The news that hepatitis C (HCV) has passed HIV as a cause of death in the United States got quite a bit of attention when it was first presented last year at ICAAC -- and no doubt the published paper, in this week's Annals of Internal Medicine, will also cause a stir. In fact, I boldly predict that going forward, (approximately) 94.2% of HCV-related research grants, journal articles, and lay press articles will cite this paper, making it (for now) the "Palella NEJM 1998" of HCV.
As providers, we spend time in hospitals, clinics and offices attempting to educate our patients on prevention and treatment of disease. But how many times have we heard that, after the patient walked out of exam room, he or she stated to the nurse, "I don't understand what the doctor just said to me about my health. Can you tell me?" The patient probably heard what Charlie Brown hears when his teacher is speaking to him. "You should do this and you shouldn't do that, mwa mwa, blah, blah, wah, wah. Have a nice day." Total gibberish!
By now I'm sure that most of you ID folks out there have received the following letter from Merck, the makers of boceprevir:
I have a very smart, very experienced colleague -- clue, his initials are CC, and he doesn't pitch for the Yankees -- who continues to use bDNA testing for HIV viral load monitoring. You know, the assay with a lower limit of detection of 75 copies. He knows that bDNA is less sensitive than PCR. He knows that it's more expensive than PCR.
The text alert came in the middle of a session. It was from a colleague and read simply "call asap." I dialed his number between patients, and when he answered, I was surprised at his quiet tone and his admission that he was really shaken. We often utilized each other for consultation and support, but on this day he sounded defeated. He told me that a patient had just died.
An e-mail from a patient last week: "Just got refills. Epivir is now generic??? Refill is simply labeled Lamivudine Tablets by Aurobindo Pharma USA, Inc ... but made in India. Should I be concerned about that???"
Over in Journal of Infectious Diseases, the so-called Setpoint study -- a randomized strategy trial -- investigated whether a 36-week period of treatment would delay the need to go on continuous HIV therapy, compared with observation. After 130 of a planned 150 patients were enrolled, a Data Safety Monitoring Board elected to stop the study due to this key finding: "... the higher rate of progression to needing treatment in the Deferred Treatment group (50%) versus the Immediate Treatment (10%) group."
How reassuring to be treated with the following news: "An SMS has been circulating that Pepsi products are contaminated with HIV but Permanis Sandilands Sdn Bhd has clarified that this is a hoax. Its marketing vice-president Hemalatha Ragavan said there was no truth to it. She urged people not to believe such claims." I have a couple of thoughts about this breaking story.
Another disappointing note was bellowed out this month concerning the discontinuation of part of a significant HIV prevention trial in women. The 1% tenofovir (Viread) gel arm of the VOICE phase 2B clinical trial was halted early by the independent Data and Safety Monitoring Board (DSMB).
Getting the level of new infections down to zero will require breakthroughs not only in medications and improved interventions, but also a broadening of our understanding about the underlying causes of high-risk behaviors which can increase vulnerability for HIV, specifically, mental health concerns.