HIV and ID Observations

February 15th, 2015

Should Antibiotics be Part of End-of-Life Care?

There’s been some truly outstanding work done recently on end-of-life care, and how we deal with it — or more accurately, how we typically don’t deal with it until the very last moment, at which time often many unfortunate decisions and events occur. Here are three I can strongly recommend: Roz Chast’s Can’t We Talk About Something More Pleasant? is probably the […]

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February 8th, 2015

Snowstorms-a-Plenty ID Link-o-Rama

A few items to discuss as we settle in for yet another Boston megastorm: The measles outbreak continues to bring forth excellent commentaries on the selfishness of vaccine-refusers, with this one from Frank Bruni one of my recent favorites. Question: Will it take a hospitalization — or even worse, a death — of an American child with measles to stop this […]

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January 28th, 2015

Quick Question: Should We Still Be Recommending This Year’s Flu Vaccine?

From a football-obsessed primary care provider, written to me on one very snowy day in New England: Hi Paul, I’ve been reading about this year’s flu vaccine, and how ineffective it is. Not surprisingly, my patients have been hearing this too, and it has only increased their reluctance to go through with it. Should I just […]

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January 21st, 2015

No Response

Not surprisingly, it’s a sad, sad day at the Brigham. Yesterday a man walked into the hospital and shot one of our cardiac surgeons, then shot himself. Both died. Amidst the grief, horror, and shock that we all are feeling, I was also reminded of the year I spent working in England before going to medical school. Somewhat to my […]

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January 18th, 2015

Opposition to HCV Screening Raises a Few Interesting Points — But Has Some Really Wacky “Facts”

Over in the British Medical Journal, there’s a provocative editorial entitled, “Is widespread screening for hepatitis C justified?” Based on the title alone, you can guess the authors’ answer to that question — a resounding “No!” By taking this position, of course, they are opposing some very data-driven and well-respected arbiters of policy and clinical practice. These include not […]

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January 7th, 2015

Are the STI Screening Guidelines for Gay Men Overkill? (And Pedro Video.)

Our “healthcare system” recently distributed a set of guidelines entitled, Primary care for gay men: screening and treatment recommendations. It included, among other things, recommendations for screening for sexually transmitted infections (STIs) and anal cancer. The former it adopted from CDC guidelines, which are this this: Screening at least once a year for syphilis, chlamydia, and gonorrhea for all sexually […]

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December 30th, 2014

Common Curbsides: The Patient with “Recurrent Zoster”

Just in time for the New Year celebration, here’s a curbside consult I’ve received several times, probably because the answer isn’t in most textbooks. As usual, the actual question is slightly edited, as well as lightly (and affectionately) annotated: Hey Paul — Quick question [of course] — I have a patient with a history of irritable bowel, otherwise well, […]

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December 20th, 2014

New HCV Option Effective, Safe, Well-Tolerated — And Use Will Likely Be Driven by Payors

As expected, the FDA approved the next treatment option for HCV on Friday — “Viekira Pak”, a (sometimes complete) regimen consisting of ritonavir-booted parataprevir and ombitasvir given as a two pills once a day, plus one pill of of dasabuvir given twice daily. It is indicated for treatment of HCV genotype 1. For those of you mechanistically inclined, parataprevir […]

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December 14th, 2014

2014 Top Stories in HIV Medicine

Boy do we love end-of-year “Best of …” and “Top Stories of …” lists! Love them! They never gets old! Until January, that is. My own particular favorites are the Best Movies of the Year lists, since for whatever reason it always seems like some masterpiece slips by. Missed it! So we leave it up to the […]

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December 6th, 2014

Holiday Season 2014 ID/HIV Link-O-Rama

A little spin around the internet brings us these ID/HIV tidbits, all of them designed to go well with holiday music, egg nog, and potato pancakes, plus a can’t-miss video clip: Flu vaccine match with circulating virus doesn’t look so great. This could mean it’s going to be a tough flu season, but estimates of flu […]

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