Rapid evidence synthesis during emerging infectious and re-emerging disease outbreaks is critical, yet traditional systematic reviews rarely meet urgent timelines. Large language models (LLMs) may accelerate evidence synthesis by extracting data from publications. We compared an LLM-assisted data extraction system with manual extraction. We conducted a 1:1, open-label, 2-period, randomized crossover trial at the National Center for Global Health and Medicine, a national reference center for emerging infectious diseases in Japan (2025). Five experienced reviewers extracted predefined items from mpox-related articles under 2 conditions: (i) LLM-assisted extraction using OpenAI's o3 model to generate structured summaries and (ii) manual review of PDF files. The primary outcome was task completion time; secondary outcomes were extraction accuracy and adverse events. Mixed-effects models included condition as a fixed effect and participant and paper IDs as random effects. The protocol, source code, and data are available at https://github.com/SRWS-PSG/emerging_infection_24K13518_open. Five evaluators (4 physicians and 1 pharmacist; 6-10 years postgraduation) completed 20 task-level evaluations (LLM, n = 9; no LLM, n = 11). Mean completion time was 27.5 minutes with LLM assistance versus 34.5 minutes without. The LLM-assisted condition was 7.9 minutes faster on average (95% CI -1.5 to 17.3; P = .099). Extraction accuracy was 100% in both conditions, and no adverse events were reported. LLM assistance might reduce data extraction time by ∼23% (7.9 minutes per article; 95% CI -1.5 to 17.3 minutes) with no observed loss of accuracy. Although statistical uncertainty remains, LLM integration may offer practical value for rapid evidence synthesis during public health emergencies as tools and prompting strategies mature.
Our understanding of the epidemiology of and risk factors for postchimeric antigen receptor T-cell therapy (CART) infections is largely based on data from single-center studies with small sample sizes. This is a multicenter, cohort study of adult patients treated with CD19 CART between 1 January 2018 and 31 August 2021. The epidemiology of infectious complications occurring within the first year after CART is described. A Fine-Gray subdistribution hazard model was built to identify risk factors for infection. Logistic regression was used to explore risk factors for early (≤90 days post-CART) versus late (>90 days post-CART) and bacterial versus viral infection. One hundred and thirty-one infections occurred in 97 of 311 patients (31.2%) within 1 year of CART. By infection type, the cumulative incidence of infection was 19.0% (viral), 20.9% (bacterial), and 2.3% (fungal). The majority of infections were mild or moderate in severity (86%). Clostridiodes difficile and bloodstream infections due to Gram-negative bacilli were common bacterial infections. Respiratory viral infections were the most common viral complication and fungal infections were rare. No independent predictors of infection were identified. Infectious complications occur in close to a third of patients post-CART but are generally mild in severity. Though we were not able to identify independent predictors of post-CART infection, a description of their clinical characteristics and epidemiology will help to optimize management of these common complications.
Neurosyphilis, ocular syphilis, and otosyphilis occur more frequently among people with HIV-1 and are associated with higher morbidity and treatment failure. Intravenous penicillin G remains the standard therapy but requires hospitalization or prolonged intravenous access, creating barriers that are amplified in resource-limited settings facing recurrent penicillin shortages. Ceftriaxone is a potential alternative; however, comparative data in people with HIV are limited. We conducted a multicenter retrospective cohort study of adults with HIV at 5 public hospitals and 2 outpatient HIV clinics in Mexico (2015-2024). Participants had confirmed neurosyphilis, ocular syphilis, or otosyphilis. Participants received intravenous penicillin G (18-24 million IU/day) or ceftriaxone (1-2 g/day) for 10-14 days. The primary outcome was early serological response (ESR), defined as a ≥4-fold nontreponemal titer decline or seroreversion at 6 months. We performed 1:1 propensity score matching (39 pairs, n = 78), followed by logistic regression in the matched cohort. Of 143 participants, 104 (73%) received intravenous penicillin G and 39 (27%) ceftriaxone. In the matched cohort, ESR occurred in 74.4% of penicillin-treated participants and 71.8% of ceftriaxone-treated participants (odds ratio 0.88, 95% confidence interval .32-2.40; P = .80). The results were consistent across all prespecified sensitivity analyses. In this multicenter cohort of people with HIV diagnosed with neurosyphilis, ocular syphilis, or otosyphilis, ceftriaxone showed comparable ESR to intravenous penicillin G. These findings support ceftriaxone as a reasonable alternative when standard therapy is limited by penicillin shortages, limited inpatient capacity, or financial constraints.
