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Topics, Trends & Updates
August 2015
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About 60% of survey respondents use the HIV clinical care guidelines for help in managing a specific patient. What about you? Do you use the guidelines to build general knowledge about HIV care or for help in managing a specific patient?

 

 
Top 5 Guidelines for July: 
Recent Updates
Updates to the HAV guideline address treatment of patients with HIV/HAV co-infection, as well as prevention, post-exposure prophylaxis, and reporting for HAV infection.

 

Options identified by NYSDOH: Medicaid, PrEP Assistance Program, two Gilead medication assistance programs, the Patient Access Network, and most private insurance carriers. 

What We're Reading

COPD Doubles Risk of Pneumonia Among HIV-Infected Veterans

Christopher Hoffmann, MD, MPH

 

Without question, the most notable publications in July were the two

NEJM articles that reported results from the START and TEMPRANO randomized clinical trials demonstrating the benefits of earlier antiretroviral therapy (ART). However, results of a new study from the nationwide Veterans Administration Cohort Study Virtual Cohort (JAIDS July 11, epub ahead of print) remind us of the ongoing importance of managing comorbidities in our HIV-infected patients. In an analysis of data from 41,933 HIV-infected veterans from the years 1996 to 2009, Attia and colleagues sought to estimate the contribution of any COPD diagnosis on community-acquired pneumonia requiring hospitalization. Pneumonia occurred at a rate of 53.9 per 1,000 person-years among veterans with HIV and COPD and at a rate of 19.4 per 1,000 person-years among HIV-infected veterans with no COPD. In an analysis of pneumonia risk adjusted for viral load >500 copies/mL, CD4 count <200 cells/mm3, age, smoking, renal disease, liver disease, and other factors, the incidence risk ratio for COPD was 1.9 (95% confidence interval 1.64-2.30), similar to the 1.76 for CD4 count <200 cells/mm3 and 1.83 for renal insufficiency. This study had several important limitations, including use of clinic or inpatient diagnosis coding to define COPD, use of hospital discharge diagnosis coding for pneumonia diagnosis, and viral load suppression defined as <500 copies/mL. Nonetheless, the findings suggest that COPD is an important risk for pulmonary infections in the era of ART and that appropriate COPD management may avert hospitalizations for some HIV-infected patients.  (Read abstract on PubMed.)

 

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HIV Clinical Guidelines Program 
New York State Department of Health AIDS Institute
In collaboration with JHU School of Medicine, Division of Infectious Diseases
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