HIV and ID Observations

(Important note:  Title has nothing to do with this post’s content. I just felt like writing something about baseball.)

As some of us eagerly await the start of the 2016 baseball season — especially Cubs fans — here are some ID/HIV items yearning to shag flies, toss around the horsehide, and play some pepper:

• Famous anti-vaxxer — and notorious scientific fraud — Andrew Wakefield was going to have his film shown at the Tribeca Film Festival, but now it’s been pulled. Robert De Niro might be a great actor, but he whiffed big time on this one. Here’s a humorous editing of the festival’s original biography of the filmmaker (notice I don’t write “scientist” or “doctor”).
• TB cases in the USA are up for the first time in 23 years. Up a little — 157 more cases in 2015 than 2014. It’s the end of a longstanding decline, a remarkable success story (so far). The CDC report accurately describes this as a “leveling” of TB rates — it’s not a “surge” as the headlines in the popular press write — but it also makes the complete elimination of TB in this country increasingly unlikely.
• CRISPR/Cas9 eliminates HIV from T-cells. With the caveat and confession that I’ve never done a single second of basic science research, my gut feeling is that this (or a related strategy) is more likely to be successful at curing HIV than giving chemotherapy-like drugs to “awaken” the latent reservoir. But what do I know? Good review of CRISPR for non-lab scientists here.
• While we’re curing HIV, let’s also try a new HIV vaccine strategy. This one will generate broadly neutralizing antibodies (bNAbs), which are all the rage.
• Lots of flu out there right now. You’d almost think influenza is seasonal, or something crazy like that.
• The outbreak of Elizabethkingia anophelis in Wisconsin continues to baffle public health officials. The bugs are genetically related, but there’s no obvious environmental source (yet), and cases are widely dispersed geographically. Contaminated injectable medications, or an intravascular medical device, both distributed from the same (unsterile) point of origin? Trivia question — what was Elizabethkingia called before it was named after microbiologist Elizabeth O. King?
• CDC has issued an updated guidance on caring for women and men of childbearing age with Zika exposure or disease. Key take home recommendations:  After symptomatic disease, women should wait at least 8 weeks before attempting conception, and men at least 6 months. With possible exposure and no symptoms, both should wait at least 8 weeks. As the data linking Zika to birth defects continues to accumulate, these guidelines make a lot of sense.
• In other mosquito-related infection news, this dengue vaccine candidate (TV003) looks very promising. All 21 vaccine recipients were protected against infection after challenge with a weakened form of dengue; by contrast 20 out of 20 placebo recipients developed viremia, 80% a rash. Importantly, TV003 elicits antibodies to all 4 dengue serotypes. At least two large clinical trials are being conducted, one in Brazil, one in Thailand.
• In this observational study, antibiotic exposure in babies was not associated with childhood obesity. It’s just one negative study; nonetheless, it would fascinating to get an interpretation from Marty “Missing Microbes” Blaser, who writes and speaks quite eloquently on this putative link between antibiotic overuse and the obesity epidemic.
• Here’s the study showing that dolutegravir significantly increases metformin exposures. These data led to a dolutegravir label change a few months ago, stating that metformin dosing should not exceed 1000 mg a day in patients taking both drugs. Dolutegravir and raltegravir have so few significant drug interactions, it’s critical to remember the important ones.
• Toxoplasmosis is associated with impulsive behavior and aggression. I gather toxo does the same thing to mice, making them more reckless — and hence more likely to be nabbed by cats (the source of the toxo to begin with). These studies on the neuropsychiatric effects of this parasitic infection in immunocompetent humans periodically appear in the medical literature; recent review here.
• Good targeted review of rapid TB diagnostics, in particular their use in low-prevalence settings. We’ve got a lot to learn from the extensive use of Xpert globally.
• Speaking of, the giant-pouched African rat can diagnose tuberculosis. It’s multi-talented, as it also can find land mines — here’s their web site. Maybe it’s just me, but I find the UTI-detecting dogs much cuter.

In case De Niro wants a movie short to replace the one he’s now cut from the Tribeca Film Festival, he can show this one — it would be better than Dirty Grandpa.

[youtube http://www.youtube.com/watch?v=3aNhzLUL2ys]