Dr. David Boulware, MD MPH
@drboulware.bsky.social
Professor of Medicine at U of MN; Practicing infectious disease doc; budding mycologist; interested in cryptococcal & TB meningitis. Ran some RCTs during COVID, but more excited to return to focus on RCTs on HIV-related meningitis & advanced HIV disease
No longer... CDC EIS RIF'ed.
October 11, 2025 at 1:57 AM
No longer... CDC EIS RIF'ed.
Twin Cities Marathon Day.
Brunch with neighbors on front lawn cheering on runners.
Brunch with neighbors on front lawn cheering on runners.
October 5, 2025 at 2:51 PM
Twin Cities Marathon Day.
Brunch with neighbors on front lawn cheering on runners.
Brunch with neighbors on front lawn cheering on runners.
Day 2 of Minnesota State Fair - the Great Minnesota Get Together.
Largest state fair in daily attendance. Today feels like a low 160,000 person day.
Largest state fair in daily attendance. Today feels like a low 160,000 person day.
August 22, 2025 at 10:05 PM
Day 2 of Minnesota State Fair - the Great Minnesota Get Together.
Largest state fair in daily attendance. Today feels like a low 160,000 person day.
Largest state fair in daily attendance. Today feels like a low 160,000 person day.
We have a great multi-national team of clinical researchers, statisticians, lab scientists, microbiologists, immunologists, pharmacologist, neuroscience, health economics, and probably another category unnamed.
If you want to change the world & change your life, consider a Fogarty Fellowship.
If you want to change the world & change your life, consider a Fogarty Fellowship.
August 15, 2025 at 8:56 PM
We have a great multi-national team of clinical researchers, statisticians, lab scientists, microbiologists, immunologists, pharmacologist, neuroscience, health economics, and probably another category unnamed.
If you want to change the world & change your life, consider a Fogarty Fellowship.
If you want to change the world & change your life, consider a Fogarty Fellowship.
Overall AI summary of low dose flucytosine (5FC) trial for #crypto meningiitis.
doi.org/10.1093/cid/...
doi.org/10.1093/cid/...
August 9, 2025 at 12:30 AM
Overall AI summary of low dose flucytosine (5FC) trial for #crypto meningiitis.
doi.org/10.1093/cid/...
doi.org/10.1093/cid/...
While survival was similar (in this small sample size n=48 vs n=171 from Ambition trial recruited in Uganda), re-hosptializations trended towards being likely higher.
August 8, 2025 at 9:54 PM
While survival was similar (in this small sample size n=48 vs n=171 from Ambition trial recruited in Uganda), re-hosptializations trended towards being likely higher.
When we looked at the Win Ratio using a hierrchical composite outcome, the standard of care (Ambition regimen) was not statistically different, but favored SOC.
This is the first fungal clinical trial to use a DOOR or Win Ratio outcome (I believe). More to come soon.
This is the first fungal clinical trial to use a DOOR or Win Ratio outcome (I believe). More to come soon.
August 8, 2025 at 9:51 PM
When we looked at the Win Ratio using a hierrchical composite outcome, the standard of care (Ambition regimen) was not statistically different, but favored SOC.
This is the first fungal clinical trial to use a DOOR or Win Ratio outcome (I believe). More to come soon.
This is the first fungal clinical trial to use a DOOR or Win Ratio outcome (I believe). More to come soon.
Mixed results - similar mortality but higher number of rehospitalizations and worse microbiolgoic clearance as compared to Ambition regimen (liposomal ampho 10mg/kg x1 + fluconazole 1200mg + 5FC at 100mg/kg) . We do not recommend.
CSF crypto clearance rate (EFA) was worse, suggesting 5FC is key.
CSF crypto clearance rate (EFA) was worse, suggesting 5FC is key.
August 8, 2025 at 9:51 PM
Mixed results - similar mortality but higher number of rehospitalizations and worse microbiolgoic clearance as compared to Ambition regimen (liposomal ampho 10mg/kg x1 + fluconazole 1200mg + 5FC at 100mg/kg) . We do not recommend.
CSF crypto clearance rate (EFA) was worse, suggesting 5FC is key.
CSF crypto clearance rate (EFA) was worse, suggesting 5FC is key.
What is the correct dose of flucytosine in cryptococcal meningitis? 100mg/kg is a round number? Is it correct? We sought to test whether lower dose 60mg/kg x 10 days was equally effective. doi.org/10.1093/cid/...