Glycopeptide antibiotics remain the cornerstone of therapy for serious Gram-positive bacteremia, yet comparative real-world effectiveness data between teicoplanin and standard-of-care agents remain limited in Middle Eastern healthcare settings. To compare clinical outcomes, safety profiles, and predictors of treatment failure between teicoplanin and standard-of-care antibiotics in adult patients with microbiologically confirmed Gram-positive bacteremia. We conducted a 7-year retrospective cohort study (January 2018-January 2025) at 2 tertiary care centers in Riyadh, Saudi Arabia. Adult patients receiving ≥72 hours of teicoplanin or standard-of-care antibiotics, including prespecified organism-directed beta-lactam therapy when clinically indicated, for Gram-positive bacteremia were included. Propensity score matching (1:1 ratio, caliper 0.2) was employed to balance baseline characteristics. Primary outcome was clinical cure at end of therapy. Secondary outcomes included 90-day all-cause mortality, nephrotoxicity, 14-day treatment failure, 30-day relapse, and antimicrobial switch due to toxicity. Among 547 screened patients, 312 met inclusion criteria (teicoplanin n = 124; standard-of-care n = 188). Prematch analysis revealed significantly higher baseline illness severity in the teicoplanin cohort (median APACHE II 18 vs 14, P = .02). Propensity score matching yielded 102 well-balanced pairs. Clinical cure rates were comparable between groups (teicoplanin 78.4% vs standard-of-care 72.5%; P = .31). Nephrotoxicity occurred significantly less frequently with teicoplanin (6.8% vs 18.2%; P = .01). Antimicrobial switch due to toxicity was lower in teicoplanin-treated patients (8.8% vs 22.5%; P = .01). Ninety-day mortality did not differ significantly (hazard ratio 0.89, 95% CI .54-1.45; log-rank P = .64). Within the teicoplanin cohort, failure to administer a loading dose (odds ratio 3.5, 95% CI 1.21-10.12; P = .02) and infective endocarditis as the infection source (odds ratio 4.1, 95% CI 1.38-12.18; P = .01) independently predicted treatment failure. Subgroup analysis demonstrated optimal teicoplanin efficacy in catheter-related bloodstream infections (cure rate 85.2%), with attenuated efficacy in pneumonia (65.0%) and endocarditis (55.5%). Teicoplanin was associated with comparable clinical efficacy and lower nephrotoxicity compared with standard-of-care antibiotics. It may represent a reasonable alternative, particularly in patients at increased risk of renal adverse events. Prospective studies are warranted.
Recurrent diarrhea after an episode of Clostridioides difficile infection (CDI) is common although not always secondary to recurrent disease. Bacterial and viral gastroenteritis has been associated with postinfectious functional bowel disorders (FBDs). We aimed to compare characteristics of patients diagnosed with CDI-associated FBD with those of patients diagnosed with initial or recurrent CDI alone. This was a retrospective review of the electronic medical records of patients referred to the Complicated C. difficile Clinic at University of Virginia Health from March 2020 to January 2023. The characteristics of the patients we studied included demographics, risk factors, and outcomes. Of 159 patients seen at the clinic, 44 (27.7%) referred for recurrent CDI had symptoms of FBD; 90 (56.6%) had symptoms of CDI alone. Compared with patients with CDI only, patients with CDI-associated FBD were younger (P = .001), more likely to be female (P = .029), had fewer comorbidities (P < .001), and more frequently had a history of anxiety (P < .001) and depression (P = .003). In a multiple regression model, FBD remained associated with fewer comorbidities (P = .032). At 3 months, patients with FBD were less frequently well (P = .039) and more frequently continued to have gastrointestinal symptoms (P < .001) than patients with CDI alone. CDI-associated FBD is prevalent but may be misdiagnosed as solely CDI recurrence, contributing to incomplete resolution of symptoms despite anti-C. difficile treatments.
