HIV and ID Observations

April 12th, 2022

Should We Prescribe Nirmatrelvir/r (Paxlovid) to Low-Risk COVID-19 Patients?

The top recommended treatment for high-risk outpatients with COVID-19 in the NIH Guidelines is nirmatrelvir/r (Paxlovid). It’s quite clear why. In the EPIC-HR study, unvaccinated people at high risk for severe outcomes had an 89% reduction in the risk for hospitalization or death compared to placebo. If we just look at mortality — another important endpoint, […]

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April 1st, 2022

As the World Around Us Moves On, We ID Docs Just … Can’t

Something quite remarkable happened as Omicron tore through the United States in December and January. Despite triggering a record number of cases — which should have made people more concerned about COVID-19 — Omicron paradoxically did the opposite. It made most of our country decide to move on, even parts famous (or infamous, depending on your […]

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March 22nd, 2022

What Have We Learned from the Pandemic So Far?

Dear Readers, I need your help. Recently one of my colleagues reached out and asked if I could give a talk to his research group. “Just give one of your canned Covid talks,” he said. Ha. Needless to say — but I will say it anyway — he’s not an ID doctor. Otherwise he’d know that, as I’ve said […]

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March 7th, 2022

How to Induce Rage in a Doctor

If you’re wondering how to make a doctor angry — really, really angry — read on. Because asking us to justify treatment decisions to insurance companies and their pharmacy benefit managers must rank right up there with the greatest tortures of practicing medicine in this country. Mind you, this isn’t just about my patient, or about […]

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February 18th, 2022

A Return of Antiretroviral Rounds — What Regimen Would You Choose?

Years ago, back in the pre- and early internet days, one of the most popular features in the newsletter Journal Watch AIDS Clinical Care was something called Antiretroviral Rounds. We’d present a case, then have two expert discussants weigh in on what they would do. The link above is a case from ancient history — 1998! […]

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February 12th, 2022

The Rise and Fall of Ivermectin — 1 Year Later

Here’s a confession few board-certified ID doctors will make — there was a brief period when I thought ivermectin could very well be an effective treatment for COVID-19. It wasn’t when the in vitro data first came out. Therapeutic concentrations were not achievable in humans. Nor when the anecdotal reports started pouring in, and sometimes making news. […]

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February 4th, 2022

Prior COVID-19 Is No Guarantee of Immunity

I’m no immunologist — a fact made vividly obvious to me several years ago when asked to teach a weekly medical student section that included cases and problem sets. The challenge was that the course combined immunology and microbiology. I was on much firmer ground with the microbiology than the immunology, the latter often a wonderfully […]

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January 28th, 2022

Required Learning Modules and How to Make People Learn

Like thousands of others who work in my organization, I’ve just finished a stultifying annual task — several hours of required online learning modules that must be completed to keep my job. How much do we look forward to them? Think annual car inspections, or tax returns, and multiply the boredom factor several-fold. You might not be […]

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January 18th, 2022

Novak Djokovic Thinks He Can Play by His Own Rules — Australia Says Think Again

There was a truly talented kid on my ninth grade basketball team — let’s call him Robbie G. He was a terrific player, fast and confident on the court, always eager to play, and just brimming with enthusiasm for the game. Every time he scored, the team and crowd (small as it was) buzzed with excitement […]

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January 12th, 2022

The Pandemic Life of an ID Doctor — in Graphic Form

Three works of art sit on my father’s desk in his office, gifts from his children from when we were in grade school. From my brother Ben, there’s a little bear, or perhaps it’s some other burly quadruped — easily a B+ in his art class from the 1960s, likely an A- now with grade inflation. A […]

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