An ongoing dialogue on HIV/AIDS, infectious diseases,
March 28th, 2010
Kidneys: Fortunately, We Have Two
Here’s a case over in our Journal Watch: AIDS Clinical Care site: a man with suspected PCP develops rapidly progressive renal failure after being starting on both empiric PCP treatment with TMP-SMX and ART with TDF/FTC plus darunavir/ritonavir. The specific questions at the end of the case were: What do you think is causing the […]
March 24th, 2010
Now for Some Good News: TB Cases Continue to Decline
From the latest MMWR: This figure speaks for itself, but two sentences from the Editorial Note deserve highlighting: The 11.4% decrease in reported TB rate in 2009 is the largest single-year decrease ever recorded. From 1953 to 1993, the single largest annual percentage decrease in TB case rate was 11.1% in 1956 Since I started my […]
March 14th, 2010
MRSA Bacteremia Question Redux — and the “Answer”
As noted here, I recently had to answer a question on management of MRSA bacteremia as part of an every-10-year cycle of test-taking. (For more on that joyous process, read this interesting debate here in the New England Journal of Medicine.) The question seemed to have no obvious right answer, so I did what one is explicitly […]
March 10th, 2010
The Extraordinary Power of Placebo
Just published 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 = […]
March 3rd, 2010
Ritonavir Tablets: Any Experience Out There Yet?
Ritonavir tablets have been approved, and are apparently now in pharmacies. The capsules will also remain available for the foreseeable future. However, I haven’t switched anyone over from the capsules yet, and neither has anyone else in our practice. Would be interested in hearing how it’s going so far — best news would be that […]
February 11th, 2010
Ritonavir Tablet Approved
It’s not on Abbott’s web site yet (update: now it’s here), but the FDA has approved a new formulation of ritonavir — a heat-stable 100 mg tablet. From an e-mail release by the FDA: On February 10, 2010, FDA approved Norvir (ritonavir) 100 mg Tablets. These tablets do not require refrigeration. Unlike the capsule formulation […]
February 4th, 2010
Non-Cirrhotic Portal Hypertension: A Rare but Serious Side Effect of ddI
The FDA has issued a warning about an association between use of ddI (didanosine) and the development of non-cirrhotic portal hypertension: Non-cirrhotic portal hypertension (portal hypertension that is not caused by cirrhosis of the liver) is rare in the United States. It occurs when blood flow in the major vein in the liver (the portal […]
January 29th, 2010
More on TaqMan Viral Load Testing
Since I first discussed the disruptive effect of introducing Mr. TaqMan to our clinic, many others have weighed in. One of my favorite reports is a nice paper from the Alabama group, presented first at IDSA, and soon to be published. It shows not only a higher rate of low-level detectable results, but also the […]
January 17th, 2010
Hey, Didn’t You Used to be the Cause of CFS?
The report last year that xenotropic murine leukemia virus-related virus (XMRV) was found in a high proportion of patients with Chronic Fatigue Syndrome (CFS) caused quite a stir — which is totally understandable given how frustrated the people with CFS are with the lack of adequate explanations for their suffering. The investigators of the original […]
January 14th, 2010
Magic Wand Destroys H1N1 — and More!
From the folks at Hammacher Schlemmer comes this extraordinary device: Tests performed by an independent antimicrobial testing laboratory showed the wand destroyed 99.98% of the H1N1 virus after a five-second exposure when held 3/4″ above the contaminated surface. Also capable of killing MRSA, mold, and dust mites, the UV-C light penetrates viral and bacterial membranes […]
Paul E. Sax, MD
Associate Editor
NEJM Clinician
Biography | Disclosures & Summaries
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FROM NEJM — Recent Infectious Disease Articles- Challenging Claims of an Autism Epidemic — Misconceptions and a Path Forward January 17, 2026Autism research programs should focus on both causes and effective services and supports. Alarmist claims, chasing of debunked theories of causation, and further stigmatizing autism are counterproductive.
- Pneumocystis jirovecii Pneumonia January 17, 2026A 60-year-old man with recently diagnosed HIV infection presented with a 10-day history of fever, dry cough, and shortness of breath. A CT scan of the chest showed diffuse nodules and ground-glass opacities.
- 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.
- 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.
- 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.
- Challenging Claims of an Autism Epidemic — Misconceptions and a Path Forward January 17, 2026