An ongoing dialogue on HIV/AIDS, infectious diseases,
December 22nd, 2010
Holiday Hafnias
Some items to consider in HIV/ID world as you dig into your salmonella-free holiday bird:
- Drug label change for stavudine (d4T): The label no longer has recommendations for dose-reduction in case of peripheral neuropathy, and cites data more strongly linking d4T use to lipoatrophy. The strategy of decreasing the dose to reduce d4T toxicity hasn’t made much sense for over a decade, since it’s long been known that most other NRTIs have less mitochondrial toxicity. Which of course begs the question — why is anyone in the United States on d4T at all?
- Speaking of HIV drug label changes, darunavir is now approved for once-daily dosing in treatment-experienced patients, provided there is no darunavir resistance. This makes sense: once-daily dosing greatly exceeds the required levels for inhibition of susceptible viruses, and the strategy was shown to be OK in the ODIN study. I suspect most of us have been doing this for many months already (certainly I have).
- Another (mostly) negative study of echinacea for colds over in the Annals of Internal Medicine. We are so desperate for something that actually works for colds that we keep flogging this dead horse. Or maybe it’s “not dead yet”? But whether this new study settles the issue once and for all, certainly any large effect of echinacea seems highly unlikely. Which reminds me — remember when pleconaril was seeking an indication for treatment of the common cold? A well-respected ID doc I know thought that if it got approved (it didn’t), hardly anyone would want it since most colds are “mild and self-limited”. But one peek at the “coughs and colds” aisle at your local pharmacy shows you just how wrong he was!
- Want the best site for the latest on the XMRV controversy? My personal favorite source is the Wall Street Journal Health blog, and here’s the most recent entry.
- For those of you vacationing in Missouri, and somehow tempted to eat raw crayfish, check out these case reports of paragonimiasis in the MMWR. My favorite sentence in the report: “Behavioral factors that led patients in this report to eat raw or undercooked crayfish included alcohol consumption, dares, and demonstration of survival skills.” Any surprise that 8 of 9 of the cases were in males?
Happy Hafnias!
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
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