HIV and ID Observations

January 28th, 2015

Quick Question: Should We Still Be Recommending This Year’s Flu Vaccine?

From a football-obsessed primary care provider, written to me on one very snowy day in New England: Hi Paul, I’ve been reading about this year’s flu vaccine, and how ineffective it is. Not surprisingly, my patients have been hearing this too, and it has only increased their reluctance to go through with it. Should I just […]

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January 18th, 2015

Opposition to HCV Screening Raises a Few Interesting Points — But Has Some Really Wacky “Facts”

Over in the British Medical Journal, there’s a provocative editorial entitled, “Is widespread screening for hepatitis C justified?” Based on the title alone, you can guess the authors’ answer to that question — a resounding “No!” By taking this position, of course, they are opposing some very data-driven and well-respected arbiters of policy and clinical practice. These include not […]

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January 7th, 2015

Are the STI Screening Guidelines for Gay Men Overkill? (And Pedro Video.)

Our “healthcare system” recently distributed a set of guidelines entitled, Primary care for gay men: screening and treatment recommendations. It included, among other things, recommendations for screening for sexually transmitted infections (STIs) and anal cancer. The former it adopted from CDC guidelines, which are this this: Screening at least once a year for syphilis, chlamydia, and gonorrhea for all sexually […]

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December 30th, 2014

Common Curbsides: The Patient with “Recurrent Zoster”

Just in time for the New Year celebration, here’s a curbside consult I’ve received several times, probably because the answer isn’t in most textbooks. As usual, the actual question is slightly edited, as well as lightly (and affectionately) annotated: Hey Paul — Quick question [of course] — I have a patient with a history of irritable bowel, otherwise well, […]

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December 20th, 2014

New HCV Option Effective, Safe, Well-Tolerated — And Use Will Likely Be Driven by Payors

As expected, the FDA approved the next treatment option for HCV on Friday — “Viekira Pak”, a (sometimes complete) regimen consisting of ritonavir-booted parataprevir and ombitasvir given as a two pills once a day, plus one pill of of dasabuvir given twice daily. It is indicated for treatment of HCV genotype 1. For those of you mechanistically inclined, parataprevir […]

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December 14th, 2014

2014 Top Stories in HIV Medicine

Boy do we love end-of-year “Best of …” and “Top Stories of …” lists! Love them! They never gets old! Until January, that is. My own particular favorites are the Best Movies of the Year lists, since for whatever reason it always seems like some masterpiece slips by. Missed it! So we leave it up to the […]

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November 23rd, 2014

Five ID/HIV Things to be Grateful for this Holiday Season, 2014 Edition

Amidst outbreak hysterias, anti-vaccine imbecility, electronic medical record whining, and slug-related eosinophilia, I bring you this year’s version of the good news — the 2014 edition of Five ID/HIV Things to be Grateful for this Holiday Season, just in time for your holiday turkeys. (Needless to say, the bird will be properly cooked to ensure it’s salmonella-free, with all cooking […]

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November 16th, 2014

Electronic Medical Records and the Demise of the Useful Medical Note

Electronic medical records (EMRs) are much on my mind, as last week at Medical Grand Rounds Robert (Bob) Wachter, chief of the medical service at UCSF, gave a brilliant talk on the unanticipated consequences of our move towards what he calls the “Digital Doctor.” Bob has thought a lot about this issue, so much so that he’s about to […]

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November 10th, 2014

Common Curbsides: The Tuberculin Skin Test and IGRA That Don’t Agree

Here’s one I’ve received twice in the past week, plus my answer. As always, names/some details changed to protect patient confidentiality, plus my annotations in brackets/italics. Hey Paul, Quick question [Need I even comment about the “quick question” phrase, and how this unintentionally devalues what ID docs do? OK, I’ve commented, and yes I’m hypersensitive] — one of my […]

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October 30th, 2014

Why the IPERGAY (Yes, That’s Its Name) Study Could Substantially Increase Use of PrEP

Yesterday, the French IPERGAY study of intermittent pre-exposure prophylaxis (PrEP) was stopped early by the Data Safety Monitoring Board, and for the best reason — the evidence demonstrating that it prevented HIV was overwhelming. For those who read French, here’s the official announcement. (Scroll down for the English.) And for those who can’t believe the name, it stands […]

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