Friday Fosfomycins

March 18, 2011

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

Today's ID/HIV comments and links are named after every ID specialist's favorite new toy for UTIs.

  • This HIV transmission from a kidney donor is getting quite a bit of media play, as such complications always do. I was at a meeting this AM when one of my colleagues (an endocrinologist) commented how horrible she thought it was. Yes ... but here's what I told her: the risk of some sort of infectious complication from transplantation, despite all our vigilance, no matter what tests we use, will never be zero. The only way to make transplants 100% safe is to stop doing them entirely. And that's not going to happen, nor should it.
  • Someone told me that CROI 2012 will be in Seattle "in late February." CROI trivia hounds will recall it was in Seattle in 2002, when we all learned the MTD (maximal tolerated dose) of caffeine. No confirmation on the date (naturally) from the CROI web site, so I wouldn't book your flights just yet.
  • Those of you who do inpatient ID consults will recognize some of the absurd dynamics in play in this animated (literally) conversation. It's an extreme example, but I confess I laughed out loud a few times anyway (sorry).
  • Friday Fosfomycins
  • Speaking of inpatient ID consults, I'm on service right now, and of course it's staph, staph, and more staph. (First-year ID fellows sometimes think they're doing a Staph aureus fellowship.) All this staph means I've had the opportunity to get some anecdotal experience with ceftaroline for MRSA. Since we learn in Statistics 101 that there's nothing less scientific than anecdotal (especially early anecdotal) evidence, I'll resist the impulse and see how things go for a bit longer, and will only say that the drug is tricky for home IV administration since it needs to be mixed up each day. Any other impressions out there?
  • Finally, for a pretty pessimistic view of the "test and treat" HIV strategy, here's a discouraging review of how few of the people living with HIV are actually engaged in care. By the estimates presented here, just under 20% of HIV-infected individuals in the United States have an undetectable HIV viral load. If the data are right, this figure says it all -- and regardless of whether there are 209,773 or 209,774 out of 1,106,400 with suppressed HIV, there's plenty of room for improvement.

Hat tip to the inimitable Rochelle Walensky for the video!

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

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This article was provided by NEJM Journal Watch. NEJM Journal Watch is a publication of the Massachusetts Medical Society.


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