As undoubtedly you’ve heard by now, there’s another person cured of HIV out there — this time, it’s a baby born to an HIV-infected mother. Here’s the story: The mother didn’t know she was HIV positive until delivery, and the baby was found to be infected by both HIV DNA and RNA right at birth. The doctors started combination antiretroviral therapy approximately one day later, essentially as soon as ...

Read more...

A flurry of coverage recently appeared about the U.S. Preventive Services Task Force’s recommendation for one-time HIV screening for all Americans, ages 15-64. Some might wonder why this is news — um, hasn’t this been recommended now for years? — and I think I’ve figured it out. Let me start by relaying that every ID/HIV specialists can tell some version of the following sad story, which is still repeated on a regular basis ...

Read more...

We specialists in infectious diseases love case conferences — especially those where the case is presented as an "unknown," and we try to figure out the diagnosis from the history. I suppose this isn’t very surprising, since ID cases in general are already among the most interesting in all of medicine. Those that are case-conference-worthy are particularly prime. “Funny bug in a funny place,” was how one of my colleagues characterized these ...

Read more...

A long time ago, I was very close to becoming a cardiologist.  Really. Even though my fascination with ID and microbiology started in medical school — and believe me, not much fascinated me in medical school — the fact that all the top residents in my program were going into cardiology made me feel that somehow I should be doing this too.  Plus, the guy who was Chief ...

Read more...

I had an interesting exchange with one of our nurses recently about a long-term patient of ours. The e-mails went something like this:

Got a fax from —-’s insurance that his Lipitor won’t be covered anymore.  They will cover simvastatin, lovastatin, and pravastatin.  Let me know what you want to do. Charlie
He’s on darunavir, and all three of those statins are contraindicated because of drug-drug interactions. Rosuvastatin? Paul
Checked with them — rosuvastatin needs ...

Read more...

Let me start by confessing I’m something of a gadget freak.  I was an early Palm Pilot adoptor, loved the iPod from the get-go, and need to avoid CNET, Engadget, Gizmodo, and David Pogue’s columns for the New York Times when deadlines loom. Not surprisingly, I embraced the shift to electronic medical records (EMRs) enthusiastically. While I acknowledge that sometimes EMRs ...

Read more...

There has been an irresistible urge for people — doctors, public health officers, politicians, journalists, the usual pundits — to compare adherence to HIV treatment in resource-rich vs. resource-limited setting. I suspect this is because the whole issue got off to a famously bad start in 2001, when then-head of  the U.S. Agency for International Development (USAID) Andrew Natsios said in an interview with the Boston Globe that Africans,

don’t know what Western time ...

Read more...

Published earlier this year in the journal Neurology – not typically on my radar screen — is this remarkable study comparing pregabalin to placebo for HIV-related distal sensory peripheral neuropathy. Here are the results:

At endpoint, pregabalin and placebo showed substantial reductions in mean Numeric Pain Rating Scale (NPRS) score from baseline: -2.88 vs -2.63, p = 0.3941 ... ... Individuals with HIV-associated neuropathy achieved NPRS treatment effect size similar to those in ...

Read more...

One of the simultaneously most enjoyable and exasperating aspects of being an infectious disease specialist is the large volume of “curbside” consultations we get from colleagues. For example, here’s this week’s tally — and it’s only Tuesday — done from memory and without systematically keeping track of emails, pages, phone calls, etc.:

  1. Duration of antibiotics after urosepsis, organism resistant to TMP/SMX and quinolones
  2. Need for repeat immunizations in splenectomized adults (got that one ...

    Read more...

Last year, 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 me, “My ICU attending said that every patient in the ICU should be on vancomycin and Zosyn.” Which brings up ...

Read more...

2 Pages

Most Popular