An ongoing dialogue on HIV/AIDS, infectious diseases,
June 21st, 2022
Mayo Clinic Study on Paxlovid Outcomes is Reassuring — but Likely Underestimates Rebound Rate
Over at Clinical Infectious Diseases, researchers from the Mayo Clinic published a retrospective analysis of nirmatrelvir/r (Paxlovid) treatment, with a careful review of each patient’s chart. The goal was to determine the clinical outcomes after the 5-day treatment course, with a focus on the frequency of rebounds — a topic of great clinical interest but with little […]
May 4th, 2022
More on Relapses after Paxlovid Treatment for COVID-19
Unless you’ve been hiding under a rock, you’ve heard that some people treated for COVID-19 with nirmatrelvir/ritonavir (Paxlovid) experience a relapse in illness shortly after stopping treatment. It’s both a recurrence of symptoms and a positive antigen test — sometimes after the test became negative. One case report published as a pre-print shows that a relapse can have […]
April 25th, 2022
Yes, Relapses After Paxlovid Happen — Now What?
Around two weeks ago, one of my long-term, very stable patients with HIV called me saying she’d just been diagnosed with COVID-19. Over 60 with hypertension, and overweight, she qualified for nirmatrelvir/r (Paxlovid) under the Emergency Use Authorization (EUA), and took it without problem. (Certain details changed for confidentiality.) In fact, she started to improve within 24 […]
April 12th, 2022
Should We Prescribe Nirmatrelvir/r (Paxlovid) to Low-Risk COVID-19 Patients?
The top recommended treatment for high-risk outpatients with COVID-19 in the NIH Guidelines is nirmatrelvir/r (Paxlovid). It’s quite clear why. In the EPIC-HR study, unvaccinated people at high risk for severe outcomes had an 89% reduction in the risk for hospitalization or death compared to placebo. If we just look at mortality — another important endpoint, […]
March 22nd, 2022
What Have We Learned from the Pandemic So Far?
Dear Readers, I need your help. Recently one of my colleagues reached out and asked if I could give a talk to his research group. “Just give one of your canned Covid talks,” he said. Ha. Needless to say — but I will say it anyway — he’s not an ID doctor. Otherwise he’d know that, as I’ve said […]
February 12th, 2022
The Rise and Fall of Ivermectin — 1 Year Later
Here’s a confession few board-certified ID doctors will make — there was a brief period when I thought ivermectin could very well be an effective treatment for COVID-19. It wasn’t when the in vitro data first came out. Therapeutic concentrations were not achievable in humans. Nor when the anecdotal reports started pouring in, and sometimes making news. […]
February 4th, 2022
Prior COVID-19 Is No Guarantee of Immunity
I’m no immunologist — a fact made vividly obvious to me several years ago when asked to teach a weekly medical student section that included cases and problem sets. The challenge was that the course combined immunology and microbiology. I was on much firmer ground with the microbiology than the immunology, the latter often a wonderfully […]
January 18th, 2022
Novak Djokovic Thinks He Can Play by His Own Rules — Australia Says Think Again
There was a truly talented kid on my ninth grade basketball team — let’s call him Robbie G. He was a terrific player, fast and confident on the court, always eager to play, and just brimming with enthusiasm for the game. Every time he scored, the team and crowd (small as it was) buzzed with excitement […]
January 12th, 2022
The Pandemic Life of an ID Doctor — in Graphic Form
Three works of art sit on my father’s desk in his office, gifts from his children from when we were in grade school. From my brother Ben, there’s a little bear, or perhaps it’s some other burly quadruped — easily a B+ in his art class from the 1960s, likely an A- now with grade inflation. A […]
December 30th, 2021
Omicron and Reduced Severity of COVID-19 — Some Good News We Desperately Need
We’ve been burned so many times making predictions about COVID-19 that I should post this conspicuously by my computer: The famous pundit meant, of course, that “you don’t know anything” — we know his true intentions since he also said “Nobody goes there anymore. It’s too crowded.” The “know nothing” quotation is a reminder that COVID-19 is […]