IDSA News - March 2010
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From the President:
The 10 x ’20 Initiative—Ten New Antibiotics by 2020
In recognition of the imbalance between the dwindling antibacterial drug pipeline and the significant clinical need for new antibiotics to treat antibacterial-resistant infections, IDSA has launched a new advocacy campaign called the
10 x '20 initiative—an effort to mobilize key leaders and resources around a specific goal—to create an antibacterial research and development enterprise powerful enough to produce 10 new antibiotics by the year 2020.
In recognition of the imbalance between the dwindling antibacterial drug pipeline and the significant clinical need for new antibiotics to treat antibacterial-resistant infections, IDSA has launched a new advocacy campaign called the
10 x '20 initiative—an effort to mobilize key leaders and resources around a specific goal—to create an antibacterial research and development enterprise powerful enough to produce 10 new antibiotics by the year 2020. IDSA’s statement describing the 10 x '20 initiative is available in the April 15 issue of Clinical Infectious Diseases.
Prior generations gave us the gift of antibiotics. Today, our global community has a moral obligation to ensure this global treasure is available for our children and future generations. For that reason, earlier this month, I reached out to U.S. Health and Human Services Secretary Kathleen Sebelius and other government leaders, including Anthony Fauci, MD, director of the National Institute for Allergy and Infectious Diseases (NIAID), and Peggy Hamburg, MD, commissioner of the U.S. Food and Drug Administration (FDA), asking that they commit to the 10 x '20 goal and work with IDSA to tackle this major public health problem.
To educate policymakers about the need for new drugs and the 10 x '20 initiative and the problem of antibiotic resistance in general, IDSA has launched a new monthly e-newsletter targeting Congress. The Antibiotic Resistance Policy Update focuses on three key areas:
- antibiotic research and development and the need for government action to achieve the
10 x '20 goal;
- antibiotic resistance in health care facilities and communities and the need to enact the Strategies to Address Antimicrobial Resistance Act (H.R. 2400), which will strengthen federal antimicrobial resistance surveillance, prevention and control and research efforts;
- antibiotic use and resistance on the farm and the need to enact the Preservation of Antibiotics for Medical Treatment Act (H.R. 1549/S.619) in combination with the FDA’s recently announced public health approach for using antibiotics in food animals.
You may view the Antibiotic Resistance Policy Update e-news online.
Finally, IDSA is working to put a human face on this major public health problem and to demonstrate that antibiotic resistance has enormous costs in terms of lives lost and dollars spent in every U.S. state and around the world. IDSA members can help in important ways by sharing patient stories with us, using IDSA’s advocacy center to contact members of Congress, and by promoting the uptake of IDSA’s antimicrobial stewardship guidelines in your community.
IDSA/SHEA Release Updated Guideline for Clostridium difficile Infection
Developed by IDSA and the Society for Healthcare Epidemiology of America (SHEA), an updated guideline for the diagnosis, management, and treatment of Clostridium difficile infection (CDI) in adults is now available.
An updated guideline for the diagnosis, management, and treatment of Clostridium difficile infection (CDI) in adults is now available. Developed by IDSA and the Society for Healthcare Epidemiology of America (SHEA), the guideline appears in the May issue of Infection Control and Hospital Epidemiology and can be found online.
Replacing guidelines published in 1995, the new document reflects an increase in the overall incidence of CDI infection, the identification of a more virulent strain responsible for more severe cases worldwide, and evidence regarding decreased effectiveness of metronidazole in treating severe CDI cases. The guideline provides recommendations regarding:
- strategies for diagnosis
- appropriate therapy
- the minimum epidemiological data that should be collected and how the data should be reported
- infection control measures for hospitals to implement routinely and during an outbreak
Several performance measures for internal performance improvement are suggested within the guideline. Infection control practices should be consistent with guideline recommendations, as should treatment of initial episodes of CDI—in particular, patients with severe CDI should be treated with vancomycin. It is also important that appropriate testing be used for diagnosis.
In addition to updated recommendations, the guideline also summarizes critical gaps where research is needed to advance clinical treatment and care of CDI. The summary is the result of a new collaboration among guideline panels, IDSA’s Research Committee, and the Society’s Standards and Practice Guidelines Committee. Research gaps are identified in four categories: epidemiology, diagnostics, management, and prevention. The project is designed to shed light on critical gaps where research funding is needed. The CDI guideline is the first to include a research gaps summary identified through this collaboration.
The guideline is available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website.
