Top Infectious Disease News of the Week—November 11, 2018

#5: NAFLD Linked With Traditional Metabolic Risk Factors in People Living With HIV Nonalcoholic fatty liver disease (NAFLD) is common among people living with HIV, but the associated risk factors have been widely unknown.

According to new research presented the 2018 American Association for the Study of Liver Diseases (AASLD) Liver Meeting, November 9-13, 2018, in San Francisco, California, investigators found that in people living with HIV, traditional metabolic risk factors, including low HDL cholesterol, hypertriglyceridemia, and body mass index (BMI) were associated with NAFLD.

A team of investigators from Massachusetts General Hospital, the University of Colorado Denver, and the University of Texas Health Science Center, set out to identify metabolic and HIV-specific risk factors for NAFLD in people living with HIV, by searching the Partners HealthCare Research Patient Data Registry to identify people living with HIV both with and without NAFLD.

From the database, 97 individuals with HIV and NAFLD and 135 without were identified, excluding individuals with significant alcohol use or viral hepatitis. The investigators defined the presence of NAFLD as fatty infiltration of the liver on imaging using either previously validated criteria or steatosis on biopsy. Absence of NAFLD was defined as normal liver imaging and/or histology.

Read more about risk factors for NAFLD for people living with HIV.

#4: Hepatitis C Virus Retreatment Successful with SOF/VEL/VOX in Patients With and Without HIV A fixed-dose combination therapy of sofosbuvir, velpatasvir, and voxilaprevir (SOF/VEL/VOX, Vosevi, Gilead) was highly effective after 12 weeks in retreating direct-acting antiviral-experienced patients with hepatitis C virus infection, with and without HIV co-infection, including those with prior noncompletion of treatment or poor adherence, according to results of a new study presented at the 2018 American Association for the Study of Liver Diseases (AASLD) Liver Meeting, November 9-13, 2018, in San Francisco, California.

Hepatitis C virus infection can be successfully treated with the use of direct-acting antiviral agents. In rare cases, patients can relapse; however, they can still be retreated successfully. SOF/VEL/VOX is one such treatment for hepatitis C virus infection that has shown success in patients who are treatment-experienced; however, many studies have not assessed the success of retreatment in patients with HIV or hepatitis B virus co-infection.

“I think many people expect that the drugs will work the same in HIV-positive patients as in HIV negative patients because of the early data in ledipasvir/sofosbuvir (Harvoni, Gilead) especially showing similar efficacy like in the ERADICATE study,” study lead investigator Eleanor MP Wilson, MD, MHS, assistant professor of medicine at the University of Maryland School of Medicine in Baltimore, Maryland, explained in an email with Contagion®’s sister publication, MD Magazine®. “[However,] some recent data has shown that in real-world studies, patients with HIV may be less likely to succeed, because of drug interactions, immunologic effects, or other factors. [Therefore,] the newer retreatment regimens need to be tested in people with HIV infection, to show that there are no drug interactions and that patients with HIV and hepatitis C virus [or hepatitis B virus] co-infection will have retreatment options.”

Read about successful retreatment with SOF/VEL/VOX in patients with and without HIV.

#3: HIV and NAFLD More Common Than Originally Thought Research on nonalcoholic fatty liver disease in persons infected with HIV revealed a prevalence of the condition of about 40%, suggesting the condition may be an underappreciated comorbidity in this population.

A team of investigators led by Matthew Copeland, DO, an internist at Medstar Georgetown University Hospital in Washington, DC, set out to determine the prevalence and characteristics of nonalcoholic fatty liver disease in persons with HIV in a regional cohort of patients.

IBM Watson’s EXPLORYS platform was used to analyze a de-identified database of medical records of patients who were seen at Medstar Health Facilities in Washington, DC, between January 1, 2006, and December 31, 2016. Diagnoses of HIV, nonalcoholic fatty liver disease, cirrhosis, hepatitis B or hepatitis C virus infection were identified through ICD-9 and ICD-10 codes.

Read about how HIV and NAFLD are more common than originally thought.

#2: Antibiotic-Resistant Infections Could Kill Millions Globally by 2050, OECD Says: Public Health Watch I landed in Glasgow, Scotland last week seeking some much-needed rest and relaxation.

Instead, I was welcomed with blaring headlines in the local press: “Antibiotic-resistant superbugs 'will kill 90,000 Britons by 2050'.” Proof, again, that when it comes to risks from infectious diseases, that there is no such thing as rest—particularly for those who face these threats head on and work to protect society from them.

Sadly, such doomsday proclamations are all too common in the press, and all too many of them, when read closely, are very often a lot of “sizzle” and little “steak.”

Unfortunately, the threat highlighted in the analysis by the Organization for Economic Co-operation and Development (OECD) in the United States—the subject of those blaring headlines mentioned above—is all too real. And the United Kingdom is not even going to face the worst of it.

Read about anticipated deaths from antibiotic resistant infections.

#1: Outbreaks of All Acute and Chronic Infectious Diseases Are Seasonal Infectious diseases can circulate on some level throughout the year, but in a new study, an investigator from the Columbia University Mailman School of Public Health shared that all outbreaks of infectious diseases have a seasonal element.

According to the World Health Organization (WHO), 3 of the top 10 causes of death worldwide in 2016 were infectious conditions—lower respiratory infections, diarrheal diseases, and tuberculosis. Although the number of deaths caused each year by these conditions has declined since 2000, together they still caused more than 5.5 million deaths globally in 2016, and along with other infectious diseases continue to create a global public health burden.

Researchers have observed that with seasonal patterns of some infectious diseases there are periodic surges in disease incidence which correspond with seasons or other annual conditions, though the mechanisms behind this seasonality of many conditions are not entirely understood. For example, investigators are still working to understand how climate drives outbreaks of influenza each year.

Investigators on a new study, published on November 8, 2018, in the journal PLOS Pathogens, explored documented seasonal cycles of human infections, and posited that all infectious diseases outbreaks have a seasonality caused by varying factors. The findings, according to the author, expand the concept of an epidemic calendar to include seasonal outbreaks of even more infectious diseases.

In the study, Micaela Martinez, PhD, an infectious disease ecologist at Columbia University in the Department of Environmental Health Sciences, noted that we are familiar with outbreaks of influenza in winter and chickenpox in the spring, and pointed to evidence suggesting that each acute infectious disease has its own seasonal window of occurrence, which can vary among geographic locations and differ from other diseases within the region.

Read about the seasonal patterns of infectious diseases.