HIV and ID Observations

July 25th, 2012

AIDS Quilt, the Early 1990s, and Sadness

The early 1990s has potentially many associations — the break-up of the Soviet Union, the first Gulf War, the World Trade Center and Oklahoma City bombings, The Lion King, Forest Gump, The Fresh Prince of Bel-Air, “Smells Like Teen Spirit”, and the cancellation of the baseball season, to name a few. But we HIV/ID specialists will always […]

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July 23rd, 2012

IAS-USA HIV Guidelines Updated

With the International AIDS Conference in Washington just starting, the International Antiviral (ahem) Society-USA has revised its HIV treatment guidelines, updating the 2010 version. As has been the case for several years now, it’s published in JAMA and also available on the IAS-USA web site. It’s a well written, evidence-driven summary of the current state of […]

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July 16th, 2012

Sizzling Summer Serratias

Several ID/HIV items to contemplate as the heat really kicks in here in the torrid USA: TDF/FTC approved for pre-exposure prophylaxis. The challenging issues of defining the best candidates for this strategy — and finding the providers to prescribe it — still remain, but FDA approval should at least help justify insurance coverage if clinicians choose […]

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July 10th, 2012

Are ID Doctors the Worst Dressed Specialists?

Unusual exchange the other day with one of my (non-ID) colleagues. All dialogue reported verbatim: Non-ID guy: Hi Paul. Me:  Hi Jon. [I’m expecting the next line to be: “Quick question: I’ve got a patient with a positive PPD and a history of BCG, etc.” Instead, it’s this bizarre comment:] Non-ID guy:  You know, I would say that […]

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June 24th, 2012

ID Learning Unit — Choosing a Quinolone

We love quinolones on medical services, and it’s easy to understand why. Advantages: Ideal spectrum for several common infections, including community-acquired pneumonia, UTIs, and more complex infections when combined with other drugs Great oral absorption Few drug-drug interactions Once- or twice-daily dosing Generally well tolerated Reasonable cost But how do you choose between them? Below, in […]

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June 18th, 2012

ID Learning Unit — Serologic Tests for Syphilis

Diagnosing syphilis is tricky for lots of reasons, including: The protean disease manifestations, many of which were best described in older medical literature — and hence not known to people who don’t read words on paper (vs a screen) very often. You can’t visualize the bug (Treponema pallidum), unless you happen to have a darkfield microscope […]

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June 15th, 2012

ID Learning Unit — The D Test

I suppose it’s not surprising that we’d follow-up the Etest with the D test, though perhaps if I were being alphabetical, the order would have been reversed. The D test is important, because it screens for a form of clindamycin resistance in MRSA that might otherwise not be detected — the “inducible” kind, which can be […]

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June 13th, 2012

Questions About HIV Cure, and a Very Funny Quote

The single case of HIV cure following allogeneic bone marrow transplant is in the news again, this time because of data just presented at “The International Workshop on HIV and Hepatitis Virus Drug Resistance and Curative Strategies” (formerly known as the “HIV Resistance Workshop” — how’s that for rebranding?). I’m not at the meeting, which is too […]

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June 12th, 2012

ID Learning Unit — The Etest

Every year I attend on the general medical service, so it gives me a chance to work directly with the medical residents — and to brush up on my non-ID-related Internal Medicine. In exchange for what they teach me, each day on rounds I try to tell them about at least one ID-related thing that they […]

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June 8th, 2012

SPARTAN: Two-Drug, NRTI-Sparing Strategies Continue to Disappoint

Just published is the cleverly named “SPARTAN” study — spartan because it leaves out both NRTIs and ritonavir — and the results are very interesting. Ninety-three treatment-naive HIV-positive study subjects were randomized 2:1 to receive either a two-drug regimen of raltegravir 400 mg BID + atazanavir 300 mg BID, or a standard regimen of TDF/FTC + boosted atazanavir. […]

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