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:
The CDC has yet again released a report highlighting the growing HIV disparity in young, black men who have sex with men (MSM). Over a decade ago, similar attention was called to what then appeared to be a public health blemish in this population. Because our prevention efforts have been largely cosmetic and woefully inadequate, the 7% increase in the infection rate among black MSM suggests this blemish is now a gushing and gaping wound requiring urgent public health action.
The effects of HIV and highly active antiretroviral therapy [HAART] on gut health were highlighted recently at the 13th International Workshop on Adverse Drug Reactions and Co-Morbidities in HIV in Rome, Italy.
The pending HIV legislation is much on my mind these days, for reasons I outlined here. Bottom line is that I don't think it's good for patient care, and we're missing a real opportunity to make things better here in the Bay State.
One famous HIV clinician/clinical researcher likens co-formulated TDF/FTC/EFV (Atripla) to a "Godzilla," so dominant has the treatment become as initial therapy for HIV. He bases his comments on this study done at his institution, showing that in 2007, fully 85% of patients starting treatment in their clinic began TDF/FTC/EFV.
First, there's the requirement for written informed consent, something that every state (except a couple) has wisely abandoned. Second, it's more than a testing law -- it's also an HIV privacy law, which is arguably unnecessary in this post HIPAA era and has all sorts of unintended consequences.
Just back from IAS 2011 (which was followed, I'm thrilled to say, with a visit to perhaps the most beautiful region in the world). Here is a Really Rapid ReviewTM of the meeting, with apologies ahead of time for lack of organization and (even more likely) leaving out something important. FYI, the abstracts are online here; I'm sure there's a place on the meeting homepage that has the same link, but I can't seem to find it.
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