HIV and ID Observations

October 10th, 2022

Molnupiravir Results in PANORAMIC Study — It’s Not All Bad News

Last week, the large PANORAMIC trial of COVID-19 treatment in outpatients with mild-moderate disease appeared in a pre-print. This large (25,783 participants!) randomized, open-label study compared molnupiravir vs. usual care in adults 50 or older, or having comorbidities known to make severe disease more likely. The results? Molnupiravir vs standard of care for outpts with Covid19. No […]

---

September 28th, 2022

Even if You Think “The Pandemic Is Over” — Let’s Make In-Person Meetings Safer

“The pandemic is over.” Someone very famous used these words recently, triggering all kinds of controversy. While most ID clinicians groaned at the comment, knowing that it would be taken out of context, repeated in headlines without any of the President’s cautionary statements, and fuel COVID denialists, it’s also worth acknowledging that most of the country really […]

---

September 8th, 2022

A Back To Work ID Link-o-Rama

A few nuggets are rattling around in the inbox post Labor Day, including this extraordinary photo of our family dogs Zelda, Zoe, and Louie, posing for their latest album cover. Woof! Besides, I haven’t done one of these Link-o-Ramas since January 11, 2021! That was either 20 months ago or 20 years, hard to keep track of […]

---

August 8th, 2022

Long-Acting Injectable HIV Therapy for People Who Won’t Take ART?

HIV treatment is so spectacularly effective that you might be surprised to hear that some people with HIV still have uncontrolled viral replication. We HIV clinicians watch with frustration and sadness as they experience progressive immunodeficiency, complications from advanced HIV disease, hospitalizations, and HIV-related deaths. Plus, while viremic, they continue to risk transmitting the virus […]

---

July 1st, 2022

Fellowship Transition and Developing a Sense of Belonging

It’s July 1, which means that today, or sometime very soon, many internal medicine residents will transition to becoming subspecialty fellows. There are many appropriate words to describe this change, including exciting, nerve-wracking, and challenging, but one that doesn’t get quite enough attention is how strangely lonely it feels. The reason this sensation occurs is because […]

---

June 21st, 2022

Mayo Clinic Study on Paxlovid Outcomes is Reassuring — but Likely Underestimates Rebound Rate

Over at Clinical Infectious Diseases, researchers from the Mayo Clinic published a retrospective analysis of nirmatrelvir/r (Paxlovid) treatment, with a careful review of each patient’s chart. The goal was to determine the clinical outcomes after the 5-day treatment course, with a focus on the frequency of rebounds — a topic of great clinical interest but with little […]

---

June 6th, 2022

Still More Fun with Old Medical Images

Back in the Before Times, this site would occasionally dabble in lighter fare: Cartoon caption contests Commentaries on doctor attire Thoughts on the first-name “Morgan” Penguins chasing a butterfly (Well, actually, this is a new one!) https://twitter.com/buitengebieden/status/1533022340887486466?s=20&t=ShPbhfDhg-BwCP2bWisXfA And, the subject of today’s post — Fun with Old Medical Images. Here’s how it works: We display an old medical […]

---

May 23rd, 2022

In Praise of Dr. Glaucomflecken

Sometimes there is someone so good at something that there is universal agreement we are witnessing something special. Babe Ruth, Serena Williams, and Michael Jordan competing at their peaks. Charles Dickens or Jane Austen creating whole worlds out of invented characters and plots. Vladimir Horowitz performing Rachmaninoff at Carnegie Hall. Bernini creating sculptures from cold, hard […]

---

May 4th, 2022

More on Relapses after Paxlovid Treatment for COVID-19

Unless you’ve been hiding under a rock, you’ve heard that some people treated for COVID-19 with nirmatrelvir/ritonavir (Paxlovid) experience a relapse in illness shortly after stopping treatment. It’s both a recurrence of symptoms and a positive antigen test — sometimes after the test became negative. One case report published as a pre-print shows that a relapse can have […]

---

April 25th, 2022

Yes, Relapses After Paxlovid Happen — Now What?

Around two weeks ago, one of my long-term, very stable patients with HIV called me saying she’d just been diagnosed with COVID-19. Over 60 with hypertension, and overweight, she qualified for nirmatrelvir/r (Paxlovid) under the Emergency Use Authorization (EUA), and took it without problem. (Certain details changed for confidentiality.) In fact, she started to improve within 24 […]

---