HIV and ID Observations

June 2nd, 2012

Cryptococcal Meningitis Study Stopped — Early HIV Therapy Clearly Harmful

From NIAID, an important clinical trial has been stopped early: The Phase IV study … was evaluating whether HIV-infected participants hospitalized with cryptococcal meningitis (CM) but not yet taking antiretroviral therapy (ART) would improve their chances of survival if they began ART while receiving CM treatment as inpatients compared with the standard practice of beginning ART […]

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October 23rd, 2011

TB, Timing of Antiretroviral Therapy, and Being a Lumper Rather Than a Splitter

Three key papers on timing of ART in patients with TB have just been published in the New England Journal of Medicine. Fortunately, Carlos Del Rio has done a bang-up job summarizing them in Journal Watch AIDS Clinical Care. And if you’re wondering how we got our title for Carlos’ piece, here’s an e-mail between our Executive Editor to me […]

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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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May 12th, 2011

HPTN 052 Results — Another Win for Early HIV Therapy

The results of the HPTN Study 052 — which randomized 1,763 serodiscordant couples to early vs delayed ART to evaluate whether this reduced the risk of HIV transmission — have just been released: Findings from the study were reviewed by an independent Data and Safety Monitoring Board (DSMB) …The DSMB concluded that initiation of ART by HIV-infected […]

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April 18th, 2011

When to Start Antiretroviral Therapy, Take 3

A third observational study on “When to Start ART” has just appeared in the Annals of Internal Medicine,  “The HIV-CAUSAL Collaboration.” As with ART-CC and NA-ACCORD, it’s a large study, starting with over 20,000 people with HIV with baseline CD4s >500 receiving care in Europe and the United States.  Out of this group, 8392 experienced CD4 […]

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March 30th, 2011

Journal Club: Even When You Think You Should Wait, It’s Probably Time to Start

Two papers just published in AIDS with relevance to the “when to start” antiretroviral therapy question. Both apply to certain patients in whom we might consider waiting to start treatment– but both these studies suggest we do otherwise. The first applies to the patients with slooooow CD4 decline. Perhaps so slow that both you and your patient […]

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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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March 28th, 2010

Kidneys: Fortunately, We Have Two

Here’s a case over in our Journal Watch: AIDS Clinical Care site:  a man with suspected PCP develops rapidly progressive renal failure after being starting on both empiric PCP treatment with TMP-SMX and ART with TDF/FTC plus darunavir/ritonavir. The specific questions at the end of the case were: What do you think is causing the renal failure? […]

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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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September 18th, 2009

Integrase Inhibitors: In Search of an Abbreviation

The alphabet soup that characterizes HIV therapeutics has always been one of its quirky challenges — for example, who could possibly know that 3TC, CBV, TZV, EPZ, and LAM all refer to drugs that are (or contain) lamivudine? This drives our ID fellows nuts, and is certainly a strong deterrent to non-HIV specialists to learning the field. […]

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