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HIV Care Today


Why I Started Supporting PrEP
By Lisa Fitzpatrick, M.D., M.P.H.
April 1, 2014

In 2011, when the U.S. Centers for Disease Control and Prevention (CDC) released interim guidance on pre-exposure prophylaxis (PrEP), I was immediately skeptical about the feasibility and pessimistic about the practicality of this intervention. If health care providers won't routinely screen for HIV, how would we convince them to prescribe a prevention pill to healthy people? Furthermore, by embracing this biomedical intervention, I believed the CDC was signaling the eventual abandonment of behavior change interventions. I was deeply disappointed -- until World AIDS Day 2013, when a young, gay man was diagnosed with acute HIV infection at our hospital. His story has forced me to face the reality of PrEP's role as a viable and necessary prevention strategy for people like him.

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CROI Is Over -- and a Baby Once Again Takes Center Stage
By Paul E. Sax, M.D.
March 10, 2014

One of our fellows asked me this AM when I was posting a RRR (Really Rapid Review™) of CROI 2014, and my response was to clear my throat, make some vague excuses, and curse the respiratory viruses that seem as perpetual as the cold weather this year.

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PRO Men: A Bay Area Program Providing Reproductive Health Support for HIV-Positive Men
By David Fawcett, Ph.D., L.C.S.W.
February 28, 2014

"Are you an HIV-positive man who has sex with women? You can have the sex life you want and the family you want," begins a flyer announcing a connections mixer at PRO Men (Positive Reproduction Options for Men), an innovative program of the Bay Area Perinatal AIDS Center (BAPAC) in San Francisco. While reproductive health services have increasingly been available for HIV-positive women, men living with the virus have had far fewer services and support. As one man states in a video produced by the program, "I thought my sex life was over [and that I would] never have a chance of having a family, but that's not the case."

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Simeprevir and (Especially) Sofosbuvir Are Great Leaps Forward -- and They Will Cost Plenty
By Paul E. Sax, M.D.
December 8, 2013

Hepatitis C has been potentially curable for decades, but it's hardly been easy. "I feel like I'm slowly killing myself," said one of my patients, memorably, during week 24 of a planned bazillion-week course of interferon-ribavirin. (Actually it was only 48 weeks, but seemed like a bazillion weeks.)

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5 ID/HIV Things to Be Grateful for This Holiday Season
By Paul E. Sax, M.D.
November 30, 2013

I was speaking with a British colleague the other day, and she was remarking how jealous she was that we get a Thanksgiving holiday each year. Starting with a long whine (or moan, as they would say) about the pressures, commercialization, cost, and religious aspects of Christmas, she then went on about how perfect Thanksgiving seems from her outsider perspective.

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Janssen to Stop Offering "Virtual Phenotype" Testing, and Musings on Progress
By Paul E. Sax, M.D.
November 16, 2013

Must say it's in some ways sad to see it go -- in my opinion the nifty work they did correlating genotype results with their database of phenotypes gave the clearest representation of what a genotype actually means. If you didn't want to order both genotype and phenotype simultaneously -- which was expensive and took weeks to come back from the lab -- vircoTYPE was was the most efficient way to get information on complex resistance patterns. Sure, one could quibble about methodology and validation of the test, but it was remarkable indeed to send a genotype and get back results estimating fold-change, upper and lower cut-offs, full and partial activity -- and virus clade, just for kicks.

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SINGLE Study Underscores Waning of the Efavirenz Era -- But Probably Just in the USA
By Paul E. Sax, M.D.
November 6, 2013

In today's New England Journal of Medicine, the SINGLE study finally makes its appearance "in print." (The study results were first presented over a year ago.) The highlights:

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Research on Two Supplements Addresses HIV-Driven Inflammation in the Gut
By Jeannie Wraight
October 31, 2013

Gastrointestinal (GI) health is proving to be a vital, though often ignored, component of HIV infection. Recent research presented at the 7th International AIDS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013), which took place this past July in Kuala Lumpur, Malaysia, showed that microbial translocation and the damage done to gut-associated lymphoid tissue (GALT) during primary HIV infection has a dramatic effect on the pathogenesis of HIV, including the disruption of microflora, resulting in ongoing and damaging inflammation. While more research on the effects of HIV on the GI system is sorely needed, the consequences of sequestration on the National Institutes of Health (NIH) budget, along with the growing competition to prioritize directions in therapeutic investigation, ranging from viral host restrictive factors to preventive vaccines, make putting anything else on the table an enormous challenge.

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GARDEL Two-Active-Drug Study Not a Game-Changer, but Might Be a Paradigm-Shifter
By Paul E. Sax, M.D.
October 25, 2013

Here are the key details about the GARDEL study, presented just this week by Pedro Cahn at the European AIDS Clinical Society meeting, or EACS:

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A Perfect Storm: Prescription Opioids, Heroin, Needles and HIV
By David Fawcett, Ph.D., L.C.S.W.
October 18, 2013

It was a common scene several years ago throughout Fort Lauderdale. Clinic parking lots were filled with cars bearing license plates from Georgia, Tennessee, Pennsylvania and Kentucky. When one vehicle pulled out it was immediately replaced by another, and another after that. These were not snow birds seeking sun and warm temperatures, but rather people trafficking opiates. They shopped at dozens of pain management clinics dotting Broward County, buying hundreds of OxyContin (oxycodone) to take home and sell. At one point, Broward County had more so-called "pill mills" than McDonald's, and a few local physicians prescribed more of the narcotic than the rest of the country combined.

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