Listeriosis is a severe foodborne illness with elevated incidence rates among pregnant women, older adults, individuals with medical comorbidities, and certain racial and ethnic subpopulations. Foodborne Diseases Active Surveillance Network (FoodNet) data allow examination of incidence trends and differences. We analyze sporadic invasive listeriosis cases reported to FoodNet from 2008 to 2023. Incidence rates and rate ratios are calculated overall and by studied period, pregnancy status, age, sex, race, and ethnicity. US Census Bureau demographic projections are used to estimate incidence rate changes expected from changes in the structure of the population with time. The overall incidence rate of domestically acquired sporadic listeriosis has remained stable in the FoodNet catchment area over the 15-year period, with a latest estimate (2020-2023) of 0.25 (95% confidence interval [95% CI, .22-.30) per 100 000 person-years. No significant temporal trend in any studied subpopulation is observed. Pregnant women have a 64-fold (95% CI, 47-87) higher risk when compared to non-pregnant women of reproductive age. Incidence rate in the non-pregnant population rises with age, and Hispanic, non-Hispanic Asian, and non-Hispanic Black populations have higher rates than non-Hispanic White populations. An increased overall incidence rate would have been expected because of demographic shifts; instead, the observed stable incidence rate suggests approximately 16% lower exposure to Listeria monocytogenes in 2023 compared with 2008. Stable listeriosis incidence rates despite demographic shifts suggest reduced population exposure to L monocytogenes. Targeted prevention for disproportionately affected subpopulations, alongside continued efforts to reduce exposure broadly, is needed to further reduce the risk of invasive listeriosis.
Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021-30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). In 2023, there were 50·9 million (95% UI 46·1-56·1) road injury incident cases, 1·34 million (1·04-1·58) deaths, and 75·3 million (59·8-89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10-39 years. Between 1990 and 2023, age-standardised incidence decreased by 38·3% (95% UI 36·9-39·7) and mortality decreased by 32·3% (6·1-49·0), but progress varied widely by World Bank income group. Mortality in low-income countries (43·8 [95% UI 31·7-56·0] deaths per 100 000 population) was approximately six times higher than in high-income countries (7·5 [7·1-7·9] deaths per 100 000), despite the high-income countries showing the highest age-standardised incidence rates (858·1 [95% UI 781·9-947·1] cases per 100 000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. Gates Foundation.
HIV-associated tuberculosis is a leading cause of mortality. Mycobacterium tuberculosis bloodstream infection (MTB-BSI) is complicated by diagnostic difficulty and severe illness. We assessed whether MTB-BSI continues to be common in the era of widespread antiretroviral therapy and whether it continues to result in increased risk of early mortality. We enrolled inpatients from medical wards irrespective of tuberculosis symptoms and outpatients with tuberculosis symptoms. All participants had HIV and were ≥18 years old, and all were recruited from 7 countries: Malawi, South Africa, Tanzania, Thailand, Uganda, Vietnam, and Zambia. Participants also had <3 doses of antituberculosis treatment in the past 60 days and no isoniazid preventive therapy in the past 6 months. We estimated the prevalence of MTB-BSI. In Bayesian survival models, we estimated the hazards of mortality for inpatients with MTB-BSI vs those without. Between 2019 and 2021, 1703 participants were included: 44% were hospitalized, the median CD4 count was 361 cells/μL, and 77% reported using antiretroviral therapy. Crude prevalence of MTB-BSI varied by country but was 4.4% (32/723) among all inpatients, 22.5% (32/142) among inpatients with microbiologically confirmed TB, and 0.2% (2/913) among all outpatients. Among all inpatients, those with MTB-BSI had 2.65-times (95% credible interval, 1.06-5.01) increased hazard of death by 30 days and 1.79-times (95% credible interval, .81-3.11) increased hazard by 70 days. Lower CD4 and older age were strongly associated with mortality. MTB-BSI is far more common for inpatients than outpatients with HIV. Across multiple settings with high tuberculosis prevalence, MTB-BSI was strongly associated with heightened risk of early mortality in PWH. Novel optimized diagnostic and treatment strategies are still needed for HIV-associated MTB-BSI.
