Top Infectious Disease News of the Week—November 3, 2019

#5: HIV Drug Rilpivirine Stops Viral Replication of Zika Virus

While Zika virus has receded from headlines since prominent outbreaks in 2016, it remains a danger for residents and travelers in countries with certain climates and mosquito species. As of October 2019, 10 Zika cases have been reported in the United States in travelers returning from affected areas. The virus was previously isolated to regions of Asia and Africa, but can now also be found in South America.

Investigators are hopeful that repurposing an existing drug used in HIV treatment could be a possible option to treat Zika and other flavivirus infections that share overlap with HIV.

Investigators at the Lewis Katz School of Medicine at Temple University published a study in Molecular Therapy showing that a drug used in HIV treatment also suppresses Zika virus infections. The investigators demonstrated that rilpivirine, a non-nucleoside reverse transcriptase inhibitor (NNRTI), targets enzymes that both Zika and HIV depend on for replication. These enzymes are also found in other flavivirus infections, such as dengue and hepatitis C.

Read the full article.

#4: Changes in Therapy Recommendations in the 2019 ATS/IDSA Guidelines for Community-Acquired Pneumonia

After about 12 years, a joint update of the community-acquired pneumonia (CAP) guidelines was recently published by the American Thoracic Society and the Infectious Diseases Society of America.^1,2 This article highlights some key updates to the antimicrobial therapy recommendations.

First, the term health care-associated pneumonia (HCAP) was introduced in the 2005 guidelines for hospital-acquired, ventilator-associated, and health care-associated pneumonia as it was thought some patients who acquired pneumonia in the community with certain risk factors for multidrug-resistant bacteria (e.g., living in nursing homes) should be treated similarly to patients with nosocomial pneumonia.^3-8 In the new guidelines, the term HCAP is clearly eliminated and it is recommended that these patients be treated as CAP patients without covering methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa unless they meet criteria for locally validated risk factors for antibiotic-resistant bacteria.

Second, the updated guidelines have a number of new culturing and diagnostic recommendations. A new strong recommendation is made for ordering sputum and blood cultures for patients started empirically on anti-MRSA or antipseudomonal antibiotics. This recommendation can result in more de-escalation when the culture findings are negative for these bacteria. The guidelines also recommend against the use of routine follow-up x-rays if patients are improving. In addition, it is advised that procalcitonin should not be used for guidance of antibiotic initiation. Lastly, urinary antigen testing for Streptococcus pneumoniae and Legionella is also discouraged.

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#3: FDA Approves RHB-105 to Treat H Pylori

The US Food and Drug Administration (FDA) has approved RHB-105 (Talicia) for the treatment of Helicobacter pylori in adults. The approval was granted to RedHill Biopharma Ltd.

H pylori affects approximately 35% of the United States adult population and is classified as a group 1 carcinogen. It is the strongest risk factor for the development of peptic ulcer disease, gastritis, and non-cardia gastric cancer.

Talicia is a 3-drug combination of omeprazole, a proton pump inhibitor, amoxicillin, a penicillin-class antibacterial, and rifabutin, a rifamycin antibacterial­­, and is a novel, fixed-dose, all-in-one delayed-release capsule 10 mg/250 mg/12.5 mg.

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#2: Do We Have the Tools to End the HIV Epidemic?

Despite progress in decreasing HIV mortality and transmission, there are still obstacles to ending the HIV pandemic globally and in the United States.

The past 4 decades of biomedical research have yielded the development of highly effective “toolkits” for preventing and treating HIV. Experts from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, have published an analysis explaining that further success will require optimization of existing interventions and continuous development of innovative approaches to prevent further transmission.

The commentary, published in Clinical Infectious Diseases, highlighted gaps between the health care community’s theoretical ability to end the HIV epidemic and the reality of implementation.

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#1: FDA Approves Fluzone High-Dose Quadrivalent Influenza Vaccine for Older Adults

The US Food and Drug Administration (FDA) has approved Sanofi’s Fluzone High-Dose Quadrivalent (Influenza Vaccine) for use in adults 65 years of age and older. The vaccine will be made available for the 2020-2021 influenza season.

The approval of the supplemental Biologics License Application marks a transition from the company’s trivalent influenza vaccine first approved in 2009 that contained 2 influenza A strains and 1 influenza B strain. Fluzone High-Dose Quadrivalent contains an additional influenza B strain.

In a phase 3 immunogenicity and safety trial, the quadrivalent vaccine met its primary end point of non-inferior immunogenicity compared with 2 trivalent formulations of Fluzone High-Dose. Additionally, each B strain in Fluzone High-Dose Quadrivalent induced a superior immune response compared with the trivalent formulation.

In a randomized controlled trial evaluating nearly 32,000 adults 65 years of age and older over 2 influenza seasons in the US and Canada, Fluzone High-Dose prevented 24 percent more cases of influenza caused by any circulating influenza strain and 51 percent more cases of influenza caused by strains similar to those contained in the vaccine compared to Fluzone.

Read the full article.