{"id":8198,"date":"2016-10-02T23:40:32","date_gmt":"2016-10-03T03:40:32","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8198"},"modified":"2016-10-05T17:12:03","modified_gmt":"2016-10-05T21:12:03","slug":"brink-hiv-cure-id-link-o-rama","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/brink-hiv-cure-id-link-o-rama\/2016\/10\/02\/","title":{"rendered":"&#8220;Brink of HIV Cure&#8221; ID Link-o-Rama"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/10\/British_scientists_on_brink_of_HIV_cure___News___The_Times___The_Sunday_Times.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-8200\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/10\/British_scientists_on_brink_of_HIV_cure___News___The_Times___The_Sunday_Times.jpg\" alt=\"british_scientists_on_brink_of_hiv_cure___news___the_times___the_sunday_times\" width=\"382\" height=\"320\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/10\/British_scientists_on_brink_of_HIV_cure___News___The_Times___The_Sunday_Times.jpg 696w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/10\/British_scientists_on_brink_of_HIV_cure___News___The_Times___The_Sunday_Times-300x252.jpg 300w\" sizes=\"auto, (max-width: 382px) 100vw, 382px\" \/><\/a>There, that title got your attention, didn&#8217;t it?<\/p>\n<p>Anyway, this HIV cure news thing and a few other ID\/HIV topics to contemplate while\u00a0buying your pumpkin, celebrating the New Year in October, or\u00a0shaking your head that all the stores seem to be putting out their Christmas stuff already. I mean, come on &#8212; it&#8217;s not even Halloween!<\/p>\n<ul>\n<li><strong>Are British scientists really on the <a href=\"http:\/\/www.thetimes.co.uk\/edition\/news\/british-scientists-on-brink-of-hiv-cure-w7zb86zw0\" target=\"_blank\">&#8220;brink&#8221; of an HIV cure?<\/a>\u00a0 <\/strong>No. Very glad they are making &#8220;remarkable progress&#8221;, but sounds like overly ambitious headline-writing to me. Reminiscent of <strong><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/how-to-interpret-medical-breakthroughs-in-the-mainstream-media\/2013\/05\/02\/\" target=\"_blank\">this story<\/a><\/strong> from a few years ago.<\/li>\n<li><strong>Nice summary over the\u00a0<a href=\"https:\/\/www.statnews.com\/2016\/09\/28\/2016-flu-season-shots-science\/?s_campaign=tw&amp;utm_content=bufferd8d1e&amp;utm_medium=social&amp;utm_source=twitter.com&amp;utm_campaign=buffer\" target=\"_blank\">latest controversies involving the flu vaccine<\/a>,<\/strong> in case your patients are asking. Repeated vaccines leading to reduced response, status of the live attenuated nasal vaccine (not dead yet &#8212; pun intended!), <a href=\"http:\/\/www.jwatch.org\/na42281\/2016\/09\/15\/do-statins-reduce-flu-vaccine-effectiveness?ijkey=qL8\/hN7\/3cWNE&amp;keytype=ref&amp;siteid=jwatch&amp;query=jwidhub&amp;variant=full-text\" target=\"_blank\">effect of statins <\/a>(but not <a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0008874909000471\" target=\"_blank\">NSAIDs<\/a> &#8212; remember that?) &#8212; lots of good stuff here. And yes, we should still be encouraging the annual shot.<\/li>\n<li><strong>Another <a href=\"http:\/\/ofid.oxfordjournals.org\/content\/3\/3\/ofw171.full\" target=\"_blank\">complication of severe influenza infection &#8212; invasive aspergillosis.<\/a><\/strong> Everyone knows about bacterial superinfections, now here&#8217;s another one to watch out for this flu season.<\/li>\n<li><strong>Serious illness appears to be <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/65\/wr\/pdfs\/mm6539e2.pdf\" target=\"_blank\">rare among children who acquire Zika.<\/a><\/strong> Refreshing to have some good news on this particular subject. Note that most of the children in this series were older (median age 14),\u00a0hence it&#8217;s not known whether acquisition of Zika in a newborn would have different clinical manifestations (in particular, long-term neurologic complications).<\/li>\n<li>On the topic of Zika, <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/65\/wr\/mm6539e1.htm?s_cid=mm6539e1_w\" target=\"_blank\"><strong>CDC now recommends that men\u00a0wait at least 6 months from last possible exposure (if even if asymptomatic) before attempting conception with their partner.<\/strong><\/a> This 6 month wait was previously recommended only for men who had symptoms. Is there a role for antibody testing after possible exposure? Unknown, but I bet good money that people will do it (understandably).<\/li>\n<li><a href=\"http:\/\/www.thelancet.com\/journals\/langas\/article\/PIIS2468-1253(16)30024-3\/abstract\" target=\"_blank\"><strong>Tenofovir alafenamide works just as well as tenofovir disoproxil fumarate for hepatitis B.