An ongoing dialogue on HIV/AIDS, infectious diseases,
October 25th, 2013
GARDEL Two-Active-Drug Study Not a Game-Changer, but Might Be a Paradigm-Shifter
Don’t look now, but a two-drug lamivudine (3TC) + LPV/r strategy did just as well as a standard three-drug regimen of two NRTIs + LPV/r. Better, actually, since virologic outcomes were the same and the two-drug regimen had fewer side effects. Here are the key details about the GARDEL study, presented just this week by Pedro […]
October 18th, 2013
Back to School: Top Questions from “ID in Primary Care”
We hold an annual post-graduate course entitled “Infectious Diseases in Primary Care”. In this 2.5 day course, we ID doctors do our best to address the concerns of clinicians on the front lines — those doing primary care. And each year, we get some great questions. Like these: Question: I work at a university health center, and […]
October 14th, 2013
MODERN Study Stopped: An NRTI-Sparing, Two-Drug Initial Regimen Disappoints Again
In case you didn’t know, “MODERN” is the clever name for the “Maraviroc Once-daily with Darunavir Enhanced by Ritonavir in a New regimen” trial, which compared TDF/FTC to maraviroc, both with boosted darunavir. And once again, the NRTI-sparing two-drug regimen comes up short, this time in a fully powered, double-blind noninferiority study. From a PDF provided by […]
October 7th, 2013
CD4 Cell Count at Presentation: A Figure with a Depressingly Small Upward Slope
You know how to make an ID/HIV specialist angry? Frustrated? Sigh loudly? Tell a clinical anecdote that involves “late” presentation of HIV diagnosis, in particular someone who has been seeking medical care for various ailments for months or even years without getting tested. You know — it goes something like this: “He was seen 3 years ago for […]
September 20th, 2013
CROI Abstract Submissions Now Open, and Old CROI Website Still “Lost” in Cyberspace
HIV researchers can now submit their abstracts to the 2014 Conference on Retroviruses and Opportunistic Infections — or “CROI”. (It rhymes with “soy”, as in “soy sauce”; or, if you prefer, “oy”, as in “oy vey”.) Further details here. General submission for abstracts closes on October 8. Meanwhile, people continue to wonder what happened to the now defunct CROI website, […]
September 13th, 2013
Clindamycin vs. TMP/SMX for Soft Tissue Infections: A Clinical Trial That Needs Some Marketing
At ICAAC this week — the ID conference with the most inscrutable acronym out there — Loren Miller from UCLA presented a clinical trial on treatment of skin and soft tissue infections that has widespread clinical applications, yet may receive little if any attention. And why is that? Simply because the drugs (clindamycin and trimethoprim/sulfamethoxazole) have been off-patent […]
September 7th, 2013
FAX machines, and the Special Power of the MD Degree
Everyone hates mindless paperwork. But certain types are particularly annoying, seemingly designed to send you screaming into the night, dragging a broken fax machine behind you as your brain explodes. Too strong? Take a look at this fax cover sheet I recently received about a patient who had been receiving IV antibiotics at home: To get at the […]
August 28th, 2013
Poll: At $14,105/year, Is Dolutegravir Fairly Priced?
The recently approved once-daily integrase inhibitor dolutegravir is now in pharmacies and, like every new HIV drug, the price — around $14k/year — has generated some controversy. For the record, here are the per-year wholesale acquisition costs of the three FDA-approved integrase inhibitors. Raltegravir: $12,976 Elvitegravir: $13,428 (once disentangled from the price of TDF/FTC) Dolutegravir: $14,105 If […]
August 26th, 2013
When Eating Guinea Pig, Make Sure to Ask for it Well Done
I’ve written before about how ID doctors are no fun to have at cook outs, what with our obsession with well-done hamburgers. Now, there’s another menu item we can berate grill-meisters on, and that’s guinea pig meat: At least 81 people fell ill from suspected salmonella poisoning after eating guinea pig meat and other foods from a […]
August 25th, 2013
Death from “Brain-Eating Parasite”: A Reminder of How Little We Really Know
Sometimes it takes a lot to surprise an ID doctor — we who try to make it seem like we’ve seen it all — but certain infections are either so severe (e.g., necrotizing fasciitis from group A strep) or so rare (e.g., endocarditis from Erysipelothrix rhusiopathiae) that even we are startled. Doubly startling are those infections […]
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
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