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.
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.