<\/strong><\/a>\u00a0As we&#8217;ve seen in other comparative studies with TDF, there was a more favorable effect on bone and renal markers. Since treatment is going to be lifelong, the rationale behind\u00a0using TAF over TDF in hepatitis B is going to be just as strong as it is with HIV. (And you can use TAF in co-infected patients, despite the package inserts for TAF\/FTC, ECF-TAF, and RF-TAF.)<\/li>\n<li>From 2010-2013, approximately <strong><a href=\"http:\/\/cid.oxfordjournals.org\/content\/63\/8\/1049.abstract\" target=\"_blank\">1 in 4 people newly diagnosed with hepatitis C already had laboratory evidence of advanced fibrosis.<\/a>\u00a0<\/strong>Suspect the situation is much better now &#8212; there&#8217;s been a huge push for screening\u00a0&#8212; but\u00a0these data indicate a substantial burden of HCV-related disease regardless.<\/li>\n<li><a href=\"http:\/\/www.gastrojournal.org\/article\/S0016-5085(16)35070-3\/abstract?referrer=http%3A%2F%2Fwww.jwatch.org%2Fna42399%2F2016%2F09%2F23%2Flong-term-outcomes-with-hepatitis-c-virus-eradication\" target=\"_blank\"><strong>Prospective study shows that patients with HCV-related cirrhosis have significantly better outcomes after HCV cure.<\/strong>\u00a0<\/a><em>Important<\/em> outcomes, too &#8212; lower rates of hepatic decompensation, hepatocellular carcinoma, and death. People\u00a0with\u00a0HCV-related cirrhosis are analogous to\u00a0HIV with CD4 &lt; 200, or AIDS complications\u00a0&#8212; that is, those likely to benefit the most, and soonest, from treatment.<\/li>\n<li><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1602044#t=abstract\" target=\"_blank\"><strong>A single dose of azithromycin significantly reduced the risk of post-cesarean section infection<\/strong><\/a> when added to standard cephalosporin prophylaxis. Putative explanation is azithromycin&#8217;s activity against <em>Ureaplasma urealyticum<\/em>. Data from this study seem very convincing, and likely to change standard of care soon.<\/li>\n<li><a href=\"http:\/\/abcnews.go.com\/Health\/anti-vaxxer-mom-mind-kids-fall-ill\/story?id=42351543\" target=\"_blank\"><strong>One mother explains why she&#8217;s no longer anti-vaccine<\/strong><\/a> after her whole family &#8212; including her three children &#8212; developed severe rotavirus infection. Very brave to go public with something like this, and valuable, too, as turnarounds from previous anti-vaccination individuals seem\u00a0particularly\u00a0persuasive. For the record, my pediatrician wife\u00a0says her practice saw a decline in hospitalizations only months after the rotavirus vaccine was approved.<\/li>\n<li><a href=\"http:\/\/oncology.jamanetwork.com\/article.aspx?articleid=2554749\" target=\"_blank\"><strong>The HPV vaccine is already reducing the incidence of incidence of cervical\u00a0intraepithelial neoplasia.<\/strong><\/a> It will be fascinating to see how guidelines for cervical cancer screening are modified (with presumably reduced need for screening) as the cohort of vaccinated females ages.<\/li>\n<\/ul>\n<p>Meanwhile, allow me to finish with this <a href=\"https:\/\/twitter.com\/PaulSaxMD\/status\/779285130850529280\" target=\"_blank\">very funny curbside<\/a>\u00a0(at least funny to us).<\/p>\n<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/10\/80s-mosquito2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-8202\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/10\/80s-mosquito2.jpg\" alt=\"80s-mosquito2\" width=\"560\" height=\"613\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/10\/80s-mosquito2.jpg 560w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/10\/80s-mosquito2-274x300.jpg 274w\" sizes=\"auto, (max-width: 560px) 100vw, 560px\" \/><\/a><\/p>\n<p>Yes, I know &#8212; ID geek jokes. <a href=\"http:\/\/www.cdc.gov\/zika\/vector\/range.html\" target=\"_blank\">80s mosquito, ha.<\/a><\/p>\n<p>Sorry.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>There, that title got your attention, didn&#8217;t it? Anyway, this HIV cure news thing and a few other ID\/HIV topics to contemplate while\u00a0buying your pumpkin, celebrating the New Year in October, or\u00a0shaking your head that all the stores seem to be putting out their Christmas stuff already. I mean, come on &#8212; it&#8217;s not even [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[365,423,427,565,1118],"class_list":["post-8198","post","type-post","status-publish","format-standard","hentry","category-health-care","tag-flu-vaccine","tag-hiv","tag-hiv-cure","tag-link-o-rama","tag-zika"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8198","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=8198"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8198\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8198"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8198"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8198"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}