An ongoing dialogue on HIV/AIDS, infectious diseases,
May 23rd, 2010
Dengue in the News … Again
The recent dengue cases acquired in Florida prompted me to think of two things. First, is this really a surprise? Dengue has become increasingly common in the Caribbean, the mosquitoes that transmit the virus are widespread in the United States, and it’s not as if there’s some sort of microbiologically (if that’s a word) impermeable barrier between […]
May 4th, 2010
Zoster Vaccine Underutilized
From the Annals of Internal Medicine: Eighty-eight percent of providers recommend herpes zoster vaccine and 41% strongly recommend it, compared with more than 90% who strongly recommend influenza and pneumococcal vaccines. For physicians in both specialties [Internal Medicine and Family Practice], the most frequently reported barriers to vaccination were financial. From my admittedly biased perspective […]
May 2nd, 2010
Learning from Clinical Trials with Limited “Generalizability”
In the ongoing debate about when to start antiretroviral therapy in our sickest patients — those with acute opportunistic infections — comes this study from Zimbabwe of early vs. deferred ART in patients with cryptococcal meningitis: The median durations of survival were 28 days and 637 days in the early and delayed ART groups, respectively […]
April 14th, 2010
Maraviroc Rarely Used for Treatment-Naive Patients
Over in Journal of Infectious Diseases, the MERIT study was recently published (with Chuck Hicks’ Journal Watch summary here), demonstrating that maraviroc is non-inferior to efavirenz — provided that the enhanced-sensitivity tropism test is used to select appropriate candidates. (The MERIT study began in 2004-5. Don’t think I’ll ever forget that, since the investigator meeting […]
April 10th, 2010
Why Are Doctors Still Carrying Beepers?
I was going through security at the airport the other day, and tossed my beeper into one of those gray bins — along with the device that should make the beeper superfluous, a cell phone. “I didn’t know anyone used beepers anymore,” said the 30-something guy behind me. What could I say? That doctors also […]
April 4th, 2010
San Francisco Public Health: Treatment Recommended for All with HIV
Could there be anything more interesting than the start of the baseball season? Maybe, because this is quite something: In a major shift of HIV treatment policy, San Francisco public health doctors have begun to advise patients to start taking antiviral medicines as soon as they are found to be infected, rather than waiting — sometimes […]
March 31st, 2010
C diff Guidelines: Metronidazole Still Preferred?
IDSA and The Society for Healthcare Epidemiology of America (SHEA) have published Clinical Practice Guidelines for Clostridium difficile infection. Not surprisingly, it’s a comprehensive, extensively-referenced document that will be an invaluable resource, especially since the previous version is approximately 15 years old. But with the caveat that I’m not an expert in this area, these particular […]
March 28th, 2010
Kidneys: Fortunately, We Have Two
Here’s a case over in our Journal Watch: AIDS Clinical Care site: a man with suspected PCP develops rapidly progressive renal failure after being starting on both empiric PCP treatment with TMP-SMX and ART with TDF/FTC plus darunavir/ritonavir. The specific questions at the end of the case were: What do you think is causing the […]
March 24th, 2010
Now for Some Good News: TB Cases Continue to Decline
From the latest MMWR: This figure speaks for itself, but two sentences from the Editorial Note deserve highlighting: The 11.4% decrease in reported TB rate in 2009 is the largest single-year decrease ever recorded. From 1953 to 1993, the single largest annual percentage decrease in TB case rate was 11.1% in 1956 Since I started my […]
March 14th, 2010
MRSA Bacteremia Question Redux — and the “Answer”
As noted here, I recently had to answer a question on management of MRSA bacteremia as part of an every-10-year cycle of test-taking. (For more on that joyous process, read this interesting debate here in the New England Journal of Medicine.) The question seemed to have no obvious right answer, so I did what one is explicitly […]
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
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