This email popped into my inbox the other day from a person I've never met:
Hi Dr. Sax,
I do mostly hospital-based ID in Pennsylvania, and was consulted on a newly diagnosed HIV patient with CD4 10, viral load 210,000, and lymphoma. I started him on Truvada and dolutegravir, which is going well so far. Because he complained of blurred vision, he had an ophtho evaluation yesterday which showed CMV retinitis. My drug-interaction checker says I can't use valganciclovir with either tenofovir or abacavir, and if I replace the Truvada with a boosted PI, it will interact with his chemotherapy. What should I do for his ART?
Thanks so much.
MMWR just published a paper entitled, Strategies for Preventing HIV Infection Among HIV-Uninfected Women Attempting Conception with HIV-Infected Men -- United States, and it's both a welcome and a very strange document indeed.
Most of you are clinicians -- doctors, nurses, PAs, PharmDs. A smaller proportion are researchers, lab-oriented types who wandered over here unexpectedly after an errant search, expecting the latest in CRISPR-Cas9 gene editing and instead getting an ID Link-o-Rama, a rumination on vintage medical photos, and a mysteriosis about listeriosis.
Since expression of gratitude makes you happier -- hey, I read it on the internet -- and whining does the reverse, I've decided to turn what was going to be a typical rant about dealing with insurance companies into an expression of thanks to a remarkable group of professionals.
Last week, the HIV/ID research world lost one of its leaders and pioneers when Dr. Mark Wainberg unexpectedly died. An astute, thoughtful virologist -- and a warm, engaging person -- he led the HIV research program at McGill University in Montreal for years, contributing to the field both through his research and patient advocacy. A strong voice in the effort to expand HIV therapy to Africa in the early 2000s, Mark was also a vocal critic of HIV denialism.
I had dinner with my daughter Mimi the other evening, and was ruminating about how things have changed since I started work as an Infectious Diseases doctor around 25 years ago.
Several years ago, one of my very brilliant colleagues posed an interesting question.
Why do ID specialists even exist?
The Conference on Retroviruses and Opportunistic Infections (CROI) returned to Seattle this past week for its 24th meeting. It's the 4th time CROI has been held in Seattle, an excellent city for a meeting of this size, which includes "only" 4200 people. The convention center is pleasant and user-friendly -- big but not cavernous, actually encourages interactions with colleagues -- and there are numerous hotels and restaurants within walking distance, plus more Starbucks per square foot than any place on the planet.
A couple of years ago, I reread some journals I'd kept during the worst years of the AIDS epidemic. I hadn't looked at them in more than a decade and was surprised not only by their vividness but also by the rawness of their content. They brought back memories of a time I'd almost forgotten or, rather, repressed because of the intense sadness they evoked. As a doctor, I was taught to keep an emotional distance from my patients. Too much emotion clouds one's judgment. But how does one keep an emotional distance from men who were like me at the time, young and gay and who ought to have had more tomorrows than yesterdays?
The people researching cardiovascular disease in HIV have quite the challenge.
Because when you think about it for a second, we HIV treaters are a pretty spoiled bunch when it comes to therapeutic success.
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