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Treatment regimens for HIV or Hepatitis C Virus do not need to be altered during Paxlovid administration for COVID-19
Treatment with Paxlovid (nirmatrelvir/ritonavir 300/100 mg two times per day for 5 days) is expected to play an important role in patients with mild-to-moderate COVID-19 who are at risk of disease progression. Nirmatrelvir targets the SARS-CoV-2 3CL protease, whereas ritonavir acts as a pharmacological enhancer. Paxlovid is an inhibitor of CYP3A (Cytochrome P450, family 3, subfamily A) and may increase plasma concentrations of drugs that are primarily metabolised by CYP3A. Guidance has been released to indicate that people with HIV or hepatitis C virus who take Paxlovid can continue their antiviral treatment, including regimens containing ritonavir or cobicistat, without interruption or dose adjustments. With concomitant use, patients should be monitored for a potentially increased risk of adverse events. Other important interactions exist, including reduced Paxlovid therapeutic effect by drugs that induce CYP3A, that require careful management.1
Infectious Diseases Society of America and HIV Medicine Association. Paxlovid for the treatment of COVID-19: considerations for people with HIV and hepatitis C. December 31, 2021. https://www.idsociety.org/globalassets/covid-19-real-time-learning-network/patient-populations/hiv/oral-covid-tx-considerations-for-people-with-hiv-and-hcv.pdf.
Published in Sexually Transmitted Infections: Depression is more common in MSM who report either sexual inactivity or condomless sex than in men who report condom-protected sex only
Studies on the association between depression and condomless sex have reported discordant findings. One possible explanation is that participants who report no recent sexual intercourse are merged with those who report condom-protected sex into a single ‘no condomless sex’ comparator group. Using data from two cross-sectional cohorts of HIV-diagnosed (n=2170) and HIV-negative (n=1477) men who have sex with men, investigators in the UK examined the relationship by separating the categories of no sex, condom-protected sex only and condomless sex. Depression was more common among HIV-diagnosed than among HIV-negative men (27% vs 11%). Regardless of HIV status, analysing the sexual behaviour categories separately produced opposing associations whereby depression was more common in the no sex and condomless sex groups than in the condom-protected sex only. Binary classification of sexual activity dilutes the relationship between depression and sexual behaviour.
Miltz AR, Rodger AJ, Phillips AN et al. Opposing associations of depression with sexual behaviour: implications for epidemiological investigation among gay, bisexual and other men who have sex with men. Sex Trans Infect 2021;97:613–8.
Single-dose 1000 mg ertapenem is non-inferior to single-dose 500 mg ceftriaxone in gonorrhoea treatment
In search for other potential treatments for gonorrhoea, a randomised non-inferiority trial compared stat doses intramuscular ceftriaxone (500 mg) with intramuscular ertapenem (1000 mg), intramuscular gentamicin (5 mg/kg, maximum 400 mg) or oral fosfomycin (6 g) in 346 MSM with anogenital infection. Success was defined as a negative nucleic acid amplification test from the primary infection site 7–14 days after treatment. While the fosfomycin arm was stopped prematurely for lack of efficacy, the per-protocol primary analysis showed cure rates of 100% for ceftriaxone, 99% for ertapenem and 93% for gentamicin, demonstrating non-inferiority between ertapenem and ceftriaxone. The minimal inhibitory concentration of antibiotics did not correlate with treatment failure. Ertapenem may be a treatment option for ceftriaxone-susceptible anogenital gonorrhoea. Further studies should evaluate efficacy against ceftriaxone-resistant and oropharyngeal infections.
de Vries HJC, de Laat M, Jongen VW, et al. Efficacy of ertapenem, gentamicin, fosfomycin, and ceftriaxone for the treatment of anogenital gonorrhoea (NABOGO): a randomised, non-inferiority trial. Lancet Inf Dis 2022:S1473-3099(21)00625-3. doi:10.1016/S1473-3099(21)00625-3.
A gonococcal vaccine of even modest efficacy could effectively reduce prevalence of gonorrhoea among MSM
Investigators used mathematical modelling to estimate the impact of a vaccine on the prevalence of gonorrhoea among MSM in Australia. Assuming an uptake of 30%, a vaccine with 100% protective efficacy at all sites of infection and against all gonococcal strains was predicted to achieve 94% reduction in prevalence within 2 years; however, there would still be 62% reduction even with 50% protective efficacy. Elimination of gonorrhoea would be achieved within 5 or 8 years, respectively, provided boosters were offered every 3 years on average. Gonorrhoea elimination was considered unlikely if a vaccine was not protective against oropharyngeal infection, even if it was 100% protective against urethral and anorectal infection. Vaccination would probably be tied to STI testing visits, predicting that uptake would vary according to STI testing coverage.
Hui BB, Padeniya TN, Rebuli N, et al. A gonococcal vaccine has the potential to rapidly reduce the incidence of Neisseria gonorrhoeae infection among urban men who have sex with men. J Infect Dis 2021;jiab581. https://doi.org/10.1093/infdis/jiab581.
Among MSM living with HIV, black men have a higher risk of anal cancer than non-black men
Anal cancer disproportionally affects MSM living with HIV. A multicentre cohort study in the USA assessed the incidence of anal cancer according to race among 7473 MSM who initiated antiretroviral therapy in 1996–2014, totalling 41 810 person-years of follow-up. The crude incidence rate (per 100 000 person-years) was 204 among black MSM vs 61 for non-black MSM. Black MSM had 2.37 times the hazard of being diagnosed with anal cancer as non-black MSM, after adjusting for demographic characteristics, HIV disease indicators, and coinfection and behavioural factors including hepatitis B, hepatitis C, tobacco smoking and alcohol abuse. Further studies are needed to elucidate race-associated factors that influence the risk of anal cancer. Meanwhile the findings highlight the importance of equitable access to human papillomavirus and anal cancer prevention strategies for MSM with HIV.
Mcneil CJ, Lee JS, Cole SR, et al. Anal cancer incidence in MSM with HIV: are black men at higher risk? AIDS 2021.
The change to HPV screening is less likely to miss invasive cancer than previous estimates
The move away from combined cytology plus human papillomavirus (HPV) testing to HPV testing alone has raised concerns that cases of cervical cancer may be missed among those with a negative HPV test. Investigators in the USA studied the prevalence of invasive cervical cancer in women with a PAP-positive/HPV-negative cotest where a diagnosis would not have occurred as a consequence of symptoms or clinical examination. Over a 17-year period there were >4 million cotests in the Kaiser Permanente Northern California laboratory database. Among these, 47 patients were identified with a PAP-positive/HPV-negative cotest and at least low-grade squamous intraepithelial lesions. On review of medical records, a minority (18 of 47, 38%) reported no symptoms and had no visible or palpable cancer at the time of diagnosis, that is, a prevalence of 1 in 225 281 (95% CI 1 in 154 083 to 1 in 418 410). Integration of laboratory and clinical data significantly allows more accurate estimates of the risk of discontinuing cytology.
Locke A, Shah NR, Fetterman B, et al. Invasive cervical cancer after a positive pap test result and negative human papillomavirus test result. Obstet Gynecol 2021;138:580–1. doi:10.1097/AOG.0000000000004543.
This study does not involve human participants.
Handling editor Anna Maria Geretti
Contributors All authors contributed to the selection of articles and to the writing of summaries. SR submitted the final version to the journal.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
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