HIV and ID Observations

November 13th, 2013

How Doctors, Nurses, and Other Medical Providers Spend Their Free Time

More absurd paperwork follies, this time from our friends at a mail-order pharmacy: Here, confronted with the challenge of refilling a patient’s HIV medications — which for the record he has been receiving unchanged for over 3 years — the pharmacy decides for the first time to reject the request and send the prescription back to […]

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November 6th, 2013

SINGLE Study Underscores Waning of the Efavirenz Era — But Probably Just in the USA

In today’s New England Journal of Medicine, the SINGLE study finally makes its appearance “in print.”  (The study results were first presented over a year ago.) The highlights: SINGLE was a double-blind, randomized clinical trial comparing abacavir/lamivudine plus dolutegravir to tenofovir/FTC/efavirenz in 833 treatment-naive study subjects. That’s right, three different drugs in each arm — you […]

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October 25th, 2013

GARDEL Two-Active-Drug Study Not a Game-Changer, but Might Be a Paradigm-Shifter

Don’t look now, but a two-drug lamivudine (3TC) + LPV/r strategy did just as well as a standard three-drug regimen of two NRTIs + LPV/r. Better, actually, since virologic outcomes were the same and the two-drug regimen had fewer side effects. Here are the key details about the GARDEL study, presented just this week by Pedro […]

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October 14th, 2013

MODERN Study Stopped: An NRTI-Sparing, Two-Drug Initial Regimen Disappoints Again

In case you didn’t know, “MODERN” is the clever name for the “Maraviroc Once-daily with Darunavir Enhanced by Ritonavir in a New regimen” trial, which compared TDF/FTC to maraviroc, both with boosted darunavir. And once again, the NRTI-sparing two-drug regimen comes up short, this time in a fully powered, double-blind noninferiority study. From a PDF provided by […]

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October 7th, 2013

CD4 Cell Count at Presentation: A Figure with a Depressingly Small Upward Slope

You know how to make an ID/HIV specialist angry? Frustrated? Sigh loudly? Tell a clinical anecdote that involves “late” presentation of HIV diagnosis, in particular someone who has been seeking medical care for various ailments for months or even years without getting tested. You know — it goes something like this: “He was seen 3 years ago for […]

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September 27th, 2013

Yes! An Economic Justification for ID Specialists

We’re currently in the middle of fellowship interview season, and I overheard the following conversation between two of my colleagues as they contemplated their upcoming interviewees: ID Doctor #1:  He seems like a great candidate — wants to study hospital and community epidemiology of highly drug-resistant bacterial infections, and has already made major contributions to his […]

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September 13th, 2013

Clindamycin vs. TMP/SMX for Soft Tissue Infections: A Clinical Trial That Needs Some Marketing

At ICAAC this week — the ID conference with the most inscrutable acronym out there — Loren Miller from UCLA presented a clinical trial on treatment of skin and soft tissue infections that has widespread clinical applications, yet may receive little if any attention. And why is that? Simply because the drugs (clindamycin and trimethoprim/sulfamethoxazole) have been off-patent […]

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September 7th, 2013

FAX machines, and the Special Power of the MD Degree

Everyone hates mindless paperwork. But certain types are particularly annoying, seemingly designed to send you screaming into the night, dragging a broken fax machine behind you as your brain explodes. Too strong? Take a look at this fax cover sheet I recently received about a patient who had been receiving IV antibiotics at home: To get at the […]

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August 28th, 2013

Poll: At $14,105/year, Is Dolutegravir Fairly Priced?

The recently approved once-daily integrase inhibitor dolutegravir is now in pharmacies and, like every new HIV drug, the price — around $14k/year — has generated some controversy. For the record, here are the per-year wholesale acquisition costs of the three FDA-approved integrase inhibitors. Raltegravir:  $12,976 Elvitegravir:  $13,428 (once disentangled from the price of TDF/FTC) Dolutegravir:  $14,105 If […]

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August 26th, 2013

When Eating Guinea Pig, Make Sure to Ask for it Well Done

I’ve written before about how ID doctors are no fun to have at cook outs, what with our obsession with well-done hamburgers. Now, there’s another menu item we can berate grill-meisters on, and that’s guinea pig meat: At least 81 people fell ill from suspected salmonella poisoning after eating guinea pig meat and other foods from a […]

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