IDSA Journal Club
This month: Studies investigating maraviroc in the initial treatment of HIV, the low recurrence of hepatotoxicity when tuberculosis (TB) treatment is reinitiated using any of three different strategies, the effectiveness of the 7-valent pneumococcal vaccine in preventing invasive disease in adults with HIV, and the timing of HIV treatment in TB/HIV coinfection.
In this feature, a panel of IDSA members identifies and critiques important new infectious diseases studies in the current literature that have a significant impact on the practice of infectious diseases medicine.
Does Maraviroc MERIT a Role in the Initial Treatment of HIV?
Reviewed by Christian B. Ramers, MD
In October 2009, the Food and Drug Administration (FDA) approved the use of maraviroc, a novel CCR5 inhibitor, for treatment-naïve patients with R5-tropic virus, following the agency’s 2007 approval for treatment-experienced patients. A study in the March 15 issue of the Journal of Infectious Diseases details the 48-week analysis of the Maraviroc versus Efavirenz Regimens as Initial Therapy (MERIT) study, the pivotal trial that led to the latest approval.
A key issue in the study and use of maraviroc is the need to determine viral tropism using a Trofile assay, which characterizes an individual’s virus as R5-tropic, X4-tropic, or dual/mixed-tropic. Maraviroc appears to have significant virologic activity only against R5-tropic HIV-1.
In the original MERIT study, 721 treatment-naïve patients were randomized to receive maraviroc 300 mg BID or efavirenz 600 mg QD, both with zidovudine-lamivudine BID. Pre-defined coprimary endpoints were the proportion of patients at week 48 achieving virologic suppression to two thresholds, < 400 and < 50 copies/mL. Although maraviroc was non-inferior to efavirenz using the 400 c/mL viral load cutoff (70.6 vs. 73.1 percent), non-inferiority criteria were not reached for the 50 c/mL cutoff (65.3 vs. 69.3 percent). However, patients were screened using an older version of the Trofile assay, causing many to be misclassified as having purely R5-tropic virus. Applying an enhanced Trofile assay blindly to frozen serum samples excluded 107 patients (15 percent) who carried X4-tropic virus at screening.
In the re-analysis, maraviroc resulted in statistically similar virologic suppression rates to efavirenz, at both cutoffs (73.3 vs. 72.3 percent, and 68.5 vs. 68.3 percent, respectively), and thus appears to be non-inferior to efavirenz for treatment-naïve patients. One other observation was a greater CD4+ increase in the maraviroc arm compared to efavirenz (170 cells/mL vs. 140 cells/mL p = 0.008), although the clinical significance of this is uncertain.
Despite FDA’s latest approval of maraviroc for treatment-naïve patients, the December 2009 Department of Health and Human Services guidelines did not recommend it as a preferred first-line agent. Given the cost and complexity of Trofile testing, and the variable prevalence of R5-tropism, its role in treatment-naïve patients remains uncertain.
(Cooper et al. J Infect Dis 2010;201:803-813.)
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Low Recurrence of Hepatotoxicity When Tuberculosis Treatment Is Reinitiated Using Any of Three Strategies
Reviewed by Christopher J. Graber, MD, MPH
Three different strategies for restarting tuberculosis (TB) treatment were associated with low reoccurrence of hepatotoxicity in patients who had had this problem initially with anti-TB therapy in a randomized trial published in the March 15 issue of Clinical Infectious Diseases.
The trial included 175 HIV-uninfected patients in India without chronic liver disease, viral hepatitis, or concomitant hepatotoxic medication use who had experienced hepatotoxicity with standard four-drug therapy (isoniazid (H), rifampin (R), pyrazinamide (Z), and ethambutol). The patients were restarted on H, R, and Z using one of three strategies following stabilization of liver function tests:
- immediate restart of H, R, and Z at full dose
- weekly incremental introduction of full-dose medication (R, then H, then Z)
- weekly incremental introduction of low-dose medication increased to full-dose over four days (H, then R, then Z)
Initial and recurrent hepatotoxicity were defined as:
- an increase in aminotransferases ≥5x upper limit of normal on one occasion or ≥3x on three consecutive occasions
- an increase in total bilirubin > 1.5 mg/dL, or
- any elevation in aminotransferase with anorexia, nausea, vomiting, and jaundice in combination with absence of evidence of viral hepatitis and resolution upon stopping H, R, or Z.
