HIV and ID Observations

March 31st, 2010

C diff Guidelines: Metronidazole Still Preferred?

IDSA and The Society for Healthcare Epidemiology of America (SHEA) have published Clinical Practice Guidelines for Clostridium difficile infection. Not surprisingly, it’s a comprehensive, extensively-referenced document that will be an invaluable resource, especially since the previous version is approximately 15 years old. But with the caveat that I’m not an expert in this area, these particular […]

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March 28th, 2010

Kidneys: Fortunately, We Have Two

Here’s a case over in our Journal Watch: AIDS Clinical Care site:  a man with suspected PCP develops rapidly progressive renal failure after being starting on both empiric PCP treatment with TMP-SMX and ART with TDF/FTC plus darunavir/ritonavir. The specific questions at the end of the case were: What do you think is causing the […]

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March 17th, 2010

This One Drives Me Crazy

In the debate over efforts to expand HIV testing by making it less “exceptional” and more like other important tests done in medical care — something I heartily endorse (no kidding) — comes one particular protest that makes absolutely no sense to me. It goes something like this: We cannot expand HIV testing before guaranteeing that […]

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March 14th, 2010

MRSA Bacteremia Question Redux — and the “Answer”

As noted here, I recently had to answer a question on management of MRSA bacteremia as part of an every-10-year cycle of test-taking. (For more on that joyous process, read this interesting debate here in the New England Journal of Medicine.) The question seemed to have no obvious right answer, so I did what one is explicitly […]

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March 10th, 2010

The Extraordinary Power of Placebo

Just published in the journal Neurology — not typically on my radar screen — is this remarkable study comparing pregabalin to placebo for HIV-related distal sensory peripheral neuropathy. Here are the results: At endpoint, pregabalin and placebo showed substantial reductions in mean Numeric Pain Rating Scale (NPRS) score from baseline: -2.88 vs -2.63, p = […]

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March 5th, 2010

Test Question on MRSA Bacteremia

I just happened to be taking a test the other day — something I do for fun every now and then, say every 10 years or so — and I came across this question (slightly condensed/changed to protect the innocent): Man with history of IDU admitted with fever, has bacteremia due to MRSA (MIC 2 […]

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February 14th, 2010

Retrovirus Conference (CROI) 2010 Preview

Just as pitchers and catchers report to Spring Training this week, many HIV specialists are gearing up for the 17th Conference on Retroviruses and Opportunistic Infections (CROI), which starts this Tuesday in San Francisco. (I don’t suppose many people see the link between those two events.  Oh well.) And since the “pocket program” to the […]

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February 11th, 2010

Ritonavir Tablet Approved

It’s not on Abbott’s web site yet (update:  now it’s here), but the FDA has approved a new formulation of ritonavir — a heat-stable 100 mg tablet.  From an e-mail release by the FDA: On February 10, 2010, FDA approved Norvir (ritonavir) 100 mg Tablets. These tablets do not require refrigeration.  Unlike the capsule formulation […]

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February 8th, 2010

Is She or Isn’t She …

… taking antiretrovirals? Over on our Journal Watch/AIDS Clinical Care web site, we’ve posted case of a pregnant woman who says she’s taking ART as prescribed, but the lab tests say otherwise. How do you manage these cases?

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February 2nd, 2010

Bats in the Bedroom: Canadians Make a Policy Change

ID doctors know all too well the panicky call — usually from a terrified friend, family member, or colleague, or possibly the emergency room or primary care doc — about finding a bat in the house. Usually in the bedroom. (In one memorable case, it was the house cat’s leaping in the air to try […]

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