HIV and ID Observations

On a lazy, brutally hot summer day, here are some more “quick questions” to think about as you hope for a cool breeze to bring relief from the stultifying (love that word) heat:

• How soon will we be able to look back at contact precautions for MRSA and VRE and laugh at our folly?
• Are we again recommending antibiotics after incision and drainage of uncomplicated skin abscesses? Hard to keep track of this one. Maybe because there’s no right answer for everyone.
• What’s the best shorthand/abbreviation for “Fourth-Generation combination HIV-1 antigen/HIV-1/2 antibody immunoassay?” Boy I’m tired of writing that. How about, “HIV screening blood test” (with all the rest of the stuff implied)?
• What proportion of those with a diagnosis of both Lyme and bartonella actually have neither?
• If dalbavancin and oritavancin weren’t so expensive — say, $500/course instead of $3000-5000 — how much would we use? (I think a lot.)
• If Sporothrix schenckii had a different name, would such a high percentage of clinicians remember its association with rose thorns? “Sporotrichosis” just sounds like a disease you get from something sharp and prickly. Oh, and sphagnum moss (not sharp and prickly) and cats (could be) are also sources, for you trivia buffs.
• What percentage of our ID consult notes are actually read by surgical consultants? Regardless — what do they think of them? Especially the really long ones.
• In community acquired pneumonia severe enough to require admission, how often are antibiotics stopped after a specific viral infection is diagnosed using molecular studies? Seems to work in kids and adults for “respiratory infections”, but for admitted patients with pneumonia? Unclear, but I’d still value the information.
• Will anyone ever figure out what is causing that outbreak of Elizabethkingia anophelis in the Midwest?
• Why isn’t there more drug development for non-tuberculous mycobacteria? Gosh darn it, there’s a clinical need here. Hey there, you medicinal chemists, lab-based ID scientists, and PhDs, get on it!
• The HIV primary care guidelines recommend “anal pap tests” as a screen for anal cancer — but how often should they be done? Can anyone in good conscious suggest a test be done annually (for example) that hasn’t yet been proven to prevent cancer or improve clinical outcomes?
• Will there ever be a flu vaccine you don’t need to repeat every year? I can dream, can’t I? Or lower hanging fruit — a better mumps vaccine?
• Who will figure out how to make an ID-approved, well-done hamburger that doesn’t taste like charred sawdust?
• In the sofosbuvir combination treatments for HCV, which of the two drugs should be said first? I’ve been saying “LDV-SOF” (spelling out the “LDV”) and “VEL-SOF” (saying “VEL”), but have noticed all kinds of variations. You could do the brand names, but please. The direct-to-patient ads for LDV-SOF are almost as common as those for razors and pickup trucks.
• With all the controversy about the Rio Olympics, Zika, and contaminated water, is there any ID-related sports story more bizarre than the leptospirosis-poisoned tennis player? Hey — it gives me first-time chance to link the British Sun, that fine example of responsible journalism. Am sure they would welcome the web traffic from here, though perhaps be a bit surprised to get it.
• How many of those “antigen-positive, toxin negative, PCR positive” patients treated for C diff really don’t have C diff at all? If you don’t know what I’m talking about, read this.
• Will I ever remember — without struggling to come up with the specific name — that Haemophilus aphrophilus is now Aggregatibacter aphrophilus and Aggregatibacter segnis? Some facts just might be for nimble young minds only, but am making this one my personal obsession.
• Will TAF/FTC work for PrEP? Good question for a clinical trial!
• Is there anything more predictable than 1) a scientific paper finding bacteria on some household item, then: 2) the media getting all grossed out by the research, minimal clinical implications notwithstanding? Latest example — your coffee maker drip tray! Ewww!
• How long before there’s a reported antibiotic shortage do the manufacturers know it’s coming? I’m thinking about you, cefepime makers! It’s not as if demand for this drug was low.
• How many “First Zika Transmission in [insert Southern US City here] Reported” will we see this year? And how many incredibly difficult to carry out pregnancy recommendations?
• When will IGRAs completely replace tuberculin skin testing? Not saying that they are more accurate, just that they’re so much easier. Might be a downside in the healthcare screening setting — too many false-positives over time.

That’s enough for now. Need to stay cool … just like the 400-year-old shark, pictured above.

And it’s not easy being funny in 140 characters. But some people succeed brilliantly!