{"id":129,"date":"2008-11-02T06:38:11","date_gmt":"2008-11-02T11:38:11","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=129"},"modified":"2015-06-04T15:31:40","modified_gmt":"2015-06-04T19:31:40","slug":"the-big-hiv-news-from-icaacidsa","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/the-big-hiv-news-from-icaacidsa\/2008\/11\/02\/","title":{"rendered":"The Big HIV News from ICAAC\/IDSA"},"content":{"rendered":"

\"\"<\/a>Tons of interesting stuff at this year’s combined ICAAC\/IDSA meeting,<\/a> most of it in non-HIV related Infectious Diseases. \u00a0In aggregate, literally hundreds of posters, presentations, and symposia on MRSA, C diff, osteomyelitis, complicated UTIs, hospital-acquired pneumonia, antibiotic resistance … It’s a great meeting to catch up on general ID, and the literature review sessions alone are practically worth the price of admission.<\/p>\n

But there are almost always a few major HIV-related studies presented as well, and this year was no exception. \u00a0These two understandably got the most attention:<\/p>\n

    \n
  1. Early antiretroviral therapy increases survival [Kitahata H-896b]. \u00a0<\/strong>The NA-ACCORD study compared all-cause mortality among more than 8,000 patients with HIV followed since 1996.\u00a0 Compared with those starting therapy with a CD4 cell count between 200 and 350, patients starting with CD4s between 350 and 500 had a 70% reduction in the risk of death. <\/em>\u00a0Wow. \u00a0[Addendum:\u00a0 Our astute editor at AIDS Clinical Care points out that this is really a 43% reduction, as the relative hazard for mortality for the group deferring is 1.7.\u00a0 Still wow.]\u00a0 Usual caveats on the limitations of cohort studies apply, but this was a very well done study with a huge sample size; its conclusions were further bolstered by the observation that virologic suppression rates did not differ between the two groups — implying comparable levels of medication adherence. \u00a0Stay tuned for a similar analysis of those starting with a CD4 > 500 cells — whispers that we’ll see this info at next year’s CROI in Montreal<\/a>. \u00a0\u00a0Will this be the final word on the “when to start treatment” question we’ve been debating now for two decades<\/a>? \u00a0Should pretty much every <\/em>patients with HIV be on therapy? \u00a0What will happen to the planned “START<\/a>” randomized trial?\u00a0\u00a0I sense unless something truly unanticipated happens with drug toxicity, we’re going to be starting a lot of asymptomatic patients on treatment over the next few years.<\/li>\n
  2. Raltegravir vs efavirenz as initial therapy [Lennox H-896a].<\/strong> \u00a0Can something be as good as efavirenz (essentially our current gold standard) \u00a0for initial therapy? \u00a0Apparently yes — raltegravir was “non-inferior*” to efavirenz when combined with TDF\/FTC in a large phase III, double-blind study:\u00a0\u00a0Virologic suppression rates at 48 weeks were 86% for RAL compared to 82% for EFV.\u00a0 There were also lower rates of drug-related averse events in the raltegravir arm, with protocol-specified CNS toxicity occurring in 18% of efavirenz and 10% of\u00a0raltegravir-treated subjects. \u00a0We’ve been using the 2NRTI + NNRTI or PI \u00a0approach as initial therapy for a long time — here at last is a new approach.\u00a0<\/li>\n<\/ol>\n

    And for the record, I’m a big fan of this combined ICAAC\/IDSA meeting, but it will be separate for at least\u00a0the next two years at least. \u00a0Oh well.<\/p>\n

    *The use of the term “non-inferior” always sounds like pedantic statistics-ese to me.\u00a0 86% “non-inferior” to 82%?\u00a0 But it does mean something specific — best described to me as “not too much worse than”, with “too much worse” generally defined as within\u00a010-12%.\u00a0 But the lower-limit of the 95% confidence interval can’t be below this 10-12%, and that’s where peculiar statements such as “86% is noninferior to 82%” come from.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

    Tons of interesting stuff at this year’s combined ICAAC\/IDSA meeting, most of it in non-HIV related Infectious Diseases. \u00a0In aggregate, literally hundreds of posters, presentations, and symposia on MRSA, C diff, osteomyelitis, complicated UTIs, hospital-acquired pneumonia, antibiotic resistance … It’s a great meeting to catch up on general ID, and the literature review sessions alone […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,6],"tags":[77,83,162,244,399,423,478,485,779,805],"class_list":["post-129","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-medical-education","tag-antiretroviral-therapy","tag-art","tag-cd4","tag-croi","tag-haart","tag-hiv","tag-icaac","tag-idsa","tag-raltegravir","tag-retrovirus-conference"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/129","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=129"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/129\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=129"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=129"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=129"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}