The edition · Infectious Diseases
Starting HIV treatment: a doravirine regimen matched dolutegravir with 2 kg less weight gain
A South African trial weighs viral suppression against weight, bone and resistance. Plus a failed E. coli vaccine in older adults, a kidney biomarker that may mark who does worse on hydrocortisone in septic shock, and a generic daptomycin supplement.
The edition in brief
In Opti-DOR, 600 treatment-naive adults in South Africa were randomised to doravirine, lamivudine and tenofovir disoproxil fumarate or to dolutegravir, emtricitabine and tenofovir alafenamide. Viral suppression at 48 weeks was non-inferior (89.0% vs 90.7%), and median weight gain was 3.0 kg against 5.0 kg. The trade-offs were greater hip and spine bone density loss with the doravirine regimen and doravirine resistance in 7 of 9 virological failures. In the E.mbrace phase 3 trial, a nine-valent conjugate vaccine against invasive E. coli disease in 17,701 adults aged 60 or over with recent UTI showed no protection (vaccine efficacy 14.6%, 95% CI −106.6 to 65.4) despite strong antibody responses; development has stopped. A post hoc VANISH analysis of 173 patients with septic shock suggested hydrocortisone may reduce kidney-failure-free days in those with high proenkephalin A, a marker of renal function; this needs validation. The FDA recorded a supplement to Fresenius Kabi's generic daptomycin application on 14 October, with no detail of the change. The pearl covers why daptomycin is not used for pneumonia and what to monitor.
A nine-valent E. coli vaccine did not prevent invasive disease in older adults
Do not expect an E. coli vaccine soon; focus prevention of E. coli bacteraemia in older adults on catheter care and good UTI management.
Hydrocortisone in septic shock: a kidney biomarker may mark who does worse
Continue hydrocortisone in septic shock per current guidance; the PENK interaction is a hypothesis awaiting validation.
FDA records a supplement to a generic daptomycin application
No change in practice: this is a routine supplement to a generic daptomycin licence.
Daptomycin: not for pneumonia, and check the CK
Do not use daptomycin for pneumonia, and monitor creatine kinase at least weekly while it is given.
Doravirine-based first-line HIV therapy: non-inferior suppression, less weight gain, more bone loss
Consider doravirine, lamivudine and TDF for treatment-naive adults most concerned about weight gain, with reliable viral load monitoring, while keeping dolutegravir-based therapy as the default.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for infectious diseases, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free