Virus World

A clinical trial in more than 4,600 people at risk of serious COVID-19 found that an inhalable asthma medication shortened the duration of disease symptoms by about 3 days. The asthma drug budesonide is an inexpensive and widely available inhalable steroid. Christopher Butler and Richard Hobbs at the University of Oxford, UK, and their colleagues tested budesonide in people who had COVID-19 symptoms but were not hospitalized (PRINCIPLE Collaborative Group et al. Preprint at medRxiv https://doi.org/f6hf; 2021). Participants either were over the age of 65 or were more than 50 years old and had conditions that increased their risk of COVID-19 complications. Participants were randomly assigned to either receive the drug or serve in a control group, but none took a placebo. Both participants and investigators knew who had received the drug. Those who took budesonide twice daily for two weeks reported that their COVID-19 symptoms ended three days earlier than those who did not use the steroid. The results have not yet been peer reviewed.

Preprint in medRxiv (April 12, 2021):

https://doi.org/10.1101/2021.04.10.21254672 

Adolescents and young adults who were born to mothers with HIV but remained uninfected themselves still face a greatly heightened risk of obesity and asthma-like symptoms, researchers from Massachusetts General Hospital (MGH) have found. In a study published in Journal of Acquired Immune Deficiency Syndromes (JAIDS), the team revealed for the first time that HIV-negative teens and young adults with a history of in utero HIV exposure showed more than fourfold increased odds of obesity and asthma-like symptoms compared to their unexposed peers.

"Our study found that there are metabolic and immune consequences to being exposed to HIV in utero," says Lindsay Fourman, MD, of the Metabolism Unit, Department of Medicine, MGH, and lead author of the study. "These results underscore the need for all children of mothers with HIV—even those who are HIV-negative—to be screened and continually monitored over their lifetimes by clinicians attuned to their health risks. Too often, their exposure to HIV is lost from their medical records after they are found to be HIV-negative."

Globally, more than one million babies are born each year to mothers with HIV. With the scale-up of prenatal antiretroviral therapy to prevent maternal transmission during pregnancy, up to 98 percent of these infants may be HIV-exposed but uninfected (HEU). While understanding the short-term health consequences of intrauterine HIV exposure has been actively investigated, the long-term health outcomes of uninfected individuals into adolescence and adulthood remain largely unknown. The MGH researchers shed light on the subject by looking at the mother's level of immune cells—known as CD4 T cells—during the last trimester of pregnancy. They found that lower maternal CD4 T cell count was strongly associated with increased body mass index (BMI), a measure of body fat based on height and weight, in their uninfected, adolescent offspring. Lower CD4 T cell count is also associated with more severe HIV infection during pregnancy. "These linkages suggest the need for good immune system control during the mother's pregnancy," emphasizes Steven Grinspoon, MD, chief, Metabolism Unit at MGH and study co-author. "Improved immune regulation may not only be good for the mother during pregnancy, but for her child over the long-term."

The comprehensive study drew on a cohort of 50 adolescents and young adults (ages 13 to 28 years old) who were HIV-exposed but uninfected (HEU), and 141 of their peers not exposed to HIV during pregnancy. All were part of the Research Patient Data Registry that includes patients from MGH, Brigham & Women's Hospital, and other affiliated hospitals. The researchers found that obesity was present in 42 percent of the HEU adolescents and young adults compared to 22 percent of their unexposed counterparts....

Published in Journal of AIDS (November 14, 2019):

https://doi.org/10.1097/QAI.0000000000002235