An ongoing dialogue on HIV/AIDS, infectious diseases,
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
September 1st, 2012
CROI 2013: March 3-7, Atlanta
The title says it all. Abstract deadline is October 9. Photo below is completely irrelevant.