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Advances in antiretroviral therapies increase opportunities for patients with HIV to have more successful treatment outcomes.

New Initiatives for HIV Taking Off This Year

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

A coalition of employers, the US Business Action to End HIV, sent a letter to Congress outlining the continued need for support from the federal government.

Why it’s Crucial to Maintain Funding for HIV Prevention, Research, Treatment 

This is the second in a series on the state of HIV today.

In late February, The US Business Action to End HIV, the largest coalition of employers dedicated to ending the HIV epidemic in the United States, sent a letter to Congress urging them to prioritize sustained federal funding for HIV prevention and treatment and underscoring the business sector’s commitment to advancing public health and ensuring progress in the fight against HIV.

“We have two goals, one to get people who are living with HIV on treatment, and two, to prevent new acquisition of HIV,” said Carl Schmid, Executive Director, HIV + Hepatitis Policy Institute.

The letter warns that funding freezes and grant delays could threaten hard-won progress, reversing declines in new HIV infections and exacerbating health disparities. Business leaders are calling on Congress to maintain investments in HIV research, prevention, and access to care, emphasizing that ending the epidemic is both a moral and economic imperative.

More specifically, the Coalition urges Congress to:

Maintain federal funding and state HIV prevention and treatment programs to safeguard decades of hard-won progress

Advance policies that sustain and expand life-saving public health efforts to keep the momentum going

Expand access to essential HIV services like testing, prevention, and treatment so everyone can stay healthy - regardless of where they live or their circumstances. (HIV continues to affect some communities more than others, particularly in parts of the US South, where access to prevention and care remains a challenge)

Strengthen public-private collaboration to close gaps in care, especially in communities most impacted by HIV.

“We saw a pretty steady decrease in the number of new HIV infections in this country between 2018 and 2022 but this progress is fragile, and reductions in funding or rollbacks and policy efforts could really risk a resurgence in new HIV infections and in preventable deaths, which would undermine all of the hard won gains that we've made,” said Stephen Massey, co-founder and co-CEO of the US Business Action to End HIV.

In terms of the business sector and their role in addressing these issues, Massey says companies have an opportunity to create a comfortable environment, to be able to have employers communicate with their employees about HIV, as well as what types of health plans they offer.

“There is an opportunity for employers to share trusted information about HIV, including how to prevent infection. There's an opportunity for employers to create workplaces where employees feel comfortable talking about HIV, asking questions, and also workplaces where employees have access to the very best care and prevention,” Massey said. “Employers play a really important role in determining health care plans that employees are offered for employees who might not be covered by their insurer. They could also provide information to employees about how they can access the social safety net of services that are available.”

“The community can advocate for ourselves, but I think it's really helpful, particularly in this time period, to have additional voices, including those of the business community,” Schmid said. “They can go into congressional offices and places where perhaps the community doesn't have the same footing.”

The Business Sector's Advocacy to Maintain Funding for HIV Prevention, Research, Treatment 

she discussed AI as a tool designed to assist pharmacists and clinicians in making more informed patient care decisions.  AI is designed to consolidate patient information

In this final part of our conversation with Sharmeen Roy, PharmD, BCPS, chief strategy and science officer at DoseMe, she discussed AI as a tool designed to assist pharmacists and clinicians in making more informed patient care decisions. According to Roy, AI is designed to consolidate patient information, aiding clinicians in their decision-making process without replacing their judgment.

"It should be a tool for pharmacists or any clinicians, not necessarily replacing their judgment, but really helping them make the best decision with the most information," Roy explained. "You’re not spending time gathering patients’ charts are complex. I don’t know if you’ve ever seen them, but they have a lot of information. There’s a lot of data, and there’s a lot of assessment going on, and that all takes time. The tool aims to consolidate that information so that clinicians can focus on making the best decisions for their patients."

A significant area of focus for AI is antimicrobial resistance (AMR), which remains a major global health concern. "As far as AMR goes, one of the mechanisms by which we see resistance emerge is subtherapeutic exposure to medication," Roy said. "What our tool allows is ensuring that you're getting the appropriate target quicker, so there’s less time spent with subtherapeutic levels that expose the bacteria, helping prevent the cycle of resistance."

While AI plays a significant role, Roy emphasized that it is designed to be supportive rather than replace clinicians. "The AI component is going to have to be more of a guardrail, supporting the clinician rather than replacing their functions," she noted. "Reducing administrative burdens and gathering information is where it’s going to be most beneficial."

