Clinical Infectious Diseases

A heavily ID-weighted issue (41 substantive articles). The high-yield haul: a phase-2 RCT showing dolutegravir lowers HTLV-1 proviral load (without a gait benefit), a meta-analysis cementing cephalosporin arthroplasty prophylaxis over non-β-lactams, strong real-world RSV-vaccine effectiveness data, a clean stewardship "stop" on VRE-active surgical prophylaxis in liver transplant, the gap in LTBI-screening labels for targeted immunotherapies, and real-world completion of the 1HP ultra-short TB preventive regimen. RCTs are summarized in PICO; high-yield non-RCT work gets a structured key-takeaway; the long tail runs as one-liners below.

Randomized Controlled Trials

Viral / RetrovirologyPhase 2 · RCTHigh yield · ID

Dolutegravir Reduces HTLV-1 Proviral Load and Improves Neurological Outcomes — A Phase 2 Controlled Trial

In HTLV-1–associated myelopathy (HAM/TSP), does dolutegravir vs vitamin C improve walking or lower proviral load over 48 weeks?

Population: Adults with HTLV-1 infection across the HAM/TSP spectrum. Open-label, randomized phase 2.
Intervention: Dolutegravir (integrase strand-transfer inhibitor).
Comparison: Vitamin C (control).
Outcome: No between-group difference in the 10-meter timed walk at week 48; dolutegravir significantly reduced HTLV-1 proviral load over 48 weeks (P < .001).

Clinical takeaway. First randomized signal that an INSTI lowers HTLV-1 proviral load, but the surrogate did not translate into a clinical (gait) benefit at 48 weeks. The editorial (Meyerowitz, ciag164) frames it as proof-of-concept worth a larger/longer trial, not a practice change. What this changes: incremental/mechanistic — no current management change for HTLV-1; keeps INSTI repurposing alive as a research avenue.

PDF: dolutegravir-reduces-human-t-cell-lymphotropic-virus.pdf

BacterialRCT · 1:1:1High yield · ID

Personal and Environmental Decolonization for Children With SSTI and Their Households — A Randomized Trial

In households of children with CA–S. aureus SSTI, does integrated personal + environmental decolonization reduce recurrent SSTI vs either component alone?

Population: 196 index children with CA–S. aureus SSTI and their households (623 people). Open-label RCT.
Intervention: Integrated — periodic personal (twice-weekly chlorhexidine bathing + monthly intranasal mupirocin) plus environmental hygiene (weekly surface disinfection + enhanced laundry).
Comparison: Periodic-personal alone vs environmental-hygiene alone.
Outcome: Cumulative household SSTI at 3 months did not differ between groups; only among those with SSTI in the prior year did the integrated arm show lower incidence at 6 and 9 months. (abstract)

Clinical takeaway. Layering environmental decontamination on top of personal decolonization did not beat either component for the whole cohort — prior-year SSTI was the dominant recurrence driver. What this changes: tempers enthusiasm for blanket household environmental decontamination; reserve intensified, integrated decolonization for the recurrent-SSTI subset.

HIV / PreventionPilot RCTHigh yield · ID

Point-of-Care Urine Tenofovir Drug-Level Feedback Counseling Improves Long-Term PrEP Adherence — Pilot RCT

In young US MSM on PrEP, does remote point-of-care urine-tenofovir feedback counseling improve long-term adherence?

Population: Young US men who have sex with men on oral PrEP. Pilot randomized trial.
Intervention: Remote, motivational-interviewing–informed self-administered POC urine tenofovir testing with feedback.
Comparison: Control (no feedback).
Outcome: Intervention increased hair tenofovir levels by the equivalent of 1–2 tablets/week, with high feasibility/acceptability. (abstract)

Clinical takeaway. A scalable, objective adherence tool for PrEP; promising but a pilot — efficacy on seroconversion is untested. What this changes: adds a practical adherence-support option; confirm in a powered trial before routine adoption.

