An ongoing dialogue on HIV/AIDS, infectious diseases, all matters medical, and some not so medical.
October 8th, 2023
An October ID (and Non-ID) Link-o-Rama
The Lyme Laser.
For those venturing next week to IDWeek here in Boston, fall gives us our very best weather. Comfortable sunny days with brilliant blue skies, cool evenings, low humidity — great weather for exercising and sleeping. Usually you just need a light jacket. And now, after one of the rainiest Septembers on record (boo!), October has so far has been heavenly (yay!).
But you don’t come to this site for a New England weather report, which might change day-by-day anyway.
How’s this for an example of this dust? Or crap, to be more accurate: You can get treatment with a “Lyme Laser”. It “addresses the concern of the biofilm established in the advanced stages of Lyme disease,” and “enhances the body’s natural abilities to improve function and regeneration.” Seriously, the unvalidated and potentially dangerous “treatments” offered for this serious infection continue to strain imagination. Note that pricing on this site (and others just like it) is conspicuously absent.
PEPFAR may be in trouble. Could a rare example of bipartisan political support for a hugely successful public health program come to an end? That’s the worrisome message expressed in recent coverage of PEPFAR, which pays for HIV treatment in resource-constrained countries with high HIV prevalence, especially in Africa. At last estimates, the program has saved 25 million lives. Wow.
Ceftobiprole was noninferior to daptomycin in treatment of Staph aureus bacteremia. Wow, talk about a blast from the past — I thought this cephalosporin (with activity against MRSA) had long been abandoned, but here it is again! Look for this paper in many ID and medicine journal clubs over the next few months, as there are numerous questions about the study design and the clinical implications. I worry in particular about the control arm — daptomycin (not oxacillin or cefazolin) for MSSA (76% of study participants)? And was daptomycin underdosed?
In other MSSA bacteremia research, here’s a different prospective randomized clinical trial: The study compared cloxacillin alone vs. cloxacillin plus fosfomycin. The combination regimen failed to show superiority, despite more rapid clearance of bacteremia at day 3 — reminds me of adjunctive gentamicin in this regard. Great to see these studies of Staph aureus bacteremia, which is almost certainly the most common reason for inpatient ID consults, at least in the United States.
These authors provide an interesting perspective on those annoying low-level viral load results that create all kinds of anxiety — namely, that the labs and clinicians should focus on the 200 copies/mL threshold as the important one for “U=U,” as this was the lowest threshold used in the large studies evaluating HIV viral load and transmission. While I agree that this is a reasonable approach (and the one I use in clinic), there is some uncertainty around this threshold, since most of the people in these studies of transmission on ART had undetectable viral loads — the 50-200 sample was necessarily small. Nonetheless, I 100% agree that flagging these results with a big red exclamation point is unnecessary. And check out panel 4 in the figure.
You know that strange sensation of time distortion since the start of the COVID-19 pandemic? “Pandemic skip” is a great descriptive term. And though the writer of this piece is just 30, it applies to every age, doesn’t it? And sometimes it feels like just a few months since those terrible dark days in 2020, and at other times it feels like it must have been many, MANY years ago, certainly much more than just 3. Don’t you agree?
Here’s a poetic rumination on microbial odors. Impressive alliteration on display: “From the fungal fragrances that sing of environmental mold to the bacterial bouquet that warns us off week-old leftovers, our air comprises a microbial miasma of information, ripe for research and exploration.” I’m sure Cliff, the C. diff-sniffing dog, would agree!
Now, a brief non-ID section:
Over in The New England Journal of Medicine (the Mother Ship of this Journal Watch enterprise), the editors kindly published how I felt when the news broke about a business decision that will dramatically reshape the clinical, research, and training experience in Boston — the departure of Dana-Farber Cancer Institute from Brigham and Women’s Hospital, where I work. Still can’t believe this is happening. Makes me very sad.
You can now order medical care on Amazon. My wife, a primary care pediatrician, says that everyone knows this by now, but somehow I missed it. But look — plenty of infections on the list! UTI, HSV, vaginal yeast infections, sinusitis. Text- or video-visit based care. And if your diagnosis is COVID-19, it’s $35 for text care, $75 for a video. Stuff like this makes you wonder about this future of healthcare, for better and (mostly) for worse, doesn’t it?