HIV and ID Observations

August 26th, 2009

Late Summer Odds and Ends: Circumcision, H1N1 Vaccine, Lyme Movie, etc.

A few ID/HIV items to cover before summer “unofficially” ends (Sept 1?  Kids back at school?  Labor Day?): Will US Public Health officials recommend infant male circumcision to prevent HIV?  They might be considering such a move, but I suspect it will not be strongly promoted.  After all, none of the studies demonstrating its efficacy have […]

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August 20th, 2009

The V.A. Opts Out

Read all about it here: As of August 17, 2009, written (signature) consent is no longer required for HIV testing in the VHA. Instead, patients will provide verbal informed consent prior to HIV testing. Furthermore, scripted pre-test and post-test counseling are no longer mandated. Since the VA is the largest HIV provider in the nation — […]

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August 5th, 2009

Just Out: Primary Care HIV Guidelines

Over on the CID web site, they have the revised version of the “IDSA Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus”. It’s a great document, filled with useful references and a particularly strong table where to find other consensus guidelines (diabetes, hyperlipidemia, mental health, others). My vote for what will […]

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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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June 8th, 2009

H1N1: A Tale of Two Practices

As an adult ID/HIV doctor, I must say the clinical impact of H1N1 thus far has been underwhelming, notable more for the calls about prophylaxis or suspected cases than the real thing. (Last week, one patient with fever and “suspected swine” — hard for people to shake that name — turned out to have … Lyme […]

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June 1st, 2009

“Long-term Nonprogressors” and “HIV Controllers”: Rare Indeed

When giving an overview of HIV pathogenesis to a group of clinicians, Bruce Walker usually asks the assembled if they have any patients in their practice who have undetectable viral loads without antiretroviral therapy. Generally about three-quarters of the audience has at least one such patient.  They are then asked to refer them to his research […]

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May 28th, 2009

The Paul Farmer Watch

Our pal Paul Farmer keeps racking up the titles: Dr. Paul Farmer, a pioneer in improving health services in the Third World, has been named chairman of Harvard Medical School’s Department of Global Health and Social Medicine … (snip) Peter Brown, spokesman for Brigham and Women’s Hospital, said Farmer also had been named to succeed Kim […]

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May 24th, 2009

Another State Gets Ready to Make HIV Testing Easier

Don’t look now, Massachusetts, but Connecticut could be next: AN ACT CONCERNING REVISIONS TO THE HIV TESTING CONSENT LAW. This bill revises the law on consent for HIV-related testing. Specifically, the bill: 1. eliminates the requirement for separate, written or oral consent for HIV testing and instead allows general consent for the performance of medical procedures […]

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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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