HIV and ID Observations

August 20th, 2009

The V.A. Opts Out

Read all about it here: As of August 17, 2009, written (signature) consent is no longer required for HIV testing in the VHA. Instead, patients will provide verbal informed consent prior to HIV testing. Furthermore, scripted pre-test and post-test counseling are no longer mandated. Since the VA is the largest HIV provider in the nation — […]

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August 14th, 2009

Who Gets Toxoplasmosis in the United States?

This might seem bizarre, but one of the reasons I chose to go into Infectious Diseases as a field was the names of the diseases (and often the micro-organisms that caused them) sounded so darn cool. For example, if you were a science fiction writer you could hardly come up with a better-sounding name for a […]

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August 5th, 2009

Just Out: Primary Care HIV Guidelines

Over on the CID web site, they have the revised version of the “IDSA Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus”. It’s a great document, filled with useful references and a particularly strong table where to find other consensus guidelines (diabetes, hyperlipidemia, mental health, others). My vote for what will […]

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July 25th, 2009

IAS Cape Town 2009: Some Greatest Hits

Below is a highly-subjective list of some of the highlights from the Cape Town IAS meeting. I’m sure I missed something — it’s impossible to see everything at these large conferences.  Corrections/additions welcome! My miss-rate might be particularly high since the international AIDS meetings are appropriately focused on HIV treatment in resource-limited settings (especially Africa) whereas […]

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June 24th, 2009

An Irrational Fear of IRIS?

One of the most important recent studies in HIV has just been “published” in (on?) PLoS ONE.  It’s ACTG 5164, led by Andrew Zolopa, which compared “early” versus “deferred” antiretroviral therapy in 282 patients presenting with acute opportunistic infections. (Full disclosure: I am on the protocol study team — but am not an author on this paper.) […]

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June 16th, 2009

Q: What is the Purpose of a Note in the Patient Chart?

A:  Depends who you’re asking. The best guidance I ever received on how to write a good note came from my residency program director, who told us that a note needn’t be encyclopedic to be excellent; in fact, he urged us to get away from the “second-year medical student” style, which typically includes absolutely everything. Instead, he […]

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June 13th, 2009

Occupational Exposures and HIV Testing

A couple of years ago, an ID-colleague of mine told me about a tough case:  While working in the ICU, an anesthesiologist sustained a pretty severe needle stick.  Approached for HIV testing, the source of the exposure felt threatened by the providers in the ICU, and refused to sign the consent. The patient then deteriorated and […]

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June 8th, 2009

H1N1: A Tale of Two Practices

As an adult ID/HIV doctor, I must say the clinical impact of H1N1 thus far has been underwhelming, notable more for the calls about prophylaxis or suspected cases than the real thing. (Last week, one patient with fever and “suspected swine” — hard for people to shake that name — turned out to have … Lyme […]

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June 1st, 2009

“Long-term Nonprogressors” and “HIV Controllers”: Rare Indeed

When giving an overview of HIV pathogenesis to a group of clinicians, Bruce Walker usually asks the assembled if they have any patients in their practice who have undetectable viral loads without antiretroviral therapy. Generally about three-quarters of the audience has at least one such patient.  They are then asked to refer them to his research […]

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May 28th, 2009

The Paul Farmer Watch

Our pal Paul Farmer keeps racking up the titles: Dr. Paul Farmer, a pioneer in improving health services in the Third World, has been named chairman of Harvard Medical School’s Department of Global Health and Social Medicine … (snip) Peter Brown, spokesman for Brigham and Women’s Hospital, said Farmer also had been named to succeed Kim […]

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