HIV and ID Observations

September 8th, 2023

Endless Recertification in Medicine — Some Thoughts About the Tests We Take

The tests issued by the American Board of Internal Medicine (ABIM) for credentialing physicians are much in the news again. There’s even a petition circulating to eliminate the Maintenance of Certification (MOC) process entirely, signed by nearly 20,000 physicians. I have a bunch of memories, thoughts, and feelings about ABIM and the tests they issue. They’re […]

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August 18th, 2023

My Vote for the Weirdest Antibiotic on the Planet

If you’re an ID doctor, there’s an excellent chance you’ve treated patients who have non-tuberculous mycobacteria (NTM) with clofazimine. In fact, based on a poll done with the utmost scientific rigor, it’s well more than half of you. And if you’re not an ID doctor, there’s a decent chance you’ve never even heard of it — […]

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August 9th, 2023

Really Rapid Review — Brisbane IAS 2023

You’ll find some conference highlights listed below from the 12th International AIDS Society Conference on HIV Science (or IAS 2023), which took place in lovely Brisbane — where the late July weather was delightful, the ubiquitous ibis was the local nuisance bird, and the riverside parks went on and on and on. Some might wonder if […]

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July 26th, 2023

REPRIEVE Trial Highlights Shift in HIV Care from ID to General Medicine

The biggest news this week at the 12th IAS Conference on HIV Science here in Brisbane, Australia, was the results of REPRIEVE, a large randomized clinical trial conducted in people with HIV. It’s not a study of novel antiretroviral regimens, or of treatment or prevention of opportunistic infections, or of an HIV eradication strategy using […]

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July 5th, 2023

The Yin and the Yang of Cabotegravir-Rilpivirine: Part Two, the Limitations

In the last post, I cited examples of patients who are doing much better now because they are on long-acting cabotegravir-rilpivirine (CAB-RPV). One of these patients said he preferred it because it’s “simpler,” by which he meant he no longer had to go to the pharmacy to refill his medications each month. I’ll grant for him […]

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June 30th, 2023

The Yin and the Yang of Cabotegravir-Rilpivirine: Part One, the Good News

Long-acting cabotegravir-rilpivirine (CAB-RPV) is the biggest advance in HIV therapeutics in years. It’s also creating quite the challenge for ID and HIV clinicians, which makes its availability a fascinating example of the importance of education, patient communication, and shared decision-making. This post will be the good news about this groundbreaking treatment; in the next post, I’ll […]

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June 15th, 2023

Clinical Teaching at the 99.9th Percentile: Dr. Martin (Marty) Samuels

One of the true joys of practicing at academic medical centers is working alongside great clinical teachers. No one exemplified this talented group better than Dr. Martin (Marty) Samuels, former chief of neurology at Brigham and Women’s Hospital (where I work), and professor of neurology at Harvard Medical School. He was quite simply the best clinical […]

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June 8th, 2023

Fifteen Years Later, Why I’m Still Writing This

Seems like just yesterday that my wonderful editors at NEJM Journal Watch helped me write a piece marking this site’s 10-year anniversary. But no — that was 5 years ago. Yikes. Let’s see, what happened since the spring of 2018 that is relevant to this place: 216 posts. According to our crack research team, that’s one every 8.449074 […]

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June 2nd, 2023

Continued Activity of NRTIs Despite Resistance Is a Real Thing

In our last post, we reviewed a case of a person with longstanding HIV with extensive multi-class resistance, but now a decade of viral suppression. They’re currently on an HIV treatment regimen of fully active raltegravir, partially active etravirine, and barely active (or not active at all!) darunavir. There are no NRTIs in the regimen, […]

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May 25th, 2023

The Legacy of a Disappointing HIV Clinical Trial — Does It Still Apply to HIV Today?

A long, long time ago, back in the early exciting days of raltegravir, the first HIV integrase inhibitor, we learned something important from a clinical trial with disappointing results. The trial bore the (barely) hidden name of the company that developed the drug — SWITCHMRK, get it? — and had a profound impact on how […]

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