Infectious DiseasesVA researchers are advancing the understanding, prevention, and treatment of numerous infectious diseases, ranging from the common cold to major public health threats such as tuberculosis, AIDS, hepatitis C, and influenza. They have developed a number of effective new preventive strategies, vaccines, and drugs for infectious diseases.

Hepatitis C is a bloodborne disease marked by inflammation of the liver. Veterans who served in the Vietnam War era, have alcohol or substance use disorders, or have psychiatric conditions are more likely to be infected with Hepatitis C. VA is the single largest care provider in the United States for Hepatitis C. As of March 2019, VA has treated more than 116,000 Veterans with oral hepatitis C medications and is on track to cure 100,000 Veterans.

Lab tests show protein reverses memory loss in HIV-infected mice
A VA scientist in Atlanta has long been trying to determine how HIV causes or worsens memory problems, in the hope that he and others can develop treatments to ease or reverse the troubling symptom. ... (07/24/2018)

Researchers seek to ease GI symptoms in Gulf War Vets
VA scientists seek to learn whether Veterans with Gulf War illness have problems with their gut bacteria. The team is doing a pilot study involving 52 Veterans.... (06/13/2018)

Single-tablet HIV treatment shows better outcomes over multi-tablet regimen
IV patients on a single-tablet daily regimen had better outcomes than patients taking multiple pills per day, in a study that included a researcher at the Michael E. DeBakey VA Medical Center in Houston.... (05/16/2018)

Epstein-Barr virus could be cause of multiple autoimmune disorders
The Epstein-Barr virus, best-known for its role in causing mononucleosis, or the "kissing disease," has now been linked to a wide range of autoimmune diseases, ranging from lupus and multiple sclerosis to inflammatory bowel disease and celiac disease.... (04/19/2018)

Protecting Veterans against infectious diseases
VA and the CDC have partnered to build a research network aimed at learning the best ways to protect patients and employees from infectious diseases in medical settings.... (01/10/2018)

Podcast: VA, CDC collaborate to fight infectious diseases

Guest: Dr. Heather Reisinger of the Iowa City VA Health Care System. (Episode #18)

02-27-2018

HIV and Hepatitis C

The problem of antibiotic overuse

New clinical trial looks at home use of fecal transplants to prevent C. difficile
VA researchers at the Minneapolis VA Health Care System are beginning a new clinical trial to assess the effectiveness of home use of fecal microbiota therapy (FMT) to prevent recurrence of Clostridium difficile infections. The study is called Microbiota or Placebo after Antimicrobial Therapy for Recurrent C. difficile at Home. MATCH will assess the effectiveness of FMT delivered via an oral capsule, rather than by colonoscopy. Read more

Reduced mortality from staph infections at VA hospitals
A team of VA researchers led by Dr. Michihiko Goto at the Iowa City VA Health Care System published a study in JAMA Internal Medicine that demonstrated the potential benefit of using specific care measures to prevent deaths related to staph infections in the bloodstream. Read more

Fixing a failing brain through the gut
Dr. Jasmohan Bajaj is a liver transplant specialist at the VA medical center in Richmond, Virginia, where he is instrumental in evaluating Veterans for liver transplantation. He also conducts research into liver disease and its effect on the brain and the gut. VARQU spoke with Dr. Bajaj about the research he is doing to develop revolutionary new treatments for hepatic encephalopathy, damage in the brain caused by a diseased liver. Read more

H. pylori treatment may raise risk of autoimmune disease

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(05/23/2019)
Drug treatment for H. pylori infection was linked to an increased risk of autoimmune disease, in a study including a VA Ann Arbor Healthcare System researcher. H. pylori is a type of bacteria that infects the digestive tract. It can cause ulcers and stomach cancer. About two-thirds of the world’s population has the bacteria in their bodies; most people don’t experience problems. Working with data on nearly 80,000 Taiwanese patients, the researchers found that patients treated to eradicate H. pylori infection had a significant increase in risk for autoimmune disease, including irritable bowel disease. The increased risk was not the result of general antibiotic treatment, since patients treated with antibiotics for urinary tract infections had lower autoimmune risk than H. pylori patients. The results suggest that H. pylori colonization could have immune system benefits, say the researchers. The study was published in the journal Clinical Gastroenterology and Hepatology last year, and more recently presented at a meeting. (Digestive Disease Week, May 21, 2019)

