Infectious Diseases

Single-dose liposomal amphotericin regimen reduces severe toxicity in HIV cryptococcal meningitis

A pre–post cohort at a US safety-net hospital compared the AMBITION regimen with daily lipid amphotericin plus flucytosine for HIV cryptococcal meningitis. Among patients with 90-day data, composite treatment success was higher with AMBITION than standard therapy (76.0% vs 35.0%). This difference was driven by markedly fewer severe adverse events with AMBITION (20.6% vs 61.5%) and fewer patient-directed discharges. Loss to follow-up was similar, and there was no clear mortality or recurrence difference. 1

BALF mNGS improves short-term outcomes in immunocompromised opportunistic pneumonias

This multicenter study of 162 immunocompromised patients with opportunistic pulmonary infections compared BALF mNGS with conventional microbiologic testing alone. In the mNGS arm, results led to antibiotic regimen changes in 80.9% of patients, including escalation and de-escalation. After propensity matching, mNGS use was associated with more frequent >30% oxygenation index improvement by day 7 and higher day-14 clinical improvement rates. Twenty-one–day mortality was significantly lower in the mNGS group (7.3% vs 34.1%), despite no reduction in septic shock. 2

Doxy-PEP modeling in Australian MSM: fewer STIs, more tetracycline resistance

An individual-based model evaluated five targeted doxy-PEP strategies for Australian MSM from 2025 to 2034. All strategies reduced bacterial STI incidence by 13.0%–47.8% and were cost-saving relative to current practice. However, each strategy increased projected high-level tetracycline resistance above the already high 73.5% baseline by 2034. Targeting men with a recent syphilis diagnosis cut STIs by 16.4% while yielding the lowest resistance proportion (81.2%). 3

Visitect point-of-care CD4 speeds ART start in advanced HIV at similar cost and outcomes

In a Ugandan cluster randomized trial, 1724 adults with advanced HIV disease were assigned to Visitect point-of-care CD4 or standard CD4 testing. Participants with CD4 ≤200 cells/µL in both arms received a standardized advanced HIV disease care package. By 24 weeks, death or loss to follow-up was similar between arms (about 7% in both; hazard ratio 0.98, 95% CI 0.69–1.40). Median time to ART initiation was 0 days with Visitect versus 7 days with standard CD4, with an adjusted hazard ratio of 1.23. 4