Injectable HIV therapy holds suppression in people who struggle with pills

The edition in brief

IMPALA randomised 540 adults in Kenya, South Africa and Uganda who had suppressed HIV but poor adherence or engagement to two-monthly injectable cabotegravir plus rilpivirine or continued oral dolutegravir-based therapy. At 48 weeks, 91.0% against 89.2% had a viral load under 50 copies, meeting non-inferiority, but confirmed virological failure occurred in five people on injections and none on tablets. In Zambia, a previously undescribed Pfkelch13 mutation, A724E, was found in about half of isolates from two western provinces, and 28% of patients carrying it were still parasitaemic on day 3 after artemisinin combination therapy, against none with the wild type; in one district its prevalence rose from 0% in 2018 to 79% in 2026. A meta-analysis of ten trials in nearly 9,000 children with non-severe pneumonia found five days or less of antibiotics gave similar failure and relapse rates to longer courses, with much better adherence. A commentary on the Galician nirsevimab programme discusses why protection against RSV hospitalisation appeared to extend into a second season, and why that needs replicating. The pearl covers what a positive day-3 malaria smear means.