The sun was gleaming on Miami's Biscayne Bay. Palm trees swayed in the gentle breeze and, in the distance, cruise ships were about to set sail for exotic ports. English, Spanish and a dozen other languages drifted through the air as happy people enjoyed the beautiful day. As perfect as it was, the idyllic scene was not all it seemed.
From NIAID, an important clinical trial has been stopped early.
As I'm sure you've heard from your patients -- as I did -- lamivudine (3TC) is now available generically.
Now comes news of the release of several generic formulations of nevirapine (NVP), an effective but always somewhat overshadowed medication. Since its approval way back when in 1996, there has always been a solid reason to pick something else.
As I've mentioned before, I have no doubt whatsoever that TDF/FTC works for PrEP, provided the person actually takes the med. And while it's not yet approved for this indication, nothing has stopped clinicians from prescribing it already. There's even a CDC "Guidance" on the practice that's now over a year old. Remember, we give TDF/FTC all the time for post-exposure prophylaxis.
I'm currently on the inpatient consult service and just saw a guy who fits the typical profile of many hospitalized HIV patients in 2012:
The excitement about "treatment as prevention," and the results of Study 052, have led to many patients asking the question (if not in these words, than using others with a less medical slant), "So if I'm on treatment and doing well, just what is the risk of my transmitting HIV to others?"
Over in Journal Watch AIDS Clinical Care, Abbie Zuger has written a fascinating perspective on the recent enthusiasm for universal HIV treatment.
Her take? Let's just say she doesn't share the enthusiasm of public health officials and members of guidelines committees. Well, that's a huge understatement.
From the key "What's New in the Guidelines" section of today's Department of Health and Human Services update:
ART is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pretreatment CD4 cell count.
Several attendees drove fifteen hours from St. Louis. Others came by caravan from Atlanta. In the hotel lobby there were happy reunions of friends who hadn't seen each other since last year. Overall nearly four hundred and fifty people made their way from 22 states to the white sandy beaches of the Florida panhandle in early March. It was spring break, but their purpose was much more a matter of life and death. They were gathering for Positive Living 15, the largest conference in the nation specifically for people living with HIV.