EMERGING TRENDS IN INFECTIOUS DISEASE
IT ’ S THE TRENDS OF THE ID WORLD , AS WE KNOW IT AUTHOR Benjamin Klausing , MD
In the not too distant future , COVID-19
will evanesce , and we will return to some normal . Instead of our hospitals clogging with COVID-19 patients , a more typical mix of patients with pneumonia , bone and joint infection , fever of unknown origin and bacteremia will fill the wards . With luck , the hot bar will triumphantly return to banish the prepackaged lunches in the doctors ’ lounge too . I cannot wait . While some things in infectious diseases have not changed much ( primacy of source control , broad spectrum antibiotics are not a substitute for rational thought , pick an antibiotic with a “ S ” next to it and not a “ R ,” and wash your hands ), discussed below are some recent non-COVID-19 trends you might have missed .
Trend 1 : Persons with HIV on effective therapy aren ’ t contagious . 1
In the 1990s , physicians were able to obtain control of HIV by using a three-drug combination of antiretrovirals . This came to be known as highly active antiretroviral therapy ( HAART ) which has been further reduced to the chic , more modern acronym , ART – antiretroviral therapy . Throughout the 1990s and early 2000s , HIV care improved patient compliance , and therefore viral suppression , by reducing pill burden ( all three HIV drugs could now be formulated in a single , once a day tablet ). Preventive measures for HIV largely centered on attempting to change people ’ s behavior by promoting safe sex techniques and increasing ongoing screening and testing . This was not particularly effective , and HIV cases continued to increase throughout the world and throughout the country .
In 2011 , an African study gave ART to HIV patients whose partner was HIV negative , a so-called “ discordant couple .” Compared to other discordant couples that received ART on a delayed basis , transmission of HIV to the negative partner decreased 96 %. This was a landmark study and for the first time suggested that ART was a two-fer : it 1 ) arrested HIV disease progression and 2 ) prevented HIV from spreading and infecting sexual partners . This study was backed up by three additional randomized controlled trials PARTNER 1 , PARTNER 2 and Opposites Attract where 151,800 condomless sex acts ( maybe enough to impress the late Wilt Chamberlain ) lead to zero cases of HIV transmission . Now it is a given that once taking ART and having achieved viral suppression for six months , HIV patients are no longer sexually contagious and that U = U ( undetectable = untransmittable ).
Trend 2 : Think twice before prescribing a long course of antibiotic therapy . 2
Because we have five fingers to each hand and seven days to each week , we tend to think of duration of antibiotic therapy in multiples of five and seven . Therefore , we have a 10-14-day course of antibiotics for pneumonia or sinusitis . It is unlikely that the bacteria ( who , on last check , have not yet evolved to have hands and do not have an accessible calendar ), think there is anything too special about five or seven days . Researchers over the course of the past quarter century have performed over 60 randomized controlled trials to see whether we should stick with our historical intervals or could reduce the duration of antibiotics . As summarized
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