HIV and ID Observations

May 10th, 2012

Advisory Meeting Today on Tenofovir/FTC for PrEP, and a Proposed “Niche” for its Use

From Bloomberg News: Gilead Sciences Inc.’s pill Truvada was safe and effective when used to protect uninfected people from getting HIV, U.S. regulators said in a report indicating the main concerns are when and how it should be used … The FDA asked its advisers to suggest who should get Truvada; what testing would be needed […]

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April 30th, 2012

Do We Really Need Primary Prophylaxis for OIs Anymore?

I’m currently on the inpatient consult service and just saw a guy who fits the typical profile of many hospitalized HIV patients in 2012: Low CD4 (in this case, 120) Irregular to non-existent outpatient care before admission (lots of no-shows, cancellations, etc) Has received several prescriptions for antiretroviral therapy but for a whole variety of reasons, hasn’t […]

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April 23rd, 2012

An Answer to a Commonly Asked Question: Is Treatment 100% Effective in Preventing HIV Transmission?

The excitement about “treatment as prevention”, and the results of Study 052, have led to many patients asking the question (if not in these words, than using others with a less medical slant), “So if I’m on treatment and doing well, just what is the risk of my transmitting HIV to others?” It’s not a question […]

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April 14th, 2012

2004 HIV Treatment Guidelines: Available Now!

Bargain hunters will be glad to hear that over on Amazon, they can get a copy of the 2004 Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents — all for the remarkably low price of $16.15. Notable content from that banner year included: for asymptomatic patients with CD4 > 350, the HIV […]

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April 10th, 2012

A Skeptical Look at “Test and Treat”

Over in Journal Watch AIDS Clinical Care, Abbie Zuger has written a fascinating perspective on the recent enthusiasm for universal HIV treatment. Her take? Let’s just say she doesn’t share the enthusiasm of public health officials and members of guidelines committees. Well, that’s a huge understatement. Specifically: This strategy, which calls for universal voluntary HIV testing and […]

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March 27th, 2012

Latest Guidelines Recommend HIV Treatment for All

From the key “What’s New in the Guidelines” section of today’s Department of Health and Human Services update: ART is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pretreatment CD4 cell count. This recommendation replaces a rather confusing categorization on when to start ART that, not surprisingly, was widely misinterpreted — […]

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March 22nd, 2012

More Confusion on Anal Cancer Screening

Screening for anal cancer in men who have sex with men (MSM) — with pap smears, high resolution anoscopy, with whatever test — is quite the quagmire. As I’ve mentioned before, the proponents of screening cite the success of cervical cancer screening and the startling high rates of anal cancer among HIV+ MSM as reason enough […]

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March 1st, 2012

Post-Exposure Prophylaxis, the World’s Most Outdated HIV Guidelines, and What To Do About Them

Every time I cover HIV prevention in a lecture, it’s always kind of embarrassing to cite the “official” post-exposure prophylaxis (PEP) guidelines, which are here (non-occupational) and here (occupational). That’s right, they were last updated in 2005, the year of Hurricane Katrina. Yes — more than six years ago. The alternative choices seem particularly curious (read: don’t do […]

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February 23rd, 2012

Hepatitis C and the “Retooling” of HIV/ID Specialists

The news that hepatitis C (HCV) has passed HIV as a cause of death in the United States got quite a bit of attention when it was first presented last year at ICAAC — and no doubt the published paper, in this week’s Annals of Internal Medicine, will also cause a stir. In fact, I boldly predict […]

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February 10th, 2012

Boceprevir – PI Interaction: A “Dear Doctor” Letter We Didn’t Want To Get

By now I’m sure that most of you ID folks out there have received the following letter from Merck, the makers of boceprevir: URGENT — IMPORTANT DRUG WARNING: VICTRELIS (BOCEPREVIR) The purpose of this communication is to inform you of recent pharmacokinetic study results evaluating drug interactions between VICTRELIS, an oral chronic hepatitis C virus (HCV) NS3/4A […]

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