Current Opinion in Infectious Diseases最新文献

Purpose of review: Development of vaccines that protect against sexually transmitted infections (STIs), including for chlamydia, gonorrhea, and syphilis, has progressed greatly over the past decade. However, little research has been conducted to examine STI vaccine acceptance and hesitancy and how these factors may impact future uptake. This review examines literature that could provide additional insights into factors that would impact STI vaccine acceptance and hesitancy.

Recent findings: Vaccine hesitancy remains a threat to the uptake of future STI vaccines despite recent findings that highlight high levels of acceptability. Vaccine characteristics including side effects postvaccination and cost could impact future uptake of these vaccines. Accurate information about the benefits of vaccination and the vaccine development process could help to improve vaccine acceptance.

Summary: STI vaccine development is progressing, leading to great promise that a chlamydia, gonorrhea, or syphilis vaccine will one day be available. However, data is limited on factors that could impact vaccine acceptance, hesitancy, and uptake. This research is instrumental in creating policies, programming and vaccination campaigns that could impact acceptance and uptake along with affordability and accessibility. Additional research is needed to better promote STI vaccines.

Purpose of review: Cognitive disorders persist in persons with HIV, despite virologically suppressive antiretroviral therapy. We summarize the current evidence on risk factors for cognitive decline in persons with HIV in the modern antiretroviral therapy-era.

Recent findings: Recent consensus recommendations have proposed a new approach for defining cognitive impairment in persons with HIV, which distinguishes true cognitive impairment from low cognitive performance alone and considers both HIV and non-HIV-associated causes of brain injury. Adverse mental health, risks associated with substance misuse, and an increasing burden of age-related comorbidities have been highlighted as important contributors toward cognitive decline in this population. Aging may potentiate these risk factors through polypharmacy and drug-drug interactions.

Summary: Cognitive decline in persons with HIV is likely multifactorial, with contributions from both HIV and non-HIV-associated mechanisms, particularly age-related comorbidities. With an aging community of persons with HIV, screening for risk factors associated with cognitive decline may be crucial to implement appropriate risk reduction strategies.

Purpose of review: To describe patient-centred multiciplinary management and care of people with HIV presenting with cognitive disorders.

Recent findings: In the era of effective antiretroviral therapy a comprehensive, multifactorial approach to assessing and managing cognitive impairment in people with HIV is required. The complexity of cognitive disorders in this population demands more than current guidelines offer, which focus primarily on HIV management, overlooking broader clinical, psychological, and social factors. Key recommendations include the integration of medical history, physical examinations, brain imaging (especially MRI), neuropsychological testing, and lumbar puncture to identify underlying causes of cognitive decline. Pharmacological treatments for HIV-related cognitive decline remain ineffective, making nonpharmacological interventions, such as cognitive training and holistic rehabilitation programs, essential for managing symptoms. Additionally, the review calls for early detection through routine screening, monitoring, and preventive care. Social and psychological support are emphasized as critical factors in addressing the mental health issues exacerbated by cognitive decline in people with HIV. Emerging models of care, such as integrated, multidisciplinary clinics, show promise in delivering comprehensive, patient-centered care that addresses both cognitive issues and broader quality of life.

Summary: This review underscores the need for a holistic, multifaceted approach to managing cognitive impairment in people with HIV, integrating clinical, psychological, and social interventions alongside HIV treatment. Given the lack of effective pharmacological options, early detection, prevention, and nonpharmacological strategies are critical in optimizing quality of life and maintaining cognitive function in this vulnerable population.

Purpose of review: Prostate cancer burden has been rising among people with HIV (PWH), yet it remains understudied in the context of HIV infection. The objective of this review article is to summarize contemporary information on the burden, risk, and outcomes of prostate cancer for people living with HIV.

Recent findings: Despite a lower apparent incidence of prostate cancer in early studies for PWH compared to uninfected persons, this malignancy is now likely to be the most common tumor for US PWH. Tumor characteristics and stage appear to have limited differences by HIV status. The optimal approach to early detection of prostate cancer remains controversial, and there are little HIV-specific data surrounding screening. Prostate cancer outcomes may have been worse for PWH in the early antiretroviral era but may have improved in more recent years.

Summary: Prostate cancer is an increasingly common clinical issue for PWH. Lower than expected incidence rates in the early ART-era may be increasing, and oncologic outcomes may also be improving. Treatment tolerability is still a key question for this patient group. Given the clinical and biological complexity of chronic HIV infection, strategies for both early detection and treatment will need continued evaluation specifically in the setting of HIV.

Purpose of review: Syphilis is rising globally, with resultant increases in morbidity and mortality that disproportionately impact underserved populations. Appropriate screening and testing for syphilis with accurate, reliable, affordable, and timely assays is crucial for combating this epidemic. This review provides a brief overview of laboratory methods for syphilis diagnosis, with a focus on recent updates in diagnostics and directions for future research.

