And now at #CROI2023, a special session on #monkeypox/#mpox.
John Brooks of @CDCgov: Mpox decline has not been even in all places -- we need to keep our eye on places where it hasn’t declined as much & need to stay vigilant for reemergence. I'm not going to try to live-tweet this one & didn't request advance permission to share slides.

It's been a long day at #CROI2023, but I'll attempt to live-tweet @MichaelPelusoMD's presentation on #longCOVID. Though mainly an #HIV meeting, CROI also includes the hot infectious diseases of the day. (Thanks Dr Peluso for providing advance slides & permission to share.) 1/ @MichaelPelusoMD .@MichaelPelusoMD & colleagues' SCOPE cohort at @UCSF + international collaborators have now studied more than 700 people with #longCOVID 2/

.@MonicaGandhi9 presents promising results from @ZSFGCare @SF_DPH SPLASH program to treat disadvantaged safety-net population at Ward 86 with long-acting injectable antiretrovirals -- even if not virally suppression at outset. #CROI2023 1/ Among those without viral suppression (ie, outside FDA indication for Cabenuva), 55 out of 57 achieved undetectable VL after starting monthly injectables -- comparable to rates seen in pivotal clinical trials. 2/

Susan Buchbinder (@SF_DPH @BridgeHIV) & Larry Corey (@fredhutch) discuss where we are with #HIV vaccines after Mosaico trial failure. Buchbinder says it's "a very vibrant time" in HIV vaccine research. Corey adds that the science is "terrifically fascinating." #CROI2023 1/ I think his characterization of sophisticated novel HIV vaccine approaches as "a little bit more complicated" & going to "take a little more time" is an underestimate. It's certainly a lot more complicated to explain versus traditional vaccines! 2/
poz.com/article/hiv-va…

.@profchloeorkin presents disturbing data on #monkeypox/#mpox among HIV+ people w/low CD4 counts. High rate of complications & death. Concludes mpox is an opportunistic pathogen & severe necrotizing form is an AIDS-defining condition, @CDCgov & @WHO should include. #CROI2023 1/ Concern about IRIS for people who start antiretrovirals once severe symptoms are underway -- can make worse. But unclear whether ART would be beneficial if started at beginning of mpox symptoms. 2/

#DoxyPEP prevented STIs in gay men, but Jenell Stewart reports this was not the case for cisgender women. May be due to differing drug concentrations in vaginal/cervical vs rectal tissue or low adherence. We’ve seen something similar with TDF/FTC PrEP for women. #CROI2023 Here's my report for @eBARnews on the #doxyPEP study in gay & bi men & trans women presented last year.
ebar.com/story.php?3193…

Since it's that time of year, here's a selection of some of my favorite articles I wrote in 2022.
My main focus is #HIV. Here, for @pozmagazine, a look at advances in antiretroviral treatment & prospects for a functional cure. 1/
poz.com/article/long-w… For @aidsmap, a report from #AIDS2022 about a 5th person cured of #HIV after a stem cell transplant. (The 4th such case was reported earlier in the year at #CROI2022/#CROI22). 2/

aidsmap.com/news/aug-2022/…

This psychologizing of people with different risk tolerance is tedious. Mask proponents can't grasp that we've seen evidence over 3 years that masking doesn't appear to affect case trajectories much at the community level & decided marginal benefits aren't worth the drawbacks. 1/ .@ianmSC can be a gadfly, but he's posted many graphs like this showing that cities & countries with mask mandates or strong masking culture have case trajectories similar to those of places that don't. 2/

https://twitter.com/ianmSC/status/1608544624746037249

#Monkeypox/#mpox had a disproportionate effect on #transgender & gender variant people. Both trans men & trans women are part of, or connected to, sexual networks of gay, bi & other men who have sex with men. @CDCgov @CDCMMWR
cdc.gov/mmwr/volumes/7… Another recent study by @profchloeorkin et al found that mpox risk factors differed for cis & trans women, with the latter being more likely to be exposed via sex & having more sex partners & a higher STI rate. 2/
poz.com/article/study-…

Promising news for #COVID treatment. But the fact that an antiviral works against both SARS-CoV-2 & #HIV does not mean COVID is similar to HIV disease. 1/
bit.ly/3AeSxoL Azvudine (used for HIV in China but not the US) is a nucleoside analog, which works as a polymerase inhibitor; when used for HIV treatment it's called a reverse transcriptase inhibitor (RT is HIV's polymerase). 2/

