HIV and ID Observations

July 9th, 2017

Should You Answer Medical Questions from Clinicians You Don’t Know About Patients You’ve Never Seen?

This email popped into my inbox the other day from a person I’ve never met: Hi Dr. Sax, I do mostly hospital-based ID in Pennsylvania, and was consulted on a newly diagnosed HIV patient with CD4 10, viral load 210,000, and lymphoma. I started him on Truvada and dolutegravir, which is going well so far. Because he complained […]

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June 4th, 2017

Can’t HIV Serodiscordant Couples Now Just Have Children the Regular Way?

MMWR just published a paper entitled, Strategies for Preventing HIV Infection Among HIV-Uninfected Women Attempting Conception with HIV-Infected Men — United States, and it’s both a welcome and a very strange document indeed. It’s welcome because it acknowledges that serodiscordant couples may wish to have children without the use of an HIV-negative sperm donor. Advances in HIV prevention […]

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May 29th, 2017

Healthcare Providers Shouldn’t Come to Work While Sick, but They Do — Here’s Why

Let’s start with two questions: Have you ever seen a doctor, nurse, PA, pharmacist or other person directly involved in patient care wearing a surgical mask because they have a respiratory tract infection? Has this mask-wearing person ever been you? Bold prediction: Virtually every reader who works in a hospital or large office practice answered “Yes” to #1. Some […]

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May 14th, 2017

Poll: Which Feature of Electronic Health Records is Most Important to Patient Care?

The first electronic medical record I used regularly — called “BICS” — initially had one purpose. It was a tool to look up a patient’s lab results. Simple, reliable, and blazingly fast, it did one thing remarkably well. Later, one of our Emergency Department doctors, who happens to have impressive coding skills, worked with a team to add a simple ambulatory medical […]

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March 19th, 2017

What Health and Human Services Secretary Tom Price Should Be Saying About Required Immunizations

In case you missed it, Secretary of Health and Human Services Tom Price said this past week that the states should make decisions about mandatory vaccination policies. Here’s the actual clip: HHS Secretary Tom Price says it should be up to states to regulate whether immunizations are required https://t.co/soyH0YpO5E — CNN Politics (@CNNPolitics) March 16, 2017 What’s notable here isn’t the […]

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March 14th, 2017

Poll: Should We Allow 24-Hour Shifts Again For Interns?

Over on Boston’s NPR site, I wrote a piece about the decision by the Accreditation Council for Graduate Medical Education (ACGME) to allow 24 hour (or longer) work shifts again for interns. My goal in writing the piece was to relay what I experienced doing these long shifts way back when during my internship — the good […]

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July 14th, 2016

Must-Read Item: This Year’s JAMA HIV/AIDS Issue

The folks over at the Journal of the American Medical Association have been doing a periodic HIV/AIDS themed issue for years, generally around the time of the International AIDS Conference. The latest issue is out this week, and it’s terrific. Here are some highlights: In serodiscordant couples practicing “condomless sex”, there were zero transmissions if the infected partner […]

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June 12th, 2016

Progress in Lyme Disease Badly Needed — Could a “Hackathon” Help?

Someone recently asked what keeps me, a specialist in Infectious Diseases, up at night. With the admission that I do all my clinical work here in the USA — a person working in the tropics would undoubtedly have a different list — several challenging patient care and public health issues came to mind. Multidrug-resistant bacteria. Endovascular infections in […]

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May 22nd, 2016

Drug Prior Authorizations Are a Very Blunt Tool for Cost Containment — And They’re Annoying

Insurance prior authorizations, or prior approvals (PAs) — those dreaded forms clinicians have to fill out, usually triggered by prescribing a non-formulary drug — are much on my mind these days. And most of it has to do with three letters, specifically “TAF.” As readers of this site probably know, there are now three tenofovir alafenamide (TAF)-based coformulations […]

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May 16th, 2016

Lots of College Graduations ID Link-O-Rama

For those of us living and working in Boston, we are most definitely smack dab in the middle of college graduation season — which means traffic is crazy, restaurants are booked, and energetic young adults are everywhere wearing gowns and funny hats. In other words, a good excuse for an ID Link-o-Rama: FDA advises against use of fluoroquinolones for uncomplicated […]

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