Good morning! Yesterday was the Hope Conference coordinated by Dr. Raj Gandhi. The lecturer was Dr. Francesca Conradie from South Africa speaking about Bedaquiline (BDQ), a medication used for drug-resistant TB. Among the benefits are improved cure rates for XDR-TB and it also enables clinicians to eliminate toxic drugs from patients’ regimens. For example, ototoxicity (hearing loss) is becoming less common with the advent of BDQ. A few other points:
- BDQ can’t be given with efavirenz (levels go down)
- Many patients in South Africa are on amitriptyline for peripheral neuropathy or depression which causes an increased QT so BDQ can’t be coprescribed with this medication.
- At the Union World Conference in Cape Town next week, there will be a symposium about resistance, monitoring for adverse events, and pharmacovigilance.
- Drug resistant TB surveillance in South Africa is done using the EDR.web system.
- Delaminid co-administration with BDQ is an area of controversy.
- Xpert Ultra/Omni will probably be approved 2016 in Europe and 2017 by the WHO. The Xpert machines won’t need to be replaced, only the software will need to be updated.
Otherwise, a few other things to note:
- Yesterday was a very busy day in clinic but I learned a lot. What a privilege to practice at MGH with a great team.
- An interesting article about heroin in the New York Times.
- An important story about the Syrian refugees and parallel’s to the 1930s.
- Pretreatment HIV drug resistance in Africa is an important issue– but viral load testing is very rarely available.
- At end of the day I was very happy to meet with Marc Siedner. Check out his innovative work. What a great friend and mentor.
- Music for today is Monk’s Dream by the Thelonious Monk Quartet, thanks to Matt Reed, one of the nurses in the MGH ID clinic and a jazz drummer.
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