Infectious Love: Coronary Angiography in Out-of-Hospital Cardiac Arrest and Risk of HIV Transmission in Serodifferent Gay Couples


Jonathan Gravel, family medicine resident at the University of Toronto and soon-to-be emergency medicine resident, is joined by Max Deschner, a resident in Internal Medicine at Western University.  Together they are covering coronary angiography after cardiac arrest without ST-elevation (COACT trial) and the risk of HIV transmission through condomless sex in serodifferent gay couples.

Ischemic heart disease is one of the leading causes of out-of-hospital cardiac arrest.  Patients with out-of-hospital cardiac arrest undergo complex management and consideration of coronary angiography. Immediate PCI (percutaneous coronary intervention) in patients with STEMI (ST-elevation myocardial infarction) improves mortality but how about beyond STEMI, who should undergo PCI? Max shares the COACT trial, which compared immediate versus delayed coronary angiography in patients following out-of-hospital cardiac arrest without STEMI; survival at 90 days was analyzed.

Previous literature has provided information on HIV transmission risk through sexual intercourse in the context of suppressive antiretroviral therapy.  This has often been in heterosexual serodifferent couples and variable condom use was reported. Jon highlights the second phase of the PARTNER trial (PARTNER2), in which the risk of HIV transmission is studied in serodifferent gay couples and condomless sex in which the HIV-positive partner is on virally suppressive antiretroviral therapy.

Next, the Good Stuff segment.  Max shares a book ‘Dopesick,’ written by Beth Macy, that paints a picture of the origins of the opioid crisis in America. Jon covers an article on the ethics of federally funding a trial of sodium restriction in prisoners.

In the special segment for this week, Sheliza Halani interviews Dr. Hance Clarke, anesthesiologist and the medical director of the Pain Research Unit at Toronto General Hospital, on how to manage pain in patients with opioid use disorders and how to advocate for their needs.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Jonathan Gravel @gravel_jon, Max Deschner @deschner_max, Sheliza Halani @sheliza_halani, and Hance Clarke @Drhaclarke.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. COACT: https://www.nejm.org/doi/full/10.1056/NEJMoa1816897

2. PARTNER: https://www.com/journals/lancet/article/PIIS0140-6736(19)30418-0/fulltext

Good Stuff

1. Dopesick: https://www.littlebrown.com/titles/beth-macy/dopesick/9780316551281/

2. Salt trial: https://annals.org/aim/article-abstract/2727205/should-prison-salt-trial-federally-funded

Special Segment

1. Harm Reduction Supplies & Locations: https://www.toronto.ca/community-people/health-wellness-care/health-programs-advice/harm-reduction-supplies-and-locations/

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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