HIV and ID Observations

An ID Link-o-Rama — get it?

We’ll get to the ID links in a moment, but first, allow me to share a few words about the election, which strangely feels like a million years ago.

(It was a week. Time is strange.)

Instead of rehashing what happened and what’s to come, here’s what I’m offering: some feelings from one specialist in infectious diseases — me.

I’ll start by saying that long-time readers can probably surmise that the winner on November 5 wasn’t the candidate I voted for. I know, shocking.

Nor would you be surprised to hear that most of my ID colleagues voted the same way I did. Not all of them, of course — our political leanings may tilt heavily one way, but they’re not unanimous.

Still, as the results of the election rolled in and it became evident that they would yield an incontestable win for the Red Team, it occurred to me (as it did in 2016) that our pervasive opinion puts us outside the norm. That’s usually okay — why be mainstream all the time? I think we ID doctors wear our distinctiveness with pride, if not with fancy clothes.

But the post-election feeling among most of my colleagues (and me) was one of disbelief — how could someone vote for that guy? It also made me feel isolated, and sad.

This is especially the case since this country of ours happens to be one that I have deep affection for, warts and all.

Truth be told, even with the election of a man who claimed that recent immigrants are eating dogs and cats, and who once suggested that injecting a disinfectant would treat a novel coronavirus, there’s no place else I’d rather live. Here’s one big reason why:  It’s that I have the freedom — the right — to voice a critical opinion of our president-elect, and that I proudly voted with the 72 million and not the 75 million voters. Let’s not take that freedom for granted, and continue to defend it.

On to the ID links, a baker’s dozen to prepare us for Thanksgiving pies, just a bit over 2 weeks from now.

Ensitrelvir prevented the development of symptomatic COVID-19 among household contacts. These are potentially exciting results, especially since Paxlovid did not work in a similar prevention study, and whatever monoclonal antibody du jour we’re using seems doomed to fail eventually as variants emerge. Ensitrelvir is a SARS-CoV-2 protease inhibitor approved for use in Japan and Singapore; I’m very hopeful we’ll have access to it here as well.

7% (8 out of 115) of dairy workers had serologic evidence of highly pathogenic avian influenza A(H5N1). That seems like a lot, doesn’t it? Whether H5N1 will eventually yield an increase in influenza case numbers and/or per-case severity during this or future flu seasons remains unknown, but most definitely deserves close watching.

A large collaborative group of ID pharmacists and doctors published WikiGuidelines for prevention and treatment of urinary tract infections. What a sensational resource of data on diagnosis, treatment, and prevention! Really great. But somewhere along the way I lost the meaning of the term “Wiki” as it applies to mega-projects like this — what does it mean?

Once again, macrolide resistance was strongly predictive of poor outcomes in pulmonary disease due to M. avium complex. Those with MICs ≥32 µg/mL had an odds ratio of 0.25 for achieving microbiological cure.

Omadacycline treatment of M. abscessus led to a faster resolution of symptoms and better microbiologic clearance than placebo. It’s a small, phase 2 study, but it would be huge if eventually omadacycline gets FDA approval for this difficult-to-treat infection.

Related, here is a “State-of-the-Art” review of nontuberculous mycobacterial pulmonary disease. Written by top experts in the field, it covers all the main topics in a practical, informative way. Highly recommended, as I do all the State-of-the-Art Reviews in Clinical Infectious Diseases!

Cases of pneumonia due to mycoplasma have increased substantially in children and young adults. I first heard of this through my most reliable (and readily available!) source of community infectious outbreaks — my primary care pediatrician wife, who says recently “everyone” seems to have it. Helpful clues (per her) are failure to respond to beta-lactams and those weird mycoplasma-related rashes.

Immunity following yellow fever vaccination appears to be durable. Breakthrough cases occur but very rarely. This paper supports the recommendation that a one-time shot for travelers need not be repeated, so very good news.

In its first year of availability, the RSV vaccine reduced the risk of hospitalization by 80% among adults over 60. It was also effective in immunocompromised hosts. It remains unclear whether these vaccines will need to be repeated; for now. there is no recommendation to do so.

According to this preprint study, by the end of 2023, 99.9% of the U.S. population had immunologic exposure to SARS-CoV-2 via either infection or vaccination or both. Previous infection was also nearly universal, at 99.4%. It’s in this immunologic milieu that current antivirals for COVID-19 must make their impact — a tall order, but I believe still achievable with appropriate symptom-based endpoints.

In data collected from two academic medical centers over 5 years, uptake of anal cancer screening for men who have sex with men who have HIV was very poor. Additionally, cytology performed badly in both sensitivity and specificity, raising questions about whether we should be doing it all (versus referring high-risk individuals directly for high-resolution anoscopy). Am I the only one who thinks that the guidelines issued for anal cancer screening are impractical to implement and not evidenced-based?

Using a hospital-based database, investigators found that 41% of patients with babesiosis had coinfection with Borrelia burgdorferi, the etiologic agent of Lyme disease. I knew it was high, but didn’t think it would be that high — should probably prompt empiric doxycycline in everyone newly diagnosed with babesia. Wow. By contrast, ehrlichiosis and anaplasmosis occurred in only 3.7% and 0.3%.

There is very little good evidence on the optimal use of long-term suppressive antibiotics therapy, prompting this sensible review. The four main categories they cover are prosthetic joint infections, hardware infections of bone not involving joints, vascular graft infections, and cardiac implantable electronic devices. The authors also offer advice about monitoring and situations to consider antibiotic cessation.

Ok, now a few bonus non-ID links — just one involving politics, I promise!

The New Yorker just reposted Claire Keegan’s exquisite short story “Foster”. It was later published as a novella, and made into a movie called The Quiet Girl. Some think the book is better than the movie, others the reverse. Regardless, I can’t recommend either of them strongly enough. The movie for another great book of hers, Small Things Like These, has just been released. Anyone see it yet?

For a laugh-out-loud read that will resonate strongly with those charged with writing letters of recommendation, give Dear Committee Members by Julie Schumacher a try. Giving new meaning to the term epistolary novel, the book captures the life of a middle-aged academic who’s clearly past his prime, but still has quite the way with words. I heard about this book from my friend (name dropping, sorry) Andy Borowitz, so thank you, Andy!

Speaking of, Andy Borowitz thinks the President-elect is in for a world of trouble. Love this quote:  “As for Trump’s war on inflation, the skyrocketing prices caused by his proposed tariffs will make Americans nostalgic for pandemic-era price-gouging on Charmin.”

The online piano instructional company Pianote has some astounding videos on YouTube. The most remarkable are those where they play a song for the first time to a gifted musician, to see what they can do with it on the spot. See the video below for a remarkable example.

Makes a person optimistic about the capabilities of the human species, doesn’t it?