WHERE DO YOU WANT TO DIE?
A new study shows that most people don’t think about this or discuss it with their relatives, but would rather die in peace at home, away from the noise and intensity of the hospital. But most end up dying in the hospital. It is hard to stick to the plan when there is a crisis. Many don’t ask hard questions of their providers about quality of life on treatments, but just accept prolonging it even though the quality of life may be miserable. In the US the default path is to do everything to prolong life, even if it will be miserable.
LOWER HEART ATTACKS WITH HEALTHY LIFESTYLE
Exercise, keeping your weight down, no more than moderate alcohol, not smoking, and eating right lowered the risk for heart attack by 86% compared to those who do none of the right things. Many of you would prefer pills, but they are quite inferior to good clean living.
HEP C TREATMENT $150,000
That is the price tag for the two new drugs out this last few months that has great success in curing Hepatitis C: Olysio® and Sovaldi® . In general these have been quite tolerable, and certainly better than the interferon and ribavirin. All so far I have treated have been cured. There is much negotiation going on to reduce prices but with no success so far. The strategy of insurers is to treat those who will have short lives if not treated; we are talking about those with stage 4 (cirrhosis).
RED SPOTS ON LEGS? MAY BE HEPATITIS C
Hepatitis C can cause a condition called cryoglobulinemia, and that causes red spots on the legs. Sometimes the Hepatitis C viral load test is negative since the virus gets tied up in a clot.SKINNY PEOPLE AT GREATER RISK FOR KIDNEY FAILURE ON TENOFOVIR
Those weighing under 65kg (143lbs) are at greater risk for kidney failure if taking tenofovir (in Viread®, Truvada®, Atripla®, Stribild®, Complera®). Ask your provider if you are taking one of these.
PHARMACIES INTEGRATING WITH OUTSIDE CLINICS
CVS and Walgreens have formed partnerships with large clinic/hospital groups to share data and improve health care. They share information, with the patients’ permission of course, so that the pharmacist can know why the patient is getting the medication, and the provider can know when the patient doesn’t pick up the medications or sees an urgent care provider in the pharmacy’s clinic. This makes sense; one of my greatest frustrations is finding out what happened at the X-ray facility, specialist office, or Emergency Room. I have learned how to ask questions better to get the information from the patient, but that is no substitute for having the complete information. My staff will spend a half hour calling the facility after getting a signed form faxed to them. A few times we can get the information to us within a half hour but it can take many hours or months or………never, even after multiple phone calls and faxes.
This also may help making sure that the medication list is correct. The most common mistake in health care is medication errors.
NO DIFFERENCES IN STROKES FOR HIV+
A large study of the computers at Kaiser in Northern California showed that those who were HIV positive did not have a higher risk of strokecompared to the HIV negative patients. When they split out the high, medium, and low CD4 groups, there still wasn’t a difference. Previously we discussed that heart attacks were higher in HIV patients.
ON-DEMAND PrEP INFORMATION COMING
There is a study in France where the high-risk gay men take the Truvada® when they need it. This is a new strategy and we will wait for results to see if it worked.
IMPORTANT PrEP FINDINGS
There was a large, international study that offered PrEP to those who wanted it. There were 1,603 participants. Many took it. Those who were at higher risk used it more. At first the condom use was less in those who used PrEP and they had more partners than before. Those who took 2-3 pills a week had good protection and the very best was at least 4 pills per week. The researchers caution that they still recommend daily dosing to keep the habit going and not forget. After some time, many used PrEP when they needed it and used condoms at other times, perhaps when the relationship was more comfortable and stable. So the right people used it and used it well, except younger people were worse at taking enough of the medicine, Truvada®, once a day.
You can see that my reservations about PrEP are being addressed by important, large studies. The only question remaining is the potential for causing resistance in those who took PrEP and became infected with HIV.
Keep those questions coming. Be Safe!
Daniel Pearce, D.O., FACOI, AAHIVS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of OsteopathicMedicine
Researcher, Veterans Administration Hospital, Loma Linda
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside