HIV and ID Observations

March 24th, 2019

Tetanus Case, No More MAC Prophylaxis, Playing in Dirt, and Low-Level Viremia — A National Puppy Day ID Link-O-Rama

In honor of spring (March 20), and the very important National Puppy Day (March 23), here are a bunch of ID and HIV-related recent items for consideration, contemplation, and perusal: A life-threatening case of tetanus in an unvaccinated boy highlights the personal and financial cost of the anti-vaccine movement. How deeply embedded are these false beliefs? […]

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March 18th, 2019

Just 1 Month of TB Preventive Therapy Works for People with HIV in TB-Endemic Regions — How About Other People in Other Places?

There’s a look our patients frequently give us when we tell them that preventive therapy for tuberculosis involves 9 months of treatment. If I were to put that look into words, they would be: Yikes, Doc, 9 months is waaay too long — you must be out of your mind. It’s the “9 months?!?!” face. […]

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March 10th, 2019

Really Rapid Review — CROI 2019 Seattle

As a foot of wet snow bore down on Boston last week — see this post for why that matters — HIV researchers and policy makers headed to Seattle for this year’s Conference on Retroviruses and Opportunistic Infections, or CROI, which took place from March 4-7. And already I was feeling the pressure, based on […]

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March 3rd, 2019

A Few Thoughts on the Day Before CROI — Our Best (and Quirkiest) Scientific Meeting

As I’ve written here numerous times, the Conference on Retroviruses and Opportunistic Infections — or “CROI” (rhymes with “toy”) — is the best of the scientific meetings on HIV. It starts March 4 in Seattle. Bringing together the perfect blend of clinical, translational, and epidemiologic research, CROI consistently boasts the highest density of worthwhile content in […]

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February 24th, 2019

Why Choose Infectious Diseases as a Medical Specialty? Here’s the Beginning of My Story, with Bonus Podcast

Forgive the autobiographical nature of this post, but here’s a recap on how I started down the the path to becoming an ID doctor. To begin, understand that my first year of medical school was rough going. In hindsight, this wasn’t surprising. After majoring in English during college (with a minor in the Harvard Lampoon to […]

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February 18th, 2019

Yes, Many People Are “Pleasant” or “Delightful,” Even “Lovely” — But Should That Be in the Medical Note?

When writing medical notes, some clinicians include an appreciation of their patient’s personality and disposition in their opening line (the “Chief Complaint”), or when they’re wrapping up (in the “Assessment and Plan”), or in both locations. You know — it goes like this: “CC:  Ms. Smith is a very pleasant 62-year-old woman admitted with …” or: […]

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February 10th, 2019

Six Musings Triggered by the Latest Measles Outbreak

In 2018, there were 372 cases of measles in the United States, the largest number since 2014. This year, we’ve already had 79 cases, many from a large outbreak in the Pacific Northwest — where anti-vaccine proponents recently protested efforts to restrict nonmedical vaccine exemptions. A few ruminations triggered by this outbreak. 1. The vaccine […]

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February 3rd, 2019

An “Interview” with the OVIVA Study of Oral vs. IV Antibiotics for Osteomyelitis

An “interview” inspired by publication of a landmark clinical trial. All responses written by me — but be assured, they are based on reading the paper, the accompanying editorial, the supplemental appendix, hundreds of comments on Twitter (some of them from the study investigators), and even a few generous comments from the the senior author in […]

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January 27th, 2019

For Our Stable HIV Patients, Why Are We Still Sending All These Lab Tests So Often?

Interesting query from a colleague recently: I’m a community ID doc in the trenches (the measles trenches at present) with an HIV question. Why do we still check CBCs & chem panels every 3-6 months in our HIV patients? Particularly our well-controlled, virologically-suppressed patients? This strikes me as a tremendous waste. I haven’t been in practice that […]

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January 22nd, 2019

Unanswerable Questions in Infectious Diseases — Treatment Duration in Endocarditis: 4 Weeks, 6 Weeks, Other?

Time to get back to some tough clinical decisions. It’s been a while. We’ve done The Abdominal Collection and Duration of Antimicrobial Therapy, Persistent MRSA Bacteremia, and The Positive Cultures for Candida in an ICU Patient. However, that series of posts appeared here in early 2014, which means it’s been 5 years with no “Unanswerable Questions.” Lest […]

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