HIV and ID Observations

November 28th, 2012

A Complicated Curbside Consult I Won’t be Doing — But One Day Might Have To

From a local primary care provider comes this email: Any chance you can look at my notes and scanned outside records from 6/22/2010 till today (including Nov 6 notation that details extensive past evaluation, including two previous ID consults) and labs? Briefly: 72 yr old woman with 6 episodes over the last 4 years of prolonged […]

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November 8th, 2012

Steroids for Bell’s Palsy and the ID Doctor

OK, let’s imagine you’ve just gotten a call/email/text from one of your colleagues about Bell’s palsy; he/she is a busy PCP who periodically asks you very reasonable ID questions. I suspect it went something like this: COLLEAGUE:  Hi Friendly ID Doctor, quick question — I have a patient with Bell’s palsy — wondering whether to give him […]

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November 7th, 2012

Vitamins and the Department of Bad Timing

Now that the election is over, we can get back to something that really matters — namely vitamins, and specifically whether they really help people. Last month there was a large, well-done study from Tanzania showing that mega-doses of vitamins not only didn’t help those HIV starting ART, but they actually were harmful — LFTs went […]

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November 2nd, 2012

Antiretroviral Rounds: Resistance on Two Fronts

Got this challenging curbside consult from a colleague, and it has a interesting wrinkle: I have a longstanding patient with HIV who had many failed regimens in the 1990’s with resultant following mutations on a genotype done in 2003: NRTI (M184V, Q151M mutations);  PI (A71, I54V, K20M, L10I, L90M, V82A mutations); no NNRTI resistance. She has been undetectable since then on TDF/FTC/EFV; […]

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October 22nd, 2012

Can a “Treat Everyone with HIV” Policy Actually Work? In San Francisco, Yes

As has often been the case in the history of the HIV epidemic, the HIV/AIDS Division at San Francisco General Hospital and the San Francisco Department of Health were ahead of the curve in 2010 when they issued a recommendation that all people with HIV should receive treatment, regardless of CD4 count. Of course, US guidelines […]

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October 17th, 2012

It’s Time to Tell Our Patients to Stop Their Vitamin Supplements

Over in JAMA, there’s a large study out today that (yet again) failed to demonstrate a benefit of vitamins. Over 3000 patients with HIV in Tanzania were randomized to receive either high-dose or standard-dose multivitamin supplementation, in addition to “HAART” (ugh). Though the study was planned for 24 months, it was stopped early by the Data Safety […]

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October 16th, 2012

Some Liver Meeting “Wow!” Studies Start to Emerge

The Liver Meeting, the annual meeting of the American Association for the Study of Liver Disease, does not take place until November 9-13, in Boston. But if you want a preview, a couple of notable studies have already been “announced” in the press. Specifically, there’s this: Abbott today announced initial results from “Aviator,” a phase 2b study of its interferon-free, […]

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October 15th, 2012

ID Doctors are Clueless about Treating Helicobacter

Every so often, we’ll get a referral from a gastroenterologist about a refractory case of Helicobacter pylori. Usually the patient has been treated multiple times, and still has symptoms and a positive test. Naturally a referral to a specialist in Infectious Diseases seems warranted. But the reality is that this is like the IV nurse contacting the […]

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October 13th, 2012

More Questions from “ID in Primary Care” Course

Some additional excellent questions from the course: For someone who has had 3 doses of hepatitis B vaccine but does not have the antibody, should we just go ahead and give another 3 shots? A:  (Per vaccine guru Howard Heller):  The guidelines say to just go ahead and give another 3 shots but if the initial […]

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October 11th, 2012

Back to School: Questions at the “ID in Primary Care” Course

We do a post-graduate course each year called “ID in Primary Care,” and it’s a great way for us to find out what people in outpatient primary care practice are thinking about from the ID perspective. I told the participants this year I’d post some of their most interesting questions on this site, with the hope that […]

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