HIV and ID Observations

April 25th, 2022

Yes, Relapses After Paxlovid Happen — Now What?

Around two weeks ago, one of my long-term, very stable patients with HIV called me saying she’d just been diagnosed with COVID-19. Over 60 with hypertension, and overweight, she qualified for nirmatrelvir/r (Paxlovid) under the Emergency Use Authorization (EUA), and took it without problem. (Certain details changed for confidentiality.) In fact, she started to improve within 24 […]

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April 12th, 2022

Should We Prescribe Nirmatrelvir/r (Paxlovid) to Low-Risk COVID-19 Patients?

The top recommended treatment for high-risk outpatients with COVID-19 in the NIH Guidelines is nirmatrelvir/r (Paxlovid). It’s quite clear why. In the EPIC-HR study, unvaccinated people at high risk for severe outcomes had an 89% reduction in the risk for hospitalization or death compared to placebo. If we just look at mortality — another important endpoint, […]

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April 1st, 2022

As the World Around Us Moves On, We ID Docs Just … Can’t

Something quite remarkable happened as Omicron tore through the United States in December and January. Despite triggering a record number of cases — which should have made people more concerned about COVID-19 — Omicron paradoxically did the opposite. It made most of our country decide to move on, even parts famous (or infamous, depending on your […]

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March 7th, 2022

How to Induce Rage in a Doctor

If you’re wondering how to make a doctor angry — really, really angry — read on. Because asking us to justify treatment decisions to insurance companies and their pharmacy benefit managers must rank right up there with the greatest tortures of practicing medicine in this country. Mind you, this isn’t just about my patient, or about […]

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February 22nd, 2022

A Personal Tribute to Dr. Paul Farmer — Who Made Everyone Feel Important

Paul Farmer’s unexpected death this weekend has all of us who knew him reeling. This just should not happen to someone so generous, so important, and so visionary about helping others — especially others who, due to being born in impoverished life circumstances, can’t help themselves. This is not fair at all. We’re heartbroken. The tributes will […]

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February 18th, 2022

A Return of Antiretroviral Rounds — What Regimen Would You Choose?

Years ago, back in the pre- and early internet days, one of the most popular features in the newsletter Journal Watch AIDS Clinical Care was something called Antiretroviral Rounds. We’d present a case, then have two expert discussants weigh in on what they would do. The link above is a case from ancient history — 1998! […]

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December 30th, 2021

Omicron and Reduced Severity of COVID-19 — Some Good News We Desperately Need

We’ve been burned so many times making predictions about COVID-19 that I should post this conspicuously by my computer: The famous pundit meant, of course, that “you don’t know anything” — we know his true intentions since he also said “Nobody goes there anymore. It’s too crowded.” The “know nothing” quotation is a reminder that COVID-19 is […]

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December 20th, 2021

Believe It or Not, We Already Have a Highly Effective Outpatient Antiviral Treatment for COVID-19

And that treatment is … (drum roll) … remdesivir. Yes, you heard me right. Remdesivir, the very same antiviral with a checkered history in COVID-19 clinical trials, with some studies showing efficacy (sort of), others not much of anything. What’s the truth here? For that, let’s turn to what gets my vote for the most unheralded highly favorable […]

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December 15th, 2021

Do We Need to Remind People that COVID-19 Is Truly Awful?

Last month, I read a deeply harrowing description of what it’s like to be hospitalized with severe COVID-19. I strongly urge you to read the full thread: https://twitter.com/CRStoli/status/1458600993621430272?s=20&t=km6XxJ5IDsQGQKsygjXfWg Something about the plain, direct language he uses to describe the patient experience hits home here like few other depictions I’ve read — it rings true in so […]

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November 23rd, 2021

Gratitude for 40 Years of Progress in HIV Care and Research

I was working with one of our outstanding senior ID fellows in clinic last week, and she presented the case she’d just seen, a 54-year-old man with HIV (certain details changed for confidentiality): Will is doing great on [fill in one-pill daily regimen], missing no doses. He’s having some difficulty with sleep (his wife says he […]

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