HIV and ID Observations

March 22nd, 2012

More Confusion on Anal Cancer Screening

Screening for anal cancer in men who have sex with men (MSM) — with pap smears, high resolution anoscopy, with whatever test — is quite the quagmire. As I’ve mentioned before, the proponents of screening cite the success of cervical cancer screening and the startling high rates of anal cancer among HIV+ MSM as reason enough […]

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March 15th, 2012

CROI 2012 Really Rapid Review — with CROI 2013 Dates!

Some highly subjective highlights — a Really Rapid Review™– from this year’s Number One Greatest Super Scientific HIV Conference, the 19th Conference on Retroviruses and Opportunistic Infections (CROI), which ended last week in Seattle: Need more evidence that maintaining a CD4 cell count > 500 is beneficial? This compelling analysis from the SMART and ESPRIT  studies found that […]

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February 26th, 2012

A Truly Bizarre “Systematic” Review

You know that tenofovir, emtricitabine, and efavirenz HIV regimen? The one that’s universally listed as one of the “Preferred,” or “Recommended” or “First-line” options in all HIV treatment guidelines in the universe? And the regimen that is easily the most widely used in the USA today? Well, here’s a surprising review from Cochrane Summaries, entitled “Effectiveness and […]

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February 14th, 2012

Is It Time To Stop Treating Acute Sinusitis?

From the pages of JAMA comes this startling clinical trial: A randomized, placebo-controlled trial of adults with uncomplicated, acute rhinosinusitis [who] were recruited from 10 community practices in Missouri between November 1, 2006, and May 1, 2009 … [Subjects received a] ten-day course of either amoxicillin (1500 mg/d) or placebo administered in 3 doses per day … There was no […]

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February 10th, 2012

Boceprevir – PI Interaction: A “Dear Doctor” Letter We Didn’t Want To Get

By now I’m sure that most of you ID folks out there have received the following letter from Merck, the makers of boceprevir: URGENT — IMPORTANT DRUG WARNING: VICTRELIS (BOCEPREVIR) The purpose of this communication is to inform you of recent pharmacokinetic study results evaluating drug interactions between VICTRELIS, an oral chronic hepatitis C virus (HCV) NS3/4A […]

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February 7th, 2012

Chronic Fatigue: Is There Hope After XMRV?

I’ve been following the chronic fatigue/XMRV story from the start, which was compelling for several reasons, including: A potential cause was identified of a very debilitating, mysterious illness. Lots of very smart ID people (including some of my colleagues) studied it. Media coverage, notably from the Wall Street Journal and the New York Times, was particularly […]

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February 3rd, 2012

More on Low (but Detectable) Viral Loads — Is Knowing This Useful?

I have a very smart, very experienced colleague — clue, his initials are CC, and he doesn’t pitch for the Yankees — who continues to use bDNA testing for HIV viral load monitoring. You know, the assay with a lower limit of detection of 75 copies. He knows that bDNA is less sensitive than PCR. He knows […]

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January 8th, 2012

Journal Club: In Early HIV Infection, Little Reason to Delay Therapy

Every experienced HIV clinician will recognize the following new-patient scenario: At least one, but often several negative HIV antibody tests in the past, generally due to being in a “high risk” group. Recent non-specific viral-type illness that, in hindsight, was undoubtedly acute HIV infection, undiagnosed. Now completely recovered, but found to be newly HIV antibody positive. […]

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December 24th, 2011

Making a List and Checking it Twice, Then Making Sure 052 is On It

How big a news story was HPTN 052, which demonstrated that HIV treatment reduced transmission by at least 96%? (I like to emphasize that “at least” bit, since it’s likely that none of the study subjects with undetectable HIV RNA levels transmitted to their partners — the one case that did transmit did so before virologic suppression.) […]

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December 18th, 2011

Let’s Just Say I’m Glad the Grades Don’t Count

A friend alerted me to this test of scientific literacy. Give it a try — no google cheating — and let me know how you do. And even though I got the first 5 questions right, my final score (to be disclosed in the comments, eventually) left little doubt that I was an English major in college. Yeah, that’s […]

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