HIV and ID Observations

March 25th, 2009

March (Guideline) Madness …

A couple of interesting ID guidelines out this week.  For those of you too busy with basketball, here are the relevant links: Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities. Identified in 24 states and now found “routinely” in New York and New Jersey, these carbapenem-resistant Enterobacteriaceae (“CPE” is much […]

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March 20th, 2009

Hair Today, Gone Tomorrow …

Since providers — especially doctors — are notoriously poor at predicting medication adherence, here’s some good news: In a paper from the Women’s Interagency Health Study, protease inhibitor levels in hair samples were the strongest independent predictor of virologic success — better than self-reported adherence, age, race, baseline viral load and CD4 cell count, and […]

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March 10th, 2009

Unwelcome Visitor: Cost of HIV Meds

Those of us who practice HIV medicine in Taxachusetts (warning, click link at your peril) live a pretty charmed life, at least so far as getting HIV medications paid for.  Due to an incredibly generous AIDS Drug Assistance Program (ADAP), rare is the patient who faces financial barriers getting his or her drugs. (By the way, […]

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March 4th, 2009

TaqMan HIV RNA Assay: Be Careful What You Wish For

At our hospital lab, we recently switched from the bDNA viral load assay to the new Roche TaqMan real-time PCR test.  The virologist in charge of our lab and the tech both agreed the assay was more accurate, more sensitive, and easier to do — so much so that we could increase the frequency of […]

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March 1st, 2009

Sedation for Colonoscopies in HIV Patients: Debate Rages

Here’s a problem we’re grappling with: A patient with HIV needs a colonoscopy, but is on either a ritonavir-boosted protease inhibitor or an efavirenz-based regimen. (This must be something like 90% of HIV patients as of March 1, 2009, based on my extremely unscientific gut impression.) For efavirenz, midazolam is contraindicated; for ritonavir, same story — or “consider […]

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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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February 11th, 2009

CROI 2010 Dates and Location Announced

February 16-20, 2010, San Francisco — at least according to John Mellors during his opening remarks here in Montreal. Is it really one day longer?  [Update — no, it’s Feb 17-20.] Really during the week of Presidents’ Day?  (School vacation week in New England … but I realize you can’t make everyone happy with schedules.) In other […]

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February 4th, 2009

Brush with Greatness: Bruce Walker

Bruce Walker has just received a $100 million grant from Terry and Susan Ragon to start a vaccine research institute, with a focus on finding an HIV vaccine. The news of this gift (which as you can imagine has been floating around these parts for some time) is all the more remarkable since it comes […]

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February 1st, 2009

Whither PEPFAR?

Mark Dybul will no longer be running the President’s Emergency Plan for AIDS Relief, or PEPFAR, the multi-billion dollar international program for HIV treatment program started by Bush in 2003. Some are happy.  Others are not. (Note the exquisite use of euphemism — he was “required to submit his resignation“, not “fired.”) Experts on global HIV treatment […]

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January 29th, 2009

Too Many Options: What Actually Happened

We recently published a case in AIDS Clinical Care entitled “Too Many Options”, describing a patient with longstanding HIV infection, virologic failure, and resistance to NRTIs, NNRTIs, and PIs. Fortunately, resistance and tropism testing gave him several options for a new drug regimen — including darunavir, etravirine, maraviroc, enfuvirtide, and — if one believes phenotypic NRTI […]

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