An ongoing dialogue on HIV/AIDS, infectious diseases,
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 […]
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 […]
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 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. […]
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 7th, 2025
Two Pandemics, Compared: Reflections on HIV and COVID-19
“Dr. Sax, what’s it like to have lived through two pandemics as an ID doctor?” The question came from a brand-new intern during afternoon sign-out. I took a breath — because wow, were they different. HIV: It Felt Like A Calling, One Miraculously Rewarded I started my internship in 1987, six years after the first […]
June 27th, 2025
The Mystery of the Isolated Hepatitis B Core Antibody, Solved
(A post inspired by years of doing eConsults, an extremely common query about hepatitis B testing, and the latest BritBox series, “Core Antibody Confidential,” starring a grizzled detective with a faded suit and a haunted past.) Your electronic medical record lists “deficiencies” in health care maintenance for one of your patients, so you order hepatitis […]
June 20th, 2025
Federal HIV Guidelines Face a Shutdown — A Critical Loss for Clinicians and Patients
Each week, our HIV clinical group gathers to review active patients, share updates, and celebrate good news. On our whiteboard, we list four columns: Inpatients, Outpatients, Issues, and Celebrations. This week, under “Issues,” one of my colleagues wrote: HIV Guidelines: ☹️ Yes, you read that right. This week, we learned that the federal HIV guidelines […]
March 22nd, 2025
Really Rapid Review: CROI 2025 San Francisco
Wow, that was an interesting conference — in ways both good and bad. The good part was the content, as the Conference on Retroviruses and Opportunistic Infections (CROI) is our leading HIV research conference. There was plenty of interesting stuff. The not-so-good part was the stunned state of many HIV clinicians and researchers. So much […]
February 6th, 2025
Could This Be the End of PEPFAR?
Short email from a longtime colleague, working in Africa at a PEPFAR site: Without USAID, PEPFAR is essentially dead. I got chills reading this. PEPFAR, the abbreviation for the President’s Emergency Plan for AIDS Relief, started in 2003 under the direction of President George W. Bush. To say it’s been a resounding success undersells the […]
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