HIV and ID Observations

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 […]

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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 […]

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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, […]

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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 […]

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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 […]

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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 […]

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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 […]

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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 […]

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June 6th, 2012

A Fun Internet Poll for ID Nerds

Over on Medscape, one of my ID heroes, John Bartlett, has a new series called, “The Medscape Awards in Infectious Diseases” and it looks like a winner. Here’s how it works: The Medscape Awards in Infectious Diseases is a new series that will honor the greatest achievements in the field of infectious diseases during 1980-2012. […]

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June 2nd, 2012

Cryptococcal Meningitis Study Stopped — Early HIV Therapy Clearly Harmful

From NIAID, an important clinical trial has been stopped early: The Phase IV study … was evaluating whether HIV-infected participants hospitalized with cryptococcal meningitis (CM) but not yet taking antiretroviral therapy (ART) would improve their chances of survival if they began ART while receiving CM treatment as inpatients compared with the standard practice of beginning […]

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