{"id":7902,"date":"2015-11-26T08:10:22","date_gmt":"2015-11-26T13:10:22","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=7902"},"modified":"2021-11-23T05:48:11","modified_gmt":"2021-11-23T10:48:11","slug":"five-ok-six-idhiv-things-to-be-grateful-for-this-holiday-season-2015-edition","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/five-ok-six-idhiv-things-to-be-grateful-for-this-holiday-season-2015-edition\/2015\/11\/26\/","title":{"rendered":"Five (OK, Six) ID\/HIV Things to be Grateful for this Holiday Season, 2015 Edition"},"content":{"rendered":"

Some quick ID\/HIV gratitude items for 2015, done rapidly as we’re hosting a big meal later today.<\/p>\n

I wonder what that might be.<\/p>\n

    \n
  1. New Ebola virus disease cases and deaths have dramatically declined.<\/strong> I write that\u00a0sentence with some trepidation, as cases continue to occur sporadically<\/a><\/strong>, and this late relapse in a nurse<\/a><\/strong> was a chilling reminder of how little we know about this disease.\u00a0Additionally, since what caused the massive outbreak in Western Africa is still poorly understood, complacency about Ebola\u00a0would be very\u00a0ill-advised. Nonetheless, the reason we should be grateful is shown clearly in this figure of Ebola incidence:<\/a><\/strong>
    \n    \"evd<\/a>
    \n<\/a>Last year at this time we were right in the middle of that steep upward slope, with no idea when<\/em> or how<\/em> cases would decline. That these\u00a0curves have plateaued is due to massive local control efforts (thank you!); work on both a vaccine and antiviral therapy also continue briskly.<\/li>\n
  2. Antibiotic prescribing declines.<\/strong> Whether it’s the growing awareness of the importance of the microbiome, concerns about resistance, publicity about the dreaded C diff, fear of drug toxicity, or (most likely) some combination of the above, people are receiving fewer prescriptions for antibiotics. The data from this study<\/a><\/strong> confirm something that most clinicians increasingly see in their patients — some sort of tipping point has been reached, where now a growing number of people are willing to tough out community-acquired respiratory infections and nagging coughs and ear aches rather than berate their doctors with references to “green phlegm” (code for “Give me a Z-pak”<\/a><\/strong>). Now if we can just get the farm animals to have a voice in this too — 80% of antibiotic use in this country is for agricultural purposes.<\/li>\n
  3. PrEP works really, really well when given to people who want (and need) it.<\/strong>\u00a0Confession:\u00a0I thought pre-exposure prophylaxis (PrEP) for HIV was forever going to remain a very small piece of the HIV prevention effort. But I’ve been wrong (many times) before — hey, I thought putting cameras in phones was a ridiculous idea — and it turns out I was wrong about PrEP, too. In both the PROUD<\/a><\/strong> and IPERGAY<\/a><\/strong> (soon to be published in a major medical journal<\/em>) studies, men who have sex with men who were at high risk of contracting HIV reduced that\u00a0risk by nearly 90% by taking TDF\/FTC. Not surprisingly, uptake of PrEP has increased dramatically in the past year, a trend I expect will continue given CDC’s efforts to get the word out.<\/a><\/strong><\/li>\n
  4. HCV treatment now works just as well in clinical practice as it does in clinical trials.<\/strong> Remember when combination HIV therapy came out in the mid-1990s, and\u00a0several papers (notably this one<\/a><\/strong>) cited far<\/em> worse outcomes in “real life” than in the clinical trials? Or when the same exact thing happened with telaprevir and boceprevir-containing regimens for HCV? Guess what — current HCV treatment is so good that “real life” (whatever that means) outcomes are outstanding<\/em>, with cure rates greatly in excess of 90% for most genotype 1 patients.<\/a><\/strong>\u00a0Although every\u00a0HCV treater has\u00a0a few\u00a0examples of treatment failure, they are just that — a few.<\/li>\n
  5. Treatment as prevention is\u00a0staggeringly effective in preventing HIV — still.<\/strong> Did anyone expect\u00a0zero<\/em> HIV transmissions from HPTN 052 participants\u00a0with virologic suppression?<\/strong> <\/a>Or from those individuals in the cohort studies of “condomless sex”? I bet somewhere the Swiss are\u00a0muttering under their breath (in French? German? Italian?), I told you so.<\/em> Bottom line is that there really is all but zero risk.<\/li>\n
  6. The end of the “When to Start” debate. <\/strong>\u00a0The much-anticipated START study showed that even the healthiest HIV-infected people — those with CD4 cell counts > 500 and no symptoms — benefit from immediate antiretroviral therapy,<\/a><\/strong> with fewer HIV and non-HIV related serious medical problems. When you add these results to the transmission benefits in item #5 above, the clear\u00a0answer to the question, “When to start?” HIV treatment is pretty straightforward. Now!<\/em><\/li>\n<\/ol>\n

    As for the video below, I’ve\u00a0been waiting eagerly\u00a0since my 8th grade typing class to see it\u00a0in action — am very grateful finally to see it.<\/p>\n