{"id":5950,"date":"2015-04-03T08:33:38","date_gmt":"2015-04-03T12:33:38","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=5950"},"modified":"2015-04-03T08:33:38","modified_gmt":"2015-04-03T12:33:38","slug":"melting-snow-id-link-o-rama","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/melting-snow-id-link-o-rama\/2015\/04\/03\/","title":{"rendered":"Melting Snow ID Link-o-Rama"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/04\/DonAdams.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-5953\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/04\/DonAdams-245x300.jpg\" alt=\"DonAdams\" width=\"245\" height=\"300\" \/><\/a>A few ID\/HIV tidbits to contemplate as\u00a0we go from slipping on\u00a0ice and snow\u00a0to dodging the\u00a0mud:<\/p>\n<ul>\n<li><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1406330#t=article\" target=\"_blank\"><strong>Beta-lactam therapy alone is non-inferior to regimens that also cover &#8220;atypicals&#8221; for hospitalized patients with pneumonia.<\/strong><\/a>\u00a0These results challenge a dogma that has been present for a couple of decades &#8212; namely, that all patients admitted with community-acquired pneumonia should get either a quinolone or a beta-lactam plus a macrolide. But is one study done in the Netherlands enough to change clinical practice?<\/li>\n<li><strong>Flurry of recent papers on the cost effectiveness of HCV therapy<i>:<\/i><\/strong>\u00a0\u00a0<a href=\"http:\/\/annals.org\/article.aspx?articleid=2197176\" target=\"_blank\">One<\/a>, <a href=\"http:\/\/annals.org\/article.aspx?articleid=2197177\" target=\"_blank\">two<\/a>,\u00a0<a href=\"http:\/\/annals.org\/article.aspx?articleid=2212248&amp;resultClick=3\" target=\"_blank\">three<\/a>, and <a href=\"http:\/\/cid.oxfordjournals.org\/content\/early\/2015\/03\/16\/cid.civ220.abstract\" target=\"_blank\">four<\/a>, to be exact. Bottom line?\u00a0A huge oversimplification goes like this &#8212; from a societal perspective, the new treatments are for the most part\u00a0cost-effective <em>and<\/em> expensive. And, of course, from an individual perspective &#8212; meaning <em>you<\/em> are the individual being treated, or the prescriber &#8212; they are a no-brainer.<\/li>\n<li>Related: <strong><a href=\"http:\/\/cid.oxfordjournals.org\/content\/early\/2015\/03\/16\/cid.civ221.full.pdf+html\" target=\"_blank\">Entertaining and informative discussion of HCV pricing, and what&#8217;s going on behind the scenes<\/a>\u00a0<\/strong>from\u00a0longtime ID\/HIV clinician, researcher, and educator Mike Saag. When it comes to this market, what&#8217;s the opposite of transparent? \u00a0Highly recommended, especially for fans of <em>Get Smart.\u00a0<\/em>And if you want some additional info on the world of &#8220;Pharmacy Benefit Managers&#8221;, read <a href=\"http:\/\/katherineeban.com\/2013\/10\/23\/painful-prescription-fortune-com\/\" target=\"_blank\">this.<\/a>\u00a0(Thanks to Mike for the link)<\/li>\n<li><a href=\"http:\/\/journals.lww.com\/aidsonline\/Abstract\/2015\/04240\/Impact_of_nucleic_acid_testing_relative_to.5.aspx\" target=\"_blank\">&#8220;<strong>Fourth Generation&#8221; HIV screening tests that detect both antigen and antibody can still miss\u00a0acute\u00a0HIV.<\/strong><\/a> Remember, the duration of p24 antigen detectability during acute HIV is relatively short.\u00a0Important to think about\u00a0this limitation, especially when evaluating patients for PrEP &#8212; we should have a low threshold to order HIV RNA.<\/li>\n<li>The <strong><a href=\"http:\/\/www.nytimes.com\/2015\/03\/31\/us\/small-indiana-city-races-to-curb-hivs-spread.html?