HIV and ID Observations

April 8th, 2015

New HIV Treatment Guidelines, and the End of an Era

The new Department of Health and Human Services (DHHS) HIV treatment guidelines are out, and thanks to skillful direction by Alice Pau, it’s as usual a must-read document — all 288 pages, of course! There are several major changes, so a good place to start is the all-important “What’s New in the Guidelines” summary page. Some of the […]

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April 3rd, 2015

Melting Snow ID Link-o-Rama

A few ID/HIV tidbits to contemplate as we go from slipping on ice and snow to dodging the mud: Beta-lactam therapy alone is non-inferior to regimens that also cover “atypicals” for hospitalized patients with pneumonia. These results challenge a dogma that has been present for a couple of decades — namely, that all patients admitted with community-acquired pneumonia should get either […]

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March 28th, 2015

Quick Question: Should HIV-Negative People in Serodiscordant Relationships All Get PrEP?

From a very thoughtful and experienced primary care provider came this query: Hey Paul, quick question — One of my patients, an HIV-negative gay man, is in a long-term relationship with one of your HIV-positive patients — my patient says his partner has been on successful HIV treatment for years. Obviously I can’t check his partner’s […]

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March 8th, 2015

Measles Vaccine Videos and the Challenge of Changing Someone’s Mind

I suspect most of you have already been treated to this highly amusing video about the measles outbreak from Jimmy Kimmel — a comedy segment featuring real-life doctors, imagine that. Not your typical late-night comedy show performers, but they forcefully (and obscenely) get their message across. If you have just returned from a tropical island where the internet connection was iffy, however, […]

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February 15th, 2015

Should Antibiotics be Part of End-of-Life Care?

There’s been some truly outstanding work done recently on end-of-life care, and how we deal with it — or more accurately, how we typically don’t deal with it until the very last moment, at which time often many unfortunate decisions and events occur. Here are three I can strongly recommend: Roz Chast’s Can’t We Talk About Something More Pleasant? is probably the […]

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January 28th, 2015

Quick Question: Should We Still Be Recommending This Year’s Flu Vaccine?

From a football-obsessed primary care provider, written to me on one very snowy day in New England: Hi Paul, I’ve been reading about this year’s flu vaccine, and how ineffective it is. Not surprisingly, my patients have been hearing this too, and it has only increased their reluctance to go through with it. Should I just […]

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January 7th, 2015

Are the STI Screening Guidelines for Gay Men Overkill? (And Pedro Video.)

Our “healthcare system” recently distributed a set of guidelines entitled, Primary care for gay men: screening and treatment recommendations. It included, among other things, recommendations for screening for sexually transmitted infections (STIs) and anal cancer. The former it adopted from CDC guidelines, which are this this: Screening at least once a year for syphilis, chlamydia, and gonorrhea for all sexually […]

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December 20th, 2014

New HCV Option Effective, Safe, Well-Tolerated — And Use Will Likely Be Driven by Payors

As expected, the FDA approved the next treatment option for HCV on Friday — “Viekira Pak”, a (sometimes complete) regimen consisting of ritonavir-booted parataprevir and ombitasvir given as a two pills once a day, plus one pill of of dasabuvir given twice daily. It is indicated for treatment of HCV genotype 1. For those of you mechanistically inclined, parataprevir […]

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December 14th, 2014

2014 Top Stories in HIV Medicine

Boy do we love end-of-year “Best of …” and “Top Stories of …” lists! Love them! They never gets old! Until January, that is. My own particular favorites are the Best Movies of the Year lists, since for whatever reason it always seems like some masterpiece slips by. Missed it! So we leave it up to the […]

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November 23rd, 2014

Five ID/HIV Things to be Grateful for this Holiday Season, 2014 Edition

Amidst outbreak hysterias, anti-vaccine imbecility, electronic medical record whining, and slug-related eosinophilia, I bring you this year’s version of the good news — the 2014 edition of Five ID/HIV Things to be Grateful for this Holiday Season, just in time for your holiday turkeys. (Needless to say, the bird will be properly cooked to ensure it’s salmonella-free, with all cooking […]

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