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Archive for October, 2012

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October 28th, 2012

Dolutegravir and the 88% Rule

In the latest treatment-naive trials of elvitegravir and dolutegravir, there’s a striking consistency in the results of the “test” regimen. Here are the studies, with the percentage of responders by treatment arm: Study 102:  TDF/FTC/EFV (84%) vs. TDF/FTC/EVG/c (88%) — non-inferior Study 103:  TDF/FTC + ATV/r (87%) vs. TDF/FTC/EVG/c (90%) — non-inferior SPRING-2:  TDF/FTC or [...]


October 22nd, 2012

Can a “Treat Everyone with HIV” Policy Actually Work? In San Francisco, Yes

As has often been the case in the history of the HIV epidemic, the HIV/AIDS Division at San Francisco General Hospital and the San Francisco Department of Health were ahead of the curve in 2010 when they issued a recommendation that all people with HIV should receive treatment, regardless of CD4 count. Of course, US guidelines [...]


October 17th, 2012

It’s Time to Tell Our Patients to Stop Their Vitamin Supplements

Over in JAMA, there’s a large study out today that (yet again) failed to demonstrate a benefit of vitamins. Over 3000 patients with HIV in Tanzania were randomized to receive either high-dose or standard-dose multivitamin supplementation, in addition to “HAART” (ugh). Though the study was planned for 24 months, it was stopped early by the Data [...]


October 16th, 2012

Some Liver Meeting “Wow!” Studies Start to Emerge

The Liver Meeting, the annual meeting of the American Association for the Study of Liver Disease, does not take place until November 9-13, in Boston. But if you want a preview, a couple of notable studies have already been “announced” in the press. Specifically, there’s this: Abbott today announced initial results from “Aviator,” a phase 2b study of [...]


October 15th, 2012

ID Doctors are Clueless about Treating Helicobacter

Every so often, we’ll get a referral from a gastroenterologist about a refractory case of Helicobacter pylori. Usually the patient has been treated multiple times, and still has symptoms and a positive test. Naturally a referral to a specialist in Infectious Diseases seems warranted. But the reality is that this is like the IV nurse [...]


October 13th, 2012

More Questions from “ID in Primary Care” Course

Some additional excellent questions from the course: For someone who has had 3 doses of hepatitis B vaccine but does not have the antibody, should we just go ahead and give another 3 shots? A:  (Per vaccine guru Howard Heller):  The guidelines say to just go ahead and give another 3 shots but if the [...]


October 11th, 2012

Back to School: Questions at the “ID in Primary Care” Course

We do a post-graduate course each year called “ID in Primary Care,” and it’s a great way for us to find out what people in outpatient primary care practice are thinking about from the ID perspective. I told the participants this year I’d post some of their most interesting questions on this site, with the hope [...]


October 8th, 2012

With One Month To Go, Candidates Eke Out Votes Wherever They Can

From the Department of Opportunistic Expediency, we have this brazen pitch from one of our two presidential hopefuls: Romney and Ryan will do more to fight the spread of Lyme Disease … As president, Mitt Romney will ensure that real action is taken to get control of this epidemic that is wreaking havoc on Northern [...]


October 2nd, 2012

The Drug-Resistant Gonorrhea: How Much of a Threat?

By now, all ID docs know about the ceftriaxone-resistant Neisseria gonorrhoeae. Or, more accurately, we’ve read about it, since the vast majority of gonorrhea cases are treated in emergency rooms, STI clinics, college health facilities, and various primary care settings — not places that most ID doctors typically work. Plus, hardly anyone does susceptibility testing [...]


HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Editor-in-Chief

NEJM Journal Watch HIV/Aids Clinical Care

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.