IDSA’s Journal of Infectious Diseases provides a monthly roundup of JID papers with direct relevance to clinicians. Read on to learn more about hepatitis E virus infection in patients from Latin America with chronic liver disease, findings that support expanding tuberculosis care beyond treatment completion and other research ready to inform clinical practice. (Titles and summaries are adapted from the April 2026 issue of JID.)
HIV Reservoir Dynamics and Bacteriome Composition Along the Gut Axis
Companion editorial: Dissecting the Impact of the Gut Microbiome on HIV Reservoir Dynamics
The gastrointestinal tract is a major reservoir of HIV and home to the body’s most diverse microbiome. Among 24 people in the Last Gift cohort, the relationship between the gut microbiome and HIV reservoir size across the gut axis (duodenum, jejunum, ileum, colon, rectum) was studied. Researchers found that higher HIV transcriptional activity in the small intestine was associated with bacterial richness; the results were opposite in the colon (bacterial richness was associated with low HIV transcriptional activity). Thus, the gut bacteriome may shape HIV reservoir size and activity differently across intestinal segments, a finding potentially important for microbiome-targeted interventions and cure strategies aiming to reduce HIV persistence in gut tissues.
A Threshold in Anti–EBNA-1 Antibody Titers Distinguishes Salivary EBV Shedders From Nonshedders
Counterintuitively, low anti-EBNA-1 antibody titers are associated with reduced risk of Epstein-Barr virus-related diseases. Longitudinal sampling of saliva samples in a cohort of 20 persons (17 typical-range antibody titers; three low titer outliers) identified no EBV shedding in low titer outliers who also had restricted antibody diversity limited to latent and immediate-early antigens. Thus, low anti-EBNA-1 titers identify a distinct phenotype with complete suppression of EBV shedding despite chronic infection, potentially marking individuals with superior viral control and reduced disease risk.
Hepatitis E virus is a major cause of acute hepatitis worldwide. This multicenter study across six Latin American countries (N = 971 persons) reveals heterogeneous hepatitis E seroprevalence in patients with chronic liver disease (e.g., highest in Chile, 45%, and lowest in Argentina, 4%), with higher rates in cirrhosis and alcohol-related liver disease, confirming zoonotic HEV-3 circulation and supporting HEV testing in patients with unexplained hepatic decompensation or acute hepatitis.
Editor’s note: The following three manuscripts extend our knowledge of the complexity and long-term impacts of infection with tuberculosis.
Cerebrospinal Fluid Hypo-Inflammation Drives Mortality in HIV-Associated Tuberculous Meningitis
Anti-inflammatory corticosteroid therapy improves survival in HIV-negative TBM, but not in people with HIV. Among 149 adults with HIV in Uganda with definite or probable TBM, non-survivors had more severe TBM disease with mortality at 90 days strongly associated with cerebrospinal fluid hypo-inflammation, in particular, low IFN-γ. Those with both peripheral CD4 depletion and low cerebrospinal fluid IFN-γ had the highest mortality (63%). Although steroids may be appropriate in those with high inflammation, personalized approaches to immunotherapy are likely necessary to improve outcomes in TBM.
The life-course impact of childhood tuberculosis, including its connection to frailty, remains poorly understood. Among 8,459 adults ≥50 years in the ELSI-Brazil study (2015-2016), including 74 with self-reported TB before age 15, frailty (phenotype) was assessed and compared using Poisson models before and after propensity-score matching (1:4; 283 controls); mediation also tested chronic obstructive pulmonary disease. Frailty was more frequent with childhood TB (23.0% vs. 8.8%; p = 0.001); after matching, childhood TB was associated with higher frailty prevalence (prevalence ratio, 2.52; 95% confidence interval, 1.43-4.44); mediation through chronic obstructive pulmonary disease was small and not statistically significant. The findings support a life-course approach to TB care.
People with HIV who have history of cured TB have worse outcomes, including increased all-cause mortality and risk for recurrent TB. The authors tested the hypothesis that persistent immune deficits contribute to subsequent poor outcomes. Sequential studies among 38 Haitian individuals with or without HIV and a history of TB suggest a proinflammatory milieu mediated by TNF persists in people with HIV even years after TB cure. It remains to be determined if the differences stem from preexisting risk factors or reflect the natural history of HIV and TB infections.
