HIV and ID Observations

October 17th, 2023

A Brilliant Strategy for Conducting Clinical Trials — The ACORN Study

The secret to doing a great clinical trial is quite simple. Here, I’ll share it with you: Come up with an important clinical question for which there’s true equipoise. Choose primary and secondary endpoints that people care about. Make the inclusion and exclusion criteria easy to understand and chosen so that they define a readily available […]

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October 8th, 2023

An October ID (and Non-ID) Link-o-Rama

For those venturing next week to IDWeek here in Boston, fall gives us our very best weather. Comfortable sunny days with brilliant blue skies, cool evenings, low humidity — great weather for exercising and sleeping. Usually you just need a light jacket. And now, after one of the rainiest Septembers on record (boo!), October has […]

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September 22nd, 2023

Long-Acting Cabotegravir-Rilpivirine for People Not Taking Oral Therapy — Time to Modify Treatment Guidelines?

HIV treatment guidelines are understandably reluctant to endorse practices that have limited data. Having served on two such panels (previously, DHHS and currently, the IAS-USA guidelines), I totally get this — you don’t want to put a stamp of approval on strategies that may ultimately do more harm than good. With the caveat that I cannot […]

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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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