HIV and ID Observations

October 7th, 2019

Our HIV Testing Algorithm Has a Major Problem — Here’s How to Fix It

Mostly, HIV testing works great. It’s long been so accurate that we can strongly support HIV testing even in relatively low-risk people. The 2014 revised lab testing guidelines made it even better, recommending a combined antigen/antibody screening test (called the 4th generation test), and replacing the Western blot with the HIV-1/2 differentiation immunoassay as the preferred […]

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September 15th, 2019

A Former Medical School Dean Invents a False Dichotomy in Curriculum Content, and Advises Physicians to Stay in Their Lane

Over on the editorial pages of the Wall Street Journal, a piece appeared last week with the following provocative title and subtitle: Take Two Aspirin and Call Me by My Pronouns At ‘woke’ medical schools, curricula are increasingly focused on social justice rather than treating illness. Dr. Stanley Goldfarb, former associate dean of curriculum at the […]

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August 11th, 2019

The United States Needs Stricter Gun Control Now — and Yes, This Is an ID Issue

In general, I’ve tried to keep this site a pretty happy place. It’s not been difficult. The ID and HIV community includes many smart, like-minded individuals involved in all sorts of interesting and challenging work, both domestically and abroad. As one of our ID fellows recalled, after he did a rotation in our ID clinic during […]

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June 30th, 2019

Antibiotic Development Is Broken, Brothers in ID Practice, and This Year’s Winner of the ID-Related Social Media Award

I am currently rounding on the inpatient ID service, the new ID fellows arrive shortly, and Louie needs intensive doggy psychotherapy after yesterday’s strong thunderstorms here in Boston. Busy times! As a result, today’s post has no unifying theme. But what it lacks in cohesiveness it more than compensates in value, as here are three highly interesting […]

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February 10th, 2019

Six Musings Triggered by the Latest Measles Outbreak

In 2018, there were 372 cases of measles in the United States, the largest number since 2014. This year, we’ve already had 79 cases, many from a large outbreak in the Pacific Northwest — where anti-vaccine proponents recently protested efforts to restrict nonmedical vaccine exemptions. A few ruminations triggered by this outbreak. 1. The vaccine is extraordinarily […]

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January 27th, 2019

For Our Stable HIV Patients, Why Are We Still Sending All These Lab Tests So Often?

Interesting query from a colleague recently: I’m a community ID doc in the trenches (the measles trenches at present) with an HIV question. Why do we still check CBCs & chem panels every 3-6 months in our HIV patients? Particularly our well-controlled, virologically-suppressed patients? This strikes me as a tremendous waste. I haven’t been in practice that long, […]

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January 13th, 2019

Are We ID Doctors Really So Unhappy Outside of Work?

Medscape released their 2019 Physician Lifestyle & Happiness Report, and the results aren’t pretty for a certain cognitive specialty, one commonly abbreviated “ID.” Out of 29 medical and surgical specialties, infectious diseases physicians ranked second to last when responding to a 7-point scale rating on their happiness. Only neurologists were gloomier than we were during their off-hours. Rheumatologists […]

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December 2nd, 2018

As A Strategy for HIV Prevention, Disabling the CCR5 Gene in Embryos Implanted in HIV-Negative Mothers Makes Zero Sense

One of the great joys of being an ID/HIV specialist is looking back at how far we’ve come in HIV prevention and treatment since the beginning of the epidemic. Here are a bunch of things we know about HIV prevention, listed roughly in order of when we learned them — and forgive me if this is an oversimplification […]

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November 12th, 2018

Sharing Radiology Images Across EMRs Is Frustratingly Terrible — and It Doesn’t Have to Be This Way

In the United States, any person who has tried getting their own (or their patient’s) radiology images from another hospital or practice will find this brief anecdote painful: https://twitter.com/sarahkliff/status/1059518100821983233 Here are several obvious reasons why the CD-ROM — briefly the darling of large-data transfer — is a truly terrible way to share radiology images in 2018: They […]

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October 28th, 2018

New Flu Drug Offers Convenience, Fast Activity, and a Novel Mechanism — at a Price

Last week, the FDA approved a new drug for treatment of influenza, baloxavir marboxil (Xofluza). The drug is indicated for treatment of symptomatic influenza in patients 12 years of age or older. As with existing treatments, it should be started within 48 hours of symptom onset. In a comparative clinical trial in otherwise healthy outpatients, baloxavir and oseltamivir […]

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