A flurry of coverage recently appeared about the U.S. Preventive Services Task Force's recommendation for one-time HIV screening for all Americans, ages 15-64.
Some might wonder why this is news -- um, hasn't this been recommended now for years? -- and I think I've figured it out.
The FDA has approved an 800-mg tablet of darunavir for treatment naive patients. This single tablet will obviously replace the two darunavir 400-mg tablets in first-line therapy. (Yes, my math is that good.) Darunavir will still require 100-mg ritonavir boosting plus two NRTIs to make a complete regimen.
Now that the election is over, we can get back to something that really matters -- namely vitamins, and specifically whether they really help people.
Got this challenging curbside consult from a colleague, and it has an interesting wrinkle.
In the latest treatment-naive trials of elvitegravir and dolutegravir, there's a striking consistency in the results of the "test" regimen. Here are the studies, with the percentage of responders by treatment arm ...
As has often been the case in the history of the HIV epidemic, the HIV/AIDS Division at San Francisco General Hospital and the San Francisco Department of Health were ahead of the curve in 2010 when they issued a recommendation that all people with HIV should receive treatment, regardless of CD4 count. Of course, U.S. guidelines (first DHHS, now IAS-USA) followed suit -- but how did the San Francisco experience play out?
Over in JAMA, there's a large study out today that (yet again) failed to demonstrate a benefit of vitamins.
Hard to believe, but we have to get rid of the HIV Western blot -- at least as our HIV confirmatory test.
We now have a third single-pill treatment available for HIV treatment, co-formulated tenofovir/emtricitabine/elvitegravir/cobicistat. From the FDA announcement:
The U.S. Food and Drug Administration today approved Stribild (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate), a new once-a-day combination pill to treat HIV-1 infection in adults who have never been treated for HIV infection. Stribild contains two previously approved HIV drugs plus two new drugs, elvitegravir and cobicistat ... Together, these drugs provide a complete treatment regimen for HIV infection.
Todd sat slumped on the sofa in my office. He avoided eye contact and described a particularly painful experience with stigma. He had recently come around the corner at his part-time job and heard several co-workers speaking about him and his HIV positive status. More specifically, they were discussing how he might have acquired the virus by speculating about the nature and frequency of his sexual activities. It was meant as a cheap laugh among themselves, but for Todd it meant much more. Although he made no effort to hide his HIV status and was "out" at the office about being gay, hearing his co-workers making disparaging remarks about his sex life and his health status in such explicit terms felt like a strong punch in his gut. He had a brief flash of anger, telling them to shut up, and then stormed out, pulling inward and automatically falling into the old habit of numbing himself by detaching from the emotional pain.
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