Top Infectious Disease News of the Week —November 4, 2018

#5: Identifying Comorbidities in People Living with HIV

For a physician treating patients with several comorbidities can be increasingly challenging, and for individuals living with HIV, comorbidities can have a significant impact on the overall health outcomes of these patients.

In a new study published in Open Forum Infectious Diseases, a team of international investigators found that comorbidities in people living with HIV tend to cluster in specific patterns that can be consistently identified, which may lead to a greater understanding of their potential impact on health and treatment outcomes.

“The presence of multiple co-occurring comorbidities is becoming increasingly common in people living with HIV, with negative consequences on health outcomes, daily functioning, working status, and health care costs,” Davide DeFrancesco, a research statistician and PhD candidate at the Institute for Global Health, part of University College London, and an author of the study told Contagion®. “The findings highlighted in our paper could have important implications for both clinical and research purposes.”

For the study, investigators used a data-driven approach to identify patterns of comorbidities in people living with HIV and evaluated associations between the patterns.

Read more about patterns of comorbidities in people living with HIV.

#4: Is Ebola on the Path to Becoming Endemic in the DRC?

As the North Kivu province Ebola outbreak enters its fourth month, international health officials are worrying if the combination of violence and insecurity in the area will render this outbreak past the point of control.

A total of 305 cases of Ebola infection have been reported in North Kivu as of November 5, 2018; 270 of these cases were confirmed. Another 60 suspected cases are currently under investigation. The region has also seen 189 deaths, 154 of which were in confirmed Ebola patients.

With the outbreak on track to become the largest in the history of the Democratic Republic of the Congo (DRC), the international community is attempting to determine if this outbreak could spread outside the DRC.

On November 5, 2018, Johns Hopkins Center for Health Security hosted a congressional seminar featuring Robert Redfield, MD, director of the US Centers for Disease Control and Prevention (CDC) and Tom Inglesby, MD, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health. The pair discussed current information on the outbreak as well as the United States’ role in the international response.

Read more about the threat of Ebola in the Democratic Republic of the Congo.

#3: High Toxocara Egg Contamination Found in Areas of Pennsylvania Parks

A study on the level of Toxocara egg contamination of several parks in Montgomery County, Pennsylvania, found that the highest amounts of contamination were in areas that could contain food droppings or animal waste. The research comes from 13-year-old Devyn Stek, a student at St. Teresa of Calcutta School in Schwenksville, Pennsylvania, who conducted an environmental surveillance study for the school’s science fair. Her research on Toxocara eggs was analyzed further by Misoo Ellison, PhD, and presented in a poster abstract session at ID Week 2018 in San Francisco, California.

Toxocara spp. is a parasite known as roundworm. The most common reservoirs are dogs who can harbor T canis, and cats, who may carry T cati; however, other animals and humans can also be reservoirs for the parasite.

Ingestion of eggs by humans can result in an infection called toxocariasis. Most infections have no symptoms and will go away without treatment, but severe infections can cause weight loss, fever and fatigue, and it is possible for the larvae to migrate to organs and stop development. Once ingested, the worms can move throughout the body, including under the skin, and in rare cases into the eye which can result in blindness.

Read more about the presence of Toxocara eggs in Pennsylvania parks.

#2: Showerheads—A Microbial Haven

Showerheads, something we all rely on but frequently forget to clean. Their design makes showerheads a perfect mechanism for the aerosolization of germs and a harbor for microbial growth. Bacteria belonging to the Mycobacterium genus have been known to propagate within showerheads and infect people through inhalation of the aerosolized mycobacteria. In hospitals, they are sometimes a source for disease transmission of waterborne microbes, such as Legionella. As such, the authors of a recent study sought to assess the microbial diversity of showerheads and evaluate just what is going on within these devices.

Investigators collected and assessed showerhead biofilm from 656 households across the United States and Europe. Not surprisingly, most common bacteria were Mycobacterium, but there was also a considerable amount of diversity. A total of 13.5% of the samples were identified as Mycobacterium genus.

Interestingly, Mycobacteria tended to be more common—twice as common!—in showerheads belonging to households that received municipal water rather than those receiving well water. The investigators noted that this is likely because of varying levels of chlorine use. Homes on municipal water had measured chlorine concentrations 15 times higher than those with well water. Mycobacteria are more resistant to chlorine and chlorine by-products than other bacteria, and so the chlorine levels play into their prevalence. Water source, chemistry, and household location also impacted microbial diversity.

Read more about the Mycobacterium presence on shower heads.

#1: Anti-HIV Antibodies Show Promise in Maintaining Viral Suppression

Imagine a world in which HIV viral suppression can be maintained without the lifelong use of antiretroviral therapy.

Well, what once seemed an impossibility may. in the not-so-distant future become reality—at least if the results of a phase 1b clinical trial published on September 27 in Nature are any indication. The authors of the paper, an international team of researchers, found that combination therapy with 2 potent monoclonal anti-HIV-1 broadly neutralizing antibodies, 3BNC117 and 10-1074, administered during analytical antiretroviral therapy treatment interruption, was able to maintain long-term viral suppression in HIV-positive individuals with antibody-sensitive viral reservoirs.

“[Our finding demonstrate] there is potential for using the antibodies to maintain [viral] control,” study co-author Michel C. Nussenzweig, MD, PhD, Zanvila A. Cohn and Ralph M. Steinman Professor and Investigator, Howard Hughes Medical Institute, The Rockefeller University, told Contagion®.

Dr. Nussenzweig and his colleagues enrolled HIV-1-infected individuals on antiretroviral therapy who were pre-screened for 3BNC117 and 10-1074 sensitivity. Study eligibility criteria included ongoing antiretroviral therapy for at least 24 months with plasma HIV-1 RNA levels of <50 copies per ml for at least 18 months (one blip <500 copies per ml was allowed) and <20 copies per ml at screening, as well as CD4+ T cell counts >500 cells per μl. Enrolled participants received 3 infusions of 30 mg/kg−1 of 3BNC117 and 10-1074 each at 0, 3 and 6 weeks.

Overall, the authors reported that the infusions of the 2 antibodies were generally well-tolerated, with mild fatigue reported in 2 study subjects. Notably, the 9 enrolled study subjects with antibody-sensitive latent viral reservoirs maintained HIV-1 viral suppression for a median of 21 weeks, with a low of 15 weeks and a high of more than 30 weeks. Importantly, none of the study subjects developed viruses that were resistant to both antibodies.

Read more about how anti-HIV antibodies show promise in maintaining viral suppression.