Topics in antiviral medicine最新文献

Transgender and gender-diverse populations have unique medical and psychosocial needs. It is important that clinicians address these needs with a gender-affirming approach in all aspects of health care for these populations. Given the significant burden of HIV experienced by transgender people, such approaches in providing HIV care and prevention are essential both to engage this population in care and to work toward ending the HIV epidemic. This review presents a framework for practitioners caring for transgender and gender-diverse individuals to deliver affirming, respectful health care in HIV treatment and prevention settings.

The golden age of antibiotics, which lasted from the 1930s until 2005, brought a brisk clip of antibiotic discovery and fueled optimism about the victory of modern medicine over bacterial infections. Since then, however, with a stalled antibiotic discovery effort and wide-spread antibiotic use, antimicrobial resistance has emerged as a major global health threat. Bacteriophages, or phages (literally viruses that infect certain bacteria), have coevolved with bacteria for almost 4 billion years and are the most abundant organisms on the earth. Substantial progress is being made such that selection, engineering, and synthetic production of phages may make it possible for these lethal enemies of bacteria to be harnessed as potent allies in our battle against antimicrobial resistance.

Vaccine hesitancy is one of the greatest health care challenges of our time, as recently highlighted by the experience with COVID-19 vaccines. It is now clear that several current COVID-19 vaccines are highly effective in preventing severe disease, hospitalization, and death from the disease, but their effectiveness has been greatly undermined by the many unfounded conspiracy theories, active disinformation, and fears (real or imagined) circulating through social media and through society in general, persuading millions of people worldwide not to receive the vaccine. Fortunately, there are numerous practical strategies that physicians and other health care professionals can employ in communicating effectively with vaccine-hesitant individuals, including using humble inquiry, compassionate listening, and storytelling, as well as engaging the entire health care team in providing accurate information. This article summarizes the major points of an IAS-USA-sponsored webinar held on August 3, 2021, titled COVID-19 Vaccine Hesitancy, Crucial Conversations, and Effective Messaging for Patients and Health Care Teams by Marie T. Brown, MD, an expert on adult immunization. The webinar was moderated by Constance A. Benson, MD.

The introduction of effective antiretroviral therapy (ART) has converted HIV infection from a lethal disease to a manageable chronic condition for most people. The drastic improvement in life expectancy of people with HIV has led to an expansion of the aging population of people with HIV globally. Recent research indicates that people with HIV on suppressive ART still sustain persistent, albeit alleviated, systemic and cerebral immune activation that can facilitate age-related causes of cognitive impairment (CI), including neurodegenerative and cerebrovascular diseases. Although HIV-associated neurocognitive disorder remains prevalent in older people with HIV on suppressive ART, the co-occurrence of other age-related causes of CI makes the investigation and management of CI more challenging. More importantly, it remains unknown if the neuropsychiatric manifestations of HIV-associated neurocognitive disorder are modified by the presence of age-related causes of CI, such as Alzheimer disease, and vice versa. This article will review findings regarding the interaction between HIV-1 infection and age-related comorbidities, namely atherosclerosis and neurodegenerative diseases, followed by cognitive outcomes of people with HIV in longitudinal studies. Cognitive symptoms of people with HIV on stable ART will be discussed. The review will go through the latest recommendations for cognitive screening in different HIV management guidelines, as well as the usefulness of various screening tools in the setting of stable viral suppression.

Chronic pain is common among older people with HIV. Etiologies of chronic pain are multifactorial in this population. A careful and thorough initial assessment of pain is important. Associated conditions that can contribute to pain should be explored and managed as indicated. Special consideration is warranted for some of the unique aspects of pain in people with HIV. Chronic pain management is multimodal; a variety of pharmacologic and nonpharmacologic strategies are effective. Among medications, opioids can be used but carry a risk of significant harms. The use and monitoring of opioids is discussed here, and recommendations are made for the safe prescribing of opioids for chronic pain.

Comorbid conditions have a major impact on the health, quality of life, and survival of people with HIV, particularly as this population ages. The 2022 Conference on Retroviruses and Opportunistic Infections (CROI) featured excellent science related to specific comorbidities, such as cardiovascular disease, type 2 diabetes, cancer, and frailty. The role of systemic inflammation in the pathogenesis of cardiovascular disease was an important theme, with strong evidence regarding the impact of microbial translocation. Other studies examined functional impairment, frailty, and potential important contributors, such as concomitant medications and sleep disturbances. The ANCHOR (Anal Cancer/High-grade Squamous Intraepithelial Lesions Outcomes Research) study provided crucial evidence that treatment of high-risk anal lesions reduces the incidence of anal cancer, which has important implications in the prevention of this devastating comorbidity. In addition, numerous presentations demonstrated the importance of comorbid conditions in COVID-19 outcomes in people with HIV and described persistent symptoms after acute SARS-CoV-2 infection has resolved. This review focuses on the abstracts presented at CROI 2022 in these areas, highlighting those with the most clinical impact.

The 2022 Conference on Retroviruses and Opportunistic Infections provided a rich source of new data and comprehensive reviews on antiviral therapy. For COVID-19, intramuscular sotrovimab was noninferior to intravenous sotrovimab, serostatus did not predict the efficacy of sotrovimab, and molnupiravir appeared safe and modestly effective in decreasing hospitalization rates. Trials from low- and middle-income countries provided data to support transitioning those on first-line therapy with or without virologic suppression and those virologically suppressed on second-line therapy to dolutegravir-based regimens. Additional data supported the use of lenacapavir as a long-acting antiretroviral drug. Data across the United States demonstrate the negative impact of the COVID-19 pandemic on the HIV care continuum, although enhanced outreach efforts and decentralization of antiretroviral therapy delivery were associated with improvements in care engagement outcomes. Researchers described potential mechanisms for the emergence of integrase strand transfer inhibitor resistance. Studies on proviral genotyping high-lighted the limitations of its use in predicting clinically significant resistance. Several studies looked at the epidemiology and treatment of hepatitis C and B and the status of current hepatitis C virus elimination efforts. Data presented on HIV, COVID-19, and maternal and pediatric health included 2-year virologic outcome data of very early antiretroviral therapy in potentially reducing the latent HIV reservoir in infants with HIV. Data presented on COVID-19 and HIV therapeutics in children included SARS-CoV-2-neutralizing monoclonal antibodies in children younger than 12 years of age, remdesivir in hospitalized infants and children, and long-acting therapies for HIV treatment in children.

The 2022 edition of the IAS-USA drug resistance mutations list updates the Figure last published in September 2019. The mutations listed are those that have been identified by specific criteria for evidence and drugs described. The Figure is designed to assist practitioners to identify key mutations associated with resistance to antiretroviral drugs, and therefore, in making clinical decisions regarding antiretroviral therapy.

Despite substantial advances in the field, liver disease morbidity and mortality remain serious issues among people with HIV. The causes of liver disease are often multifactorial and include hepatitis viruses, hepatic steatosis and oxidative stress, bacterial translocation with activation of hepatic macrophages and stellate cells, and direct toxicities from alcohol and drugs of abuse. Biopsychosocial factors including a high prevalence of psychiatric disorders, food insecurity, insufficient access to care and medications, and social stigma all play roles in the persistence of liver injury and hepatic fibrosis development among people with HIV. Rising rates of hepatocellular carcinoma have been observed, suggesting that the epidemiology of liver disease is evolving.