HIV and ID Observations

May 24th, 2009

Another State Gets Ready to Make HIV Testing Easier

Don’t look now, Massachusetts, but Connecticut could be next: AN ACT CONCERNING REVISIONS TO THE HIV TESTING CONSENT LAW. This bill revises the law on consent for HIV-related testing. Specifically, the bill: 1. eliminates the requirement for separate, written or oral consent for HIV testing and instead allows general consent for the performance of medical procedures […]

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May 19th, 2009

Time for a Switch? Room for Debate

With first-line therapy for HIV being so astonishingly successful, much of what we do in practice is tweak regimens that are by virologic and immunologic standards, working just fine:  Viral load undetectable, CD4 stable. But not so fast — while one of my colleagues said that if he didn’t change his patients’ regimens, then he’d have […]

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May 13th, 2009

Working While Contagious: Why Do We Do This?

File this under, “physicians behaving badly”:  The nearly universal MD practice of going to work while sick. The ironic thing is we think we’re being selfless — after all, if we don’t show up, our patients will need to be rescheduled, or someone will need to cover, or some administrative/teaching task will not get done — […]

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May 7th, 2009

Human Rabies from Bats: Another Look at the Numbers

The gang from Canada is at it again, reviewing human rabies cases from bats and trying to make some sense of the data. (For a summary of their outstanding prior paper in CID, read this.) But before we get to their latest masterwork, here are some questions to ponder.  While doing so, keep in mind the practice […]

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May 3rd, 2009

H1N1! Didn’t You Used to Be Swine Flu?

At the end of last week, “swine flu” became “H1N1”.  The CDC web site explains why: This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in North America. But further study has […]

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April 29th, 2009

Swine Flu Treatment Guidelines — For Now

The swine flu situation is so dynamic that what I wrote earlier this week now seems hopelessly dated — except that from the perspective of a clinical ID doctor, it still feels eerily similar to the anthrax and SARS outbreaks. But related to that post — specifically the use of antivirals — these interim guidelines for […]

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April 26th, 2009

Swine Flu Curbsides: Anthrax, SARS Redux?

In my email in-box yesterday AM from a primary care doc: A patient of mine, 40 year old woman totally healthy, is going to Cancun on Tuesday for a conference.  She’ll be there for 6 days. I know there are no cases of swine flu in Cancun yet, and the situation is evolving, but here’s my question:  […]

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April 24th, 2009

Colonoscopy in HIV Patients, Part II: Problem (Mostly) Solved

Both here and on the AIDS Clinical Care site, we posted a case of a 50-year-old HIV+ man in need of a screening colonoscopy.  What sedation could he receive while on tenofovir/FTC and ritonavir-boosted atazanavir?  Specifically, would midazolam and fentanyl (“contraindicated” in the ritonavir package insert) be ok? (Same issue for efavirenz, by the way.) We solicited […]

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April 11th, 2009

Another Drug Linked to PML — Law Firms Waiting for Your Call

The psoriasis drug Raptiva (efalizumab) has been linked to progressive multifocal leukoencephalopathy: On Oct. 16, 2008, FDA updated the FDA-approved labeling for Raptiva to warn of the risk of life-threatening infections, including PML. On Feb. 19, 2009, the FDA issued a Public Health Advisory informing patients and prescribers of the risk of PML in patients taking […]

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April 6th, 2009

Delayed Opening Day Videos, and More

Some random HIV/ID issues while awaiting a delayed opening day here in cold, rainy Boston: If you enjoy video highlights, check out these of HIV making its way from T cell to T cell.  If you’re short on time, #’s 9-12 are particularly amazing.  Still, I don’t imagine that this video will make it to Youtube anytime […]

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