HIV and ID Observations

I was working with a medical intern in clinic this past week who is potentially interested in ID. After seeing our 3rd consecutive stable HIV patient, he asked me what I thought the next big challenge would be in our field — especially since HIV treatment has been “solved.”

“Solved” might be stating it a bit strongly — after all, we still have no cure, the drugs aren’t perfect, not everyone can get them, there’s no vaccine,  etc — but he had a point.  Many of the research questions on HIV treatment are now about moving things forward incrementally, and it’s hard to imagine an advance anytime soon along the lines of combination therapy in the mid 1990s, or even the second wave of newer treatments that become available in 2006-8.

So what’s the answer to his question?  I compiled a brief list, shown below in no particular order:

• Highly drug-resistant bacteria — MRSA, carbapenemase-producing gram negatives, etc.
• Influenza, obviously, plus other SARS-like respiratory viruses
• Hepatitis C, though we’ll have to take this back from the hepatologists — I doubt they’ll mind — with nearly a hundred novel treatments in development
• Infections associated with therapeutic immunosuppression — TNF blockers, other biologics
• Food safety
• Device-related infections
• Novel diagnostics — PCR, other amplification techniques, direct antigen detection methods, etc
• Finding the next infectious cause of some idiopathic or autoimmune disease — some helicobacter-like discovery regarding Crohn’s, or multiple sclerosis, or sarcoid

(Not on my list are issues specifically related to ID in resource-limited settings, because that’s not what I do.)

I’m sure I’m missing something, but it’s a start.