HIV and ID Observations

October 10th, 2025

DOTS: Optimism Around a “Negative” Dalbavancin Trial

The DOTS randomized clinical trial of dalbavancin versus standard-of-care for Staph aureus bacteremia (SAB) just landed in JAMA, where it undoubtedly will be featured in numerous ID, hospitalist, and medical resident journal clubs over the next several months. Proof:  one of our great second-year ID fellows tagged it immediately for his journal club literally the […]

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September 26th, 2025

My Dog Louie, the Best Dog Ever, Is Seriously Ill

We got some bad news about our dog Louie, the world’s greatest dog. Writing his story here is therapeutic, so forgive the oversharing. In January, 2013, my wife forwarded me this email: She doesn’t usually use 5 exclamation points or 6 question marks, and the unusual punctuation betrayed her excitement. The answer to “What do […]

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September 19th, 2025

Two Drugs, Not Three: The DOLCE Study in Advanced HIV Disease

Three-drug therapy has been the standard of care for HIV therapy for so long it’s difficult to shake the view that it must be more effective than two drugs. This is particularly the case for those with advanced, HIV-related immunosuppression or very high viral loads, as they provide an important stress test for all regimens. […]

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September 10th, 2025

When Required Learning Modules Surprise You (In a Good Way)

Like most clinicians, I have a checkered history with required online learning modules. You know the drill: click play, get lectured in monotone about hand hygiene or fire safety, then spend the next 8 minutes desperately searching for the fast-forward button, hoping it’s not disabled. My personal low point (or high point, depending on your […]

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September 4th, 2025

End-of-Summer Musings — Hepatitis B, Dalbavancin, Alpha-Gal, and More

The last time I did one of these quick “musings” posts, I listed 21, and someone asked me, “Why 21?” The answer — obviously — is that I originally planned on writing 20, but then had to add a 21st, just because that’s exactly how many points you need to win a ping pong game. […]

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August 29th, 2025

Watching the Chaos at the CDC — with Sadness and Alarm

Throughout my career as an infectious diseases doctor, the CDC has been a rock-solid source. Need reliable data on an outbreak? The CDC. Need thoughtful, evidence-based guidelines? The CDC. Need an authoritative reference for a consult question or to steer a colleague or trainee to the right place? The CDC. Need the latest, most accurate […]

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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. […]

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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 […]

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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 […]

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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” […]

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