Topics in antiviral medicine最新文献

The National Clinician Consultation Center (NCCC) has operated for the past 30 years as a federally supported educational resource for US clinicians, addressing a wide range of questions regarding HIV and viral hepatitis care. Changes in practice spurred on by scientific breakthroughs and new research have led to new questions and challenges for HIV practitioners. These include optimal clinical and laboratory monitoring for people receiving postexposure prophylaxis, preexposure prophylaxis, or long-acting injectable antiretroviral therapy; evolving approaches to maternal and infant antiretroviral therapy for prevention of perinatal HIV transmission; and management of comorbidities such as hepatitis C and substance use disorders. Prevalent questions received by NCCC consultants over the last 5 years are described, high-lighting key areas of HIV medicine that clinicians and clinical educators commonly face in practice, as well as opportunities for future research to address areas of ongoing clinical uncertainty.

The primary care clinician can play a substantial role in the management and prevention of viral hepatitis infections, which cause a substantial burden of hepatocellular carcinoma and cirrhosis worldwide and in the US. One-time hepatitis B and C virus testing is now recommended as part of universal adult screening measures, and more frequently based on risk factors. Immunization strategies for hepatitis A and B have also been updated, with a new adjuvanted, conjugated hepatitis B vaccine (HepB-CpG) that provides greater efficacy than older vaccines. Management of hepatitis B and C has been streamlined based on current tolerable, effective oral regimens that can reduce the individual's risks of liver fibrosis and cancer and interrupt the cycles of community transmission. The epidemiology and natural history of these viral infections are summarized and concise updates of screening, diagnosis, treatment, and prevention strategies are provided.

There has been a substantial increase in the prevalence of sexually transmitted infections (STIs) and a widening gap in health care disparities over the past decade. New technologies, emerging public health research, and growing antimicrobial resistance have changed how practitioners counsel patients and diagnose and manage common STIs. Updating practitioners' understanding of best care practices for patients with STIs is crucial in averting preventable morbidity and mortality. This review covers important changes in the screening, diagnosis, treatment, and prevention of common STIs over the past 5 years.

Modern antiretroviral therapy has led to a dramatic reduction in HIV-associated opportunistic infections and mortality, but late diagnosis of HIV and poor linkage to care persist and lead to a worse prognosis. HIV care is now focused on early therapy initiation and virologic control, and new practitioners may have less experience and fewer educational resources for diagnosis and management of opportunistic infections. In this special issue, we outline the clinical presentation, diagnosis, and management of opportunistic infections in the modern antiretroviral therapy era alongside clinical photography, radiographic findings, and microbiologic, endoscopic, pathologic, and retinal images.

Aging-related comorbid conditions have major effects on health, quality of life, and survival in people with HIV (PWH). The 2025 Conference on Retroviruses and Opportunistic Infections (CROI) featured numerous studies about comorbid diseases in PWH. Cardiovascular diseases, including atherosclerosis and heart failure were important topics at the CROI, with ancillary analyses from REPRIEVE (the Randomized Trial to Prevent Vascular Events in HIV) and studies from lower- and middle-income countries. Numerous studies examined epigenetic markers of biologic aging in PWH and the effects of treatments, including glucagon-like peptide-1 receptor agonists. In a clinical trial, cytomegalovirus suppression was shown to decrease immune activation and systemic inflammation, as well as improve physical function. Large epidemiologic studies examining the effect of switching to integrase strand transfer inhibitors showed an increased risk of diabetes and hypertension, which was independent of weight gain. This review focuses on the abstracts presented at CROI 2025 in these areas, highlighting those with the most clinical impact.

