{"id":8231,"date":"2016-12-04T17:10:18","date_gmt":"2016-12-04T22:10:18","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8231"},"modified":"2016-12-06T16:46:06","modified_gmt":"2016-12-06T21:46:06","slug":"just-wondering","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/just-wondering\/2016\/12\/04\/","title":{"rendered":"Just Wondering:  Quick ID\/HIV Questions to Ponder During Month Number 12"},"content":{"rendered":"<p>A selection of ID\/HIV questions that have been dogging\u00a0me over the past year, some longer:<\/p>\n<ul>\n<li><strong>Why is there no reliable, readily available\u00a0PCR diagnostic test for malaria?<\/strong>\u00a0Seems especially ironic since the one for babesia\u00a0has become so commonly used. Does the <a href=\"https:\/\/www.fishersci.com\/shop\/products\/alere-binaxnow-malaria-tests-3\/p-3987135\" target=\"_blank\">Binax antigen test<\/a> make it unnecessary?<\/li>\n<li><strong>Why aren&#8217;t we <em>actively<\/em> recommending Zika testing for\u00a0couples who return from endemic areas and are interested in conceiving?<\/strong>\u00a0A negative test would make a low-likelihood but serious outcome (congenital Zika) even less likely. They could still wait the recommended six months if they want.<\/li>\n<li><strong><em>What is the right abbreviation for Pneumocystis<\/em> pneumonia? <\/strong>\u00a0Is it\u00a0&#8220;PCP&#8221; (<em>PneumoCystis<\/em>\u00a0pneumonia) or &#8220;PJP&#8221; (<em>Pneumocystis jirovecii<\/em>\u00a0pneumonia)? Have heard smart people use both; I prefer the former.<\/li>\n<li><strong>Once there\u00a0are more manufacturers of generic daptomycin and the price drops, how long before it&#8217;s used more than vancomycin?<\/strong> If we never have to monitor vancomycin levels again, there should be\u00a0a small celebration.<\/li>\n<li><strong>In the big new HIV vaccine study just starting,\u00a0how many participants will also be receiving\u00a0PrEP?<\/strong>\u00a0Here&#8217;s the <a href=\"http:\/\/www.avac.org\/trial\/hvtn-702\" target=\"_blank\">study design of HVTN 702,<\/a> and PrEP clearly is allowed. I suspect it won&#8217;t be available to most of the participants, otherwise it\u00a0could make it hard to discern\u00a0whether the vaccine actually works.<\/li>\n<li><strong>Does anyone really know the full\u00a0meningococcal vaccination recommendations without looking them up?\u00a0<\/strong>For the 99% of us who don&#8217;t, <a href=\"http:\/\/www.immunize.org\/askexperts\/experts_men.asp#recommendations\" target=\"_blank\">here they are.<\/a> This is an old bugaboo, inspired by the new recommendation to give meningococcal immunization to all HIV patients.<\/li>\n<li><strong>Could the headlines be any more misleading about how many patients contracted\u00a0HIV or HCV from the dentist who used his own equipment?<\/strong>\u00a0<a href=\"http:\/\/www.miamiherald.com\/news\/nation-world\/national\/article118293798.html\" target=\"_blank\">Here&#8217;s an example<\/a>\u00a0&#8212; you have to read it carefully to make sure you see the &#8220;May&#8221; in there.\u00a0But gotta sell papers\/get clicks (and I just contributed to the latter).<\/li>\n<li><strong><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/drones-to-shoot-mm-vaccine.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-8252\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/drones-to-shoot-mm-vaccine.png\" alt=\"drones-to-shoot-mm-vaccine\" width=\"356\" height=\"382\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/drones-to-shoot-mm-vaccine.png 604w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/drones-to-shoot-mm-vaccine-280x300.png 280w\" sizes=\"auto, (max-width: 356px) 100vw, 356px\" \/><\/a>Speaking of, is this the headline of the year?<\/strong>\u00a0I think we have a winner, folks &#8212; &#8220;GOVERNMENT DRONES WILL SHOOT VACCINATED M&amp;MS AT PRAIRIE DOGS.&#8221; The disease, for the record, is the &#8220;sylvatic plague.&#8221; You have to read <a href=\"http:\/\/www.popsci.com\/government-drones-will-shoot-vaccinated-mms-at-prairie-dogs-to-save-ferrets?con=TrueAnthem&amp;dom=tw&amp;src=SOC&amp;utm_campaign=&amp;utm_content=58423c3cb8a9fe00071cce7a&amp;utm_medium=&amp;utm_source=\" target=\"_blank\">the full story to believe it.<\/a> And just wait for the anti-vaxxers to protest.<\/li>\n<li><strong>If primary care clinicians\u00a0had a rapid diagnostic test that could tell patients definitively that they had a specific viral respiratory tract infection, would this decrease the use of outpatient antibiotics?<\/strong>\u00a0They could say,\u00a0&#8220;Mr. Smith, your test came back, and you have rhinovirus.&#8221; I say &#8220;Yes it will&#8221;; my colleague Jeff Linder (a primary care internist who studies antibiotic overuse) is skeptical.<\/li>\n<li><strong>Will broadly neutralizing antibodies (&#8220;bNAbs&#8221;) ever have a role in HIV treatment?<\/strong> Not based on <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1608243\" target=\"_blank\">this study.<\/a> Admittedly it&#8217;s early in bNAb research, but to date I&#8217;m not getting the bNAb enthusiasm.<\/li>\n<li><strong>We have penicillin G, and penicillin V, but what about the other letters?<\/strong>\u00a0Hat tip to\u00a0John Cafardi for this one.<\/li>\n<li><strong>Wouldn&#8217;t it be useful if ID doctors had some formal training in wound management?<\/strong> Big gap for many (most?) of us.<\/li>\n<li><strong>What percentage of non-occupational HIV post-exposure prophylaxis courses are unnecessary?<\/strong> I&#8217;m estimating 99.9994%, but that train seems to have left the station, with no going back.