For those who read French, here's the official announcement. (Scroll down for the English.) And for those who can't believe the name, it stands for "Intervention Prophylactique pour Et avec les Gays". Of course.
As expected, the FDA just approved the first single-pill treatment for hepatitis C genotype 1, a tablet containing 400 mg of sofosbuvir (SOF) and 90 mg of ledipasvir (LDV). For those not following this story closely, sofosbuvir is the pan-genotypic NRTI polymerase inhibitor approved last December to much rejoicing -- and controversy about the price. Ledipasvir is the first HCV NS5A inhibitor, and is only available as part of this combination.
If you're an ID doc based in the U.S., you probably received notice last week that two new HIV drugs were approved -- cobicistat and elvitegravir.
And if you're wondering what the big deal is, welcome to the club.
One of my HIV pts, doing wonderfully well, is planning to enroll in a nursing program. She does not want to disclose her HIV status (fine with me), but the hospital requests a list of current meds which, of course, would blow her cover. My inclination is simply to leave the HIV meds off the list, but I asked our legal office who advises me not to do so -- they say just decline to fill out the form. However, I don't like that advice, since it essentially means my patient cannot enroll in the program. Of course I question whether the employer has the legal right to know all the meds, but I can't change that in the short term.
When it comes to preventing mother-to-child transmission (MTCT) of HIV anywhere in the world, the target must be zero. Of course, we know that a lot of variables may affect the chain of events that can lead to an HIV-infected child.
Post-exposure prophylaxis (PEP) for HIV, which consists of immediate treatment for possible exposure to HIV to prevent infection, has been the standard of care for quite a few years.
People who contract HIV once can contract it again, often through the same risk behaviors that led to the initial infection. A long-standing question has been whether getting infected with a second strain of HIV leads to more rapid HIV disease progression than infection with a single strain.
So ended Joep's last email to me.
Last year, like many others in the HIV community, I was thrilled to learn that a little girl born in Mississippi with HIV may have been cured of HIV infection by the early initiation of antiretroviral treatment. I thought that we were on the cusp of a monumental public policy and humanitarian advance -- not one that required experimental space-age treatments, but one achievable today with the very antiretroviral tools we already have. The enthusiasm that Ms. Mississippi's story generated demonstrates just how urgently we all desire a HIV cure, even if not for all adults, at least for the babies born to HIV-infected mothers. The community cared about her story, and the media cared about her story. Her story was on the front page of the New York Times and the Wall Street Journal alike.
I am a doctor who specializes in LGBT health and HIV medicine. I have spent the last 30 years working to help my patients who have HIV live with the illness and trying to help those who are HIV negative stay that way. I am also a 60-year-old gay man who has spent those same three decades trying to keep myself from becoming infected with HIV. I am tired of being scared, so I am starting on PrEP (pre-exposure prophylaxis). I hope that by sharing my story I may help others make decisions about protecting their own health.
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