HIV and ID Observations

May 14th, 2010

The Luxury of the START Study … and Running Out of ART in Uganda

Over on our Journal Watch AIDS Clinical Care site, we did a poll asking about the ongoing START study: In the START study, HIV-infected patients with CD4 counts greater than 500 cells per cubic mm are being randomized to start antiretroviral therapy right away or to wait until the CD4 count falls to 350 cells per […]

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May 2nd, 2010

Learning from Clinical Trials with Limited “Generalizability”

In the ongoing debate about when to start antiretroviral therapy in our sickest patients — those with acute opportunistic infections — comes this study from Zimbabwe of early vs. deferred ART in patients with cryptococcal meningitis: The median durations of survival were 28 days and 637 days in the early and delayed ART groups, respectively (P=.031, […]

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April 14th, 2010

Maraviroc Rarely Used for Treatment-Naive Patients

Over in Journal of Infectious Diseases, the MERIT study was recently published (with Chuck Hicks’ Journal Watch summary here), demonstrating that maraviroc is non-inferior to efavirenz — provided that the enhanced-sensitivity tropism test is used to select appropriate candidates. (The MERIT study began in 2004-5.  Don’t think I’ll ever forget that, since the investigator meeting overlapped […]

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April 4th, 2010

San Francisco Public Health: Treatment Recommended for All with HIV

Could there be anything more interesting than the start of the baseball season? Maybe, because this is quite something: In a major shift of HIV treatment policy, San Francisco public health doctors have begun to advise patients to start taking antiviral medicines as soon as they are found to be infected, rather than waiting — sometimes years — […]

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March 3rd, 2010

Ritonavir Tablets: Any Experience Out There Yet?

Ritonavir tablets have been approved, and are apparently now in pharmacies.  The capsules will also remain available for the foreseeable future. However, I haven’t switched anyone over from the capsules yet, and neither has anyone else in our practice. Would be interested in hearing how it’s going so far — best news would be that the tablets […]

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November 30th, 2009

WHO HIV Treatment Guidelines Updated

This just in: WHO is now recommending that ART be initiated at a higher CD4 threshold of 350 cells/mm3 for all HIV-positive patients, including pregnant women, regardless of symptoms. Which makes eminent sense, of course.  Because if starting HIV therapy might prolong survival in developed countries, why shouldn’t it do the same in the developing world? In fact, […]

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June 24th, 2009

An Irrational Fear of IRIS?

One of the most important recent studies in HIV has just been “published” in (on?) PLoS ONE.  It’s ACTG 5164, led by Andrew Zolopa, which compared “early” versus “deferred” antiretroviral therapy in 282 patients presenting with acute opportunistic infections. (Full disclosure: I am on the protocol study team — but am not an author on this paper.) […]

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February 13th, 2009

CROI 2009: Greatest Hits

Fresh back from lovely Montreal, where the temperature (I’m glad to report) climbed into the balmy 40’s … Here’s a rapid-fire listing of the Greatest Hits.  As I’m sure to be leaving something off this list, happy to accept other suggestions: Interleukin-2 does not work.  The ESPRIT and SILCAAT studies are over. Yes, the CD4’s increase, but […]

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January 4th, 2009

Top Stories in HIV Medicine

Happy New Year! In the spirit of list-making that seems to permeate the world right about this time, we’ve just published our own list over at AIDS Clinical Care.  Check it out — our editorial board this year did a superb job of summarizing the field. I have a strong feeling that next year’s version will have […]

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November 30th, 2008

How to End the HIV Epidemic

Answer:  Put everyone on treatment. Conspicuously absent for decades, the prevention part of the “when to start antiviral therapy?” question has now moved front and center in two recent papers:  In this week’s Lancet, a group from the WHO estimated what would happen if there were annual universal HIV testing, and then immediate treatment for all […]

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