HIV and ID Observations

September 28th, 2019

What Is the Best Treatment for Advanced HIV Disease?

One of the things that keeps me on Twitter — besides cute dog videos — is the periodic realization that the platform can help patients. Which is, after all, why most of us do this doctor thing — to help people get better. Example: Several months ago we had a challenging patient. I asked twitter if anyone […]

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July 21st, 2019

AIDS Conference Returns to Mexico City, Where We Saw an Underrated, Great Advance in HIV Therapy

If you’ve been an ID or HIV specialist for only a decade or so, the following statement might seem unfathomable to you: Until 2008, there were lots of people with HIV whose medication adherence was perfect — but they still had virologic failure. How could that be? The simple answer is that their virus had too […]

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July 22nd, 2018

FDA Approves First PI-Based Single-Tablet Treatment for HIV — How Will It Be Used?

The latest HIV drug approval from the FDA came this past week with the release of a single-tablet treatment containing the following drugs: Darunavir (DRV) 800 mg Cobicistat (c) 150 mg Emtricitabine (FTC) 200 mg Tenofovir alafenamide (TAF) 10 mg Often abbreviated “DCF-TAF,” this is the first full treatment regimen in a single pill with a […]

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October 29th, 2015

The Most Important HIV Study at IDWeek 2015

After reporting my choice for the most important HIV study at ICAAC, I received this email from a colleague: If that’s the most important study, I really didn’t miss much … Now she has notoriously high standards — hard to impress her — but her opinion notwithstanding, I still think the STRIIVING study has some important messages we can apply […]

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December 6th, 2014

Holiday Season 2014 ID/HIV Link-O-Rama

A little spin around the internet brings us these ID/HIV tidbits, all of them designed to go well with holiday music, egg nog, and potato pancakes, plus a can’t-miss video clip: Flu vaccine match with circulating virus doesn’t look so great. This could mean it’s going to be a tough flu season, but estimates of flu […]

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October 14th, 2013

MODERN Study Stopped: An NRTI-Sparing, Two-Drug Initial Regimen Disappoints Again

In case you didn’t know, “MODERN” is the clever name for the “Maraviroc Once-daily with Darunavir Enhanced by Ritonavir in a New regimen” trial, which compared TDF/FTC to maraviroc, both with boosted darunavir. And once again, the NRTI-sparing two-drug regimen comes up short, this time in a fully powered, double-blind noninferiority study. From a PDF provided by […]

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August 28th, 2013

Poll: At $14,105/year, Is Dolutegravir Fairly Priced?

The recently approved once-daily integrase inhibitor dolutegravir is now in pharmacies and, like every new HIV drug, the price — around $14k/year — has generated some controversy. For the record, here are the per-year wholesale acquisition costs of the three FDA-approved integrase inhibitors. Raltegravir:  $12,976 Elvitegravir:  $13,428 (once disentangled from the price of TDF/FTC) Dolutegravir:  $14,105 If […]

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November 18th, 2012

The 800-mg Darunavir Tablet Arrives, and Scoring the Top Protease Inhibitors

The FDA has approved an 800-mg tablet of darunavir for treatment naive patients. This single tablet will obviously replace the two darunavir 400-mg tablets in first-line therapy. (Yes, my math is that good.) Darunavir will still require 100-mg ritonavir boosting plus two NRTIs to make a complete regimen. Once upon a time I might have thought this was […]

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December 11th, 2011

An Unlikely Interviewee Discusses “Six-Class” HIV Drug Resistance

He’d never acknowledge it, but in our field, it’s no secret this guy is something of a rock star. I can think of several key principles in HIV pathogenesis and treatment that he and his research group have discovered, or elucidated most clearly, or simply explained the best — largely through his unique ability to link […]

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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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