Treatment options are currently limited for persons with HIV‐1 (PWH) who are heavily treatment‐experienced and/or have multidrug‐resistant HIV‐1. Three agents have been approved by the U.S. Food and Drug Administration (FDA) since 2018, representing a significant advancement for this population: ibalizumab, fostemsavir, and lenacapavir. However, there is a paucity of recommendations endorsed by national and international guidelines describing the optimal use (e.g., selection and monitoring after initiation) of these novel antiretrovirals in this population. To address this gap, a modified Delphi technique was used to develop these consensus recommendations that establish a framework for initiating and managing ibalizumab, fostemsavir, or lenacapavir in PWH who are heavily treatment‐experienced and/or have multidrug‐resistant HIV‐1. In addition, future areas of research are also identified and discussed in the main document.

Treatment options are currently limited for persons with HIV‐1 (PWH) who are heavily treatment‐experienced and/or have multidrug‐resistant HIV‐1. Three agents have been approved by the U.S. Food and Drug Administration (FDA) since 2018, representing a significant advancement for this population: ibalizumab, fostemsavir, and lenacapavir. However, there is a paucity of recommendations endorsed by national and international guidelines describing the optimal use (e.g., selection and monitoring after initiation) of these novel antiretrovirals in this population. To address this gap, a modified Delphi technique was used to develop these consensus recommendations that establish a framework for initiating and managing ibalizumab, fostemsavir, or lenacapavir in PWH who are heavily treatment‐experienced and/or have multidrug‐resistant HIV‐1. In addition, future areas of research are also identified and discussed.

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Well-designed randomized controlled trials (RCTs) have demonstrated safe and effective use of oral antimicrobial therapy for bone and joint infections. Application of data for implementation into real-world practice, however, has inherent challenges. This retrospective cohort study compared real-world use of intravenous versus oral antimicrobial therapy in bone and joint infections within a large healthcare system comprising both academic and community medical centers. The primary outcome was the proportion of treatment failure. Key secondary outcomes included the proportion of patients with logistical failure and risk factors associated with treatment and logistical failure. Among 166 patients included, 136 (82%) and 30 (18%) received predominantly intravenous and oral antimicrobial therapy, respectively. Treatment failure occurred in (77/121) 64% versus (18/25) 72% of patients in the intravenous and oral antimicrobial groups (p = 0.491; OR, 1.38; 95% CI, 0.56–3.33). Logistical failure occurred in 29% versus 47% of patients in the intravenous and oral antimicrobial groups (p = 0.150; OR, 1.93; 95% CI 0.79–4.70). Risk factors for treatment failure included peripheral vascular disease (OR, 2.61; 95% CI 1.02–7.80) and higher Charlson Comorbidity Index scores (OR, 1.18; 95% CI 1.04–1.36). Similar to previously published RCTs, treatment failure appeared comparable between groups; however, oral antimicrobial therapy was overall underutilized.

Universal "opt-out" human immunodeficiency virus (HIV) or hepatitis C virus (HCV) testing involves testing individuals for HIV or HCV regardless of symptoms, unless they decline. Little is known about the characteristics of individuals who decline. We conducted a retrospective, medical record review of adults evaluated at an outpatient clinic in South Carolina. "Opt-out" HIV/HCV testing was implemented in Feb 2019; we reviewed medical records of individuals evaluated in May - July 2019. We excluded individuals who did not meet age-based screening criteria (HIV: 18-65 years; HCV: 18-74 years), had a prior HIV/HCV diagnosis, were tested for HIV/HCV within the preceding 12 months, and whose "opt-out" decision was not documented. We used multivariable logistic regression to estimate adjusted odds ratios (aOR) and 95 % confidence intervals (CI) for "opt-out" decision, with age, sex, race/ethnicity, insurance status, visit type, and genitourinary vs. non-genitourinary chief complaints as predictors. The final analyses included 706 individuals for HIV and 818 for HCV. Most individuals were non-Hispanic Black (77 % and 78 %) and female (66 % and 64 %). The mean ages were 49.1 (±11.9) and 51.9 (±13.2). Nearly one-third of individuals declined HIV and HCV testing (31 % and 30 %). Black males were more likely to decline HIV and HCV testing than Black females (aOR = 1.61 [95 % CI. 1.08 - 2.40] and aOR = 1.50 [95 %CI. 1.04 - 2.16]). Despite HIV/HCV testing being the standard of care, approximately one-third of eligible individuals may decline testing, the demographic characteristics of whom may overlap with individuals who are traditionally unaware of their status. Despite HIV/HCV testing being the standard of care, approximately one-third of eligible individuals may decline testing, the demographic characteristics of whom may overlap with individuals who are traditionally unaware of their status.