HIV and ID Observations

March 20th, 2009

Hair Today, Gone Tomorrow …

Since providers — especially doctors — are notoriously poor at predicting medication adherence, here’s some good news: In a paper from the Women’s Interagency Health Study, protease inhibitor levels in hair samples were the strongest independent predictor of virologic success — better than self-reported adherence, age, race, baseline viral load and CD4 cell count, and […]

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March 14th, 2009

Maybe It’s Not the Cheeseburgers

… At least that’s the implied message in this nice paper from the latest Annals of Internal Medicine, which evaluated responses to lipid-lowering therapy among patients with and without HIV. The study included patients from the Kaiser Permanente of Northern California integrated health system, with 829 individuals with HIV and 6941 without. The quick summary […]

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March 10th, 2009

Unwelcome Visitor: Cost of HIV Meds

Those of us who practice HIV medicine in Taxachusetts (warning, click link at your peril) live a pretty charmed life, at least so far as getting HIV medications paid for.  Due to an incredibly generous AIDS Drug Assistance Program (ADAP), rare is the patient who faces financial barriers getting his or her drugs. (By the […]

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March 4th, 2009

TaqMan HIV RNA Assay: Be Careful What You Wish For

At our hospital lab, we recently switched from the bDNA viral load assay to the new Roche TaqMan real-time PCR test.  The virologist in charge of our lab and the tech both agreed the assay was more accurate, more sensitive, and easier to do — so much so that we could increase the frequency of […]

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March 1st, 2009

Sedation for Colonoscopies in HIV Patients: Debate Rages

Here’s a problem we’re grappling with: A patient with HIV needs a colonoscopy, but is on either a ritonavir-boosted protease inhibitor or an efavirenz-based regimen. (This must be something like 90% of HIV patients as of March 1, 2009, based on my extremely unscientific gut impression.) For efavirenz, midazolam is contraindicated; for ritonavir, same story […]

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February 1st, 2009

Whither PEPFAR?

Mark Dybul will no longer be running the President’s Emergency Plan for AIDS Relief, or PEPFAR, the multi-billion dollar international program for HIV treatment program started by Bush in 2003. Some are happy.  Others are not. (Note the exquisite use of euphemism — he was “required to submit his resignation“, not “fired.”) Experts on global […]

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January 29th, 2009

Too Many Options: What Actually Happened

We recently published a case in AIDS Clinical Care entitled “Too Many Options”, describing a patient with longstanding HIV infection, virologic failure, and resistance to NRTIs, NNRTIs, and PIs. Fortunately, resistance and tropism testing gave him several options for a new drug regimen — including darunavir, etravirine, maraviroc, enfuvirtide, and — if one believes phenotypic […]

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January 22nd, 2009

Fear of Vaccines: Not Just Parents

Fear of vaccines are legion among many parents, with enormous public health resources devoted to defusing this fear and trying to debunk common myths.  I find this site particularly useful. (Talk about a “hot button” topic.  Read this to get an idea about how passionate views on vaccine safety can be.  Wow.) This fear, however, […]

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January 13th, 2009

Can We Have “Too Many Options?”

As part of our regular series “Antiretroviral Rounds” in AIDS Clinical Care, today we post a case of a highly treatment-experienced patient with dreaded “triple class” resistance — that is, resistance to NRTIs, NNRTIs, and PIs. The good news now, of course, is that we have more than these three drug classes. The tough part […]

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January 4th, 2009

Top Stories in HIV Medicine

Happy New Year! In the spirit of list-making that seems to permeate the world right about this time, we’ve just published our own list over at AIDS Clinical Care.  Check it out — our editorial board this year did a superb job of summarizing the field. I have a strong feeling that next year’s version […]

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