An ongoing dialogue on HIV/AIDS, infectious diseases,
January 9th, 2013
HIV Exceptionalism is Alive and Well — and That’s Too Bad
Email exchange with a colleague who works at one of our community health clinics: Guy: Hi Paul, your patient 17432862 [that’s a made-up medical record number] came to our walk-in clinic with a rash on her hand. OK that I gave her a week of topical steroids? I know how inhaled steroids interact with some […]
January 3rd, 2013
What’s a Fulyzaq? I Thought You’d Never Ask
As Physician’s First Watch noted, we sure know what the folks at the FDA were doing this holiday season — and most emphatically they weren’t visiting Aunt Selma in Boca Raton. Nope, they were stuck in White Oak, Maryland, reviewing various new drug applications, with three of the four related to Infectious Disease. The FDA’s […]
December 22nd, 2012
Chaos in the Diagnosis of C diff, and Dogs are Amazing Creatures
If you’re confused about the best way to diagnose C diff these days, welcome to the club. There are all kinds of tests out there, and no uniform approach between labs. Our lab actually does three tests — and will do a fourth (the classic cytotoxicity assay) if you request it. The result? Chaos, confusion, […]
December 20th, 2012
Severe Telaprevir Rashes and Waiting (or Not Waiting) to Treat Hepatitis C
Yesterday, the FDA issued a drug safety alert about severe rashes — “some fatal” — in patients treated for HCV with interferon, ribavirin, and telaprevir. The culprit, of course, is the telaprevir. The label already contained warning information about serious skin rashes with the drug, and this alert serves to heighten our awareness of the […]
December 5th, 2012
Top HIV Stories of 2012
Somewhere in our genome, we are programmed to use the end of the year as a time to reflect on the previous 12 months — and to make lists! If you don’t believe me, there’s barely a publication or web site out there that hasn’t already succumbed, and we’re just in early December. And what […]
November 28th, 2012
A Complicated Curbside Consult I Won’t be Doing — But One Day Might Have To
From a local primary care provider comes this email: Any chance you can look at my notes and scanned outside records from 6/22/2010 till today (including Nov 6 notation that details extensive past evaluation, including two previous ID consults) and labs? Briefly: 72 yr old woman with 6 episodes over the last 4 years of […]
November 22nd, 2012
The U.S. Preventive Services Task Force Recommends HIV Screening — And Why is This News?
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 […]
November 18th, 2012
The 800-mg Darunavir Tablet Arrives, and Scoring the Top Protease Inhibitors
The FDA has approved an 800-mg tablet of darunavir for treatment naive patients. This single tablet will obviously replace the two darunavir 400-mg tablets in first-line therapy. (Yes, my math is that good.) Darunavir will still require 100-mg ritonavir boosting plus two NRTIs to make a complete regimen. Once upon a time I might have thought this […]
November 7th, 2012
Vitamins and the Department of Bad Timing
Now that the election is over, we can get back to something that really matters — namely vitamins, and specifically whether they really help people. Last month there was a large, well-done study from Tanzania showing that mega-doses of vitamins not only didn’t help those HIV starting ART, but they actually were harmful — LFTs […]
November 2nd, 2012
Antiretroviral Rounds: Resistance on Two Fronts
Got this challenging curbside consult from a colleague, and it has a interesting wrinkle: I have a longstanding patient with HIV who had many failed regimens in the 1990’s with resultant following mutations on a genotype done in 2003: NRTI (M184V, Q151M mutations); PI (A71, I54V, K20M, L10I, L90M, V82A mutations); no NNRTI resistance. She has been undetectable since […]
Paul E. Sax, MD
Associate Editor
NEJM Clinician
Biography | Disclosures & Summaries
Learn more about HIV and ID Observations.
FROM NEJM — Recent Infectious Disease Articles- Borrelia burgdorferi Infection and Erythema Migrans January 15, 2026Expansion of the range of the lone star tick, a vector for southern tick-associated rash illness, has led to overlap with the range of the Lyme disease vector Ixodes scapularis, which may cause diagnostic uncertainty.
- Case 2-2026: A 63-Year-Old Man with Pulmonary Nodules, Liver Mass, and Vision Loss January 15, 2026A 63-year-old man was admitted to the hospital because of fever, cough, and vision loss in the right eye. He had pulmonary nodules, a liver mass, and multiple brain lesions. A diagnosis was made.
- Primary Palmoplantar Pustulosis January 15, 2026A 60-year-old man with a 30-pack-year smoking history presented with a 2-year history of a painful rash on his palms and soles. Numerous pustules with erosions, crusting, and surrounding erythema were noted.
- The Things We Carry January 15, 2026The ID, the pen, the epinephrine, the scalpel are the nonnegotiables, the necessities for any hospital shift. But they are not the only things a physician carries, and certainly not the most burdensome.
- Serogroup Switching in Neisseria meningitidis with Dual Antibiotic Resistance January 8, 2026Serogroup switching away from serogroup Y has been identified in the major ciprofloxacin-resistant Neisseria meningitidis strain, which may impede identification of ciprofloxacin-resistant cases of N. meningitidis infection.
- Borrelia burgdorferi Infection and Erythema Migrans January 15, 2026