Nineteen (10.9 percent) of 175 patients had recurrence of hepatotoxicity, with no clear difference between the three strategies (8/58 in the first arm, 6/59 in the second, and 5/58 in the third). Because of the lower-than-anticipated overall rate of recurrent hepatotoxicity (possibly due to the relatively low-risk population enrolled and the somewhat less stringent entry criterion (c) above), the study was underpowered to detect differences in the three arms. However, the overall finding of a low rate of hepatotoxicity recurrence no matter which strategy was used is reassuring to clinicians who frequently encounter this scenario.
(Sharma et al. Clin Infect Dis 2010;50:833-9.)
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The 7-Valent Pneumococcal Conjugate Vaccine: Not Just for Kids Anymore?
Reviewed by Ed Dominguez, MD
Streptococcus pneumoniae is a significant cause of pneumonia, sinusitis, otitis media, and meningitis throughout the world. For HIV-infected individuals, the risk of invasive disease is up to 100 times higher. Although the 7-valent pneumococcal vaccine is effective in preventing invasive disease in children with HIV, the efficacy in infected adults is unknown.
A report in the March 4 issue of the New England Journal of Medicine describes a randomized, double-blind, placebo-controlled trial of secondary prophylaxis involving 496 adults in Malawi, 88 percent of whom were infected with HIV. Patients, all of whom had recovered from invasive pneumococcal illness, were vaccinated with either two doses of Prevnar heptavalent vaccine or matching placebo given four weeks apart. The primary endpoint was invasive disease, defined as a positive culture for a vaccine-specific serotype S. pneumonia during a four-year period.
There were 67 episodes of invasive disease in 52 patients, all with HIV-infection. Of these, 24 (35.8 percent) were caused by a vaccine serotype or serotype 6A; five occurred in vaccine recipients and the remaining 19 in placebo recipients. The vaccine efficacy, therefore, was 74 percent.
There were 73 deaths from any cause in the vaccine group, and 63 in the placebo group, leading to a hazards ratio in the vaccine group of 1.18, which is not statistically significant. While minor adverse events were more common in the vaccine group (41 vs. 13), serious adverse events (death or hospitalization) were less common in the vaccine group (3 vs. 17). Nine deaths were reported in the trial, two in the vaccine group and seven in the placebo group.
The efficacy of the heptavalent vaccine for secondary prophylaxis in adults was high, especially in the first 12 months after vaccination. It was also high for HIV-infected patients with CD4+ counts below 200. Although this was not evaluated, the investigators extrapolate that the vaccine may also be effective as primary prophylaxis for HIV-infected adults. They suggest that the immunogenicity of this adjuvant vaccine merits further investigation as to its possible use with other vaccines in HIV patients.
(French at al. NEJM 2010;362:812-822.)
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Timing of HIV Treatment in TB/HIV Coinfection: Concurrent Treatment Better Than Sequential Therapy
Reviewed by Rachel Simmons, MD
Initiating HIV therapy during treatment for tuberculosis (TB) was associated with a 56 percent reduction in mortality compared to sequential therapy. Investigators reported the findings of the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPIT) trial in the Feb. 25 issue of the New England Journal of Medicine.
In the open-label trial, 642 people with HIV infection, a CD4+ cell count less than 500, and TB infection were randomized into three groups:
- Early integrated: Antiretrovirals (didanosine, lamivudine, efavirenz) initiated within four weeks of starting tuberculosis therapy.
- Late integrated: Antiretrovirals started within four weeks of completing the intensive phase of TB treatment.
- Sequential: Antiretrovirals started within four weeks after the completion of TB therapy.
Based on a planned interim analysis, the study’s data and safety monitoring committee recommended that all patients in the sequential group start on antiretrovirals. The integrated groups were pooled and compared to the sequential therapy group. The median CD4 T cell count was 150 in the integrated therapy group and 140 in the sequential therapy group.
The death rate in the combined integrated group was 5.4 deaths per 100 person-years (25 deaths among 429 patients), compared to 12.1 deaths per 100 person years in the sequential group (27 deaths among 213 patients). The hazard ratio in the integrated group was 0.44 (95 percent CI 0.25 to 0.79, p = 0.003). There was an increased rate of immune reconstitution inflammatory syndrome (IRIS) in the combined integrated group (12.4 percent) compared to the sequential therapy group (3.8 percent). Five of the 53 people in the combined group that developed IRIS required treatment with glucocorticoids. No deaths were attributed to IRIS, and the rates of serious adverse events were similar in both groups.
This study does not fully address when during TB therapy to start antiretrovirals, but the findings show it is detrimental to wait until the completion of TB treatment.
