{"id":1422,"date":"2011-03-08T17:17:45","date_gmt":"2011-03-08T22:17:45","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=1422"},"modified":"2015-06-04T15:23:54","modified_gmt":"2015-06-04T19:23:54","slug":"really-rapid-review-of-croi-2011-and-no-croi-2012-dates","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/really-rapid-review-of-croi-2011-and-no-croi-2012-dates\/2011\/03\/08\/","title":{"rendered":"Really Rapid Review of CROI 2011 — and No CROI 2012 Dates"},"content":{"rendered":"

\"\"<\/a>With CROI 2011 now officially over, I offer below the following Really Rapid Review\u2122\u00a0for ID\/HIV Specialists with limited time — or for those who said they went to the conference but spent the entire week shopping in the Prudential Mall and eating at Legal Seafood:<\/p>\n

    \n
  1. Lots <\/em>on PrEP<\/a>. \u00a0Bottom line — it works if you take it, but lots of people in iPrEx didn’t take it, especially in non-US sites. \u00a0And bone density goes down a bit in those receiving TDF\/FTC, long-term implications not known. \u00a0Based on conversations I had with colleagues, it didn’t seem that anyone had been prescribing PrEP much thus far.<\/li>\n
  2. HCV treatment is about to get much <\/em>more effective, and much <\/em>more complicated. \u00a0The drug-drug interactions with antiretroviral drugs and the first two HCV-protease inhibitors — telaprevir and boceprevir — are going to be really, really dicey. Sensational web-cast here<\/a> of a plenary given by Stefan Zeuzem\u00a0that summarizes lots of the key issues.<\/li>\n
  3. Once-daily raltegravir doesn’t work quite as well as twice-daily.\u00a0Old news, but detailed data on the trial presented here<\/a> for the first time. \u00a0Turns out PK does matter after all in the QD group.<\/li>\n
  4. Speaking of raltegravir, if you predicted that approximately 25% of treatment-naive subjects who were put on boosted darunavir plus raltegravir would experience virologic failure<\/a>, you are smarted than I am. These are two of our best drugs — how can we explain this?<\/li>\n
  5. Time to learn a new drug name: \u00a0“S\/GSK1349572\u201d = \u201c572\u201d = \u201c<\/strong>dolutegravir<\/a>\u201d = <\/strong>“DTG”, which really does have antiviral activity against some raltegravir-resistant viruses.<\/li>\n
  6. Two additional studies (here<\/a> and here<\/a>) show that\u00a0blacks in the USA do worse than whites in clinical trials. \u00a0The explanation must be at least in part socioeconomic, since clearly Africans in Africa are doing just as well on ART as people in resource-rich settings. Critical to figure out why we have this disparity.<\/li>\n
  7. Many studies on inflammation and immune activation, including this incredibly counter-intuitive study<\/a> of maraviroc intensification of already suppressive ART. \u00a0Results are too complex for this Really Rapid Review\u2122, but they go something like this: \u00a0certain markers increased; others decreased; no one knows why; no one knows the clinical implications. \u00a0Which pretty much sums up this whole “inflammation and immune activation” field right now.<\/li>\n
  8. If you have active TB and advanced HIV-related immunosuppression — that is, CD4 < 50 — the time to start ART is sooner rather than later.<\/a> <\/em> (Similar findings in this study<\/a>.) \u00a0All this makes complete sense, given what we’ve seen from earlier studies in such sick patients (A5164, CAMELIA). \u00a0Fact: \u00a0Untreated advanced AIDS is worse than IRIS.<\/li>\n
  9. Several years ago, plunked right into the middle of a slide session on clinical studies of antiretrovirals, came an out-of-nowhere basic science presentation (this<\/a> might have been it) on “zinc fingers”. \u00a0So odd was its appearance that it became something of an inside joke (a very <\/em>inside joke) among certain HIV clinicians. \u00a0(“Oh, he can’t tolerate ritonavir — maybe he’d do better on a zinc finger inhibitor.”) \u00a0And guess what — zinc fingers are back! <\/a> And it’s actually very cool stuff.<\/li>\n
  10. Does PI-based ART in the mom lead to premature delivery? \u00a0The Europeans have been saying so for some time, and this randomized clinical trial<\/a> from Botswana supports that view. \u00a0The questions remain — how clinically important? \u00a0And what are the best alternatives?<\/li>\n
  11. You know that question about whether NRTIs are needed in 2nd-line therapy (and beyond)? \u00a0Based on these two studies (here<\/a> and here<\/a>), it certainly seems so. \u00a0A randomized clinical trial — the so-called OPTIONS study — is ongoing to try and answer this question definitively.<\/li>\n<\/ol>\n

    Finally, unlike last year<\/a>, if the CROI 2012 dates were announced, I didn’t hear them — nor did anyone else I spoke to at the conference. \u00a0Darn. That “announcement” up there is a mock-up kindly crafted by my sister, who always did help me with my art projects in grade school.<\/p>\n

    But in case the conference organizers are still looking, there’s plenty of space at the Hynes Convention Center should they want to come back to Boston. \u00a0Right now, this group<\/a> is the only meeting booked for the whole month of February!<\/p>\n","protected":false},"excerpt":{"rendered":"

    With CROI 2011 now officially over, I offer below the following Really Rapid Review\u2122\u00a0for ID\/HIV Specialists with limited time — or for those who said they went to the conference but spent the entire week shopping in the Prudential Mall and eating at Legal Seafood: Lots on PrEP. \u00a0Bottom line — it works if you […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,5,6,10],"tags":[244,423,805],"class_list":["post-1422","post","type-post","status-publish","format-standard","hentry","category-hiv","category-infectious-diseases","category-medical-education","category-research","tag-croi","tag-hiv","tag-retrovirus-conference"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1422","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=1422"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1422\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=1422"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=1422"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=1422"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}