HIV and ID Observations

January 3rd, 2025

On the Inpatient ID Consult Service, Oral Antibiotics Have a Rocky Road to Acceptance

Having just completed a stint doing inpatient ID consults, I came away impressed with three things: Staph aureus remains the Ruler of Evil Invasive Pathogens in the hospital setting. You can “jinx” a holiday season by saying it’s usually quiet on Christmas. This year it sure wasn’t quiet, hoo boy. Some surgeons aren’t ready to accept […]

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December 8th, 2024

Who’s Going to Get Lenacapavir for HIV Prevention?

At the International AIDS Conference this past summer, Dr. Linda-Gail Bekker brought down the house presenting the results of the PURPOSE 1 trial of twice-yearly injectable lenacapavir for prevention of HIV in women. The results — zero infections out of over 2000 participants — demonstrated clear superiority over oral PrEP with TDF/FTC. The study simultaneously […]

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November 27th, 2024

Some ID Things to Be Grateful for This Holiday Season — 2024 Edition

The calendar says it’s nearly the fourth Thursday of November, so here in the United States, the Thanksgiving holiday is upon us. It’s a day when we gather with family and friends to express thanks, to eat plenty (usually too much), to watch a bunch of spectacular athletes bash themselves to smithereens in the name […]

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October 8th, 2024

Why We Have Antibiotic Shortages and Price Hikes — And What One Very Enterprising Doctor Did in Response

At the start of our weekly case conference, we get announcements from one of our ID pharmacists. New drug approvals, hospital policies, updated guidelines — that kind of thing. But over the last decade or so, the most common topic they’ll comment on is the latest important antibiotic shortage. For those not in medicine, you […]

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September 19th, 2024

How Electronic Health Records Tyrannize Doctors — ID Doctors in Particular

A paper just appeared in the Journal of General Internal Medicine entitled “National Comparison of Ambulatory Physician Electronic Health Record Use Across Specialties.” The goal of the study was to track clinician workload by specialty, divided into various functions — documentation, chart review, orders, inbox. Importantly, there was no gaming the system. By using Epic’s built-in […]

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September 6th, 2024

Five Reflections after Attending on General Medicine This Year

Here are five things that occurred to me after a stint on General Medicine this year, where (per our department’s wise policy), I was paired with an experienced and excellent hospitalist to oversee two medical residents, three interns, and two medical students. #1:  Energy. Medical house officers radiate positive energy. Yes, it was summertime, and motivations […]

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July 14th, 2024

Should We Continue to Use Contact Precautions for Patients with MRSA?

Back in the early 2000s, I heard about a local hospital that eliminated contact precautions while caring for patients with methicillin-resistant Staphylococcus aureus (MRSA). No more required gowns and gloves, or warning signs on the doors, or private rooms for patients known to have MRSA. They planned to track MRSA cases carefully over the next […]

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June 9th, 2024

The Mysteries and Challenges of the RPR — and a Proposed Clinical Trial

Last week, we had a real treat for our weekly ID/HIV clinical conference — a review of controversies in the management of syphilis in adults by Dr. Khalil Ghanem, from Johns Hopkins. He’s a well-known expert in the field of sexually transmitted infections, syphilis in particular. A highlight of the talk was his dismantling of a […]

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May 28th, 2024

More on ID Doctors and Primary Care for People with HIV

A recently published study suggested that “non-ID doctors do better” when it comes to providing primary care to people with HIV. At least that was the attention-grabbing subject line of an email summary distributed by a local primary care doctor, Dr. Geoffrey Modest. He periodically sends around detailed descriptions of studies he finds interesting, then […]

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May 11th, 2024

Just in Time for Mother’s Day, Some Admiration and Gratitude

As I’ve written here before, I’m in awe of my mother — a smart woman who doesn’t celebrate Mother’s Day. So in place of celebrating, I’m going to use the holiday anyway as an excuse to share an event that highlights her strengths and resourcefulness. It has an ID theme eventually, so stick around to the end. […]

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