(Karim et el. NEJM 2010;362:697-706.)
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EIN: Immunosuppressed Patients and Norovirus
The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of EIN, IDSA (EIN’s sponsor), or the Centers for Disease Control and Prevention (CDC), which funds the EIN. The reader assumes all risks in using this information.
A recent discussion on the EIN listserv suggested the need for additional research into treatment options for norovirus in immunosuppressed patients with a protracted illness. Currently, there is no vaccine to prevent norovirus infection and no drug to treat people who are infected. (This webpage from the Centers for Disease and Control and Prevention (CDC)’s division of viral diseases offers additional information about noroviruses for the public and for clinicians.)
A member in Florida asked, “Has anyone had experience with immunosuppressed patients who have a prolonged illness with rotavirus or norovirus and used nitazoxanide?”
Putting the question in context, the member reported “seeing lots of gastroenteritis in my area among hospital staff, family and friends. One of our allogeneic BMT [bone-marrow transplant] patients admitted for dehydration and gastroenteritis tested positive for norovirus by PCR of stool.” The patient improved with hydration and time but was not on corticosteroids and was three years removed from his transplant. Another BMT patient experienced symptoms for a longer duration (two weeks) and “got much better with nitazoxanide 500mg po bid for one week, longer than the three-day usual course, which we instituted when the diagnosis was confirmed.”
The Florida member referenced three articles related to the use of nitazoxanide:
- An April 2009 article from Clinical Medicine: Therapeutics, “Current Approaches to the Treatment of Gastrointestinal Infections: Focus on Nitazoxanide.”
- An article from the November 2006 issue of Alimentary Pharmacology & Therapeutics, “Nitazoxanide in the treatment of viral gastroenteritis: a randomized double-blind placebo-controlled clinical trial.”
- An International Journal of Infectious Diseases article from July 2009, “Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: a randomized, single-blind, controlled trial in Bolivian children.”
A respondent in Florida noted an article and related editorial that appeared in the October 2009 issue of Clinical Infectious Diseases and addressed allogeneic hematopoietic stem cell transplantation and norovirus gastroenteritis as a previously unrecognized cause of morbidity. “Nitazoxanide is not mentioned,” the respondent wrote.
A member in South Carolina asked if there had been “virologic confirmation of the etiology of the current apparently very widespread outbreak of a viral gastroenteritis syndrome in the last few weeks in the U.S.?”
The EIN member who posted the original question about nitazoxanide responded that a county health department on Florida’s Gulf Coast had reported outbreaks of norovirus in four chronic-care facilities and a nursing home. The member also referenced an October 2009 article in the New England Journal of Medicine about norovirus gastroenteritis. The article “never mentioned treatment with nitazoxanide, I assume because it’s a self-limited illness in the vast majority of people. Sounds like it’s a needed study in immunosuppressed patients with a protracted illness.”
More research may be needed in this area, as no EIN member was able to offer other suggestions for treatment of immunosuppressed individuals with prolonged illness.
E-mail the Emerging Infections Network.
The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public-health community detect trends in emerging infectious diseases.
A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) with funding from the Centers for Disease Control and Prevention (CDC), EIN tracks emerging infectious diseases and keeps the public-health community up to date with new disease trends, difficult cases, and other issues affecting members’ clinical practices. The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. Click here for more information or to join EIN.
Drug Approvals, Recalls, Adverse Events Update
IDSA offers two e-mail services to help members stay informed of updates from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). Content includes a range of topics, including new drug approvals and warnings. Recent alerts have included:
IDSA members can sign up for these services online. (You must be logged in to have access to this link.)
Is Your Facility Experiencing Antibiotic Shortages?
Report these to FDA and IDSA
Fragile PEPFAR Gains Slipping Away, Ugandan Clinician Tells U.S. Lawmakers
The Center for Global Health Policy brought Ugandan HIV clinician Peter Mugyenyi, MD, to Washington this month to give U.S. officials a firsthand account of the consequences in Africa from the near flat-funding of the President’s Emergency Plan for AIDS Relief (PEPFAR).
At a U.S. House of Representatives hearing, Dr. Mugyenyi testified that the flat lining in global AIDS funding has forced him and other health care providers to turn away sick patients—as many as 15 to 20 a day—who were promised treatment.
“Recently, an HIV-infected woman who was breastfeeding her HIV-negative child because she could not afford formula milk came to our clinic, having been turned away from three other clinics in Kampala because they had no slots. She knew that every day she breastfed her baby without being on treatment greatly increased the chances of her child getting infected, but she had no alternative,” Dr. Mugyenyi told U.S. lawmakers.
