HIV and ID Observations

September 22nd, 2023

Long-Acting Cabotegravir-Rilpivirine for People Not Taking Oral Therapy — Time to Modify Treatment Guidelines?

HIV treatment guidelines are understandably reluctant to endorse practices that have limited data. Having served on two such panels (previously, DHHS and currently, the IAS-USA guidelines), I totally get this — you don’t want to put a stamp of approval on strategies that may ultimately do more harm than good. With the caveat that I cannot […]

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August 18th, 2023

My Vote for the Weirdest Antibiotic on the Planet

If you’re an ID doctor, there’s an excellent chance you’ve treated patients who have non-tuberculous mycobacteria (NTM) with clofazimine. In fact, based on a poll done with the utmost scientific rigor, it’s well more than half of you. And if you’re not an ID doctor, there’s a decent chance you’ve never even heard of it — […]

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August 9th, 2023

Really Rapid Review — Brisbane IAS 2023

You’ll find some conference highlights listed below from the 12th International AIDS Society Conference on HIV Science (or IAS 2023), which took place in lovely Brisbane — where the late July weather was delightful, the ubiquitous ibis was the local nuisance bird, and the riverside parks went on and on and on. Some might wonder if […]

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June 2nd, 2023

Continued Activity of NRTIs Despite Resistance Is a Real Thing

In our last post, we reviewed a case of a person with longstanding HIV with extensive multi-class resistance, but now a decade of viral suppression. They’re currently on an HIV treatment regimen of fully active raltegravir, partially active etravirine, and barely active (or not active at all!) darunavir. There are no NRTIs in the regimen, […]

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May 15th, 2023

Types of HIV Papers — A Quick Guide

I spend a lot of my time reading HIV clinical research papers. A lot.  So here, for your viewing pleasure, is a poster I updated and modified from a brilliant xkcd web comic (using this tool), describing some common HIV clinical research themes. Suitable for framing, it should prove helpful as you embark on your next […]

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March 27th, 2023

Three Effective Treatments for COVID-19 Not in Treatment Guidelines — at Least Not Yet

A few weeks ago, in a patented (and copyrighted and trademarked) Really Rapid Review™, I summarized some of the Greatest Hits from CROI 2023. The conference included new data on not just HIV, but also a grab bag of opportunistic infections, STIs, viral hepatitis — and, as has been the case since 2020, COVID-19. You know, […]

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March 16th, 2023

Oral Antibiotic Therapy for Endocarditis — Are We There Yet?

Two terms in clinical research appear frequently in abstracts, conference presentations, and published papers — “clinical practice” and more recently, “real-world.” Many research snobs turn up their noses at both, finding them imprecise or pretentious. I confess to flinching each time I read “real-world” — isn’t everything “real-world”? If not, what’s the opposite? Mouse studies? (They’re […]

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February 14th, 2023

Interferon Lambda for COVID-19 — Looking Good, but Still Not Available

Way back in the spring of 2022, I was asked to give an update on outpatient treatment of COVID to a group of general internists. The talk featured this slide on the TOGETHER trial of peginterferon lambda: These data came from a press release from the company developing the drug. It’s dated March 17, 2022. I added […]

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January 17th, 2023

After the PANORAMIC Study — Whither Molnupiravir?

We turn now to the second of the controversial papers published in late 2022 on COVID-19 — namely the PANORAMIC study of molnupiravir versus usual care in outpatients with the disease. This one is controversial not because the study was poorly done, or unimportant, but because molnupiravir has, from the start, been a contentious treatment […]

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February 12th, 2022

The Rise and Fall of Ivermectin — 1 Year Later

Here’s a confession few board-certified ID doctors will make — there was a brief period when I thought ivermectin could very well be an effective treatment for COVID-19. It wasn’t when the in vitro data first came out. Therapeutic concentrations were not achievable in humans. Nor when the anecdotal reports started pouring in, and sometimes making news. […]

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