Top Infectious Disease News of the Week— October 28, 2018

#5 MSM Who Use Mobile Apps for Sex More Likely to Have STIs

According to a study published in BMC Public Health, men who have sex with men who seek out sexual partners on smartphone apps are more likely to have sexually-transmitted infections—including syphilis, gonorrhea, and chlamydia—than those who do not use these apps. Mobile platforms dedicated to HIV prevention may help reduce this likelihood, the study’s investigators suggest.

“The prevalence of men who have sex with men-related HIV infection is increasing worldwide. Advances in communication technology now offer men who have sex with men different opportunities to meet sexual partners,” the investigators, led by Haidong Wang, MD, of the North China University of Science and Technology, wrote. “With the proliferation of apps, increased use of these apps may facilitate finding casual sexual partners, resulting in unsafe sexual practices. Prior work has shown that men who have sex with men who use these apps (app-users) tend to have more sexual encounters, more frequent anal intercourse, more unprotected sex, and a larger number of sexual partners known to have HIV and other sexually-transmitted infections …[yet] some studies suggested that app-users may be more likely to practice safer sex with these partners than are non-users.”

Read more about the link between MSM using mobile apps for sex and STIs.

#4 First Complete Darunavir-Based Single-Tablet Regimen for HIV Sees Positive Results at 96 Weeks

Results for the combination of darunavir 800 mg, cobicistat 150 mg, emtricitabine 200 mg, and tenofovir alafenamide 10 mg (D/C/F/TAF, SYMTUZA, Janssen) for the treatment of HIV-1, continue to be positive as the latest data indicate that 85% of study participants (308/362) achieved virologic suppression (viral load <50 copies/mL) at week 96. A total of 6% of participants (20/362) had virologic failure (viral load >50 c/mL) when treated with D/C/F/TAF. Furthermore, none of the patients experienced darunavir, primary protease inhibitor, or tenofovir resistance-associated mutations, according to a statement from Janssen on the newest HIV treatment.

“The 96-week AMBER data further demonstrate the importance of [D/C/F/TAF] as a treatment option for adults new to HIV therapy who may benefit from a single-tablet regimen that offers the protective barrier to resistance of darunavir along with the tolerability profile of TAF,” said Joseph Eron, MD, professor of medicine and director, Clinical Core, University of North Carolina Center for AIDS Research, Chapel Hill, North Carolina in the statement. “Based on the US Department of Health and Human Services guidelines, darunavir-based regimens are a recommended option [for patients with HIV] in situations where clinicians may not have all genotypic resistance test results, when patients may be at risk for sub-optimal adherence or in rapid initiation scenarios.”

The US Food and Drug Administration (FDA) approved D/C/F/TAF in July 2018 as the first and only complete, darunavir-based single-tablet regimen for the treatment of HIV in treatment-naïve and certain virologically-suppressed adults based on the AMBER and EMERALD trial results.

Read more about the darunavir-based single-tablet regimen.

#3 Dengue Vaccine Receives Priority Review from FDA

Sanofi Pasteur’s dengue vaccine (Dengvaxia) is moving one step closer to being approved in the United States as the US Food and Drug Administration (FDA) just accepted a Biologics License Application for the vaccine. The vaccine was previously granted priority review and included in the FDA’s Tropical Disease Priority Review Voucher Program. It is the “first and only medical prevention tool against dengue, including severe dengue, which is considered an unmet medical need,” according to a statement from Sanofi.

Dengue is a mosquito-borne viral infection that is a leading cause of illness and death in the tropics and subtropics, according to the US Centers for Disease Control and Prevention. Up to 400 million people are infected each year. More than 12,000 cases of dengue infection occurred in Puerto Rico in 2010, prior to the equally devastating Zika virus outbreak that affected the country. Furthermore, dengue was the second most commonly transmitted mosquito-borne disease in the continental United States according to data reported to the National Notifiable Diseases Surveillance System between 2004 and 2016.

Read more about the dengue vaccine’s priority review from FDA.

#2 Antiretroviral Therapy Initiation Leads to Short-Term Spike in Viral Shedding Among Patients with HIV/HSV-2 Coinfection

Patients with HIV and herpes simplex virus coinfection see an increase in herpes viral shedding when they begin antiretroviral therapy, according to new research; although, the effect appears to be short-lived.

Previous research has shown that antiretroviral therapy can have an adverse impact on people with chronic herpes virus infection. Investigators from the University of Washington, Baylor All Saints Medical Center, the Fred Hutchinson Cancer Research Center, in Seattle, Washington, and the Simmons Transplant Institute, in Dallas, Texas, wanted to gain a better understanding of how and when that worsening of herpes infection occurs, and whether it is sustained long-term.

To study the question, the investigators tracked 45 patients who were HIV positive and also infected with HSV-2, some of whom were on antiretroviral therapy, some of whom were not. The majority—38 patients&mdash;were men. Those patients conducted daily genital swabs and also tracked their symptoms. They had follow-up visits with the investigators over up to 3, non-contiguous 60-day periods.

Read more about the short-term spike in viral shedding.

#1 Fluoroquinolone Antibiotics: More Recommendations for Prudent Use

The safety committee of the European Medicines Agency (EMA)—the Pharmacovigilance Risk Assessment Committee (PRAC)&mdash;has recommended restricting the use of fluoroquinolone and quinolone antibiotics following a review of safety issues reported with these medicines.

The PRAC recommended that fluoroquinolone antibiotics should not be used for the following:

• To treat self-resolving infections (such as throat infections)
• To prevent traveler’s diarrhea or recurring lower urinary tract infections
• To treat patients who have previously had serious adverse effects from a fluoroquinolone or quinolone antibiotic
• To treat mild or moderately severe infections unless other antibacterial medicines commonly recommended for these infections cannot be used

With the release, the EMA joins other regulatory agencies, such as the US Food and Drug Administration (FDA) and Health Canada, that have warned doctors and the public about the risk of disabling and persistent serious adverse reactions. The FDA has issued a series of safety alerts regarding the use of fluoroquinolone antibiotics (see Figure). The first boxed warning for fluoroquinolones was added in July 2008 for the increased risk of tendinitis and tendon rupture, and the FDA has since added another boxed warning and several label updates.

Read more about the recommendations for prudent fluoroquinolone use.