Topics in antiviral medicine最新文献

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.

A high proportion of individuals with HIV infection currently are diagnosed at an advanced stage of disease (late presenters), increasing their risk for immune reconstitution inflammatory syndrome (IRIS). IRIS typically occurs within 6 months of initiation of antiretroviral therapy (ART) in patients with low CD4+ cell counts and can occur before any marked elevation in CD4+ count is achieved on ART. In addition to low CD4+ count at ART initiation, 2 other major clinical predictors of IRIS are preexisting opportunistic infection (including subclinical infection) and shorter treatment period for opportunistic infection prior to starting ART. Mycobacterial infection-associated IRIS, including tuberculosis (TB)-associated IRIS, and cryptococcal infection-associated IRIS are the most common forms of the syndrome. Corticosteroid prophylaxis and early treatment can be effective in reducing incidence of TB-IRIS and severity of symptoms in select patients. Sterilization of the cerebrospinal fluid should be achieved prior to starting ART in patients with TB meningitis and cryptococcal meningitis. This article summarizes a presentation by Irini Sereti, MD, MHS, at the International Antiviral Society-USA (IAS-USA) continuing education program held in Washington, DC, in April 2019.

Effective antiretroviral therapy has extended life expectancy for individuals with HIV. Estimates from 2015 indicate that 47% of persons with HIV in the US were older than 50 years of age and 16% were older than 65 years. These older patients are at increased risk of age-related diseases and conditions. Further, there is substantial evidence that patients with HIV infection accumulate age-related conditions earlier than do those in the general population. There is risk for increased comorbidities and polypharmacy in the aging HIV-infected population. Specific measures for assessing and reducing the risk of cardiovascular disease and other age-related conditions in the aging HIV population are needed. This article summarizes a presentation by Judith A. Aberg, MD, at the International Antiviral Society-USA (IAS-USA) annual continuing education program held in Chicago, Illinois, in May 2019.

Achieving a cure for HIV remains a priority in HIV research. Two cases of 'sterilizing cure' have been observed-in Timothy Ray Brown and the "London" patient; both patients received allogeneic hematopoietic stem cell transplantation (HSCT) from donors homozygous for the CCR5-delta 32 deletion, which impairs function of an HIV coreceptor on host cells. Other strategies that have been evaluated for achieving sterilizing cure or functional cure--ie, sustained virologic remission in the absence of antiretroviral therapy (ART)-include: HSCT with wild-type CC chemokine receptor (CCR5); early ART to limit size of the HIV latent reservoir; shock and kill strategies using latency reversing agents and/or anti-HIV broadly neutralizing antibodies; and gene therapy, including attempts to modify CCR5 genes, HIV proviruses in autologous host cells, or enhanced T cells. This article summarizes a presentation by Jonathan Li, MD, MMSc, at the International Antiviral Society-USA (IAS-USA) continuing education program held in Atlanta, Georgia, in March 2019.

The 2019 edition of the IAS-USA drug resistance mutations list updates the Figure last published in January 2017. The mutations listed are those that have been identified by specific criteria for evidence and drugs described. The Figure is designed to assist practitioners in identifying key mutations associated with resistance to antiretroviral drugs, and therefore, in making clinical decisions regarding antiretroviral therapy.