HIV and ID Observations

January 11th, 2013

How to Make the Flu Vaccine More Popular, Warts and All

In a week that saw both our hospital’s influenza-induced bed crunch make the New York Times, and my son, mother-in-law, and me succumb to this seasonal plague despite our receiving flu shots, I have been highly attuned to all things influenza. But the focus here will be on that perennial whipping boy of preventive Infectious Diseases, […]

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January 1st, 2013

HIV Incidence: The Latest Numbers

The CDC has recently issued the latest report on HIV incidence (i.e., new infections) in the United States, and as always it’s fascinating to review the numbers. To start, the year-by-year estimated incidence: 2007:  53,200 2008:  47,500 2009:  45,000 2010:  47,500 (38,000 men, 9,500 women) Nope, not much change. Will data from HPTN 052 — published […]

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December 22nd, 2012

Chaos in the Diagnosis of C diff, and Dogs are Amazing Creatures

If you’re confused about the best way to diagnose C diff these days, welcome to the club. There are all kinds of tests out there, and no uniform approach between labs. Our lab actually does three tests — and will do a fourth (the classic cytotoxicity assay) if you request it. The result? Chaos, confusion, […]

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December 20th, 2012

Severe Telaprevir Rashes and Waiting (or Not Waiting) to Treat Hepatitis C

Yesterday, the FDA issued a drug safety alert about severe rashes — “some fatal” — in patients treated for HCV with interferon, ribavirin, and telaprevir. The culprit, of course, is the telaprevir. The label already contained warning information about serious skin rashes with the drug, and this alert serves to heighten our awareness of the […]

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December 17th, 2012

On Service — But Some Works in Progress

When several of my colleagues attend on the inpatient consult service, they turn on an “out of office” message that provides an automated e-mail reply that goes something  like this: I am currently attending on the inpatient consult service. During this busy time, I may not be able to respond to email in a timely […]

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December 5th, 2012

Top HIV Stories of 2012

Somewhere in our genome, we are programmed to use the end of the year as a time to reflect on the previous 12 months — and to make lists! If you don’t believe me, there’s barely a publication or web site out there that hasn’t already succumbed, and we’re just in early December. And what […]

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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 […]

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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 […]

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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 […]

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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 […]

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