Although great strides have been made at combating human immunodeficiency virus, leading to better quality of life and a longer life expectancy for those living with the virus, significant problems remain.
Recently the Massachusetts Department of Public Health sent out this concerning notice:
The Massachusetts Department of Public Health (MDPH) has noted an increase in newly diagnosed and acute HIV infections among persons who inject drugs (PWID). To date in calendar year 2017 (through November 21), there have been 64 HIV infections reported among individuals who inject drugs in Massachusetts ... Over the past 5-10 years, newly diagnosed HIV infection in PWID amounted to 32-62 cases annually, representing a stable proportion of 4-8% of all reported HIV infections. Investigation of cases is ongoing.
Most HIV-positive people in France under treatment take a daily dose of antiviral drugs for life. However, a major trial is currently underway that may confirm that patients could omit several days of treatment a week without risk to their health.
In case you missed it, Betty Price, a Georgia state representative, said the following last week:
There's considerable controversy in an area of HIV medicine that one would think should be all but solved by now.
Here's a most entertaining email about a tricky case (some details changed for the usual reasons), with my annotations in brackets:
I never expected to have AIDS, let alone to survive. I got sober in my 20s and could count my sexual partners on one hand. When diagnosed in 1988, at age 34, I had been out as a gay man less than a decade, was years into my first significant relationship and was quickly progressing in my career. Out of the blue, that first opportunistic infection began an endless series of precarious conditions that, almost overnight, wrenched my life into a non-stop struggle for survival. After countless hospitalizations, coming close to death with non-Hodgkin's lymphoma and losing more friends than I could count, a dark sense of hopelessness and inevitable doom settled in that was validated by everything around me. I spent my 30s and 40s preparing to die, having little energy to feel loss, sadness and anger.
Last week, the International AIDS Society meeting returned to Paris for the first time since 2003.
This email popped into my inbox the other day from a person I've never met:
Hi Dr. Sax,
I do mostly hospital-based ID in Pennsylvania, and was consulted on a newly diagnosed HIV patient with CD4 10, viral load 210,000, and lymphoma. I started him on Truvada and dolutegravir, which is going well so far. Because he complained of blurred vision, he had an ophtho evaluation yesterday which showed CMV retinitis. My drug-interaction checker says I can't use valganciclovir with either tenofovir or abacavir, and if I replace the Truvada with a boosted PI, it will interact with his chemotherapy. What should I do for his ART?
Thanks so much.
MMWR just published a paper entitled, Strategies for Preventing HIV Infection Among HIV-Uninfected Women Attempting Conception with HIV-Infected Men -- United States, and it's both a welcome and a very strange document indeed.
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