Widespread immunity from vaccination and infection has reduced COVID-19 morbidity and mortality, but this immunity varies across the population. Understanding how repeated antigenic exposures influence antibody responses helps to inform future vaccination strategies. We characterized neutralizing antibody (nAb) responses in serum samples collected 1- and 6-months after XBB.1.5 vaccination from 25 healthcare workers with varying, complex histories of vaccination and reported infections. Neutralizing activity was assessed against a range of variants, from pre-Omicron to recent Omicron JN.1 sublineage, and divergent BA.3.2 variants using lentiviral pseudoviruses. Participants were stratified into 5 exposure groups based on their documented vaccination and reported infection history. XBB.1.5 vaccination elicited broad neutralizing responses, with strong boosting against previously encountered antigens relative to vaccine-matched XBB.1.5 and newer variants. Geometric mean neutralization titers were generally comparable across exposure groups, though small subgroup sizes and considerable intragroup heterogeneity precluded definitive conclusions about the influence of prior exposure history. At 6 months, titers declined by 36-62% across all variants. Titers remained highest against pre-Omicron variants and were lowest against JN.1 sublineage variants, with some falling to very low levels. In this cohort with extensive prior antigenic exposures, broad nAb profiles were observed following XBB.1.5 vaccination, though these responses waned substantially after 6 months. The observed waning of cross-neutralizing antibodies against emerging variants underscores the challenge of maintaining durable protection and supports the need for continued monitoring of antibody responses to guide evidence-based updates to COVID-19 vaccines.
Data on respiratory syncytial virus (RSV) acute respiratory infection (ARI) among community-dwelling U.S. adults aged 18 to 64 years, particularly those with high-risk conditions (HRC), remain limited. This study estimated incidence and attack rates of RSV-ARI and RSV lower respiratory tract disease (LRTD) in adults with and without HRCs. A multistate, community-based prospective cohort of adults aged 18 to 64 years with and without HRCs was followed from October 2022 to September 2024. Incidence rates and annual attack rates of RSV-ARI and RSV-LRTD were calculated by HRC presence and age group. Of 3375 adults with at least 1 HRC, the RSV-ARI incidence rate was 17.9 per 1000 person-years (attack rates: year 1, 1.87%; year 2, 1.56%), compared with 14.8 per 1000 person-years (year 1, 1.33%; year 2, 1.50%) among adults without HRCs. RSV-LRTD incidence was 10.0 per 1000 person-years in adults with HRCs versus 5.7 per 1000 person-years in those without. Asthma, congenital immunodeficiency, and immunosuppressive medication use were associated with increased incidence of RSV-ARI and RSV-LRTD; whereas adults with solid organ transplant and chronic kidney disease had a significantly higher incidence rate of RSV-LRTD compared to those without these conditions. Adults aged 18 to 49 years with HRCs had significantly higher RSV-LRTD incidence (9.6 vs 4.3 per 1000 person-years). After adjustment for age and sex, having ≥1 HRC was associated with a 62% increased RSV-LRTD risk, rising to 117% among adults aged 18 to 49 years. Adults with HRCs-particularly asthma, congenital immunodeficiency, chronic kidney disease, immunosuppressive medication use, and solid organ transplant-experienced higher RSV-ARI and RSV-LRTD incidence. The elevated RSV-LRTD burden was most pronounced in adults aged 18 to 49 years with HRCs.