The situation, he said, jeopardizes the incredible gains PEPFAR has achieved in its first five years. “PEPFAR has saved millions of lives in Africa,” he said. “These people—and their mothers, husbands, wives, and children—got a chance to live” because of PEPFAR. But those fragile gains are already slipping away, he said.
Dr. Mugyenyi directs Uganda’s Joint Clinical Research Center, the largest PEPFAR implementer in East Africa. He was one of a half-dozen people in the room when PEPFAR was conceived in 2003 and has been one of the program’s most passionate supporters. During his trip to D.C., arranged by the Global Center and other groups, Dr. Mugyenyi met with key members of Congress, White House officials, reporters, and advocates, urging the U.S. to keep the promises made when Congress reauthorized PEPFAR as the Lantos-Hyde Act in 2008.
Read more about Dr. Mugyenyi’s visit and other global health news at the Global Center’s blog, www.sciencespeaks.wordpress.com.
Recent blog highlights include:
- A Q&A with Mel Spigelman, MD, president of the Global Alliance for TB Drug Development, about a new initiative designed to accelerate the development and approval of life-saving new treatments for tuberculosis (TB).
- Highlights of a new issue brief outlining the threat of drug-resistant TB and detailing comprehensive steps that policymakers need to take to combat multi-drug-resistant (MDR) and extensively drug-resistant (XDR) TB. The full brief can be found here.
- An interview with Dr. Kevin De Cock, recently tapped to launch the CDC’s new Center for Global Health.
Final Health Reform Bill Includes ID-Related Provisions
The health care reform bill President Obama signed into law March 23 includes several provisions related to IDSA’s priorities that will affect ID clinicians in the months and years ahead. Please see next month’s issue of IDSA News for more analysis of the final legislation and how it will affect you and your patients.
A brief summary is below. The bill includes measures related to prevention and wellness, which will:
- Expand coverage of all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) in all private plans, Medicare, and Medicaid
- Reauthorize the Section 317 program, which provides funding for immunizations
- Create a Prevention and Wellness Fund, which will provide an additional $7 billion over 10 years for prevention and wellness activities
- Establish new federal grants at the Centers for Disease Control and Prevention (CDC) to assist in surveillance and response to infectious diseases
The legislation also calls for a study of how expanding coverage of all vaccines under Medicare Part D would affect access. Other provisions will establish testing of new physician payment models, such as bundled payments, payments through accountable care organizations (ACOs), and the use of quality measures and cost-of-care models to determine payments.
The final health reform package did not address the need for a permanent fix to the Sustainable Growth Rate (SGR) under the Medicare physician reimbursement system. Physicians will see a 21 percent across-the-board cut in their Medicare payments due to Congress’ failure to pass another short-term fix before the current fix expires on April 1. Given that Congressional action on this issue is a near certainty, however, Medicare has instructed its contractors to hold claims for two weeks, providing more time for Congress to pass a short-term fix. For updates, please see IDSA’s website.
For analysis of the final health care reform legislation from the HIV Medicine Association (HIVMA), please click here.
ID Physicians Face Challenges to Earning Federal Incentives for Electronic Health Records
Some infectious disease physicians may find it difficult to quality for new financial incentives that are intended to encourage physicians to adopt electronic health records (EHR) systems. That was the message that IDSA sent to federal officials in a March 15 comment letter on a proposed rule for implementing the new program—which is slated to take effect Jan. 1, 2011.
IDSA told the Centers for Medicare and Medicaid Services (CMS) that the agency’s proposed rule is too administratively burdensome to encourage broad acceptance and participation by ID physicians. Additionally, IDSA said, CMS’s proposed definition of hospital-based “eligible professionals” (EPs) and the agency’s decision not to include a quality measures group specifically for infectious diseases could preclude many ID physicians from participating.
IDSA offered several suggestions to simplify the reporting requirements and expand the number of ID physicians who would be eligible. For example, IDSA noted that ID physicians who provide a substantial amount of inpatient care also play a unique and pivotal role in transitioning hospitalized patients with serious infections to the outpatient setting to receive complex antimicrobial infusion therapies. Unfortunately, hospital EHRs cannot typically be integrated into an office-based practice—meaning that many hospital-based ID physicians still need to purchase their own EHRs and should be eligible for financial incentives to do so.
