Top Infectious Disease News of the Week—February 16, 2020

#5: Addressing Weight Gain That Follows Life-Saving Antiretroviral Therapy

Weight gain after life-saving antiretroviral therapy (ART) is common. Some of this weight gain early after ART initiation often represents effective viral suppression leading to restoration of healthy preinfection weight known as the “return-to-health” phenomenon. However, excessive clinically undesirable weight gain that places an individual in the overweight or obese category has been noted.

There is growing evidence supporting greater weight gain when patients start or are switched off a stable regimen to integrase strand transfer inhibitors (INSTIs) compared with existing agents. This finding is clinically important, as INSTI-based regimens are now recommended first-line ART, and patients living with HIV (PLWH) are at an increasing risk for obesity, metabolic comorbidities, and cardiovascular disease.¹

Separating weight gain due to improved health status from weight gain due to an undesired effect of therapy, understanding the pathogenesis of weight gain, and its health repercussions are of paramount importance.

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#4: Bacteriophage-Antibiotic Combinations: A Promising Alternative for Refractory Infections?

The constant increase of multidrug-resistant (MDR) organisms has led to an unavoidable decline of effective antimicrobials. Despite a resurgence of the antibiotic pipeline in recent years, the discovery of novel therapeutic targets remains limited.¹ Obligately lytic bacteriophages (phages) are viruses that target, infect, and kill bacterial cells.² As multiple reports have shown that phages used in combination with antibiotics could lead to improved efficacy (eg, phage-antibiotic synergy, resensitization of antibiotic therapy, etc), this therapeutic strategy could be a rational method to battle the antibiotic resistance currently facing clinicians.^3-6

INTRODUCTION TO BACTERIOPHAGES

Phage therapy was first implemented in the early 20th century, but the introduction of antibiotics, among other factors, overshadowed their therapeutic potential throughout the majority of the world.^7,8 Despite this initial abandonment, the era of antibiotic resistance has led to a resurgence of phage therapy into clinical practice, primarily in refractory cases or to attack MDR organisms.^2,3,8,9 Phages depend on their bacterial hosts for replication, and the 2 main life cycles for viral replication are the lytic, or virulent cycle (in which the phage kills the bacterial cell) and the lysogenic, or temperate cycle (in which the phage lays dormant within the bacterial genome and does not immediately kill the bacterial cell). In clinical practice, lytic phages are favored for use.^10,11

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#3: The Persistence of SARS-CoV-2 on Inanimate Surfaces

The outbreak of the novel coronavirus, SARS-CoV-2, has now led to more than 69,000 cases of COVID-19 across the world. With this influx of cases comes an unparalleled amount of questions regarding control and response measures. While the world is inundated with information regarding the novel virus, in most cases the lessons learned from sudden acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) have been guiding the way.

One concern that has captivated health care professionals and world leaders alike relates to the ability of coronaviruses to live on surfaces and inanimate objects. While some are worried about goods being shipped from China, the bigger issue for clinicians and infection prevention efforts is does SARS-CoV-2 require unique disinfection efforts?

Unfortunately, research is still needed to assess the differences in persistence of SARS-CoV-2 environmentally as compared with other human coronaviruses.

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#2: Is There Any Reason to Use Corticosteroids in Coronavirus Treatment?

The novel coronavirus COVID-19 continues to spark fear and concern around the globe. While few cases have been deadly outside of China, the virus has led to serious illness in some individuals within affected areas and has been declared a public health emergency of international concern by the World Health Organization (WHO).

The clinical course and disease progression of COVID-19 is still unknown, and in the absence of a treatment with proven efficacy many different therapies are being deployed in hopes of treating those who fall ill.

As in previous outbreaks of Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS), some clinicians have turned to corticosteroids to treat COVID-19 .

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#1: CDC Begins to Test Patients with Flu-like Symptoms for Coronavirus

In a call with members of the media on Friday, February 14, 2020, the US Centers for Disease Control and Prevention (CDC) said they will begin to test individuals with influenza-like-illness for the novel coronavirus. This will take place at public health labs in Los Angeles, San Francisco, Seattle, Chicago, and New York City.

The CDC plans to expand this initiative to more cities in the coming weeks with the goal of eventually conducting national surveillance in order to guide response strategy.

“This is an extra layer of our response that will help us detect if and when this virus is spreading in the community,” said Nancy Messonnier, MD, director of the CDC’s Center for Immunization and Respiratory Diseases. “All of our efforts are now to prevent the sustained spread of the virus in our community, but we need to be prepared for the possibility that it will spread.”

While this was a call focused on the worldwide coronavirus outbreak, Messonnier added that reports of the flu have increased the past few weeks.

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