HIV and ID Observations

October 7th, 2013

CD4 Cell Count at Presentation: A Figure with a Depressingly Small Upward Slope

You know how to make an ID/HIV specialist angry? Frustrated? Sigh loudly? Tell a clinical anecdote that involves “late” presentation of HIV diagnosis, in particular someone who has been seeking medical care for various ailments for months or even years without getting tested. You know — it goes something like this: “He was seen 3 […]

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September 27th, 2013

Yes! An Economic Justification for ID Specialists

We’re currently in the middle of fellowship interview season, and I overheard the following conversation between two of my colleagues as they contemplated their upcoming interviewees: ID Doctor #1:  He seems like a great candidate — wants to study hospital and community epidemiology of highly drug-resistant bacterial infections, and has already made major contributions to […]

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September 13th, 2013

Clindamycin vs. TMP/SMX for Soft Tissue Infections: A Clinical Trial That Needs Some Marketing

At ICAAC this week — the ID conference with the most inscrutable acronym out there — Loren Miller from UCLA presented a clinical trial on treatment of skin and soft tissue infections that has widespread clinical applications, yet may receive little if any attention. And why is that? Simply because the drugs (clindamycin and trimethoprim/sulfamethoxazole) have […]

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August 28th, 2013

Poll: At $14,105/year, Is Dolutegravir Fairly Priced?

The recently approved once-daily integrase inhibitor dolutegravir is now in pharmacies and, like every new HIV drug, the price — around $14k/year — has generated some controversy. For the record, here are the per-year wholesale acquisition costs of the three FDA-approved integrase inhibitors. Raltegravir:  $12,976 Elvitegravir:  $13,428 (once disentangled from the price of TDF/FTC) Dolutegravir: […]

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August 26th, 2013

When Eating Guinea Pig, Make Sure to Ask for it Well Done

I’ve written before about how ID doctors are no fun to have at cook outs, what with our obsession with well-done hamburgers. Now, there’s another menu item we can berate grill-meisters on, and that’s guinea pig meat: At least 81 people fell ill from suspected salmonella poisoning after eating guinea pig meat and other foods […]

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August 25th, 2013

Death from “Brain-Eating Parasite”: A Reminder of How Little We Really Know

  Sometimes it takes a lot to surprise an ID doctor — we who try to make it seem like we’ve seen it all — but certain infections are either so severe (e.g., necrotizing fasciitis from group A strep) or so rare (e.g., endocarditis from Erysipelothrix rhusiopathiae) that even we are startled. Doubly startling are those […]

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August 20th, 2013

Underreporting of Lyme Disease No Surprise, but a Big Problem

In a welcome update, CDC just presented revised data on the number of Lyme Disease cases annually in the United States. Here are the key facts: Cases reported by clinicians: 30,000 Estimated number of cases using additional information from insurance claims, laboratories, and patient reports: 300,000 Go ahead, check my math — that’s a whopping […]

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August 6th, 2013

Nelson Cruz and Yet Another ID-Baseball Link

Texas slugger Nelson Cruz is one of the Biogenesis gang just suspended from baseball for use of performance-enhancing drugs (PEDs). For those who care about these things, he’s also probably the most important player from the banned list, since he’s 1) very good and 2) on a team in contention for a playoff spot. For […]

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August 1st, 2013

Poll: Will There Be A Shortage of HIV Providers?

Over on NEJM Journal Watch — love that new name — I reviewed a paper on the demographics of people living with AIDS in San Francisco. Bottom line — more than half are now older than 50. Implication — that’s so old! First, it really isn’t, unless you compare it to the dismal era 20+ […]

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July 23rd, 2013

Guess it Wasn’t the Acyclovir After All

Big news in baseball land is that superstar Ryan Braun has been suspended for the rest of the season for using performance enhancing drugs (PEDs). And why is this information in an Infectious Diseases blog? Three main reasons: When Braun first got nabbed for PEDs in 2011, it was widely rumored it had something to […]

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