Talk:Management of HIV/AIDS
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Difference or transition from HIV to AIDS
It might be helpful to provide the reader with an understanding of how the virus transitions from HIV to AIDS and how they are different. It may help to understand how the specific treatments listed affect the HIV virus but not the AIDs. (http://www.aids.gov/hiv-aids-basics/hiv-aids-101/what-is-hiv-aids/)
Explanation of HIV-1
It might be helpful to explain why there is a distinction between HIV and HIV-1 and explain what HIV-1 is.
HIV-1 is a type of HIV. HIV can be divided into two major types, HIV type 1 (HIV-1) and HIV type 2 (HIV-2). — Preceding unsigned comment added by 2600:8807:5582:5700:FD38:CCCD:2059:D308 (talk) 18:42, 7 June 2016 (UTC)
Infant mortality statistics
In 4.4.2 (Special Populations -> Children), this study is cited as saying that 52% of children (in Africa) infected with HIV die within 24 months.
However, see this paragraph on page 4 of the pdf document:
Overall, estimated cumulative mortality rates were 110 per 1000 livebirths at 12 months and 174 at 24 months. We estimated that by 12 months of age, 35·2% of infected children would have died, compared with an estimated 4·9% of uninfected children (figure 1). At 2 years of age, an estimated 52·5% of` infected and 7·6% of uninfected children would have died.
It looks like the maximum mortality rate is only 17.4% (174 of 1000 for 24 months). The "52·5%" figure seems to be referring to 52 children, or equivalently 5%. I'm unsure where the exact numbers for this calculation are coming from, but I believe the 52% mortality rate is off by a rather large number.
I don't like the addition of section on drug advertisements by WhatamIdoing because while it is historically true, I think it gives an incorrect impression of the current state of HIV care which is the focus of this article. While 15 years ago it might have been unrealistic to show active healthy people in HIV drug ads, this is now the reality for many people I know with HIV. They live with it as a chronic disease that does not affect their lifestyle very much and they do in fact mountain climb and sail. This section seems opposite to the earlier sections on the more current discussion of "the end of AIDS" by Fauci and others. Pgcudahy (talk) 14:34, 12 January 2016 (UTC)
- Can you propose a more appropriate page for documenting the very unusual marketing requirements around these drugs? There is no page about the drugs themselves; HIV medication, AIDS drug, HAART, and more than a dozen others all redirect here. Therefore, it seems to me that information about the drugs, including their political, legal, and business history needs to be on this page.
- Also, I think that personal experiences probably vary. If you've got severe diarrhea from Kaletra, then you're probably not climbing any mountains, and if you've got hepatotoxicity from ritonavir, then you're probably not looking very glamorous. But regardless of what you believe is the typical patient experience, it's now actually illegal for drug companies to use athletic images in American advertisements or to misrepresent models as being patients. (There are HIV-related ads that show actual patients, just as there are for other drugs/other diseases, but they're less common than they used to be.)
- I suspect that HIV ads are more criticized than any other type. If you use ads showing a happy, healthy, sexy man, then you're criticized for misrepresenting reality and causing HIV+ people to be careless about safer sex practices (PMID 12441813, etc.). If you use ads that communicate fear, then you get criticized for that, too. WhatamIdoing (talk) 01:21, 13 January 2016 (UTC)
- I think your examples illustrate my point. Kaletra has not been a preferred regimen for 10 years. Even if you're having diarrhea from it, you can now boost it with cobicistat since it's the ritonavir that drives diarrhea and cobi hasn't had that issue. Same with ritonavir and hepatotoxicity, that's rare when used as a low dose booster and ritonavir hasn't been used at antiviral doses in over 15 years. Also, again we now have cobi if it does become an issue. Besides all that, we have the newer nnrtis and instis that are super well tolerated. Or even the new attachment and maturation inhibitors in phase III trials.
- To me this is a historical footnote which isn't applicable to the article, let alone need its own section. In other places the history of ART is mentioned because it has bearing on the current management of disease, but I don't think this does. This isn't even the history of ART, it's the history of a regulatory issue with the marketing of ART. The FDA has been silent on the issue for 15 years since the drug companies haven't pushed it, but I highly doubt they would have the same reaction today that they did back then. To me this section reads as "The FDA thinks if you have HIV that you will be sick and not doing active things" but there is no way that I can believe that their opinion on the proper representation of HIV disease has not evolved in the last 15 years.
- What article does it belong in? I don't know, but it doesn't fit here. Maybe start an article on the marketing of ART, I think that would be super interesting since it does have so many facets. Even now there are controversies with marketing PrEP which are interesting. Pgcudahy (talk) 18:39, 13 January 2016 (UTC)