HIV and ID Observations

October 28th, 2025

Two COVID Vaccine Studies — One Actionable, the Other Not So Much

As we await the results of placebo-controlled COVID-19 vaccine studies, what are we clinicians to do when our patients ask us whether they should get a booster this fall? What once was a no-brainer in the early days of limited immunity to the virus — and the spectacular results of the first placebo-controlled trials — […]

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October 10th, 2025

DOTS: Optimism Around a “Negative” Dalbavancin Trial

The DOTS randomized clinical trial of dalbavancin versus standard-of-care for Staph aureus bacteremia (SAB) just landed in JAMA, where it undoubtedly will be featured in numerous ID, hospitalist, and medical resident journal clubs over the next several months. Proof:  one of our great second-year ID fellows tagged it immediately for his journal club literally the […]

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August 16th, 2025

Anal Cancer Screening in HIV: When Guidelines Get Ahead of the Evidence

Should every person with HIV over age 35 (if MSM or transgender woman) or 45 (everyone else) have an anal Pap smear, a digital anal rectal exam (DARE), and possibly a high-resolution anoscopy every 1–2 years? According to recent guidelines, yes. But here’s the problem: we don’t know if this screening effort actually prevents cancer. […]

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July 25th, 2025

Who Gets Sent to ID Clinic? A Field Guide to Outpatient Referrals

Sometimes people ask me what kind of cases get referred to ID doctors in the outpatient setting. Despite what the latest television series might suggest, it’s rarely suspected Ebola (fortunately) or Tsutsugamushi fever — a disease that is much more fun to say by its Japanese name than its common one, scrub typhus. (In Japanese, “tsutsuga” […]

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June 27th, 2025

The Mystery of the Isolated Hepatitis B Core Antibody, Solved

(A post inspired by years of doing eConsults, an extremely common query about hepatitis B testing, and the latest BritBox series, “Core Antibody Confidential,” starring a grizzled detective with a faded suit and a haunted past.) Your electronic medical record lists “deficiencies” in health care maintenance for one of your patients, so you order hepatitis […]

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June 12th, 2025

Why the Sudden Firing of ACIP Members Should Put Every Clinician on High Alert

There are certain irrefutable verities when, like me, you’re an infectious diseases specialist married to a pediatrician. Here are our top two, which are deeply interrelated: Infectious deaths in children, or severe illnesses that lead to lifelong disability, are more devastating than similar events in adults. Each such case in a baby or child is […]

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June 6th, 2025

How ID Doctors Get Paid, Part 3: The Grab Bag Edition

If you’ve made it this far, congratulations! You’re now deep into the ID Reimbursement Rabbit Hole. Part 1 and Part 2 covered how ID doctors contribute immense value through patient care, stewardship, infection control, travel clinics — proudly fighting along the way for appropriate compensation as the “Loss Leaders” of the hospital. (Did you get […]

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May 18th, 2025

How ID Doctors Get Paid — The Bread, Butter, and Budget Deficits of Infectious Diseases

Two decades ago, Dr. Atul Gawande wrote a memorable piece for The New Yorker about how doctors in the United States get paid. Providing a nice mix of self-reflection about his own experience and some skillful reporting, he described the challenging process of figuring out what he, a newly hired surgeon, should earn for a […]

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April 11th, 2025

Looking Back at a Defunct ID Meeting — and Ahead to a Thriving One

Back in prehistoric times, many ID doctors and microbiologists would gather each fall at a meeting to review the latest antimicrobial clinical trials and promising “bug-drug” studies of novel compounds in development. The meeting was called the Interscience Conference on Antimicrobial Agents and Chemotherapy, abbreviated ICAAC. There were a bunch of problems with ICAAC. First, […]

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April 3rd, 2025

Gepotidacin — New Antibiotic or Rare Tropical Bird?

Imagine you’re birdwatching in the Costa Rican rainforest, Merlin app in hand. A flash of iridescent blue catches your eye. You scan the canopy and whisper excitedly: Look, it’s the elusive Blujepa! A rare sighting! No, not a real bird, but the brand name of gepotidacin, something rarer — and arguably more exciting — than […]

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