HIV and ID Observations

Here are a few ID/HIV items blowing around the neighborhood on this, a bitterly cold and windy first weekend of March (at least here in Boston):

• Compared with the standard dose vaccine, the high-dose flu vaccine reduced deaths among older adults. The benefit was seen in the 2012-13 flu season, but not 2013-14. The authors speculate that the circulating strain (H3N2) and low overall effectiveness in 2012-113 explain this discordance. Notably, ACIP still does not formally endorse any particular vaccine for the elderly, but I’m becoming a believer in the high-dose strategy.
• A mother recounts her experience raising a child with congenital CMV infection. This is a skillful and moving description of congenital cytomegalovirus, and the strange obscurity of the virus that “causes more birth defects in the United States than any other nongenetic disease.” That it remains so relatively unknown is a perplexing paradox (especially in the Zika era) — one she artfully explores.
• There’s an estimated 20-fold increase in certain birth defects in pregnancies with Zika infection. Approximately 6% of the babies had microcephaly, neural tube defects, eye defects, or other central nervous system (CNS) problems. Long term follow-up, of course, may identify additional abnormalities.
• Not all infections related to thorn injuries are sporotrichosis. In fact, the number of sporotrichosis cases in this series of over 1000 patients with thorn injuries was (wait for it) … zero. Oh well, guess common things are common.
• Does our president have neurosyphilis? Yes, syphilis is the “great imposter”. Yes, it sometimes can be difficult to diagnose. Yes it can cause bizarre behavior. But good grief, this is an extreme form of medical speculation. For the record, 5 different people sent me this link (you know who you are).
• This site catalogues all the major HIV clinical trials. Under the direction of François Raffi, Anton Pozniak, and Pedro Cahn, ARV-Trials.com is helpful source if you can’t remember the difference between the MERIT, MOTIVATE, MONET, MONOI, MONARK, and MODERN studies. Of course you remember all the ACTG study numbers — but if not, you can find them there too. Site is also kind of a throwback to 1990s web design, in case you’re feeling nostalgic.
• Drug development for hepatitis C is a risky business. Not only that, even established “blockbusters” face declining sales. Incentives in our healthcare “system” can sometimes be truly perverse — and boy, is this cartoon apt. (And brilliant.)
• Vancomycin is better than metronidazole for C diff — again. I can’t think of any reason to use metronidazole for patients who actually have C diff, the real thing. Those who are just PCR positive with minimal symptoms — which really should be called pseudo-C diff — usually don’t require any treatment.
• RFK Jr and Robert De Niro offered $100,000 to anyone who can prove vaccines are safe. Darn, this pediatrician has already nabbed the prize. Guess De Niro has already made Raging Bull, now he’s making Raging Bulls–t.
• This pharmacy’s ad campaign on the NYC subway advocates “very, very strong antibiotics” since “someone sneezed.” News flash:  Antibiotics don’t work for colds, no matter how “strong” they are. See image at top of this post, proving that I didn’t make that up. And it looks like another one of their ads isn’t too popular right now either. I love you too, by the way.
• Here’s an interview with Dr. Brad Spellberg on the importance of antibiotic stewardship. He’s one of the top figures in this field right now, and is very compelling on the subject. Imagine a world where all antibiotic use in the hospital is restricted to ID approval, analogous to chemotherapy for oncologists. And no, he wouldn’t like those NYC subway ads either!
• Short-course empiric gentamicin added to broad spectrum therapy for patients with sepsis did not improve outcomes. Gentamicin-treated patients did have more acute renal injury, even though the median duration of therapy was only 2 days. This was once a common practice in our hospital, where one of our residents used to call it “death gent”, for obvious reasons. Seems now we can all stop doing it!
• Yes, there’s an E. coli O157:H7 outbreak linked to a product called “I.M. Healthy.” It’s soy nut butter, in case you were wondering. No word on the company’s web site whether the post-recall I.M. Healthy will be called “I.M. Now Healthier.”
• Matt Iseman won Celebrity Apprentice. And why, you must be wondering, is that being mentioned in an ID blog? Turns out he’s the son of Mike Iseman, the noted tuberculosis expert. And before he (Matt, not Mike) became a comedian, he had another job.

Only 28 days until Opening Day!

(Hat tip to Chuck Daley for this last item.)