HIV Care Today

HIV Opportunistic Infection Guidelines Updated
By Paul E. Sax, M.D.
May 8, 2013

Some very hard-working folks at the NIH, CDC and IDSA have updated the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, which are available for review here.

As with the previous versions (the prior iteration is from 2009), the OI Guidelines are comprehensive, exhaustively referenced (184 references for TB alone!), and authoritative. Note that the PDF version weighs in at 416 pages, so I doubt many people will be printing this out and carrying it around in their white coats. Fortunately, for the first time these Guidelines are also available in their entirety online in an HTML version, which is undoubtedly how most will access them, and certainly make them easier to update.

Read more … Rethinking How We Learn to Practice HIV Medicine
By Benjamin Young, M.D., Ph.D.
May 6, 2013

Less than 20 years ago, when I started doing HIV/AIDS care, most of my patients died within a year or two of their diagnosis. Medications were only marginally effective and caused side effects (or even death), and the notion of long-term survival was only a hope. To discuss a normal life expectancy was wishful thinking, perhaps false hope.

Read more …

How to Interpret Medical Breakthroughs in the Mainstream Media
By Paul E. Sax, M.D.
May 2, 2013

There it is, right in your daily paper, on your tablet or computer screen, or wherever you get your news today -- a headline about a great medical breakthrough everyone's been waiting for:

Scientists on Brink of HIV Cure
Researchers believe that there will be a breakthrough in finding a cure for HIV "within months."

Yes, I read this exact headline recently.

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Lost and Found: Helping Patients Develop Emotional Resilience
By David Fawcett, Ph.D., L.C.S.W.
April 30, 2013

Widespread publication of the treatment cascade has heightened the level of concern for engaging and retaining patients in HIV care. A significant percentage of persons living with HIV are unaware of their status, and an astonishingly low number of people have successfully suppressed their viral loads. Despite recent articles that have reported potential variation in these calculations, it is clear that a significant number of people remain out of care, marginally engaged or worse.

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Data Safety Monitoring Board Closes HIV Vaccine Study -- the End of Adenovirus as a Vaccine Vector?
By Paul E. Sax, M.D.
April 29, 2013

On Friday, the NIH announced that HVTN 505, a clinical trial of an HIV vaccine using an adenovirus vector, would be stopped based on a finding of futility by an independent DSMB.

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Postexposure Prophylaxis (PEP) After Blast Injuries
By Paul E. Sax, M.D.
April 20, 2013

From a colleague came this query:

We are being consulted by surgeons who are finding within blast victims tissues from other humans. We have been offering post-exposure prophylaxis. Have you folks developed any policies re PEP for explosion victims?
Welcome your thoughts,

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How Often Do You Measure CD4 Cell Counts?
By Paul E. Sax, M.D.
March 28, 2013

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:

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Redefining Expanded Access for Patients With Multidrug-Resistant HIV
By Nelson Vergel, B.S.Ch.E., M.B.A.
March 21, 2013

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."

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Really Rapid Review: CROI 2013, Atlanta
By Paul E. Sax, M.D.
March 10, 2013

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.

Read more …

Exploring the Media Fascination With the Baby Cured of HIV
By Paul E. Sax, M.D.
March 5, 2013

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.

Read more …

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