November 30, 2016
In typical years, a noteworthy development in the world of HIV would be the result of a landmark clinical trial or perhaps a gem of a lab study with a novel finding. But, 2016 was not typical. What made the most difference for people living with HIV and their health care providers this past year was less a paper published or presented than major shifts in our thinking about how best to prevent and manage HIV infection.
This was the year of the "shake-up" and the eschewing of the good-enough status quo. HIV-positive patients and their providers, traditionally cautious in their approach to treatment, have recently become willing to embrace change, including to antiretroviral regimens. "Switch and simplification" have replaced "stay the course" as a guiding HIV therapeutics mantra. New drugs and formulations offer treatment options that are markedly easier and safer than the medications on hand just a year or two ago. Even the dogma regarding what constitutes highly active antiretroviral therapy (ART) is being questioned by daring ART minimalists for whom fewer drugs mean lower risks and costs. At the same time, the movement that advocated successfully for earlier administration of HIV therapy is now pushing for provision of medications the same day a patient presents for testing. For all this radicalism, there were also throwbacks to retro ideas, such as using antibodies to fight HIV -- an approach that was tried but failed early in the epidemic.
Overshadowing this evolution of thought were the results of the presidential election and the delivery of control of both the House and Senate, as well as a few governorships, to the Republican Party. Perhaps no other development will have as much impact (think: comet, dinosaurs) on the future of people living with HIV as the 2016 elections -- and that is where we start.
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David Alain Wohl, M.D., is a professor in the Division of Infectious Diseases at the University of North Carolina at Chapel Hill, director of the North Carolina AIDS Training and Education Center and site leader of the University of North Carolina Chapel Hill AIDS Clinical Research Site.
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