The edition · Infectious Diseases
HPV vaccine works well in HIV — if it is given before CD4 falls
Pooled seroconversion above 97% for HPV16 across all three vaccine generations, but 71% in those with a CD4 count of 200 or below. Plus what molecular surveillance shows about artemisinin partner-drug resistance in Africa, five mpox rapid tests measured against PCR, the case for combination antifungal therapy, and ivermectin against permethrin for head lice.
The edition in brief
A systematic review and meta-analysis of 25 studies, with 12 contributing to pooled estimates, examined prophylactic HPV vaccination in people living with HIV. Seroconversion was 97.8% for HPV16, 94.2% for HPV18, 97.0% for HPV6 and 97.1% for HPV11, with high heterogeneity throughout and GRADE certainty moderate for three of the four types. CD4 count modified response substantially: HPV16 seroconversion was 98.5% above 350 cells per microlitre against 71.1% at 200 or below. Two doses of nonavalent vaccine were non-inferior to three in virologically suppressed women, and no vaccine-related serious adverse events were reported. A meta-analysis of several hundred studies of Plasmodium falciparum molecular markers across sub-Saharan Africa found validated PfKelch13 artemisinin-resistance mutations expanding in east Africa to 10-25% prevalence in Rwanda, Uganda and Tanzania, while chloroquine and amodiaquine resistance markers fell sharply and sulfadoxine-pyrimethamine markers remained near fixation. Five antigen-based mpox rapid diagnostic tests were compared against PCR on lesion swabs from 190 patients in Kinshasa: sensitivities ranged from 39.2% to 77.3% with specificities of 93.5% to 96.8%. A Personal View argues that the totality of evidence favours triazole-echinocandin combination therapy in invasive aspergillosis despite a narrowly negative trial. A school-based randomised trial in Thailand found oral ivermectin cured 95.5% of head lice infestations against 37.0% for 1% permethrin.
HPV vaccination in HIV: immunogenic, and time-critical
Give HPV vaccine to people with HIV as early in the disease course as possible: seroconversion is above 97% with a preserved CD4 count and falls to about 71% at 200 or below.
Artemisinin resistance markers are spreading while partner-drug resistance recedes
Artemisinin partial-resistance markers have reached 10-25% in parts of east Africa, so slow clearance in a patient infected there deserves parasitological follow-up rather than an assumption of poor adherence.
Mpox rapid tests: useful when positive, unsafe when negative
The best mpox antigen rapid test missed about a quarter of PCR-positive lesions, so a positive can confirm where PCR is unavailable but a negative must never rule out.
The argument for reading a narrowly negative antifungal trial differently
The case for triazole-echinocandin combination in invasive aspergillosis rests on a trial that narrowly missed significance — worth a considered discussion in immunocompromised patients, not a change of default.
Treat the contact, not just the patient, in scabies and lice
In scabies and head lice, treat every household contact on the same day and repeat at a week — reinfestation, not drug failure, is the usual reason treatment appears not to work.
Permethrin failed two-thirds of children with head lice
Permethrin 1% cured only about a third of children with head lice while two doses of oral ivermectin cured 95%, so repeated permethrin failure should prompt a change of agent rather than a repeat course.
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