HIV and ID Observations

A few ID/HIV issues to ponder as we welcome back the most important sport in the universe:

• Interesting new Guidelines on UTIs from IDSA — especially their recommendations not to use fluoroquinolones for uncomplicated cystitis and to promote nitrofurantoin for 5 days to first-line for this indication. And welcome to fosfomycin — though this could eliminate one of the ID consultant’s few remaining tricks when getting a challenging UTI consult.
• So opportunistic infections are decidedly uncommon after prolonged virologic suppression, even if the CD4’s don’t increase. (Read the full paper for details.) I was asked once to give a talk to a group of HIV providers on what to do for persistently low CD4s despite effective therapy.  It would have been a very short talk — the answer is basically “do nothing.”  One could argue that we should stop CD4 measurements entirely after a couple of years of successful ART.  What’s the point?
• Thought M abscessus infection was difficult to treat? Turns out it’s even harder than we thought — some of the macrolide-susceptible strains are actually “susceptible” (note quotes), as they have an inducible macrolide resistance gene (called “erm”) that cannot be detected on susceptibility testing.  Read this latest study suggesting the importance of surgical therapy here, and this outstanding (and entertaining) editorial here for further info on this always-challenging entity.
• The latest ADAP Watch is here (PDF) — and it’s not pretty.  To quote the report:  “As of February 10, 2011, there were 6,235 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in 10 states. This is a 32 percent increase from the 4,732 individuals on the December 2010 ADAP Watch.”  Looks like more than half (3,204, to be precise) live in Florida — seems like some sort of action there is likely soon, right?
• I’ve been reading — and enjoying — Mark Crislip’s ID blog over on Medscape for several months now. It’s terrific!  Well-written, funny, wise, and full of just the sort of cases we ID doctors see all the time, plus an impressive smattering of literature-citing even in situations that don’t obviously lend themselves to this approach. I cannot recommend it highly enough.

By the way, for those planning the trip out to Boston later this month for the Retrovirus Conference, we have a decided warming trend this week.  Snow gone by the opening plenaries?

“Pitchers and catchers…”