An ongoing dialogue on HIV/AIDS, infectious diseases,
June 24th, 2009
An Irrational Fear of IRIS?
One of the most important recent studies in HIV has just been “published” in (on?) PLoS ONE. It’s ACTG 5164, led by Andrew Zolopa, which compared “early” versus “deferred” antiretroviral therapy in 282 patients presenting with acute opportunistic infections. (Full disclosure: I am on the protocol study team — but am not an author on […]
June 16th, 2009
Q: What is the Purpose of a Note in the Patient Chart?
A: Depends who you’re asking. The best guidance I ever received on how to write a good note came from my residency program director, who told us that a note needn’t be encyclopedic to be excellent; in fact, he urged us to get away from the “second-year medical student” style, which typically includes absolutely everything. […]
June 13th, 2009
Occupational Exposures and HIV Testing
A couple of years ago, an ID-colleague of mine told me about a tough case: While working in the ICU, an anesthesiologist sustained a pretty severe needle stick. Approached for HIV testing, the source of the exposure felt threatened by the providers in the ICU, and refused to sign the consent. The patient then deteriorated […]
June 8th, 2009
H1N1: A Tale of Two Practices
As an adult ID/HIV doctor, I must say the clinical impact of H1N1 thus far has been underwhelming, notable more for the calls about prophylaxis or suspected cases than the real thing. (Last week, one patient with fever and “suspected swine” — hard for people to shake that name — turned out to have … […]
June 1st, 2009
“Long-term Nonprogressors” and “HIV Controllers”: Rare Indeed
When giving an overview of HIV pathogenesis to a group of clinicians, Bruce Walker usually asks the assembled if they have any patients in their practice who have undetectable viral loads without antiretroviral therapy. Generally about three-quarters of the audience has at least one such patient. They are then asked to refer them to his […]
May 28th, 2009
The Paul Farmer Watch
Our pal Paul Farmer keeps racking up the titles: Dr. Paul Farmer, a pioneer in improving health services in the Third World, has been named chairman of Harvard Medical School’s Department of Global Health and Social Medicine … (snip) Peter Brown, spokesman for Brigham and Women’s Hospital, said Farmer also had been named to succeed […]
May 24th, 2009
Another State Gets Ready to Make HIV Testing Easier
Don’t look now, Massachusetts, but Connecticut could be next: AN ACT CONCERNING REVISIONS TO THE HIV TESTING CONSENT LAW. This bill revises the law on consent for HIV-related testing. Specifically, the bill: 1. eliminates the requirement for separate, written or oral consent for HIV testing and instead allows general consent for the performance of medical […]
May 19th, 2009
Time for a Switch? Room for Debate
With first-line therapy for HIV being so astonishingly successful, much of what we do in practice is tweak regimens that are by virologic and immunologic standards, working just fine: Viral load undetectable, CD4 stable. But not so fast — while one of my colleagues said that if he didn’t change his patients’ regimens, then he’d […]
May 13th, 2009
Working While Contagious: Why Do We Do This?
File this under, “physicians behaving badly”: The nearly universal MD practice of going to work while sick. The ironic thing is we think we’re being selfless — after all, if we don’t show up, our patients will need to be rescheduled, or someone will need to cover, or some administrative/teaching task will not get done […]
May 7th, 2009
Human Rabies from Bats: Another Look at the Numbers
The gang from Canada is at it again, reviewing human rabies cases from bats and trying to make some sense of the data. (For a summary of their outstanding prior paper in CID, read this.) But before we get to their latest masterwork, here are some questions to ponder. While doing so, keep in mind […]
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