In this episode, host Dr Michael Saag speaks with Dr Paul Volberding, founder of the world's first dedicated HIV outpatient clinic, about their clinical experience treating HIV from the early days of the pandemic until now. They discuss the medical breakthroughs that they have seen over the years and how the history of HIV treatment directly informs treatment today.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963236). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals.

Resources

Kaposi sarcoma clinical presentation https://emedicine.medscape.com/article/279734-clinical

Lymphadenopathy: endpoint or prodrome? Update of a 24-month prospective study https://pubmed.ncbi.nlm.nih.gov/6335951/

Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS) https://pubmed.ncbi.nlm.nih.gov/6189183/

The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial https://pubmed.ncbi.nlm.nih.gov/3299089/

The history of PCR http://siarchives.si.edu/research/videohistory_catalog9577.html

History of HAART -- the true story of how effective multi-drug therapy was developed for treatment of HIV disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1716971/

Dr Michael Saag and Dr Aadia Rana discuss best practices that providers can implement to prevent the spread of HIV in their local communities and connect HIV-positive patients to lifesaving care.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963237). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals.

Resources

90-90-90 Treatment for all https://www.unaids.org/en/resources/909090

Too Many People Living with HIV in the U.S. Don't Know It https://www.hiv.gov/blog/too-many-people-living-hiv-us-don-t-know-it

CDC: HIV Testing Guidelines https://www.cdc.gov/hiv/testing/index.html

The science is clear: with HIV, undetectable equals untransmittable https://www.nih.gov/news-events/news-releases/science-clear-hiv-undetectable-equals-untransmittable

Initiating Antiretroviral Therapy for HIV at a Patient's First Clinic Visit: The RapIT Randomized Controlled Trial https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002015

Implementation of an Immediate HIV Treatment Initiation Program in a Public/Academic Medical Center in the U.S. South: The Miami Test and Treat Rapid Response Program https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6934174/

Development of a Citywide Rapid Antiretroviral Therapy Initiative in San Francisco https://pubmed.ncbi.nlm.nih.gov/34686290/

Immediate Initiation of HIV Treatment https://www1.nyc.gov/site/doh/providers/health-topics/aids-hiv-immediate-antiretroviral-therapy.page

Drs Michael Saag and Constance Benson discuss antiretroviral therapy, maintenance, and switching.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963238). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals.

Resources

Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2021 Update https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf

AIDS Clinical Trials Group https://actgnetwork.org/

Clarithromycin Therapy for Bacteremic Mycobacterium Avium Complex Disease https://www.acpjournals.org/doi/10.7326/0003-4819-121-12-199412150-00001?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

UC San Diego Medical Center https://healthlocations.ucsd.edu/san-diego/200-w.-arbor-drive-hospital

Highlights from the Ryan White Clinical Conference https://www.hiv.gov/blog/long-acting-injectables-hold-promise-maintaining-viral-suppression-and-preventing-hiv

Clinical Effectiveness of Integrase Strand Transfer Inhibitor–Based Antiretroviral Regimens Among Adults With Human Immunodeficiency Virus: A Collaboration of Cohort Studies in the United States and Canada https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8492356/

Key Considerations and Recommendations for Early (Acute and Recent) HIV Infection https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/early-acute-and-recent-hiv-infection?view=full

Rising Rates of Recent Preexposure Prophylaxis Exposure Among Men Having Sex with Men Newly Diagnosed With HIV: Antiviral Resistance Patterns and Treatment Outcomes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876422/

Long-acting Cabotegravir Plus Rilpivirine for Treatment in Adults With HIV-1 Infection: 96-week Results of the Randomised, Open-Label, Phase 3 FLAIR Study https://linkinghub.elsevier.com/retrieve/pii/S2352-3018(20)30340-4

Drs Michael Saag and Michael Mugavero discuss the connection between antiretroviral therapy, retention, and care for patients with HIV.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963239). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.

