June 15th, 2011

Hockey Helicobacters

Today’s ID/HIV items come to you courtesy of a winter game being played during a summer month:

  • So it appears that community-based care of HCV augmented by telemedicine is just as good as traditional clinic visits to specialists. My first thought on reading this important paper is that there are undoubtedly lots of ways to incorporate technology into patient care for the better, extending the reach of specialty services.  But — and call me a cynic —  if in a fee-for-service world, specialists get paid for services rendered during office visits, and not for setting up and managing telemedicine, which one do you think they’ll choose?  To quote the editorialist:  “It is also important to develop models for financing this innovative care model, with respect to both the specialists and the primary care providers involved.” Emphatically agree.
  • Here’s a comprehensive list of sprout-related outbreaks, if you’re keeping score.
  • In the flurry of recent drug approvals in the ID/HIV world — ceftaroline, nevirapine XR, rilpivirine, fidaxomicin [update: apparently not available until later this summer], boceprevir, telaprevir, generic zidovudine/lamivudine — I always wonder what the early anecdotal experience will be from experienced providers. Any first impressions?  So far I’ve used ceftaroline and rilpivirine, not the others.
  • Did you see this latest “scorecard” on states’ compatibility with the 2006 HIV Testing Guidelines? It includes three suggested key elements of HIV consent to facilitate testing:  1) changing from opt-in to opt-out 2) allowing general consent for care to include HIV testing, and 3) permitting written or oral consent.  Good news:  now only 4 states per this report have HIV testing laws outside these recommendations. In fact, there is only one state that is incompatible with all three components.  And that state is …  Massachusetts, thank you very much! (FYI, we’re working on changing this.)
  • Can’t believe I missed commenting on this remarkable paper in Lancet ID, which clearly documents the clinical relevance of transmitted drug resistance, as well as the importance of baseline genotype testing in reducing the risk of treatment failure. It also hints that in the presence of any transmitted resistance, a boosted PI-based regimen might be the best choice, at least for virologic outcomes. Makes sense.  Further commentary in Journal Watch AIDS Clinical Care here.

And as you watch tonight’s Stanley Cup final, and thoughts turn to winter, you might note that the 2012 CROI dates and location still have not been announced.  Are the conference organizers awaiting the outcome of tonight’s game to decide where to go?  Both Boston and Vancouver in February would be suitably cold options.

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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