Top Infectious Disease News of the Week—July 21, 2019

Stay up-to-date on the latest infectious disease news by checking out our top 5 articles of the week.

#5: SEARCH Study Evaluates Population-Level PrEP Uptake

The Sustainable East Africa Research in Community Health (SEARCH) study is an ongoing trial assessing evidence-based interventions that lead to the elimination of HIV in rural communities in select areas of East Africa. The second phase of the study, which will be completed in July 2020, is evaluating the impact of targeted pre-exposure prophylaxis (PrEP), targeted HIV testing, and targeted care interventions for universal treatment and streamlined care.

The study is being led by investigators from the University of California, San Francisco, who report that optimal PrEP delivery approaches are needed in the African region. In a presentation at the 10th IAS Conference on HIV Science (IAS 2019), study investigators presented a poster on population-level PrEP uptake and engagement following near-universal HIV testing in rural Kenya and Uganda.

As part of the investigation, the research team initiated community-level PrEP outreach and education. Following the implementation, the team conducted home-based testing and offered PrEP to individuals who were at a higher risk (as determined by a self-assessment, seroconversion risk score, or serodiscordance). To determine effectiveness, the study team evaluated PrEP uptake within 90 days of HIV testing. More specifically, the team assessed program engagement, medication refills, and self-reported 3-day adherence over 72 weeks among the individuals who initiated PrEP.

Read more about the SEARCH study.

#4: New Data Support Switch to B/F/TAF in Women and Patients With Resistance to Other HIV Therapies

New data presented at the 10th IAS Conference on HIV Science (IAS 2019) suggest that bictegravir 50 mg/emtricitabine 200 mg/tenofovir alafenamide 25mg tablets (B/F/TAF) could be efficacious treatment for HIV in women and virologically suppressed individuals with known resistance to other therapies.

B/F/TAF (Biktarvy) was approved by the US Food and Drug Administration in February 2018 for the treatment of HIV-1 in individuals weighing at least 25 kilograms who do not have a history of antiretroviral treatment history or individuals who are virally suppressed on an antiretroviral regimen with no history of treatment failure.

The drug, which was developed by Gilead, was recently evaluated in 2 phase 3 trials, for which data were presented at the IAS 2019 meeting in Mexico City, Mexico.

Read about a switch to B/F/TAF.

#3: Risk of Neural Tube Defects Slightly Higher in Children Born to Women on Dolutegravir

Use of antiretroviral therapy (ART) in pregnancy and the effects on the fetus are a pressing topic in the field of HIV science, specifically the association between dolutegravir use in early pregnancy and neural tube defects (NTDs).

Initial data from the Tsepamo Study in Botswana presented last year suggested a link between the use of dolutegravir from conception and NTDs. Now, at the 10th IAS Conference on HIV Science (IAS 2019), investigators are presenting a more complete collection of Tsepamo data collected through March 2019 on the link between ART exposure in pregnancy and birth defects.

The research team found that children born to women on ART regimens containing dolutegravir at the point of conception do have a slightly higher risk of NTDs compared with women on other ART regimens.

Read more about the neural tube defects.

#2: The Complexities of the DRC Ebola Outbreak

The outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) is the second largest in history and a lot has happened over the last couple of weeks. Here’s an overview to give you the latest information not only on the outbreak but also on the challenges of response. In a situation that has been marked by conflict and insecurity, response efforts are met with new challenges as health workers try to learn new response tactics to tackle the outbreak.

Current Status of Outbreak

The most recent data show that the outbreak has exceeded 2484 confirmed cases, with over 1600 fatalities. Cases have been climbing in the double-digits on a daily basis, which fuels concern for this growing outbreak. On Thursday, July 18, 2019, the DRC Ministry of Health epidemiological situation report noted 10 new confirmed cases and 7 new confirmed deaths, with 402 cases under investigation. One of these new cases is in a vaccinated health care worker, which adds to the growing volume of 137 health care workers who have become infected, 41 of whom have died.

Read more about the Ebola outbreak.

#1: Two Takes on the Possible Future of Antibiotic Resistance: Public Health Watch

Is it the best of times or the worst of times?

We don’t often have the opportunity to quote literary classics in this space, but 2 recent articles—a commentary published by The Washington Post and an analysis from The Economist—on the issue of antimicrobial resistance have left us feeling downright Dickensian.

And we’re likely not alone.

First, in her July 8 commentary in the Post, Michelle A. Williams, ScD, dean of the faculty and angelopoulos professor in public health and international development at the Harvard TH Chan School of Public Health and Harvard Kennedy School, describes mainstream media coverage of antibiotic resistance as tinged with “alarm…and helplessness.” Although she acknowledges that “[m]uch of this is warranted,” she believes “there is a clear path to reversing the situation.” You see, we’re thinking Dickens, but she’s focusing on another Charles: Darwin.

As Williams writes, humanity has faced infection-based public health challenges in the past (she cites smallpox and polio) and come out on top (think: survival of the fittest)—eventually. And she feels we can do it again when it comes to infections caused by antibiotic-resistant bacteria. To meet the challenges head on, she recommends a 3-pronged approach that includes:

  1. Infection prevention through antibiotic stewardship and hospital infection-control programs and the reduction of antibiotic use in farm animals and food production.
  2. Increased incentives for antibiotic development. Here she highlights CARB-X and a proposal by former Goldman Sachs exec Jim O’Neill that effectively involves nationalizing drug companies that produce novel antibiotics.
  3. Considering antibiotics “public goods that should be available to all” (read: affordable and accessible to those in the developing world).

Read more about the potential future of antibiotic resistance.