HIV and ID Observations

August 5th, 2009

Just Out: Primary Care HIV Guidelines

Over on the CID web site, they have the revised version of the “IDSA Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus”. It’s a great document, filled with useful references and a particularly strong table where to find other consensus guidelines (diabetes, hyperlipidemia, mental health, others). My vote for what […]

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July 10th, 2009

Time for a Switch? What Actually Happened

A couple of months ago, I presented these three clinically stable, virologically suppressed patients — and asked if they should switch treatment: 50 year old man on ABC/3TC, EFV since 2000.  No renal disease.  Hyperlipidemia, on atorvastatin 80 mg a day.  Father died of an MI age 48. 63 year old man, on EFV + […]

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June 13th, 2009

Occupational Exposures and HIV Testing

A couple of years ago, an ID-colleague of mine told me about a tough case:  While working in the ICU, an anesthesiologist sustained a pretty severe needle stick.  Approached for HIV testing, the source of the exposure felt threatened by the providers in the ICU, and refused to sign the consent. The patient then deteriorated […]

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June 8th, 2009

H1N1: A Tale of Two Practices

As an adult ID/HIV doctor, I must say the clinical impact of H1N1 thus far has been underwhelming, notable more for the calls about prophylaxis or suspected cases than the real thing. (Last week, one patient with fever and “suspected swine” — hard for people to shake that name — turned out to have … […]

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June 1st, 2009

“Long-term Nonprogressors” and “HIV Controllers”: Rare Indeed

When giving an overview of HIV pathogenesis to a group of clinicians, Bruce Walker usually asks the assembled if they have any patients in their practice who have undetectable viral loads without antiretroviral therapy. Generally about three-quarters of the audience has at least one such patient.  They are then asked to refer them to his […]

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May 28th, 2009

The Paul Farmer Watch

Our pal Paul Farmer keeps racking up the titles: Dr. Paul Farmer, a pioneer in improving health services in the Third World, has been named chairman of Harvard Medical School’s Department of Global Health and Social Medicine … (snip) Peter Brown, spokesman for Brigham and Women’s Hospital, said Farmer also had been named to succeed […]

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May 19th, 2009

Time for a Switch? Room for Debate

With first-line therapy for HIV being so astonishingly successful, much of what we do in practice is tweak regimens that are by virologic and immunologic standards, working just fine:  Viral load undetectable, CD4 stable. But not so fast — while one of my colleagues said that if he didn’t change his patients’ regimens, then he’d […]

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May 13th, 2009

Working While Contagious: Why Do We Do This?

File this under, “physicians behaving badly”:  The nearly universal MD practice of going to work while sick. The ironic thing is we think we’re being selfless — after all, if we don’t show up, our patients will need to be rescheduled, or someone will need to cover, or some administrative/teaching task will not get done […]

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May 7th, 2009

Human Rabies from Bats: Another Look at the Numbers

The gang from Canada is at it again, reviewing human rabies cases from bats and trying to make some sense of the data. (For a summary of their outstanding prior paper in CID, read this.) But before we get to their latest masterwork, here are some questions to ponder.  While doing so, keep in mind […]

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May 3rd, 2009

H1N1! Didn’t You Used to Be Swine Flu?

At the end of last week, “swine flu” became “H1N1”.  The CDC web site explains why: This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in North America. But further study […]

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