I almost wrote "raging controversy" -- but the adjective "raging" doesn't really fit the sort of people who specialize in Infection Control, who are some of the most measured, data-driven, and methodical individuals in all of medicine. You know the stereotype of the brash, volatile, and cowboy surgeon, the person that everyone tiptoes around?
After reporting my choice for the most important HIV study at ICAAC, I received this email from a colleague:
In the newspaper today -- and yes, we still do get it delivered (some habits die hard) -- is this headline: "Millions More Need H.I.V. Treatment, W.H.O. Says"
It's true -- these updated guidelines say that all should be treated soon after diagnosis, regardless of CD4 cell count or whether they have symptoms.
The big ID story the past couple of weeks is that the price of pyrimethamine -- a drug that's been available generically for decades -- went from $13.50 to $750 for one pill after the exclusive rights to the drug were purchased by Turing Pharmaceuticals.
Recently, an ENT colleague (fictionally named "Clint" below), sent me two emails triggered by drug-drug interaction warnings he received while seeing HIV patients.
Pre-exposure prophylaxis (PrEP) against HIV infection utilizing tenofovir/emtricitabine (Truvada) has been nothing short of revolutionary in changing the landscape of HIV prevention. What has been less discussed are the enormous secondary benefits that have followed the introduction of PrEP.
Recently we got great news from a real-world study of HIV pre-exposure prophylaxis (PrEP).
Researchers at San Francisco's Kaiser Permanente Medical Center reported on the real-world experience of 657 people who started PrEP between 2012 and 2015. Over 99% were men who have sex with men, 84% reported multiple sexual partners, and 30% had HIV-positive partners. Together they were observed for over 388 person-years of PrEP use.
We're in the midst of an HIV prevention revolution. Over the past few years, we have gained new tools and knowledge to prevent HIV, from pre-exposure prophylaxis (PrEP) to the knowledge that an undetectable viral load dramatically reduces the risk of transmission.
By now, the fact that HCV treatment carries a high price is a fact as well known to the medical and non-medical public as 1) a million dollars doesn't get you much in Manhattan or Bay-area real estate; 2) a Rolex is an expensive way to know what time it is; and 3) even though a Tesla doesn't need gas, buying one won't save you money.
An email query from a colleague:
Just got a call from one of our surgeons who got a needlestick from a suture needle, small amount of blood. Patient is HCV+. Any post-exposure prophylaxis recommended?
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