HIV and ID Observations

A few notable ID stories out there for this remarkable convergence in our Judeo-Christian holiday calendar:

• Experimental Ebola vaccine “100%” effective. Impressive scientific progress on prevention of this terrifying disease, with even better strategies expected soon.
• 10 days of antibiotics is better than 5 for childhood (age < 2) otitis media. For the record, my “inside source” on this question is not surprised one bit at the result. We’re seeing the opposite trend in sinusitis and pneumonia treatments of adults, toward shorter antibiotic courses.
• The USPSTF recommends against routine serologic screening for genital herpes. The serologic test is lousy, with lots of false positives — from the summary:  “The positive predictive value may be as low as 75% for the biokit test and as low as 50% for HerpeSelect.” As I’ve noted before, the recommendation against general screening probably won’t apply to patients who come in requesting to be tested, where you can explain the pros and cons of the strategy.
• The American College of Cardiology/American Heart Association risk calculator discriminates cardiovascular risk “adequately” in people with HIV. Adding HIV-specific factors (HIV viral load, CD4 lymphocyte count, antiretroviral therapy, and protease inhibitor use) to the calculator did not improve the performance. A take away point is that at the lower estimates, these should be considered the minimum risk.
• Listerine is active against pharyngeal gonorrhea. At last, the answer
  to the challenges of the post-antibiotic era! And time to bring back this classic ad campaign (see poster), with slight modification:  “He’s not going to call — but the Department of Public Health will!”
• Two-drug HIV therapy with dolutegravir and rilpivirine is non-inferior to continued triple therapy. Full results of these studies — called SWORD — are to be presented at a scientific conference, presumably at CROI in February 2017.
• IAS-USA released an update of the HIV drug resistance mutations. Even today, when emergent resistance to antiretrovirals is less common, this is a critical and authoritative resource for all HIV providers.
• The investigational HCV treatment glecaprevir/pibrentasvir has been submitted to the FDA. This protease inhibitor/NS5A inhibitor combination pill is a pan-genotypic approach that will be 8 weeks for treatment-naïve, 12 weeks for treatment-experienced or anyone with compensated cirrhosis. Clinical trials have included a wide range of patients, including those with HIV, advanced renal disease (including ESRD), and people who have failed current HCV therapy — the last of these granting a Breakthrough Therapy Designation, meaning likely fast approval.
• Think that because antibiotics in food is bad PR, there has been a significant decline in the food industry’s use? Think again — according to the latest FDA reports, sale of antibiotics to farms increased by 1% in 2015 compared with the year before.
• Topical azithromycin does not prevent Lyme disease. Oh well. On the plus side, there is at least some active research on a new Lyme vaccine.
• Phage therapy seems to have helped cure this case of multi-drug resistant Pseudomonas. It’s just a case report, and not (yet) in a peer-reviewed publication, but it’s quite the story nonetheless — and has prompted numerous non-ID doctors to ask me about it, especially in the ICUs. Fascinating list of potential non-antibiotics approaches to drug-resistant bacteria here.
• Results of anaerobic cultures rarely influence clinical management. In general, most of the patients with positive anaerobic cultures were already receiving therapy directed against the isolated bacteria, or there was no acknowledgement of the result at all. The authors call for anaerobic cultures to be ordered more selectively, which makes sense.
• Pubic hair grooming is associated with increased risk of certain sexually transmitted infections. In a study like this, the possibility of “confounding by indication” is astoundingly high (to be a stats nerd for a moment) — meaning that those who were extensively grooming may have been extensively doing other things, too! It remains a provocative finding nonetheless.
• If you’re cared for by a female physician, you’re more likely to survive. Maybe because so many of them choose ID and pediatrics!

Finally, it’s been a tough year for giants in music, especially if you’re a fan of a certain age. We lost Prince, David Bowie, Leonard Cohen, Leon Russell, Keith Emerson, Sir George Martin … and today, George Michael.

Here’s a somewhat less-famous song of his (certainly less flashy — here if you want that), with a nice late-Beatles/John Lennon quality to it, and lyrics quite appropriate to the times. Enjoy.

[youtube https://www.youtube.com/watch?v=goroyZbVdlo]