December 6th, 2014

Holiday Season 2014 ID/HIV Link-O-Rama

village snowA little spin around the internet brings us these ID/HIV tidbits, all of them designed to go well with holiday music, egg nog, and potato pancakes, plus a can’t-miss video clip:

  • Flu vaccine match with circulating virus doesn’t look so great. This could mean it’s going to be a tough flu season, but estimates of flu season severity are notoriously terrible. And here’s a un-bold prediction — this news will make the flu vaccine skeptics (patients and health care providers alike) feel more entrenched about not getting or giving the vaccine than ever. Until there’s a shortage of shots in the midst of a bad flu season, that is.
  • “The Excrement Experiment” is the title of a highly entertaining article on fecal microbial transplantation (FMT) in the New Yorker. Probably should be required reading for all ID doctors and gastroenterologists, if for nothing else than for the nicknames of the “professional” stool donors.
  • Should we reconsider our enthusiasm for PrEP to prevent HIV? Have been holding this one for a while (sorry, it was published a few weeks ago), but it’s one of the best summaries to date describing the conflict between policy makers (such as CDC), who favor PrEP for high-risk HIV negative gay men, and the AIDS Healthcare Foundation, led by Michael Weinstein, who most certainly does not. Comments section demonstrates the strong feelings people have on this issue.
  • Even our microbiome gets jet lag says this Cell paper, providing yet another reason why crossing time zones makes us feel so horrible. And not only that, these sleep-deprived bacteria may promote diabetes and obesity. In other words: “These findings provide evidence of coordinated metaorganism diurnal rhythmicity and offer a microbiome-dependent mechanism for common metabolic disturbances in humans with aberrant circadian rhythms, such as those documented in shift-workers and frequent flyers.” Exactly!
  • More fat gain with atazanavir than darunavir-based initial regimens. In this small randomized clinical trial comparing ATV/r with DRV/r (both with TDF/FTC), subcutaneous and total fat increased more in the ATV/r arm, along with triglycerides and markers of insulin resistance. This is exactly the opposite of what I would have expected, which is why doing randomized trials is so important!
  • Polio crisis worsens in Pakistan. Bad news out of what’s called the “world’s incubator” for this scary disease. (Just ask anyone from the pre-immunization era how scary.) Pakistan has reported 260 cases this year, four times the 2013 number. Blame refugee displacement, political chaos, and a Taliban-held belief that immunization efforts are a CIA-driven, covert Western plot. The glimmer of hope here is that the government of Pakistan is deeply committed to broadening immunization rates, and there is apparently good external aid.
  • Is depression really an infectious disease? Could be, says this provocative (but highly speculative) piece in the New York Times. It’s entitled “What if We’re Wrong About Depression?”, and let me answer that question right now — YES WE ARE WRONG, just as we are wrong (or more kindly, “still learning”) about treatment of virtually all major psychiatric diseases. We clearly haven’t figured them out yet. But before we start seeking referrals from our psychiatry colleagues to treat cases of depression with antibiotics, here’s the cited lead investigator’s much more nuanced take: “There’s never been enough compelling data to isolate one or even several infectious agents that are reliably associated with the development of depression.” Sounds right to me.
  • Tapeworm parasite slowly eats a man’s brain. No, not a 1950s horror movie, just the cause of this poor patient’s four years (!) of “experiencing headaches and strange smells.” Serial MRIs demonstrated something slowly crawling through his brain, or more accurately, “migration of the lesions from the right hemisphere through the thalamus” to the left. Ultimately, the diagnosis of sparganosis from Spirometra erinaceieuropaei (you knew it all the time) was made by sequencing tissue from a second brain biopsy sample. And check out the coverage of the case report in The Guardian — the “Related Content” and comments from readers at the bottom of the page are intentionally and unintentionally quite amusing (that is, if you’re an ID doctor).

Hey, what a treat — a Colbert interview with the one-and-only Dr. Paul Edward Farmer:

(Seasonally appropriate hat tips to Drs. Carlos Del Rio and Ralph Blair for helpful suggestions. And you can receive a 100% sterile, autoclaved notification of new posts by entering your email address in the subscription box on the right. Our holiday gift to you, free of charge.)

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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