VaccinesPhase 3b · RCTHigh yield · ID

AS01_E-Adjuvanted RSV Prefusion F Vaccine in At-Risk Adults 18–49 vs Adults ≥60

In at-risk adults 18–49, is adjuvanted RSVPreF3 immunologically non-inferior to its performance in ≥60-year-olds?

Population: Adults 18–49 at increased RSV risk (chronic conditions) vs a ≥60-year-old comparator group (n = 1458). Open-label phase 3b.
Intervention: Adjuvanted RSVPreF3 in the 18–49 at-risk group.
Comparison: The ≥60-year-old group (immunobridging).
Outcome: Immunological non-inferiority demonstrated at 1 month (RSV-A/RSV-B neutralizing GMT ratios + seroresponse); reactogenicity higher in 18–49 (84.3% vs 69.4% solicited events) but mostly mild–moderate. (abstract)

Clinical takeaway. Supports extending adjuvanted RSV vaccine to younger high-risk adults on immunogenicity grounds (an efficacy endpoint was not tested here). What this changes: reinforces the trend toward RSV vaccination in younger at-risk adults, ahead of/with evolving ACIP risk-based guidance.

HIVPhase 2b · RCTLower yield · IM/ID

Effects of Semaglutide on Cognitive Function in People With HIV — A Randomized Controlled Trial

In people with HIV and lipohypertrophy, does semaglutide improve cognitive function vs placebo at 32 weeks?

Population: 108 PWH on ART with central adiposity/lipohypertrophy, BMI ≥25, no diabetes. Phase 2b, double-blind.
Intervention: Subcutaneous semaglutide (titrated to 1.0 mg weekly), 32 weeks.
Comparison: Placebo.
Outcome: No difference in overall Cognivue score; visuospatial subscore higher with semaglutide (86 vs 76, P = .01) but only borderline after adjustment (P ≈ .05); mediation pointed to reduced hs-CRP/sCD163 rather than fat loss. (full text)

Clinical takeaway. Hypothesis-generating only — a single domain, small trial, surrogate endpoint; the inflammation-over-adiposity mechanism is interesting but not actionable. What this changes: none — no cognitive indication for GLP-1 RAs in HIV.

VaccinesPhase · RCTLower yield · IM/ID

Safety and Immunogenicity of a Fourth Dose of Omicron BA.1-Adapted BNT162b2 in Adults 18–55

In adults 18–55, what are the safety and neutralizing responses of a 4th-dose BA.1-adapted BNT162b2 (mono- vs bivalent)?

Population1054 adults with 3 prior BNT162b2 doses. Intervention / ComparisonRandomized to mono- vs bivalent BA.1-adapted boosters (safety = primary). OutcomeWell tolerated; BA.1 neutralizing GMFRs 15.4–24.6 at 1 month. (abstract)

Clinical takeaway. Confirms the adapted-booster platform works immunologically; clinically moot now that BA.1 is historical. What this changes: none for current practice.

Guideline / Guidance Updates

No formal IDSA/society clinical guideline this issue. Two society/expert guidance pieces are worth awareness.

HIV / FrameworkHigh yield · ID (conceptual)

A Framework for Reporting Emergent HIV-1 Drug Resistance in Randomized Trials

•What changed: proposes standardized reporting of emergent HIV drug resistance in ART trials. •Key point: regimens that are non-inferior on virologic failure can still differ in resistance barrier. •Fellow-level implication: weigh resistance-barrier data alongside efficacy/safety when comparing ART regimens — non-inferiority on failure is not the whole story.

Diagnostics / MicrobiologyLower yield

Navigating Nomenclature in Patient Care — CAP Microbiology Committee Taxonomy Considerations

•College of American Pathologists statement on keeping microbial nomenclature/taxonomy current and consistent across lab platforms; operational/quality focus rather than a clinical-management change.

Major Studies & New Antimicrobials

StewardshipMeta-analysis · 23 studiesHigh yield · carded

Cephalosporins vs Non-Cephalosporin Antibiotics for Perioperative Prophylaxis in Primary Arthroplasty — Systematic Review & Meta-Analysis

•What changed / key figure: across 23 studies, cephalosporin prophylaxis had significantly lower odds of prosthetic joint infection (OR 0.59; 95% CI .46–.75); no overall difference in superficial SSI. (full text) •Fellow-level implication: reinforces cefazolin as the standard; a vague penicillin-allergy label should be assessed/de-labeled rather than reflexively defaulting to a non-β-lactam (associated with more PJI).

