Earlier Is Better

For years now there has been controversy about whether early HIV infection should be treated. Could the immune system be spared the ravages of the HIV virus through early therapy? Or does early therapy just make treatment last longer? The jury has been out, and might still be deliberating, but a new piece of evidence has emerged. 

 Deeks et al have shown that, compared to people treated later in HIV disease, those treated within 6 months of initial infection show less immune system damage over time. This might be a sign that early treatment is good.  

We still lack clear evidence that such benefits of early treatment outweigh the downsides of HIV treatment. The side effects, costs and other risks are real. So, we still await a clear sign. 

When face-to-face with a patient with early HIV infection, I tell them what we know, and what we don't, and we share the decision-making. Does the possibility of ongoing immune damage scare them enough to make taking an HIV pill or two daily worth it? Or  does the prospect of starting decades of therapy freak them out more? We talk through it, and most (but not all) start therapy. 

Someday, let's hope we know more.

Your Kid Probably Doesn't Need Antibiotics

 How to help everyone prevent the looming "antibiotic apocalypse"

We're looking for a new pediatrician, and, over coffee with friends, recommendations started flying. When it came out that our 14-year-old son had never taken antibiotics, the conversation stopped on a dime.

"What about for ear infections?" one said.

"Hasn't he ever had strep?" said another.

"Never?" said the third.

Read our full article at The Atlantic.

New paper about HIV-related tuberculosis

We found that HIV-infected adults who had tuberculosis before had double the risk of getting tuberculosis again. We should target preventive interventions here.

Click here to read my article in Clinical Infectious Diseases

Medical Student Training in Global Health Ethics

Many medical students are excited to serve overseas. But more and more commentators have raised concerns about the ethical and other pitfalls of what they call "service tourism."

What should students learn before and after global health outreach? Our paper in Academic Medicine  proposes a curriculum in global health ethics so students can avoid those ethical pitfalls.