Testing

Fairly soon, now, you may be able to get a test to detect the presence of HIV (as now: due to the presence of antibodies) at your walk-in clinic, at your dentist, in the hospital and at your primary care provider...

Yes - everybody will soon be able to have testing... MAYBE even without asking for it: It COULD be that folks will automatically have an HIV test unless they specifically ask not to have that included with regular laboratory blood work.

Is that the face of the future? Is that the right direction in which to move forward? Is the balance of society's larger need great enough that people should be subjected to a test that may occur without their realizing it because for the greater good, it's better that we all know... Or is that a step too far?

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?

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!

Groups of people surviving long-term with HIV

Many years ago, at the outset of the HIV epidemic as now know it (i.e., back in the early 1980s) we knew so very little about what was happening: Researchers, physicians, HIV-positive individuals - we were all in the dark. Slowly - as studies and work progressed and we first identified the virus, found some initial but toxic treatments and then continued to fight for greater information and better regimens that actually worked and produced fewer, liveable side-effects - we ended up with groups of people for whom we couldn't work fast enough to help save; then groups of people whom we were saving but with so many difficult-to-live-with issues; and that was with (oftentimes) large numbers of pills to take and many side effects, some of them irreversible.

Now, as we live in an era whereby some folks are eligible for and actually only take one pill once-per-day, have we yet a third group of folks who are living with HIV? Is this yet another clear distinction as we progress toward cures and vaccines? Is this another major group in the long fight that we're all so embattled with? What is the next step, after progressing from losing so many folks through keeping so many around but with such difficulty, to such relatively simple and easy pill burdens and quality-of-life issues, nowadays (at least compared with before)?

Does this make is ever-more hopeful that there are few steps left because the next group (or cohort, if you will) must be something even better than just such a simple regimen as we now have?

What are your thoughts?

A D H E R E N C E

Not many years ago, much was made of the fact that roughly 95% (or better) adherence was needed in order for antiretroviral treatments to remain successful in the face of a constantly mutating (often said to be “sloppy”) virus which, if offered the chance for a breakthrough through reduced adherence, would become resistant to the medications being taken. Obviously, the serious worry was over a reduction in successful treatment options.

In more recent times, there appears to be less made of this adherence figure (without saying that it isn’t still a target, as there is some evidence and, thus, there are some in the community who admit that 95% may be higher than needed); however, acknowledging that at least some high level of adherence is required, what supportive measures can we expect / provide as expanded HAART programs target the more disadvantaged populations in this province in a testing and treatment campaign? The rock and the hard place, on this one, appear to be that either we do or we do not need such strict “take these medications at the time and in the manner directed” instructions, always without fail… and that this is dependent to some degree upon the specific medications and the frequency of dosing (just as it also is an individualized biological issue). Is every individual going to have a different threshold? How is that communicated? The message, here, may seem inconsistent, but in fact we’re aiming for as high an adherence as possible – period. The higher and (to some degree) the lower levels of adherence (in numbers) appear to be better than an irregular off-and-on strategy. In other words, if you’re going to miss, they say it’s better to miss all the time than to hit-and-miss a lot.

What are your thoughts?

Holidays half over; treatment plans intact?

Many people are aware that current treatment plans involve a lifetime committment. This means whether once-per-day or twice, whatever combination of medicines is prescribed needs to be taken in the same way at the same time, daily, as instructed.

This can be very challenging during holiday periods: There may be travel involved (which may include time-zone changes); there could be guests visiting or being visited (which might mean a change in how, where and to what degree the prescription-taking is visible to others, and to whom); there may be changes in eating and also drinking patterns (possibly involving parties, dinners, get-togethers and other things) and this combination needs to be accounted for in our holiday planning.

While a great majority of the "rush" of the season is now behind us all, there are still a few more days (almost a week, in fact) when many people are still away, or otherwise not yet returning to normal routines, be they work, school or whatever.

How are you coping? Has it been a challenge? Was there some adjustment? Did it all go well? Were there some rough patches?

Nobody is perfect, for if we were, how "human" would we be? Still, where possible, we must try to give the research and team of healthcare professionals who are literally working on our behalf the best possible outcome they've worked for - and this is not to mention our own selves... for we deserve it - by trying to account for these holiday-period changes and recognizing the challenges, where possible, ahead of time. Planning for that, and doing what we need to do to accommodate these differences in our daily routines, will go a tremendously long way toward the success of our treatment plan and toward better health outcomes for us!

Here is hoping that 2010 is the year when it all comes together, if it hasn't; and here's also hoping that the gains of 2009 improve while the pains lessen in this coming year. To whatever extent we have control over these issues, here's hoping we'll take that control and use it wisely, and that to whatever extent it's out of our hands, we are favoured with nothing but the best!

The Season

At a time in the year when people's thoughts turn to holidays of one kind or another, whether travelling or hosting, whether near or far; regardless of religion or not, and with the emphasis on getting it all done, no matter what that may be (even just stocking up on supplies when things are closed down for so long): How do people cope? How does anyone cope with the rush, the demands, and the resulting stress that is seasonally ours - subscriber or not?

For some, it may be just turning to those they regularly seek out and are with; others may find comfort in finding long-ago (even recent) folks who've moved, been less involved or are otherwise distant. Reducing stress is shown to be of benefit in healthcare settings of all kinds, whether just helping to reduce blood pressure or helping with behaviour changes that reduce risk and include harm reduction measures. Friends, family and even strangers may have it in them to help, but we have to let them or seek it, or at least actively engage. Whatever way one does it, make sure that this holiday season, there is something in your stockings (whether hung or worn) that really helps take stress levels down as much as one can. You'll feel and be better for it!

So, what reduces your stress?