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Controlling HIV Without Medication

Controlling HIV Without Medication

Research indicates that about 1% of patients with HIV are able to keep the infection under control without the need for antiretroviral therapy (ART). Dubbed “controllers,” these patients have been thought to hold clues on how to develop a vaccine against HIV because of their unique immune responses. “The body’s defenses in these patients allow them to fight the virus more effectively than others with the infection but don’t prevent them from being infected,” says Richard T. D’Aquila, MD. “Understanding the underlying processes could help researchers determine which immune responses should be boosted in non-controllers so that their stronger defenses could hold the line against HIV without ART in the same way these processes happen in controllers.” Understanding Controllers Controllers have plasma viral loads that are consistently less than 5,000 copies/mL as well as stable, high CD4 cell counts for many years without ART, according to Dr. D’Aquila, senior author of a study of controllers published in PLoS ONE. For their study, the research team investigated a newly discovered immune defense called the APOBEC3 system. APOBEC3 proteins work within immune system cells to block replication of HIV. In most patients with HIV, a gene produced by HIV works to remove APOBEC3 from cells so that HIV can replicate. “We hypothesized that controllers may have a stronger APOBEC3 defense than most patients with HIV,” Dr. D’Aquila notes. Upon studying the cells of controllers, the investigators found that controllers do indeed have larger supplies of APOBEC3, long after acquiring HIV, in specific white blood cells. It is within these cells (resting memory T cells) where HIV lies inactive until ART is...
CROI 2015

CROI 2015

New research was presented at CROI 2015, the annual Conference  on Retroviruses and Opportunistic Infections, from February  23 to 26 in Seattle. The features below highlight some  of the studies that emerged from the conference. Deferring HCV Treatment in Patients With HIV The Particulars: Studies have shown that successful treatment of hepatitis C virus (HCV) reduces the risk of liver-related complications. However, treatment is often deferred in patients with limited liver fibrosis due to cost considerations and the promise of better treatment options in the future. Little is known about the impact of deferring HCV treatment on liver progression among patients with HIV. Data Breakdown: For a study, researchers compared liver-related events and duration of infectiousness between patients with HIV who were treated for HCV 1 month after an HCV diagnosis, 1 year after a diagnosis, or as they reached fibrosis grades F2, F3, or F4. When compared with treating patients 1 month after diagnosis, delaying treatment until 1 year after diagnosis or until F2, F3, or F4 led to 14, 43, 142, and 418 additional cases of liver-related death per 1,000 HCV infections, respectively. The average length of time that patients were infectious increased from 5 years with treatment started 1 month after diagnosis to 21 years with treatment started at grade F4 fibrosis. Take Home Pearl: Timely treatment of HCV infection among patients with HIV appears to help prevent liver-related death and decrease the length of time that patients are infectious. Incentivizing Linkage to Care & Viral Suppression The Particulars: Data are lacking on the effect of financial incentives for linkage to care and viral suppression (VS)...
Alcohol Abuse Among Physicians: Taking Control

Alcohol Abuse Among Physicians: Taking Control

Physicians, like many adults in the general public, enjoy drinking an alcoholic beverage in a socially-appropriate context when they are not taking call. But what happens when casual drinking becomes a problem? Nine out of 10 doctors recognize when they’ve reached their alcohol limit and stop drinking. However, an estimated 10% of doctors allow alcohol to adversely affect their overall well-being, health, and medical practices (1). The National Institute of Health (NIH) suggests a man—younger than 65 years of age—not have more than 14 drinks a week, and a woman—who is not pregnant or attempting to become pregnant—not exceed more than seven drinks per week (2). If you or a colleague drink more than that, an unhealthy drinking habit may be emerging. Rigorously honest self-evaluation or peer-reporting is the next necessary step to avoid developing more serious issues of alcoholism. Reporting Harmful Behaviors Benefits the Medical Community The American Medical Association (AMA) Code of Ethics, considered the most widely accepted ethics guide for physicians, requires all doctors to promote personal health and wellness and to promptly inform relevant authorities of an impaired or incompetent colleague (3). Yet, one in three (36%) physicians surveyed in a recent national poll said they’ve had firsthand knowledge of a physician struggling with drug and/or alcohol misuse and yet did nothing. Some of the reasons these surveyed doctors gave for ignoring harmful behaviors included: “someone else would take care of the problem,” “nothing would happen as a result of the report,” “fear of retribution,” and feelings of being ill-prepared to deal with an unstable colleague (4). If we are to continue safeguarding patients’ care...
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