The latest medical research on Infectious Disease
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about infectious disease gathered by our medical AI research bot.
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Request AccessComparing short-term mortality between people with and without HIV admitted to the intensive care unit: A single-centre matched cohort study (2000-2019).
HIV MedicineThe survival rate of people with HIV admitted to intensive care units (ICUs) is approaching that of people without HIV. We conducted a matched-cohort study of people with and without HIV admitted to ICU at a large hospital to compare short-term mortality, during 2000-2019.
People with HIV were matched to people without HIV (1:2) on age, sex, admission year and Acute Physiology and Chronic Health Evaluation (APACHE)-II score. Applying logistic regression models fitted using independence estimating equations, we describe population-averaged associations of HIV with short-term (in-ICU, in-hospital) mortality during a patient's first admission to ICU, and explore whether these varied by year.
A total of 177 people with HIV were matched to 354 people without HIV (71.2% vs. 71.2% male; median age: 47 vs. 48 years, median APACHE-II: 18 vs. 17, median admission year: 2013 vs. 2013). Among people with HIV, 73.4% were on antiretroviral therapy, 51.2% had HIV-RNA ≤50 copies/mL and median CD4 T-cell count was 132 cells/ μ $$ \upmu $$ L. People with HIV had higher in-ICU (24.3% vs. 15.3%) and in-hospital (31.6% vs. 20.1%) mortality. People with HIV had 1.69-fold higher odds (95% confidence interval: 1.03-2.76) of in-ICU mortality and 1.86 (1.19-2.91) higher odds of in-hospital mortality than people without HIV, adjusted for age, sex, year and APACHE-II. There was no evidence that these associations varied by year (p-interaction-in-ICU = 0.90; p-interaction-in-hospital = 0.46).
Our findings suggest that although outcomes have improved over time, people with HIV continue to have higher short-term in-ICU and in-hospital mortality following ICU admission compared with people without HIV with similar characteristics.
Long-acting antiretroviral therapy in low-income and middle-income countries: considerations for roll-out.
Current Opinion in Cell BiologyLong-acting ART (LA-ART) in low-income and middle-income countries (LMICs) may address specific issues that affect people living with HIV (PWH) and people at substantial risk of HIV infection. We reviewed products in use and under consideration in LMICS, current and anticipated challenges for implementation, and offer strategies for effective rollout.
Factors to consider for effective implementation of LA-ART in LMICs are: managing co-conditions (pregnancy) and comorbidities (TB and hepatitis B); medication access, both cost and supply-related; and health systems delivery mechanisms for products.
LA-ART present promising new alternatives in LMICs. Although they may tackle certain adherence concerns and systemic issues, which impact delivery of services, significant obstacles remain before their widespread implementation in people that require them most, particularly in countries most affected by HIV. We offer best practices from prior experiences and implementation studies for effective coordination of multiple stakeholders, critical for effective rollout.
Future options for long-acting HIV treatment and prevention.
Current Opinion in Cell BiologyThe aim of this review was to describe future options for long-acting HIV treatment and preexposure prophylaxis (PrEP) regimens featuring both innovations with currently approved antiretrovirals and a profile of investigational agents in the pipeline.
Newer formulations and modes of delivery for existing antiretroviral drugs and a number of investigational agents are under study for long-acting HIV treatment and PrEP. Regimens with weekly oral dosing for HIV treatment, monthly oral dosing for HIV PrEP, and injectable agents with longer dosing intervals (every 3 months or longer) for treatment and PrEP are in clinical development. Newer agents with novel mechanisms of action and newer modes of administration including vaginal rings, implants, patches, and rectal douches also are under investigation.
Despite the success of current antiretroviral therapy and PrEP with one-pill, once-daily regimens, there is a continuing need for new formulations, investigational agents, and novel modes of delivery to overcome barriers to implementation and ensure real-world effectiveness. Newer long-acting antiretroviral regimens for HIV treatment and PrEP using novel preparations and strategies will offer choice, enhance adherence, decrease toxicity, and improve patient and provider satisfaction.
Transforming HIV prevention: the promise of long-acting preexposure prophylaxis in high HIV burden settings.
Current Opinion in Cell BiologyRecent research on efficacy and safety of long-acting preexposure prophylaxis (PrEP) holds the promise to transform HIV prevention in high HIV burden settings. We review emerging findings regarding early end-user acceptability of long-acting PrEP modalities, feasibility of integrating long-acting PrEP into health systems, and considerations regarding drug resistance and cost.