Recent findings: Syphilis can be complex and time-consuming to diagnose and stage appropriately. The historic use of darkfield microscopy for diagnosis has been eclipsed by algorithms that include both nontreponemal and treponemal antibody tests for screening and confirmation of active Treponema pallidum infection. Newer diagnostic modalities include nucleic acid amplification assays (NAATs) and point-of-care testing (POCT), which hold promise for increasing identification of active syphilis but have notable limitations. More work is needed to develop accurate, reliable, affordable, and expeditious tests to optimize syphilis diagnosis.

Summary: Algorithms utilizing a combination of serological treponemal and nontreponemal assays remain standard of care for the diagnosis of syphilis, but recently developed NAATs and POCT assays present opportunities to increase syphilis detection. Further research is warranted to improve upon these testing modalities and explore other markers that could aid in syphilis diagnosis.

Purpose of review: Extreme weather events (EWEs) pose a challenge to achieving UNAIDS goal of eliminating HIV as a public health threat by 2030. This review summarizes recent findings describing the disruption of HIV services by EWEs and discusses strategies for a resilient HIV care programme in resource-limited settings.

Recent findings: EWEs impact each component of the continuum of care - HIV testing, linkage to treatment, viral suppression and other HIV prevention services. EWEs disrupt healthcare provision either through impacting the ability of the healthcare system to deliver care because of infrastructure damage and increased workload or by limiting people's ability to seek healthcare because of access challenges and forced displacements. This culminates in disengagement from care, poor treatment adherence and increase in HIV disease progression with more vulnerable groups such as women and young people being more adversely impacted.

Summary: Most people affected by or at risk of HIV reside in resource-poor settings which are the region with the least capacity to adapt to climate change. Few recent studies with very limited geographical coverage show that EWEs affect the delivery of HIV care in this setting. Climate adaptation and mitigation policies are required to protect health in resource-limited settings.

Purpose of review: Several microorganisms, which are not traditionally considered sexually transmitted infections (STIs), are capable of sexual transmission and have the potential to cause global outbreaks. The aim of this review is to describe pathogens which are not traditionally defined as STIs, to grant insight on current and potential outbreaks and call for clinical vigilance among members of key populations.

Recent findings: Recent findings emphasize that several pathogens, not traditionally classified as STIs, can be sexually transmissible. These include the mpox virus, enteric infections such as Shigella spp., dermatophytes such as Trichophyton mentagrophytes, ectoparasites and atypical bacterial genito-urinary infections such as Neisseria meningitidis. The internationally reported outbreaks and the reports on potential sexual transmission of these pathogens underlines the emerging risks, the need for a broader STI definition and the importance of vigilant public health control strategies.

Summary: These findings suggest that clinical practice should broaden STI testing and awareness to include pathogens not traditionally considered sexually transmissible, particularly among key populations. Clinicians must be vigilant for atypical presentations, ensuring comprehensive sexual healthcare and diagnostic testing. Development of targeted preventive efforts and continuous surveillance to detect and manage emerging sexually transmissible infections is paramount.

Purpose of review: Discuss the recent evidence on climate change and related extreme weather events (EWE) and linkages with HIV prevention and care outcomes.

Recent findings: We identified 22 studies exploring HIV prevention and care in the context of EWE. HIV prevention studies examined sexual practices that increase HIV exposure (e.g., condomless sex, transactional sex), HIV testing, and HIV recent infections and prevalence. HIV care-related outcomes among people with HIV included clinical outcomes (e.g., viral load), antiretroviral therapy adherence and access, HIV care engagement and retention, and mental and physical wellbeing. Pathways from EWE to HIV prevention and care included: structural impacts (e.g., health infrastructure damage); resource insecurities (e.g., food insecurity-related ART adherence barriers); migration and displacement (e.g., reduced access to HIV services); and intrapersonal and interpersonal impacts (e.g., mental health challenges, reduced social support).

Summary: Studies recommended multilevel strategies for HIV care in the context of EWE, including at the structural-level (e.g. food security programs), health institution-level (e.g., long-lasting ART), community-level (e.g. collective water management), and individual-level (e.g., coping skills). Climate-informed HIV prevention research is needed. Integration of EWE emergency and disaster preparedness and HIV services offers new opportunities for optimizing HIV prevention and care.

Purpose of review: Effective vaccines to prevent sexually transmitted Chlamydia trachomatis (Ct) infection have eluded researchers for decades. However, recent studies of a promising vaccine in human trials, and emerging understanding of the complexity of the natural immune response to infection have provided hope for the eventual approval of a vaccine. This review highlights recent progress toward developing effective vaccines for Ct.

Recent findings: In 2019, the first-in-human Ct vaccine, CTH522, Phase I/IIB trial was reported. Recent studies of this vaccine and its derivatives have further established CTH522 as the lead vaccine against sexually transmitted Ct. A variety of vaccines have entered the preclinical development pipeline, with researchers reporting efforts to target non-MOMP antigens, include novel adjuvants in vaccine formulations, and use alternative routes of administration to increase efficacy.

Summary: While the approval of a vaccine for Ct is closer than ever, the need for careful consideration of future implementation is especially important for the successful clinical translation of Ct vaccines into humans.