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Two drugs regimens for HIV
Purpose of review As the evidence for two-drug regimens (2DR) for HIV treatment accumulates and 2DR start to enter consensus guidelines, this review covers the history, rationale and current evidence for 2DR in first-line and switch settings. Recent findings Until recently, most evidence for 2DR was for boosted protease inhibitor-based therapies but now we have large, randomized trials to support the use of dolutegravir (DTG)-based 2DR, both for initial therapy and suppressed switch, with high efficacy and no emergent resistance at failure. Summary 2DR will increasingly form part of the choice we are able to offer ...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: HIV INFECTIONS AND AIDS: Edited by David Dockrell Source Type: research

Undetectable viral load and HIV transmission dynamics on an individual and population level: where next in the global HIV response?
Purpose of review To examine recent literature on the efficacy and effectiveness of HIV treatment in preventing HIV transmission through sexual exposure, at both an individual and at a population level. Recent findings Two recent studies on the individual-level efficacy of treatment as prevention (TasP) have added to the now conclusive evidence that HIV cannot be transmitted sexually when the virus is suppressed. However, four large cluster-randomized population-level trials on universal HIV testing and treatment in Africa have not delivered the expected impact in reducing HIV incidence at a population level. Two of t...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: HIV INFECTIONS AND AIDS: Edited by David Dockrell Source Type: research

Weight gain and integrase inhibitors
This article comprehensively reviews available data and summarizes our current understanding of the topic. Recent findings Recent studies support the concept that weight gain and treatment emergent obesity are worse with INSTI-based regimens, particularly dolutegravir. Women and nonwhites appear to be the most at risk, and the accompanying nucleoside reverse transcriptase inhibitor may play a role. Lipohypertrophy, an abnormal accumulation of visceral fat and/or ectopic fat depots, continues to be a problem among PLWH, but the role of INSTIs is inconsistent. The pathogenesis of weight gain and changes in body compositio...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: HIV INFECTIONS AND AIDS: Edited by David Dockrell Source Type: research

Interventions to reduce acute hepatitis C virus in HIV-positive MSM
Purpose of review The WHO has set ambitious targets for hepatitis C virus (HCV) elimination by 2030. In this review, we explore the possibility of HCV micro-elimination in HIV-positive (+) MSM, discussing strategies for reducing acute HCV incidence and the likely interventions required to meet these targets. Recent findings With wider availability of directly acting antivirals (DAAs) in recent years, reductions in acute HCV incidence have been reported in some cohorts of HIV+ MSM. Recent evidence demonstrates that treatment in early infection is well tolerated, cost effective and may reduce the risk of onward transmis...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: HIV INFECTIONS AND AIDS: Edited by David Dockrell Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: EDITORIAL INTRODUCTIONS Source Type: research

Carbapenem-sparing strategy: carbapenemase, treatment, and stewardship
Purpose of review describing the current role of carbapenems and carbapenem-sparing strategies in the setting of antimicrobial stewardship programs. Recent findings sparing carbapenems with other drugs appears to be an interesting perspective for a variety of reasons in the current context of the multidrug-resistant (MDR) pandemic. Specific algorithms should also be precisely investigated to define better how to spare carbapenems within empiric and targeted regimens, with combination treatment or monotherapies, aiming at the best use of the new drugs and improving de-escalation as soon as possible for most of the pati...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

An overview of guidelines for the management of hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria
Purpose of review Multidrug-resistant (MDR) Gram-negative pathogens in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are associated with poor clinical outcomes. These pathogens represent a global threat with few therapeutic options. In this review, we discuss current guidelines for the empiric management of HAP/VAP caused by MDR Gram-negative pathogens. Recent findings The incidence of MDR Gram-negative bacteria is rising among cases of nosocomial pneumonia, such that it is now becoming a significant challenge for clinicians. Adherence to international guidelines may ensure early and adeq...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Pharmacologic optimization of antibiotics for Gram-negative infections
Purpose of review Antimicrobial resistance among Gram-negative organisms is a rapidly escalating global challenge. Pharmacologic dose optimization based on pharmacokinetic/pharmacodynamic principles is essential for managing Gram-negative infections. High-risk patient populations may receive nonoptimized antimicrobial dosing because pf physiologic changes in acute illness and/or medical interventions. The purpose of this review is to discuss opportunities for pharmacologic optimization of new agents and highlight patient populations that are often associated with poor drug exposure profiles. Recent findings Dose optim...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

