HIV and ID Observations

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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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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August 7th, 2013

Occupational Post-Exposure Prophylaxis (PEP) Guidelines Updated — And They Are Clear and Sensible

Good news here — the United States Public Health Service has issued new national guidelines for management of occupational exposure to HIV. Authored by an expert panel, these updated occupational PEP guidelines replace the (woefully outdated, sorry, had to write that) previous version, which dates back to 2005. On a quick read-through, despite the density of print, the […]

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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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August 1st, 2012

Really Rapid Review — 2012 International AIDS Conference, Washington, DC

Last week’s International AIDS Conference in Washington got plenty of media attention, mostly because it was the first time in umpteen years that it was held in the United States, the delay between meetings due to our absurd (and now repealed) immigration laws regarding HIV. (Quick trivia question — where was the conference supposed to be […]

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June 8th, 2012

SPARTAN: Two-Drug, NRTI-Sparing Strategies Continue to Disappoint

Just published is the cleverly named “SPARTAN” study — spartan because it leaves out both NRTIs and ritonavir — and the results are very interesting. Ninety-three treatment-naive HIV-positive study subjects were randomized 2:1 to receive either a two-drug regimen of raltegravir 400 mg BID + atazanavir 300 mg BID, or a standard regimen of TDF/FTC + boosted atazanavir. […]

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March 1st, 2012

Post-Exposure Prophylaxis, the World’s Most Outdated HIV Guidelines, and What To Do About Them

Every time I cover HIV prevention in a lecture, it’s always kind of embarrassing to cite the “official” post-exposure prophylaxis (PEP) guidelines, which are here (non-occupational) and here (occupational). That’s right, they were last updated in 2005, the year of Hurricane Katrina. Yes — more than six years ago. The alternative choices seem particularly curious (read: don’t do […]

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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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