IDSA also urged CMS to include infectious diseases as a specialty group for the purpose of reporting clinically relevant quality measures through the Physician Quality Reporting Initiative (PQRI). The 2010 PQRI includes eight HIV/AIDS accountability measures that ID physicians who treat this population can use. ID physicians who treat hepatitis C patients may be able to identify with the gastroenterology group. But under CMS’s current proposal, other ID physicians would not qualify.
The HIV Medicine Association (HIVMA) also expressed concerns about the CMS proposal, urging the agency to simplify the criteria and qualifying requirements. The way the program is currently structured, HIVMA said, it would favor larger, better-funded practices and early adopters of electronic records.
The new incentives don’t take effect until 2011, and CMS is expected to issue a final rule later this year that could shed more light on whether more ID and HIV physicians will be eligible.
In the meantime, physicians who believe they will qualify for EHR incentives should take the time to do their homework to ensure they select a system that’s best suited to their practice needs. There is very little financial benefit to implementing a system now, since Medicare/Medicaid incentive payments in 2011 and 2012 will be the same (see CMS chart below).
For IDSA’s March 15 letter to CMS, click here. For HIVMA’s March 11 letter, click here.
For information about selecting an EHR system, see www.idsociety.org/healthit.htm (you must be logged in to access this link).
Welcome, New Members!
Agarwal, Ritesh, MD
Antalek, Matthew, DO
Chengappa, Kambayanda, MD
DiArra, Bassirou, BCh
Hekman, Aliza, PA-C
Hillman, Jeffrey, PhD
Klein, Oscar, MD
Mathur, Purva, MD
McCarty, James, MD
Steenhoff, Andrew, MD
Zabner, Rachel, MD
Brown, Brandon, MPH
Cassin, Maureen, MD
Cohall, Alwyn, MD
Damania, Blossom, PhD
Godfrey, Todd, MBA
Hoagbin, Joseph, MD, MA
Ismail, Kamal, MBBS
Kovacs, Katherine, BSN, MSN, NP
Kundus, Mary, MPH
Lakat, Michael, PhD
Ludy, William, RPh
Mazur, William, MD
Orlovic, Dragana, MD
Peterson, Dorothy, MBA, MT(ASCP)
Ramsey, Kelly, MD
Simpson, Donna, MBA
Banerjee, Suryabrata, MBBS
Bode-Sojobi, Ibidunni, MBBS
Devarajan, Vidya, MD
Doppalapudi, Avanthi, MD, MBBS
Jourjy, Jacqueline, PharmD
Krause, Jens, MD
Mawdsley, Emily, MD
McCulloh, Russell, MD
Miloshoff, James, PharmD
Pusch, Tobias, MD
Roussy, Jean-Francois, MD
Sanchez-Perez, Lilia, MD
Sharma, Konark, MD
Suh, Gina, MD
Trasboulsi, Rana, MD
Yager, Jessica, MD
Advancement to IDSA Fellow – Application Deadline April 15
There is still time to submit your application for advancement to IDSA fellow. Fellowship honors members who have achieved professional excellence and provided significant service to the profession. IDSA fellows are recognized by their peers as leaders in the field, either nationally or locally, in their communities, and in their hospitals. It is an honored rank that the Society reserves for its highest achievers.
Each application must be accompanied by two letters of nomination from current IDSA fellows. The deadline to apply is April 15. Additional information and the advancement to fellow application are available online. If you have questions about the application process, please contact Member Services at email@example.com or (703) 299-0200.
Practice Guidelines Available for iPhones and PDAs
Several IDSA and HIVMA practice guidelines are now available in a format designed for iPhones. Visit IDSA’s website for instructions for downloading and using these guidelines on an iPhone. Guidelines are also available for other mobile devices, including personal digital assistants (PDAs), on this webpage.
In addition, pocket-sized quick reference guides are available for guidelines on candidiasis, primary care management of HIV-infected patients, aspergillosis, community acquired pneumonia (CAP), and immunization. To view electronic previews and to order the 4-by-7-inch Pocketcards, visit IDSA’s website. IDSA members are eligible for a 20 percent discount when ordering. Use discount code DCIDSA09.
Use Your Member Discount at the ID/HIV Career Center
IDSA members receive a 30 percent discount when posting a physician position with the ID/HIV Career Center, the official online career center of IDSA and the HIV Medicine Association (HIVMA). The site is your link to first-rate job listings and job seekers in ID and HIV medicine, including academic/research, general, and pediatric. To learn more about cost-effective recruitment packages, visit the ID/HIV Career Center or call (888) 884-8242.