An ongoing dialogue on HIV/AIDS, infectious diseases,
September 19th, 2025
Two Drugs, Not Three: The DOLCE Study in Advanced HIV Disease
Three-drug therapy has been the standard of care for HIV therapy for so long it’s difficult to shake the view that it must be more effective than two drugs. This is particularly the case for those with advanced, HIV-related immunosuppression or very high viral loads, as they provide an important stress test for all regimens. […]
September 10th, 2025
When Required Learning Modules Surprise You (In a Good Way)
Like most clinicians, I have a checkered history with required online learning modules. You know the drill: click play, get lectured in monotone about hand hygiene or fire safety, then spend the next 8 minutes desperately searching for the fast-forward button, hoping it’s not disabled. My personal low point (or high point, depending on your […]
September 4th, 2025
End-of-Summer Musings — Hepatitis B, Dalbavancin, Alpha-Gal, and More
The last time I did one of these quick “musings” posts, I listed 21, and someone asked me, “Why 21?” The answer — obviously — is that I originally planned on writing 20, but then had to add a 21st, just because that’s exactly how many points you need to win a ping pong game. […]
August 29th, 2025
Watching the Chaos at the CDC — with Sadness and Alarm
Throughout my career as an infectious diseases doctor, the CDC has been a rock-solid source. Need reliable data on an outbreak? The CDC. Need thoughtful, evidence-based guidelines? The CDC. Need an authoritative reference for a consult question or to steer a colleague or trainee to the right place? The CDC. Need the latest, most accurate […]
August 16th, 2025
Anal Cancer Screening in HIV: When Guidelines Get Ahead of the Evidence
Should every person with HIV over age 35 (if MSM or transgender woman) or 45 (everyone else) have an anal Pap smear, a digital anal rectal exam (DARE), and possibly a high-resolution anoscopy every 1–2 years? According to recent guidelines, yes. But here’s the problem: we don’t know if this screening effort actually prevents cancer. […]
August 6th, 2025
Does the Fact That AI Is Brilliant at Writing “Learning Objectives” Prove They’re Not Really Needed?
Recently, I was invited to speak at a primary care conference on a terrific topic: “Can’t Miss Diagnoses in ID for the PCP.” Love it. So many great examples come to mind — endocarditis, Lemierre syndrome, vertebral osteomyelitis, acute HIV. A wonderful opportunity to teach about the “rare but there” diagnoses hidden among everyday outpatient […]
August 2nd, 2025
The Short Political Half-life of a Medical Contrarian
In early May, I wrote about the surprising FDA appointment of Dr. Vinay Prasad to lead the FDA’s Center for Biologics Evaluation and Research. Prasad is a UCSF hematologist-oncologist known for his views on COVID-19, oncology clinical trials, and his sometimes sharp-elbowed communication style, in particular directed at people with whom he disagrees. My goal was […]
July 25th, 2025
Who Gets Sent to ID Clinic? A Field Guide to Outpatient Referrals
Sometimes people ask me what kind of cases get referred to ID doctors in the outpatient setting. Despite what the latest television series might suggest, it’s rarely suspected Ebola (fortunately) or Tsutsugamushi fever — a disease that is much more fun to say by its Japanese name than its common one, scrub typhus. (In Japanese, “tsutsuga” […]
July 17th, 2025
Ceftriaxone Is a Narrow Antibiotic Now — and Other Musings
In no particular order, 20 things I’ve found interesting lately — a mix of ID (mostly), language quirks, clinical stuff, even tennis, and an apology (#21) at the very end. Bonus videos embedded because we all need a break. 1. Isn’t it amazing how, over time, an antibiotic once considered “broad spectrum” later becomes the […]
July 12th, 2025
The Patient Did Well — So the Insurance Company Won’t Pay
Sometimes, you can predict a bad outcome. Examples: Proposing marriage after an awkward first date — and doing so over gas station nachos. Moving to a Cambridge apartment with no off-street parking, then buying a Tesla Cybertruck. Trying to recruit for ID fellowships from a group of cosmetic dermatologists. But predicting what happens in clinical […]
Paul E. Sax, MD
Associate Editor
NEJM Clinician
Biography | Disclosures & Summaries
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FROM NEJM — Recent Infectious Disease Articles- Primary Measles Infection February 26, 2026A previously healthy man presented with a 5-day history of fever, nausea, and vomiting and a 2-day history of an itchy rash. Examination showed an exanthem consisting of minute macules and subtly elevated papules.
- Tecovirimat for the Treatment of Mpox February 26, 2026Mpox continues to spread in many communities. Tecovirimat has activity against orthopoxviruses in vitro. In a phase 3 trial involving patients with acute mpox, tecovirimat showed no evidence of clinical activity.
- Microbial Flora in War Wounds from the Ukrainian Front Line February 26, 2026Battlefield injuries are often contaminated with potentially infecting microbes. In this study, swabs obtained in the field after injury were profiled. Microbes and potential antimicrobial-resistance genes were characterized.
- AI-Enabled Precision-Education Systems — Transforming Lifelong Learning in Medicine February 26, 2026Trainees’ paths to safe, independent practice are variable. Artificial intelligence could help accelerate implementation of competency-based medical education to support individualized development.
- From Efficacy to Access in Long-Acting HIV Therapy February 26, 2026Over the past three decades, advances in antiretroviral therapy (ART) have dramatically improved life expectancy, decreased frailty, and improved quality of life for persons with human immunodeficiency virus (HIV).1,2 These gains have accrued primarily among those who can reliably access health care and adhere to daily treatment. For...
- Primary Measles Infection February 26, 2026