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HIV JournalView

Top 10 HIV Clinical Developments of 2012

December 2012

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The Cascade, the Cascade!

A review of:

U.S. Centers for Disease Control and Prevention (CDC). Vital Signs: HIV prevention through care and treatment -- United States. Morb Mortal Wkly Rep. 2011 Dec 2; 60:1618.

Engagement in HIV Care

Ideas flow easily and instantaneously in our hyper-connected, socially networked age, but some concepts split from the cacophony: They resonate clearly and singularly, spreading in a way that can only be described as viral. Ed Gardner and colleagues created such a meme in a simple graph last year, illustrating for us the proportions of those living with HIV in our midst who are (and are not) aware of their infection, engaged in care, receiving HIV therapy and achieving viral suppression. At the exhausting end of the exercise, we are left with an embarrassingly small percentage of infected folks who have achieved HIV nirvana.

Their staircase image is simple and brilliant. With each step, there is failure -- but also opportunity: Get more into care, and every bar downstream should get higher.

This year the CDC updated Gardner's original calculations, finding a slightly rosier picture and spreading the "cascade" concept far and wide.

We are now blessed and cursed with The Cascade. Experts debate whether raising the left side or the right side should be the focus of our attentions (how about the middle?). Regardless, The Cascade is an important visual totem of where we stand and what we have to do -- a visual reference that we can use to conceptualize the state of the HIV epidemic and our responses. And, it is here to stay.

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This article was provided by TheBodyPRO.com. It is a part of the publication HIV JournalView.
 

Reader Comments:

Comment by: Ashley (QMsiijnYJx) Thu., Jan. 10, 2013 at 10:18 am EST
the HIV virus is very fragile once it is oudtsie of the human body. when it is exposed to the air, it dies in about 2 hours. so, dried semen will only have dead HIV cells. you are safe.
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Comment by: Mani (UubwaSyASLWZnBAlN) Thu., Jan. 10, 2013 at 9:29 am EST
I've talked to both my patrens about it at differnt times. My mom thinks it nessasary. She knows that teens r going to have sex and they need to be educated.My dad thinks its better to be educated then to not know anythingI think sex-ed is needed for everyone. I never though my dad (the republican who was in the army) Would be so libral
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Comment by: harleymc Tue., Dec. 25, 2012 at 11:02 pm EST
I was very happy to read this article.
I'm someone who's been on combinations containing boosted PIs and suffer badly with them. When my current script runs out in a few days I'll be switching to TDF/FTC/rilpivirine + raltegravir (already on the raltegravir). It was reassurring to read of an improvement in outcomes.

It's one thing to have a fabulous viral load but when side effects are both vile and life threatening, a change sounds brilliant.
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Comment by: Anonymous Mon., Dec. 17, 2012 at 10:48 am EST
good message of hope
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Comment by: Sean (Dublin, Ireland) Fri., Dec. 14, 2012 at 6:38 am EST
Thanks for the section called "The Cure Agenda". If YOU are feeling optimistic, that makes me feel optimistic.

Happy Yule!
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Comment by: Patrick D (South Deerfield, MA) Thu., Dec. 13, 2012 at 3:56 pm EST
Dr. Wohl writes "In the past, I have played with the HIV therapies of patients doing well, and on more than a few occasions I have been burned," then describes some of the benefits that may come from switching from a more complex drug regime to a more simplified one. Dr. Wohl clearly has his patients best interests in mind, but I want to remind him that when a switch in meds fails (temporarily or permanently) for patients who had been doing well on an older regime, it isn't the doctor who gets burned, it's the patient. I have had occasion to remind my own doctors of this, when they seem to want to fiddle with a regime that is working perfectly well, with negligible side effects, for no other reason than to put their signature on my treatment.

It can indeed be a benefit to simplify a drug regime, especially for patients who have trouble taking their meds in the first place. But as I've reminded several doctors, for many HIV patients, HIV drugs are not the only drugs we're taking (and that's not taking supplements into account), so simplifying the HIV drug regime alone doesn't result in not taking other drugs at other times of the day, and thus may not be a strong reason for changing a regime that's working.
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