Episode 015 — HIV and millet seeds

Posted in: Infectious Disease Posted on

In episode 015 we devote much of the episode HIV. In keeping with this, we also discuss AIDS-defining illnesses, including fungal infections and disseminated tuberculosis. We touch on PrEP, and then Alex closes us out with his story of contracting giardia.

The sociocultural history of HIV

  • “The Man Who Was Immune to AIDS” [NY Magazine, 2014 article]
  • Angels in America [Wikipedia]
  • Ryan White [Wikipedia]
  • AIDS and Accusation by Paul Farmer (UC Press)
    • “Does the scientific ‘theory’ that HIV came to North America from Haiti stem from underlying attitudes of racism and ethnocentrism in the United States rather than from hard evidence? Award-winning author and anthropologist-physician Paul Farmer answers with this, the first full-length ethnographic study of AIDS in a poor society.”
  • PrEP
    • CDC PrEP page [CDC]
    • Long acting PrEP candidate drug that Alex mentioned [Nature]
    • Seattle, King County, and Washington…
      • PrEP provider map [kingcounty.gov]
      • WADOH PrEP drug assistance program
        • PrEP DAP (Pre-Exposure Prophylaxis Drug Assistance Program) is a drug assistance program for HIV-negative people who have risk factors that expose them to HIV. PrEP DAP pays for certain PrEP and other medication costs listed on the approved formulary. PrEP DAP enrollees are assigned a group number which gives them access to the medications on the formulary based on their enrollment status.
      • Seattle / King County PrEP prescribing guidelines that I mentioned during the episode. We talked about the way that these guidelines suggest ‘talking about PrEP’ to patients who are chlamydia+ but strongly suggest prescribing for gonorrhea+ or syphilis+ … this seems a little odd, since GC and CT often ‘come together as a pair’ so to speak. In spring of 2018 tried to figure out why GC would be seen as more significant a marker of HIV risk than CT. My research findings (or lack thereof) about that are below.
        • There are only three citations in the KCPH document, one of which is about the efficacy of PrEP, one is the CDC guidelines (no help there), and one is a King County based study that is interesting but doesn’t look at rectal infection and doesn’t stratify by GC vs CT
        • I did a primary literature search and didn’t come up with much. If anything I found other places with local data showing mixed or equal data for risk of HIV seroconversion among those with rectal chlamydia cf gonorrhea. This led me to look for King County’s local epidemiologic data (since the reasoning isn’t cited in their guidelines I figured maybe it was based on uncited local data). They do publish a yearly epi report that talks about rectal STIs, but nothing useful in there (looked at 2015 and 2017). I then found an expedited partner therapy document that finally cited the apparent source that supports the recommendation. But when I read this paper (Pathela, et al, Clinical Infectious Diseases, 2013) it looks to me like they don’t stratify their recommendations/discussion by GC vs CT, and they simply say that GC/CT rectal infection carries a RR of 2.58 (and I think this is because their univariate analysis found no statistical significance for stratifying; see Table 2).
        • A physician who listens to the show wrote to us and suggested that the prevalence of CT vs GC might explain the reasoning. This sounds like a pretty reasonable hypothesis to me. (ie prevalence of gonorrhea is 1/4 that of chlamydia, so contracting gonorrhea might be a marker or more risky practices.)
  • America’s Hidden HIV Epidemic [NY Times]
    • “Why do America’s black gay and bisexual men have a higher H.I.V. rate than any country in the world?”

EBM

Youssef D, et al. “Effective strategy for decreasing blood culture contamination rates: the experience of a Veterans Affairs Medical Centre.” J Hosp Infect. 2012. [PubMed]

I mistakenly said that Dan Ariely had conducted the workplace coffee fund study, but I couldn’t find any such study with him as the author, and when I found the one I was thinking of, it turns out it was actually several other researchers. The point I was making about environmental influences is still correct, however, and I have included an image from the study  at right so you can see the difference in monies paid when flowers were present, versus eyes. What I’m about to say might just be wishful thinking (aka data torturing, aka statistically invalid subgroup analysis) but I do notice that the two pairs of eyes that are looking directly at the coffee drinker have the highest reimbursement, whereas those that are a glance from the side are much closer to flowers. (And particularly the pair that is wide-eyes and dramatically lit has by far the highest money paid per liter.)

Vocab

Miliary (as in: miliary tuberculosis) → Mert & Ozaras. “A Terminological Controversy: Do Disseminated and Miliary Tuberculosis Mean the Same?” Respiration. 2005. [PubMed]

— Episode credits —

Hosted by Addie, Kim, and Alex. Audio production and editing by Addie. Show notes written by Addie. Theme music (Too Cool, and Laserpack) by Kevin MacLeod of incompetech.com, licensed under Creative Commons: By Attribution 3.0 License.