MEN OUT OF PRISON, TRANSMIT LESS STIs

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These recent “free” men are less likely to transmit or receive Sexually Transmitted Infections after attending an educational program in the prison or the parole/probation program. Most gonorrhea and chlamydia infections have no symptoms but can ruin a person’s life if not treated.

MEXICO CENTRALIZES FUNDING FOR HIV SERVICES. PROBLEMS RESULT

There is a new rule in Mexico that the government will provide the care and medicines now for HIV patients.  This stops funds going to community projects for outreach, testing, care, and medicines.  The government says they have plenty of medicines. LGBT rights groups are protesting, saying that this is a perfect storm for many to drop out of care and/or miss medications.  Is the government set up to have the outreach for counseling, testing, and prevention services? The access to government clinics and medications is not very efficient, and a labor strike made it worse recently.  95,000 patients are at risk.  Antivirals will be given out for only a month, rather for 3 months.

The most at risk are gay men, people who are transgender, and sex workers.  The government has not been friendly towards these groups and many avoid contact with the government.

The purpose of the reforms is to minimize corruption and diversion of funds by centralizing the flow of funds. Already delays have happened.

Mexico has about 220,000 HIV positive patient and only 60% are on antivirals. The public health clinics treat 95,000 and the rest are treated by community projects, previously supported by government funds. About 12,000 new cases diagnosed/year, 33 cases a day.

UNCONTROLLED PAIN, PROVIDERS SCARED TO PRESCRIBE OPIOIDS

An unintended consequence of the push to not overprescribe opioids has resulted in under-prescribing them for valid reasons. Some providers have abruptly stopped refilling prescriptions resulting in withdrawal and severe pain. Some of these patients will go to the street and that will result in more deaths due to contaminants such as fentanyl in the street drugs. There is a push to find the middle ground.  The New England Journal of Medicine has a free module I am working through that gives 60 case studies with great explanations as to how to handle many types of pain. We providers need to know what is good medicine and acceptable to the courts, and these modules are helpful.

TELEMEDICINE APPOINTMENTS

A new study described several models of Hepatitis C treatment: mixed in with regular primary care, or in an HIV clinic, or in a methadone clinic in addition to having home care nursing or telemedicine.  No major differences were found in the outcomes of these five methods.  At Borrego, we do telemedicine visits for Hepatitis C, Transgender Health, and Suboxone treatment (for opioid addiction) and less often for HIV and Hepatitis B when the patient lives closer to one of our clinics but far from where the specialist is.  I care for patients near Indio and Barstow from offices in San Bernardino, Riverside, and San Jacinto.

Telemedicine is taking off to meet the great need for medical care. Underserved areas such as rural towns and prisons are getting more telemedicine. Others are using it for physicians to supervise nurse practitioners and physician’s assistants or consulting to a practice or hospital where a local consultant is not available. For example, a tele-hospitalist can handle problems at night for a hospital.

BIRTH DEFECTS

Dolutegravir (in Triumeq® and Tivicay®) had no spinal cord birth defects in the latest look at more pregnancies. Last year 4 babies with defects were discovered in a study in Botswana in a smaller study; was this random or from the medication?  Providers are encouraged to report any birth defects in babies born to mothers on HIV medications. Many changed the dolutegravir to other drugs when the Botswana news came out but with larger numbers, this does not seem to be as much of a concern. The guidelines have not changed as to whether dolugtegravir is safe in pregnancy.

Another study found no loss of viral control when the pregnant patient’s antivirals were changed to a more acceptable one.

Randomness is a strange thing. If you flip a coin a 100 times the result will be near half for heads and half for tails, but there will be times when you get 4 heads in a row. Feel free to try this. Research tries to see if an event is a random occurrence or associated with a cause. Larger coin flips evens it out to 50/50.

UB-421 HIV ANTIBODY SEEMS PROMISING

A new study showed that an antibody attaching to the HIV causing the body to destroy it has shown promising trial results, way better than our body. Our body doesn’t produce an effective immune response to HIV.  This intravenous treatment is very expensive and is entering more trials to make sure it is safe and effective.

Keep those questions coming, be safe!

Daniel Pearce, D.O., FACOI, AAHIVMS

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 Osteopathic Medicine

HIV Specialist, Borrego Health (Riverside, San Bernardino, San Jacinto)

Member, Coachella Valley Clinical Research Initiative


REFERENCES: Medscape®

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