IDSA’s Journal of Infectious Diseases provides a monthly roundup of JID papers with direct relevance to clinicians. Read on to learn more about the efficacy of switching to doravirine/islatravir despite baseline resistance in proviral DNA, how immunocompromised individuals hospitalized with COVID-19 remain at increased mortality risk and other research ready to inform clinical practice. (Titles and summaries are adapted from the September 2026 issue of JID.)
Companion editorial: Do They, or Don’t They? Integrase Strand Transfer Inhibitors, Tenofovir Alafenamide, and Excessive Weight Gain in People With HIV
Weight gain is a common clinical problem after antiretroviral therapy initiation. This study examined 32,514 treatment-naïve adults (2007-2020) in the North American AIDS Cohort Collaboration on Research and Design two years after initiating ART. Greater mean predicted weight gain occurred with integrase strand transfer inhibitors (4.9 kg, 95% confidence interval, 4.6-5.2; bictegravir > dolutegravir > raltegravir > elvitegravir) and protease inhibitors (4.7 kg, 95%CI, 4.4-5.1) compared to non-efavirenz non-nucleoside reverse transcriptase inhibitors (2.7 kg, 95%CI, 2.4-2.9). Black females on bictegravir or dolutegravir with tenofovir alafenamide had the highest gain after two years (10.0 kg, 95%CI, 7.4-12.6).
Doravirine/islatravir is a two-drug, single-tablet regimen in clinical development for once-daily treatment of adults with HIV-1. Baseline resistance-associated mutations in proviral DNA in virologically suppressed participants (N = 1,227) were examined in three Phase 3 studies (P051 [NCT05631093], P052 [NCT05630755] and P054 [NCT05766501]). Among the participants in the studies, 26.3% (N = 323) had baseline NNRTI RAMs, and 5.7% (N = 70) had baseline M184I/V. Doravirine/islatravir maintained HIV-1 RNA < 50 copies/mL (week 48) in ≥ 88% of participants with and/or without NNRTI RAMs and/or M184I/V detected in proviral DNA at baseline.
The vaginal microbiota may impact acquisition of Chlamydia trachomatis infection. A cohort of female students (18-24 years old) from the i-Predict prevention trial in France was assessed clinically and microbiologically over 18 months (baseline then every 6 months) for incident C. trachomatis infection. Vaginal Community State Type 4 (CST IV, high diversity, anaerobe dominant) at the preceding sample compared to CST I (low diversity, Lactobacillus crispatus dominant) and multiple concomitant partners in the prior six months were associated with increased risk of C. trachomatis acquisition. Lifetime condom use decreased incidence and remains one of the main tools to prevent incident C. trachomatis infections.
Whether peak nasal viral loads for SARS-COV-2 and influenza A and B differ is unknown. During 2022-2025, nasal swabs from children or adults positive for only one of these viruses were analyzed by qPCR. SARS-CoV-2 viral load (N = 612) peaked on the second symptomatic day but varied by immunization status. Influenza A (N = 328) peaked on the first symptomatic day, but influenza B (N = 157) peaked on the fourth symptomatic day. The viral load kinetics of common respiratory tract viruses differ potentially impacting test use.
COVID-19 remains the most prevalent circulating infectious-like-illness in Europe. Whether individuals with immunocompromising conditions remain at increased mortality risk, especially during the Omicron era, is unclear. Among 42,488 hospitalized COVID-19 patients (1,675, 3.9%, with immunocompromising conditions) across eight countries (2020–2023), these conditions increased 28-day mortality (odds ratio, 1.49) without Omicron attenuation and remains a significant risk factor for in-hospital death, especially if pneumonia develops.
