HIV and ID Observations

December 13th, 2009

Infection and the ICU: Outcome Predictable, but Important

If you enrolled over 14,000 ICU patients into a study on a single day, and then did follow-up, what would you find regarding the relationship of infection to the outcomes of ICU stay and mortality? Just such a study was published in JAMA last week, and here are the not-so-stunning conclusions: Infections are common in patients in […]

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December 8th, 2009

Vancouver, Phishing Phlu Scam, Telavancin, and Cartoon

A few things to ponder as the flu activity (mercifully) declines, at least for now: Interested in evidence that HIV treatment has become staggeringly effective?  Fully 87% of patients receiving treatment in the large British Columbia cohort have an HIV RNA < 50; not only that, the incidence of HIV drug resistance has declined more than […]

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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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November 30th, 2009

WHO HIV Treatment Guidelines Updated

This just in: WHO is now recommending that ART be initiated at a higher CD4 threshold of 350 cells/mm3 for all HIV-positive patients, including pregnant women, regardless of symptoms. Which makes eminent sense, of course.  Because if starting HIV therapy might prolong survival in developed countries, why shouldn’t it do the same in the developing world? In fact, […]

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November 20th, 2009

Ties Tied to Bugs

Are doctors’ neckties causing infections?  That’s the implication of this Wall Street Journal piece: The list of things to avoid during flu season includes crowded buses, hospitals and handshakes. Consider adding this: your doctor’s necktie. … A 2004 analysis of neckties worn by 42 doctors and medical staffers at the New York Hospital Medical Center of […]

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November 7th, 2009

A Career in Infectious Diseases and “The Next Big Thing”

I was working with a medical intern in clinic this past week who is potentially interested in ID. After seeing our 3rd consecutive stable HIV patient, he asked me what I thought the next big challenge would be in our field — especially since HIV treatment has been “solved.” “Solved” might be stating it a bit […]

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March 31st, 2009

Infectious Disease in the ICU: Help Please? Part II

In Part I of this topic, I commented on the ironic sameness of ICU Infectious Diseases — that incredibly sick, complex patients entered the ICU with vastly different problems, then over time, seemed to converge, presenting similar kinds of clinical issues and management challenges for the ID doc. Or, as a visiting medical student said to […]

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March 25th, 2009

March (Guideline) Madness …

A couple of interesting ID guidelines out this week.  For those of you too busy with basketball, here are the relevant links: Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities. Identified in 24 states and now found “routinely” in New York and New Jersey, these carbapenem-resistant Enterobacteriaceae (“CPE” is much […]

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March 4th, 2009

TaqMan HIV RNA Assay: Be Careful What You Wish For

At our hospital lab, we recently switched from the bDNA viral load assay to the new Roche TaqMan real-time PCR test.  The virologist in charge of our lab and the tech both agreed the assay was more accurate, more sensitive, and easier to do — so much so that we could increase the frequency of […]

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January 25th, 2009

Just Twenty Days Until Pitchers and Catchers Report …

As the temperature in Boston again falls below 10 degrees, my thoughts longingly turn to baseball — and how a  locally unpopular team is making a foray into the world of Infectious Diseases: The potential of a serious staph infection affecting a member of the team has not been lost on the New York Yankees. According […]

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