Insurance prior authorizations, or prior approvals (PAs) -- those dreaded forms clinicians have to fill out, usually triggered by prescribing a non-formulary drug -- are much on my mind these days. And most of it has to do with three letters, specifically "TAF."
Two patient-related anecdotes, then a news item.
In my first years of medical practice, dealing with AIDS at that time was invariably fatal. Years later, still battling HIV, we are now faced with another outbreak of a similar nature -- the Zika virus. I remember the time when we did not have a clinical-epidemiological diagnosis of a new disease. I remember the era when we did not have a precise etiologic diagnosis. I remember a time when we had not yet discovered the virus responsible for AIDS. Pathogenesis was discussed by inferences but it took us four years to discover HIV (then HTLV-III or LAV) and even more time to understand how it caused immunodeficiency, although a lot still needs to be learned.
The approval last week of TAF/FTC/RPV -- that's coformulated tenofovir alafenamide, emtricitabine, and rilpivirine -- brings us another one-pill, once-daily option for HIV treatment.
Got a Zika question? Welcome to the club -- once again, as with any "new" or "emerging" infection, this is uncharted territory, and there are plenty of answers to these questions that could be summarized with 3 words: We Don't Know.
These peculiar infections resolved, and the doctors just attributed these temporary illnesses to another infection picked up in the bathhouses or through needle sharing on the streets. No one put these individual cases together and wondered whether some common condition could explain their individual patients' illnesses. Yet an epidemic -- the AIDS epidemic -- was exploding before our very eyes.
Something interesting happens when you poll people who treat HIV -- and people who have HIV -- about whether they'd prefer a treatment option that consists of a periodic injection or infusion in place of the pill or pills that they take every day.
Medical marijuana is now officially available in New York, the city with by far the largest number of people living with HIV/AIDS in the country. Reporting on the first dispensary in Manhattan, the aptly named Julie Weed (yes! her real name!) writes:
Earlier this week, JAMA Internal Medicine published a study entitled, "Level of Computer Use in Clinical Encounters Associated with Patient Satisfaction".
A more descriptive title would have been "More Computer Use in Clinical Encounters Associated with Reduced Patient Satisfaction", as here's the take home point:
Some quick ID/HIV gratitude items for 2015, done rapidly as we're hosting a big meal later today.
I wonder what that might be.