{"id":7613,"date":"2015-08-17T09:12:13","date_gmt":"2015-08-17T13:12:13","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=7613"},"modified":"2015-08-17T09:49:19","modified_gmt":"2015-08-17T13:49:19","slug":"dog-days-of-summer-id-link-o-rama","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/dog-days-of-summer-id-link-o-rama\/2015\/08\/17\/","title":{"rendered":"Dog Days of Summer ID Link-o-Rama"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/08\/dogjump.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-7616 size-medium\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/08\/dogjump-300x200.jpg\" alt=\"dogjump -- http:\/\/www.unprofound.com\/viewpic.php?pic=dogjump.jpg&amp;photographer=rusworks\" width=\"300\" height=\"200\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/08\/dogjump-300x200.jpg 300w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/08\/dogjump-1024x683.jpg 1024w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/08\/dogjump-900x600.jpg 900w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2015\/08\/dogjump.jpg 1167w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>A few ID\/HIV items of note to consider as you gather up your sunscreen, flip flops, towels, and sand toys and head off to the beach:<\/p>\n<ul>\n<li>Interesting\u00a0review of the <strong><a href=\"http:\/\/www.ibtimes.com\/legionnaires-disease-outbreak-2015-south-bronx-why-it-happened-area-plagued-health-2049102\" target=\"_blank\">impact of low\u00a0socioeconomic status\u00a0in the recent outbreak of Legionnaires&#8217; Disease in the South Bronx.<\/a><\/strong>\u00a0It&#8217;s just like (almost) every infection &#8212;\u00a0the combined effects of crowding, poor sanitation, and high levels of other comorbid diseases greatly amplify\u00a0the risk of getting this disease.<\/li>\n<li>Want an exception to this rule? <strong><a href=\"http:\/\/www.nytimes.com\/2015\/08\/13\/fashion\/ticks-summers-unwanted-guests.html?_r=0\" target=\"_blank\">How about Lyme Disease?<\/a>\u00a0<\/strong>Quite the statement that the linked\u00a0article appeared in the Fashion and Style section of the <em>Times!<\/em> And here&#8217;s the first paragraph: <em>&#8220;At a recent dinner party in Greenwich, Conn., Topic A was not stock futures or boarding school, but something decidedly less tony: <a class=\"meta-classifier\" title=\"In-depth reference and news articles about Ticks.\" href=\"http:\/\/health.nytimes.com\/health\/guides\/poison\/ticks\/overview.html?inline=nyt-classifier\">ticks<\/a>.&#8221;<\/em><\/li>\n<li>Which is emphatically <em>not<\/em> to say that Lyme is a small\u00a0problem, or just the product of the overactive imagination of the worried-well leisure class.\u00a0An\u00a0upcoming paper in <em>Emerging Infectious Diseases<\/em> <strong><a href=\"http:\/\/www.nlm.nih.gov\/medlineplus\/news\/fullstory_154076.html\" target=\"_blank\">estimates there are around 329,000 cases annually<\/a><\/strong>.\u00a0And if you want to see the highest incidence locations, here&#8217;s a <strong><a href=\"http:\/\/wwwnc.cdc.gov\/eid\/article\/21\/8\/14-1878-f1\" target=\"_blank\">remarkable map<\/a><\/strong> from last month&#8217;s issue.<\/li>\n<li>Last tick item, promise (though it is the season) &#8212; I&#8217;ve noticed a bunch of sites\u00a0now refer to the\u00a0<em>Ixodes<\/em> tick vector for Lyme-anaplasma-babesia as the<strong> <a href=\"http:\/\/www.cdc.gov\/lyme\/transmission\/blacklegged.html\" target=\"_blank\">&#8220;blacklegged&#8221; tick instead of the &#8220;deer tick.&#8221;<\/a>\u00a0<\/strong>When did that happen?\u00a0Did the deer get the memo from\u00a0the <strong><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/citing-who-guidelines-squirrels-protest-latest-virus-discovery\/2015\/07\/11\/\" target=\"_blank\">variegated squirrels<\/a><\/strong>, and are now protesting? What about all the other creatures with black legs? How do you think they feel?<\/li>\n<li><a href=\"http:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/ucm455888.htm\" target=\"_blank\"><strong>Daclatasvir is now available<\/strong>,<\/a> and the excellent\u00a0<strong><a href=\"http:\/\/www.hcvguidelines.org\/full-report\/initial-treatment-hcv-infection\" target=\"_blank\">HCV treatment guidelines have been updated.<\/a> <\/strong>The most important change is the recommendation for treatment of genotype 3 &#8212; 12 weeks of daclatasvir\/sofosbuvir if no cirrhosis, 24 weeks (with or without RBV) with cirrhosis.<\/li>\n<li>Several more important HIV\/HCV coinfection\u00a0studies published: \u00a0<strong><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1501315\" target=\"_blank\">sofosbuvir\/ledpasvir<\/a>, <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1503153\" target=\"_blank\">sofosbuvir plus daclatasvir<\/a><\/strong>, and <strong><a href=\"http:\/\/www.thelancet.com\/journals\/lanhiv\/article\/PIIS2352-3018(15)00114-9\/abstract\" target=\"_blank\">grazoprevir\/elbasvir<\/a><\/strong>. (Last of these\u00a0slated for approval within 6 months.) All have outstanding (&gt;95%) cure rates, comparable to those without HIV. It&#8217;s the drug-drug interactions that need watching &#8212; very useful\u00a0<strong><a href=\"http:\/\/www.hcvguidelines.org\/full-report\/unique-patient-populations-patients-hivhcv-coinfection\" target=\"_blank\">figure here.