An ongoing dialogue on HIV/AIDS, infectious diseases,
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.) […]
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 […]
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 […]
March 31st, 2009
Infectious Disease in the ICU: Help Please? Part II
In Part I of this topic, I commented on the ironic sameness of ICU Infectious Diseases — that incredibly sick, complex patients entered the ICU with vastly different problems, then over time, seemed to converge, presenting similar kinds of clinical issues and management challenges for the ID doc. Or, as a visiting medical student said […]
March 25th, 2009
March (Guideline) Madness …
A couple of interesting ID guidelines out this week. For those of you too busy with basketball, here are the relevant links: Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities. Identified in 24 states and now found “routinely” in New York and New Jersey, these carbapenem-resistant Enterobacteriaceae (“CPE” is […]
March 20th, 2009
Hair Today, Gone Tomorrow …
Since providers — especially doctors — are notoriously poor at predicting medication adherence, here’s some good news: In a paper from the Women’s Interagency Health Study, protease inhibitor levels in hair samples were the strongest independent predictor of virologic success — better than self-reported adherence, age, race, baseline viral load and CD4 cell count, and […]
March 14th, 2009
Maybe It’s Not the Cheeseburgers
… At least that’s the implied message in this nice paper from the latest Annals of Internal Medicine, which evaluated responses to lipid-lowering therapy among patients with and without HIV. The study included patients from the Kaiser Permanente of Northern California integrated health system, with 829 individuals with HIV and 6941 without. The quick summary […]
March 10th, 2009
Unwelcome Visitor: Cost of HIV Meds
Those of us who practice HIV medicine in Taxachusetts (warning, click link at your peril) live a pretty charmed life, at least so far as getting HIV medications paid for. Due to an incredibly generous AIDS Drug Assistance Program (ADAP), rare is the patient who faces financial barriers getting his or her drugs. (By the […]
March 4th, 2009
TaqMan HIV RNA Assay: Be Careful What You Wish For
At our hospital lab, we recently switched from the bDNA viral load assay to the new Roche TaqMan real-time PCR test. The virologist in charge of our lab and the tech both agreed the assay was more accurate, more sensitive, and easier to do — so much so that we could increase the frequency of […]
March 1st, 2009
Sedation for Colonoscopies in HIV Patients: Debate Rages
Here’s a problem we’re grappling with: A patient with HIV needs a colonoscopy, but is on either a ritonavir-boosted protease inhibitor or an efavirenz-based regimen. (This must be something like 90% of HIV patients as of March 1, 2009, based on my extremely unscientific gut impression.) For efavirenz, midazolam is contraindicated; for ritonavir, same story […]
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
Learn more about HIV and ID Observations.
