Topics in antiviral medicine最新文献

At the 2021 virtual Conference on Retroviruses and Opportunistic Infections ,several speakers described the disparities in both HIV and SARS-CoV-2 in-fections and outcomes in racial and ethnic minorities. A household survey suggested that there may have been more than 39 million SARS-CoV-2 infections in the United States by October 30, 2020, with an estimated infection fatality ratio of 0.64%; this compares with an estimated 7.3 million confirmed cases at that time. Several presentations found severe disruptions in HIV testing, prevention, and treatment services during COVID-19-related lockdowns; models suggest that severe interruption of antiretroviral therapy services could lead to a 1.5- to 3-fold increase in mortality. HIV testing remains the gateway to both treatment and prevention, and innovative strategies to improve testing uptake were presented. Preexposure prophylaxis (PrEP) agents may delay detection of HIV infection using standard testing algorithms. Data were presented on promising investigational PrEP agents, including cabotegravir, islatravir, and the dapivirine vaginal ring. Progress is being made in point-of-care assays to measure PrEP adherence with tenofovir-based regimens. HIV incidence remains low in populations of PrEP users, with higher rates among persons who never refilled their prescription. More work remains to be done to increase PrEP uptake among populations most heavily impacted by HIV.

Comorbid conditions have a major impact on the health, quality of life, and survival in people with HIV, particularly as they age. The 2021 Conference on Retroviruses and Opportunistic Infections featured excellent science related to specific comorbidities as well as multimorbidity. A number of presentations related to comorbidities in women with HIV reflected a new wave of research aimed at understanding how the epidemiology and pathogenesis of comorbidities may differ by sex. Weight gain related to antiretroviral therapy was also a major theme of the comorbidity abstracts presented at the meeting. Several 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, a nascent topic that will expand over time. This review focuses on research presented at the conference in these areas, highlighting those with the most clinical impact.

Vaccines play an important role in HIV primary care and are available for several sexually transmitted infections, including those caused by hepatitis A virus (HAV), hepatitis B virus (HBV), and human papillomavirus (HPV). HAV vaccination is increasingly important, given recent hepatitis A outbreaks and lack of immunity in many adults. A novel formulation of the hepatitis B vaccine shows promise in increasing rates of seroprotection. The Advisory Committee on Immunization Practices recommends the meningococcal conjugate vaccine for all individuals with HIV and has expanded the age range for administration of the HPV vaccine, recommending shared decision making about its administration in adults aged 27 to 45 years. This article summarizes a presentation by Steven C. Johnson, MD, at the International Antiviral Society-USA (IAS-USA) annual continuing education program held in New York, New York, in September 2019.

Aging is associated with declines in physical function that can be influenced by many factors, including HIV. These limitations may manifest as increased vulnerability to stressors, or frailty. Functional limitations and frailty can be used to guide clinical decisions, protect people from harm, and avoid strategies that are not likely to provide benefits. Such limitations could also serve as clinically relevant endpoints for some clinical trials. Interventions should ideally focus on early impairments that begin to occur in midlife, well before an individual becomes frail or experiences disabilities. Overall, physical activity is safe and effective in improving physical function, and counseling about physical activity should be a routine component of HIV care to increase the lifespan and healthspan of individuals with HIV. There are some promising pharmaceutical options, but more research is needed to determine the safety and long-term efficacy. This article summarizes an International Antiviral Society-USA (IAS-USA) webinar presented by Kristine M. Erlandson, MD, MS, on July 24, 2020. This webinar is available on demand at https://www.iasusa.org/courses/on-demand-webinar-2020-erlandson/.

Transgender individuals face discrimination, violence, social exclusion, and other social, political, and economic factors that result in increased vulnerability to HIV. Rates of viral suppression and uptake of preexposure prophylaxis are lower among transgender individuals than the general population. HIV clinics can help improve these rates by promoting inclusivity and tailoring care to the specific needs of transgender patients. This article summarizes an International Antiviral Society-USA (IAS-USA) webinar presented by Asa E. Radix, MD, PhD, MPH, on August 18, 2020. This webinar is available on demand at https://www.iasusa.org/courses/on-demand-webinar-2020-radix/.

Adolescents in the United States are at increased risk for acquiring HIV and other sexually transmitted infections (STIs). Rates of chlamydia, gonorrhea, and primary and secondary syphilis are increasing among individuals aged 15 to 24 years, among both sexes. Approximately 1 in 5 new HIV diagnoses is occurring among individuals aged 13 to 24 years. Compared with heterosexual and cisgender youth, sexual and gender minority youth may be more likely to have had sex before age 13 years, and young transgender women have the highest rates of HIV and STIs than other sexual and gender minority youth. Comprehensive, culturally sensitive, and developmentally sensitive care is needed to address sexuality-related issues in adolescents and young adults. This article summarizes a presentation by Allison Agwu, MD, ScM, at the International Antiviral Society-USA (IAS-USA) annual continuing education program held in New York, New York, in September 2019.

Due to COVID-19, this year marked the first virtual Conference on Retroviruses and Opportunistic Infections (CROI) in the conference's 27-year history. There were important studies presented that provided new insights into the prevention, diagnosis, and treatment of tuberculosis (TB) and other HIV coinfections. Highlights related to TB and HIV coinfections from this year's meeting are reviewed below.

At the 2020 Conference on Retroviruses and Opportunistic Infections, held virtually as a result of the emerging COVID-19 pandemic, trends in the HIV epidemic were highlighted, with decreasing HIV incidence reported across several countries, although key regions remain heavily impacted, including the US South. Adolescent girls and young women, men who have sex with men (MSM), transgender persons, and people who inject drugs continue to experience a high burden of new infections. Sexually transmitted infections during pregnancy can lead to a number of adverse outcomes in infants; novel strategies to detect and treat these infections are needed. Innovative HIV testing strategies, including self-testing and assisted partner services, are expanding the reach of testing; however, linkage to care can be improved. Novel preexposure prophylaxis (PrEP) delivery strategies are increasing uptake of PrEP in different groups, although adherence and persistence remain a challenge. Use of on-demand PrEP is increasing among MSM in the US. Strategies are needed to address barriers to PrEP uptake and persistence among cis- and transgender women. Several novel regimens for postexposure prophylaxis show promise.

Therapeutic vaccines and broadly neutralizing antibodies (bNAbs) represent potential approaches to antiretroviral-free treatment of HIV. Although therapeutic vaccines have been able to produce transient reductions in viral load during analytic treatment interruptions (ATIs), thus far none has been able to induce long-term remission. Pairing with latency reversal agents and immune modulators may improve vaccine efficacy. The bNAbs are investigated as a promising approach to achieving durable virologic control in the absence of antiretroviral therapy. Combinations of antibodies are necessary for increasing overall breadth and potency of coverage and preventing emergence of resistance. The next generation of antibodies includes engineered bispecific and trispecific antibodies that target 2 or 3 independent viral sites. This article is based on a presentation by Magdalena E. Sobieszczyk, MD, MPH, at the International Antiviral Society-USA (IAS-USA) continuing education program held in New York in March 2019.