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A network of federally funded training centers has existed since the early 1990’s to educate and build the capacity of clinicians and healthcare professionals to diagnose, treat and manage HIV and other sexually transmitted diseases (STDs), substance use disorders (SUDs), mental health disorders and other social determinants of health, which impact access to quality care for vulnerable populations.
Hepatitis C virus (HCV) co-infection affects roughly 25% of people with HIV in the United States (U.S.).[i] To effectively combat this epidemic, ongoing provider education has been identified as a key initiative to enhance screening, diagnosis, linkage to care, and treatment of HCV.
At CROI 2019, investigators presented 48-week results from the Phase 3 international multisite ATLAS and FLAIR studies of long-acting 2-drug injectable therapy. The study regimen consisted of the integrase inhibitor cabotegravir (CAB) plus the NNRTI rilpivirine (RPV), both given every 4 weeks as intramuscular (IM) injections.
TDF/FTC (Truvada) is the only ARV combination currently approved by the FDA for use as preexposure prophylaxis (PrEP). The multinational Phase 3 DISCOVER Study compared the efficacy and safety of TAF/FTC (Descovy) with TDF/FTC, in HIV-uninfected cisgender MSM and transgender women at high risk of sexually acquired HIV.
In April 2019, the U.S. Food and Drug Administration approved a combination pill comprising the integrase inhibitor dolutegravir (DTG), 50 mg, and the NRTI lamivudine (3TC), 300 mg, for use as a complete ARV regimen for initial HIV treatment of patients. The approval specifies that DTG/3TC is intended only for adults who have never received ART and whose HIV has no resistance to either of the two components. It is to be taken once daily without food restrictions.
Immediate antiretroviral therapy (ART) refers to starting HIV treatment as soon as possible after the diagnosis of HIV infection, preferably on the first clinic visit (and even on the same day the HIV diagnosis is made). This strategy also is known as "rapid ART," "same-day ART," and "treatment upon diagnosis."
Immediate ART initiation may bring earlier benefits in personal health, and earlier reductions in the risk of onward transmission of HIV. For persons with acute infection, immediate ART may limit the HIV viral reservoir.
The emergence of chronic disease complications in controlled HIV disease has changed the landscape of HIV clinical care. HIV infection confers an increased cardiovascular disease risk which is thought to be due to a complex interplay of mechanistic factors. While traditional cardiovascular risk factors likely play a role, recent evidence suggests that HIV-associated inflammation and immune activation are important mediators of cardiovascular risk.[i]
Regional AETCs across the United States are working to bring new clinicians into the HIV workforce through inter-professional education (IPE) programs. IPE trains learners in teams in clinical settings where trainees learn from, about, and through each other. One project in Los Angeles is conducting their IPE program through three separate health campuses for nursing (Charles Drew University), medicine (University of California, Los Angeles), and pharmacy (University of Southern California). Cross-posted from TargetHIV coverage of the 2018 National Ryan White Conference.