HIV and ID Observations

March 3rd, 2013

It’s Not Safe Sex If You’ve Just Had the Smallpox Vaccine

One of my more memorable teachers used to love warning us about the hazards of sex. No, this wasn’t in my 8th grade health class — this was during my first year of Infectious Diseases fellowship, and the teacher was one of our highly experienced attending physicians, now retired. To him, sex carried limitless infectious risks. He […]

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February 28th, 2013

Guest Post: CROI at 20 — A Look Back

The inimitable Carlos del Rio looks back at our premier scientific meeting, the annual Conference on Retroviruses and Opportunistic Infections (CROI), which starts this Sunday: CROI, which started as a small national conference held in a hotel in Washington DC, will hold its 20th meeting this year . When CROI first took place, we had just returned from Berlin, and HIV scientists […]

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February 24th, 2013

Solve This Problem Please — Microbiology Results in Electronic Medical Records

Our hospital and affiliated practices have had electronic medical record (EMRs) of some sort for decades, so I’ve had my chance to try my hand at multiple “platforms,” both commercial and home-brew. (Weirdly — and I kid you not on this — a version of the first iteration from the 1980s is still around, running parallel […]

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February 17th, 2013

An Adherence Intervention That Works — But There’s a Catch

In a previous post, we reviewed the various flavors of medication non-adherence, and concluded with this tantalizing line: Next up:  An Adherence Intervention that Actually Works — But There’s a Catch Well here it is, just published online in JAMA Internal Medicine. Dr. Robert Gross (a long-time HIV adherence researcher from U Penn) and colleagues enrolled 180 patients […]

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February 13th, 2013

Medication Adherence: The Final Frontier

Treatment of HIV has become so amazingly effective that when it fails, it’s no overstatement to say that it’s usually because the patient is not taking the medications.  There are all kinds of provider-related reasons for this — inadequate patient education, prescribing and dispensing errors, failure to address language or education deficits — but here […]

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February 7th, 2013

Ciguatera Is Hot (But It Could Be Cold)

The news about the cases of ciguatera fish poisoning in New York (NY Times here, MMWR here) reminded me of several unusual things about this form of “harmful algal bloom,” as it is so artfully called by the experts. Specifically, here are six: Symptoms are bizarre.  It starts out like a standard case of gastroenteritis — nausea […]

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January 31st, 2013

When Your Language Gives Away That You Don’t Have a Clue

I was doing a clerkship in Medicine way back in my third year of medical school, and had this memorable exchange with one of the hospital’s Distinguished Professors during a case presentation on morning rounds: Me (nervous):  This is a 72-year-old man admitted with chest pain. He has a past medical history notable for a heart […]

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January 30th, 2013

“So You Think You’re an HIV Expert?”

I’ve been working with the folks over at Clinical Care Options (in particular, Elaine Seeskin) on a program entitled, “So You Think You’re an HIV Expert”, and it was just released here. It’s a series of quick interactive case presentations, and thanks to some nifty programming and great questions submitted by my colleagues Drs. Daar, […]

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January 21st, 2013

Must-Read Piece: “Fever of Too Many Origins”

Every so often a commentary gets something just right, and fortunately we have an example in this week’s New England Journal of Medicine. Entitled “Fever of Unknown Origin or Fever of Too Many Origins?”, it’s the best depiction I’ve read about doing ID consults in the intensive care unit (ICU). The author, Harold Horowitz (who has practiced […]

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January 16th, 2013

More Evidence That Early HIV Treatment — REALLY Early — Is Beneficial

Management of recently acquired HIV infection — especially acute HIV, pre-seroconversion — has long been controversial, with the risks and benefits of treatment versus observation debated now for nearly two decades. (Yes, it’s been that long since the publication of this controlled trial of zidovudine monotherapy. Amazing.) On the risk side of the equation is the toxicity […]

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