HIV and ID Observations

October 28th, 2012

Dolutegravir and the 88% Rule

In the latest treatment-naive trials of elvitegravir and dolutegravir, there’s a striking consistency in the results of the “test” regimen. Here are the studies, with the percentage of responders by treatment arm: Study 102:  TDF/FTC/EFV (84%) vs. TDF/FTC/EVG/c (88%) — non-inferior Study 103:  TDF/FTC + ATV/r (87%) vs. TDF/FTC/EVG/c (90%) — non-inferior SPRING-2:  TDF/FTC or ABC/3TC […]

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October 22nd, 2012

Can a “Treat Everyone with HIV” Policy Actually Work? In San Francisco, Yes

As has often been the case in the history of the HIV epidemic, the HIV/AIDS Division at San Francisco General Hospital and the San Francisco Department of Health were ahead of the curve in 2010 when they issued a recommendation that all people with HIV should receive treatment, regardless of CD4 count. Of course, US guidelines […]

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October 17th, 2012

It’s Time to Tell Our Patients to Stop Their Vitamin Supplements

Over in JAMA, there’s a large study out today that (yet again) failed to demonstrate a benefit of vitamins. Over 3000 patients with HIV in Tanzania were randomized to receive either high-dose or standard-dose multivitamin supplementation, in addition to “HAART” (ugh). Though the study was planned for 24 months, it was stopped early by the Data Safety […]

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October 11th, 2012

Back to School: Questions at the “ID in Primary Care” Course

We do a post-graduate course each year called “ID in Primary Care,” and it’s a great way for us to find out what people in outpatient primary care practice are thinking about from the ID perspective. I told the participants this year I’d post some of their most interesting questions on this site, with the hope that […]

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September 19th, 2012

It’s Time to Dump the HIV Western Blot

Hard to believe, but we have to get rid of the HIV Western blot — at least as our HIV confirmatory test. Here’s why (case adapted from several seen the past few years; I’m sure most of you have seen similar): 30-year-old man, high risk for HIV. He’s worried he might have become infected due to recent […]

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September 1st, 2012

CROI 2013: March 3-7, Atlanta

The title says it all. Abstract deadline is October 9. Photo below is completely irrelevant.

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August 31st, 2012

“PEARLS” Study a Massive, Impressive Accomplishment

One of the most frequent criticisms of randomized clinical trials of HIV therapy is that certain patient groups — in particular gay men — are over represented compared to the HIV population as a whole. For example, in the recently published and presented clinical trials of the Quad and dolutegravir, women accounted for < 20% of […]

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August 28th, 2012

“Quad” Approved by FDA

We now have a third single-pill treatment available for HIV treatment, co-formulated tenofovir/emtricitabine/elvitegravir/cobicistat. From the FDA announcement: The U.S. Food and Drug Administration today approved Stribild (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate), a new once-a-day combination pill to treat HIV-1 infection in adults who have never been treated for HIV infection. Stribild contains two previously approved HIV […]

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August 13th, 2012

A Poll: Clintons vs Bush

Got this email recently from a former colleague who now does mostly international work: Hey Paul — nice recap of the IAC conference. But I was wondering if you’d forgotten about someone very important when you wrote, “I can’t think of any major politicians who have done more for HIV than the Clintons.” Um, how about […]

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August 9th, 2012

New PrEP “Guidance” Released by CDC

The CDC issued its second “Interim Guidance” on the use of tenofovir/FTC as pre-exposure prophylaxis for prevention of HIV, this time for prevention of HIV in heterosexually active adults. The rationale? Since January 2011, data from studies of PrEP among heterosexual men and women have become available, and on July 16, 2012, the Food and Drug […]

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