HIV and ID Observations

Some ID/HIV items jangling around in the inbox, just dying to get out, before they are covered in snow:

• Interesting, balanced piece in the New York Times about the slow uptake for PrEP, in particular among gay men. This caught my eye: “Certainly, fewer people have tried PrEP than many experts had anticipated.” I wonder who those experts were? Seems this always was going to be a relatively niche intervention.
• Fascinating editorial in the latest New England Journal of Medicine about preserving antibiotics, which includes this amazing statistic:  Almost 80% of antibiotic use in the United States is for livestock. And here’s a great slide for your next talk on antibiotic resistance. Don’t those cows worry about upsetting their microbiome?
• Speaking of antibiotic resistance, I neglected to highlight this extraordinary CDC report on Antibiotic Resistant Threats when it first came out this year. The top three, with threat levels of “Urgent,” are C. difficile, Carbapenem-resistant Enterobacteriaceae (look at this chilling map), and Drug-resistant Neisseria gonorrhoeae. Sounds about right — but I’d have substituted MRSA for the last one — way greater clinical impact. MRSA’s threat level, by the way, is listed as “Serious.”
• Is some chronic low back pain caused by bacterial infection? According to this paper, and this randomized trial of amox-clav, the answer is clearly yes! An editorial rightly describes the implications of these studies for spine surgeons and pain specialists — never mind patients — as “momentous.” Yes, these are the winners of The Most Surprising Studies in ID, 2013. Confirmation of these findings by other investigators eagerly awaited. (What an understatement.)
• These three deaths from Lyme carditis are most worrisome — the patients were really young (26–38 years old), and though two of three had some pre-existing cardiac disease, they were overall pretty healthy. Fortunately, a review of 20,000 pathology specimens at a tissue bank did not find any additional cases, suggesting that Lyme carditis as a cause of death is rare indeed. Still, wouldn’t it be great if the Lyme vaccine for humans were available again?
• As more HIV drugs become generic, this should mean cost-savings, right? Not always, according to this remarkable (and disheartening) report. Lesson: If you don’t like the price of a generic drug, it pays to shop around for the best price. And if you live near a Costco Pharmacy, give them a try, even if you’re not a member — their pharmacies are available to all, with consistently low prices.
• SPOILER ALERT — if you haven’t seen the movie Philomena, just skip to the trailer below and read no further. But if you’re on the fence, you must see it, since it could have been the best film of 2013 — entertaining, well-acted, funny, heartbreaking. Just great. I cite it here on this site because one major plot turn occurs when the main character’s long-lost son is found to have died of AIDS — and though she is naturally very sad, her response was completely non-judgmental in a very non-Hollywood way. I was expecting the typical moral outrage, and was pleasantly surprised that it never came.

Stay warm, everyone, and Happy New Year!