Trial was designed by the great ID UMN fellow Tom McHale @umn-idim.bsky.social
Trial was designed by the great ID UMN fellow Tom McHale @umn-idim.bsky.social
August 8, 2025 at 9:51 PM
What is the correct dose of flucytosine in cryptococcal meningitis? 100mg/kg is a round number? Is it correct? We sought to test whether lower dose 60mg/kg x 10 days was equally effective. doi.org/10.1093/cid/...
Trial was designed by the great ID UMN fellow Tom McHale @umn-idim.bsky.social
Trial was designed by the great ID UMN fellow Tom McHale @umn-idim.bsky.social
CDC has removed the ACIP presentation from the website, but this is the slide 20 with the fake citation.
Fake Citation that is made up. No such manuscript exists.
Look at Neurotoxicity 2008 journal page 914-922. sciencedirect.com/journal/neur...
Fake Citation that is made up. No such manuscript exists.
Look at Neurotoxicity 2008 journal page 914-922. sciencedirect.com/journal/neur...
June 24, 2025 at 11:17 PM
CDC has removed the ACIP presentation from the website, but this is the slide 20 with the fake citation.
Fake Citation that is made up. No such manuscript exists.
Look at Neurotoxicity 2008 journal page 914-922. sciencedirect.com/journal/neur...
Fake Citation that is made up. No such manuscript exists.
Look at Neurotoxicity 2008 journal page 914-922. sciencedirect.com/journal/neur...
Under he NIH Parent Announcements for NIH grant applications, there is just a blank space where PhD fellowship training awards used to be listed.
grants.nih.gov/funding/nih-...
grants.nih.gov/funding/nih-...
May 9, 2025 at 5:29 PM
Under he NIH Parent Announcements for NIH grant applications, there is just a blank space where PhD fellowship training awards used to be listed.
grants.nih.gov/funding/nih-...
grants.nih.gov/funding/nih-...
@CIDJournal Publication
"Cryptococcal Meningitis Treatment Beyond HIV: Recognizing the need for Individualized Immune-Based Strategies"
Immune status is an untapped key in treating infectious diseases. It's complicated, particularly in those without HIV
academic.oup.com/cid/advance-...
"Cryptococcal Meningitis Treatment Beyond HIV: Recognizing the need for Individualized Immune-Based Strategies"
Immune status is an untapped key in treating infectious diseases. It's complicated, particularly in those without HIV
academic.oup.com/cid/advance-...
April 26, 2025 at 8:28 PM
@CIDJournal Publication
"Cryptococcal Meningitis Treatment Beyond HIV: Recognizing the need for Individualized Immune-Based Strategies"
Immune status is an untapped key in treating infectious diseases. It's complicated, particularly in those without HIV
academic.oup.com/cid/advance-...
"Cryptococcal Meningitis Treatment Beyond HIV: Recognizing the need for Individualized Immune-Based Strategies"
Immune status is an untapped key in treating infectious diseases. It's complicated, particularly in those without HIV
academic.oup.com/cid/advance-...
NIH budget proposal from Trump Administration in the context of recent history. Budget in constant dollars (adjusted for inflation).
Per the US Constitution, the budget is set by Congress but the President submits a proposal reflecting their vision of how to make America great.
Per the US Constitution, the budget is set by Congress but the President submits a proposal reflecting their vision of how to make America great.
April 17, 2025 at 7:09 PM
NIH budget proposal from Trump Administration in the context of recent history. Budget in constant dollars (adjusted for inflation).
Per the US Constitution, the budget is set by Congress but the President submits a proposal reflecting their vision of how to make America great.
Per the US Constitution, the budget is set by Congress but the President submits a proposal reflecting their vision of how to make America great.
NIH objective to slowly kill clinical research is apparent by the proportion of NIH grants going to physicians which have dropped from ~20% to ~10% over the last two decades.
This affects quality and quanity of clinical ID research for conferences, such as IDWeek.
This affects quality and quanity of clinical ID research for conferences, such as IDWeek.
April 13, 2025 at 5:57 PM
NIH objective to slowly kill clinical research is apparent by the proportion of NIH grants going to physicians which have dropped from ~20% to ~10% over the last two decades.
This affects quality and quanity of clinical ID research for conferences, such as IDWeek.
This affects quality and quanity of clinical ID research for conferences, such as IDWeek.
HARVEST Trial was a huge team effort spanning four continents.
April 13, 2025 at 4:37 PM
HARVEST Trial was a huge team effort spanning four continents.
Complexities of TB meningitis further clear evidence that a one-sized fits all approach to opportunistic infectious diseases may be overly simplistic. For some opportunistic infections, one cannot ignore the host immune status.
Damage-response framework is key
www.nature.com/articles/nrm...
Damage-response framework is key
www.nature.com/articles/nrm...
