An ongoing dialogue on HIV/AIDS, infectious diseases,
March 10th, 2009
Unwelcome Visitor: Cost of HIV Meds
Those of us who practice HIV medicine in Taxachusetts (warning, click link at your peril) live a pretty charmed life, at least so far as getting HIV medications paid for. Due to an incredibly generous AIDS Drug Assistance Program (ADAP), rare is the patient who faces financial barriers getting his or her drugs. (By the […]
March 4th, 2009
TaqMan HIV RNA Assay: Be Careful What You Wish For
At our hospital lab, we recently switched from the bDNA viral load assay to the new Roche TaqMan real-time PCR test. The virologist in charge of our lab and the tech both agreed the assay was more accurate, more sensitive, and easier to do — so much so that we could increase the frequency of […]
March 1st, 2009
Sedation for Colonoscopies in HIV Patients: Debate Rages
Here’s a problem we’re grappling with: A patient with HIV needs a colonoscopy, but is on either a ritonavir-boosted protease inhibitor or an efavirenz-based regimen. (This must be something like 90% of HIV patients as of March 1, 2009, based on my extremely unscientific gut impression.) For efavirenz, midazolam is contraindicated; for ritonavir, same story […]
February 1st, 2009
Whither PEPFAR?
Mark Dybul will no longer be running the President’s Emergency Plan for AIDS Relief, or PEPFAR, the multi-billion dollar international program for HIV treatment program started by Bush in 2003. Some are happy. Others are not. (Note the exquisite use of euphemism — he was “required to submit his resignation“, not “fired.”) Experts on global […]
January 29th, 2009
Too Many Options: What Actually Happened
We recently published a case in AIDS Clinical Care entitled “Too Many Options”, describing a patient with longstanding HIV infection, virologic failure, and resistance to NRTIs, NNRTIs, and PIs. Fortunately, resistance and tropism testing gave him several options for a new drug regimen — including darunavir, etravirine, maraviroc, enfuvirtide, and — if one believes phenotypic […]
January 22nd, 2009
Fear of Vaccines: Not Just Parents
Fear of vaccines are legion among many parents, with enormous public health resources devoted to defusing this fear and trying to debunk common myths. I find this site particularly useful. (Talk about a “hot button” topic. Read this to get an idea about how passionate views on vaccine safety can be. Wow.) This fear, however, […]
January 13th, 2009
Can We Have “Too Many Options?”
As part of our regular series “Antiretroviral Rounds” in AIDS Clinical Care, today we post a case of a highly treatment-experienced patient with dreaded “triple class” resistance — that is, resistance to NRTIs, NNRTIs, and PIs. The good news now, of course, is that we have more than these three drug classes. The tough part […]
January 4th, 2009
Top Stories in HIV Medicine
Happy New Year! In the spirit of list-making that seems to permeate the world right about this time, we’ve just published our own list over at AIDS Clinical Care. Check it out — our editorial board this year did a superb job of summarizing the field. I have a strong feeling that next year’s version […]
December 29th, 2008
Required Reading: Introducing the “iPatient”
Many HIV/ID specialists first heard of Abraham Verghese from his book My Own Country: A Doctor’s Story, which was published in 1994. He told us what it was like to be a newly-minted ID doctor, thrust into treating the first cases of HIV/AIDS in a remote town in Tennessee during the mid-1980s. Compelling stuff — […]
December 23rd, 2008
Flu Resistance to Oseltamivir: The Bugs Win Again
I must admit, the recent report that 49 of the 50 H1N1 flu viruses tested by the CDC are resistant to oseltamivir caught me by surprise. For the non-math majors among the readership, that’s a 98% resistance rate. Yikes. Actually, the rate of resistance is so high that at first I didn’t believe it when my […]
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