Over in Journal Watch AIDS Clinical Care, Abbie Zuger has written a fascinating perspective on the recent enthusiasm for universal HIV treatment.
Her take? Let's just say she doesn't share the enthusiasm of public health officials and members of guidelines committees. Well, that's a huge understatement.
From the key "What's New in the Guidelines" section of today's Department of Health and Human Services update:
ART is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pretreatment CD4 cell count.
Several attendees drove fifteen hours from St. Louis. Others came by caravan from Atlanta. In the hotel lobby there were happy reunions of friends who hadn't seen each other since last year. Overall nearly four hundred and fifty people made their way from 22 states to the white sandy beaches of the Florida panhandle in early March. It was spring break, but their purpose was much more a matter of life and death. They were gathering for Positive Living 15, the largest conference in the nation specifically for people living with HIV.
Screening for anal cancer in men who have sex with men (MSM) -- with pap smears, high resolution anoscopy, with whatever test -- is quite the quagmire.
Some highly subjective highlights -- a Really Rapid Review™ -- from this year's Number One Greatest Super Scientific HIV Conference, the 19th Conference on Retroviruses and Opportunistic Infections (CROI), which ended last week in Seattle:
You know that tenofovir, emtricitabine, and efavirenz HIV regimen? The one that's universally listed as one of the "Preferred," or "Recommended" or "First-line" options in all HIV treatment guidelines in the universe? And the regimen that is easily the most widely used in the USA today? Well, here's a surprising review from Cochrane Summaries, entitled "Effectiveness and safety of first-line tenofovir + emtricitabine + efavirenz for patients with HIV" ...
The news that hepatitis C (HCV) has passed HIV as a cause of death in the United States got quite a bit of attention when it was first presented last year at ICAAC -- and no doubt the published paper, in this week's Annals of Internal Medicine, will also cause a stir. In fact, I boldly predict that going forward, (approximately) 94.2% of HCV-related research grants, journal articles, and lay press articles will cite this paper, making it (for now) the "Palella NEJM 1998" of HCV.
As providers, we spend time in hospitals, clinics and offices attempting to educate our patients on prevention and treatment of disease. But how many times have we heard that, after the patient walked out of exam room, he or she stated to the nurse, "I don't understand what the doctor just said to me about my health. Can you tell me?" The patient probably heard what Charlie Brown hears when his teacher is speaking to him. "You should do this and you shouldn't do that, mwa mwa, blah, blah, wah, wah. Have a nice day." Total gibberish!
By now I'm sure that most of you ID folks out there have received the following letter from Merck, the makers of boceprevir:
I have a very smart, very experienced colleague -- clue, his initials are CC, and he doesn't pitch for the Yankees -- who continues to use bDNA testing for HIV viral load monitoring. You know, the assay with a lower limit of detection of 75 copies. He knows that bDNA is less sensitive than PCR. He knows that it's more expensive than PCR.