_r=0\" target=\"_blank\">outbreak of injection drug use (IDU)-related HIV in Indiana<\/a><\/strong> is a stark reminder of how quickly HIV can spread with the right mix of bad ingredients &#8212; rising rates of opiate addiction, poverty, and lack of access to clean needles. Notably, in\u00a0the rest of the US this mode of HIV transmission has become quite rare &#8212;\u00a0here in Boston, I haven&#8217;t seen a newly acquired case of HIV from IDU in years. <a href=\"http:\/\/www.thenation.com\/blog\/203185\/indiana-hiv-crisis-didnt-have-happen\" target=\"_blank\">Bad time for complacency on this issue.<\/a><\/li>\n<li><strong><a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6412a2.htm?s_cid=mm6412a2_w\" target=\"_blank\">Watch out for ciprofloxacin-resistant shigella in returning travelers<\/a>.\u00a0<\/strong>As noted in the report,\u00a0&#8220;shigella is transmitted easily from person-to-person&#8221;, which is\u00a0something of an understatement since some people can get sick after ingesting <a href=\"http:\/\/www.about-shigella.com\/\" target=\"_blank\">fewer than 100 bacteria.<\/a><\/li>\n<li><a href=\"http:\/\/ehp.niehs.nih.gov\/1408555\/\" target=\"_blank\"><strong>The air\u00a0near beef cattle feed yards\u00a0carries antibiotics, antibiotic resistance genes, and resistant bacteria.<\/strong><\/a>\u00a0Yuck, good idea to stay up-wind. Remember, 80% of our national use of antibiotics goes to livestock. Will the <a href=\"http:\/\/www.nytimes.com\/2015\/03\/28\/us\/politics\/obama-seeks-to-double-funding-to-fight-antibiotic-resistance.html\" target=\"_blank\">programs announced this week by Obama actually reduce this use?<\/a><\/li>\n<li>I recently learned that two\u00a0of\u00a0the HACEK organisms have new names:\u00a0<strong><a href=\"http:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0063181\" target=\"_blank\"><em>Haemophilus aphrophilus<\/em> is now <em>Aggregatibacter aphrophilus, <\/em>and\u00a0<em>Actinobacillus actinomycetemcomitans<\/em> is now <em>Aggregatibacter actinomycetemcomitans<\/em>.<\/a><\/strong>\u00a0Wow. The mnemonic &#8220;HACEK&#8221; still works, however, standing for\u00a0<em><strong>H<\/strong>aemophilus<\/em> species, <em><strong>A<\/strong>ggregatibacter<\/em> species, <em><strong>C<\/strong>ardiobacterium hominis<\/em>, <em><strong>E<\/strong>ikenella corrodens<\/em>, and <em><strong>K<\/strong>ingella<\/em> species.\u00a0I&#8217;m convinced some\u00a0of us chose ID as a specialty just so we could know information like this.<\/li>\n<\/ul>\n<p>Hey, it&#8217;s Holy Week. Colored (sometimes green)\u00a0eggs and ham! <a href=\"http:\/\/www.marshmallowpeeps.com\/\" target=\"_blank\">Peeps!<\/a> Matzo balls and brisket! <a href=\"http:\/\/www.manischewitzstore.com\/Manischewitz-Fruit-Slices-Gift-Pack-Tray--Pareve-8-oz_p_3796.html\" target=\"_blank\">Jelly fruit slices!<\/a> For those of a less traditional spiritual bent, enjoy this:<\/p>\n<p><center><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/1kDso5ElFRg\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/center><br \/>\n<em>H\/T to Joel Gallant for the vid.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A few ID\/HIV tidbits to contemplate as\u00a0we go from slipping on\u00a0ice and snow\u00a0to dodging the\u00a0mud: Beta-lactam therapy alone is non-inferior to regimens that also cover &#8220;atypicals&#8221; for hospitalized patients with pneumonia.\u00a0These results challenge a dogma that has been present for a couple of decades &#8212; namely, that all patients admitted with community-acquired pneumonia should get [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,8,9,10],"tags":[565],"class_list":["post-5950","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","category-policy","category-research","tag-link-o-rama"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/5950","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=5950"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/5950\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=5950"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=5950"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=5950"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}