Increased cleaning time may not improve hospital room disinfection

Photo by Mitch Mirkin

(03/27/2019)
More time spent cleaning patient rooms in a hospital may not improve disinfection, found a Central Texas Veterans Healthcare System study. Researchers measured the infectious bacteria count on five room surfaces in a VA medical center—bedrail, tray table, call button, toilet seat, and bathroom handrail—after cleaning in between patients. For some rooms, cleaning time was limited to 25 minutes, while for others cleaning time was unlimited. Longer time spent cleaning did not lead to fewer infectious organisms on surfaces. The results suggest that time spent cleaning beyond 25 minutes may not be necessary to properly disinfect a hospital room, as long as appropriate disinfectants are used and staff is properly trained, say the researchers. (Infection Control and Hospital Epidemiology, March 25, 2019)

Telehealth a viable way to improve antimicrobial stewardship

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(10/04/2018)
A pilot telehealth program shows promise in improving infectious disease control at rural medical centers, according to a Louis Stokes Cleveland VA Medical Center study. Staff at two rural VA medical centers used videoconferencing to work with infectious disease physicians at other facilities. These videoconference antimicrobial stewardship teams (VASTs) held weekly meetings to discuss ways to combat antimicrobial resistance on a patient-by-patient basis. After a year of the program, one site accepted VAST recommendations in 73 percent of cases presented, and the other accepted 65 percent of the recommendations. Participants felt that the sessions improved their antimicrobial stewardship efforts and patient care. (Infection Control and Hospital Epidemiology, Sept. 6, 2018)

Stimulant use increases mortality risk for HIV-infected men

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(05/11/2018)
Stimulant use increases mortality risk for men with HIV, but cannabis use does not, according to the Veterans Aging Cohort Study. Researchers surveyed more than 3,000 men with HIV. At baseline, 15 percent of participants used cannabis, or marijuana; and 24 percent used stimulants, such as cocaine and methamphetamines. Cannabis was not linked to increased mortality risk based on the VACS Index, a measure of the risk of all-cause mortality. Those using stimulants, however, scored five points higher on the risk scale, compared with cannabis and alcohol users. Participants who used stimulants were also more likely to have unhealthy alcohol and opioid use. This was not true for those who used cannabis. The results suggest that efforts to reduce stimulant use in this population may reduce mortality. The researchers do note that demographic factors—such as age, race, and education—seem to impact mortality risk more than alcohol, cannabis, or stimulant use. (AIDS and Behavior, April 2018) 

Up to nine months between doctor's visits do not worsen viral load for HIV patients

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(04/25/2018)
Gaps up to nine months between HIV primary care visits do not worsen viral load, found a study including a Michael E. DeBakey VA Medical Center researcher. Current guidelines say that HIV patients should visit their doctors every six months for viral monitoring. Looking at more than 6,000 patients with HIV, researchers found that patients who went up to nine months between doctor's visits did not have significant increases in viral load. Patients with visit gaps greater than 12 months were much more likely to have lost viral suppression. The results show that primary care visit intervals between six and nine months may be appropriate for HIV patients, say the researchers. (AIDS Patient Care and STDs, April 2018)

Accepting hepatitis C-positive liver transplants could improve life expectancy

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(04/11/2018)
Patient without hepatitis C needing a liver transplant may have increased life expectancy if they are willing to accept a donated liver that is positive for the hepatitis C virus, according to a mathematical model. A team including a researcher from the Michael E. DeBakey VA Medical Center used data from published studies to create a simulated trial. They found that accepting any liver regardless of hepatitis C status resulted in increased life expectancy over waiting for a liver free of the hepatitis C virus. Although infected livers could have adverse outcomes, the virus can now be treated very effectively post-transplant using direct-acting antivirals. (Hepatology, Dec. 9, 2017)

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