Preventive Therapy for Contacts of Drug-Resistant Tuberculosis

Preventing the progression of a drug-resistant tuberculosis (DR-TB) infection to disease is an important pillar of the DR-TB elimination strategy. International guidelines have recently proposed fluoroquinolones for tuberculosis preventive therapy (TPT) in DR-TB contacts, although the available evidence is low quality. The pooled data from small observational studies suggest that a fluoroquinolone-based TPT is safe, effective and cost-effective as a preventive treatment in DR-TB contacts. Three clinical trials are currently ongoing to generate higher quality evidence on the efficacy of levofloxacin and delamanid as a DR-TB preventive therapy. Additional evidence is also needed, regarding TPT treatment in fluoroquinolone-resistant-TB contacts, patient and health care worker perceptions on DR-TB preventive therapy for contacts, and the service delivery models to increase DR-TPT access. This state-of-the-art review presents the current literature on TPT for contacts of DR-TB cases, focusing on the available evidence and international guidelines

COVID-19 Vaccines against Omicron Variant: Real-World Data on Effectiveness

The efficacy of vaccines against coronavirus disease 2019 (COVID-19) has now been well established in phase III clinical trials. However, clinical studies based on real-world data remain critical to assess vaccines effectiveness (VE), especially in specific populations and against variants of concern (VOC). This review presents the principles and methods of VE studies and the main available results on VE of COVID-19 vaccines at the time of Omicron circulation. References for this narrative review were identified through searches of PubMed database up to 13 September 2022. The results of phase III clinical trials have been globally confirmed by VE in real-life studies, including in the elderly. Emergence of VOC Omicron emphasized the importance of booster doses to maintain a high level of protection against severe forms. There are still numerous challenges regarding booster(s) and duration of immunity, particularly in specific subpopulations, and regarding the need for adapted vaccines

Performance of Radiomics in Microvascular Invasion Risk Stratification and Prognostic Assessment in Hepatocellular Carcinoma: A Meta-Analysis

Background: Primary liver cancer is the sixth most commonly diagnosed cancer and the third leading cause of cancer death. Advances in phenomenal imaging are paving the way for application in diagnosis and research. The poor prognosis of advanced HCC warrants a personalized approach. The objective was to assess the value of imaging phenomics for risk stratification and prognostication of HCC. Methods: We performed a meta-analysis of manuscripts published to January 2023 on MEDLINE addressing the value of imaging phenomics for HCC risk stratification and prognostication. Publication information for each were collected using a standardized data extraction form. Results: Twenty-seven articles were analyzed. Our study shows the importance of imaging phenomics in HCC MVI prediction. When the training and validation datasets were analyzed separately by the random-effects model, in the training datasets, radiomics had good MVI prediction (AUC of 0.81 (95% CI 0.76–0.86)). Similar results were found in the validation datasets (AUC of 0.79 (95% CI 0.72–0.85)). Using the fixed effects model, the mean AUC of all datasets was 0.80 (95% CI 0.76–0.84). Conclusions: Imaging phenomics is an effective solution to predict microvascular invasion risk, prognosis, and treatment response in patients with HCC

COVID-19 vaccines: A race against time

International audienceNo abstract availabl

Comparing COVID-19 vaccines for their characteristics, efficacy and effectiveness against SARS-CoV-2 and variants of concern

Vaccines are critical cost-effective tools to control the COVID-19 pandemic. However, the emergence of more transmissible SARS-CoV-2 variants may threaten the potential herd immunity sought from mass vaccination campaigns. The objective of this study was to provide an up-to-date comparative analysis of the characteristics, adverse events, efficacy, effectiveness and impact of the variants of concern (Alpha, Beta, Gamma and Delta) for fourteen currently authorized COVID-19 vaccines (BNT16b2, mRNA-1273, AZD1222, Ad26.COV2.S, Sputnik V, NVX-CoV2373, Ad5-nCoV, CoronaVac, BBIBP-CorV, COVAXIN, Wuhan Sinopharm vaccine, QazCovid-In, Abdala and ZF200) and two vaccines (CVnCoV and NVX-CoV2373) currently in rolling review in several national drug agencies. Overall, all COVID-19 vaccines had a high efficacy against the traditional strain and the variants of SARS-CoV-2, and were well tolerated. BNT162b2, mRNA-1273 and Sputnik V had the highest efficacy (>90%) after two doses at preventing symptomatic cases in phase III trials. Efficacy was ranging from 10.4% for AZD1222 in South Africa to 50% for NVX-CoV2373 in South Africa and 50 % for CoronaVac in Brazil, where the 501YV.2 and P1 variants were dominant. Seroneutralization studies showed a negligible reduction in neutralization activity against Alpha for most of vaccines, whereas the impact was modest for Delta. Beta and Gamma exhibited a greater reduction in neutralizing activity for mRNA vaccines, Sputnik V and CoronaVac. Regarding observational real-life data, most studies concerned the Pfizer and Moderna vaccines. Full immunization with mRNA vaccines effectively prevents SARS-CoV-2 infection against Alpha and Beta. All vaccines appeared to be safe and effective tools to prevent symptomatic and severe COVID-19, hospitalization and death against all variants of concern, but the quality of evidence greatly varied depending on the vaccines considered. There are remaining questions regarding specific populations excluded from trials, the duration of immunity and heterologous vaccination. Serious adverse event and particularly anaphylaxis (2.5-4.7 cases per million doses among adults) and myocarditis (3.5 cases per million) for mRNA vaccines ; thrombosis with thrombocytopenia syndrome for Janssen vaccine (3 cases per million) and AstraZeneca vaccine (2 cases per million) and Guillain-Barre syndrome (7.8 cases per million) for Janssen vaccine are very rare. COVID-19 vaccine benefits outweigh risks, despite rare serious adverse effect