I think this is a terrible idea. As we saw many times with #COVID & now #monkeypox the accepted consensus can change -- & it should change as we get more evidence. Who's smart enough & prescient enough to decide what's misinformation? 1/ nytimes.com/2022/08/29/tec… Yes, sometimes misinformation is obvious -- those are the easy cases.
- Is SARS-CoV-2 airborne?
- Were school closures beneficial or harmful?
- How common is long COVID?
- Is monkeypox an STI?
Just a few questions where experts disagree & our understanding has evolved. 2/

There's a new round of dis/misinformation about the safety of #COVID vaccines during pregnancy. While pregnant women weren't included in clinical trials (as is typical), hundreds of thousands have safely gotten the vaccines in the real world.

https://twitter.com/DHSCgovuk/status/1564663832974442496

Good thread on the topic by @VikiLovesFACS:

https://twitter.com/VikiLovesFACS/status/1564301702068568064

It's true children historically got #monkeypox in African countries where the virus is endemic. But until recently, MPX was considered rare. It was not thought to spread easily between humans & outbreaks were small. That's still the case for everyone *except* gay/bi/MSM. 1/

https://twitter.com/DE2344/status/1564378997156646912

That remained true until an outbreak in Nigeria in 2017, when cases shifted towards young urban men. Dr. Ogoina (profiled here) & other experts think it might be transmitted sexually there as well (& not necessarily limited to sex between men). 2/
n.pr/3PPiCR5

Just to be clear, @WHO reports 140 people under age 18 with #monkeypox. @CDCgov reports <20 in US. There has been no known transmission in schools. Official data lags, but cases in children have remained well under 1% for 3 months. 1/ If MPX were going to spread like wildfire among kids — & if it were easily transmitted through casual contact or the air — surely we’d have started to see some indication of that by now. 2/

Gay men don't need government directives or community shaming -- just be honest about how #monkeypox is spreading (ie, don't suggest sex, dancing together & touching clothing are equal risks) & they'll figure it out for themselves. It's already happening.
wapo.st/3PbtLuk Behavior change didn't *fail* to curb #HIV -- rather it was an incomplete success, so we needed new approaches like U=U & PrEP. Until #monkeypox vaccines are readily available, abstinence, fewer partners, different activities & condoms are all part of the harm reduction toolbox.

This could be a game-changer for containing the spread of #monkeypox. Saliva test results were concordant with lesions swabs & some people tested positive before they developed lesions. @drklausner @alexmeshkin @FlowHealthHQ 1/
bit.ly/3A9Fpld It's not clear whether people can transmit MPX before they develop lesions, but some research suggests asymptomatic transmission might be possible. 2/
papers.ssrn.com/sol3/papers.cf…

Things we do & do not know about this case. We know a daycare worker has #monkeypox. We're told some number of young children were exposed. None of the kids have MPX so far, but the incubation time is too short. 1/
nbcnews.to/3zD0CT9 The reported exposure ranges from touching the same objects to possibly varying degrees of skin-to-skin contact. Some of these exposure risks are considered very low risk, others are higher. 2/

People on both ends of the political spectrum came to distrust public health & the media during COVID because they think mitigation policies were either too strict or too lax & we warned the public either too much or not enough. The same thing is happening with #monkeypox. 1/ Through COVID social media, I've been exposed to a wider diversity of viewpoints than I was used to. And the way people on the two "sides" are reacting doesn't look all that different. 2/

I have no idea what condition this person might have, but #monkeypox shouldn’t still be producing new lesions at 6 weeks, right? Is this a known phenomenon? Like many of the women on social media claiming to have monkeypox, a quick scan of her posts doesn’t show her saying she actually tested positive. The lesions she photographs could be many things.

If you read just one #monkeypox article, make it this one, illustrating both the folly of not listening to people on the ground in the most affected communities & the perils of shaming & stigmatizing sex so much that people won't talk about it. 1/ @NPR

n.pr/3PPiCR5 This Nigerian doctor, Dimie Ogoina (@Dimostic) just addressed a special #monkeypox session at #AIDS2022. 2/

#Monkeypox vaccine messaging is difficult & conflicting because there's not enough research. Data so far is based on immunogenicity (essentially, antibody production) not real-world effectiveness. Starting with 1 dose is a good strategy to get more people some protection ASAP. 1/ But saying a single dose provides adequate protection is premature. In particular, people with #HIV have a lower response rate & it seems like they should be prioritized for 2nd doses. @dr_demetre says @US_FDA stands by its recommended 2-dose regimen. #AIDS2022 2/