Top Infectious Disease News of the Week—December 23, 2018

#5: CRISPR and DIY Biohacking: An Infectious Disease Threat to Be Aware of in 2019

Although it may not be the most urgent concern right now, the world of genome editing and synthetic biology is one that has the infectious disease community increasingly worried.

Genome-editing technologies such as Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) allow scientists to edit DNA in specific sections of genetic code. These methods have grown in popularity as scientists continue to refine the process and work through many of the technical kinks. Researchers are increasingly worried, however, because the use of CRISPR without any sort of oversight triggers a whole host of ethical questions that have yet to be answered.

CRISPR has great potential to improve the human condition through research, medicine, agriculture, etc. With great power though, comes great responsibility; there is a real concern that the technology is moving too fast for its own good and too fast for governance, regulation, and oversight to keep up. Biosecurity experts have been raising the red flag about the disruptive nature of genome editing, pointing out that the manipulation of biological systems and processes can have untold consequences. A recent study published by investigators from George Mason and Stanford universities notes that the technology must be taken seriously and the broader and ever-evolving landscape of biosecurity must be considered. For instance, it is possible that genome editing could one day be used to create biological weapons—think of a totally resistant tuberculosis or an influenza with increased virulence.

Read more about why the infectious disease community is weary of CRISPR and DIY biohacking.

#4: HIV Linkage to Care After Home Testing Improved with HIV App

A smartphone app could be the critical link between at-home HIV testing and rapid access to care for people whose tests come back positive, according to the results of a new study.

At-home rapid HIV testing has been available in the United States since the US Food and Drug Administration (FDA) approved the OraQuick device in 2012; however, other countries, including Canada, have yet to allow at-home testing.

Investigators at McGill University, Montreal, wanted to gauge the potential of home testing for high-risk populations, especially men who have sex with men (MSM). However, they also wanted to combat a potential flaw of at-home testing—patients who test positive for HIV but may be unwilling or unable to seek medical care.

Nikita Pant Pai, MD, MPH, PhD, the study’s lead author, wrote that current tests on the market do not do enough for people who find out they are HIV-positive.

“Currently approved HIV self-tests offer toll-free lines that are insufficient for initiating expedited linkages to counseling and care, accurate interpretation, and support during HIV self-testing,” Dr. Pant Pai and colleagues noted.

To combat that problem, they developed an application—HIVSmart!—that can work on a smartphone or tablet. The app walks patients through the testing process, helps interpret the results, and then links HIV-positive patients with counseling or health care while also providing encouragement.

Read more about at-home rapid HIV testing.

#3: Metronidazole Comparable to Vancomycin for Mild C Diff Infections

A study by investigators from the Providence Veterans Affairs Medical Center indicates that metronidazole is an appropriate treatment option for mild cases of Clostridium difficile infection, despite new guidelines which no longer recommend the antibiotic for initial and non-severe C diff cases.

In the new study published in the journal Clinical Infectious Diseases, investigators aimed to compare the effectiveness of metronidazole with vancomycin in patients with mild C diff infection. The study comes following the 2018 release of updated clinical practice guidelines from the Infectious Diseases Society of America. Prior to the new guidelines, metronidazole was recommended over vancomycin as a first-line antibiotic for mild to moderate cases of C diff. The new guidelines recommend either vancomycin or fidaxomicin over metronidazole for an initial C diff infection episode based on evidence showing better outcomes associated with vancomycin as compared to metronidazole in patients with severe C diff infection. The authors note that, to their knowledge, this is the first study to focus specifically on identifying predictors of success and the first to compare treatment options in patients with an initial episode of mild C diff infection.

For the study, investigators conducted a 2-stage analysis among a large national cohort of veterans with a mild and first episode of C diff infection, defined as a stool sample positive for C diff toxin and 2 or more days of C diff infection treatment. They defined successful treatment as patients who did not die or have a C diff infection recurrence at day 30, and treatment failure as those who died or had a C diff infection recurrence within 30 days following treatment. Among 3656 patients with mild C diff infection and treated with metronidazole, the study team identified 3282 patients with success at day 30 post-treatment and 374 patients without success.

Read more about metronidazole as treatment for mild C diff infections.

#2: Taking Stock of 2018 and Setting New Goals for 2019: Public Health Watch

A year ago, we had the temerity to propose 4 New Year’s resolutions for infectious disease and public health specialists.

As 2018 draws to a close, we’ve decided to take a look at just how much has been accomplished in these key areas in the months since and also set some new goals for the coming year.

This time last year, we noted the growing threat of opioid abuse/misuse and its relationship to case clusters of various infectious diseases—most notably, HIV and hepatitis C. At the time, we urged infectious disease clinicians to get involved in efforts to track illegal opioid use, help spearhead initiatives to educate those at risk for addiction, and treat those who become addicted.

The past year has shown that much still needs to be done to address the so-called “opioid epidemic” and the health-related collateral damage it has caused. In September, for example, Contagion® reported on an HIV case cluster in Seattle, Washington, linked with drug use within a homeless community there. Similarly, in June, we documented a number of hepatitis C case clusters across the country that were attributed to opioid abuse among the affected populations.

It’s clear that the United States is still in the throes of a crisis related to opioid abuse/misuse, and that this seemingly intractable problem will not go away unless health care professionals remain engaged.

Read more about what the infectious disease community accomplished in 2018.

#1: Top HIV News of 2018

Contagion® counts down the top HIV news stories of 2018, including FDA approvals, breakthrough studies, recommendations from the frontlines, and a big-picture look at just how close we are to a cure.

Among the most important HIV news of the year: the FDA approval of Gilead Sciences, Inc.’s Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide), a tablet regimen to be taken once-daily for the treatment of HIV-1 infection; the US Preventive Services Task Force’s recommendation of pre-exposure prophylaxis (PrEP) in HIV prevention; the advancement of the Undetectable=Untransmittable campaign; and more.

Read our full recap of the top HIV news of 2018 here.