April 13, 2025 at 4:35 PM
Complexities of TB meningitis further clear evidence that a one-sized fits all approach to opportunistic infectious diseases may be overly simplistic. For some opportunistic infections, one cannot ignore the host immune status.
Damage-response framework is key
www.nature.com/articles/nrm...
Damage-response framework is key
www.nature.com/articles/nrm...
American Society of Tropical Medicine & Hygiene (ASTMH) position on April 1 US government actions
April 2, 2025 at 9:59 PM
American Society of Tropical Medicine & Hygiene (ASTMH) position on April 1 US government actions
Estimated change in new infections with the abrupt termination of PEPFAR. Treatment as prevention has been the mantra for the last decade. Put people on HIV therapy, and Undetectable (HIV virus in blood) = Untransmittable" (U=U). Stop HIV therapy in millions, opposite will happen. T = T
March 14, 2025 at 2:15 PM
Estimated change in new infections with the abrupt termination of PEPFAR. Treatment as prevention has been the mantra for the last decade. Put people on HIV therapy, and Undetectable (HIV virus in blood) = Untransmittable" (U=U). Stop HIV therapy in millions, opposite will happen. T = T
What will US foreign aid cuts mean in relative terms to some countries? Low income countries are highly dependent on US aid. Middle income countries are less dependent financially, but PEPFAR still fills key gaps.
March 14, 2025 at 2:08 PM
What will US foreign aid cuts mean in relative terms to some countries? Low income countries are highly dependent on US aid. Middle income countries are less dependent financially, but PEPFAR still fills key gaps.
PEPFAR accomplishments to date
March 14, 2025 at 2:06 PM
PEPFAR accomplishments to date
Super exciting times whenever a phase III trial unblinds.
Really great multinational group of HARVEST TB meningitis trial investigators.
Incredibly fun to write up as a team together in rapid fashion.
Protocol: doi.org/10.12688/wel...
Really great multinational group of HARVEST TB meningitis trial investigators.
Incredibly fun to write up as a team together in rapid fashion.
Protocol: doi.org/10.12688/wel...
February 25, 2025 at 8:40 PM
Super exciting times whenever a phase III trial unblinds.
Really great multinational group of HARVEST TB meningitis trial investigators.
Incredibly fun to write up as a team together in rapid fashion.
Protocol: doi.org/10.12688/wel...
Really great multinational group of HARVEST TB meningitis trial investigators.
Incredibly fun to write up as a team together in rapid fashion.
Protocol: doi.org/10.12688/wel...
What's the impact of US gov funded medical research?
1 in 8 women will develop breast cancer.
The 5-year survival rate has dramatically improved over the last 50 years.
Therapies continue to improve.
1 in 8 women will develop breast cancer.
The 5-year survival rate has dramatically improved over the last 50 years.
Therapies continue to improve.
February 23, 2025 at 10:42 AM
What's the impact of US gov funded medical research?
1 in 8 women will develop breast cancer.
The 5-year survival rate has dramatically improved over the last 50 years.
Therapies continue to improve.
1 in 8 women will develop breast cancer.
The 5-year survival rate has dramatically improved over the last 50 years.
Therapies continue to improve.
Minnesota Name a Snowplow competition winners for 2025.
My personal favorite: "I came, I thaw, I conquered."
My personal favorite: "I came, I thaw, I conquered."
February 13, 2025 at 1:45 AM
Minnesota Name a Snowplow competition winners for 2025.
My personal favorite: "I came, I thaw, I conquered."
My personal favorite: "I came, I thaw, I conquered."
22 States sued the Federal government today in federal court in Boston regarding change in NIH indirects to 15%.
PUBLIC LAW 118–47— 138 Stat 688, sec 224.
Congress mandated in March 23, 2024 law that NIH indirects shall continue at level of Q3 2017.
PUBLIC LAW 118–47— 138 Stat 688, sec 224.
Congress mandated in March 23, 2024 law that NIH indirects shall continue at level of Q3 2017.
February 10, 2025 at 5:44 PM
22 States sued the Federal government today in federal court in Boston regarding change in NIH indirects to 15%.
PUBLIC LAW 118–47— 138 Stat 688, sec 224.
Congress mandated in March 23, 2024 law that NIH indirects shall continue at level of Q3 2017.
PUBLIC LAW 118–47— 138 Stat 688, sec 224.
Congress mandated in March 23, 2024 law that NIH indirects shall continue at level of Q3 2017.
What's the scope of these cuts to major universities? Tens of millions of dollars.
February 8, 2025 at 12:24 AM
What's the scope of these cuts to major universities? Tens of millions of dollars.