Long-acting PrEP, particularly injectables, was found to be highly acceptable among individuals across key populations in high HIV burden settings. Concerns around use of long-acting PrEP highlight the importance of choice and ability to switch methods. Existing provider-level barriers to oral PrEP implementation (e.g., overburdened staff, training gaps) may impact long-acting PrEP rollout - however, utilization of PrEP implementation strategies such as task-shifting, timely PrEP training for all providers, differentiated service delivery, and integration with sexual health services, may mitigate barriers. Studies modeling injectable PrEP scale-up demonstrate substantial benefits in HIV mortality reduction, outweighing risks of increased integrase inhibitor resistance, but also highlight the urgency of pricing long-acting PrEP to ensure access and affordability.
Long-acting PrEP could be a game changer in HIV prevention in high burden settings. There is an urgent need for rapid scale production and price reductions to ensure access in high HIV burden settings. Implementation strategies are needed to address individual and provider-level barriers.
Rising mortality among people who inject drugs living with HIV in Scotland, UK: A 20-year retrospective cohort study.
HIV MedicineOur aim was to examine mortality trends in the era of antiretroviral therapy, among people who inject drugs (PWID) who are living with HIV. The study objectives were to assess and quantify mortality among PWID diagnosed with HIV over time in Scotland, in the context of a recent outbreak of HIV and rise in drug-related mortality.
This was a retrospective cohort study of those diagnosed with HIV in Scotland between January 2000 and February 2020, with acquisition related to injecting drug use, linked to mortality data. Factors associated with all-cause mortality were examined using Cox proportional hazards regression.
Among 430 individuals with 3143 person-years (py) of follow-up, 88 (20.5%) died. Drug-related deaths accounted for 45.5% of all deaths, rising to 60% among those diagnosed in 2015-2020. The crude all-cause mortality was 28.00 per 1000 py overall and 37.62 per 1000 py within 5 years of diagnosis. Mortality risk was markedly higher among PWID diagnosed in 2015-2020 [adjusted hazard ratio (aHR) = 3.53], relative to those diagnosed in 2000-2004. Among those diagnosed in 2015-2020 (as part of the HIV outbreak), the mortality risk was higher among those not on, compared with those on, opioid agonist therapy (aHR = 3.87).
Mortality among PWID living with HIV in Scotland has risen substantially in the 21st century. Our findings highlight the important role of opioid-agonist therapy, alongside other prevention and treatment measures to address high levels of drug-related mortality for PWID living with HIV, including within HIV outbreaks in this population group.
The Outcomes of Adenovirus Infection in Kidney Transplant Recipients.
Transplant Infectious DiseaseAdenovirus (ADV) infection can lead to significant morbidity and mortality in immunocompromised patients, particularly in those with hematopoietic stem cells or solid organ transplants. The incidence of ADV infection in kidney transplant (KT) is not well-defined as ADV is often asymptomatic and not routinely checked.
This retrospective case-series study included KT and simultaneous pancreas-KT (SPKT) recipients from January 1, 2008, to January 31, 2024, across three Mayo Clinic sites (Arizona, Florida, and Minnesota) with symptomatic adenovirus polymerase chain reaction cases. The primary outcomes were allograft function at various intervals post-ADV infection, allograft, and patient survival.
We report one of the largest multi-site case series regarding outcomes of ADV in KT with 17 patients. The median time to ADV infection was 30 weeks (5-74). Five patients (29%) developed disseminated infection. Nine patients (53%) of the entire cohort experienced graft loss within a median of 35 (4-168) weeks, with four (44%) of graft loss attributed to ADV. Nine patients (53%) developed rejections post-ADV infection with a median of 4 (2-8) weeks after resolution. One patient died from acute hypoxic respiratory failure from ADV infection.
ADV should be considered in KT/SPKT patients with renal dysfunction, hematuria, and with or without fever. Despite the low mortality rate, there is a significant risk of graft loss and rejection after ADV infection. It is crucial to screen for ADV and develop intervention strategies for treatment. Further multicenter studies are needed to better define, stage, and manage ADV infection.
Impact of Bebtelovimab Treatment Timing on COVID-19 Outcomes in Ambulatory Solid Organ Transplant Recipients.