<\/a><\/strong><\/li>\n<li>This meta analysis found <strong><a href=\"http:\/\/annals.org\/article.aspx?articleid=2424872\" target=\"_blank\">impressive benefits of corticosteroids as adjunctive treatment for community acquired pneumonia.<\/a>\u00a0<\/strong>Probably not ready for standard-of-care (yet), and\u00a0I like the suggestion from the editorialist to find surrogates (clinical or lab-based) for which patients would benefit the most.<\/li>\n<li>The <strong><a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6430a3.htm\" target=\"_blank\">updated flu vaccine guidelines have been released<\/a><\/strong>, and as usual they are quite\u00a0a mouthful: &#8220;The vaccines will contain hemagglutinin (HA) derived from an A\/California\/7\/2009 (H1N1)-like virus, an A\/Switzerland\/9715293\/2013 (H3N2)-like virus, and a B\/Phuket\/3073\/2013-like (Yamagata lineage) virus &#8230;\u00a0Quadrivalent influenza vaccines will contain these vaccine viruses, and a B\/Brisbane\/60\/2008-like (Victoria lineage) virus.&#8221; Got that? Report also includes updates on the live attenuated vaccine, and indications for vaccination in general, which include basically everyone.<\/li>\n<li><a href=\"http:\/\/cid.oxfordjournals.org\/content\/61\/5\/683.full#content-block\" target=\"_blank\"><strong>Long-term valacyclovir provides no benefit after HSV encephalitis.<\/strong><\/a>\u00a0An\u00a0important negative study, it could not have been easy to identify eligible patients and enroll them. (It took nearly 10 years to complete.) The\u00a0overall excellent outcome in both arms &#8212; 86-90% with mild or no neurologic sequelae at 2 years &#8212;\u00a0likely reflects the exclusion of the sickest patients with this scary condition.<\/li>\n<li>Anyone notice<strong> <a href=\"http:\/\/survivinghiv.blogspot.com\/2007\/06\/ziagen-abacavir-can-cause-anxiety-in.html\">an association between abacavir and anxiety?<\/a><\/strong>\u00a0Link is to an observation (and a couple of published case reports, though the second one could have been EFV) from long-time HIV\/AIDS advocate, Nelson Vergel. I personally have not seen this side effect, though it does seem that some people starting integrase-based treatments (including dolutegravir) develop\u00a0insomnia.<\/li>\n<li>Baseball\/ID overlap warning &#8212; Los Angeles Dodger fans are no doubt happy that their excellent\u00a0third-baseman <a href=\"http:\/\/www.baseball-reference.com\/players\/t\/turneju01.shtml\" target=\"_blank\">Justin Turner<\/a> is off the disabled list after a <strong><a href=\"http:\/\/www.latimes.com\/sports\/dodgers\/dodgersnow\/la-sp-dn-dodgers-justin-turner-nears-return-20150812-story.html\" target=\"_blank\">bad bout of\u00a0MRSA.<\/a><\/strong>\u00a0Contact precautions in the locker room? Gowns and gloves when he comes to bat? Purell stations at each base?<\/li>\n<\/ul>\n<p>Title of this post notwithstanding, the weather in Boston this summer has been great\u00a0&#8212; mostly warm days, cool nights, low humidity &#8212; hence the energetic jumping pooch in the picture (not mine, click on it for full effect).\u00a0I just love the phrase, &#8220;dog days of summer&#8221;, and wanted an excuse to use it.<\/p>\n<p>Hey, it&#8217;s <a href=\"http:\/\/www.wunderground.com\/q\/zmw:00000.1.41194\" target=\"_blank\">hot somewhere!<\/a><\/p>\n<p>[youtube http:\/\/www.youtube.com\/watch?v=Pl_wK6pOmxE&amp;w=560&amp;h=315]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A few ID\/HIV items of note to consider as you gather up your sunscreen, flip flops, towels, and sand toys and head off to the beach: Interesting\u00a0review of the impact of low\u00a0socioeconomic status\u00a0in the recent outbreak of Legionnaires&#8217; Disease in the South Bronx.\u00a0It&#8217;s just like (almost) every infection &#8212;\u00a0the combined effects of crowding, poor sanitation, [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,7,8,10],"tags":[408,423,1067,501,1064,565,575,630],"class_list":["post-7613","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-misc","category-patient-care","category-research","tag-hcv","tag-hiv","tag-hsv-encephalitis","tag-influenza-vaccine","tag-legionnaires","tag-link-o-rama","tag-lyme","tag-mrsa"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/7613","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=7613"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/7613\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=7613"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=7613"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=7613"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}