HIV and ID Observations

December 29th, 2008

Required Reading: Introducing the “iPatient”

Many HIV/ID specialists first heard of Abraham Verghese from his book My Own Country: A Doctor’s Story, which was published in 1994.  He told us what it was like to be a newly-minted ID doctor, thrust into treating the first cases of HIV/AIDS in a remote town in Tennessee during the mid-1980s. Compelling stuff — I […]

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December 10th, 2008

Unintended Consequences of ART “Rollout”

According to this BBC article, teenagers in South Africa are grinding up antiretrovirals and then smoking them for their “hallucinogenic and relaxing effect”.  (Apologies for the pun on the title.) It’s impossible to tell with a report like this how widespread the practice is, but it’s potentially worrisome.  And no mention in the article which antivirals are being used, […]

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December 5th, 2008

New Case Definition for HIV Infection? Yawn …

The CDC has revised its case definition for HIV infection and AIDS, so that now laboratory evidence — a positive antibody test, or detectable HIV RNA or DNA – is required for the diagnosis. It’s not intended to guide clinical practice, but still — what took them so long?  A clinical diagnosis of AIDS was only necessary […]

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December 4th, 2008

More Support for HIV Screening

On Monday December 1 — World AIDS Day, if you’re keeping track — the American College of Physicians released a position paper supporting routine HIV screening for adolescents and adults in the United States.  (If you don’t want to read the whole thing, we’ll have a perfectly-executed summary by the inimitable Abbie Zuger on our AIDS Clinical […]

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November 30th, 2008

How to End the HIV Epidemic

Answer:  Put everyone on treatment. Conspicuously absent for decades, the prevention part of the “when to start antiviral therapy?” question has now moved front and center in two recent papers:  In this week’s Lancet, a group from the WHO estimated what would happen if there were annual universal HIV testing, and then immediate treatment for all […]

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November 22nd, 2008

“Salvage” Rx for HIV: Macro Good News, Micro Bad News

I’ve written before how the number of treatment experienced patients who have no options for successful therapy has dwindled to a tiny — but unfortunate — few.  Darunavir, maraviroc, raltegravir, and etravirine (in order of FDA approval) are that good. Two presentations at recent scientific meetings confirmed the staggering efficacy of these newer drugs. Notably, both […]

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November 17th, 2008

Promising C diff Rx, and Google as Surveillance Tool

A few items from recent ID/HIV news: Bad enough when it happens once, relapsing C diff is one of the modern plagues for which our bag of tricks sometimes comes up woefully short.  (Anything that tests stool transplants as a therapy is pretty desperate.)  Here was some bright news on the treatment front, however:  an experimental […]

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November 10th, 2008

Yes, Just a Case Report, but Incredibly Cool

At this year’s Retrovirus Conference (was it really this year’s conference, seems like much longer ago than that), there was a poster presentation summarizing a very unusual case.  A man with HIV, stable on antiretroviral therapy, developed acute leukemia.  He underwent an allogeneic bone marrow transplant — here’s the kicker — from a donor who […]

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November 2nd, 2008

The Big HIV News from ICAAC/IDSA

Tons of interesting stuff at this year’s combined ICAAC/IDSA meeting, most of it in non-HIV related Infectious Diseases.  In aggregate, literally hundreds of posters, presentations, and symposia on MRSA, C diff, osteomyelitis, complicated UTIs, hospital-acquired pneumonia, antibiotic resistance … It’s a great meeting to catch up on general ID, and the literature review sessions alone […]

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October 21st, 2008

Back to School, Day 4: PEP and More PEP

After a lecture on HIV for Primary Care Providers in our course last week, the most controversial topic was, not surprisingly, the use of post-exposure prophylaxis (PEP) for both occupational and non-occupational exposures.  And today, after an entire lecture on PEP to a group of HIV providers in our AIDS course, again the subject drew […]

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