HIV and ID Observations

June 13th, 2013

PrEP Works in Injection Drug Users, CDC Offers “Guidance”

From The Lancet comes this important study of tenofovir pre-exposure prophylaxis for injection drug users (IDUs): In this randomised, double-blind, placebo-controlled trial, we enrolled volunteers from 17 drug-treatment clinics in Bangkok, Thailand … We randomly assigned [2413] participants to either tenofovir or placebo … 50 became infected during follow-up: 17 in the tenofovir group and 33 […]

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June 11th, 2013

Both Simeprevir and Sofosbuvir Likely Approved by 2014 — Clinical/Ethical/Pharmacoeconomic Dilemmas Loom

As expected, simeprevir, and now also sofosbuvir, are being given “priority review” by the FDA. With the 6-month rule under the Prescription Drug User Fee Act — usually just said as “pah-DOOF-ah” — that means there’s a good chance we’ll have both of these anti-HCV drugs some time in late 2013. Which also means HCV treaters will soon […]

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June 6th, 2013

ID Learning Unit — Aminoglycosides

You young whippersnappers out there may not believe it, but we once used aminoglycosides all the time — literally every day on inpatient medical and surgical services, especially in the ICUs. They were an inevitable part of “triples” (e.g., amp/gent/clinda), a broad-spectrum combination given to almost every critically ill patient way back when — think right around […]

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May 31st, 2013

Fecal Microbiota Transplantation — Try This At Home?

As noted before, the FDA says that an investigational new drug (IND) application is required for therapeutic use of fecal microbiota transplantation. The practical effect of this decision, at least at our institution, is to stop providing this service — it’s on hold pending those “internal discussions” planned by the FDA on the regulatory issues surrounding the procedure. Which […]

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May 29th, 2013

The New SARS-Like Coronavirus (MERS-CoV), and What To Do When You Don’t Know Anything About The Latest Outbreak

From one of my close friends — a non-MD — comes this alarming video (sorry, can’t remove the preceding ad). And here’s his email: Concerned? Terrified? I bet your department is buzzing about this. Um, not quite — especially since, among the 49 cases in the world (apparently there are 5 more than the WHO reported), exactly zero […]

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May 21st, 2013

ID Learning Unit — “Isolator” Blood Cultures

Here’s a little secret about those brilliant ID consults we do on patients with mysterious fevers: Sometimes we don’t know what’s going on either. I know, I know — shocking. But now that the secret is out, I can tell you something we do know, and that’s how to recommend lots of tests — the more obscure, […]

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May 16th, 2013

ID Learning Unit — Antibiotics with Excellent Oral Absorption

Guaranteed:  Every day at a hospital near you, a patient is receiving antibiotic therapy for an infection, and the orders include the following: A slew of various oral medications, both continued from outpatient care and started anew on admission. An intravenous antibiotic. The odd thing about this combination is that there are many antibiotics with excellent […]

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May 12th, 2013

FDA: Fecal Transplants Need Investigational New Drug Application

Gastroenterologists, ID doctors, C diff-sufferers, and microbiome-obsessed humanoids everywhere were treated to this surprising news recently — a decision by the FDA about fecal microbiota transplantation (FMT). From an email sent by the IDSA: Because fecal microbiota transplantation (FMT) is not approved for any therapeutic purposes, an investigational new drug (IND) application is needed for the […]

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May 8th, 2013

HIV Opportunistic Infection Guidelines Updated

Some very hard-working folks at the NIH, CDC, and IDSA have updated the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, which are available for review here. As with the previous versions (the prior iteration is from 2009), the OI Guidelines are comprehensive, exhaustively referenced (184 references for TB alone!), […]

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April 25th, 2013

In Praise of the Diversity of Being an Infectious Diseases Specialist

I have a friend who is a thoracic surgeon. Imagine his daily agenda: 5:00 AM:  Oops, slept late. 5:30 AM:  Drive to hospital; not much traffic. 6:00 AM:  Round on inpatients. They’re all doing great! Wonder why they’re not more talkative. 6:15 AM:  Coffee, gossip with other surgeons. 7:00 AM:  Get in scrubs, prepare for first case. […]

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