With HIV and drug addiction, we often focus on injection drug use (IDU) as a risk factor for HIV transmission. Only 2.6% of the country’s population over the age of 13 reports having injected drugs at some point during their lives1. Approximately10% of new HIV infections occur through shared injection equipment2. 22% of people with HIV were infected through IDU.3 These numbers do not account for people who use non-injection drugs, who experience HIV prevalence similar to that of people who inject drugs.4
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. While this is great news, physicians are learning that chronic HIV infection can place their patients at a higher risk of developing certain health problems earlier in life. One example is heart disease.
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.
Dolutegravir has several characteristics that, in theory, suggest it will not be significantly removed by dialysis:
I have been working on website accessibility for many years in my role as Production Manager at the UCSF Center for HIV Information. Despite that experience, I still encounter problems that confound me. I recently reached out to an accessibility expert for ideas on how to manage a particularly difficult compliance problem.
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 during pregnancy.
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 boosted PIs, 200/25 mg without boosters) or continued on TDF/FTC; the background third agents were not changed. At 48 weeks, 94.3% of TAF/FTC recipients and 93% of TDF/FTC recipients maintained HIV RNA suppression; the difference was not significant.
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 tenofovir alafenamide (TAF). This is of interest because administration of TAF (25 mg orally) results in 90% lower plasma concentrations of the TFV and TFV-DP than TDF, and 7-fold higher levels of TFV in mononuclear cells.
I would like to start this new year introducing myself to the AIDS Education and Training Center (AETC) community. I had the pleasure of joining the AETC National Coordinating Resource Center (NCRC) as a Health Educator in December 2015. I look forward to using my skill set as a Certified Health Educator Specialist and seasoned patient navigator/linkage to care coordinator (LTCC) to provide a perspective based on direct interaction and delivery of care to clients from another standpoint in the healthcare team.
Our understanding of quality in healthcare—how we talk about it and how we measure it—has evolved over time. However, the goal has remained the same: improving the health of people living with HIV. This means constantly challenging ourselves to do better. In essence, do quality improvement (QI) better.