HIV and ID Observations

December 28th, 2009

Holiday Surprise: Generic Valacyclovir

Last week one of my patients went to refill a Valtrex prescription, and was offered generic valacyclovir for the first time.  It made him nervous, so he requested I write a “brand-name only” script. I confess the existence of a generic formulation of valacyclovir — which according to the PharmD here has been available for several […]

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December 20th, 2009

Infections from Transplant Donors: Rare but Inevitable

Two kidney transplant patients are critically ill due to Balamuthia mandrillaris encephalitis they acquired from the organ donor: The same infection probably killed the organ donor, but it was not diagnosed; his doctors thought he had an autoimmune disease. Two other patients also received heart and liver transplants from the donor, but neither has become ill. Infections […]

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December 13th, 2009

Infection and the ICU: Outcome Predictable, but Important

If you enrolled over 14,000 ICU patients into a study on a single day, and then did follow-up, what would you find regarding the relationship of infection to the outcomes of ICU stay and mortality? Just such a study was published in JAMA last week, and here are the not-so-stunning conclusions: Infections are common in patients in […]

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December 2nd, 2009

So Much in Less than a Week!

First the updated WHO Guidelines.  Then the following: Updated DHHS Guidelines.  Agree?  Disagree?  Sensible or crazy?  Practical or ivory-tower academic? South Africa does the right thing.  Yes, it’s about time, but good news nonetheless. 2012 International AIDS Meeting in Washington, D.C. First time in USA in a long, long time — 1990, to be exact — […]

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November 30th, 2009

WHO HIV Treatment Guidelines Updated

This just in: WHO is now recommending that ART be initiated at a higher CD4 threshold of 350 cells/mm3 for all HIV-positive patients, including pregnant women, regardless of symptoms. Which makes eminent sense, of course.  Because if starting HIV therapy might prolong survival in developed countries, why shouldn’t it do the same in the developing world? In fact, […]

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November 20th, 2009

Ties Tied to Bugs

Are doctors’ neckties causing infections?  That’s the implication of this Wall Street Journal piece: The list of things to avoid during flu season includes crowded buses, hospitals and handshakes. Consider adding this: your doctor’s necktie. … A 2004 analysis of neckties worn by 42 doctors and medical staffers at the New York Hospital Medical Center of […]

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November 13th, 2009

Practical H1N1 Management Question

Let’s imagine you’re seeing a case of pneumonia, and you suspect (as is quite reasonable these days) that it is precipitated by H1N1 influenza. What antibiotics do you choose for an outpatient? (If someone is sick enough to be admitted — especially to the ICU — I’m assuming the all-guns blazing approach will be adopted.) Even though some […]

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November 7th, 2009

A Career in Infectious Diseases and “The Next Big Thing”

I was working with a medical intern in clinic this past week who is potentially interested in ID. After seeing our 3rd consecutive stable HIV patient, he asked me what I thought the next big challenge would be in our field — especially since HIV treatment has been “solved.” “Solved” might be stating it a bit […]

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October 20th, 2009

Well That Was Fast! HIV Vaccine Trial Published

Remember the HIV vaccine trial press release?  The one announcing the first-ever positive result? Then the backlash, with people questioning how the analyses were done, and reported? Now, less than a month later, we have the scientific presentation and the paper appear on the same day. Read all about it here and here. If you want the view […]

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September 30th, 2009

The Battle for Colonic Microflora

My two favorite newspapers (New York Times and Wall Street Journal — sorry, hometown paper) have just covered opposite ends of a topic on the edges of ID practice — namely, colonic micro-organisms. Too few? Too many? Wrong type? In the Times, a review of the probiotic debate: Probiotics are live micro-organisms that work by restoring the balance of intestinal […]

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