HIV and ID Observations

February 26th, 2012

A Truly Bizarre “Systematic” Review

You know that tenofovir, emtricitabine, and efavirenz HIV regimen? The one that’s universally listed as one of the “Preferred,” or “Recommended” or “First-line” options in all HIV treatment guidelines in the universe? And the regimen that is easily the most widely used in the USA today? Well, here’s a surprising review from Cochrane Summaries, entitled “Effectiveness and […]

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February 23rd, 2012

Hepatitis C and the “Retooling” of HIV/ID Specialists

The news that hepatitis C (HCV) has passed HIV as a cause of death in the United States got quite a bit of attention when it was first presented last year at ICAAC — and no doubt the published paper, in this week’s Annals of Internal Medicine, will also cause a stir. In fact, I boldly predict […]

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February 14th, 2012

Is It Time To Stop Treating Acute Sinusitis?

From the pages of JAMA comes this startling clinical trial: A randomized, placebo-controlled trial of adults with uncomplicated, acute rhinosinusitis [who] were recruited from 10 community practices in Missouri between November 1, 2006, and May 1, 2009 … [Subjects received a] ten-day course of either amoxicillin (1500 mg/d) or placebo administered in 3 doses per day … There was no […]

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February 12th, 2012

Impossible Curbside at Medical Grand Rounds

Scene:  Medical Grand Rounds, 5 minutes before the start. Lecture is on coronary artery disease, which may have a link to Infectious Disease even if it isn’t actually caused by Chlamydia pneumoniae or CMV after all. A well-regarded, experienced primary care physician (PCP) approaches. PCP: Hi Paul, I have quick question*. [*Curbsiders often use this exact phrase — and rarely does […]

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February 10th, 2012

Boceprevir – PI Interaction: A “Dear Doctor” Letter We Didn’t Want To Get

By now I’m sure that most of you ID folks out there have received the following letter from Merck, the makers of boceprevir: URGENT — IMPORTANT DRUG WARNING: VICTRELIS (BOCEPREVIR) The purpose of this communication is to inform you of recent pharmacokinetic study results evaluating drug interactions between VICTRELIS, an oral chronic hepatitis C virus (HCV) NS3/4A […]

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February 7th, 2012

Chronic Fatigue: Is There Hope After XMRV?

I’ve been following the chronic fatigue/XMRV story from the start, which was compelling for several reasons, including: A potential cause was identified of a very debilitating, mysterious illness. Lots of very smart ID people (including some of my colleagues) studied it. Media coverage, notably from the Wall Street Journal and the New York Times, was particularly […]

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February 3rd, 2012

More on Low (but Detectable) Viral Loads — Is Knowing This Useful?

I have a very smart, very experienced colleague — clue, his initials are CC, and he doesn’t pitch for the Yankees — who continues to use bDNA testing for HIV viral load monitoring. You know, the assay with a lower limit of detection of 75 copies. He knows that bDNA is less sensitive than PCR. He knows […]

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