Tag Archives: HIV

Are virtual medical meetings the wave of the future?

It’s now possible to go to a medical meeting without actually going to the meeting.CROI Webcasts

I was assigned to cover the annual Conference on Retroviruses and Opportunistic Infections (CROI), one of the year’s most important HIV/AIDS meetings, currently underway in San Francisco. But through a series of snafus too boring to mention I was not able to register for the conference.

No problem, said the organizers, more than 90% of the conference will be webcast.

I’ve heard this song before, and usually it means that at some distant future date some low-quality audio may be available for purchase at the rate of $40/session or thereabouts.

But I was pleasantly surprised to learn that CROI is offering much, much more. The webcasts are free, they include high quality audio, video, and PowerPoint slides, and the day’s sessions are all available the same evening. Oh, and the audio files, with slides, are also available for download in mp3 and iTunes format. For free.

Virtual attendance via webcast has both advantages and disadvantages compared to physical attendance in “meatspace.”

Advantages

  • No need to pay for travel, hotel, or even meeting registration.
  • Smaller environmental impact.
  • Can attend all sessions, even ones occurring simultaneously.
  • Can clearly hear and see the speaker, the slides, and participants in the Q&A session.
  • Can pause and rewind audio, study PowerPoint slides closely, and actually read those slides that speakers introduce by saying, “Now this slide is a little busy, but . . .”
  • Can attend in pajamas.

Disadvantages

  • No schmoozing, no networking, no catching up with old friends and colleagues.
  • Requires a fairly fast Internet connection for non-jerky video. Even with a fast connection (in CROI’s implementation, at least) streaming tended to stop halfway through a 2-hour session, and the only way to resume was to exit and reload.
  • Not possible to get a sense of how interested–or uninterested–the audience was in a particular talk.
  • I’m a big fan of poster sessions, but the CROI did not make the posters available on its webcast.
  • No way to earn CME credit for watching the webcasts, in this implementation at least.
  • No opportunity to spend time in San Francisco, one of the most exciting and beautiful cities on Earth.

I’m interested in hearing from physicians who have attended a conference via webcast. What did you think about the experience? I’d also like to hear from physicians who think this is the worst idea since bloodletting went out of fashion. Please vote in the poll and leave comments!

— Bob Finn (on Twitter @bobfinn)

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Filed under IMNG, Infectious Diseases, Polls, Practice Trends

Hepatitis C: Drugs in the Pipeline

Photo by flickr user zieak (Creative Commons).

A rich pipeline of anticipated new drugs to treat hepatitis C is motivating one clinician to delay treatment in select patients who have chronic disease and can safely defer treatment.

According to Dr. Norah Terrault, director of the Viral Hepatitis Center at the University of California, San Francisco, two new protease inhibitors — boceprevir and telaprevir — are expected to be approved as add-on therapy for hepatitis C sometime in the first quarter of 2011, to be used in combination with pegylated interferon and ribavirin.

At a recent conference, Dr. Terrault discussed the pros and cons of treating vs. delaying treatment of hepatitis C in patients co-infected with HIV. The co-infected patients whose hepatitis C she generally treats without delay include any with genotypes 2 or 3  (because all the new drugs are being developed primarily for genotype 1), patients with low levels of hepatitis C RNA regardless of genotype (because they’re the most likely to achieve a sustained viral response to therapy), patients with advanced fibrosis (because “they can’t wait for new treatments”), and patients with acute (not chronic) hepatitis C who are on stable antiretroviral therapy with no opportunistic infections and CD4 counts above 200 cells per cubic millimeter.

For all other co-infected patients, “it’s a matter of weighing the risks and benefits of treating now versus later,” she said. For example, hepatitis C tends to progress faster in the presence of HIV, which could argue for earlier treatment, but the new regimens should offer a better chance of response, if the patient can wait. Toxicity with today’s hepatitis C drugs is a bigger burden for patients with HIV than those without HIV, but the new drug combinations will be even harder to tolerate.

