HIV and ID Observations

February 12th, 2012

Impossible Curbside at Medical Grand Rounds

Scene:  Medical Grand Rounds, 5 minutes before the start. Lecture is on coronary artery disease, which may have a link to Infectious Disease even if it isn’t actually caused by Chlamydia pneumoniae or CMV after all. A well-regarded, experienced primary care physician (PCP) approaches. PCP: Hi Paul, I have quick question*. [*Curbsiders often use this exact phrase — and rarely does […]

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February 10th, 2012

Boceprevir – PI Interaction: A “Dear Doctor” Letter We Didn’t Want To Get

By now I’m sure that most of you ID folks out there have received the following letter from Merck, the makers of boceprevir: URGENT — IMPORTANT DRUG WARNING: VICTRELIS (BOCEPREVIR) The purpose of this communication is to inform you of recent pharmacokinetic study results evaluating drug interactions between VICTRELIS, an oral chronic hepatitis C virus (HCV) NS3/4A […]

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February 7th, 2012

Chronic Fatigue: Is There Hope After XMRV?

I’ve been following the chronic fatigue/XMRV story from the start, which was compelling for several reasons, including: A potential cause was identified of a very debilitating, mysterious illness. Lots of very smart ID people (including some of my colleagues) studied it. Media coverage, notably from the Wall Street Journal and the New York Times, was particularly […]

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February 3rd, 2012

More on Low (but Detectable) Viral Loads — Is Knowing This Useful?

I have a very smart, very experienced colleague — clue, his initials are CC, and he doesn’t pitch for the Yankees — who continues to use bDNA testing for HIV viral load monitoring. You know, the assay with a lower limit of detection of 75 copies. He knows that bDNA is less sensitive than PCR. He knows […]

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January 29th, 2012

Pre-Super Sunday Scombroids

Some quick ID/HIV links while we await big guys playing the big game with a big (or at least bigger) ball. Did you see how this doctor cheated Medicaid out of more than $700,000 by prescribing HIV meds to people who didn’t have HIV? Not surprisingly, he’s going to jail. Proof that if there’s money behind a […]

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January 22nd, 2012

Generic Lamivudine Has Arrived

An e-mail from a patient last week: Just got refills. Epivir is now generic???  Refill is simply labeled Lamivudine Tablets by Aurobindo Pharma USA, Inc …but made in India.  Should I be concerned about that??? John I told John (not his real name) not to be concerned — he is merely substituting the generic for the […]

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January 21st, 2012

More Medical Testing! No, Less! You Decide

Fascinating Yin-Yang this week on the issue of medical testing. Want more? Want less? First, this remarkable piece on retail medical labs, including a description of a company called ANY LAB TEST NOW: Labs where folks can just walk in and order tests on themselves are popping up in retail centers across the country… At Any Lab Test […]

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January 18th, 2012

ID Case Conference Discussant Types

We specialists in Infectious Diseases love case conferences — especially those where the case is presented as an “unknown”, and we try to figure out the diagnosis from the history. I suppose this isn’t very surprising, since ID cases in general are already among the most interesting in all of medicine. Those that are case-conference-worthy are […]

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January 8th, 2012

Journal Club: In Early HIV Infection, Little Reason to Delay Therapy

Every experienced HIV clinician will recognize the following new-patient scenario: At least one, but often several negative HIV antibody tests in the past, generally due to being in a “high risk” group. Recent non-specific viral-type illness that, in hindsight, was undoubtedly acute HIV infection, undiagnosed. Now completely recovered, but found to be newly HIV antibody positive. […]

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January 4th, 2012

How Does Herpes Treatment Trigger a Positive Test for Performance-Enhancing Drugs?

Here’s my guess on how many of this blog’s readers know the following “facts”: Acyclovir and related drugs are used to treat herpes: nearly 100% Ryan Braun, superstar left fielder for the Milwaukee Brewers, is facing a 50 game suspension for testing positive for elevated levels of a “banned substance”, most likely testosterone: 10% Braun has […]

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