HIV and ID Observations

April 10th, 2012

A Skeptical Look at “Test and Treat”

Over in Journal Watch AIDS Clinical Care, Abbie Zuger has written a fascinating perspective on the recent enthusiasm for universal HIV treatment. Her take? Let’s just say she doesn’t share the enthusiasm of public health officials and members of guidelines committees. Well, that’s a huge understatement. Specifically: This strategy, which calls for universal voluntary HIV testing and […]

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January 4th, 2011

HIV Year in Review Posted on Journal Watch

Want to catch up quickly in HIV clinical care? Forgive the bias, but the best strategy may well be to read our “Year in Review 2010” summary over on Journal Watch: AIDS Clinical Care. Always interesting to speculate what we’ll be choosing next year — I wouldn’t be surprised if progress in eradication (i.e., cure!) starts moving […]

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December 2nd, 2009

So Much in Less than a Week!

First the updated WHO Guidelines.  Then the following: Updated DHHS Guidelines.  Agree?  Disagree?  Sensible or crazy?  Practical or ivory-tower academic? South Africa does the right thing.  Yes, it’s about time, but good news nonetheless. 2012 International AIDS Meeting in Washington, D.C. First time in USA in a long, long time — 1990, to be exact — […]

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July 10th, 2009

Time for a Switch? What Actually Happened

A couple of months ago, I presented these three clinically stable, virologically suppressed patients — and asked if they should switch treatment: 50 year old man on ABC/3TC, EFV since 2000.  No renal disease.  Hyperlipidemia, on atorvastatin 80 mg a day.  Father died of an MI age 48. 63 year old man, on EFV + LPV/r […]

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June 24th, 2009

An Irrational Fear of IRIS?

One of the most important recent studies in HIV has just been “published” in (on?) PLoS ONE.  It’s ACTG 5164, led by Andrew Zolopa, which compared “early” versus “deferred” antiretroviral therapy in 282 patients presenting with acute opportunistic infections. (Full disclosure: I am on the protocol study team — but am not an author on this paper.) […]

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June 13th, 2009

Occupational Exposures and HIV Testing

A couple of years ago, an ID-colleague of mine told me about a tough case:  While working in the ICU, an anesthesiologist sustained a pretty severe needle stick.  Approached for HIV testing, the source of the exposure felt threatened by the providers in the ICU, and refused to sign the consent. The patient then deteriorated and […]

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April 24th, 2009

Colonoscopy in HIV Patients, Part II: Problem (Mostly) Solved

Both here and on the AIDS Clinical Care site, we posted a case of a 50-year-old HIV+ man in need of a screening colonoscopy.  What sedation could he receive while on tenofovir/FTC and ritonavir-boosted atazanavir?  Specifically, would midazolam and fentanyl (“contraindicated” in the ritonavir package insert) be ok? (Same issue for efavirenz, by the way.) We solicited […]

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