See How Far We’ve Come in 40 Years

We’re celebrating 40 years of our sister product, Pharmacist’s Letter, this month!

Help us commemorate with a throwback to a couple of the topics we covered in June 1985...our very first issue.

HIV. We’ve come a LONG way with HIV over the past 40 years...from considering it an incurable infection to one we can now prevent.

What we said in 1985:   There is no cure for AIDS on the immediate horizon despite all the news coverage.

What we say now:  Advocate ways to support HIV prevention.

Consider starting HIV pre-exposure prophylaxis (PrEP) at ED discharge for patients at risk (those who share needles, recent antibiotic for sexually transmitted infection, etc)...and others who request it, even if they don’t report at-risk behavior.

Explain that daily oral PrEP prevents HIV infection in about 1 in 50 adults at higher risk...such as a person whose partner is living with HIV.

Recommend generic emtricitabine/tenofovir DISOPROXIL fumarate (Truvada) daily for most patients...it costs less than other options.

Also know when to start POST-exposure prophylaxis (PEP)...after possible HIV exposure due to sexual assault, needlestick, etc. Ensure PEP is started ASAP within 72 hr of exposure...and continued for 28 days.

Be aware, preferred PEP regimens recently changed.

For most adults and teens, lean toward bictegravir/emtricitabine/tenofovir ALAFENAMIDE (Biktarvy)...it’s a single tablet taken once daily.

Use our checklists, HIV PrEP and HIV PEP, for screening and monitoring, alternative meds, how to help patients afford meds, and more.

Ischemic stroke. We’ve known for decades that antiplatelets reduce the risk of recurrent stroke. But we’re still studying the best approach.

What we said in 1985:  Persantine (dipyridamole) with aspirin is no better than aspirin alone in the prevention of strokes.

What we say now:  Ensure patients with a previous stroke are on aspirin 81 mg, clopidogrel, or dipyridamole ER/aspirin.

But consider starting a short course of dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel after a high-risk TIA (ABCD² score 4 or above) or milder stroke (NIH Stroke Scale score 5 or less).

In these cases, recent data suggest that starting DAPT within 72 hr and continuing it for 21 days prevents 1 recurrent stroke for every 53 patients treated compared to aspirin alone.

But avoid DAPT with more severe or cardioembolic strokes...or for those who get a thrombolytic or take an anticoagulant. There’s no proof that the benefit of DAPT outweighs the risk of bleeding in these cases.

Dive into our chart, Antiplatelets for Recurrent Ischemic Stroke, for more on the preferred options, dosing, and estimated cost.

• Chart: Antiplatelets for Recurrent Ischemic Stroke
• Checklist: HIV Pre-Exposure Prophylaxis (PrEP)
  
• Checklist: HIV Postexposure Prophylaxis (PEP) Checklist