Leading up to this year, some researchers and clinicians had optimistically viewed dolutegravir an invincible ARV, a drug so mighty that it was unlikely to fail, and even more unlikely to be victim to emergent resistance mutations. Two presentations at CROI demonstrated the vulnerability of dolutegravir to failure and to the development of resistance when it is used as monotherapy.
In February 2016 Elyse Malanowski, MLS, became the Education Coordinator for Parkland Health and Hospital System/North Texas for the South Central AETC (SCAETC). The SCAETC along with the University of Texas Southwestern (UTSW) Medical Center co-host a weekly informational session for clinicians and medical staff called the Tuesday Morning HIV Discussion Series (“Series”). These sessions are meant to educate participants about all aspects of HIV care and include a wide array of speakers.
At the ASM Microbe meeting in June, researchers from Gilead Sciences presented data on use of TDF/FTC (Truvada) PrEP in the United States according to sex and race. They evaluated national pharmacy databases to identify prescriptions of TDF/FTC given for PrEP between January 2012 and September 2015; they eliminated prescriptions given for ART, PEP, and HBV.
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 participated in the pilot, 95% of them started ART within 24 hours.
The PARTNER Study, a multisite European study, evaluated rates of HIV transmissions within serodifferent heterosexual and MSM couples (n = 548 and n = 340, respectively, contributed eligible data). The HIV-positive partners were on ART with HIV RNA levels of <200 copies/mL, and the couples engaged in ongoing condomless sex (vaginal and/or anal) during a median of 1.3 years per couple (1,238 "couple years"). It was noted that 33% of HIV-negative MSM had outside partners, compared with 4% of HIV-negative heterosexual subjects).
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 very early; patients were followed for 144 weeks. They found that DNA integration occurs early and rapidly, and that with early and continued ART, total and integrated HIV DNA drops quickly and continues to decrease over time.
Using data from the Medical Monitoring Project, this article presents a useful view of ARV treatment in the United States. The analysis demonstrates that U.S. national rates of both ARV prescribing (for persons maintained in care) and viral suppression to <200 copies/mL increased from 2009 to 2013--last at 94% and 80%, respectively, with notable increases over time in nearly all demographic subgroups examined, including women, younger-aged patients, and non-Hispanic blacks. Not surprisingly, though, disparities in viral suppression remain.
This article describes the CDC investigation and response (through October 2015) to the ongoing HIV (and HCV) outbreak in a rural county in Indiana, centered in people who inject opiates (especially the prescription drug Opana [oxymorphone]). The outbreak was first recognized in 2015 and continues to spiral onward--there are now >200 cases.