Transplant Infectious DiseaseOutcomes after bebtelovimab treatment for COVID-19 were favorable for most but not all solid organ transplant recipients (SOTRs) during the era of Omicron BA.2 to BA.5, but effects of timing of bebtelovimab administration on these outcomes are unknown. We sought to compare outcomes of SOTR who received early bebtelovimab ("EBT", given ≤ 2 days from diagnosis) versus late bebtelovimab ("LBT", given between Days 3 and 7), versus no bebtelovimab (NBT).
This was a retrospective cohort study of SOTRs with mild-to-moderate COVID-19, with endpoint of 30-day COVID-19-related hospitalization. Multivariable logistic regression was performed to determine variables associated with receiving EBT, and to assess impact of EBT on hospitalization. A propensity score (PS) was calculated for EBT versus NBT.
Of 297 SOTRs, 162 (58.1%) received EBT, 46 (16.5%) LBT, and 71 (25.4%) NBT. Early bebtelovimab treatment was associated with a lower risk of 30-day COVID-19-related hospitalization compared to NBT (OR, 0.112 [95% CI, 0.018-0.686]; p = 0.018). There was no significant difference in hospitalization risk between LBT and NBT, suggesting that delayed administration may not confer additional benefits over no treatment.
Early bebtelovimab treatment in outpatient SOTRs was associated with a lower risk of hospitalization compared to no treatment, while late administration did not show a significant advantage over no treatment. Although bebtelovimab is no longer authorized, these findings suggest that the timing of COVID therapies for SOTRs may be important to optimize outcomes.
Feasibility and Impact of Community Pharmacy and Novel Pick-up Points for Antiretroviral Therapy Pre-exposure Prophylaxis Initiation and Continuation in Low and Middle-income Countries.
Current HIV/AIDS ReportsThis review assesses recent developments in community access to pre-exposure prophylaxis (PrEP) for HIV prevention in low-and middle-income countries (LMICs). It examines literature on differentiated service delivery (DSD) and alternative delivery modes for PrEP, focusing on the role of community pharmacies and novel pick-up points. Key considerations include barriers to access, potential benefits, and strategies for implementation.
Challenges to optimal HIV healthcare delivery persist globally, with LMICs facing greater barriers due to resource constraints and structural obstacles. Community pharmacies and novel pick-up points offer promising avenues to expand access to HIV medication, especially in hard-to-reach populations. However, operational complexities and regulatory frameworks present significant challenges. Recent initiatives, such as collaborative practice agreements and programmes by global health agencies, highlight efforts to integrate community pharmacies into HIV prevention and care delivery. Mobile health clinics and home delivery services have also shown promise in improving treatment coverage. Community pharmacies and novel pick-up points play a crucial role in enhancing access to HIV PrEP in LMICs. Despite challenges related to infrastructure, funding, and regulatory oversight, innovative strategies like DSD and mobile outreach offer opportunities to reach marginalized populations. Real-life examples from LMICs demonstrate the feasibility and effectiveness of leveraging community pharmacies for HIV treatment. However, addressing policy gaps, strengthening pharmacist training, and promoting patient-centred approaches are essential for scaling up access to PrEP. Collaboration between governments, health agencies, and local communities is key to realizing the full potential of community pharmacies in HIV prevention and care.
In vitro and patient studies with platelets to explore off-target cardiovascular effects of integrase inhibitors.
HIV MedicinePeople with HIV currently face a tenfold higher risk of developing cardiovascular disease (CVD) than those without HIV. Studies have shown various off-target effects of antiretroviral treatment (ART) on the cardiovascular system, but little is known about the effects of currently used integrase strand transfer inhibitors (INSTIs) on platelets. Platelet activation is associated with increased CVD, thrombus formation, and release of proinflammatory mediators, so exploring platelet effects from currently prescribed ART may contribute to the understanding of CVD etiopathogenesis in people with HIV.
We aimed to identify potential effects of INSTIs on platelet aggregation and activation markers from individuals without HIV after in vitro treatment with clinically relevant drug concentrations. We used bictegravir (BIC) and dolutegravir (DTG) individually or in the therapeutic drug combinations BIC/emtricitabine (FTC)/tenofovir alafenamide fumarate (TAF) or DTG/lamivudine (3TC). Additionally, we conducted a pilot study to compare platelet activity profiles from people with HIV on BIC/FTC/TAF and DTG/3TC.
Changes to in vitro platelet aggregation responses upon exposure to different INSTIs were observed both upon individual drug application and when using therapeutic combinations. However, these effects were not reflected in flow-cytometric evaluation of platelet degranulation. A pilot study in eight people with HIV and eight without HIV revealed no significant effects but established protocols for future patient studies.
