HIV and ID Observations

May 20th, 2012

News on HIV and HCV Testing, and in Praise of Accurate Screening Tests

Two recent news items reminded me how lucky we are to have some very accurate screening tests for certain infectious diseases. The news: An expert FDA panel backed approval of the first true home test for HIV, the OraQuick mouth swab test. Approval of OraQuick for home use may occur later this year. While home testing for […]

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May 7th, 2012

Difficulties and Differences on C difficile

Some things in our field — diseases, treatments, generalizations, cliches, fads — have really changed since back in the early 1990s, when I started in this business. Here are a few that quickly come to mind: “Double coverage” of pseudomonas with a beta lactam plus an aminoglycoside was de rigueur MRSA was an inpatient concern only You […]

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April 14th, 2012

2004 HIV Treatment Guidelines: Available Now!

Bargain hunters will be glad to hear that over on Amazon, they can get a copy of the 2004 Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents — all for the remarkably low price of $16.15. Notable content from that banner year included: for asymptomatic patients with CD4 > 350, the HIV […]

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April 10th, 2012

A Skeptical Look at “Test and Treat”

Over in Journal Watch AIDS Clinical Care, Abbie Zuger has written a fascinating perspective on the recent enthusiasm for universal HIV treatment. Her take? Let’s just say she doesn’t share the enthusiasm of public health officials and members of guidelines committees. Well, that’s a huge understatement. Specifically: This strategy, which calls for universal voluntary HIV testing and […]

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March 27th, 2012

Latest Guidelines Recommend HIV Treatment for All

From the key “What’s New in the Guidelines” section of today’s Department of Health and Human Services update: ART is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pretreatment CD4 cell count. This recommendation replaces a rather confusing categorization on when to start ART that, not surprisingly, was widely misinterpreted — […]

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March 1st, 2012

Post-Exposure Prophylaxis, the World’s Most Outdated HIV Guidelines, and What To Do About Them

Every time I cover HIV prevention in a lecture, it’s always kind of embarrassing to cite the “official” post-exposure prophylaxis (PEP) guidelines, which are here (non-occupational) and here (occupational). That’s right, they were last updated in 2005, the year of Hurricane Katrina. Yes — more than six years ago. The alternative choices seem particularly curious (read: don’t do […]

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January 21st, 2012

More Medical Testing! No, Less! You Decide

Fascinating Yin-Yang this week on the issue of medical testing. Want more? Want less? First, this remarkable piece on retail medical labs, including a description of a company called ANY LAB TEST NOW: Labs where folks can just walk in and order tests on themselves are popping up in retail centers across the country… At Any Lab Test […]

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January 3rd, 2012

Prevnar Now Approved for Adults — But Should We Start Using It?

From the FDA (and thanks to Physician’s First Watch for reporting the news): Prevnar 13, a pneumococcal 13-valent conjugate vaccine, was approved today by the U.S. Food and Drug Administration for people ages 50 years and older to prevent pneumonia and invasive disease caused by the bacterium, Streptococcus pneumoniae. As shown in multiple studies, Prevnar has dramatically […]

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October 26th, 2011

Xigris is Gone — Not That Many ID Docs Will Notice

From the FDA comes this news: FDA notified healthcare professionals and the public that on October 25, 2011, Eli Lilly and Company announced a worldwide voluntary market withdrawal of Xigris [drotrecogin alfa (activated)]. In a recently completed clinical trial (PROWESS-SHOCK trial), Xigris failed to show a survival benefit for patients with severe sepsis and septic shock. Some […]

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September 22nd, 2011

Common Sense on HIV Testing

There’s an editorial in today’s Boston Globe that concisely (188 words) describes the problems with both the current and proposed HIV testing laws in Massachusetts. I’ve not been shy about the fact that I agree with every word of this piece. And though I strongly recommend reading the whole editorial — it’s very well written — if you […]

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