Top Infectious Disease News of the Week—March 31, 2019

#5 The Case for On-Demand PrEP

On-demand PrEP, also known as event-driven or pericoital PrEP, is HIV prevention based on planned intercourse and is taken only when needed, ie, if a sexual encounter is with a person of known HIV-positive or unknown status, in order to prevent HIV acquisition in MSM. The IAS-USA and EACS guidelines have endorsed this alternative dosing strategy for TDF/FTC for on-demand PrEP based on favorable results from the Intervention Préventive de l’Exposition aux Risques avec et pour les Gays (IPERGAY) trial. This strategy entails taking 2 TDF/FTC pills 2 to 24 hours before sexual intercourse followed by 2 single doses of TDF/FTC 24 and 48 hours after the first drug was taken (2-1-1). This alternative dosing is recommended for HIV prevention only in MSM with infrequent sexual exposures but high-risk sexual behavior.

The IPERGAY trial, conducted in France and Canada, was a randomized, double-blind trial evaluating sexual activity based on oral HIV PrEP care in MSM at high risk. PrEP care was prescribed as 2-1-1 with continued daily dosing if there was additional sex, with a maximum dose of 7 pills per week. Results showed high protection (86%; 95% CI, 40-98) against HIV infection in seronegative MSM at high risk when on-demand PrEP was taken as prescribed (2-1-1).

Read about the case for on-demand PrEP.

#4 PrEP May Offer Psychological Benefits, Study Suggests

Pre-exposure prophylaxis (PrEP) use may have psychological benefits for gay and bisexual men, according to a recent study that reported lower sexual anxiety among men who were taking PrEP.

"For many gay and bisexual men, the fear of HIV is still very real, and this fear may be negatively impacting their mental health," Thomas Whitfield, a graduate student at City University of New York and first author of the study, told Contagion^®."PrEP may put some of these men’s minds at ease and allow them to enjoy their sex lives better."

The study, published in The Journal of Sex Research, involved more than 1000 gay and bisexual men throughout the United States who completed a Multidimensional Sexual Self-Concept Questionnaire including 100 items at multiple times before and after beginning their PrEP use.

Read about the potential psychological benefits of PrEP.

#3 Hospital-Associated Condition Penalties: What They Really Mean

Has your hospital received a financial penalty for health care-associated conditions (HACs)? The truth is that there are probably a lot of hospitals in your area that had poor HAC ratings.

The story of HACs actually goes back to 2008 when the Centers for Medicaid and Medicare Services (CMS) began tying hospital quality metrics to Medicare reimbursements. Simply put, CMS was done paying full price for substandard care. Under the previous rules, hospitals would receive full Medicare reimbursement even if a patient ended up getting an infection or pressure ulcer as a result of care.

In 2014, CMS established another rule tying health care quality of care and reimbursement—the HAC Reduction Program. Although this started with reporting of certain conditions, such as central-line associated bloodstream infections, these pay-for-performance programs were expanded over time. The program links hospital performance in certain categories with reimbursement. That’s right, if a hospital performs poorly, they can be hit where it hurts—the bank.

Read about hospital-associated condition penalties.

#2 Biktarvy: A Regimen of Choice for HIV Therapy

Integrase strand transfer inhibitors (INSTIs), when combined with 2 nucleoside analogue reverse transcriptase inhibitors (NRTIs), make up the bulk of first-line HIV therapy regimens. With over 30 drugs approved for the treatment of HIV infection, the regimen choice is often determined by concerns over pill burden, tolerability and/or toxicity, and barrier to resistance.

Biktarvy is a fixed-dose, single-tablet regimen of bictegravir, emtricitabine, and tenofovir alafenamide. It received FDA approval on February 7, 2018, for treatment-naïve patients with HIV or those already virologically suppressed on an antiretroviral therapy regimen for at least 3 months with no known resistance to any of the drug components. Two of the 3 drug components, emtricitabine and tenofovir alafenamide, are already part of other first-line therapy regimens and are known to be safe and well tolerated by most patients. Biktarvy is a new, highly active INSTI with both a high barrier to resistance and few drug—drug interactions. These advantages have allowed Biktarvy to quickly become a regimen of choice among HIV health care providers.

Read about biktarvy for HIV therapy.

#1 Flu Shot, Nasal Spray Recommended Equally for Kids for 2019-2020 Season

The American Academy of Pediatrics is giving its recommendation to the nasal spray form of the influenza vaccine for the 2019-2020 flu season, meaning parents will have 2 choices when getting their children vaccinated this fall.

As in previous years, the AAP is also giving its recommendation for the flu shot (inactivated influenza vaccine).

“Every year, we are never sure if the vaccine strains are going to be perfectly matched up with incoming flu strains, but based on the information that we have now, we believe the nasal spray is an acceptable option,” said Bonnie Maldonado, MD, who chairs the academy’s committee on infectious diseases, in a press release.

Though the AAP has been firm in its recommendation that children be vaccinated against the flu, its stance on the nasal spray form of the vaccination (live attenuated influenza vaccine) has varied from year to year based on its performance and available data. For instance, the nasal spray was found to have underperformed against the A/H1N1 strain of influenza during the 2013-2014 and 2015-2016 flu seasons. As a result, the AAP did not recommend the nasal spray in the 2016-2017 and 2017-2018 flu seasons. However, the academy said the vaccine was altered in 2017 to better fight against A/H1N1, and early indications were that the change had been successful. At a meeting on March 14, the AAP’s Board of Directors was sufficiently satisfied with the latest vaccine data to issue its recommendation.

The AAP plans to issue a formal policy statement on the matter later in the year. They made the announcement this month because this is the time many clinics are ordering their vaccine supplies for the coming year.

Flu vaccinations among children have been on pace this year to beat last year’s vaccination levels. By November 2018, 45% of children had been vaccinated against the flu, up from 37% in November 2017.

Read about pediatric flu shot recommendations.