HIV and ID Observations

September 4th, 2009

For Suspected H1N1, Get Out the N95 Masks?

So says the Institute of Medicine’s recommendations for protection of health care workers: Healthcare workers (including those in non-hospital settings) who are in close contact with individuals with nH1N1 influenza or influenza-like illnesses should use fit-tested N95 respirators … Employers should ensure that the use and fit testing of N95 respirators be conducted in accordance […]

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September 2nd, 2009

Etravirine Warning

From the FDA Advisory: There have been postmarketing reports of cases of Stevens-Johnson syndrome, toxic epidermal necrolysis and erythema multiforme, as well as hypersensitivity reactions characterized by rash, constitutional findings, and sometimes organ dysfunction, including hepatic failure. Intelence therapy should be immediately discontinued when signs and symptoms of severe skin or hypersensitivity reactions develop. These […]

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August 26th, 2009

Late Summer Odds and Ends: Circumcision, H1N1 Vaccine, Lyme Movie, etc.

A few ID/HIV items to cover before summer “unofficially” ends (Sept 1?  Kids back at school?  Labor Day?): Will US Public Health officials recommend infant male circumcision to prevent HIV?  They might be considering such a move, but I suspect it will not be strongly promoted.  After all, none of the studies demonstrating its efficacy […]

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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 […]

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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 […]

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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) […]

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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 […]

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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. […]

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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 […]

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