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The Sensitive Subject of HIV Treatment Side Effects

The Sensitive Subject of HIV Treatment Side Effects

Antiretroviral therapy (ART) is essential to keeping HIV from replicating and further infecting CD4 lymphocytes. When taken as prescribed, these medications have significantly increased life expectancy over the past 25 years. HIV has shifted from being an infection with dire consequences to one that is considered a manageable, chronic condition when treated with ART. Dealing With Side Effects While the benefits of modern combination ART (cART) treatments have been well documented, so too have their potential to cause side effects. Some side effects are easily managed, but others—such as insomnia, gastrointestinal abnormalities, fatigue and rashes—can be much more severe for patients. Some may only be present during the first month or two of starting cART treatment while the body adapts to the medication. When side effects become too burdensome, adherence to cART regimens can diminish, leading to serious consequences and putting patients at risk for developing resistance to the components of cART. Poor adherence can also lead to ongoing replication of HIV and subsequent loss of CD4 lymphocytes. Patients may fail to notify their doctors when side effects become so severe that they stop taking their medications. To prevent this non-disclosure, it’s important to establish a clear line of communication as patients begin treatment. Patients should be instructed to be vigilant about any changes in their regular bodily functions and counseled to contact their physician immediately to determine if their treatment is causing any of these changes. Tackling That Sensitive Subject Whether they feel embarrassed or simply that it’s inappropriate, patients may avoid talking openly about side effects like diarrhea. With this in mind, there is an underscored importance...
Examining Why HIV Patients Discontinue ART

Examining Why HIV Patients Discontinue ART

Discontinuation of antiretroviral therapy (ART) among patients with HIV has been found to lead to virologic failure, drug resistance, and onward HIV transmission. “It’s imperative that we understand how many patients in the United States discontinue treatment, why they stop, and which patients are more likely to do this,” says Alison J. Hughes, MPH. “This information can allow us to more effectively target interventions to increase treatment persistence and optimize outcomes of people living with HIV.” New Data For a study published in the Journal of Acquired Immune Deficiency Syndromes, Hughes and colleagues conducted interviews with, and reviewed medical records for, a nationally representative sample of HIV-infected adults receiving HIV care from 2009 to 2010. The research team examined patient characteristics of ART discontinuation—defined as not currently taking ART—based on whether discontinuation was provider- or non–provider-initiated. “The good news was that 93% of patients in HIV care had initiated ART,” says Hughes. “However, of those who initiated ART, nearly 6% discontinued treatment, representing about 22,000 adults in the U.S.” Nearly half of patients reported that their healthcare provider had recommended treatment discontinuation. “We speculate that the high rate of provider-initiated discontinuation reflects treatment guidelines that were in place at the time, which recommended ART only for patients with a CD4 count less than 350 cells/mm3,” adds Hughes. The researchers also found that certain patients were more likely to stop treatment than others (Table). “Younger age, female gender, not having continuous health insurance, incarceration, injection drug use, and a high CD4 cell count were all associated with treatment discontinuation,” explains Hughes. “Unmet need for supportive services, no care in the...

What’s the Point of Medical Licensing?

A surgeon emailed me the following:. OK, I know this is radical but consider my argument… Medical licensing protects no one and costs physicians hundreds to thousands of dollars each year. If a physician is negligent, can the injured party sue the state that licensed him? I’m guessing not. When I moved to my current location, I had to send lots of documentation to the state medical board so they could verify that I was a true and competent surgeon. I provided my employer with the same info so they could also verify my credentials. Now my employer can and will get sued if I commit a negligent act and absolutely should verify my credentials prior to handing me a scalpel. But the state? Its license is useless. Most people choose a surgeon based on recommendations and word-of-mouth reputation, and these are by far better indicators of quality than any credentialing board. Nobody asks to see my license, and, even if they did, it would not protect them any more than their trust in the health system in which I work. If I was in private practice and had my license displayed on my wall, it may give some reassurance to my patients, but it does not say anything about the quality of my work. Most doctors who really screw up due to negligence are licensed by the state. I contend again, that word of mouth and reputation are the best indicators of a surgeon’s ability, anything beyond that is useless. Caveat emptor, “let the buyer beware” remains the mantra of the informed consumer. Thanks for letting me vent....
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