There is currently no consistent evidence of an effect of INSTIs on platelet activation. Further study is warranted, focusing on models with more pathophysiological relevance, including extensive studies in people with HIV.
Safety, outcomes, and pharmacokinetics of isavuconazole as a treatment for invasive fungal diseases in pediatric patients: a non-comparative phase 2 trial.
Antimicrobial Agents and ChemotherapyInvasive aspergillosis (IA) and mucormycosis (IM) cause significant morbidity and mortality in immunocompromised and/or hospitalized patients. Isav...
Global burden associated with rare infectious diseases of poverty in 2021: findings from the Global Burden of Disease Study 2021.
Infectious Diseases of PovertyRare infectious diseases of poverty (rIDPs) involve more than hundreds of tropical diseases, which dominantly affect people living in impoverished and marginalized regions and fail to be prioritized in the global health agenda. The neglect of rIDPs could impede the progress toward sustainable development. This study aimed to estimate the disease burden of rIDPs in 2021, which would be pivotal for setting intervention priorities and mobilizing resources globally.
Leveraging data from the Global Burden of Disease Study 2021, the study reported both numbers and age-standardized rates of prevalence, mortality, disability-adjusted life-years (DALYs), years lived with disability, and years of life lost of rIDPs with corresponding 95% uncertainty intervals (UIs) at global, regional, and national levels. The temporal trends between 1990 and 2021 were assessed by the joinpoint regression analysis. A Bayesian age-period-cohort model was used to project the disease burden for 2050.
In 2021, there were 103.76 million (95% UI: 102.13, 105.44 million) global population suffered from rIDPs with an age-standardized DALY rate of 58.44 per 100,000 population (95% UI: 42.92, 77.26 per 100,000 population). From 1990 to 2021, the age-standardized DALY rates showed an average annual percentage change of - 0.16% (95% confidence interval: - 0.22, - 0.11%). Higher age-standardized DALY rates were dominated in sub-Saharan Africa (126.35 per 100,000 population, 95% UI: 91.04, 161.73 per 100,000 population), South Asia (80.80 per 100,000 population, 95% UI: 57.31, 114.10 per 100,000 population), and countries with a low socio-demographic index. There was age heterogeneity in the DALY rates of rIDPs, with the population aged under 15 years being the most predominant. Females aged 15-49 years had four-times higher age-standardized DALY rates of rIDPs than males in the same age. The projections indicated a slight reduction in the disease burden of rIDPs by 2050.
There has been a slight reduction in the disease burden of rIDPs over the past three decades. Given that rIDPs mainly affect populations in impoverished regions, targeted health strategies and resource allocation are in great demand for these populations to further control rIDPs and end poverty in all its forms everywhere.
Implementation of patient-reported outcomes for people living with HIV: Insights from patients and healthcare providers in a Danish outpatient clinic.
HIV MedicinePatient-reported outcomes (PROs) have emerged as a valuable tool for aligning HIV care with patient needs and priorities. This study aimed to explore patient and healthcare provider (HCP) experiences of integrating a PRO solution into standard clinical care for HIV in a Danish outpatient clinic.
A tailored PRO solution for people living with HIV was developed in a Danish outpatient clinic. Patients were eligible if they were aged >18 years, spoke Danish, had been on effective antiretroviral therapy for 2 years, and had no additional health issues. Patients completed an electronic questionnaire 14 days before in-clinic consultations. HCPs reviewed patients' responses before these consultations. We assessed the usability, acceptability, and relevance of the PRO solution by conducting semi-structured interviews with 24 patients (12 responders and 12 non-responders) and six HCPs. A further 95 non-responders were interviewed over the phone. Data were analysed using thematic analysis.
Respondents found that PROs improved patient-provider communication, treatment planning, and self-management. Non-respondents faced barriers such as health literacy, cultural beliefs, and access to technology, necessitating alternative delivery methods. HCPs found that PROs facilitated person-centred care and symptom management, but HCPs faced challenges such as insufficient training, resources, and organizational support.
Implementing PROs in HIV care is challenging because of the patient diversity, clinician training needs, and organizational adaptations. Nevertheless, the use of PROs is associated with enhanced person-centred care. Future recommendations include tailored use of PROs, better understanding of the impact on patient groups, on-site questionnaire completion, and emphasis on shared decision-making between patients and HCPs.