PDF: cephalosporins-versus-non-cephalosporin-antibiotics-perioperative-prophylaxis.pdf

VaccinesMeta-analysis · 8 studiesHigh yield · carded

Real-World Effectiveness of RSVpreF and RSVpreF3 in Preventing RSV Hospitalization and ED Visits in Older Adults — Meta-Analysis

•What changed / key figure: pooled across 8 studies, vaccination was associated with markedly lower RSV hospitalization (OR 0.23; 95% CI 0.20–0.27; ~77% effective; I² = 6.5%); effectiveness lower in immunocompromised adults (OR 0.31). (full text) •Fellow-level implication: strong real-world confirmation of trial efficacy for older adults; counsel immunocompromised patients that protection, while real, is attenuated.

PDF: real-world-effectiveness-rsvpref-rsvpref3-vaccines-preventing.pdf

Stewardship / Transplant IDMulticenter cohortHigh yield · carded

Impact of VRE-Active Perioperative Prophylaxis in Liver Transplant Patients Colonized by VRE

•What changed / key figure: retrospective multicenter cohort — no reduction in 30-day VRE infection (8.7% vs 12.9%; P = .621; also no difference at 7 or 14 days). (full text) •Fellow-level implication: don't add VRE-active agents to surgical prophylaxis for colonization alone — it broadens spectrum without preventing infection (a clean stewardship "stop").

PDF: impact-vancomycin-resistant-enterococci-vre-active-perioperative.pdf

TB / StewardshipCross-sectionalHigh yield · carded

TB-Infection Screening Recommendations for Targeted Immunotherapies — Prescribing Info vs Clinical Resources vs Quality Measures

•What changed / key figure: of 269 targeted immunotherapies, only 35 (13%) carried a TB-screening recommendation in FDA prescribing information, with major discordance across clinical resources and quality measures. (full text) •Fellow-level implication: don't rely on the drug label — proactively screen for LTBI before TNF inhibitors and many newer IL-/JAK-pathway and other biologics; the prescribing information is an unreliable safety net.

PDF: tuberculosis-infection-screening-recommendations-targeted-immunotherapies-comparison.pdf

TBBrief ReportHigh yield · carded

Short-Course TB Preventive Therapy in a High-Migration Setting — Early Experience With 1HP in Cook County, Illinois

•What changed / key figure: 77% of evaluated clients initiated TPT and 71% completed, comparable to longer regimens; completion lower among newly-arrived migrants (58% vs 80%; P < .001). (full text) •Fellow-level implication: 1HP (1 month, daily INH + rifapentine) is a legitimate ultra-short LTBI option alongside 3HP and 4R; expect attrition in mobile populations and front-load support.

PDF: short-course-tuberculosis-preventive-therapy-high-migration.pdf

Pediatric TBHigh yield · ID

Asymptomatic Tuberculosis in Children With Household Exposure to M. tuberculosis

•What changed / key figure: of 430 household-exposed children, 35.8% met TB criteria, and 35.7% of all TB cases were asymptomatic — including 81% of microbiologically confirmed cases. (abstract) •Fellow-level implication: symptom screening alone misses most childhood TB in contacts — investigate all exposed children (CXR ± microbiology); don't wait for symptoms before treating.