Infectious Complications of Targeted Therapies for Solid Cancers or Leukemias/Lymphomas

Background: Infections are well known complications of some targeted drugs used to treat solid organ cancer and hematological malignancies. Furthermore, Individual patient risk factors are associated with underlying pathologies, concomitant immunosuppressive treatment, prior treatment and use of anti-infective prophylaxis. Immune-related adverse events (irAEs) are frequent among patients treated with new targeted drugs. Objectives: In this narrative review, we present the current state of knowledge concerning the infectious complications occurring in patients treated with immune checkpoint inhibitors (ICIs), Bruton’s tyrosine kinase (BTK) inhibitors, phosphatidylinositol 3-kinase (PI3K) inhibitors, antiapoptotic protein BCL-2 inhibitors, Janus kinase inhibitors or CAR-T cell infusion. Sources: We searched for studies treating infectious complications of ICIs, BTK inhibitors, PI3K inhibitors, antiapoptotic protein BCL-2 inhibitors and CAR-T cell therapy. We included randomized, observational studies and case reports. Content: Immune-related adverse events (irAEs) are frequent among patients treated with new targeted drugs. Treatment of irAEs with corticosteroids and other immunosuppressive agents can lead to opportunistic infections. Bruton’s tyrosine kinase (BTK) inhibitors are associated with higher rate of infections, including invasive fungal infections. Implications: Infections, particularly fungal ones, are common in patients treated with BTK inhibitors even though most of the complications occurring among patients treated by ICIs or CART-cells infusion are associated with the treatment of side effects related to the use of these new treatments. The diagnosis of these infectious complications can be difficult and may require extensive investigations

COVID-19 vaccine boosters: What do we know so far?

International audienceNo abstract availabl

Landscape of TB Infection and Prevention among People Living with HIV

Tuberculosis (TB) is one of the leading causes of mortality in people living with HIV (PLHIV) and contributes to up to a third of deaths in this population. The World Health Organization guidelines aim to target early detection and treatment of TB among PLHIV, particularly in high-prevalence and low-resource settings. Prevention plays a key role in the fight against TB among PLHIV. This review explores TB screening tools available for PLHIV, including symptom-based screening, chest radiography, tuberculin skin tests, interferon gamma release assays, and serum biomarkers. We then review TB Preventive Treatment (TPT), shown to reduce the progression to active TB and mortality among PLHIV, and available TPT regimens. Last, we highlight policy-practice gaps and barriers to implementation as well as ongoing research needs to lower the burden of TB and HIV coinfection through preventive activities, innovative diagnostic tests, and cost-effectiveness studies

Landscape of TB Infection and Prevention among People Living with HIV

Tuberculosis (TB) is one of the leading causes of mortality in people living with HIV (PLHIV) and contributes to up to a third of deaths in this population. The World Health Organization guidelines aim to target early detection and treatment of TB among PLHIV, particularly in high-prevalence and low-resource settings. Prevention plays a key role in the fight against TB among PLHIV. This review explores TB screening tools available for PLHIV, including symptom-based screening, chest radiography, tuberculin skin tests, interferon gamma release assays, and serum biomarkers. We then review TB Preventive Treatment (TPT), shown to reduce the progression to active TB and mortality among PLHIV, and available TPT regimens. Last, we highlight policy-practice gaps and barriers to implementation as well as ongoing research needs to lower the burden of TB and HIV coinfection through preventive activities, innovative diagnostic tests, and cost-effectiveness studies

Patient-centered approach to the management of drug-resistant tuberculosis in France: How far off the mark are we?

Drug-resistant tuberculosis (DR-TB) is a major public health concern worldwide. The prolonged isolation required is a source of challenges for both healthcare workers and patients, especially in high-income countries where DR-TB patients are frequently migrants with vulnerabilities. However, data on the needs of these vulnerable patients are scarce. Our objective was to identify and quantify conflict or inappropriate care situations experienced by both DR-TB patients and healthcare workers. This 10-year retrospective observational study (01/2008 to 10/2018) was conducted in a referral center for resistant tuberculosis management in Paris, France. Sixty-five DR-TB patients were hospitalized during the study period. Their demographic, clinical and social characteristics and any conflict or inappropriate care situations they experienced with healthcare workers while hospitalized were analyzed. Conflict or inappropriate care situations with healthcare workers were reported for 24 patients during their stay (36.9%). Eleven patients (16.9%) had difficulty adhering to respiratory isolation rules, 15 (23.1%) were discharged against medical advice, 9 (13.8%) were excluded from hospital for disciplinary reasons, verbal or physical violence was reported for 7 patients (10.8%), and 4 arrests (6.2%) were made by the police. Conflict situations were reported more often when there was a language barrier (70.8%, p<0.0001). More than one-third of patients with DR-TB in this referral center experienced at least one inappropriate care situation with healthcare workers. This study illustrates the urgent need to promote a patient-centered approach and to respond to the challenges of its practical implementation