Tuesday, September 28, 2010

Guidelines for Starting Treatment

Isn't it fascinating that a group of almost-equally and well-educated plus extremely well-versed physicians, scientists and other researchers can get together and examine the virtually identical body of double-blinded, peer-reviewed, placebo-controlled evidence (in some cases) in Europe, Britain, the US, Australia and British Columbia, yet come up with somewhat different suggestions as to when and what to use in treating HIV?

It seems to follow that certain guidelines will likely come into effect in one place as will occur elsewhere since the same bases are used to determine what evidence has merit and what does not. However, there is room for interpretation, and where one group of experts will discount an element of a study because (for example) it didn't control for an important factor or compounder, still another group will excuse the omission and choose to weigh that evidence more heavily and - therefore - change their recommendations based upon it.

There is no particular body of evidence to which this blog post refers; it is simply a note that the wider body of all evidence is - particularly in this current age of instant / worldwide / electronic communication and publication - easily available to us all... and it forms the basis for all these decisions; yet, there is some discrepancy (look no further than the BHIVA recommendations that suggest ATRIPLA is the first-line regimen most highly recommended, whereas US-IAS and US DHHS recommendations suggest several different preferred regimens in slightly older guidelines of the same era).

Some considerations are (of course) given to the cost-benefit analysis that is part of whether a province (or other jurisdiction) places something on the drug formulary and for what considerations / indications, and some other consideration goes into first-line versus treatment-experienced patient treatment... Still, it makes one wonder...

Do you agree?

Monday, September 13, 2010

Potential Co-morbidities & challenges with HIV

Much has recently been made of the damage that the human immunodeficiency virus (HIV) does - not only to a person's CD4 cell count, but also to the entire body - via an inflammatory process which engages when the body's own defense mechanism is activated by the HIV.

What we have long known and are beginning to understand more about, now, is that cardiac (heart); cerebral (brain); osteo (bone); and other body systems are affected - though age at infection, length of time from infection to testing & detection, general overall health, treatment and other factors seem to influence the outcomes to varying degrees - as might logically be expected with any difference in disease progression from person to person.

Some people take special precautions, particularly if closely monitored by healthcare professionals and / or they are on treatment: These can include taking such things as statins (lipid-lowering agents that help fight higher-than-appropriate values in LDL-C and triglycerides: markers of cholesterol imbalance that can lead to heart disease); calcium and vitamin D supplements to help fight bone mineral density (BMD) decreases, which are not uncommon in HIV-positive persons, etc...

What other treatments - whether specifically suggested by healthcare professionals or not - are people using / taking / considering for overall healthy organ and system health in light of HIV infection?

Let us all know!