<\/li>\n<li><strong><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/Mytesi3.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-8251\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/Mytesi3.png\" alt=\"mytesi3\" width=\"323\" height=\"285\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/Mytesi3.png 726w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/Mytesi3-300x265.png 300w\" sizes=\"auto, (max-width: 323px) 100vw, 323px\" \/><\/a>Why did the new makers of crofelemer change the name from (the absurdly wonderful) <em>Fulyzaq<\/em> to (the less remarkable) <em>Mytesi?<\/em> <\/strong>And here&#8217;s an artist&#8217;s rendition of a Mytesi, in case you were sad\u00a0about the extinction of <a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/whats-a-fulyzaq-i-thought-youd-never-ask\/2013\/01\/03\/\" target=\"_blank\">Fulyzaq<\/a>.<\/li>\n<li><strong>In Lyme-endemic areas, why is there no recommendation to give a\u00a0single dose of antibiotics to\u00a0children with tick bites?<\/strong> Odd that we use this strategy in\u00a0essentially all\u00a0adults, and almost\u00a0no\u00a0children &#8212; it&#8217;s as if we were applying drinking-age criteria to this completely unrelated issue.<\/li>\n<li><strong>Why is a CSF exam recommended in all patients with optic or otic syphilis?<\/strong> Treatment is the same (IV penicillin) regardless of the results. Have been asking this question for years.<\/li>\n<li><strong>What fraction of HIV viral load tests that come back &#8220;VIRAL RNA DETECTED BUT BELOW THE QUANTIFIABLE RANGE OF THE ASSAY&#8221; are clinically important?<\/strong> Boy that must be rare. The ratio of (Emotionally important to patient)\/(Clinically important to patient) must be nearly infinite.<\/li>\n<li><strong>What&#8217;s it like to have an oral <\/strong><strong>carbapenem?<\/strong>\u00a0Someone <a href=\"http:\/\/www.ijidonline.com\/article\/S1201-9712(12)01238-6\/fulltext\" target=\"_blank\">from Japan might know.<\/a><\/li>\n<\/ul>\n<p>Ok, time for a couple of quick non-ID ones:<\/p>\n<ul>\n<li><strong>When will the Washington Redskins change their offensive name?<\/strong> Or the Cleveland Indians get rid of their unfunny\u00a0mascot?<a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/retire-chief-wah.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-8249\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/retire-chief-wah.png\" alt=\"retire-chief-wah\" width=\"414\" height=\"266\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/retire-chief-wah.png 590w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/retire-chief-wah-300x193.png 300w\" sizes=\"auto, (max-width: 414px) 100vw, 414px\" \/><br \/>\n<\/a><\/li>\n<li><strong>When will the torture of choosing a password be replaced by something easier and more reliable?<\/strong> Here&#8217;s one recent example. Arrghh.<br \/>\n<a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/password-torture.jpg\"><br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-8250\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/password-torture.jpg\" alt=\"password-torture\" width=\"489\" height=\"288\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/password-torture.jpg 589w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/12\/password-torture-300x177.jpg 300w\" sizes=\"auto, (max-width: 489px) 100vw, 489px\" \/><\/a><\/li>\n<\/ul>\n<p>Hey, it&#8217;s <a href=\"http:\/\/www.cdc.gov\/flu\/nivw\/index.htm\" target=\"_blank\">National Influenza Vaccination\u00a0Week!<\/a> Check your party schedule carefully.<\/p>\n<p><a title=\"It's National Influenza Vaccination Week (NIVW)! Did you know that flu season can begin as early as October, it usually peaks between December and February, and it can last as late as May? As long as flu virsues are spreading, it's not too late to get a flu vaccine to protect yourself and your loved ones through fall, winter and into spring. #GetAFluVax\" href=\"http:\/\/www.cdc.gov\/flu\/protect\/whoshouldvax.htm?s_cid=seasonalflu-bb-065\"><img decoding=\"async\" class=\"\" style=\"width: 610px;height: 299px;border: 0px\" src=\"http:\/\/www.cdc.gov\/flu\/images\/freeresources\/animated-nivw-2014.gif\" alt=\"It's National Influenza Vaccination Week (NIVW)! Did you know that flu season can begin as early as October, it usually peaks between December and February, and it can last as late as May? As long as flu virsues are spreading, it's not too late to get a flu vaccine to protect yourself and your loved ones through fall, winter and into spring. #GetAFluVax\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A selection of ID\/HIV questions that have been dogging\u00a0me over the past year, some longer: Why is there no reliable, readily available\u00a0PCR diagnostic test for malaria?\u00a0Seems especially ironic since the one for babesia\u00a0has become so commonly used. Does the Binax antigen test make it unnecessary? Why aren&#8217;t we actively recommending Zika testing for\u00a0couples who return [&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],"tags":[1146],"class_list":["post-8231","post","type-post","status-publish","format-standard","hentry","category-health-care","tag-just-wondering"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8231","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=8231"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8231\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8231"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8231"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8231"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}