Reducing adverse drug events (ADEs) is another crucial area where the AI tool can have a positive impact, especially in preventing acute kidney injury (AKI), which is a common and costly outcome of antimicrobial treatment. Roy highlighted that March 24 marked National Adverse Drug Event Awareness Day, underscoring the fact that ADEs are among the leading causes of death in the United States.

"Adverse drug events are the fourth or some references say the third leading cause of death in the US," Roy said. "And many of them are related to medication. You can imagine why it's an important cause for us to address. Our tool allows for the reduction of adverse events, specifically with antimicrobials."

Roy explained that one of the most critical ADEs, AKI, can lead to a cascade of complications, from prolonged hospital stays to the need for renal replacement therapy. "You can imagine the healthcare costs associated with any acute kidney injury, starting from an increased length of stay to patients ultimately needing renal replacement therapy," she said.

In addition to addressing adverse events, Roy also discussed the importance of real-world evidence in patient dosing, particularly for pediatric populations. Roy, who has a background in pediatric critical care, emphasized the challenges unique to treating pediatric patients, who range from infants with immature organ function to adolescents nearing adulthood.

"We are going to be presenting a poster at ESCMID this year, and that’s looking at a special cohort: pediatrics," she said. "This is special to me because I’m a pediatric critical care-trained pharmacist, so that’s where my practice was as a clinician. I know the challenges in that patient population. You have patients ranging from birth to adolescence to 18-year-olds, so you're looking at a spectrum of patients with very immature organ functions to adulthood."

The upcoming poster presentation at ESCMID will highlight the impact that Bayesian dosing has on target attainment in the pediatric cohort, using real-world data to guide clinical practice. "What we’re going to be presenting at ESCMID is our data and real-world evidence on the pediatric cohort and the impact that Bayesian dosing has in target attainment," Roy shared. "It’s all about guiding practice using real-world data."

Sharmeen Roy, PharmD, BCPS, on AI in improving decision-making, reducing adverse drug events on National Adverse Drug Event Awareness Day, and upcoming research on pediatric dosing at European Society of Clinical Microbiology and Infectious Diseases.

AI as a Tool to Support Clinicians, Not Replace Them

Ashraf S. Ibrahim, PhD, details over 20 years of research on a spore coating protein and the development of VX-01 to block fungal tissue invasion.

Humanized VX-01 Monoclonal Antibody Targets Mucormycosis Invasion

Researchers have developed VX-01, a humanized monoclonal antibody designed to target mucormycosis, a severe fungal infection predominantly affecting immunocompromised individuals. VX-01 enhances the host's immune response and prevents fungal angioinvasion, offering a promising adjunctive treatment for this often fatal disease.

Mucormycosis, caused by Mucorales fungi, poses significant risks, especially to those with weakened immune systems. In the second part of our conversation with researcher Ashraf S. Ibrahim, PhD, senior investigator at the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, he discusses over 20 years of research on mucormycosis, focusing on a key cell surface protein that facilitates the organism's aggressive tissue invasion.

“Basically, what we did is we've done a lot of work, and this is really the result of more than 20 years of research at the bench side trying to understand how the infection happens. So we've identified a cell surface protein that is expressed on the cell surface of the spores and the hyphae form of the organism. So you inhale the organism as spores. But what happens is they basically start germinating, forming hyphae. And that hyphae is really extremely aggressive in invading tissues, including blood vessels.”

The research identified a 16-amino acid peptide within this protein, which, when targeted with antibodies, could potentially block the organism's binding to mammalian cells.

“We've identified a protein called a spore coating protein. These proteins are professional invasins. In other words, their task is for the hyphae and the spores to bind the host cells, mammalian cells, human cells, and allow the organism to enter into the cell, embedding it and continuing to invade,” Ibrahim explains. “Within the protein itself, we've identified a 16-amino acid peptide that is highly immunogenic, surface exposed, and really resides in the binding facet of the spore coating protein to its receptor. The idea was to raise antibodies against that 16-amino acid peptide and see whether we can block the ability of the protein binding to its receptor, and as a result, prevent the organism from binding to the mammalian cell.”

Animal studies demonstrated efficacy, particularly when the antibody was combined with antifungal drugs.

“So in animal studies, we see actually very good efficacy of the antibody by itself given to mice. But then when you combine it with antifungals, the synergy is enormous. It's much better than either the antibody or the antifungal drug alone,” Ibrahim says.

