Thirty-three million people are infected with HIV worldwide, but less than 50% receive antiretroviral therapy. This was the stark reality addressed in June at the 10th International Conference on HIV Treatment and Prevention Adherence (Adherence 2015), which is jointly provided by the International Association of Providers of AIDS Care (IAPAC) and the Postgraduate Institute for Medicine (PIM). Every aspect of the ubiquitous treatment cascade was addressed in an effort to stop the "leaks" of people not engaging in treatment, falling out of care or not maintaining viral suppression. While access to prevention and treatment has significantly improved worldwide, certain issues such as stigma still impact prevention and treatment, and gender, age, race and sexual orientation continue to make certain populations vulnerable and in need of interventions tailored to their specific needs.
Vancouver will always have a special place in HIV treatment history. It was here, in 1996, that many of us first saw the potential of combination antiretroviral therapy to control this disease.
Because current levels of HIV spending are unsustainable, HIV prevention and intervention efforts must become highly targeted in order to maximize their impact. This was the theme of many presentations at the 10th International Conference on HIV Treatment and Prevention Adherence. The conference, held June 28 to 30 in Miami, Florida, was jointly provided by the International Association of Providers of AIDS Care (IAPAC) and the Postgraduate Institute for Medicine (PIM).
Last month, I spoke at the closing plenary of the HIV Forum for Collaborative HIV Research National Summit in Arlington, Virginia. I began with a brief look back at how the fight against the HIV epidemic has evolved. I reflected on a time when there were only a few tools and even fewer resources available to make an impact on the disease. This is in direct contrast to the progress that we have made in today's fight, where we have many tools available to us that work to combat and bring an end to the HIV and HCV epidemics. But I am reminded, and wanted to remind everyone in attendance, that a challenge still remains. We need to work differently and more effectively to bring an end to both of these epidemics. The following is an excerpt from the presentation I gave, where I provided a top 10 list of things that we must consider and incorporate in our work to end both epidemics.
In last week's post, I asked about two of the key components of the HIV care cascade -- the "undiagnosed" vs the "diagnosed but not in care," and which group was larger in the USA. Here are your answers as of now:
The information is everywhere -- on your computer, your phone, your tablet -- whatever screen happens to be glowing in front of you.
Two years ago, the Alachua County Community Support Services, Victim Services and Rape Crisis Center in Gainesville, Florida, contacted me to inquire about Walgreens' partnership in assisting uninsured sexual assault victims to obtain HIV post-exposure prophylaxis (PEP) prescriptions during weekends and holidays. This issue is of great importance because once an individual is sexually assaulted, there is only a 72-hour window to begin PEP. Ideally, it is recommended to start the regimen as soon as possible. I have learned that when a person is sexually assaulted, local emergency rooms only provide a one-day dose of the regimen. As a result, this leaves the victim advocate and patient foraging for medication to cover the remaining days of the typical 28-day regimen. In addition, the problem is further compounded if the assault occurs on a holiday weekend.
One of the stupid things about being an HIV/ID specialist is the highly arcane code we use to abbreviate HIV treatments.
The Strategic Timing of AntiRetroviral Treatment (START) study began in 2009, enrolling over 4000 asymptomatic people with HIV and CD4 cell counts > 500, and randomizing them to immediate ART or to wait until the count dropped to 350. Now, from the National Institute of Allergy and Infectious Diseases comes this important announcement:
It's not often that a FDA drug approval for cosmetic dermatologists and plastic surgeons will get the attention of HIV/ID specialists, but this past week was an exception. From the FDA report:
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