Top Infectious Disease News of the Week—December 29, 2019

#5: ART Adherence in Transgender and Gender Nonconforming People

Transgender and gender nonconforming (TGNC) people are at significantly increased risk for acquiring HIV. In 2015, the number of transgender people diagnosed with HIV was 3 times the national average. Transgender women have 49 times the odds of having HIV compared with the general population, and transgender men also have notably higher rates of infection.

Antiretroviral therapy (ART) decreases morbidity, mortality, and transmission; therefore, ART adherence is critical to the health of TGNC patients with HIV. Understanding adherence patterns is the first step to combatting the HIV epidemic in this population.

A recent study published in Transgender Health analyzed TGNC ART adherence based on the US Trans Survey (USTS), the largest survey of TGNC people in the United States. This large-scale evaluation, which reached TGNC people from many backgrounds, may provide more representative data than previous studies focusing on HIV patients connected to health care.

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#4: The Search for HIV-Associated Neurocognitive Disorder Biomarkers

Researchers must discover the diagnostic and prognostic biomarkers for HIV-associated neurocognitive disorder (HAND), according to an article by Howard E. Gendelman published in EBioMedicine.

Gendelman explained that HAND is a viral co-morbidity that remains common despite advancements in antiretroviral therapy (ART). Additionally, the commentary noted that cognitive, behavioral, and motor dysfunctions, including asymptomatic neurocognitive impairment (ANI), mild neuro cognitive disorder (MND), and HIV-associated dementia (HAD) often lead to HAND in up to half of ART-treated and virus infected people.

“The presence of inflammation and linked neurodegeneration in both the brain as well as the cerebrospinal fluid of infected and ART-treated people affects production of disease biomarkers. Each also underscores the strong associations between inflammation and disease,” noted Gendelman. “Several groups propose several of disease inflammatory biomarkers including, but are not limited to, platelet activating factor, arachidonic acid and its metabolites, granulocyte macrophage colony stimulating factor, interleukin-6, tumor necrosis factor alpha (TNF-a) and matrix metalloproteinases 1 and 7 (reviewed in 1).”

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#3: Antibiotic Marketing and Pipeline Shortages in the Era of Stewardship: An Industry Perspective

Numerous reports have been published on the rising tide of antibiotic resistance across the globe. Most recently the US Centers for Disease Control and Prevention (CDC) released the 2019 update of its comprehensive report, Antibiotic Resistance in the United States. The report, last updated in 2013, highlights the challenges of infectious diseases surveillance. The publication also emphasizes the severe underestimation of resistance rates and dire consequences, pointing to the fact that in the United States 2.8 million individuals have an infection due to a resistant pathogen and 35,000 people die each year in the US alone.

Post-Antibiotic Era?

Although the CDC reports that the post-antibiotic era may already be here, it cannot be ignored that despite the numerous challenges to commercialize new antibiotics, industry has responded. In the early years of this millennium we saw a continued exodus from antibiotic development and a depleted pipeline. However, in the last decade, 12 new intravenous antibiotics were approved in the United States. Clearly, we can’t declare victory. Ongoing research and significant investments are needed to address the challenges with Acinetobacter infections, metallo-beta-lactamase-producing pathogens, Mycobacterium, and the ever-evolving resistance profiles of existing treatment options.

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#2: Health Care Workers Often Work Despite Illness

Hospitals and other health care organizations invest untold resources in their ever-present battle against health care-associated infections (HAIs), but new research suggests there’s 1 risk health care workers routinely downplay: themselves.

A study released this summer found 95% of ill health care workers reported working at least 1 day while symptomatic. The research is based on thousands of illness diaries by health care workers at 9 Canadian hospitals during 4 flu seasons between 2010 and 2014.

Brenda Coleman, PhD, of the Infectious Disease Epidemiology Research Unit at Toronto’s Mount Sinai Hospital, told Contagion® the numbers were not surprising, but they were disappointing. Coleman said studies performed 20 years ago showed similar rates of working while sick in American and British hospitals.

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#1: The Ebola Outbreak Response So Far

The ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC) is the 2^nd largest Ebola outbreak in history, outpaced only by the 2013-2016 West African epidemic. The outbreak continues to be recognized as a public health emergency of international concern by the World Health Organization (WHO).

The US Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) has provided a summary of the Ebola response from August 2018 through November 2019, noting 2196 deaths as well as consistent challenges to outbreak control due to government mistrust and ongoing armed conflict in the region.

A total of 3296 Ebola cases have been reported as of November 17, 2019. The 2196 reported deaths represent a 67% mortality rate. The West African epidemic, in comparison, led to 28,600 cases and 11,325 deaths.

The DRC Ministry of Health has worked with a variety of partners, including the United Nations Children’s Fund, the Alliance for International Medical Action, Doctors Without Borders, WHO, and CDC, to control the outbreak.

The DRC Ministry of Health established a strategic coordination center in the city of Goma to coordinate surveillance, vaccination, and burials. Several vaccines have been evaluated in the field during response efforts. The US Food and Drug Administration recently announced the approval of Ervebo, which has been used as an investigational vaccine in the DRC.

The MMWR detailed the epidemiologic history of the outbreak. The 5 most affected health zones in DRC between August 2018 and November 2019 were Beni, Katwa, Mabalako, Mandima, and Butembo. These zones accounted for 69% of cases reported.

A majority of the cases, 1857, occurred in women. People aged 18 years or less accounted for 968 (29%) of cases. Health workers themselves accounted for 165 cases. The ongoing Kivu conflict has been responsible for displacing residents and spreading the virus, including the first cases in Uganda since 2013.

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