Expert Review of Anti-infective Therapy最新文献

Background: There are few studies that describe the impact of SARS-CoV-2 infection on HIV outcomes. We aimed to assess the viral adverse changes associated with SARS-CoV-2 infection in PLHIV.

Research design and methods: This retrospective cohort study enrolled 3327 PLHIV on ART. Baseline information was collected through questionnaires and electronic health records. PLHIV with and without SARS-CoV-2 infection (reference) were propensity score matched. The association between SARS-CoV-2 infection and HIV viral rebound was assessed by using log-binomial regression models, with relative risks estimated.

Results: We included 446 PLHIV without SARS-CoV-2 infection and 446 PLHIV with SARS-CoV-2 infection after matching. Compared to PLHIV without SARS-CoV-2 infection, PLHIV with SARS-CoV-2 infection had relatively higher HIV VLs (75th percentile: 105 versus 51 copies per mL; 80th percentile: 257 versus 196 copies per mL; 90th percentile: 5170 versus 2360 copies per mL). PLHIV infected with SARS-CoV-2 had a significantly increased risk of viral rebound (RR of 1.32, 95% confidence interval [CI]: 1.25, 1.40). The risk was higher among males than females but was comparable across age groups. Similar patterns were observed for secondary outcomes.

Conclusions: These findings suggest that SARS-CoV-2 infection is a risk factor for viral rebound in PLHIV on ART.

Introduction: For more than 15 years, artemisinin-based combination therapy (ACT) and atovaquone-proguanil have been recommended as treatment of Plasmodium falciparum malaria in most nonendemic countries. However, new challenges have emerged that complicate the management of travelers with malaria, including the occurrence of artemisinin-related hemolysis and the increasing numbers of treatment failure possibly related to drug resistance.

Areas covered: We reviewed the epidemiology, pattern and risk factors for artemisinin-related hemolysis and for treatment failure with ACT or atovaquone-proguanil among travelers with P. falciparum malaria diagnosed in nonendemic countries. We collected detailed information on clinical features, pharmacokinetic parameters or mutations conferring resistance observed in failing cases.

Expert opinion: Several factors (e.g. lack of prior immunity, older age, overweight, comorbidities, and comedication) distinguish travelers from people residing in malaria-endemic areas. Yet, current uniform treatment recommendations across settings do not address many considerations that predominantly affect nonimmune travelers with malaria. This population may also be more vulnerable to complications of malaria as reduced susceptibility to key antimalarials spreads. We propose specific adaptations to the management of malaria in travelers, with a focus on structured clinical follow-up to detect toxicity and failure, and on systematic genomic surveillance in concert with existing initiatives in endemic countries.

Introduction: Sepsis is a leading cause of death worldwide. Its lethality, along with the complexity of diagnosis and treatment, is worsened by rising antibiotic resistance. Managing sepsis and septic shock is challenging, as underlying conditions can limit the reliability of many biomarkers used for early diagnosis.

Areas covered: This review comprehensively overviews the epidemiologic characteristics of sepsis, with particular emphasis on the key biomarkers used to support early diagnosis. Additionally, it explores emerging techniques for rapid microbiological identification of sepsis caused by multidrug- resistant organisms and evaluates the effectiveness of newly introduced antibiotics.

Expert opinion: In severe cases progressing to septic shock, timely and accurate diagnosis is critical. It is mandatory to make every effort to shorten the time to diagnosis in order to enable appropriate supportive care and targeted antibiotic therapy. In this context, novel microbiological diagnostic methods should be considered to facilitate early detection of multidrug-resistant organisms and promote the initiation of effective empiric antibiotic treatment. Furthermore, the development of new molecules with innovative mechanisms of action, alongside therapeutic strategies targeting specific patterns of the immune response, is expected to improve the patient survival rates.

Introduction: While antibiotic combination therapy remains a common clinical practice, its scientific foundation is fragile. The available evidence is fragmented, biased, and fails to capture the complexity of modern infectious disease scenarios. This perspective reinterprets the role of combination therapy through a critical lens, challenging current dogmas and proposing a pathogen-specific approach, focusing also on severe acute infections.

Areas covered: This Critical Perspective focused on selected studies from 2018 to 2025 identified through a focused PubMed search on the place in therapy and efficacy of antibiotic combinations on main gram-positive (Streptococcus spp. Enterococcus spp. and Staphylococcus aureus) and gram-negative (Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia) pathogens.

Expert opinion: After reviewing the current available literature, in our opinion, a strong indication to use antibiotic combination therapy can be only for specific situations and clinical syndromes (such as endocarditis, toxic shock syndrome due to S. pyogenes, or persistent bacteremia due to S. aureus and few others). However, especially in severe infections due to gram negatives, clinical trial and strong data are insufficient to draw definite clinical indications. Consequently, further randomized clinical trial should be performed, and they should include new antibiotics to define the potential role of combination therapy.

Introduction: Viral hemorrhagic fevers (VHFs) represent a group of severe diseases caused by RNA viruses with high fatality rates, posing significant global health threats. These diseases are prioritized by the World Health Organization due to their epidemic potential, geographical restrictions, and limited therapeutic options.

Areas covered: This review discusses the current state of therapeutic advancements, challenges in treatment, and post-exposure prophylaxis for various VHFs. Relevant literature on VHFs and therapeutic interventions was identified through searches of PubMed, Scopus, Web of Science, WHO and CDC databases, and ClinicalTrials.gov from database inception to November 2025. Key therapies like ribavirin for Crimean-Congo hemorrhagic fever and Lassa fever, along with monoclonal antibodies for Ebola and Marburg virus disease, have demonstrated clinical efficacy. However, gaps remain in effective antivirals and vaccines for many VHF pathogens.

Expert opinion: Notable challenges in therapeutic development include ethical concerns in randomized controlled trials, logistical barriers in endemic areas, and the evolving immune response in late-stage disease. The role of cytokine modulation and the growing potential of monoclonal antibodies offer new directions for treatment. Strengthening observational studies and expanding international collaboration are critical for improving patient outcomes and advancing therapeutic options for these deadly diseases.

Background:  To evaluate 96-week virologic, immunologic, resistance and metabolic outcomes of bictegravir/emtricitabine/tenofovir alafenamide fumarate (BIC/FTC/TAF) in antiretroviral therapy (ART)-naïve people living with HIV (PLWH).

Methods: Retrospective cohort of ART-naïve PLWH initiating BIC/FTC/TAF between January 2020 and December 2022. Primary outcome was HIV-1 RNA <50 copies/mL at week 96. Secondary outcomes included drug resistance and changes in CD4⁺ T cell count, CD4⁺/CD8⁺, body weight, lipid profile, liver and renal function by week 96.

Results: We enrolled 228 patients; median age 32 years, 92.1% male, homosexual intercourse 57.0%. Virologic suppression did not differ by baseline HIV-1 RNA levels, CD4⁺ T cell counts, or opportunistic infection (OI), and immune reconstitution was similarly consistent across subgroups. One patient developed V179E mutation. Median body mass index increased from 21.7 (20.0-23.7) to 23.1 (21.2-25.1) by week 48 and then stabilized. Lipid levels increased early and remained stable, liver function remained stable after week 48, and renal function showed a slight decline before stabilizing by week 48.

Conclusion: BIC/FTC/TAF demonstrated strong efficacy in patients with high baseline HIV-1 RNA and OIs, with no patient developing drug-related resistance mutations and minimal impact on metabolism, liver and renal function, supporting its use in broader populations as a first-line regimen.