HIV and ID Observations

A few ID/HIV items of note to consider as you gather up your sunscreen, flip flops, towels, and sand toys and head off to the beach:

• Interesting review of the impact of low socioeconomic status in the recent outbreak of Legionnaires’ Disease in the South Bronx. It’s just like (almost) every infection — the combined effects of crowding, poor sanitation, and high levels of other comorbid diseases greatly amplify the risk of getting this disease.
• Want an exception to this rule? How about Lyme Disease? Quite the statement that the linked article appeared in the Fashion and Style section of the Times! And here’s the first paragraph: “At a recent dinner party in Greenwich, Conn., Topic A was not stock futures or boarding school, but something decidedly less tony: ticks.”
• Which is emphatically not to say that Lyme is a small problem, or just the product of the overactive imagination of the worried-well leisure class. An upcoming paper in Emerging Infectious Diseases estimates there are around 329,000 cases annually. And if you want to see the highest incidence locations, here’s a remarkable map from last month’s issue.
• Last tick item, promise (though it is the season) — I’ve noticed a bunch of sites now refer to the Ixodes tick vector for Lyme-anaplasma-babesia as the “blacklegged” tick instead of the “deer tick.” When did that happen? Did the deer get the memo from the variegated squirrels, and are now protesting? What about all the other creatures with black legs? How do you think they feel?
• Daclatasvir is now available, and the excellent HCV treatment guidelines have been updated. The most important change is the recommendation for treatment of genotype 3 — 12 weeks of daclatasvir/sofosbuvir if no cirrhosis, 24 weeks (with or without RBV) with cirrhosis.
• Several more important HIV/HCV coinfection studies published:  sofosbuvir/ledpasvir, sofosbuvir plus daclatasvir, and grazoprevir/elbasvir. (Last of these slated for approval within 6 months.) All have outstanding (>95%) cure rates, comparable to those without HIV. It’s the drug-drug interactions that need watching — very useful figure here.
• This meta analysis found impressive benefits of corticosteroids as adjunctive treatment for community acquired pneumonia. Probably not ready for standard-of-care (yet), and I like the suggestion from the editorialist to find surrogates (clinical or lab-based) for which patients would benefit the most.
• The updated flu vaccine guidelines have been released, and as usual they are quite a mouthful: “The vaccines will contain hemagglutinin (HA) derived from an A/California/7/2009 (H1N1)-like virus, an A/Switzerland/9715293/2013 (H3N2)-like virus, and a B/Phuket/3073/2013-like (Yamagata lineage) virus … Quadrivalent influenza vaccines will contain these vaccine viruses, and a B/Brisbane/60/2008-like (Victoria lineage) virus.” Got that? Report also includes updates on the live attenuated vaccine, and indications for vaccination in general, which include basically everyone.
• Long-term valacyclovir provides no benefit after HSV encephalitis. An important negative study, it could not have been easy to identify eligible patients and enroll them. (It took nearly 10 years to complete.) The overall excellent outcome in both arms — 86-90% with mild or no neurologic sequelae at 2 years — likely reflects the exclusion of the sickest patients with this scary condition.
• Anyone notice an association between abacavir and anxiety? Link is to an observation (and a couple of published case reports, though the second one could have been EFV) from long-time HIV/AIDS advocate, Nelson Vergel. I personally have not seen this side effect, though it does seem that some people starting integrase-based treatments (including dolutegravir) develop insomnia.
• Baseball/ID overlap warning — Los Angeles Dodger fans are no doubt happy that their excellent third-baseman Justin Turner is off the disabled list after a bad bout of MRSA. Contact precautions in the locker room? Gowns and gloves when he comes to bat? Purell stations at each base?

Title of this post notwithstanding, the weather in Boston this summer has been great — mostly warm days, cool nights, low humidity — hence the energetic jumping pooch in the picture (not mine, click on it for full effect). I just love the phrase, “dog days of summer”, and wanted an excuse to use it.

Hey, it’s hot somewhere!

[youtube http://www.youtube.com/watch?v=Pl_wK6pOmxE&w=560&h=315]