HIV and ID Observations

April 30th, 2012

Do We Really Need Primary Prophylaxis for OIs Anymore?

I’m currently on the inpatient consult service and just saw a guy who fits the typical profile of many hospitalized HIV patients in 2012: Low CD4 (in this case, 120) Irregular to non-existent outpatient care before admission (lots of no-shows, cancellations, etc) Has received several prescriptions for antiretroviral therapy but for a whole variety of reasons, […]

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April 23rd, 2012

An Answer to a Commonly Asked Question: Is Treatment 100% Effective in Preventing HIV Transmission?

The excitement about “treatment as prevention”, and the results of Study 052, have led to many patients asking the question (if not in these words, than using others with a less medical slant), “So if I’m on treatment and doing well, just what is the risk of my transmitting HIV to others?” It’s not a […]

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April 18th, 2012

Been There, Done That

I’d estimate the verisimilitude of the following video at approximately 100%: (Thanks to Raphy Landovitz for the link!)

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April 10th, 2012

A Skeptical Look at “Test and Treat”

Over in Journal Watch AIDS Clinical Care, Abbie Zuger has written a fascinating perspective on the recent enthusiasm for universal HIV treatment. Her take? Let’s just say she doesn’t share the enthusiasm of public health officials and members of guidelines committees. Well, that’s a huge understatement. Specifically: This strategy, which calls for universal voluntary HIV […]

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April 4th, 2012

Infectious Diseases Specialists Take the Best Medical Histories

In an era where control-c followed by control-v — that’s cut and paste, for those of you who don’t use keyboard shortcuts — is the prime method by which most clinicians write their medical notes, I’d like to come right out and brag that ID doctors take the best medical histories. You could argue (as […]

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March 30th, 2012

Our Obsession with Dental Antibiotic Prophylaxis and an E-mail from Mom

I have a regular, highly efficient email correspondence with my mother — who never really liked talking on the phone to begin with (neither do I), so email is perfect for us. The topics we cover are mostly family stuff, and food — she’s a food writer, after all, so it might be a recipe […]

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March 27th, 2012

Latest Guidelines Recommend HIV Treatment for All

From the key “What’s New in the Guidelines” section of today’s Department of Health and Human Services update: ART is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pretreatment CD4 cell count. This recommendation replaces a rather confusing categorization on when to start ART that, not surprisingly, was widely […]

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March 22nd, 2012

More Confusion on Anal Cancer Screening

Screening for anal cancer in men who have sex with men (MSM) — with pap smears, high resolution anoscopy, with whatever test — is quite the quagmire. As I’ve mentioned before, the proponents of screening cite the success of cervical cancer screening and the startling high rates of anal cancer among HIV+ MSM as reason […]

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March 15th, 2012

CROI 2012 Really Rapid Review — with CROI 2013 Dates!

Some highly subjective highlights — a Really Rapid Review™– from this year’s Number One Greatest Super Scientific HIV Conference, the 19th Conference on Retroviruses and Opportunistic Infections (CROI), which ended last week in Seattle: Need more evidence that maintaining a CD4 cell count > 500 is beneficial? This compelling analysis from the SMART and ESPRIT  studies found […]

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March 1st, 2012

Post-Exposure Prophylaxis, the World’s Most Outdated HIV Guidelines, and What To Do About Them

Every time I cover HIV prevention in a lecture, it’s always kind of embarrassing to cite the “official” post-exposure prophylaxis (PEP) guidelines, which are here (non-occupational) and here (occupational). That’s right, they were last updated in 2005, the year of Hurricane Katrina. Yes — more than six years ago. The alternative choices seem particularly curious (read: […]

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