Current U.S. Department of Health and Human Services (DHHS) guidelines clearly recommend that when an HIV-infected woman on effective antiretroviral therapy (ART) becomes pregnant, she should continue to receive ART. However, treatment interruptions — particularly during the first trimester — still occur, partly because of concerns about potential adverse effects of antiretrovirals …
Modeling outcomes in HIV care can provide insight into future trends and costs relating to various care strategies. Now, researchers have used a Monte Carlo health-state transition simulation to predict long-term outcomes for a hypothetical 10,000 patients in each of four CD4-count categories on care entry: ≤200, 201–350, 351–500, and 501–900 cells/mm3. They assumed that a patient entering care at a CD4 count >500 cells/mm3 would …
Analysis of the cascade of HIV care in the U.S. (JW AIDS Clin Care Dec 22 2011) has identified particular problems with retention in care. NA-ACCORD investigators recently reported improved viral suppression rates among patients starting antiretroviral therapy (ART), with rates varying widely by region (JW AIDS Clin Care Feb 25 2013). In a new analysis, researchers investigated the retention-in-care rate and associated factors …
Despite the intuitive appeal of structured treatment interruption (STI), the strategy failed miserably in 2006, with several large trials yielding negative results. Most notable were the SMART (Strategies for Management of Antiretroviral Therapy) study and the Trivacan ANRS 1269 study, both of which used a CD4 count <250 cells/mm3 as the threshold for restarting therapy. Enrollment in the SMART study was halted when clinical progression was noted to be significantly more common with STI than with continuous therapy. The causes of morbidity and mortality were widely …
Increased triglyceride levels are commonly seen in HIV-infected patients and have been linked to an increased risk for cardiovascular disease. Standard
Introduction Dolutegravir (DTG) 50 mg once daily was superior to darunavir/ritonavir (DRV/r) 800 mg/100 mg once daily through Week 48, with 90% vs. 83% of participants achieving HIV RNA 50 c/mL ( p =0.025) [ 1 ]. We present data through Week 96. Material and Methods FLAMINGO is a multicentre, randomized, open‐label, Phase IIIb non‐inferiority study, in which HIV‐1‐positive ART‐naïve adults with HIV‐1 RNA≥1000 c/mL and no evidence of viral resistance were randomized 1:1 to receive DTG or DRV/r, with investigator‐selected backbone NRTIs (TDF/FTC or ABC/3TC). Participants were stratified by screening HIV‐1 RNA (≤100K c/mL) and NRTI backbone. Results A total of 484 adults were randomized and treated; 25% had baseline HIV RNA 100K c/mL. At Week 96, the proportion of participants with HIV RNA 50 c/mL was 80% in the DTG arm vs. 68% in the DRV/r arm (adjusted difference 12.4%; 95% CI 4.7, 20.2%; p =0.002). Secondary analyses supported primary results: per‐protocol [(DTG 83% vs. DRV/r 70%), 95% CI 12.9 (5.3, 20.6)] and treatment‐related discontinuation = failure [(98% vs. 95%), 95% CI 3.2 (−0.3, 6.7)]. Overall virologic non‐response (DTG 8%; DRV/r 12%) and non‐response due to other reasons (DTG 12%; DRV/r 21%) occurred less frequently on DTG. As at Week 48, the difference between arms was most pronounced in participants with high baseline viral load (82% vs. 52% response through Week 96) and in the TDF/FTC stratum (79% vs. 64%); consistent responses were seen in the ABC/3TC stratum (82% vs. 75%). Six participants (DTG 2, none post‐Week 48; DRV/r 4, two post‐Week 48) experienced protocol‐defined virologic failure (PDVF; confirmed viral load 200 c/mL on or after Week 24); none had treatment‐emergent resistance to study drugs. Most frequent drug‐related adverse events (AEs) were diarrhoea, nausea and headache, with diarrhoea significantly more common on DRV/r (24%) than DTG (10%). Significantly more participants had Grade 2 fasting LDL toxicities on DRV/r (22%) vs. DTG (7%), p <0.001; mean changes in creatinine for DTG (~0.18 mg/dL) observed at Week 2 were stable through Week 96. Conclusions Once‐daily DTG was superior to once‐daily DRV/r in treatment‐naïve HIV‐1‐positive individuals, with no evidence of emergent resistance to DTG in virologic failure and relatively similar safety profiles for DTG and DRV/r through 96 Weeks.
Women medical students experience unique stressors and challenges during medical school related to inherent structural androcentric norms. Through a longitudinal qualitative study of 17 women medical students in their first two years of medical school, we sought to investigate how they navigated their medical school experience. We used a critical lens and narrative inquiry to understand their experiences within the powerful and marginalizing culture of medical school. Our participants identified two essential support groups: those relationships made within, and those sustained outside, medical school. These findings invoked a kinship framework—one where women medical students have a network of chosen kin who provide essential support for them during their first 2 years. The participants' chosen kin within medical school provided support through recognition of one another, belonging by not belonging, being encouraged to reach out, and creating long-term relationships. The chosen kin outside medical school provided support by reminding the student who they are and creating stability. Integrating models of kinship into medical school as practiced by women medical students may have immense value in providing essential supports for medical students, preventing burnout, and changing the culture of care for future physicians that would align recognition and practice of self-care with patient care.
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