Resources

HIV Undetectable=Untransmittable (U=U), or Treatment as Prevention https://www.niaid.nih.gov/diseases-conditions/treatment-prevention#:~:text=U%3DU%20means%20that%20people,transmit%20the%20virus%20to%20others.

Ryan White Care Act https://ryanwhite.hrsa.gov/about/legislation

Beyond Binary Retention in HIV Care: Predictors of the Dynamic Processes of Patient Engagement, Disengagement, and Re-entry Into Care in a US Clinical Cohort https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136972/pdf/nihms-980338.pdf

Missed Visits and Mortality in Patients Establishing Initial Outpatient HIV Treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737584/

Beyond Core Indicators of Retention in HIV Care: Missed Clinic Visits Are Independently Associated With All-Cause Mortality https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215067/

Missed Office Visits and Risk of Mortality Among HIV-Infected Subjects in a Large Healthcare System in the United States https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739947/

Enhanced Personal Contact With HIV Patients Improves Retention in Primary Care: A Randomized Trial in 6 US HIV Clinics https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366591/pdf/ciu357.pdf

Drs Michael Saag and Glenn Treisman discuss methods of managing mental health and substance abuse in HIV patients.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963241). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.

Resources

Depression Prevalence, Antidepressant Treatment Status, and Association with Sustained HIV Viral Suppression Among Adults Living with HIV in Care in the United States, 2009-2014 https://link.springer.com/article/10.1007/s10461-019-02613-6

The Role of Dopamine in Inflammation-Associated Depression: Mechanisms and Therapeutic Implications https://link.springer.com/chapter/10.1007/7854_2016_13

Depression and Anxiety in Systemic Lupus Erythematosus https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6076116/pdf/medi-97-e11376.pdf

Substance Abuse Treatment in Persons with HIV/AIDS: Challenges in Managing Triple Diagnosis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999248/pdf/nihms544493.pdf

Mesolimbic Pathway https://www.sciencedirect.com/topics/neuroscience/mesolimbic-pathway

Dopamine System Dysregulation in Major Depressive Disorders https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716179/pdf/pyx056.pdf

Drs Michael Saag and Judith Currier discuss options for long-acting HIV therapies, minimizing patient interactions with the healthcare system, and honoring patient preferences.

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/963242). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.

Resources

AIDS Clinical Trials Group (ACTG) https://www.niaid.nih.gov/research/aids-clinical-trials-group

Cabotegravir/Rilpivirine (Rx) https://reference.medscape.com/drug/cabenuva-cabotegravir-rilpivirine-4000156

Patient-Reported Outcomes Through 1 Year of an HIV-1 Clinical Trial Evaluating Long-Acting Cabotegravir and Rilpivirine Administered Every 4 or 8 Weeks (ATLAS-2M) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8563641/

Antiretroviral Therapy for HIV Infection https://emedicine.medscape.com/article/1533218-overview

Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/interactions-between-integrase-inhibitors-and-non-nucleoside

Initiation of Long-acting Cabotegravir Plus Rilpivirine as Direct-to-Injection or With an Oral Lead-in in Adults With HIV-1 Infection: Week 124 Results of the Open-Label Phase 3 FLAIR Study https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(21)00184-3/fulltext

Lenacapavir (Pending FDA Approval) https://reference.medscape.com/drug/lenacapavir-4000240

Gilead and Merck Announce Temporary Pause in Enrollment for Phase 2 Study Evaluating an Oral Weekly Combination Regimen of Investigational Islatravir and Investigational Lenacapavir https://www.gilead.com/news-and-press/company-statements/gilead-and-merck-announce-temporary-pause-in-enrollment-for-phase-2-study-evaluating-an-oral-weekly-combination-regimen-of-investigational-islatravir-and-investigational-lenacapavir

Drug Database: Lenacapavir https://clinicalinfo.hiv.gov/en/drugs/lenacapavir/health-professional

Doravirine Prescribing Information https://www.merck.com/product/usa/pi_circulars/p/pifeltro/pifeltro_pi.pdf

