Category: HIV

Cryptococcus Meningitis – Making Amphotericin Float Like a Crashing Seagull and Sting Like a Scorpion

Am I going there? Am I going to look into a topic that one of my attendings literally wrote the guidelines for? I guess I am. Cryptococcus is a yeast that is typically found everywhere there is bat/pigeon droppings or contaminated soil, as well as in certain tree species throughout the world. The most common

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Two vs Three: The Magic Number for HIV Therapy

HIV therapy has undergone many iterations. Long gone are the days of AZT and semi-literal drug cocktails and we have entered into an era where HIV treatment is as easy as just getting one pill per day with Triumeq, Biktarvy, and Atripla which include three-active components. Newcomer, Cabotegravir, may change the game going forward as

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Chagas Disease Reactivation – What to Watch Out For

Primary infection with T. cruzi, also known as American trypanosomiasis, is generally asymptomatic with a small percentage having non-specific symptoms such as fever, malaise, lymphadenopathy, and in certain cases, a Chagoma. The vast majority of people go on to develop an “intermediate” form of the disease, where serology is positive but there is no sign

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PJP in AIDS-Patients vs non-AIDS Patients

Consider this post a continuation of the prior one on prophylaxis. I mention a bit on the pathophysiology, where adaptive immunity seems to play a key role in the way the body deals with the fungus, with mice with SCID infected with pneumocystis not being able to mount an inflammatory response. As a result of

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Tracking Disseminated Histoplasmosis Treatment

When I say bat poop, caves, and Indiana, the answer is Histoplasmosis. In general, most people will not get disease even when inhaling any conidia, however those who have decreased cellular immunity (i.e. solid organ transplant and HIV) are at risk of pulmonary or disseminated disease. One of the difficult issues in those patients is

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Tivi-que? Why Dolutegravir is the GOAT(Thus Far)

Stop me if I have mentioned this before, but HIV therapy is actually quite simple these days. No longer do patients have to take a “cocktail” of medications (whatever that means, I typically think of the alcoholic cocktail) with regimens being streamlined into one simple pill: Atripla, Odefsy, Genvoya/Stribild, Triumeq, and the (relatively) new kid

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M184V – The Friendly Mutation?

As it so happens, someone much smarter than me has already written on this topic, so check out Paul Sax’s post: https://blogs.jwatch.org/hiv-id-observations/index.php/the-curious-case-of-m184v-part-2-and-more/2019/09/08/ There is no doubt that anti-retroviral therapy has been one of the greatest accomplishments in HIV care. Nowadays, HIV is essentially a chronic disease that is easily managed with combined therapy, usually with

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HIV Main Meds – Cheat Sheet

What to start? In general, start any combination that has an integrase inhibitor. In general, either Descovy OR Truvada + Dolutegravir Biktarvy (I think the most popular choice) Triumeq (if no HLA-B5701) There are newer combinations, which I will not go over (for instance, Dovato aka 3TC/DTG, Juluca aka DTG/RPV, Delstrigo aka TDF/3TC/DOR) nor will

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Microbiological Diagnosis of PJP – PCR and Beta D glucan

This post will not cover the clinical course or risk factors. We’ll be going over the direct fluorescence antibody, PCR, as well as the elusive beta-D glucan as well as taking a brief look at the original ways we used to diagnose PJP (or in some places, how they still diagnose it. In the days

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