HIV and ID Observations

September 20th, 2015

EHR and Drug Prescribing Warnings: The Good, the Bad, the Ugly

Part 1. The Good. Recently, an ENT colleague (fictionally named “Clint” below), sent me two emails triggered by drug-drug interaction warnings he received while seeing HIV patients. Here’s #1: Hey Paul, I saw Mark C yesterday for hoarseness, and his exam was negative. Thought we’d try a PPI for reflux, but when I wrote the script, I […]

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September 13th, 2015

Station Eleven Is a Very Good Read — Even for ID Doctors

One of my colleagues, an MD/PhD, stopped me after our clinical conference a few weeks ago. He does basic science research, doesn’t see patients anymore — but he still comes to our clinical conference. Definitely scores points for that. And for being a very smart, interesting, and nice fellow. This was our conversation, reproduced verbatim: HIM:  Hey Pablo […]

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September 7th, 2015

Two Drugs with High Prices — One is (Surprise!) Good Value, The Other is Truly a Rip-off

By now, the fact that HCV treatment carries a high price is a fact as well known to the medical and non-medical public as 1) a million dollars doesn’t get you much in Manhattan or Bay-area real estate; 2) a Rolex is an expensive way to know what time it is; and 3) even though […]

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August 30th, 2015

(Not) Doing the Retinal Exam, and the Importance of Acknowledging Limitations

This past week, the New England Journal of Medicine released one of its excellent instructional videos, detailing how to do direct ophthalmoscopy to examine the retina. That’s the use of one of those hand-held gizmos — an ophthalmoscope, see picture on the right — to look at the back of the eye. As usual, the video was […]

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August 23rd, 2015

Post-Exposure Prophylaxis for HCV Can’t Be Cost-Effective — But We Might End Up Recommending It Anyway

An email query from a colleague: Hi Paul, Just got a call from one of our surgeons who got a needlestick from a suture needle, small amount of blood. Patient is HCV +. Any post-exposure prophylaxis recommended? Thanks, Dan The quick answer is no, it’s not recommended. From the guidelines: But it’s a natural question to ask for several reasons — […]

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August 17th, 2015

Dog Days of Summer ID Link-o-Rama

A few ID/HIV items of note to consider as you gather up your sunscreen, flip flops, towels, and sand toys and head off to the beach: Interesting review of the impact of low socioeconomic status in the recent outbreak of Legionnaires’ Disease in the South Bronx. It’s just like (almost) every infection — the combined effects of crowding, poor sanitation, and […]

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August 9th, 2015

The Pain — and Potential Power — of Electronic Health Records in One Little Anecdote

Here’s a scintillating series of events that happened recently on our inpatient consult service: Reason for consult: “Treatment of UTI in a 26-year-old pregnant woman with multiple allergies.” Culture result:  Group B strep, resistant to clindamycin and nitrofurantoin. She’s been on the latter. Patient’s allergies as listed on her chart:  Penicillins, cephalosporins, sulfonamides. Plan per OB service: […]

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August 1st, 2015

Ten Reasons to Attend Our “Infectious Diseases in Primary Care” Course

With an up-front apology for the shameless plug — sorry! — here are 10 great reasons to attend our annual postgraduate course. It’s called Infectious Diseases in Primary Care, and takes place October 14-16 here at the Fairmont Copley Plaza Hotel in Boston. All the topics are clinically relevant to day-to-day practice. Look at these topics! There’s a strict […]

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July 26th, 2015

Really Rapid Review — IAS 2015, Vancouver

Vancouver will always have a special place in HIV treatment history. It was here, in 1996, that many of us first saw the potential of combination antiretroviral therapy to control this disease. Specifically, Study 035 of AZT, 3TC, and indinavir (presented by Trip Gulick) demonstrated the astounding finding that triple therapy induced sustained virologic suppression and dramatic immunologic improvement. Could it be that not everyone […]

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July 18th, 2015

Disrupting the Normal Microbiota Might Make Us Fat, Allergic, Asthmatic, and Lead to Celiac Disease

Over at Open Forum Infectious Diseases, I recently had the opportunity to interview Dr. Martin Blaser, Professor of Medicine and Microbiology at New York University. He’s also the Director of the Human Microbiome Project, and author of the book, Missing Microbes: How the overuse of antibiotics is fueling our modern plagues. Marty has been a long-time champion of […]

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