However, the development of VX-01 faced challenges, particularly in the transition from murine to human antibodies.

“The difficulty was taking a mouse-derived monoclonal antibody and trying to give it to humans. In order for us to do this, we have to humanize it, because you can't give a mouse antibody to a human. One of two things would happen: either the antibody would be recognized as a foreign component and get destroyed by the human immune system, or you would have a severe allergic reaction, potentially leading to anaphylactic shock that might kill the patient,” Ibrahim notes.

Advances in humanization allowed for successful back mutations, improving the antibody's binding capability tenfold.

“We've done the humanization, and when we did this full humanization, we lost the activity of the antibody. It was no longer able to bind to the target protein. We had to go back and do back mutations—changing certain amino acids from the human frame back into the mouse frame. And we were able to do this with around 10 amino acids, which is acceptable by the FDA,” Ibrahim explains. “And then, all of a sudden, we not only restored the binding capability of the antibody, but we actually improved it by tenfold. We went from approximately 50 nanomolar to five nanomolar, which is really acceptable by the FDA for therapeutic antibodies.”

Production posed another challenge, particularly with Chinese hamster ovary (CHO) cells, the standard cell line for producing biologics.

“The only problem we've had in humanization was really production in CHO cells, which is the standard cell line for producing therapeutics. We were able to produce commercially viable quantities of approximately two to three grams per liter. What also helps us is that we don't have to go into high amounts of production because we don't have to give a huge amount of the antibody to see efficacy,” Ibrahim says. “So we see efficacy, on the basis of a human being, at approximately 100 milligrams total, which is considered to be a very low dose.”

VX-01 Monoclonal Antibody Targets Mucormycosis by Blocking Angioinvasion

Gu Y, Singh S, Alqarihi A, et al. A humanized antibody against mucormycosis targets angioinvasion and augments the host immune response. Sci Transl Med. 2025;17(789):eads7369. doi:10.1126/scitranslmed.ads7369

Ashraf S. Ibrahim, PhD, details over 20 years of research on a spore-coating protein and the development of VX-01 to block fungal tissue invasion.

Humanizing Monoclonal Antibodies for Mucormycosis Treatment

Ashraf S Ibrahim, PhD, discusses how VX-01 prevents fungal invasion of blood vessels and enhances immune response in immunocompromised patients.

Mucormycosis, caused by Mucorales fungi, poses significant risks, especially to those with weakened immune systems. In the first part of our conversation with researcher Ashraf S Ibrahim, PhD, senior investigator at the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, he explains, “Mucormycosis is a lethal fungal infection that became more prevalent during the COVID pandemic. Many patients treated with high doses of corticosteroids, especially those with diabetes and hyperglycemia, became infected with the fungus.” The infection occurs when individuals inhale spores that are commonly found in the environment. “You can inhale it all the time,” Ibrahim adds.

People with poorly controlled diabetes and those who are neutropenic or have leukemia are at higher risk of infection. “The classic patients at high risk in the West are neutropenic or leukemic patients, and those undergoing transplants, especially bone marrow transplants,” notes Ibrahim. He emphasizes the grave nature of the disease: “The lethality is extremely high; it's a very aggressive infection that targets blood vessels.” This process, known as angioinvasion, leads to severe tissue necrosis and infarction.

Traditional antifungal therapies have limitations, which underscores the need for innovative treatments. VX-01 is the result of humanizing a murine monoclonal antibody, C2, that targets CotH proteins—key fungal invasins that help the fungus invade host cells. “Rather than just trying to kill the organism, we focused on preventing it from invading host tissues, particularly blood vessels,” explains Ibrahim. Preclinical studies have shown that VX-01 is ten times more effective in binding to these proteins than its predecessor, C2.

VX-01 does not directly kill the fungus, but instead blocks its ability to infiltrate vital tissues. “This approach reduces the ability of the infection to be angioinvasive,” Ibrahim adds. When used in combination with antifungal drugs, VX-01 has shown the best outcomes in animal models, offering a new potential strategy for treating the disease.

Safety evaluations of VX-01 reveal no detectable damage to host cells in vitro, and minimal binding to cytoplasmic proteins in human tissue cross-reactivity studies. These findings suggest that VX-01 may offer a safer alternative to existing treatments. Ibrahim shares, “In our studies, we found no detectable damage to host cells in vitro, and minimal binding to cytoplasmic proteins in human tissue cross-reactivity studies.” This is encouraging as VX-01 progresses toward clinical trials.

