Injectable HIV therapy held suppression in adults who struggle with pills

The edition in brief

Today's infectious diseases edition opens with POET II (NEJM, 28 August), a 508-patient randomised trial in stable left-sided endocarditis caused by Staphylococcus aureus, Enterococcus faecalis or streptococci. After at least two to four weeks of treatment and clinical stabilisation, stopping antibiotics gave 13 more antibiotic-free days over six months and was non-inferior for death, unplanned surgery or embolism (8.2% vs 10.7%), but relapse rose from 1.6% to 5.1%. A Zambian molecular study (Lancet Infectious Diseases, 7 October) found a new Pfkelch13 mutation, A724E, in half of falciparum isolates in two western provinces; 28% of patients carrying it were still parasitaemic on day 3 after artemisinin combination therapy, against none with wild-type parasites. On the regulatory side, the FDA records a supplement to a generic voriconazole application held by Hetero Labs — an administrative action. The pearl is the day 3 smear as the bedside marker of artemisinin response. The practice changer is IMPALA (NEJM, 15 October): in 537 virally suppressed adults with adherence or engagement problems in Kenya, South Africa and Uganda, injections of cabotegravir and rilpivirine every 8 weeks kept 91.0% suppressed at 48 weeks against 89.2% on oral dolutegravir, meeting non-inferiority. Five people on injections (1.9%) had confirmed virological failure against none on tablets, and baseline resistance testing was not done, so follow-up viral loads matter. Long-acting therapy is not yet widely available in India.