The role of new β-lactamase inhibitors in gram-negative infections
Purpose of review In recent years, traditional β-lactams have dramatically reduced their effectiveness against gram-negative bacteria mainly because of their ability to express multiple β-lactamase or carabapenemases that are not hydrolyzed by the old β-lactam inhibitors (BLIs) such as clavulanic acid, tazobactam, and sulbactam. New BLIs molecules have been developed to face the need of compounds that are active against multidrug or pandrug resistant gram-negative pathogens. The aim of this review is to summarize the new generation of BLIs and β-lactams combinations. Recent findings A number of new molecules with ...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Risk stratification for multidrug-resistant Gram-negative infections in ICU patients
Purpose of review Antimicrobial resistance among Gram-negative microorganisms has alarmingly increased in the past 10 years worldwide. Infections caused by these microorganisms are difficult to treat, especially in critically ill patients. The present review examines how to accurately predict which patients carry a greater risk of colonization or infection on which to base the timely choice of an effective empirical antibiotic treatment regimen and avoid antibiotic overuse. Recent findings There are many risk factors for acquiring one of many multidrug-resistant Gram-negative microorganisms (MDR-GN); however, scores ...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

The role of fosfomycin for multidrug-resistant gram-negative infections
Purpose of review In the last decade, an increasing interest in using fosfomycin for the treatment of multidrug-resistant gram-negative (MDR-GNB) infections have been registered, especially when none or only a few other active alternatives remained available. Recent findings Fosfomycin may remain active against a considerable proportion of MDR-GNB. In observational studies, a possible curative effect of oral fosfomycin monotherapy has been described for uncomplicated urinary tract infections (UTI) and bacterial prostatitis caused by MDR-GNB, whereas intravenous fosfomycin has been mostly used in combination with other...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Epidemiology of carbapenem-resistant Gram-negative infections globally
Purpose of review The spread of carbapenem-resistant Gram-negative bacteria (GNB) with changes in institutional epidemiology continues to evolve worldwide. The purpose of this review is to evaluate new data with regard to the epidemiology, mechanisms of resistance and the impact of carbapenem resistance on mortality. Recent findings The rapid expansion of acquired carbapenem resistance is increasingly propagated by mobile genetic elements such as epidemic plasmids that transfer carbapenemase genes within and between GNB. The risk of acquisition of carbapenem-resistant Acinetobacter baumannii increases four-fold with c...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Neisseria meningitidis and meningococcal disease: recent discoveries and innovations
Purpose of review Meningococcal disease is a severe consequence of infection with Neisseria meningitidis, a pathobiont of the pharynx. This organism is panmitic so virulent clones transformed with new genetic material can emerge and cause severe outbreaks. The key to sustainable prevention is to restrict carriage of disease-causing strains and thus reduce the chances of transmission between human hosts. Recent findings Meningococcal population biology has changed recently with emergence of virulent strains linked to a number of sublineages of clonal complex 11. These strains have variously expressed the capsular mater...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Adenovirus infection and disease in recipients of hematopoietic cell transplantation
Purpose of review To provide an update on risk factors associated with adenovirus (ADV) infection in patients after hematopoietic cell transplant (HCT) and on options for ADV monitoring and treatment in the setting of HCT. Recent findings Among patients undergoing HCT, ADV infection continues to be more common amongst those receiving a T-cell-depleted or graft other than from a matched-related donor. Among children undergoing HCT, reactivation in the gastrointestinal tract appears to be the most common source, and the virus is detectable by quantitative PCR in the stool before it is detectable in the blood. Thus, scre...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: VIRAL: Edited by Roy F. Chemaly Source Type: research

Human herpesvirus 6 in transplant recipients: an update on diagnostic and treatment strategies
Purpose of review The current review article focuses on recent advances in the approach to the diagnosis and treatment of human herpesvirus 6B (HHV-6B) in hematopoietic cell and solid organ transplant recipients. Recent findings Over the past few years, key studies have broadened our understanding of best practices for the prevention and treatment of HHV-6B encephalitis after transplantation. Moreover, important data have been reported that support a potential role of HHV-6B reactivation in the development of acute graft-versus-host disease and lower respiratory tract disease in transplant recipients. Finally, increas...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: VIRAL: Edited by Roy F. Chemaly Source Type: research