HIV and ID Observations

May 4th, 2015

A Drug for Neck Fat, and Some Thoughts on Fat Accumulation Syndromes in HIV

It’s not often that a FDA drug approval for cosmetic dermatologists and plastic surgeons will get the attention of HIV/ID specialists, but this past week was an exception. From the FDA report: The U.S. Food and Drug Administration today approved Kybella (deoxycholic acid), a treatment for adults with moderate-to-severe fat below the chin, known as submental […]

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April 22nd, 2015

Seriously — How Much Would You Pay for a Curbside Consult?

Yes, seriously. Let me start with an email exchange I had with a PCP recently: Hi, Paul, quick question 😉 This lady, 49 YO woman from Haiti, asymptomatic, totally healthy. Got TSpot done for immigration purposes, it’s positive with negative chest Xray. Treated with INH 6 months in 2001. She travels to Haiti annually so could had been reexposed, though […]

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April 8th, 2015

New HIV Treatment Guidelines, and the End of an Era

The new Department of Health and Human Services (DHHS) HIV treatment guidelines are out, and thanks to skillful direction by Alice Pau, it’s as usual a must-read document — all 288 pages, of course! There are several major changes, so a good place to start is the all-important “What’s New in the Guidelines” summary page. Some of the […]

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April 3rd, 2015

Melting Snow ID Link-o-Rama

A few ID/HIV tidbits to contemplate as we go from slipping on ice and snow to dodging the mud: Beta-lactam therapy alone is non-inferior to regimens that also cover “atypicals” for hospitalized patients with pneumonia. These results challenge a dogma that has been present for a couple of decades — namely, that all patients admitted with community-acquired pneumonia should get either […]

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March 28th, 2015

Quick Question: Should HIV-Negative People in Serodiscordant Relationships All Get PrEP?

From a very thoughtful and experienced primary care provider came this query: Hey Paul, quick question — One of my patients, an HIV-negative gay man, is in a long-term relationship with one of your HIV-positive patients — my patient says his partner has been on successful HIV treatment for years. Obviously I can’t check his partner’s […]

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March 21st, 2015

ID Learning Unit: Coagulase-Negative Staph, and the “Anti-Zebra” Residents’ Report

At the risk of betraying a deep streak of nerdiness, I confess to being a huge fan of Residents’ Report. This infatuation goes back to my medical student days, when the occasional chance to watch the Chief Medical Resident — who seemed the smartest doctor on the planet — lead a discussion of an interesting case inspired […]

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March 8th, 2015

Measles Vaccine Videos and the Challenge of Changing Someone’s Mind

I suspect most of you have already been treated to this highly amusing video about the measles outbreak from Jimmy Kimmel — a comedy segment featuring real-life doctors, imagine that. Not your typical late-night comedy show performers, but they forcefully (and obscenely) get their message across. If you have just returned from a tropical island where the internet connection was iffy, however, […]

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February 21st, 2015

Fusobacterium, Pharyngitis, and the Limits of Limiting Antibiotics

A paper on pharyngitis in young adults, just published in the Annals of Internal Medicine, is creating a controversy in the intersecting worlds of primary care and Infectious Diseases. The first author is Robert Centor, of the famous Centor criteria that assess the likelihood of group A strep. He’s been writing about our need to expand […]

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February 15th, 2015

Should Antibiotics be Part of End-of-Life Care?

There’s been some truly outstanding work done recently on end-of-life care, and how we deal with it — or more accurately, how we typically don’t deal with it until the very last moment, at which time often many unfortunate decisions and events occur. Here are three I can strongly recommend: Roz Chast’s Can’t We Talk About Something More Pleasant? is probably the […]

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February 8th, 2015

Snowstorms-a-Plenty ID Link-o-Rama

A few items to discuss as we settle in for yet another Boston megastorm: The measles outbreak continues to bring forth excellent commentaries on the selfishness of vaccine-refusers, with this one from Frank Bruni one of my recent favorites. Question: Will it take a hospitalization — or even worse, a death — of an American child with measles to stop this […]

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