I was a new provider in the clinic, and she was one of my first patients, HIV positive for over 10 years. As I entered the exam room and saw her staring out the window, I made at least half a dozen intuitive assessments about her. She was well-dressed; clearly a strong and authoritative woman; a well-respected professional with very high standards of herself and others. As she began to share her story, I realized I was correct on all counts. Judging by the questions she asked me, I was not spared from her high expectations.
Preliminary research suggests that a patch could deliver an AIDS drug to patients ... The researchers successfully used transdermal patches to administer 96 percent of an AIDS drug to simulated skin over a week. "Still, the important limitation of pills, regardless of how few there are or even how minimal the side effects, is adherence," Johnston [the investigator] noted. Research has shown that many patients, if not most, don't take their pills all the time.
Public apprehension about recreational drugs, especially those that impact HIV, seems to come in waves that swell with increasing alarm and then peak and fade away, always to be replaced by the next "drug du jour." Heroin, cocaine, and methamphetamine, each with a well-deserved reputation for putting people at risk for HIV or, if HIV positive, for interfering with their ability to properly manage their health, have all gained notoriety in recent years.
World Series time, hence the baseball reference in the title. (Doesn't take much.) But over in Lancet Infectious Diseases -- which has turned out to be a terrific journal, by the way -- there's a study reminding us that advances in HIV treatment in the late 2000s were truly spectacular.
Introducing yourself to an older adult as a health care provider requires being sensitive to generational issues. It is not appropriate to address clients by their given or first name without requesting their express permission to do so.
If you're looking for a good way to pass the time while running errands, traveling, or walking to work, I highly recommend the Freakonomics podcasts, which have taught me all sorts of interesting things.
As we await the enrollment, analysis, and results of the START study -- which is randomizing patients with CD4>500 to start HIV therapy vs waiting until the CD4 falls to 350 -- much of the research on "when to start" ART in patients with high CD4's comes from observational studies. Several have already been published (NA-ACCORD, ART-CC, CAUSAL), but one limitation of each of them is that none could accurately assess duration of HIV infection.
As I just celebrated another birthday and relocated to Houston, Texas, to a nice home with lots and lots of stairs, I couldn't help but think about aging. My knees and back are aching. I'm just plain tired! I know that in the clinical setting you are hearing similar complaints among your older clients. We can be an achy mess as we age! For our clients, is it the untreated/inadequately treated HIV, aging, or both?
When studies evaluate the prognostic importance of measuring HIV viral load, they generally do so by assessing a single measurement rather than values obtained longitudinally. One obvious limitation of this approach is that baseline VL poorly predicts outcome after ART initiation -- a finding in stark contrast to the original description of VL from the MACS cohort prior to effective HIV therapy.
It's been several years since the "preferred" or "recommended" initial regimens for HIV treatment have been consolidated into one of the following four: