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Guidelines for PrEP to Prevent HIV Infections

Guidelines for PrEP to Prevent HIV Infections

Since the early days of the HIV epidemic in the United States, clinicians have made continued efforts to educate people on behaviors that could significantly reduce their risk of acquiring HIV infection. However, over the last 10 to 15 years, the rate of new infections in the U.S. has remained steady at about 50,000 per year. Recently, pre-exposure prophylaxis (PrEP)—daily doses of two specific antiretroviral medications to uninfected patients at high-risk of HIV infection—has been shown to be safe and effective to prevent HIV acquisition. “Despite our best efforts, we haven’t seen declines in annual HIV infection rates,” says Dawn K. Smith, MD, MS, MPH. The CDC recently released guidelines on PrEP to provide clinicians the information they need to use this prevention strategy and help drive down the rate of new HIV infections. Important Recommendations Published in the Morbidity and Mortality Weekly Report, the CDC guidelines report that taking PrEP regularly provides substantial protection against HIV acquisition in multiple populations. The guidelines offer recommendations on indications for prescribing PrEP medication. PrEP is recommended for HIV-uninfected patients who: ♦  Are in an ongoing sexual relationship with an HIV-infected partner. ♦  Are gay or bisexual men who have had sex without condoms or have been diagnosed with a sexually transmitted infection within the past 6 months, and are not in a mutually monogamous relationship with a partner who recently tested HIV-negative. ♦  Are heterosexual and do not always use condoms when having sex with partners known to be at risk for HIV (eg, injection drug users or bisexual men of unknown HIV status), and are not in a mutually monogamous...
Teens With HIV: A Look at Treatment Trends

Teens With HIV: A Look at Treatment Trends

In recent years, the incidence of HIV infection has decreased for most age groups. Study results have shown that presenting to care earlier in the disease course can limit immune deterioration and HIV transmission. The CDC recommends that all people aged 13 and older be tested for HIV, a recommendation that appears to have made an impact on testing rates. However, recent research indicates that HIV incidence rates are actually increasing among adolescents. Taking a Closer Look “Studies have shown that more adults aged 18 and older are entering care with higher CD4 counts than what has been seen in the past,” says Allison L. Agwu, MD, ScM. “However, data from adult studies don’t necessarily represent trends in adolescents. My colleagues and I wanted to see if these same improvements in CD4 counts are also occurring in adolescents.” For a retrospective cohort study published in JAMA Pediatrics, Dr. Agwu and colleagues assessed data on nearly 1,500 antiretroviral therapy-naïve patients aged 12 to 24 who presented for care between 2002 and 2010 at any of 13 clinics in the HIV Research Network. Throughout the study, the proportion of patients who presented for care with a CD4 count less than 350 cells/mm3 remained between 30% and 45%. “These patients are presenting having already met criteria for treatment,” Dr. Agwu says, “We’ve shown that these patients are actually less likely to be treated.” African Americans, Hispanics, males, heterosexuals, older patients, and those with higher HIV-1 RNA levels were more likely than their counterparts to present for care with CD4 counts less than 350 cells/mm3. According to Dr. Agwu, providing extra support and...
On the Unity of Doctors

On the Unity of Doctors

Doctors are facing challenges like never before. Not only are new medications being discovered and novel technologies being implemented, we are being bombarded with new regulations. Years ago, people were talking about how to improve the doctor-patient relationship. Currently, all the journals are talking about big data, EHR, meaningful use, and ICD-10. Not only do we need to stay current with all the medical innovation taking hold, we need to learn how to comply with all these regulations. Many doctors feel these requirements are actually not helpful as being touted. In fact, we feel there is harm being done because they are taking us away from direct contact with the patient. According to a study out of the American Journal of Emergency Medicine, it has been estimated that ER docs spend 44% of time on electronic data entry and 28% on patient contact. Doctors are becoming increasingly vocal on speaking up against these regulations that we are forced to comply with. However, after years of being forbidden to unionize or collectively bargain, we are often doing it alone. We feel isolated in this sea of chaos. Polices will never change based on just one voice. If we are to drive policy change and shape regulations to become meaningful for the quality of medicine, we need to find a unified voice. How can doctors find unity and speak up against wrongful healthcare policies? 1. We can share information about these policy changes. We all need to stay up-to-date with them for our own practices. When we are aware, share them and discuss with other doctors why or why not these...
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