An ongoing dialogue on HIV/AIDS, infectious diseases,
May 2nd, 2010
Learning from Clinical Trials with Limited “Generalizability”
In the ongoing debate about when to start antiretroviral therapy in our sickest patients — those with acute opportunistic infections — comes this study from Zimbabwe of early vs. deferred ART in patients with cryptococcal meningitis: The median durations of survival were 28 days and 637 days in the early and delayed ART groups, respectively […]
April 24th, 2010
Choosing an Official State Microbe
Wisconsin has selected Lactococcus lactis as its official state microbe: The people of the state of Wisconsin, represented in senate and assembly, do enact as follows: SECTION 1. 1.10 (3) (t) of the statutes is created to read: 1.10 (3) (t) The bacterium Lactococcus lactis is the state microbe. SECTION 2. 1.10 (4) of the statutes is amended […]
April 22nd, 2010
Should Transmission of HIV be a Crime?
Not according to Journal Watch editor and New York Times writer Abigail Zuger, writing here in the Times. She’s referring to the recent Darren Chiacchia case, where his former partner has filed a legal complaint that Chiacchia did not disclose having HIV — potentially a first-degree felony in Florida. Were it a matter of science […]
April 4th, 2010
San Francisco Public Health: Treatment Recommended for All with HIV
Could there be anything more interesting than the start of the baseball season? Maybe, because this is quite something: In a major shift of HIV treatment policy, San Francisco public health doctors have begun to advise patients to start taking antiviral medicines as soon as they are found to be infected, rather than waiting — sometimes […]
March 31st, 2010
C diff Guidelines: Metronidazole Still Preferred?
IDSA and The Society for Healthcare Epidemiology of America (SHEA) have published Clinical Practice Guidelines for Clostridium difficile infection. Not surprisingly, it’s a comprehensive, extensively-referenced document that will be an invaluable resource, especially since the previous version is approximately 15 years old. But with the caveat that I’m not an expert in this area, these particular […]
March 24th, 2010
Now for Some Good News: TB Cases Continue to Decline
From the latest MMWR: This figure speaks for itself, but two sentences from the Editorial Note deserve highlighting: The 11.4% decrease in reported TB rate in 2009 is the largest single-year decrease ever recorded. From 1953 to 1993, the single largest annual percentage decrease in TB case rate was 11.1% in 1956 Since I started my […]
March 14th, 2010
MRSA Bacteremia Question Redux — and the “Answer”
As noted here, I recently had to answer a question on management of MRSA bacteremia as part of an every-10-year cycle of test-taking. (For more on that joyous process, read this interesting debate here in the New England Journal of Medicine.) The question seemed to have no obvious right answer, so I did what one is explicitly […]
February 28th, 2010
CROI 2010 Recap: No Obvious Blockbusters, But …
Ok, I’ll admit it — I didn’t see any studies presented at CROI this year that will immediately transform HIV care on a day-to-day basis. Nothing that will alter practice right now. Nothing like last year’s NA-ACCORD, or 2008’s surprising DAD study, or 2007’s raltegravir studies, to name a few recent examples. (All subsequently published, of course — links […]
February 14th, 2010
Retrovirus Conference (CROI) 2010 Preview
Just as pitchers and catchers report to Spring Training this week, many HIV specialists are gearing up for the 17th Conference on Retroviruses and Opportunistic Infections (CROI), which starts this Tuesday in San Francisco. (I don’t suppose many people see the link between those two events. Oh well.) And since the “pocket program” to the […]
February 2nd, 2010
Bats in the Bedroom: Canadians Make a Policy Change
ID doctors know all too well the panicky call — usually from a terrified friend, family member, or colleague, or possibly the emergency room or primary care doc — about finding a bat in the house. Usually in the bedroom. (In one memorable case, it was the house cat’s leaping in the air to try […]
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
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