HIV and ID Observations

August 8th, 2022

Long-Acting Injectable HIV Therapy for People Who Won’t Take ART?

HIV treatment is so spectacularly effective that you might be surprised to hear that some people with HIV still have uncontrolled viral replication. We HIV clinicians watch with frustration and sadness as they experience progressive immunodeficiency, complications from advanced HIV disease, hospitalizations, and HIV-related deaths. Plus, while viremic, they continue to risk transmitting the virus […]

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July 22nd, 2022

The Paperwork Demands for Academic Medical Teaching Are OUT OF CONTROL

Why all caps in the above title? It’s to call attention to a problem that’s getting worse each year in academic medicine, especially when it involves teaching or talks. The requirement to submit a veritable truckload of forms, documents, attestations, and summaries, all due months before the actual event. Let’s explore in more detail what this might […]

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July 1st, 2022

Fellowship Transition and Developing a Sense of Belonging

It’s July 1, which means that today, or sometime very soon, many internal medicine residents will transition to becoming subspecialty fellows. There are many appropriate words to describe this change, including exciting, nerve-wracking, and challenging, but one that doesn’t get quite enough attention is how strangely lonely it feels. The reason this sensation occurs is because […]

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June 21st, 2022

Mayo Clinic Study on Paxlovid Outcomes is Reassuring — but Likely Underestimates Rebound Rate

Over at Clinical Infectious Diseases, researchers from the Mayo Clinic published a retrospective analysis of nirmatrelvir/r (Paxlovid) treatment, with a careful review of each patient’s chart. The goal was to determine the clinical outcomes after the 5-day treatment course, with a focus on the frequency of rebounds — a topic of great clinical interest but with little […]

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June 6th, 2022

Still More Fun with Old Medical Images

Back in the Before Times, this site would occasionally dabble in lighter fare: Cartoon caption contests Commentaries on doctor attire Thoughts on the first-name “Morgan” Penguins chasing a butterfly (Well, actually, this is a new one!) https://twitter.com/buitengebieden/status/1533022340887486466?s=20&t=ShPbhfDhg-BwCP2bWisXfA And, the subject of today’s post — Fun with Old Medical Images. Here’s how it works: We display an old medical […]

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May 23rd, 2022

In Praise of Dr. Glaucomflecken

Sometimes there is someone so good at something that there is universal agreement we are witnessing something special. Babe Ruth, Serena Williams, and Michael Jordan competing at their peaks. Charles Dickens or Jane Austen creating whole worlds out of invented characters and plots. Vladimir Horowitz performing Rachmaninoff at Carnegie Hall. Bernini creating sculptures from cold, hard […]

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May 12th, 2022

As They Say, “Some Personal News”

This week marks the 14th anniversary of HIV and ID Observations, give or take a few weeks. I started writing this blog* in 2008 — and since then there have been 832 posts, a gazillion comments, and one awful (and ongoing) pandemic. For the opportunity, I sincerely thank Matt O’Rourke, a wonderful and generous editor […]

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May 4th, 2022

More on Relapses after Paxlovid Treatment for COVID-19

Unless you’ve been hiding under a rock, you’ve heard that some people treated for COVID-19 with nirmatrelvir/ritonavir (Paxlovid) experience a relapse in illness shortly after stopping treatment. It’s both a recurrence of symptoms and a positive antigen test — sometimes after the test became negative. One case report published as a pre-print shows that a relapse can have […]

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April 25th, 2022

Yes, Relapses After Paxlovid Happen — Now What?

Around two weeks ago, one of my long-term, very stable patients with HIV called me saying she’d just been diagnosed with COVID-19. Over 60 with hypertension, and overweight, she qualified for nirmatrelvir/r (Paxlovid) under the Emergency Use Authorization (EUA), and took it without problem. (Certain details changed for confidentiality.) In fact, she started to improve within 24 […]

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April 12th, 2022

Should We Prescribe Nirmatrelvir/r (Paxlovid) to Low-Risk COVID-19 Patients?

The top recommended treatment for high-risk outpatients with COVID-19 in the NIH Guidelines is nirmatrelvir/r (Paxlovid). It’s quite clear why. In the EPIC-HR study, unvaccinated people at high risk for severe outcomes had an 89% reduction in the risk for hospitalization or death compared to placebo. If we just look at mortality — another important endpoint, […]

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