HIV and ID Observations

April 29th, 2009

Swine Flu Treatment Guidelines — For Now

The swine flu situation is so dynamic that what I wrote earlier this week now seems hopelessly dated — except that from the perspective of a clinical ID doctor, it still feels eerily similar to the anthrax and SARS outbreaks. But related to that post — specifically the use of antivirals — these interim guidelines […]

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April 26th, 2009

Swine Flu Curbsides: Anthrax, SARS Redux?

In my email in-box yesterday AM from a primary care doc: A patient of mine, 40 year old woman totally healthy, is going to Cancun on Tuesday for a conference.  She’ll be there for 6 days. I know there are no cases of swine flu in Cancun yet, and the situation is evolving, but here’s […]

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April 24th, 2009

Colonoscopy in HIV Patients, Part II: Problem (Mostly) Solved

Both here and on the AIDS Clinical Care site, we posted a case of a 50-year-old HIV+ man in need of a screening colonoscopy.  What sedation could he receive while on tenofovir/FTC and ritonavir-boosted atazanavir?  Specifically, would midazolam and fentanyl (“contraindicated” in the ritonavir package insert) be ok? (Same issue for efavirenz, by the way.) […]

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April 20th, 2009

Another HIV Pharmaceutical Partnership

GlaxoSmithKline and Pfizer have created an alliance for HIV drug development. Since there is only one collaborative effort in the HIV treatment area — the colossally-successful “Atripla” between Gilead and BMS — I had thought this kind of arrangement was fairly rare in the drug biz, but according to this interesting take, apparently not. Perhaps […]

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April 18th, 2009

Ceftriaxone and Calcium — OK Again in Adults!

As every house officer, hospitalist, intensivist, and ID doc knows, ceftriaxone and calcium have been contraindicated since 2007 due to fears of a potentially fatal precipitation of the two that led to the death of 5 neonates. Pediatricians are fond of saying “kids are not small adults” (I should know), and if that’s true, it’s […]

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April 11th, 2009

Another Drug Linked to PML — Law Firms Waiting for Your Call

The psoriasis drug Raptiva (efalizumab) has been linked to progressive multifocal leukoencephalopathy: On Oct. 16, 2008, FDA updated the FDA-approved labeling for Raptiva to warn of the risk of life-threatening infections, including PML. On Feb. 19, 2009, the FDA issued a Public Health Advisory informing patients and prescribers of the risk of PML in patients […]

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April 6th, 2009

Delayed Opening Day Videos, and More

Some random HIV/ID issues while awaiting a delayed opening day here in cold, rainy Boston: If you enjoy video highlights, check out these of HIV making its way from T cell to T cell.  If you’re short on time, #’s 9-12 are particularly amazing.  Still, I don’t imagine that this video will make it to Youtube […]

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March 31st, 2009

Infectious Disease in the ICU: Help Please? Part II

In Part I of this topic, I commented on the ironic sameness of ICU Infectious Diseases — that incredibly sick, complex patients entered the ICU with vastly different problems, then over time, seemed to converge, presenting similar kinds of clinical issues and management challenges for the ID doc. Or, as a visiting medical student said […]

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March 25th, 2009

March (Guideline) Madness …

A couple of interesting ID guidelines out this week.  For those of you too busy with basketball, here are the relevant links: Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities. Identified in 24 states and now found “routinely” in New York and New Jersey, these carbapenem-resistant Enterobacteriaceae (“CPE” is […]

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March 20th, 2009

Hair Today, Gone Tomorrow …

Since providers — especially doctors — are notoriously poor at predicting medication adherence, here’s some good news: In a paper from the Women’s Interagency Health Study, protease inhibitor levels in hair samples were the strongest independent predictor of virologic success — better than self-reported adherence, age, race, baseline viral load and CD4 cell count, and […]

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