Important new data were presented at the 2025 Conference on Retroviruses and Opportunistic Infections. Mathematic models predicted a reversal of progress toward Ending the HIV Epidemic metrics if funding is discontinued. Interventions that improved HIV care outcomes included a clinic-based, person-centered care intervention and a low-barrier care clinic service delivery model. Several studies demonstrated varying trends in hepatitis B and C incidence and outcomes, and data from one trial showed the seroprotective durability of the adjuvanted hepatitis B vaccine in people with HIV. Focus continued on long-acting antiretroviral therapy (ART) including data on promising new agents and formulations. Integrase strand transfer inhibitors (InSTIs) may be effective in the real world despite baseline reverse transcriptase resistance, although 2 studies highlighted the emergence of mutations outside the integrase genome that contribute to InSTI resistance. The data on HIV and maternal and pediatric health included studies aimed at HIV testing and counseling. It also covered drug interactions between implant and injectable hormonal contraceptives and dolutegravir-based ART, along with selected pharmacokinetics and safety data for ART in infants and children. Various abstracts addressed weight gain and cardiometabolic dysfunction in youth with perinatally acquired HIV and in women with HIV, as well as health outcomes for children exposed to HIV and ART in utero.

New research on acute and postacute COVID-19 was presented at the 2025 Conference on Retroviruses and Opportunistic Infections (CROI). Results of the SCORPIO-PEP (Stopping COVID-19 Progression With Early Protease Inhibitor Treatment-Postexposure Prophylaxis) study indicated that the protease inhibitor ensitrelvir is effective for postexposure prophylaxis. Results from the second phaseof the Ubuntu study suggested that monovalent or bivalent booster doses of mRNA vaccines are equally protective in people with or without HIV. A phase II study of an inhaled broad-spectrum antiviral small interfering RNA showed faster clearance of virus and more rapid resolution of symptoms with its use. In addition, numerous studies improved our understanding of the long-term consequences of SARS-CoV-2 infection, including immunologic, metabolic, cardiovascular, neurologic, and other clinical sequelae. The application of new and more specific case definitions in research studies of long COVID provided new insights into the epidemiology and pathogenesis of this condition, although data on therapeutics from randomized clinical trials are still lacking.

The 2025 Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco maintained its existing format with a combination of plenary lectures, workshops, oral and poster abstract sessions, themed discussions, and interactive symposia to deliver the latest advances in HIV/AIDS research to the approximately 4000 delegates in attendance. The conference featured a comprehensive collection of presentations addressing the molecular biology of HIV-1, with the basic virology track offering mechanistic insights into viral replication, immune evasion, and host-pathogen interactions. CROI showcased a range of innovative approaches to decipher and target the latent reservoir. From high-resolution lineage tracking in nonhuman primates to dissection of chromatin landscapes and latency regulatory circuits, studies presented at this year's meeting underscored the complexity of HIV persistence and the need for multidimensional intervention strategies. Selected abstracts are high-lighted, emphasizing mechanistic insights, methodologic innovations, and therapeutic implications. As with prior renditions of the conference, CROI continues to set the standard for engagement of early career investigators. Sessions such as the Scott M. Hammer Workshop for New Investigators and Trainees provide an effective forum for orientation to the various thematic areas covered at CROI.

Updated strategies and new insights into tuberculosis and mpox treatment were a major focus at the 2025 Conference on Retroviruses and Opportunistic Infections, headlined by findings that high-dose rifampicin plus levofloxacin increased early mortality in hospitalized people with HIV with disseminated tuberculosis, whereas tecovirimat demonstrated no efficacy for clade II mpox. Herein, we summarize clinically relevant updates related to tuberculosis, mpox, Kaposi sarcoma, human papillomavirus, and other HIV-associated infectious complications presented at the conference.

Certain mutations in HIV-1 that emerge during exposure to antiretroviral drugs may have varied impact on the effectiveness of current and subsequent treatments for HIV. This 2025 edition of the International Antiviral Society-USA (IAS-USA) drug resistance mutations list updates the Figure last published in November 2022 based on new data that have become available. The mutations listed are those that have been identified by specific criteria to contribute to a reduced virologic response to currently available antiretroviral drugs. The Figure is designed to assist practitioners in identifying key mutations associated with resistance to antiretroviral drugs, and therefore, to consider when making clinical decisions regarding the components of an initial antiretroviral regimen and changing a regimen in the settings of avoiding toxicity, regimen simplification, or previous or current virologic failure.