention that Actually Works — But There’s a Catch Well here it is, just published online in JAMA Internal Medicine. Dr. Robert Gross (a long-time HIV adherence researcher from U Penn) and colleagues enrolled 180 patients […]

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February 13th, 2013

Medication Adherence: The Final Frontier

Treatment of HIV has become so amazingly effective that when it fails, it’s no overstatement to say that it’s usually because the patient is not taking the medications.  There are all kinds of provider-related reasons for this — inadequate patient education, prescribing and dispensing errors, failure to address language or education deficits — but here […]

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January 9th, 2013

HIV Exceptionalism is Alive and Well — and That’s Too Bad

Email exchange with a colleague who works at one of our community health clinics: Guy:  Hi Paul, your patient 17432862 [that’s a made-up medical record number] came to our walk-in clinic with a rash on her hand. OK that I gave her a week of topical steroids? I know how inhaled steroids interact with some meds […]

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January 3rd, 2013

What’s a Fulyzaq? I Thought You’d Never Ask

As Physician’s First Watch noted, we sure know what the folks at the FDA were doing this holiday season — and most emphatically they weren’t visiting Aunt Selma in Boca Raton. Nope, they were stuck in White Oak, Maryland, reviewing various new drug applications, with three of the four related to Infectious Disease. The FDA’s late […]

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January 1st, 2013

HIV Incidence: The Latest Numbers

The CDC has recently issued the latest report on HIV incidence (i.e., new infections) in the United States, and as always it’s fascinating to review the numbers. To start, the year-by-year estimated incidence: 2007:  53,200 2008:  47,500 2009:  45,000 2010:  47,500 (38,000 men, 9,500 women) Nope, not much change. Will data from HPTN 052 — published in the […]

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December 20th, 2012

Severe Telaprevir Rashes and Waiting (or Not Waiting) to Treat Hepatitis C

Yesterday, the FDA issued a drug safety alert about severe rashes — “some fatal” — in patients treated for HCV with interferon, ribavirin, and telaprevir. The culprit, of course, is the telaprevir. The label already contained warning information about serious skin rashes with the drug, and this alert serves to heighten our awareness of the problem, […]

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December 5th, 2012

Top HIV Stories of 2012

Somewhere in our genome, we are programmed to use the end of the year as a time to reflect on the previous 12 months — and to make lists! If you don’t believe me, there’s barely a publication or web site out there that hasn’t already succumbed, and we’re just in early December. And what we can […]

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November 18th, 2012

The 800-mg Darunavir Tablet Arrives, and Scoring the Top Protease Inhibitors

The FDA has approved an 800-mg tablet of darunavir for treatment naive patients. This single tablet will obviously replace the two darunavir 400-mg tablets in first-line therapy. (Yes, my math is that good.) Darunavir will still require 100-mg ritonavir boosting plus two NRTIs to make a complete regimen. Once upon a time I might have thought this was […]

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November 7th, 2012

Vitamins and the Department of Bad Timing

Now that the election is over, we can get back to something that really matters — namely vitamins, and specifically whether they really help people. Last month there was a large, well-done study from Tanzania showing that mega-doses of vitamins not only didn’t help those HIV starting ART, but they actually were harmful — LFTs went […]

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November 2nd, 2012

Antiretroviral Rounds: Resistance on Two Fronts

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 then on TDF/FTC/EFV; […]

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