The rise in mucormycosis cases is due, in part, to the global diabetes epidemic and advancements in treatments for cancer and transplants, both of which can weaken the immune system. “It’s not a surprise that mucormycosis cases are increasing,” Ibrahim says. “As medical advancements improve survival rates for other diseases, we’re seeing more infections. But we need to think outside the box to tackle this issue.”

VX-01 represents a significant step forward in the development of immunotherapies for mucormycosis, which continues to be a major challenge for immunocompromised patients. As new strategies for treating this aggressive and deadly infection are explored, VX-01 could emerge as an effective adjunctive treatment.

Gu Y, Singh S, Alqarihi A, et al. A humanized antibody against mucormycosis targets angioinvasion and augments the host immune response. 

2025;17(789):eads7369. doi:10.1126/scitranslmed.ads7369

Ashraf S. Ibrahim, PhD, discusses how VX-01 prevents fungal invasion of blood vessels and enhances immune response in immunocompromised patients.

Whole-genome sequencing may represent a significant advancement in case management for this population.

Identifying Invasive Pneumococci in Pediatric Infections Through Whole Genome Sequencing

 (pneumococcus) is a major cause of infections, including pneumonia, sepsis, and meningitis, which can severely impact young children. According to the World Health Organization, pneumococcal pneumonia caused 1,189,937 deaths and 197.05 million incidents in 2016, globally. In looking at the mortality, nearly a third—341,029 of these deaths—occurred in children under 5 years of age.¹

Identifying this bacterium in children can be especially challenging. “Microbiological identification is challenging, since collecting respiratory samples in children is more problematic compared to adults,” Rueda et al. write. “Some microbiological tests have low sensitivities in children. Previous research has shown different etiologic attributions depending on the anatomical origin of collected specimens (induced sputum, nasopharyngeal or oropharyngeal aspirate or swab, blood, and/or urine) and the diagnostic tests employed (PCR, acute or convalescent serology, cultures, direct or indirect immunofluorescence).”

Jose Alexander, MD, ABMM, ABAIM, FCCM, CIC, ASCP, BCMAS, medical director of the microbiology laboratory at AdventHealth in Orlando, FL, points out that there is even a greater burden in low- and middle-income countries as they have limited access to screening.

“Low-income countries have no access to specialized microbiology laboratories. Isolation, identification, and even basic imaging or testing can be really challenging,” Alexander said.

Having experience both as a practicing physician and now as a laboratorian, Alexander is able to utilize his clinical and diagnostic expertise in patient care. He recently authored an article, 

Genotyping Invasive Pneumococci: A Game-Changer in Pediatric Infection Management

In his piece, he notes that vaccines have led to a sharp decline in invasive pneumococcal disease (IPD). Still, he explains, IPD evolves—especially as unvaccinated serotypes quickly fill the void. While newer vaccines are being developed to address these emerging serotypes, the importance of robust testing cannot be overlooked.

He sees WGS as a game-changer because it provides a complete genetic blueprint of the bacterium, helping to identify antimicrobial resistance.

Alexander emphasizes that this level of specificity can provide real-time, more precise information, leading to better patient outcomes. “We don’t want the patient to get these reports 2 or 3 months later,” Alexander said. “We want to be able to provide this result while the patient is still in the hospital.”

Alexander asked clinicians at his institution what it would mean if they could receive WGS results while the patient was still hospitalized. His clinical team responded that they could, “use this information to adjust, improve, escalate, or optimize treatment.”

1.Al-Jumaili A, Dawood HN, Ikram D, Al-Jabban A. Pneumococcal Disease: Global Disease Prevention Strategies with a Focus on the Challenges in Iraq. 

. 2023;16:2095-2110. Published 2023 May 29. doi:10.2147/IJGM.S409476
2.Rueda, Z.V., Aguilar, Y., Maya, M.A. 

 Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents. 

, 169 (2022). https://doi.org/10.1186/s12887-022-03235-z

This method represents a significant advancement in case management for this population. In our latest From Pathogen to Infectious Disease Diagnosis Podcast, Jose Alexander, MD, ABMM, ABAIM, FCCM, CIC, ASCP, BCMAS, provides insights on its capabilities and how it can potentially aid clinicians in reducing antimicrobial resistance. 

MARY BANOUB, PHARMD

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