In the late 1990s, a patient was admitted to our hospital with HIV-associated PCP. He had advanced AIDS, a CD4 cell count < 100, and was sick enough to require a temporary stay in our ICU.
Those clinical details aren't so remarkable -- "late" diagnoses of HIV still happen, and happened even more back then. What's remarkable is what happened to him before he got admitted.
I recall when a colleague told me in 2014 that some transgender women advocates were unhappy with iPrEx. I was surprised and disappointed. Since the study was conceived in 2004, I had struggled to include trans women for so many reasons and against so many objections.
A 28yo woman had a positive 4th gen +Ag/Ab assay, but a negative HIV-1/2 differentiation assay and negative HIV viral load. She had no signs of acute HIV, but is not using condoms with her partner, whose HIV status she doesn't know. We repeated the test yesterday and she is again Ag/Ab+, the remainder of the test is pending. If we get the same results again, would you try to get a Western blot?
The International AIDS Conference returned this year to Durban, South Africa, where it was famously first held in 2000. At that time the HIV epidemic was exploding in South Africa; funding for HIV treatment was essentially non-existent, and there was ongoing HIV denialism quite openly from some very influential figures in the South African government (including the President). Globally, fewer than 1 million people were receiving antiretroviral therapy, hardly any of them in Africa.
The folks over at the Journal of the American Medical Association have been doing a periodic HIV/AIDS themed issue for years, generally around the time of the International AIDS Conference. The latest issue is out this week, and it's terrific.
One of the ways ID and hepatology hepatitis C experts like to show off is by discoursing on the nuances of cleverly named clinical trials, and how these impact treatment guidelines.
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.
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