HIV and ID Observations

March 2nd, 2026

Farewell to This Blog — and Hello to NEJM Voices

After 18 years of HIV and ID Observations, this is my final post here. That’s nearly 1000 posts since March 2008 — commentary on new HIV data, debates about antibiotic duration, EMR rants, cartoon caption contests, conference highlights, pandemic pain and progress, and more than a few peeves about “quick questions.” Along the way we […]

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February 26th, 2026

Some Ruminations on CROI — Still the Best HIV Meeting

CROI, which just wrapped up in Denver, is not like other scientific meetings — it’s quirky. Let me count the ways. There’s the name — the Conference on Retroviruses and Opportunistic Infections — coined in the early 1990s, when fax machines were cutting-edge technology. It’s pronounced to rhyme with boy, by the way. No one […]

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February 17th, 2026

Two Things Can Be True: The FDA Process Was Inconsistent, and the mRNA Vaccine Data Were Disappointing

Any time I write about vaccines, especially mRNA vaccines, things get dicey. Any negative comments might fuel attacks from one wing that I’m trying to fuel vaccine doubt, or (from another), hostility toward corporate innovation and profits. And of course, there’s a small but vocal minority that believes that all vaccines are inherently harmful; it’s […]

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February 12th, 2026

Sometimes You Just Need to Get Input from a Real Human Being

If you’re not using AI in clinical medicine yet, allow me to strongly recommend you start — soon. Like now. It’s a phenomenal tool for looking things up quickly. I’d call it the future of information retrieval, but that future has already arrived. OpenEvidence is currently leading the pack, at least around here. Doximity is […]

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February 4th, 2026

Mystifying Abbreviations — Infectious Diseases Edition

Motivated by an attending stint on the general medical service, I once wrote a post here called, “Mystifying Abbreviations on Medical Rounds.” It proved to be quite popular, so I’m pleased to inform you that saying “RUQUS” (right upper quality ultrasound) and “G and G” (glucan and galactomannan) have truly entered the vernacular, especially here […]

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January 27th, 2026

Florida Moves to Cut AIDS Drug Assistance Program — and Drops the Most Prescribed HIV Regimen in the Country

We prescribers of HIV medications — and our patients — have for the most part lived in a very privileged space in this country. Newer drugs with advantages in efficacy, safety, or convenience have generally been covered, either by private insurance or by government drug-assistance programs. Drug coverage was historically so good that it even […]

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January 21st, 2026

Rabies Is Terrifying — and the Challenge of Managing a Low Risk of a Dreadful Disease

Three case reports of human rabies recently appeared in the MMWR. Reading each one served as a reminder of just how horrifying this infection is when it strikes — which very fortunately is quite rare in our country. Two cases were domestic and followed recognized direct bat exposures with no post-exposure preventive measures taken. Here are […]

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January 14th, 2026

Influenza — So Familiar, Still So Mysterious

In what feels like the fastest-peaking influenza season in quite some time, I find myself returning to a familiar answer when asked questions about this miserable virus: “We just don’t know.” At least I hope it’s peaking — take a look at this encouraging recent trend: Decline notwithstanding, there’s still tons of influenza activity out […]

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January 6th, 2026

How the Z-Pak Took Over Outpatient Medicine, Part 2: The Reckoning

Part 1 of this azithromycin series explained how the drug became ubiquitous. In Part 2, we’ll explore why many of us infectious diseases physicians now groan when they hear the words, “They already started a Z-Pak.” Because what began as a genuine pharmacologic advance became, through sheer volume of use, an antibiotic that doesn’t work […]

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December 29th, 2025

How the Z-Pak Took Over Outpatient Medicine

Chances are, across this great land of ours, right at this very moment, someone is coughing, or sneezing, or struggling with a sore throat, or some combination of the above, and taking the antibiotic azithromycin. Or they might be just fevering, with no discernible cause, and still they’re taking azithromycin. They might have obtained it […]

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