This Week in Infectious Disease: HIV Lipid Management and Sepsis Care

From the New England Journal of Medicine, a trial examined pitavastatin versus placebo in people with HIV aged 40 to 75 years on stable antiretroviral therapy ^[1].

The study found that the drug significantly lowered LDL and MACE risk, suggesting that clinicians might consider LDL lowering as a primary prevention goal for this population, aiming for accepted care targets. Meanwhile, researchers turned their attention to psychosocial support, where a systematic review and network meta-analysis evaluated interventions for people with HIV ^[5].

The authors describe how multicomponent psychosocial interventions improve antiretroviral therapy adherence, offering a complementary strategy to pharmacological management.

Elsewhere this week, a phase 3 randomised controlled trial in 7667 patients with suspected sepsis across 20 English and Welsh emergency departments compared procalcitonin-guided care to usual care ^[2].

The intervention showed no difference in early antibiotic initiation but resulted in lower 28-day mortality, though the mechanism remains unclear. A separate study in The Lancet meta-analysed the role of procalcitonin, reinforcing the idea that guided care may lower mortality without delaying necessary antibiotic treatment.

Finally, the focus shifted to orthopedic infections. In The Journal of Arthroplasty, a systematic review and meta-analysis evaluated 157466 adult patients who had total joint arthroplasty undergoing dental procedures ^[3].

Findings suggest that dental antibiotic prophylaxis does not reduce periprosthetic joint infection risk, leading to a consideration of limiting such prophylaxis to select high-risk TJA patients. Conversely, another study in the same journal evaluated dual antibiotic-loaded bone cement versus single antibiotic-loaded bone cement in patients undergoing hip arthroplasty ^[4].

The results indicate that dual cement reduces surgical site infection risk compared to single cement, potentially benefiting hemiarthroplasty patients. We also saw research in The Journal of Nursing Research regarding adherence, further broadening the scope of HIV management strategies discussed this week.