HIV and ID Observations

January 17th, 2010

Hey, Didn’t You Used to be the Cause of CFS?

The report last year that xenotropic murine leukemia virus-related virus (XMRV) was found in a high proportion of patients with Chronic Fatigue Syndrome (CFS) caused quite a stir — which is totally understandable given how frustrated the people with CFS are with the lack of adequate explanations for their suffering. The investigators of the original […]

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January 10th, 2010

Ceftobiprole’s Long Road to Approval Gets Longer

Cephalosporins with activity against MRSA are out there, but we don’t have them yet.  Just recently, the leader of the pack, ceftobiprole, hit another roadblock: The FDA has indicated in its Complete Response Letter to Johnson & Johnson PRD that it has completed the review of the application and has determined that it cannot approve […]

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January 1st, 2010

Top 10 Stories of the Year

No end-of-year wrap-up is complete without a “Top 10” list, and Journal Watch: AIDS Clinical Care is no exception. This year we did two lists, one chosen by the Editors, the other a numeric tally of what’s read on line by the Readers. The “When to start” issue was the top story from the Editors. […]

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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 […]

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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 […]

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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 […]

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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 […]

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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 […]

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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.) […]

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