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?
It is estimated that 1.1 million people in the United States are living 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 diagnoses suggests a true decline in new infections. The statistics in the Southern United States are not as promising.
The U.S. Department of Health and Human Services currently recommends that every person living with HIV begin antiretroviral therapy (ART) as soon as possible after diagnosis.
According to a new study published in the Journal Annals of Internal Medicine, one in nine American men is infected with the oral form of the human papillomavirus (HPV). Nationwide, rates of oral HPV infection are 11.5% of men vs. 3.2% women. HPV 16, the most common type of high-risk HPV and known to contribute to head and neck cancers, was six times higher in men than women.
I had the honor to help develop the first legal syringe access program (SAP) in Atlantic City, NJ, almost 10 years ago. In 2006, the New Jersey legislature passed the Blood-Borne Disease Harm Reduction Act, which allowed for the establishment of up to six pilot SAPs in NJ; however, approval from each selected city’s government was required before opening.
Doravirine (DOR) is an investigational NNRTI that currently is being developed in a coformulation with TDF and FTC. A Phase 3 comparison of DOR + 2 NRTIs (87% of study subjects were given TDF/FTC) and DRV/r + 2 NRTIs in initial therapy was presented at CROI earlier this year (DRIVE-FORWARD); the DOR arm was found to be noninferior to the DRV arm (see CROI 2017: Doravirine Noninferior to Darunavir + Ritonavir in Initial Treatment).
The EMERALD Study is a Phase 3 randomized (2:1), open-label, noninferiority study examining the strategy of switching patients with suppressed HIV RNA on a regimen consisting of a boosted protease inhibitor plus tenofovir disoproxil fumarate (TDF)/emtricitabine to an investigational single-tablet regimen containing
darunavir 800 mg/cobicistat 150 mg/emtricitabine 200 mg/tenofovir alafenamide 10 mg (D/C/F/TAF).
These studies demonstrate that coformulated BIC/TAF/FTC is noninferior to two gold-standard regimens comprised of DTG with 2-NRTI backbones, and in fact suggest that BIC/TAF/FTC is better tolerated than the coformulation DTG/ABC/3TC. Importantly, rates of virologic suppression were very high with all regimens, and no resistance mutations were seen in the rare cases of virologic failure.
Highlights from Laura W. Cheever, MD, ScM, HRSA HIV/AIDS Bureau Associate Administrator and Conference Co-Chair. "It’s a great balance between state-of-the-art treatment and science and pragmatic things that Ryan White HIV/AIDS Program providers struggle with and need assistance with."
I remember driving to Chicago on my first day as a Midwest AETC Practice Transformation (PT) Coach filled with both excitement and apprehension to participate in a 3-day intensive training titled Building Blocks of High Performing Primary Care. While the concepts of PT were familiar to me after over a decade of change and analytical work, the translation to HIV care capacity building and targeted workforce development was uncharted territory for me. I left Chicago with the conviction that this was a project worth fully investing in.
