HIV and ID Observations

October 3rd, 2011

CASCADE: When to Start, (Yet) Another Take

As we await the enrollment, analysis, and results of the START study — which is randomizing patients with CD4>500 to start HIV therapy  vs waiting until the CD4 falls to 350 — much of the research on “when to start” ART in patients with high CD4’s comes from observational studies. Several have already been published […]

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September 24th, 2011

Warning: Viral Replication is Hazardous to Your Health

When studies evaluate the prognostic importance of measuring HIV viral load, they generally do so by assessing a single measurement rather than values obtained longitudinally.  One obvious limitation of this approach is that baseline VL poorly predicts outcome after ART initiation — a finding in stark contrast to the original description of VL from the […]

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September 22nd, 2011

Common Sense on HIV Testing

There’s an editorial in today’s Boston Globe that concisely (188 words) describes the problems with both the current and proposed HIV testing laws in Massachusetts. I’ve not been shy about the fact that I agree with every word of this piece. And though I strongly recommend reading the whole editorial — it’s very well written — if you […]

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September 4th, 2011

“Novel” Approaches to Initial HIV Therapy: Part II

Two studies were just published on alternative strategies for initial HIV therapy. I’ve already reviewed the first one here. The second paper is a single-arm (n=112) study of darunavir/r (once daily) plus raltegravir, the latest riff on the “NRTI sparing” approach. As I mentioned when I first covered this study, the high rate of virologic failure — […]

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September 3rd, 2011

“Novel” Approaches to Initial HIV Therapy: Part I

It’s been several years since the “preferred” or “recommended” initial regimens for HIV treatment have been consolidated into one of the following four: TDF/FTC + efavirenz TDF/FTC + atazanavir/r TDF/FTC + darunavir/r TDF/FTC + raltegravir Any room for improvement in this “TDF/FTC + key third drug” approach? With the recent approval of TDF/FTC/rilpivirine, certainly this will […]

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August 19th, 2011

A Reason To Continue Restrictive HIV Testing Laws? Not Really …

The pending HIV legislation is much on my mind these days, for reasons I outlined here. Bottom line is that I don’t think it’s good for patient care, and we’re missing a real opportunity to make things better here in the Bay State. But yesterday I heard a perspective on the bill I hadn’t considered, and […]

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August 11th, 2011

Next Single-Pill HIV Treatment Approved, and It’s Not Called “B-Tripla”

One famous HIV clinician/clinical researcher likens co-formulated TDF/FTC/EFV (Atripla) to a “Godzilla,”  so dominant has the treatment become as initial therapy for HIV. He bases his comments on this study done at his institution, showing that in 2007, fully 85% of patients starting treatment in their clinic began TDF/FTC/EFV. Does this big lizard of a regimen […]

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August 3rd, 2011

Why the Proposed Massachusetts HIV Testing Bill is Bad for Patients

As I’ve written about here multiple times, I’m not a big fan of the HIV testing law in our state. First, there’s the requirement for written informed consent, something that every state (except a couple) has wisely abandoned. Second, it’s more than a testing law — it’s also an HIV privacy law, which is arguably unnecessary […]

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July 28th, 2011

Really Rapid Review — IAS 2011 Rome

Just back from IAS 2011 (which was followed, I’m thrilled to say, with a visit to perhaps the most beautiful region in the world). Here is a Really Rapid Review™ of the meeting, with apologies ahead of time for lack of organization and (even more likely) leaving out something important.  FYI, the abstracts are online […]

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July 20th, 2011

CROI 2012 Dates Now Official: March 5-8, Seattle

Good news for coffee lovers!

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