This study was conducted to investigate the diagnostic value of fungal biomarker differentials and T2Candida polymerase chain reaction (PCR) from catheter and peripheral blood samples and to re-evaluate classical conservative methods, such as differential time to positivity of blood cultures (BCs), for the early identification of catheter-related candidemia (CRC) before catheter removal. This prospective study was conducted (March 2023-April 2025) in 2 tertiary hospitals in Spain and Italy. Adults (aged ≥18 years) with candidemia and a central venous catheter in place at diagnosis were included, provided catheter removal occurred within 48 hours of index BC positivity. CRC was defined in patients with candidemia who showed 1 or 2 of the following criteria in the catheter tip: (1) ≥ 15 CFU/plate (Maki technique) or ≥ 1000 CFU/mL (sonication) and (2) any Candida growth on the catheter tip. Blood samples were collected from peripheral veins and catheter lumens to compare the differentials of 1,3-β-D-glucan (BDG), Candida albicans germ tube antibodies, mannan antigen, antimannan antibody, and T2Candida PCR results. Diagnostic metrics were calculated for each test. Of 179 episodes of candidemia reviewed, 28 (15.6%) met the inclusion criteria (13 in Spain, 15 in Italy). CRC was confirmed in 11 patients (39.3%) using criterion 1 and in 15 patients (53.6%) using criterion 2. BDG differentials (any difference) demonstrated the highest diagnostic accuracy as follows: sensitivity 81.82%, specificity 82.35%, positive predictive value 75.00%, negative predictive value 87.50%, and overall accuracy 82.14% (criterion 1). However, stricter BDG thresholds (≥20 or ≥30 pg/mL) and the application of criterion 2 reduced the sensitivity. Other biomarkers and T2Candida PCR demonstrated low sensitivity (0%-40%) and variable specificity (25%-100%), with overall accuracies of <64%. Differential time to positivity of BCs yielded a sensitivity of 72.73% and a specificity of 52.94%, with limited accuracy. None of the investigated methods achieved sufficient accuracy to diagnose CRC without catheter removal. Despite the limited sample size, this study emphasizes the limitations of current diagnostic approaches and the need for novel tools for reliable noninvasive identification of CRC.
Directly Observed Therapy (DOT) is a recommended modality for tuberculosis (TB) treatment, yet is underutilized in many settings. Although DOT has been evaluated in clinical trials, less is known about its effectiveness in routine programs. We estimated the contribution of DOT to TB treatment success in Brazil. Using data from Brazil's National Disease Notification System for 2015-2018, we fit regression models estimating the relationship between DOT coverage and individual treatment success, leveraging municipality-level variation in DOT usage to avoid confounding due to nonrandom DOT receipt at the individual level. Models were adjusted for demographic and clinical covariates, using generalized estimating equations to account for correlation of outcomes within municipalities. Fitted models were used to project the impact of expanded DOT coverage, with robustness tested using alternative specifications. The study included 278 007 individuals from 4783 municipalities. Average DOT coverage was 45.3%, with significant geographic variability. Treatment success was 86.9% with DOT and 73.2% without DOT. DOT coverage was associated with a 1.46 (95% confidence interval: 1.38, 1.55) odds ratio (OR) of treatment success. ORs ranged from 1.11 to 2.52 under alternative specifications, consistently indicating a positive impact. Scenario analyses indicated that reducing DOT nonutilization in each municipality by 50% would reduce the proportion of unsuccessful treatment outcomes by 7.1% (6.1, 8.2), equivalent to an average 5.5 (4.7, 6.3) percentage point increase in success probability for individuals newly receiving DOT. In this routine programmatic setting, higher DOT utilization was associated with better treatment outcomes, underscoring the importance of adherence-supported interventions for TB care.