A5357: A Study of Long-Acting Cabotegravir Plus VRC01LS to Maintain Viral Suppression in HIV-1-Infected Adults https://actgnetwork.org/studies/actg-a5357-a-study-of-long-acting-cabotegravir-plus-vrc01ls-to-maintain-viral-suppression-in-hiv-1-infected-adults/

Study to Evaluate the Effects of Cenicriviroc Mesylate on Arterial Inflammation in People Living With HIV https://clinicaltrials.gov/ct2/show/NCT04334915?term=ACTG+5363&draw=2&rank=1

Two Randomized Trials of Neutralizing Antibodies to Prevent HIV-1 Acquisition https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189692/

Evusheld (Formerly AZD7442) Long-acting antibody Combination Authorised for Emergency Use in the US for Pre-exposure Prophylaxis (Prevention) of COVID-19 https://www.astrazeneca.com/media-centre/press-releases/2021/evusheld-long-acting-antibody-combination-authorised-for-emergency-use-in-the-us-for-pre-exposure-prophylaxis-prevention-of-covid-19.html

Drs Michael S. Saag and Charles W. Flexner discuss the mechanisms of drug-drug interactions and the promise and limitations of longer-acting HIV therapeutics for both treatment and prevention.

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/986504). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.

Resources

HIV Infection and AIDS https://emedicine.medscape.com/article/211316-overview

Drug Interactions With Antiretroviral Therapy (ART) https://emedicine.medscape.com/article/2039809-overview

Common Drug Interactions With Protease Inhibitors https://emedicine.medscape.com/article/2041624-overview

HIV-Protease Inhibitors https://pubmed.ncbi.nlm.nih.gov/9562584/

The Role of Drug Metabolizing Enzymes in Clearance https://pubmed.ncbi.nlm.nih.gov/24392841/

AIDS Clinical Trials Group https://actgnetwork.org/

Ritonavir https://reference.medscape.com/drug/norvir-ritonavir-342627

The Cytochrome P450 Isoenzyme and Some New Opportunities for the Prediction of Negative Drug Interaction In Vivo https://pubmed.ncbi.nlm.nih.gov/29780235/

Boosting https://clinicalinfo.hiv.gov/en/glossary/boosting

Cytochrome p450 Structure, Function and Clinical Significance: A Review https://pubmed.ncbi.nlm.nih.gov/28124606/

Darunavir https://reference.medscape.com/drug/prezista-darunavir-342647

Atazanavir https://reference.medscape.com/drug/reyataz-atazanavir-342608

Tenofovir Disoproxil Fumarate https://clinicalinfo.hiv.gov/en/drugs/tenofovir-disoproxil-fumarate/patient

The Structure and Mechanism of Drug Transporters https://pubmed.ncbi.nlm.nih.gov/34272696/

Tenofovir Alafenamide (TAF) Clinical Pharmacology https://pubmed.ncbi.nlm.nih.gov/35146360/

Prodrugs for Improved Drug Delivery: Lessons Learned From Recently Developed and Marketed Products https://pubmed.ncbi.nlm.nih.gov/33137942/

Update on Drug-Drug Interaction at Organic Cation Transporters: Mechanisms, Clinical Impact, and Proposal for Advanced In Vitro Testing https://pubmed.ncbi.nlm.nih.gov/33896325/

The Role of Organic Anion Transporting Polypeptides in Drug Absorption, Distribution, Excretion and Drug-Drug Interactions https://pubmed.ncbi.nlm.nih.gov/27783531/

Creatinine Clearance https://pubmed.ncbi.nlm.nih.gov/31334948/

Dolutegravir https://reference.medscape.com/drug/tivicay-tivicay-pd-dolutegravir-999861

Cobicistat https://reference.medscape.com/drug/tybost-cobicistat-999845

Paxlovid https://pubmed.ncbi.nlm.nih.gov/35138785/

Interaction Between Ritonavir and Statins https://pubmed.ncbi.nlm.nih.gov/11959074/