It’s only in the past year that she’s begun deferring treatment for hepatitis C, she said, and the main reason is that better treatments are “just around the corner.”

Dr. Terrault has received research support from Schering-Plough Corporation (boceprevir)  and Vertex Pharmaceuticals Incorporated (telaprevir) as well as numerous other pharmaceutical manufacturers.

— Sherry Boschert (@sherryboschert on Twitter)
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Filed under Family Medicine, Gastroenterology, IMNG, Infectious Diseases, Internal Medicine

Celebrity Viruses

Thin-section transmission electron micrograph of HIV. courtesy of CDC's Dr. A. Harrison; Dr. P. Feorino

Transmission electron micrograph of HIV, courtesy of CDC.

Today the Institute of Medicine released its report on improving recognition of and care for chronic hepatitis B and C infections.  In the report the IOM highlighted the lack of knowledge about hepatitis B and C among the general public but also among physicians, other healthcare providers, and social service providers. (see story)

In particular, the IOM recommended mounting a public awareness campaign similar to the successful HIV/AIDS campaign.  That begs the question of why HIV/AIDS has engendered such attention while hepatitis B and C have not.  Why has HIV been a sort of celebrity virus?  It’s estimated that 3-5 times as many people live with chronic hepatitis B and C than with HIV/AIDS. Yet in general, even physicians are poorly educated about these diseases.

Why?  Is it because HIV/AIDS posed an imminent threat to the health of an individual (i.e. death) when it was initially identified and before effective treatment regimens were available, ?  Is it because those with hepatitis B and C are often asymptomatic?  Is it because there are no celebrities with hepatitis B and C?  Is it because HIV/AIDS organizations are better organized and less fragmented?

The pervasive lack of knowledge about hepatitis B is particularly troubling, given that there is a very effective vaccine to prevent infection.  However, you can’t really get the vaccine if your physician doesn’t know about it.

Let us know what you think.  What’s behind the disparity?

—Kerri Wachter ( @knwachter on Twitter)

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Filed under Infectious Diseases, Primary care

Hooray for Basic Science!

Telomere Staining courtesy of the U.S. Dept. of Energy

Telomere Staining courtesy of the U.S. Dept. of Energy

With all of the commotion over health care reform these days, today’s announcement that the 2009 Nobel prize for physiology or medicine has been awarded to Elizabeth H. Blackburn, Ph.D., Carol W. Greider, Ph.D.,  and Jack W. Szostak, Ph.D., for their discovery of telomeres and the related enzyme telomerase, serves as a timely reminder of the importance of basic research to medicine.

According to the official Nobel press release: “Elizabeth Blackburn and Jack Szostak discovered that a unique DNA sequence in the telomeres protects the chromosomes from degradation. Carol Greider and Elizabeth Blackburn identified telomerase, the enzyme that makes telomere DNA. These discoveries explained how the ends of the chromosomes are protected by the telomeres and that they are built by telomerase.”  

The findings have important implications for aging and cancer but the origins are humble.  Dr. Szostak and Dr. Blackburn conducted their research with single-celled organisms from pond water (Tetrahymena) and yeast.  Notably, none of the three researchears are clinicians.

A look at the last 10 years’ worth of Nobel prizes in physiology and medicine shows that the Royal Swedish Academy of Sciences seems to favor basic science research in medicine.  Only the awards in 2008 and 2005 have obvious clinical ties—HIV/HPV and Helicobacter pylori.  The other award recipients have opened up our ability to modify genes using embryonic stem cells, allowed us to see inside the body without picking up a scalpel, and better understand how the nervous system works.

So, ladies and gentlemen, can we have a round of applause please, for all of those unrecognized basic science researchers quietly slaving away over petri dishes, microscopes and chemical assays? 

—Kerri Wachter, @knwachter on Twitter

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Filed under Genomic medicine, Geriatric Medicine, Medical Genetics, Oncology