An ongoing dialogue on HIV/AIDS, infectious diseases,
October 4th, 2011
Hormonal Contraception MAY Increase Risk of HIV
From the pages of Lancet Infectious Diseases, a study from Africa: We aimed to assess the association between hormonal contraceptive use and risk of HIV-1 acquisition by women and HIV-1 transmission from HIV-1-infected women to their male partners … Among 1314 couples in which the HIV-1-seronegative partner was female, rates of HIV-1 acquisition were 6·61 […]
October 3rd, 2011
CASCADE: When to Start, (Yet) Another Take
As we await the enrollment, analysis, and results of the START study — which is randomizing patients with CD4>500 to start HIV therapy vs waiting until the CD4 falls to 350 — much of the research on “when to start” ART in patients with high CD4’s comes from observational studies. Several have already been published […]
September 24th, 2011
Warning: Viral Replication is Hazardous to Your Health
When studies evaluate the prognostic importance of measuring HIV viral load, they generally do so by assessing a single measurement rather than values obtained longitudinally. One obvious limitation of this approach is that baseline VL poorly predicts outcome after ART initiation — a finding in stark contrast to the original description of VL from the […]
September 22nd, 2011
Common Sense on HIV Testing
There’s an editorial in today’s Boston Globe that concisely (188 words) describes the problems with both the current and proposed HIV testing laws in Massachusetts. I’ve not been shy about the fact that I agree with every word of this piece. And though I strongly recommend reading the whole editorial — it’s very well written — […]
September 17th, 2011
Drinking Coffee Prevents MRSA
I follow the medical literature on coffee very closely. Why? Because I’m completely addicted — and, judging from the lines at the Starbucks, Dunkin’ Donuts, etc at the airports before early morning flights, I am not alone. (It’s just one cup a day. Any more and say hello to palpitations, jitters, sweats, and long sleepless […]
September 11th, 2011
Must-Read Paper: “Antiscience” and Lyme Disease
As I’ve written before, there are few clinical encounters more challenging for Infectious Diseases specialists than the patient who, despite negative standard diagnostic testing, believes he/she has Lyme disease. Now, in Lancet Infectious Diseases, comes a paper entitled “Antiscience and ethical concerns associated with advocacy of Lyme disease.” It meticulously describes the distinctive world of alternative diagnosis, […]
September 4th, 2011
“Novel” Approaches to Initial HIV Therapy: Part II
Two studies were just published on alternative strategies for initial HIV therapy. I’ve already reviewed the first one here. The second paper is a single-arm (n=112) study of darunavir/r (once daily) plus raltegravir, the latest riff on the “NRTI sparing” approach. As I mentioned when I first covered this study, the high rate of virologic failure […]
September 3rd, 2011
“Novel” Approaches to Initial HIV Therapy: Part I
It’s been several years since the “preferred” or “recommended” initial regimens for HIV treatment have been consolidated into one of the following four: TDF/FTC + efavirenz TDF/FTC + atazanavir/r TDF/FTC + darunavir/r TDF/FTC + raltegravir Any room for improvement in this “TDF/FTC + key third drug” approach? With the recent approval of TDF/FTC/rilpivirine, certainly this […]
August 31st, 2011
It’s Time for Antibiotic Placebos
As I’m sure you all agree, it’s high time we had a good antibiotic placebo. Just think — we’d be able to prescribe a 100% effective treatment for viral respiratory tract infections, with the assurance of no risk of antibiotic resistance, C diff, allergic reactions, tendon ruptures, photosensitivity, drug-drug interactions, or any of the myriad […]
August 19th, 2011
A Reason To Continue Restrictive HIV Testing Laws? Not Really …
The pending HIV legislation is much on my mind these days, for reasons I outlined here. Bottom line is that I don’t think it’s good for patient care, and we’re missing a real opportunity to make things better here in the Bay State. But yesterday I heard a perspective on the bill I hadn’t considered, […]
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
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