Worldwide Trends in HIV Vaccine: Are We There Yet?

By Olivier Lucar
October 16, 2018

Chronic HIV infection remains a major public health issue. According to 2017 data from UNAIDS, there are still 36.9 million HIV-positive individuals worldwide, including 1.1 million in the USA, of whom 1 in 7 are unaware of their status. HIV infection usually has a slow and paucisymptomatic infectious development, which makes recognition of infection difficult and leads to its persistence. HIV disproportionately affects individuals in less developed countries and can only be treated with multiple expensive drugs, the availability of which depends on the country. Furthermore, despite the phenomenal progress in anti-HIV drug efficacy (leading to sustained undetectable levels of viral load), long-term infection and treatment are associated with other comorbidities from cardiovascular diseases to certain cancers (Taiwo et al., 2013). The search for therapeutic or prophylactic vaccines remains the best option to fight HIV and prevent its permanent development. Continue reading “Worldwide Trends in HIV Vaccine: Are We There Yet?”

Cervical Cancer Screening Using HPV Testing Alone: Are We There Yet?

By Martina McGrath, MD
July 18, 2018

Although the overall incidence of cervical cancer is decreasing, it is estimated that over 200,000 women are living with cervical cancer in the US, and it is expected to lead to over 4,000 deaths in 2018.1 Cervical cancer is predominantly caused by infection of the cervical mucosa with human papilloma virus (HPV), particularly by several pro-oncogenic subtypes. Multiple HPV genotypes can infect the genital tract mucosa, but types 16 and 18 are responsible for the majority of cervical cancers. HPV infection is highly prevalent in sexually active young woman, and the majority will clear the infection within 8–24 months.2 Although cleared, HPV infection can lie dormant for prolonged periods. It can recur and be detected again decades later, mandating the need for cervical screening throughout a patient’s lifetime.3 In addition, observational data indicates that the relative risk of abnormal cervical cytology is markedly increased in those with persistent HPV infection, particularly where infection is with a high-risk type of HPV.2 Continue reading “Cervical Cancer Screening Using HPV Testing Alone: Are We There Yet?”

Vitamin D Supplementation and Reduced Risk of Upper Respiratory Tract Infections

By Martina M. McGrath, MD
August 30, 2017

As the cooler weather descends and the school year starts, we are again entering the season of viruses, colds, flu, and miscellaneous sniffles. Aside from vaccination and good hand hygiene, what else can we recommend to our patients to reduce their risk of upper respiratory tract infection?

A large meta-analysis of 25 randomized controlled trials of vitamin D supplementation and respiratory tract infections was published in the BMJ earlier this year.1 The researchers accessed patient-level data on 10,933 trial participants treated with supplemental vitamin D versus placebo. The trials included all age ranges, from birth to adults in their 70s , and had varied dosing regimens for vitamin D supplementation. Continue reading “Vitamin D Supplementation and Reduced Risk of Upper Respiratory Tract Infections”

Vancomycin as a Rare Cause of Drug-Induced Cytopenias

By Martina M. McGrath, MD
May 30, 2017

Vancomycin is a glycopeptide antibiotic, with activity against gram positive organisms, including MRSA. It is widely prescribed for hospital-acquired infections, device-related infections, and treatment of resistant organisms. While side effects such as red man syndrome, ototoxicity, and nephrotoxicity are well recognized, immune thrombocytopenia is a less common, but potentially severe, complication of vancomycin therapy. Indeed, because many affected patients are critically ill or treated with other potential culprit agents such as heparin, vancomycin-induced platelet destruction can go unrecognized. Continue reading “Vancomycin as a Rare Cause of Drug-Induced Cytopenias”

Severe C. Difficile Infection: Vancomycin or Metronidazole as First-Line Therapy?

By Martina M. McGrath, MD
February 16, 2017

In 2011, there were almost half a million cases of Clostridium difficile (C. diff) infection in the US and 29,000 patients died from this disease.1 Initially recognized in the 1970s, a more virulent strain appeared in the early 2000s with increased associated mortality. Now one of the commonest health care-associated infections, C. diff has a disproportionate impact on patients who are frail, immunosuppressed, and malnourished. Between 15 and 50% of patients can suffer from recurrent C. diff infection, leading to increased health care costs and further risk of complications. Continue reading “Severe C. Difficile Infection: Vancomycin or Metronidazole as First-Line Therapy?”

Hepatitis B Reactivation During Treatment for Hepatitis C

Conquering one foe only to unleash another.

By Martina M. McGrath, MD
January 12, 2017

In October 2016, the FDA published a drug safety communication warning of the risk of Hepatitis B (HBV) reactivation in patients treated with direct-acting antivirals (DAAs) for Hepatitis C (HCV) infection.1 They reported 24 cases of HBV reactivation, including two deaths and one patient who required liver transplantation. Interestingly, the HBV status of affected patients was heterogenous and included those with positive and negative HBV viral loads, as well as positive and negative HBsAg. Reactivation appears to occur early, within four to eight weeks of treatment initiation. Continue reading “Hepatitis B Reactivation During Treatment for Hepatitis C”

Candida Auris—A New Deadly Fungus

By Ajay Singh, MBBS, FRCP
November 10, 2016

There are few things that wake federal health officials up at night. One is the possibility of a deadly infection that might spread throughout the United States.

In an article in the MMWR, Snigdha Vallabhaneni from the Center for Disease Control (CDC) and colleagues report seven cases in the United States of a potentially deadly drug-resistant fungal infection—Candida auris. Continue reading “Candida Auris—A New Deadly Fungus”