More high-yield — held to issue cap

•CD4 nadir & cervical-cancer risk in WWH (HIV): in >66,000 women, lowest CD4 over 30 months was the strongest, HIV-RNA-independent predictor of cervical dysplasia/cancer — risk-stratify screening by CD4 nadir, not just current viral load. (abstract) •HCC risk after DAA cure in HIV/HCV (Hepatitis): 6-year HCC risk 2.5% in advanced fibrosis/cirrhosis; annual risk fell below ~0.4% only after year 3 — cure does not retire semiannual HCC surveillance. (full text) •US HCV prevalence in the DAA era (Hepatitis): HCV-RNA prevalence 0.7% (~1.70M infected); clearance lower in younger adults (63.8% vs 81.1%) — a current elimination denominator. (full text) •MDR/RR-TB in pregnancy (two reports) (TB): bedaquiline-based and all-oral 6-month regimens usable in pregnancy with generally favorable maternal outcomes; counsel on real infant risks and ensure infant follow-up. (companion) (abstracts) •TB transmission in healthcare settings (Infection control): 7.1% overall (3.8% since 2005 ventilation standards); driven by prolonged, unprotected (no N95), poorly-ventilated exposure — supports risk-stratified contact investigations. (abstract) •CSF metagenomic NGS — first-year experience (Diagnostics): sensitivity 64%, 43% of confirmed neuroinfections diagnosed by mNGS alone; reserve for high-suspicion CNS infection, especially in immunocompromised hosts. (abstract)

New antimicrobials & agents to watch

•MK-8527 — oral nucleoside reverse-transcriptase translocation inhibitor (NRTTI); single dose ≥0.5 mg produced ≥1.0 log₁₀ HIV-RNA decline at day 7 (phase 1); long-acting PrEP/treatment candidate. •mRNA-1345 RSV vaccine in SOT — immunogenic (4.9-/3.4-fold RSV-A/-B nAb rise by day 29), no rejection events in interim phase 3; supports RSV vaccination in transplant recipients. •Low-dose infliximab for paradoxical CNS-TB inflammation — 60% disability-free survival, 75% improved at 3 months (retrospective); emerging adjunct for refractory inflammatory complications. •Point-of-care testing roadmap — viewpoint: nucleic-acid POCT delivers most value embedded in critical-care + stewardship workflows. •TB-Feron near-POC IGRA — sensitivity 88.4% but specificity only 70.0% (κ 0.61 vs QFT-Plus); a faster IGRA with a specificity caveat.

Also in this issue (screened in, lower yield — no card): CRP for prognosis in advanced HIV (CRP ≥10 prognostic, not actionable; ciaf560); Age-related outcomes in PWH, Spain (serious non-AIDS events declining/occurring later; ciaf622); Diabetes & TB transmission (lower incident TB in contacts of diabetic index patients — counter-intuitive; ciaf647); MAP & Crohn's disease (higher seropositivity vs controls, association only; ciaf738); Late-onset Group B Strep genomics (no genomic feature predicted severity; all PCN-susceptible; ciaf603); OPAT remote therapeutic monitoring (cut utilization events, aHR 0.62, non-randomized; ciag009); Long COVID vs post-COVID-vaccination syndrome (autoantibody phenotyping; ciaf624); Lineage-specific COVID VE methods (period-based VE can misclassify; ciag059); Appalachian hepatitis/overdose syndemic (regional surveillance; ciaf730); ADAP & viral suppression (clients = 30.8% of suppressed PWH; ciag034); CMV shedding in pregnancy (~18.8% shed; child-saliva contact; ciag076); Rifampicin exposure & TB response (higher AUC → faster culture conversion; ciaf586); Dexamethasone PK in TB meningitis (high clearance; lopinavir/ritonavir interaction; ciaf642); Clinical phenotypes for TB precision medicine (omics/AI-guided stratification review; ciaf663). Plus 10 Correspondence, 3 Photo Quizzes, a Voices essay, and an In-the-Literature synopsis (screened out).

Summaries are original paraphrases prepared for educational use. Figures are from the archived full text for the 6 carded items plus the semaglutide and dolutegravir articles; all others are from the article's structured abstract (PubMed), flagged "(abstract)". Read the full articles at academic.oup.com/cid (subscription required). Citation: Clin Infect Dis 2026; Vol. 82, No. 5. PDFs for the high-yield set accompany this digest in the Drive folder. Anki: 6 cards minted this issue (cephalosporin PJI prophylaxis, real-world RSV VE, VRE prophylaxis futility, LTBI-screening gap, 1HP, dolutegravir/HTLV-1); tagged CID::<Type> + Subject::Infectious_Disease.