Doravirine-based first-line HIV therapy matched dolutegravir on suppression with 2 kg less weight gain

The edition in brief

Opti-DOR, published in JAMA on 20 October, randomised 600 treatment-naive adults at two South African sites to doravirine, lamivudine and tenofovir disoproxil fumarate or dolutegravir, emtricitabine and tenofovir alafenamide. Viral suppression at 48 weeks was 89.0% against 90.7%, within the non-inferiority margin. Median weight gain was 3.0 kg against 5.0 kg, but hip and spine bone density fell more on the doravirine regimen, and doravirine resistance emerged in 7 of 9 virological failures. A Lancet Infectious Diseases phase 3 trial of a nine-valent extraintestinal E. coli conjugate vaccine in 17,701 adults aged 60 or over with recent UTI was stopped for futility: 11 against 13 invasive cases, vaccine efficacy 14.6% with an interval spanning far below zero, despite strong antibody responses. Development has been discontinued. An NEJM review sets out the main gram-negative threats — ESBL and carbapenem-resistant Enterobacterales, difficult-to-treat Pseudomonas and carbapenem-resistant Acinetobacter — and stresses diagnostics, targeted newer beta-lactams, source control and short courses. The FDA database records a supplement action on 21 October for the linezolid NDA; the record does not state its content. The pearl covers linezolid's serotonergic and haematological cautions.