Over in Clinical Infectious Diseases, a recent study pretty much nails the fact that routine measurement of CD4 cell counts in clinically stable patients is an all but useless exercise. As summarized by Abbie Zuger in Journal Watch, here's the key finding:
In a host of meetings on treatment access and HIV research, we have repeatedly heard the following statements about multidrug-resistant HIV (MDR-HIV) patients:
"These patients no longer exist -- they're either dead or have responded to the latest ARVs."
As noted previously by Carlos del Rio in his nice summary, the Conference on Retroviruses and Opportunistic Infections (CROI) turned 20 this year. It also made it's first-ever stop in Atlanta, home of many things that begin with "C" -- CDC (note that insiders rarely say, "the CDC"), CNN, Coca Cola, and Carlos himself.
As undoubtedly you've heard by now, there's another person cured of HIV out there -- this time, it's a baby born to an HIV-infected mother.
She's back. Tina, that is. Crystal, crank, meth, ice, amp -- all slang for the same drug: methamphetamine. In the early part of the millennium, meth was pervasive both in rural America and in urban gay communities. Its use peaked around 2005 when, following a federal law limiting access to its primary precursor, pseudoephedrine, usage seemed to drop. In gay communities, men became aware of its hazards as they watched friends lose lovers, jobs, health, freedom and even their lives. Pursued by law enforcement, hardcore users went underground but never really went away. Now, because of the cycles of recreational drugs, a new generation, short memories, and the seductive power of this dopamine-releasing supermolecule, the drug appears to be making a comeback, at least in the gay community.
In a previous post, we reviewed the various flavors of medication non-adherence, and concluded with this tantalizing line:
Next up: "An Adherence Intervention that Actually Works -- But There's a Catch"Well here it is, just published on-line in JAMA Internal Medicine.
Treatment of HIV has become so amazingly effective that when it fails, it's no overstatement to say that it's usually because the patient is not taking the medications. There are all kinds of provider-related reasons for this -- inadequate patient education, prescribing and dispensing errors, failure to address language or education deficits -- but here I want to focus on the patient-related causes.
In other words, on non-adherence.
In the modern world it can be remarkably easy to discover where you are. A simple tap on the screen of a smart phone or consultation with a car's GPS device instantly reports our location on the planet with almost absurd precision. Such effortless ability to locate ourselves in time and space can shroud the complications of maintaining emotional bearings in the more ambiguous, upside-down world of living with HIV. Those who are newly diagnosed, as well as long-term survivors, are buffeted by the powerful forces unleashed by living with or around HIV, and frequently find it challenging to maneuver this emotional realm.
Calimmune, a small biotechnology company, has been given the go-ahead by the U.S. Food and Drug Administration to start enrolling HIV-infected people in a first-of-its-kind gene therapy study that will modify two HIV attachment sites in CD4+ cells.
Management of recently acquired HIV infection -- especially acute HIV, pre-seroconversion -- has long been controversial, with the risks and benefits of treatment versus observation debated now for nearly two decades.
(Yes, it's been that long since the publication of this controlled trial of zidovudine monotherapy. Amazing.)