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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September 8th, 2019

The Curious Case of M184V, Part 2 — and More!

The inspiration for today’s post comes from two recent emails from ID/HIV colleagues — thank you. Here’s the first, from Dr. Mehri McKellar from Duke: Hi Paul, When are you going to do part 2 of The Curious Case of M184V, Part 1? I am waiting patiently. 🙂 Mehri Mehri, wait no more, because here it is! […]

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May 20th, 2018

Why the Dolutegravir Pregnancy Warning Is Important — and What We Should Do Now

Last week, in response to newly available surveillance data, multiple agencies issued a warning about the HIV integrase inhibitor dolutegravir (DTG) and pregnancy. The warnings cite an increased risk of neural tube defects in babies born to women who became pregnant while receiving the drug. From the U.S. Department of Health and Human Services: The concern stems from […]

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October 15th, 2017

The Best Antiretroviral Therapy for Pregnant Women? The Controversy Continues

There’s considerable controversy in an area of HIV medicine that one would think should be all but solved by now. It’s what HIV treatment we should give pregnant women. The issue isn’t how to prevent the virus from being transmitted to the newborn — suppress the virus in mom, baby doesn’t get it — it’s what’s safest […]

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October 13th, 2015

Yes, There Are Important HIV Studies at ICAAC and IDWeek — Here’s One

Both ICAAC and IDWeek (formerly IDSA) are now over, IDWeek ending this past Sunday. These are the two large Infectious Diseases scientific meetings that take place each year in the Fall. They’ve been battling it out for years for attendance, but it looks like finally IDWeek (formerly IDSA) has won the Fall slot — ICAAC is moving next year to […]

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November 6th, 2013

SINGLE Study Underscores Waning of the Efavirenz Era — But Probably Just in the USA

In today’s New England Journal of Medicine, the SINGLE study finally makes its appearance “in print.”  (The study results were first presented over a year ago.) The highlights: SINGLE was a double-blind, randomized clinical trial comparing abacavir/lamivudine plus dolutegravir to tenofovir/FTC/efavirenz in 833 treatment-naive study subjects. That’s right, three different drugs in each arm — you […]

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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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August 12th, 2013

Dolutegravir Approval Signals a Beginning and the End of Something Very Special

As anticipated, the FDA approved dolutegravir today for HIV treatment, the third integrase inhibitor now available. This was about as surprising as the arrival of Royal Baby Prince George. We knew dolutegravir was coming soon, just not exactly when or what it would be named. Here’s a short list of the data we have thus far on this drug […]

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July 14th, 2013

Will Dolutegravir Instantly Become the Integrase Inhibitor of Choice in Patients with Treatment Failure?

Here’s the short answer : Yes. Probably. And here’s why. In a randomized, double blind clinical trial just published in the Lancet — it’s called SAILING — once-daily dolutegravir was compared to twice daily raltegravir in treatment-experienced patients. The site investigators could choose one or two other fully active agents to develop an optimized background regimen (OBR). […]

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October 28th, 2012

Dolutegravir and the 88% Rule

In the latest treatment-naive trials of elvitegravir and dolutegravir, there’s a striking consistency in the results of the “test” regimen. Here are the studies, with the percentage of responders by treatment arm: Study 102:  TDF/FTC/EFV (84%) vs. TDF/FTC/EVG/c (88%) — non-inferior Study 103:  TDF/FTC + ATV/r (87%) vs. TDF/FTC/EVG/c (90%) — non-inferior SPRING-2:  TDF/FTC or ABC/3TC […]

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