Release from correctional settings is a high-stakes time for persons with HIV, as it is for those with other health issues. People with substance use disorders often relapse, and those with HIV often stop ART and do not engage in HIV care, increasing the risk of declines in personal health as well a...
The single-pill combination of bictegravir (BIC) with tenofovir alafenamide (TAF) and emtricitabine (FTC) has been shown in four Phase III trials to be effective as initial therapy.Also as a switch regimen in patients with stably suppressed HIV RNA and no resistance to BIC, TAF, or FTC. In these stu...
HPV oral and oropharyngeal cancers are more difficult to detect than tobacco-related cancers because the symptoms are not always obvious to an individual, and health professionals may lack the education and background to diagnose HPV-related lesions. Although there are many adjunctive oral cancer sc...
The AIDS epidemic raged around me like a wildfire in the late '80s and early '90s while I trained in medicine in San Francisco. During that storm, I began working with people with HIV. In 1995, ready to start a primary medical practice, I landed at a community clinic in Berkeley, California, oversee...
Nurses are on the front-lines of increasing access to health care. As a nurse, my first priority is always the patient. A recent case demonstrates the importance of the role of nursing in providing needed services for patients. In this case, a young person was a victim of sexual assault resulting in...
I often get this question from non-dental personnel including case managers, physician assistants, nurses, and nurse practitioners. The following is a short list of questions you can ask patients to guide dental referrals for emergency care:
A recent study that was conducted among 1200 HIV patient of whom 600 each belonged to with ART and without ART and the occurrence of oral candidiasis and oral hairy leukoplakia. This study shows that oral candidiasis and leukoplakia was less among patients on ART as well as a decrease in the number...
The question I most commonly get asked by oral health providers is...
Do I pre-medicate patients based on a high viral load and low CD4 count?
There is no supporting data to support the need for routine antibiotic coverage pre or post dental treatment based on the CD4 or viral load. Antibiotic use in...
It is estimated that 1.1 million people in the United States are infected with HIV. Of those, 1 in 7 do not know they are infected.[1] The number of new HIV diagnoses fell 19% from 2005 to 2014.[1] Because HIV testing rates have remained stable or increased in recent years, this decrease in diagnose...
The U.S. Department of Health and Human Services currently recommends that every person with HIV begin antiretroviral therapy (ART) as soon as possible after diagnosis. Increased availability of testing and treatment along with the above guidelines have reduced the number of new HIV infections by 18...
I remember driving to Chicago on my first day as a Midwest AETC Practice Transformation (PT) Coach. I was filled with both excitement and apprehension to participate in a intensive training titled Building Blocks of High Performing Primary Care. While the concepts of PT were familiar to me after ov...
This publication presents the results of San Francisco General Hospital's Ward 86 pilot study of immediate ART initiation. This RAPID program systematically offered ART to patients upon diagnosis of HIV; patients were referred from HIV testing sites in San Francisco. Of the 39 patients who participa...
We know that very early treatment in acute HIV infection decreases HIV RNA; this study shows it also greatly decreases proviral DNA (and reservoir size). Researchers investigated 2 small cohorts of patients in Thailand with acute (and very early) HIV infection, 1 untreated and 1 treated with ART ver...
HIV-positive men and women can now live longer than ever before. A 2013 study found that a newly diagnosed 20 year old on effective antiretroviral therapy (ART) can expect to live into their 70s. A lifespan only slightly lower than in people without HIV.[1] While this is great news, physicians are l...
Tenofovir disoproxil fumarate (TDF) may cause decreases in bone mineral density (BMD). In both HIV-infected patients treated with TDF-containing ARV regimens, and in HIV-uninfected persons who use it for PrEP. A substudy of the large iPrEx trial of TDF/FTC PrEP in MSM and transgender women evaluated...
Dolutegravir has several characteristics that, in theory, suggest it will not be significantly removed by dialysis: It has a large apparent volume of distribution (17.4 L) and is highly protein bound (98.9%). A small study of 5 HIV-infected patients with end-stage renal disease undergoing convention...
Three studies presented at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) explored the pharmacokinetics of antiretrovirals administered during pregnancy. These studies support the use of standard-dose efavirenz, once-daily dolutegravir, and BID ritonavir-boosted darunavir du...
Researchers at the 2016 Conference on Retroviruses and Opportunistic Infections presented results from a randomized double-blind, double-dummy switch study of TAF/FTC. Over 660 patients with virologic suppression on TDF/FTC-containing 3-drug regimens were either switched to TAF/FTC (200/10 mg with b...
There was a pharmacokinetic study presented at the Conference on Retroviruses and Opportunistic Infections in Boston in February. It evaluated concentrations of tenofovir (TFV) and TFV-diphosphate (DP) in genital and rectal tissue. Also in anogenital fluid samples after administration of oral tenofo...
The prevailing opinion among experts regarding the optimal CD4 T-cell count at which to start patients on antiretroviral therapy (ART) has shifted several times during the evolution of HIV treatment. These shifts reflect attempts to strike a balance between preventing HIV-associated illness and deat...
