HIV and ID Observations

February 17th, 2013

An Adherence Intervention That Works — But There’s a Catch

In a previous post, we reviewed the various flavors of medication non-adherence, and concluded with this tantalizing line: Next up:  An Adherence Intervention that Actually Works — But There’s a Catch Well here it is, just published online in JAMA Internal Medicine. Dr. Robert Gross (a long-time HIV adherence researcher from U Penn) and colleagues […]

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February 13th, 2013

Medication Adherence: The Final Frontier

Treatment of HIV has become so amazingly effective that when it fails, it’s no overstatement to say that it’s usually because the patient is not taking the medications.  There are all kinds of provider-related reasons for this — inadequate patient education, prescribing and dispensing errors, failure to address language or education deficits — but here […]

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February 7th, 2013

Ciguatera Is Hot (But It Could Be Cold)

The news about the cases of ciguatera fish poisoning in New York (NY Times here, MMWR here) reminded me of several unusual things about this form of “harmful algal bloom,” as it is so artfully called by the experts. Specifically, here are six: Symptoms are bizarre.  It starts out like a standard case of gastroenteritis […]

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January 21st, 2013

Must-Read Piece: “Fever of Too Many Origins”

Every so often a commentary gets something just right, and fortunately we have an example in this week’s New England Journal of Medicine. Entitled “Fever of Unknown Origin or Fever of Too Many Origins?”, it’s the best depiction I’ve read about doing ID consults in the intensive care unit (ICU). The author, Harold Horowitz (who has […]

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January 17th, 2013

Why the Results of the C Diff Study (You Know Which One) Were No Surprise

In cased you missed it, fecal transplant — use of poop from a healthy donor, which is then infused into the colon either from above (nasogastric tube) or below (colonoscope) — is unquestionably the most effective treatment for people who have multiple recurrences of C. difficile colitis (C diff). We know this because of a […]

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January 11th, 2013

How to Make the Flu Vaccine More Popular, Warts and All

In a week that saw both our hospital’s influenza-induced bed crunch make the New York Times, and my son, mother-in-law, and me succumb to this seasonal plague despite our receiving flu shots, I have been highly attuned to all things influenza. But the focus here will be on that perennial whipping boy of preventive Infectious Diseases, […]

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January 9th, 2013

HIV Exceptionalism is Alive and Well — and That’s Too Bad

Email exchange with a colleague who works at one of our community health clinics: Guy:  Hi Paul, your patient 17432862 [that’s a made-up medical record number] came to our walk-in clinic with a rash on her hand. OK that I gave her a week of topical steroids? I know how inhaled steroids interact with some […]

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January 3rd, 2013

What’s a Fulyzaq? I Thought You’d Never Ask

As Physician’s First Watch noted, we sure know what the folks at the FDA were doing this holiday season — and most emphatically they weren’t visiting Aunt Selma in Boca Raton. Nope, they were stuck in White Oak, Maryland, reviewing various new drug applications, with three of the four related to Infectious Disease. The FDA’s […]

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December 22nd, 2012

Chaos in the Diagnosis of C diff, and Dogs are Amazing Creatures

If you’re confused about the best way to diagnose C diff these days, welcome to the club. There are all kinds of tests out there, and no uniform approach between labs. Our lab actually does three tests — and will do a fourth (the classic cytotoxicity assay) if you request it. The result? Chaos, confusion, […]

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December 20th, 2012

Severe Telaprevir Rashes and Waiting (or Not Waiting) to Treat Hepatitis C

Yesterday, the FDA issued a drug safety alert about severe rashes — “some fatal” — in patients treated for HCV with interferon, ribavirin, and telaprevir. The culprit, of course, is the telaprevir. The label already contained warning information about serious skin rashes with the drug, and this alert serves to heighten our awareness of the […]

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