Top Infectious Disease News of 2019

#5: Working Toward a Cure for HIV: Where Are We?

The landscape of HIV treatment continues to shift and grow, with new and streamlined therapies introduced on a regular basis. People living with HIV today can lead very different lives than those of people who were diagnosed in the ’90s and early 2000s. Antiretroviral therapy (ART) makes it possible for a person living with HIV to experience complete viral suppression, even engaging in condomless sexual intercourse, or gestating a baby without fear of passing on the virus (Undetectable=Untransmittable). Investigators, however, are still in pursuit of the holy grail—total eradication of HIV from the body. Is there a cure? How long until we find it? And will it work for the majority of people living with HIV?

It’s important to understand that the definition of “cure” differs from investigator to investigator, and some disdain the term altogether. “I don’t even use the word ‘cure’ anymore,” Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told Contagion®. “I refer to it as different pathways to a sustained remission.”

Although ART has been considered a gamechanger for people living with HIV, allowing them to be completely virally suppressed for long periods, it’s not the right option for certain patients. “People psychologically don’t like to be reminded every day that they have to take ART to suppress their virus,” Fauci said. “It reminds you every single day that you’ve got a virus and you have to do something to suppress it.” Complicating things is the fact that some patients are quite sensitive to the potentially toxic side effects of ART. Other patients are simply resistant to ART. The goal, he said, is to offer people something that lasts longer than a daily pill.

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#4: Sounding Off: Dr Drew on How LA’s Homeless Problem is a Public Health Emergency

Drew Pinsky, MD, cannot understand how the situation on the Pacific Coast, and Los Angeles, in particular, is being tolerated.

“It’s beyond anything that is sustainable or rational or morally allowable,” he said of the humanitarian crisis that’s driving a rise in infectious diseases there.

Contagion® recently spoke with Pinsky, an internist, addiction medicine specialist, and prominent media personality, about the situation out West, what contributing factors are at play, and how health care providers can help.

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#3: 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.

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#2: Resolved E coli Outbreak Linked to Romaine Lettuce

US Food and Drug Administration (FDA) officials are informing the public of a recent Escherichia coli O157:H7 outbreak likely associated with romaine lettuce. Shiga toxin-producing E coli O157:H7 can sometimes lead to serious complications such as severe diarrhea and kidney damage.

As of November 1, 2019, 23 confirmed illnesses were associated with the outbreak. Illnesses initiated on dates ranging from July 12, 2019 to September 8, 2019. There were no illnesses reported after the US Centers for Disease Control and Prevention (CDC) began its investigation on September 17, 2019. In total, 12 states were affected.

The outbreak was investigated by the US Centers for Disease Control and Prevention (CDC) and FDA, but is believed to be over at this time. CDC notified the FDA of the E coli related illness cluster in mid-September 2019 and a traceback investigation was promptly initiated. The FDA, CDC, and local partners investigated the illnesses associated with the outbreak. Among the 23 illnesses associated with the outbreak, 11 individuals were hospitalized but no deaths were reported.

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#1: Herpes Vaccine HSV529 Shows Favorable Results in Phase 1 Trial

HSV529, a vaccine for herpes simplex virus 2 (HSV2), showed favorable results in a recent phase 1 trial. The study found that the vaccine was safe and elicited antibody and T-cell responses in HSV seronegative adults.

According to details published in the Journal of Infectious Diseases, the randomized, double-blind, placebo-controlled trial included 60 adults ages 18 to 40 years divided into 3 serogroups that received the vaccine or a placebo at 0, 1, and 6 months. In each group, 15 participants received the vaccine, derived from HSV2 strain 186, and 5 received a placebo.

“Prior studies to prevent HSV infection have focused on subunit vaccines with a goal to induce neutralizing antibodies,” the study noted. “HSV2 dl5-29 is a replication-defective HSV2 vaccine that can infect cells and should result in a broader immune response.”

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