April 360: Trending Infectious Disease News of the Month

During the month of April, the Contagion® staff covered the European Clinical Congress of Microbiology and Infectious Diseases (ECCMID 2019), the Society for Healthcare Epidemiology of America’s Spring Meeting (SHEA 2019) and published the latest edition of the print publication with a new cover.

In addition to the conference coverage and print publication, the staff launched a new weekly column which provides a weekly recap of infectious disease-related US Food and Drug Administration news.

April also saw a severe uptick in measles cases, as the number of cases in a given year reached an all-time high since the disease was declared eliminated in 2000. In case you missed it, Contagion® also debuted a new Insights series this month featuring a discussion between Glenn Fennelly, MD, MPH, professor and chair of pediatrics at Rutgers New Jersey Medical School and a pediatric infectious disease specialist, and Christina (Tina) Tan, MD, MPH, a state epidemiologist and an assistant commissioner with the New Jersey Department of Health, on how public health officials are responding to this outbreak.

The US Centers for Disease Control and Prevention (CDC) announced outbreaks of E coli linked to ground beef, Salmonella linked to pre-cut melons, Listeria monocytogenes linked to deli sliced meats, and cheeses, and Salmonella linked to frozen raw tuna during the month of April. A list of affected states and case counts for all of these outbreaks can be found on the Contagion® Outbreak Monitor.

Check out a list of the top 5 articles from the month of April below.

#5: World Health Day 2019: Evaluating the Infectious Disease Landscape

Each year on April 7th, the World Health Organization (WHO) celebrates World Health Day.

The WHO’s campaign for 2019 is focusing on universal health coverage and ensuring that individuals across the world have access to the care that they need when they need it.

This year for World Health Day, Contagion® is reflecting on the scientific advancements in treatment and prevention that have been made in the areas of infectious disease, while also looking at the infectious disease landscape to identify areas that require further improvement to reduce preventable deaths globally.

Read about World Health Day 2019.

#4: CAMERA2: Combination Therapy for MRSA Bacteremia Effective but Linked to Higher Mortality, AKI Rates

In vitro, animal models, and observational studies in humans have demonstrated that combination therapy comprising vancomycin, the current standard treatment, with a β-lactam appears to be more effective than monotherapy in treating methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.

But results from the largest clinical trial to date have raised concerns over the effects of combination therapy on mortality and rates of acute kidney injury (AKI).

The CAMERA2 study, presented at the European Congress of Clinical Microbiology and Infectious Disease (ECCMID 2019), sought to evaluate combination therapy through an investigator-initiated randomized controlled trial of patients with MRSA bacteremia.

Read about the results of CAMERA-2.

#3: FURI Study Case: Ibrexafungerp Successfully Treats Esophageal Candidiasis

Candida species are a common cause of mucosal and invasive candidiasis. In certain circumstances, patients may develop refractory candidiasis as a result of either resistance to antifungals or innate immune system deficiencies.

While conducting a study evaluating the safety and efficacy of ibrexafungerp (IBX, formerly SCY-078), investigators observed that a case of severe refractory esophageal candidiasis was treated successfully with the novel glucan synthase inhibitor antifungal.

Details on this case were presented in a poster presentation at the European Congress for Clinical Microbiology and Infectious Diseases (ECCMID 2019).

IBX has documented broad spectrum of activity against common species of Candida, Aspergillus, and Pneumocystis. The antifungal is being evaluated in an open-label clinical trial of patients either intolerant or refractory to antifungal therapy. The trial is called SCYNEXIS Study 301, or FURI.

Read more about the FURI case study on esophageal candidiasis.

#2: Receipt of PrEP at Study Enrollment Linked With Increased Incidence of STIs

As pre-exposure prophylaxis (PrEP) is recommended to populations at a higher risk for acquiring HIV, some clinicians have grown concerned that use of PrEP could be associated with an increased incidence of bacterial sexually transmitted infections (STIs).

Now, a new study by a team of Australian investigators published in the Journal of the American Medical Association reports that, among gay and bisexual men, receipt of PrEP during the study was associated with an increased incidence of STIs when compared with before the study period.

The team set out to describe STI incidence as well as behavioral risk factors among gay and bisexual men using PrEP, in addition to exploring changes in STI incidence following initiation of a PrEP regimen.

The research was conducted as part of the Pre-exposure Prophylaxis Expanded (PrEPX) study, which was a multisite, open-label intervention study within the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) clinic network. The study enrolled a total of 4275 participants between July 26, 2017, and April 1, 2018, in Victoria, Australia.

Read about the increased incidence of STIs in the PrEPX study

#1: HIV Infection in 2019: A Cure Is Not the Real News

The announcement of the London patient, the second person cured of HIV infection through hematopoietic stem cell transplant, sent waves through the media and spurred a series of inaccurate headlines that put HIV back into focus for people who do not think about it often. I personally received a series of text messages along the lines of “Did you hear about the HIV cure?” and “I heard there’s someone in Europe with a cure for AIDS.” Because these came from intelligent, nonmedical people, it led me to reflect on the paucity of knowledge that most people have about the breakthroughs in HIV management and therapies.

One-pill regimens have been a reality for HIV regimens since the approval of efavirenz, emtricitabine, and tenofovir disoproxil fumarate (Atripla) more than 10 years ago. This revolution has continued with integrase strand transfer inhibitor (INSTI)—based regimens earlier this decade. Regimens containing 3 drugs can be replaced with 2-drug regimens, sparing patients from exposure to a third agent. In many ways, therapy for HIV infection has become easier to manage than that of diabetes. However, this is not well known outside infectious diseases clinicians, and even many HIV care practitioners are hesitant to transition patients whose infection is undetectable on an older 3-drug regimen to a novel regimen that decreases antiretroviral exposure.

Pre-exposure prophylaxis (PrEP) has transformed HIV prevention. Patients at high risk who are taking a single, well-tolerated antiretroviral are well protected from HIV infection, as is the public, by a reduction in transmission. It is a true public health revolution. However, the benefit has reached communities that are at risk at varying levels. Coastal gateway cities that formerly had the highest incidence of HIV infection but have instituted PrEP programs have been replaced by cities in the Southeast. Cities with a high prevalence and that provide PrEP programs are seeing the incidence drop. Despite high coverage by insurance companies, only a small proportion of patients who could benefit from PrEP currently receive it. Much needs to be done to spread the word to primary care providers and other clinicians, including pharmacists, nurse practitioners, and physician’s assistants, to screen and recommend PrEP when appropriate.

Read this month’s letter from Editor-in-Chief Jason C. Gallagher, PharmD.