May 2018 (2/3): Obesity after HIV treatment and gender bias in organ transplantation

Obesity develops in almost 1 in 5 patients with HIV infection after the intiation of ART. Use of an INSTI-based regimen rather than a  NNRTI or PI-based regimen appeared to be the strongest risk factor for developing obesity in this retrospective study (RR 7.12; p<0.0001), though an important limitation is that only 1% of the patients in the study (about 15 subjects) were in the INSTI arm. 29722811

~230,00 women in the US are living with HIV infection; of these, most do not use any long-acting contraception, and 8,500 give birth each year, which includes several hundred unplanned pregnancies annually. This is important in light of the recent FDA warning about neural tube defects in fetuses of women receiving dolutegravir, which has our #1 first-line antiretroviral for the past several years. 29771940

Women are more likely than men to be delisted for liver transplantation on account of being "too sick". This was shown in a retrospective review of over 44,000 liver transplant candidates. After adjusting for medical comorbidities, acuity of illness and calculated risk of mortality, being a woman was associated with a 10% higher risk of being removed from the transplant list. Gross. 29194969

Early infection in heart transplant patients is associated with prior LVAD use (especially if that was infected), delayed chest closure, and need for CRRT. Importantly, the large majority of post-surgical GNR infections in this population are due to organisms that are resistant to the cephalosporins given for standard peri-operative prophylaxis, suggesting that more reliable agents (e.g. carbapenems, aminoglycosides, tigecycline) might be more appropriate periop ppx for this specific population. 29775554

Of patients newly diagnosed with HIV infection in South Carolina, two thirds had had a previous medical encounter (and of those, they 'd had a mean 7 encounters), and almost 30% had been previously diagnosed with an STD. This goes to show that diagnosis of an STD is an important opportunity to test for HIV and offer PrEP if the patient is not already taking it. 29790923

48-week results from the DRIVE-FORWARD trial show the new NNRTI doravirine is equally efficacious and just as well tolerated as darunavir-ritonavir when combined with 2 NRTIs to treat HIV infection. From what I've read, doravirine will be a nice addition to our HIV armamentarium. Other than a ~5% incidence of headache, it doesn't seem to have any serious side effects. It has a completely different resistance pathway than other NNRTIs, meaning we should still be able to use it in patients who have prior NNRTI exposures or resistance mutations (in this way it is similar to darunavir vs other PIs). Finally, as an NNRTI, doravirine probably won't have too many drug interactions or need adjustment for renal function, although we should wait to read the package insert. Doravirine plus dolutegravir or darunavir-cobicistat (or all three together) could make a great salvage regimen to reduce pill burden in highly ART-experienced patients with multiclass drug resistance. 29592840