COVID-19 Drug Interactions https://www.covid19-druginteractions.org/checker

Cabotegravir https://reference.medscape.com/drug/vocabria-apretude-cabotegravir-1000364

Lenacapavir https://reference.medscape.com/drug/sunlenca-lenacapavir-4000240

Inhibitors of the HIV-1 Capsid, a Target of Opportunity https://pubmed.ncbi.nlm.nih.gov/29782334/

Flip-Flop Pharmacokinetics--Delivering a Reversal of Disposition: Challenges and Opportunities During Drug Development https://pubmed.ncbi.nlm.nih.gov/21837267/

Polymeric Biomaterials for Medical Implants and Devices https://pubmed.ncbi.nlm.nih.gov/33465850/

Microneedle Arrays Combined With Nanomedicine Approaches for Transdermal Delivery of Therapeutics https://pubmed.ncbi.nlm.nih.gov/33419118/

Preexposure HIV Prophylaxis https://emedicine.medscape.com/article/2054869-overview

Drs Michael S. Saag and Monica Gandhi discuss COVID-19 and the impact this pandemic has had on patients diagnosed with HIV, including vaccines, boosters, and patients who are older or have chronic comorbid conditions.

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/986505). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.

Resources

Coronavirus Disease 2019 (COVID-19) https://emedicine.medscape.com/article/2500114-overview

HIV Infection and AIDS https://emedicine.medscape.com/article/211316-overview

HIV https://www.who.int/news-room/fact-sheets/detail/hiv-aids

Molnupiravir, an Oral Antiviral Treatment for COVID-19 https://pubmed.ncbi.nlm.nih.gov/34159342/

Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients https://pubmed.ncbi.nlm.nih.gov/34914868/

Molnupiravir for the Treatment of COVID-19 in Immunocompromised Participants: Efficacy, Safety, and Virology Results From the Phase 3 Randomized, Placebo-Controlled MOVe-OUT Trial https://pubmed.ncbi.nlm.nih.gov/36648627/

Molnupiravir Plus Usual Care Versus Usual Care Alone as Early Treatment for Adults With COVID-19 at Increased Risk of Adverse Outcomes (PANORAMIC): An Open-Label, Platform-Adaptive Randomised Controlled Trial https://pubmed.ncbi.nlm.nih.gov/36566761/

Paxlovid https://pubmed.ncbi.nlm.nih.gov/35138785/

Protease Inhibitors as Promising Weapons Against COVID-19: Focus on Repurposing of Drugs Used to Treat HIV and HCV Infections https://pubmed.ncbi.nlm.nih.gov/34727849/

A Trial of Lopinavir-Ritonavir in Adults Hospitalized With Severe Covid-19 https://pubmed.ncbi.nlm.nih.gov/32187464/

Tenofovir Disoproxil Fumarate and Coronavirus Disease 2019 Outcomes in Men With HIV https://pubmed.ncbi.nlm.nih.gov/35848570/

Development of COVID-19 Vaccines–An Unanticipated Moon Shot Achieved at Warp Speed https://pubmed.ncbi.nlm.nih.gov/36689231/

Emerging Viral Diseases From a Vaccinology Perspective: Preparing for the Next Pandemic https://pubmed.ncbi.nlm.nih.gov/29199281/

A Bivalent Omicron-Containing Booster Vaccine Against Covid-19 https://pubmed.ncbi.nlm.nih.gov/36112399/

New Boosters Are Here! Who Should Receive Them and When? https://pubmed.ncbi.nlm.nih.gov/36354037/

Effectiveness of Paxlovid in Reducing Severe Coronavirus Disease 2019 and Mortality in High-Risk Patients https://pubmed.ncbi.nlm.nih.gov/35653428/

Nirmatrelvir Use and Severe Covid-19 Outcomes During the Omicron Surge https://pubmed.ncbi.nlm.nih.gov/36001529/