HIV and ID Observations

March 31st, 2010

C diff Guidelines: Metronidazole Still Preferred?

IDSA and The Society for Healthcare Epidemiology of America (SHEA) have published Clinical Practice Guidelines for Clostridium difficile infection. Not surprisingly, it’s a comprehensive, extensively-referenced document that will be an invaluable resource, especially since the previous version is approximately 15 years old. But with the caveat that I’m not an expert in this area, these particular treatment recommendations […]

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March 28th, 2010

Kidneys: Fortunately, We Have Two

Here’s a case over in our Journal Watch: AIDS Clinical Care site:  a man with suspected PCP develops rapidly progressive renal failure after being starting on both empiric PCP treatment with TMP-SMX and ART with TDF/FTC plus darunavir/ritonavir. The specific questions at the end of the case were: What do you think is causing the renal failure? […]

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March 24th, 2010

Now for Some Good News: TB Cases Continue to Decline

From the latest MMWR: This figure speaks for itself, but two sentences from the Editorial Note deserve highlighting: The 11.4% decrease in reported TB rate in 2009 is the largest single-year decrease ever recorded. From 1953 to 1993, the single largest annual percentage decrease in TB case rate was 11.1% in 1956 Since I started my ID career […]

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March 17th, 2010

This One Drives Me Crazy

In the debate over efforts to expand HIV testing by making it less “exceptional” and more like other important tests done in medical care — something I heartily endorse (no kidding) — comes one particular protest that makes absolutely no sense to me. It goes something like this: We cannot expand HIV testing before guaranteeing that all newly-diagnosed […]

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March 14th, 2010

MRSA Bacteremia Question Redux — and the “Answer”

As noted here, I recently had to answer a question on management of MRSA bacteremia as part of an every-10-year cycle of test-taking. (For more on that joyous process, read this interesting debate here in the New England Journal of Medicine.) The question seemed to have no obvious right answer, so I did what one is explicitly allowed to […]

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March 10th, 2010

The Extraordinary Power of Placebo

Just published in the journal Neurology — not typically on my radar screen — is this remarkable study comparing pregabalin to placebo for HIV-related distal sensory peripheral neuropathy. Here are the results: At endpoint, pregabalin and placebo showed substantial reductions in mean Numeric Pain Rating Scale (NPRS) score from baseline: -2.88 vs -2.63, p = 0.3941. (-snip-) […]

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March 5th, 2010

Test Question on MRSA Bacteremia

I just happened to be taking a test the other day — something I do for fun every now and then, say every 10 years or so — and I came across this question (slightly condensed/changed to protect the innocent): Man with history of IDU admitted with fever, has bacteremia due to MRSA (MIC 2 mcg/mL […]

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March 3rd, 2010

Ritonavir Tablets: Any Experience Out There Yet?

Ritonavir tablets have been approved, and are apparently now in pharmacies.  The capsules will also remain available for the foreseeable future. However, I haven’t switched anyone over from the capsules yet, and neither has anyone else in our practice. Would be interested in hearing how it’s going so far — best news would be that the tablets […]

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