The coronavirus disease 2019 (COVID-19) pandemic had dramatic impacts on the epidemiology of respiratory syncytial virus (RSV). We used surveillance data collected by the Georgia Emerging Infections Program to investigate seasonality and severity of RSV pre- versus postpandemic in children under 5 years old in Atlanta, Georgia. We analyzed 3282 RSV-associated hospitalizations of children under 5 years old residing in the Atlanta area from 2018 to 2023. There were 4 distinct waves of RSV hospitalizations: 2 prepandemic and 2 postpandemic. Using regression modeling, we assessed the impact of wave on the length of hospital stay and intensive care unit (ICU) admission among all hospitalizations and on the length of ICU stay and mechanical ventilation among ICU admissions. The 2 postpandemic waves of RSV-associated hospitalizations fell outside of the typical viral respiratory season in the northern hemisphere, seemingly delayed by COVID-19-associated disruptions in transmission. Age at hospitalization and race/ethnicity differed significantly across all waves, with age increasing over time. Regression models for all hospitalizations showed a statistically significant reduction in severity (shorter length of hospital stay and lower risk of ICU admission) postpandemic after adjustment for age and race/ethnicity. Analysis of ICU admissions adjusted for age, race/ethnicity, and underlying medical conditions tended toward shorter ICU stays and lower risk of mechanical ventilation postpandemic, although these findings did not show statistical significance. The COVID-19 pandemic delayed the expected annual seasonality of RSV in children under 5, and the delayed peaks of hospitalizations consisted of, on average, less severe disease than prepandemic.
The Ending the HIV Epidemic in the US (EHE) initiative, launched by the White House in 2019, aims to reduce HIV transmissions by 75% by 2025 and 90% by 2030 as compared with total annual transmissions in 2017. We sought to determine levels of improvement in testing, care, and prevention needed to meet the EHE goals for men who have sex with men (MSM) in the United States. We modeled HIV transmissions based on current care (Status quo) and strategies improving HIV testing, treatment, and/or preexposure prophylaxis (PrEP). Status quo included testing frequency (every 6.8 years), antiretroviral therapy linkage (77%), care engagement (78%), viral suppression (81%), and PrEP coverage (41% for MSM at increased HIV infection risk, 7% for lower risk). The primary outcome was percentage reduction in HIV transmissions. We examined data uncertainty in sensitivity analysis. Status quo would reduce HIV transmissions by 32% by 2035. The most influential individual intervention would be improved engagement in HIV care (67% reduction in transmissions with 98% engagement). Combined testing and care interventions at high levels, with expanded PrEP for MSM at increased risk, could achieve 89% reduction by 2035. Only with major improvements in HIV testing, care, and prevention will EHE goals be met by 2036.
Giardia is the most common enteric parasite among children in low-resource settings, causing diarrhea and leading to prolonged infection or asymptomatic carriage. We assessed whether the effect of water, sanitation, and handwashing (WSH) interventions on Giardia infection among rural Bangladeshi children varies with seasonal conditions. We conducted a secondary analysis of the WASH Benefits Bangladesh cluster-randomized trial, with 450 clusters assigned to 4 arms in a 2 × 2 factorial design (WSH: WSH, WSH + Nutrition; no WSH: Control, Nutrition). Giardia infection was measured by multiplex real-time polymerase chain reaction in stool samples after 2 years of intervention. Effects were estimated by marginal treatment and assessed for heterogeneity by season when Giardia was measured. We also assessed heterogeneity by cumulative exposure to dry and monsoon seasons from birth to measurement age to estimate cumulative seasonal exposure history. Giardia prevalence, measured among 2773 children (median age: 30 months, range: 22-38 months), was higher in the dry seasons (32%) than in the monsoon (21%). Improved WSH was associated with a consistent 20% relative reduction and a modest absolute reduction that was slightly greater during the dry season (-6.1%; 95% confidence interval: -10.1 to -2.1), although interaction test did not show strong evidence of effect modification by season. Prevalence remained lower in the WSH group across increasing dry season exposure, with the largest differences among children with more than 17 months of dry-season exposure. We demonstrate how WSH provides resilience to seasonal variation in infection risk and mitigates climate-driven, seasonally varying Giardia transmission.
We surveyed 1475 US adults (March-April 2024) about antibiotic therapy durations and adherence. Most reported preferring longer antibiotic courses (≥7 days) and believed always finishing an antibiotic course is important. These findings highlight the need for effective strategies to align public beliefs with current recommendations supporting short duration therapy.
