HIV and ID Observations

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 […]

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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 […]

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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 […]

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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 […]

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June 6th, 2025

How ID Doctors Get Paid, Part 3: The Grab Bag Edition

If you’ve made it this far, congratulations! You’re now deep into the ID Reimbursement Rabbit Hole. Part 1 and Part 2 covered how ID doctors contribute immense value through patient care, stewardship, infection control, travel clinics — proudly fighting along the way for appropriate compensation as the “Loss Leaders” of the hospital. (Did you get your […]

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May 31st, 2025

How ID Doctors Get Paid, Part 2: Infection Control and Other Invaluable (but Often Invisible) Work

Before getting to today’s main topic, allow me a brief protest — three recent vaccine-related actions that reek of profound (and misguided) vaccine distrust from HHS leadership. They are: Cancellation of a grant to develop an H5N1 vaccine. Preparation for this looming pandemic threat is critical, and there’s arguably no better way than having a vaccine ready. […]

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May 22nd, 2025

The Pros and Cons of the Latest FDA Actions on COVID Vaccines

In case you missed it, last week the FDA granted full approval for the Novavax COVID-19 vaccine. This vaccine, which uses a more traditional protein-plus-adjuvant strategy instead of the mRNA approach of Pfizer and Moderna, is no longer in “Emergency Use Authorization (EUA)” limbo. Here’s what that means in practical terms: It shows the data the company […]

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May 18th, 2025

How ID Doctors Get Paid — The Bread, Butter, and Budget Deficits of Infectious Diseases

Two decades ago, Dr. Atul Gawande wrote a memorable piece for The New Yorker about how doctors in the United States get paid. Providing a nice mix of self-reflection about his own experience and some skillful reporting, he described the challenging process of figuring out what he, a newly hired surgeon, should earn for a salary. […]

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May 7th, 2025

FDA’s Latest Appointment Is … Interesting

Those of us who follow infectious diseases and vaccine science closely (OK, obsessively) know that the FDA’s Center for Biologics Evaluation and Research (CBER) plays an enormous role in public health. Vaccines, gene therapies, monoclonal antibodies, blood products — all pass through CBER on their path to approval. During the COVID-19 pandemic, this center became […]

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April 30th, 2025

On-Service ID Link-o-Rama — Osmosis Edition

First-year ID fellows this time of year bring a lot to inpatient consult rotations. Years of high-volume inpatient care have sharpened their clinical instincts, and at this point they have an impressive fund of ID knowledge. Plus, the fellow on our current rotation gets along great with everyone — patients and consulting clinicians alike — […]

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