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Paul Sax @paulsaxmd.bsky.social · 1d

Do you think clofazimine works? I can't think of a single clinical trial where a clofazimine vs a non-clofazimine arm showed that the clofazimine arm did better.

Yes, we use it -- but it sure would be nice to see some robust evidence that it's worth it.

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Paul Sax @paulsaxmd.bsky.social · 2d

Tremendous honor -- thank you so much @idsainfo.bsky.social and especially @darcy-id-doc.bsky.social #IDSky
www.idsociety.org/education--t...

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Paul Sax @paulsaxmd.bsky.social · 3d

open.substack.com/pub/paulsaxm...

Update on Louie and One Interesting ID Fact

To quote my friend, he's "not dead yet", and we're glad for the time.

open.substack.com

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Paul Sax @paulsaxmd.bsky.social · 3d

Update on the little guy -- plus one very interesting ID fact! (It's an ID blog, after all, not a dog blog.) #IDSky
(See next post if it doesn't open on your phone NEJM Journal Watch is working out some bugs.) blogs.jwatch.org/hiv-id-obser...

Update on Louie and One Interesting ID Fact

First, I want to express my sincere thanks to all those who commented, emailed, and texted about our dog Louie. My family and I truly appreciate the concern and the feelings people shared about their ...

blogs.jwatch.org

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Reposted by Paul Sax

IDSA @idsainfo.bsky.social · 11d

New #LetsTalkID! ID physician and artist Ana Velez, MD, FACP, joins @paulsaxmd.bsky.social to share how art shapes her work in ID and brings new meaning to medicine.

Transcript: bit.ly/3Iu863j

Bid now to own her original artwork and support IDSA's mission: givebutter.com/c/pclXSb/auc...

Blending Art, Medicine and Charity

Ana Velez, MD, FACP, joins Paul Sax, MD, FIDSA, to share how her passion for art fuels her work in infectious diseases.

bit.ly

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Paul Sax @paulsaxmd.bsky.social · 12d

Very well put! So sad.

(Your dog and Louie could be related ...)

Paul Sax @paulsaxmd.bsky.social · 12d

Thanks, Ilan. It's not good news from the work-up, as suspected. He probably has only a few days or weeks left.

(That's a really cute photo of Ricotta!)

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Paul Sax @paulsaxmd.bsky.social · 12d

Wrote this one with tears in my eyes 😢

blogs.jwatch.org/hiv-id-obser...

My Dog Louie, the Best Dog Ever, Is Seriously Ill

We got some bad news about our dog Louie, the world’s greatest dog. Writing his story here is therapeutic, so forgive the oversharing. In January, 2013, my wife forwarded me this email: She doesn’t us...

blogs.jwatch.org

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Paul Sax @paulsaxmd.bsky.social · 14d

Personally haven't used interferon for HCV in over a decade -- not since the great rush of HCV antivirals from 2013-16. Even when battling for insurance coverage, we knew that eventually we could treat people without this incredibly toxic (and not very effective) drug.

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Paul Sax @paulsaxmd.bsky.social · 15d

Hooray! Working on this one clinician at a time ... next up, "DAAs" for HCV!

C'mon, when was the last time someone used a something other than a "directly acting" antiviral for HCV?

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Paul Sax @paulsaxmd.bsky.social · 15d

I'm doing another required learning module, and alas it's back to the usual grind:

- start video
- try to fast-forward (disabled)
- run in background while doing other menial tasks
- take exam to get "Certificate of Completion"

Any evidence that this drudgery actually improves anything?

Paul Sax @paulsaxmd.bsky.social · 28d

An online required learning module that didn’t have me scrambling for the "fast forward" button? I’m stunned -- but impressed. Curious what module pulled off this miracle? Here are the details: blogs.jwatch.org/hiv-id-obser... #IDSky #MedSky

When Required Learning Modules Surprise You (In a Good Way)

Like most clinicians, I have a checkered history with required online learning modules. You know the drill: click play, get lectured in monotone about hand hygiene or fire safety, then spend the next ...

blogs.jwatch.org

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Paul Sax @paulsaxmd.bsky.social · 15d

Still time to register! Reasons to attend:
- updates on antibiotics and immunizations
- "can't miss" diagnoses
- expert approaches to C diff, H pylori, STIs, tick-related infections
- viral hepatitis/HIV for PCPs ... and MORE!

Live-streaming -- join us from anywhere!
idprimarycare.hmscme.com

Infectious Diseases in Primary Care

Harvard CME: The Comprehensive Infectious Disease Update—Prevention, Diagnosis, Treatment

idprimarycare.hmscme.com

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Paul Sax @paulsaxmd.bsky.social · 16d

truly impossible to remember these criteria, who agrees?

