HIV and ID Observations

A few Infectious Diseases/HIV items to consider as we wait (and keep waiting!) for the warm weather to arrive in chilly, and often wet, New England:

• CRISPR-Cas9 excises latent HIV from the cells of humanized mice. With the usual caveat about not overreacting (like this) to an animal model, this CRISPR strategy seems like a more viable HIV cure intervention than other approaches. Nonetheless, we still have a long way to go before something like this is tested in humans and deemed to be safe.
• Zinc might shorten the duration of cold symptoms after all. Time for a fully powered, randomized, double-blind trial!
• Do the rare late relapses after HCV cure warrant checking HCV RNA a year after completing therapy, and not just at week 12? These guidelines from the American Gastroenterological Association Institute state that “some clinicians may think it prudent.” (Read that with a George Bush Sr. accent, via Dana Carvey.) Probably the best reason to re-check HCV RNA is to document re-infection, not a relapse. Regardless, this strategy does make sense.
• Largest measles outbreak in Minnesota in decades sickens children, leads to hospitalizations. (Edit: Excellent original coverage here, including comments from discredited vaccine researcher Andrew Wakefield, who states, “I don’t feel responsible at all” for the outbreak. Good grief.) And another outbreak in Portugal led to the death of a 17-year-old girl. Wouldn’t it be great if we had a simple, effective way of preventing measles? Oh, wait.
• The AIDSinfo site has been extensively updated. Well worth checking out for all your guidelines, patient information, and educational needs. Mobile apps, too. One pet peeve — I prefer “ART” over “ARV” as an abbreviation for “antiretroviral therapy.” How about you? Let’s do a poll:

Quick poll:

What abbreviation do you prefer for "antiretroviral therapy"?

— Paul Sax (@PaulSaxMD) May 7, 2017

• Tick-related illnesses could be a particular problem this year. Mice + Acorns = potential explosion in tick population. Get that doxycycline ready.
• One penicillin dose for early syphilis in people with HIV is good as three. More is not always better. And isn’t it extraordinary that Treponema pallidum still hasn’t figured out how to develop resistance to penicillin?
• This superb review of the book Drug Dealer, M.D skillfully outlines how we got into this opiate addiction mess. I kept nodding with agreement while reading this piece by my friend and colleague Abbie Zuger. I think it should be required reading for all current doctors, nurses, PAs, PharmDs, as well as students of these healthcare professions.
• The Massachusetts Medical Society voted to support medically supervised safe injection sites. There is excellent evidence from Europe and Canada that these sites save lives, clean up the streets and parks, and offer people with addiction information on how to access treatment. The idea has support from our local paper, too. Now, will it actually happen here? Currently there are zero in the USA. We are, as a society, very paranoid about “enabling” risky behavior by making it safer.
• Wonder why oral vancomycin is still so expensive despite having multiple generic manufacturers? Me too — the linked review covers this unique (and frustrating) situation, one that highlights the oddity of drug pricing in the USA and hints at price collusion.
• Worthy long-read: This fascinating profile of AIDS Healthcare Foundation’s director, Michael Weinstein. Ironically, the piece reminded me of another powerful person in the annals of HIV treatment, only in a completely different area — organic chemist Ray Schinazi. Both elicit strong reactions, pro and con.
• The 2019 Conference on Retroviruses and Opportunistic Infections (CROI) will take place in Seattle, March 4-7. The date and location of this important meeting used to be the best-kept secret in Infectious Diseases, which made creating academic schedules a nightmare. Vastly prefer this advance notice!
• This drug name emoji game is awesome. I selected every ID doctor’s favorite antibiotic for display up at the top of the post. It should prove especially useful for this bad upcoming tick season. And imagine if this is how we had to write prescriptions.

OK, now for a quick non-ID section:

• Here is a spot-on criticism of the “Milestones” process for evaluating medical residents and fellows. These ACGME Milestones offer a perfect example of how quantifying skills for which there are no reliable metrics leads to distracting noise, not real data. We got much more valuable information in the past when resident evaluations were done by narrative, using actual language rather than checking boxes.
• The New York City Department of Public Health keeps meticulous records of dog names. Bella is right now #1 for females, Max for males. And it looks like Nellie is very popular in my parent’s neighborhood. Just so you know.

NYC Dept of Health released a list of NYC's most popular dog names today with a map showing what's hot where. What's the health angle here? pic.twitter.com/9zixMkdv8A

— Helen Branswell 🇨🇦 (@HelenBranswell) May 5, 2017

• If you have even the slightest interest in baseball, I strongly recommend the book Smart Baseball, by Keith Law. Did you know that batting average, RBIs, and pitcher wins are highly flawed measurements of a player’s ability? And that you should never bunt solely to advance the runner? That the pitcher “save” is an evil force in the game? All 100% true, and clearly and entertainingly explained. I can also strongly endorse the author’s excellent blog, where he writes about books, food, movies, and is a consistent and forceful defender of the importance of vaccines for personal and public health. We like that!
• The television series “American Crime” is outstanding, but hardly anyone is watching. Despite critical acclaim, the ratings are only fair — seems like a quality/ratings ratio on par with “Friday Night Lights,” another terrific series that was relatively ignored when it aired. The linked piece places some of the blame on the rather blah and misleading title, a very good point.

Hey, I started with CRISPR/Cas9, so here’s the big finish. Take it away, A Capella Science!