HIV and ID Observations

September 4th, 2017

Meropenem-Vaborbactam, Zika Cases Decline, Gas Station Nachos, and More — An End-of-Summer ID Link-o-Rama

There’s so much interesting ID material out there. The only solution — an ID Link-o-Rama, especially curated for the long Labor Day weekend. (Actually, not really, but that sounded good.) Off we go! Even if it doesn’t provide 100% protection, the flu vaccine may reduce the severity of influenza. Good to have this paper handy […]

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August 27th, 2017

Who’s Most Likely to Leave an Out-of-Office Message While on Service?

Once upon a time, I used being on service as a convenient excuse for not writing very much — or certainly, not writing very much of importance — on this site. The on-service time also allowed me to poke gentle fun at my colleagues, several of whom always turn on an “out-of-office” message when they attend on the inpatient […]

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August 20th, 2017

Two Quick Thoughts Inspired by Inpatient ID Consults, and An Inspirational Baseball Poster

A couple of quick thoughts for those of us doing inpatient care these days: Thought One:  Is daptomycin now preferred over vancomycin in most clinical settings?  It’s taken a while, but we’re getting there — close to that Gladwelllian “tipping point”.  Allow this recap of vancomycin’s problems: The growing recognition that higher drug levels — […]

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August 13th, 2017

Dog-Related Infectious Diseases as an Excuse to Show Pictures of Dogs

For proof that we’re not like other human members of the planet, when ID doctors think of dogs, it sometimes brings to mind one or more of following associations: Gastroenteritis due to Campylobacter jejuni. No, there’s nothing cuter in the world than a puppy — but remember that these little critters are particularly predisposed to symptomatic (and asymptomatic) campylobacter […]

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August 6th, 2017

Have We Reached the End of HCV Drug Development?

Two new HCV regimens gained FDA approval recently, bringing us closer to the end of this extraordinary phase of drug development. Think about it — has there ever been a more spectacularly rapid improvement in treatment of anything? If so, please let me know what that is. Remember, as recently as early 2013, highly toxic interferon-based therapy (with ribavirin and […]

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July 30th, 2017

Really Rapid Review — Paris IAS 2017

Last week, the International AIDS Society meeting returned to Paris for the first time since 2003. Yes, you and I are that old. Jeeze. Here’s a Really Rapid Review® of some of the conference highlights, roughly ordered by “cure”, prevention, treatment, and complications. As always, feel free to use the comments section for notable studies I […]

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July 19th, 2017

Mystifying Cochrane Library Review on HCV Therapy Elicits Strong Response from IDSA

Last month, the Cochrane Review published a controversial paper on HCV therapy that left many ID doctors and hepatologists perplexed. After reviewing 138 randomized clinical trials using directly acting, non-interferon based therapies, they came to the following conclusions: The use of sustained virologic response (“SVR”) — or “cure”, if you want to use plain English — […]

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July 9th, 2017

Should You Answer Medical Questions from Clinicians You Don’t Know About Patients You’ve Never Seen?

This email popped into my inbox the other day from a person I’ve never met: Hi Dr. Sax, I do mostly hospital-based ID in Pennsylvania, and was consulted on a newly diagnosed HIV patient with CD4 10, viral load 210,000, and lymphoma. I started him on Truvada and dolutegravir, which is going well so far. Because he […]

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July 2nd, 2017

Delafloxacin, a New Quinolone, Is Approved for Skin Infections — But That’s Not Where It’s Really Needed

The history of the fluoroquinolone antibiotics can be divided into four eras, alternating good news and bad: Ciprofloxacin is approved — it covers everything, and is miraculous. We’re talking some tough customers here. Pseudomonas aeruginosa! Staphylococcus aureus! Neisseria gonorrhoeae! Plus, pretty much every gram negative causing urinary tract infections. There was no intravenous formulation initially, but that hardly mattered since it […]

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June 18th, 2017

On Father’s Day, A Rumination on Families with Lots of Doctors

My father is a doctor. So was my father’s father. And my father’s uncle. And my father’s cousin. But that’s not all. My father’s brother was also a doctor — he loved being a doctor more than anyone on the planet, and attended neurology meetings long after he retired, right up until the time he […]

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