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)...

Appeals Court Strips Graduate of MD Degree

A three-judge panel of the US Court of Appeals for the Sixth Circuit reversed a federal district court decision and said that Case Western Reserve University could withhold an MD degree from a student who they said exhibited unprofessional behavior. I have written about this situation on two previous occasions—here and here. Briefly, a medical student who had performed well academically had committed a few transgressions outside the classroom. These included: sexually harassing some female students at a dance; attempting to avoid payment of a taxi fare; having problems interacting with staff, patients, and families, resulting in a failing grade and requirement to repeat a [sub?]internship; and asking faculty members not to mark him late for teaching sessions, which occurred 30% of the time. The issue that prompted the school to expel the student just prior to graduation was a conviction in another state for driving while intoxicated. He denied or had excuses for most of the incidents. The original court decision pointed out that his earlier problems had apparently not been considered serious because the school had given him positive letters of recommendation. The lower court also opined that professionalism was distinct from academic matters. The appeals court disagreed and said, “professionalism is part of what [medical] students must learn and practice.” It added that the school’s definition of professionalism in moral judgment terms was appropriate and should not be separated from academic performance. Here are some of the ways the school defined professionalism in its curriculum: ethical, honest, responsible and reliable behavior; respectful dialogue with peers, faculty, and patients, to enhance learning and resolve differences; recognize personal...
Severe Chronic  Bronchitis  in Advanced  Emphysema

Severe Chronic Bronchitis in Advanced Emphysema

Studies have shown that chronic bronchitis occurs in 18% to 45% of patients with COPD and is associated with a higher risk for exacerbations and hospitalizations as well as an accelerated decline in lung function. However, chronic bronchitis has not been well described in patients with advanced emphysema. “The data regarding mortality in this patient population are conflicting,” says Victor Kim, MD. “Few studies have assessed the effects of chronic bronchitis on hospitalization rates in those with advanced emphysema.” A Novel Concept Severe chronic bronchitis is a novel concept, according to Dr. Kim, MD, lead author of a study published in the journal COPD that investigated this relationship. “We defined severe chronic bronchitis as the presence of cough and sputum along with chest trouble based on patient responses to the St. George’s Respiratory Questionnaire (SGRQ), a measure of health-related quality of life (HRQOL),” he says. Patients who had been randomized to medical therapy in the National Emphysema Treatment Trial were grouped by Dr. Kim and colleagues into those with or without chronic bronchitis. “The classic definition of chronic bronchitis is based on affirmative answers to questions about the presence of cough and sputum for 3 months out of the year for at least 2 consecutive years,” Dr. Kim explains. Participants were then categorized into those with severe chronic bronchitis or no severe chronic bronchitis based on the presence of chest trouble. Associations between chronic bronchitis and severe chronic bronchitis with all-cause mortality and time to all-cause hospitalization were assessed. Lung function and SGRQ scores over time were also compared between groups. Key Findings “Emphysema and chronic bronchitis are generally...