Guidelines now support anal squamous cell carcinoma (ASCC) screening in men who have sex with men (MSM) living with HIV (LWH) aged ≥35 years. There is limited data on screening in MSM LWH <35 years. Two academic HIV clinics in the Northeastern US. We retrospectively evaluated all anal cytology and high-resolution anoscopy (HRA; referral criteria: atypical cells of undetermined significance [ASC-US] or worse cytology) performed for MSM LWH between ages 18-34 from 2013 to 2023. We evaluated risk factors for abnormal cytology or histology, and prevalence of high-grade dysplasia (HSIL) and ASCC. Of 216 eligible MSM LWH, 111 (51%) were screened for ASCC at least once. Screened individuals had longer follow-up (median 4.0 vs 1.6 years) but were otherwise similar to unscreened individuals. Among 246 cytology tests, 19% were unsatisfactory and 31% abnormal, of which 1.2% reported HSIL. Of 23 HRAs following abnormal cytology, 10 (43%) revealed HSIL. Testing in response to symptoms was associated with abnormal results (OR 8.54; 95% CI 2.55-28.67). Human papillomavirus vaccination trended toward protection against abnormal results. We identified two cases of local ASCC, both in individuals with symptomatic condyloma and severe immunosuppression. Over 10 years, ASCC screening in MSM LWH <35 years was variable. Anal cytology had high unsatisfactory rates and poor correlation with histology. Despite high dysplasia prevalence among those undergoing HRA, ASCC was rare and diagnosed early from symptoms. Findings support excluding younger (≤34 years) MSM LWH from asymptomatic screening, and support symptom-driven testing to diagnose anal cancer early.
Dengue-associated liver injury is common, prognostically significant, and associated with high mortality at severe thresholds. Oxidative stress is a key, potentially modifiable mechanism. N-acetylcysteine has strong biological plausibility and supportive preclinical data, but clinical evidence remains limited, underscoring the need for well-designed randomized trials to inform practice and policy.
Lenacapavir (LEN), a first-in-class long-acting human immunodeficiency virus type 1 (HIV-1) capsid inhibitor, has demonstrated potent antiviral activity in heavily treatment-experienced (HTE) people with HIV (PWH) in clinical trials, but real-world data remain limited. We describe outcomes from 6 US HIV clinics using LEN-based regimens in a largely HTE cohort of PWH to assess virologic response, regimen potency, and tolerability. We conducted a multicenter retrospective cohort study of adults with HIV who initiated LEN between November 2020 and June 2025 at 6 clinics in Chicago, Illinois and Pittsburgh, Pennsylvania. Demographic, clinical, and genotypic data were abstracted from electronic health records. Virologic suppression was defined as HIV viral load <200 copies/mL. Stanford genotypic susceptibility scores (S-GSS) were calculated to assess regimen potency. Wilcoxon signed-rank tests compared antiretroviral therapy pill burden and regimen potency before and after LEN initiation. Seventy PWH initiated LEN. Median follow-up was 12 months. At baseline, 18 (26%) PWH with available genotypes had multidrug-resistant HIV, and 54% had unsuppressed virus. Among 38 PWH with unsuppressed virus, 34 (89%) achieved viral suppression, and none of the PWH with suppressed HIV experienced rebound. LEN significantly improved regimen potency (P < .00005) and reduced daily pill burden from 2 tablets to 1 tablet (P < .00005). Injection site reactions occurred in 30% and led to discontinuation in 1 person. In this real-world cohort, LEN-based regimens achieved high rates of virologic suppression, improved regimen activity, and reduced pill burden with good tolerability. LEN represents a promising salvage therapy for PWH, warranting equitable and implementation-focused integration into HIV care.
A central Texas resident found an engorged Ornithodoros turicata tick attached to their ankle while at home. The tick tested positive for Borrelia turicatae, an agent for soft tick-borne relapsing fever. Three weeks earlier, the patient started experiencing febrile episodes, rash, and nausea, yet the etiological agent went undiagnosed.