Dolutegravir and doravirine are individually safe and effective antiretroviral therapy (ART) components, but their combined use has not been studied in clinical trials and is not recommended in HIV treatment guidelines. We noted persons with HIV (PWH) receiving dolutegravir with doravirine at our Washington, DC, infectious disease clinic and undertook a service evaluation to understand why providers selected this ART, whether HIV virologic suppression was achieved and identify adverse effects of concomitant use. Case registry and prescriptions data identified 21 PWH receiving concomitant dolutegravir and doravirine with mean follow-up 576.1 days (range 413–751); frequent reasons for switching were multiple ART resistance (57.1%), proton pump inhibitor usage (28.6%) and renal failure (28.6%), with 52.4% switched from protease inhibitor or cobicistat-boosted regimens. Dolutegravir with doravirine alone was prescribed for 60%, and additional ART in 40%. During 12 months follow-up mean CD4 was 585.9 (baseline 570.7) with undetectable viral load in 77.8% (baseline 66.7%). No discontinuations for drug-related adverse events or virologic failure occurred. Dolutegravir with doravirine was well tolerated in small numbers of highly treatment experienced PWH at our clinic, achieving virologic suppression in most. Establishing the efficacy and safety of dolutegravir with doravirine for HIV treatment in randomized trials remains important.

Background: One in 3 people with human immunodeficiency virus (HIV-1; PWH) are hepatitis B (HBV) core antibody positive (anti-HBc+) and surface antigen negative (HBsAg−) suggesting prior exposure. HBV reactivation can occur in this group if nucleos(t)ide reverse transcriptase inhibitor antiretrovirals (ARV) active against both HIV and HBV are stopped. We describe HBV reactivation in anti–HBc+/HBsAg− PWH following switch from ARV with HBV activity to ARV without HBV activity. Methods: We identified an at-risk cohort of 5986 anti-HBc+ participants switched from HBV-active to non–HBV-active ARV on or before 31 December 2023 and HBsAg− on the most recent result preceding switch from 63 153 PWH in the Veterans Aging Cohort Study. We defined HBV reactivation as HBV DNA detection or HBsAg+ result at any time following switch. HBV-active ARV included lamivudine, emtricitabine, or tenofovir. Results: Forty (0.67%) anti-HBc+/HBsAg− PWH experienced HBV reactivation after switch to non–HBV-active ARV, with median time to reactivation 8.9 months (interquartile range 5.5–26.7). The rate of HBV reactivation was 25.1 per 10 000 person-years (95% confidence interval [CI], 18.4–34.3). Prespecified subgroup analyses revealed higher rates per 10 000 person-years of HBV reactivation in those HBsAg+ in the remote past with no hepatitis B surface antibody positive (anti-HBs+) result (321; 95% CI, 120–855) versus subgroups never previously HBsAg+ or anti-HBs+ (38.0; 95% CI, 22.9–63.0), or anti-HBs+ but never HBsAg+ (17.4; 95% CI, 11.2–27.0). Conclusions: Overall risk of HBV reactivation appears low after switch from HBV-active to non–HBV-active ARV among anti-HBc+ PWH with no prior HBsAg+. Our results inform provider-patient discussion about HBV reactivation risk when considering ARV switching.

Human immunodeficiency virus (HIV) continues to persist as an issue of public health concern with more than a million people living with HIV (PLWH) in the United States [ 1]. One of the pillars of the “Ending the HIV Epidemic” (EHE) initiative is to implement treatment as prevention strategies to lower viral load and prevent new transmissions among PLWH [ 2]. Although current antiretroviral (ARV) regimens are highly tolerable and efficacious, a relatively high proportion of PLWH lack durable viral suppression (VS) [ 3–7]. Potential reasons for the low proportion of those with VS include barriers to adherence to oral ARV regimens. Previous studies have found that stigma, substance use disorders, and mental health comorbidities pose barriers to adherence to oral ARV regimens [ 8–10].

Strongyloides stercoralis is a soil transmitted helminth endemic to tropical and subtropical areas that can persist for decades in immunocompetent human hosts as a chronic asymptomatic infection. The use of corticosteroids, a mainstay of treatment for patients hospitalized with severe coronavirus disease (COVID-19), can trigger a life-threatening Strongyloides hyperinfection syndrome and disseminated disease. We identified 22 previously published cases of strongyloidiasis occurring in individuals with COVID-19, with one death reported among the seven patients who had Strongyloides hyperinfection syndrome. A total of seventeen patients had previously received corticosteroids, and of the five with no prior corticosteroid use, one presented with hyperinfection syndrome. We identify the key challenges in the diagnosis and treatment of Strongyloides within the context of COVID-19, including our imprecise knowledge of the global distribution of Strongyloides, the overlapping symptoms and signs of COVID-19 and Strongyloides hyperinfection syndrome, the limited utility of eosinophilia as a clinical marker for strongyloidiasis in this setting, the lack of validated algorithms to screen for Strongyloides prior to corticosteroid use, and the paucity of treatment options for critically ill patients with COVID-19 who cannot take oral ivermectin. Future research should focus on improved diagnostic methods and population prevalence estimates, optimizing the approaches for Strongyloides screening in persons with COVID-19 (including clinical trial participants and strategies for resource-limited settings) and better defining the role of pre-emptive treatment.

The high proportion of people with HIV (PWH) in the 2022–2023 mpox outbreak has raised questions surrounding the association between HIV and mpox. The objectives of this study were to evaluate the association between engagement in HIV-associated healthcare and mpox diagnosis, as well as to characterize cases of mpox among PWH. The DC Cohort is a longitudinal cohort of PWH in Washington, DC. We conducted a 5:1 (controls:cases) nested case-cohort study on male participants, matching age and care site. Cases were participants with an identified mpox diagnosis. Conditional logistic regression was used to assess the impact of indicators of engagement in HIV-associated healthcare on mpox diagnosis. We identified 70 cases of mpox in DC Cohort participants randomly matched to 323 controls, for a total of 393 participants included in the analysis. Study participants were primarily non-Hispanic Black (72.3%) with a median age of 41 (IQR: 36, 50). There was no association between engagement in care and mpox diagnosis; however, low CD4 was associated with increased odds of mpox diagnosis (aOR: 4.60 (95% CI: 1.23, 17.11)). Among a cohort of PWH, engagement in care was not associated with mpox diagnosis, suggesting that the overrepresentation of PWH among mpox cases is not due to surveillance bias.