Lost Generation - 1883-1900
Greatest Generation - 1901-1927
Silent Generation - 1928-1945
Baby Boomer - 1946-1964
Generation X - 1965 - 1980
Millennial - 1981-1996
Generation Z - 1997-2012
Generation Alpha - 2013 - present

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Paul Sax @paulsaxmd.bsky.social · 17d

The latest in the controversy between 3 vs 2 drugs for HIV treatment -- now in advanced HIV disease, with the DOLCE study. @drlaurajwaters.bsky.social #IDSky #HIVsky blogs.jwatch.org/hiv-id-obser...

Two Drugs, Not Three: The DOLCE Study in Advanced HIV Disease

Three-drug therapy has been the standard of care for HIV therapy for so long it’s difficult to shake the view that it must be more effective than two drugs. This is particularly the case for those wit...

blogs.jwatch.org

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Paul Sax @paulsaxmd.bsky.social · 27d

just twiddling my thumbs, waiting for the next module

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Paul Sax @paulsaxmd.bsky.social · 28d

An online required learning module that didn’t have me scrambling for the "fast forward" button? I’m stunned -- but impressed. Curious what module pulled off this miracle? Here are the details: blogs.jwatch.org/hiv-id-obser... #IDSky #MedSky

When Required Learning Modules Surprise You (In a Good Way)

Like most clinicians, I have a checkered history with required online learning modules. You know the drill: click play, get lectured in monotone about hand hygiene or fire safety, then spend the next ...

blogs.jwatch.org

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Paul Sax @paulsaxmd.bsky.social · 28d

Amazing, generous, and rare attitude! Far preferable to the condescending views one often hears in places like these.
p.s. Do they adopt the English spelling of "center" in Canada? 😄

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Paul Sax @paulsaxmd.bsky.social · 29d

Thanks for the references. Hard to evaluate in these studies how much of a role clofazimine played given the multiple other active agents. It's possible that they would have been just as effective without it.

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Paul Sax @paulsaxmd.bsky.social · 29d

I'd feel better about the effort to get it if it worked -- but I can't find much to support that claim! blogs.jwatch.org/hiv-id-obser...

My Vote for the Weirdest Antibiotic on the Planet

If you’re an ID doctor, there’s an excellent chance you’ve treated patients who have non-tuberculous mycobacteria (NTM) with clofazimine. In fact, based on a poll done with the utmost scientific rigor...

blogs.jwatch.org

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Paul Sax @paulsaxmd.bsky.social · 29d

Is there any prospective randomized trial that shows a benefit with clofazimine treatment for either TB or NTM infections? We use it because options are so limited, but the data have been consistently disappointing.

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Paul Sax @paulsaxmd.bsky.social · Sep 6

Thank you, Isaac!

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Paul Sax @paulsaxmd.bsky.social · Sep 5

Hepatitis B transmission, dalbavancin for staph bacteremia, alpha-gal allergy, vaccine policy shifts, too much screening in pt care ... Some end-of-summer ID musings, with scattered other thoughts silly and not ID-related at all. And tennis, of course! #IDSky blogs.jwatch.org/hiv-id-obser...

End-of-Summer Musings -- Hepatitis B, Dalbavancin, Alpha-Gal, and More

The last time I did one of these quick “musings” posts, I listed 21, and someone asked me, “Why 21?” The answer — obviously — is that I originally planned on writing 20, but then had to add a 21st, ju...

blogs.jwatch.org

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Paul Sax @paulsaxmd.bsky.social · Aug 30

I meant that Covid gave license to all their anger. Gives them a "justification" for acting on their worst impulses, because they can point to things that the agency "got wrong" and claim it validates all their cruel and destructive actions.

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Paul Sax @paulsaxmd.bsky.social · Aug 30

For us ID doctors, the CDC has been a rock. Data, guidelines, surveillance, travel advice -- all there, vetted by experts, referenced, reliable. Perfect? No. But watching its dismantling now breaks my heart. Some thoughts: blogs.jwatch.org/hiv-id-obser...

Watching the Chaos at the CDC -- with Sadness and Alarm

Throughout my career as an infectious diseases doctor, the CDC has been a rock-solid source. Need reliable data on an outbreak? The CDC. Need thoughtful, evidence-based guidelines? The CDC. Need an au...

blogs.jwatch.org

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Paul Sax @paulsaxmd.bsky.social · Aug 28

When we care for PWH who have virologic suppression, but possible or confirmed NRTI resistance, can we switch them to a simple oral treatment -- once-daily BIC/FTC/TAF? This study says yes, with results strengthened by proviral DNA testing. #IDSky #HIVSky www.sciencedirect.com/science/arti...

Bictegravir, emtricitabine, and tenofovir alafenamide versus ritonavir-boosted protease inhibitor-based antiretroviral therapy in people with HIV and viral suppression on second-line therapy in Haiti:...

Patients on second-line protease inhibitor-based regimens in low-income and middle-income countries have high rates of nucleoside reverse transcriptas…

www.sciencedirect.com

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