July 15, 2016

Treat to prevent

The story

Treating HIV may be the best way to prevent its spread, and new evidence suggests that suppressing viral load in HIV-positive patients decreases transmission regardless of sexual practice.

The background

Couples where one partner is HIV-positive and the other is HIV-negative ("serodiscordant couples") are a favorite target for trials evaluating the effect of anti-retroviral therapy (ART) on the spread of HIV. In 2011, HPTN 052 was stopped early after investigators found that early ART was associated with a 96% reduction in the risk of HIV transmission among 1,700 serodiscordant, heterosexual couples.

The evidence

The PARTNER trial looked at HIV spread in serodiscordant men who have sex with men (MSM) and heterosexual couples in a prospective, observational study. All participants reported condomless sex, and at baseline all HIV-positive partners had a viral load less than 200 copies / mL. In over 1,200 eligible couple-years, the study found no cases of in-couple HIV transmission. There were, however, 11 out-of-couple seroconversions of HIV-negative patients. 

The takeaway

PARTNER adds evidence that ART decreases the spread of HIV in condomless sex and in MSM couples. The 11 out-of-couple seroconversions mean you still need to remind your patients about safe sex. 

Say it on rounds

When your patient's nausea makes your own stomach hurt

There's nothing pleasant about emetogenic chemotherapy. An RCT of 380 patients found that adding olanzapine to a standard anti-nausea regimen reduced nausea symptoms relative to placebo in the first 24 hours following treatment, and benefit was seen throughout the 5-day study period. Researchers suspect that olanzapine controls nausea through effects on dopamine and serotonin receptors in the brain.

When your friends mistake everyday objects for Pokémon

Not the same. Also disturbingly not the same: physician salaries. Recent studies have shown a gender-based pay gap in community medicine, but the difference persists in academics. A national study of 10,000 faculty appointments at US medical schools shows women earn an average of $20,000 less per year than men, even when accounting for age, rank, specialty, and other markers of productivity. This table shows difference in salary by specialty.
JAMA Intern Med

When you thread an arterial line on the first try

Great work, but leave the larger vessels to the pros. A retrospective study found that emergent resuscitative endovascular balloon occlusion of the aorta (REBOA) improved blood pressure and serum lactate concentration in 8 patients when used as a last-ditch effort to control hemorrhagic shock from nonvariceal upper GI bleeds.  
World J Emerg Surg

Brush up

Numbers game

Add pulmonary embolism and deep venous thrombosis to get an estimated 10 million worldwide cases of venous thromboembolism (VTE) per year. Incidence increases exponentially with age, and men are about twice as likely as women to get VTE if pregnancy and estrogen therapy are taken out of the equation. A third to a half of VTE cases are unprovoked, 20% are secondary to cancer, and 15% are secondary to surgery. 

Get meta

With novel oral anticoagulants (NOACs) in the treatment of VTE. A look at 6 phase 3 trials with over 27,000 patients found a 39% relative reduction in the risk of major bleeding on NOACs vs. coumadin. The results applied to high-risk patients, including those with pulmonary embolism, age > 75 years, obesity, and renal insufficiency. Episodes of recurrent VTE were similar between groups. 


Curious how the current presidential administration views its progress on health reform? First author Barack Obama explains

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