Another disappointing note was bellowed out this month concerning the discontinuation of part of a significant HIV prevention trial in women. The 1% tenofovir (Viread) gel arm of the VOICE phase 2B clinical trial was halted early by the independent Data and Safety Monitoring Board (DSMB).
Getting the level of new infections down to zero will require breakthroughs not only in medications and improved interventions, but also a broadening of our understanding about the underlying causes of high-risk behaviors which can increase vulnerability for HIV, specifically, mental health concerns.
Over in Journal Watch AIDS Clinical Care, Carlos Del Rio reviews a couple of remarkable studies on HIV and aging.
A research letter recently published in the journal AIDS by Vorkas et al determined that testosterone use was associated with polycythemia, and intramuscular administration demonstrated a stronger association than topical (testosterone patch) use. No adverse cardiovascular or thrombotic events were observed. HIV-infected patients taking testosterone should undergo routine hematologic monitoring with adjustment of therapy when appropriate.
I didn't attend "The Liver Meeting" (the nickname for the annual meeting of the American Association for the Study of Liver Diseases, AASLD), but the studies presented there this week on HCV treatment were absolutely mind-boggling.
I recently wrote a "stand-up" blog (pun intended) on erectile dysfunction in HIV-positive men over age 50, which caused a few tongues to wag. So in order to present "fair balance" between the genders, this "dictates" (oh my) that I must blog on HIV-positive women over 50 and sexual function, or lack thereof.
I was a new provider in the clinic, and she was one of my first patients, HIV positive for over 10 years. As I entered the exam room and saw her staring out the window, I made at least half a dozen intuitive assessments about her. She was well-dressed; clearly a strong and authoritative woman; a well-respected professional with very high standards of herself and others. As she began to share her story, I realized I was correct on all counts. Judging by the questions she asked me, I was not spared from her high expectations.
Preliminary research suggests that a patch could deliver an AIDS drug to patients ... The researchers successfully used transdermal patches to administer 96 percent of an AIDS drug to simulated skin over a week. "Still, the important limitation of pills, regardless of how few there are or even how minimal the side effects, is adherence," Johnston [the investigator] noted. Research has shown that many patients, if not most, don't take their pills all the time.
Public apprehension about recreational drugs, especially those that impact HIV, seems to come in waves that swell with increasing alarm and then peak and fade away, always to be replaced by the next "drug du jour." Heroin, cocaine, and methamphetamine, each with a well-deserved reputation for putting people at risk for HIV or, if HIV positive, for interfering with their ability to properly manage their health, have all gained notoriety in recent years.
World Series time, hence the baseball reference in the title. (Doesn't take much.) But over in Lancet Infectious Diseases -- which has turned out to be a terrific journal, by the way -- there's a study reminding us that advances in HIV treatment in the late 2000s were truly spectacular.