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.
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.
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,
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:
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."
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.
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.
She's back. Tina, that is. Crystal, crank, meth, ice, amp -- all slang for the same drug: methamphetamine. In the early part of the millennium, meth was pervasive both in rural America and in urban gay communities. Its use peaked around 2005 when, following a federal law limiting access to its primary precursor, pseudoephedrine, usage seemed to drop. In gay communities, men became aware of its hazards as they watched friends lose lovers, jobs, health, freedom and even their lives. Pursued by law enforcement, hardcore users went underground but never really went away. Now, because of the cycles of recreational drugs, a new generation, short memories, and the seductive power of this dopamine-releasing supermolecule, the drug appears to be making a comeback, at least in the gay community.
In a previous post, we reviewed the various flavors of medication non-adherence, and concluded with this tantalizing line:
Next up: "An Adherence Intervention that Actually Works -- But There's a Catch"Well here it is, just published on-line in JAMA Internal Medicine.
Treatment of HIV has become so amazingly effective that when it fails, it's no overstatement to say that it's usually because the patient is not taking the medications. There are all kinds of provider-related reasons for this -- inadequate patient education, prescribing and dispensing errors, failure to address language or education deficits -- but here I want to focus on the patient-related causes.
In other words, on non-adherence.