HIV and ID Observations

Several ID/HIV tidbits to keep you entertained until Sunday night’s opening “day” — for baseball that is.

(I hear there’s some sort of basketball tournament going on as well.)

Away we go!

• Female-to-female sexual transmission of HIV is extremely uncommon — though one such case was diagnosed at our hospital over 20 years ago — but this most recent report from Texas is probably the strongest case report to date, with both convincing behavioral and phylogenetic evidence of the transmission. Note that the infected partner had stopped HIV treatment in 2010, and had an HIV RNA of 82,000.
• Thoughtful and interesting piece in the New York Times by noted health-care economist Uwe E. Reinhardt about the controversy over the price of sofosbuvir. Good primer on cost-effectiveness as well. The challenge here is that sofosbuvir is both an incredibly expensive drug and an incredible advance on what we had previously. Quandary indeed.
• We ID doctors do love ceftriaxone — almost as much as we love doxycycline — and at least anecdotally, have been pushing this envelope of this third generation cephalosporin by using it more and more for Staph aureus infections. This report of high rates of ceftriaxone resistance among MSSA isolates might give us pause, however. Important caveat: no link to clinical outcomes in ceftriaxone-treated patients.
• Taking acetaminophen with phenylephrine — a common combination “cold remedy” — can significantly raise phenylephrine levels, potentially to dangerous levels. One of the great ironies in your drug store is the vast array of cold medicines for sale — when basically none of them works at all. Because if one did work, don’t you think that would be the one we’d all use?
• Speaking of colds, I’d bet one of the most common questions primary care providers (and ID doctors) get is, “Is it safe to exercise when I have a cold?” Thoughtful response here on the Mayo Clinic site, which I will instantly adopt.
• Some of my friends were surprised when I didn’t comment on this latest flurry of news about the dangers of cat bites. Hey, stuff like this is ho-hum to us ID docs, we know already that cat bites are bad — but cat-to-human transmission of tuberculosis? Now that’s news! Importantly, this was M. bovis, which responds nicely to standard TB treatment. So add Mycobacterium bovis to toxoplasmosis, Bartonella spp (cat scratch disease), Pasteurella multocida … here, kitty kitty!
• So the “Five Second Rule” for food dropped on the floor is real: “Time is a significant factor in the transfer of bacteria from a floor surface to a piece of food.” Extraordinary! Either that, or these British researchers have way too much time on their hands. Note that carpet is safer from a microbe perspective if fluffier. For a paranoid’s view of the whole issue, plus a scientist in an oh-so natty outfit, watch this.
• Want to make your head spin? Read the methods section in this study on the use of xenodiagnosis for Lyme disease. It can be tough going at times (“Ticks were crushed and tested by PCR and injection of the lysate subcutaneously into an SCID mouse and/or by isothermal amplification followed by PCR and electrospray ionization mass spectroscopy, IA/PCR/ESI-MS,” egad), so this commentary is a big help — especially with this statement: “…detection of borrelial DNA by xenodiagnosis is not tantamount to detection of viable spirochetes.” Agree.

Back to baseball. Here’s the best story from Spring Training, the stray dog (Hank) who wandered into the Brewers’ training facility. Sure beats some guy with a mustache sliding into a mug of beer: