An ongoing dialogue on HIV/AIDS, infectious diseases,
August 16th, 2025
Anal Cancer Screening in HIV: When Guidelines Get Ahead of the Evidence
Should every person with HIV over age 35 (if MSM or transgender woman) or 45 (everyone else) have an anal Pap smear, a digital anal rectal exam (DARE), and possibly a high-resolution anoscopy every 1–2 years? According to recent guidelines, yes. But here’s the problem: we don’t know if this screening effort actually prevents cancer. First, […]
August 6th, 2025
Does the Fact That AI Is Brilliant at Writing “Learning Objectives” Prove They’re Not Really Needed?
Recently, I was invited to speak at a primary care conference on a terrific topic: “Can’t Miss Diagnoses in ID for the PCP.” Love it. So many great examples come to mind — endocarditis, Lemierre syndrome, vertebral osteomyelitis, acute HIV. A wonderful opportunity to teach about the “rare but there” diagnoses hidden among everyday outpatient complaints: […]
August 2nd, 2025
The Short Political Half-life of a Medical Contrarian
In early May, I wrote about the surprising FDA appointment of Dr. Vinay Prasad to lead the FDA’s Center for Biologics Evaluation and Research. Prasad is a UCSF hematologist-oncologist known for his views on COVID-19, oncology clinical trials, and his sometimes sharp-elbowed communication style, in particular directed at people with whom he disagrees. My goal was […]
July 25th, 2025
Who Gets Sent to ID Clinic? A Field Guide to Outpatient Referrals
Sometimes people ask me what kind of cases get referred to ID doctors in the outpatient setting. Despite what the latest television series might suggest, it’s rarely suspected Ebola (fortunately) or Tsutsugamushi fever — a disease that is much more fun to say by its Japanese name than its common one, scrub typhus. (In Japanese, “tsutsuga” means […]
July 17th, 2025
Ceftriaxone Is a Narrow Antibiotic Now — and Other Musings
In no particular order, 20 things I’ve found interesting lately — a mix of ID (mostly), language quirks, clinical stuff, even tennis, and an apology (#21) at the very end. Bonus videos embedded because we all need a break. 1. Isn’t it amazing how, over time, an antibiotic once considered “broad spectrum” later becomes the […]
July 12th, 2025
The Patient Did Well — So the Insurance Company Won’t Pay
Sometimes, you can predict a bad outcome. Examples: Proposing marriage after an awkward first date — and doing so over gas station nachos. Moving to a Cambridge apartment with no off-street parking, then buying a Tesla Cybertruck. Trying to recruit for ID fellowships from a group of cosmetic dermatologists. But predicting what happens in clinical medicine? […]
July 7th, 2025
Two Pandemics, Compared: Reflections on HIV and COVID-19
“Dr. Sax, what’s it like to have lived through two pandemics as an ID doctor?” The question came from a brand-new intern during afternoon sign-out. I took a breath — because wow, were they different. HIV: It Felt Like A Calling, One Miraculously Rewarded I started my internship in 1987, six years after the first […]
June 27th, 2025
The Mystery of the Isolated Hepatitis B Core Antibody, Solved
(A post inspired by years of doing eConsults, an extremely common query about hepatitis B testing, and the latest BritBox series, “Core Antibody Confidential,” starring a grizzled detective with a faded suit and a haunted past.) Your electronic medical record lists “deficiencies” in health care maintenance for one of your patients, so you order hepatitis B […]
June 20th, 2025
Federal HIV Guidelines Face a Shutdown — A Critical Loss for Clinicians and Patients
Each week, our HIV clinical group gathers to review active patients, share updates, and celebrate good news. On our whiteboard, we list four columns: Inpatients, Outpatients, Issues, and Celebrations. This week, under “Issues,” one of my colleagues wrote: HIV Guidelines: ☹️ Yes, you read that right. This week, we learned that the federal HIV guidelines — long […]
June 12th, 2025
Why the Sudden Firing of ACIP Members Should Put Every Clinician on High Alert
There are certain irrefutable verities when, like me, you’re an infectious diseases specialist married to a pediatrician. Here are our top two, which are deeply interrelated: Infectious deaths in children, or severe illnesses that lead to lifelong disability, are more devastating than similar events in adults. Each such case in a baby or child is […]