The Centers for Disease Control and Prevention (CDC) recently announced that it is monitoring a newly identified SARS-CoV-2 variant called BA.2.87.1 from South Africa that has mutations that may pose a risk of immune escape, but so far there's no sign that it is spreading widely.

South African scientists have identified nine BA.2.87.1 sequences in samples that were collected between September and December of 2023. No cases have been identified outside of South Africa. "The fact that only nine cases have been detected in one country since the first specimen was collected in September suggests it does not appear to be highly transmissible – at least so far," the CDC said in a February 9 statement.

South African cases reported from three provinces

In South Africa, though, the cases were reported from three provinces over 3 months, suggesting that BA.2.87.1 can spread among people, the CDC said.

The CDC said it is monitoring BA.2.87.1 because it has more than 30 changes in the spike protein compared to XBB.1.5, the variant covered by the current monovalent vaccine. The CDC said variants with multiple spike protein changes could increase the potential for immune escape from earlier infection or vaccination. Experience with BA.2.86 and its JN.1 offshoot was a reminder that a variant's ability to transmit can change quickly over time.

BA.2.87.1 isn't fueling a detectable increase in South Africa's COVID cases, the CDC said. So far, it's not clear how well the current vaccine would protect against BA.2.87.1, but the group added that recent experience with the JN.1 variant suggests that the current COVID vaccine can help protect against a diverse range of variants.

The European Centre for Disease Prevention and Control (ECDC) is also tracking BA.2.87.1 as a variant under monitoring (VUM).

A large-scale, population-based study in China reports that chronic obstructive pulmonary disease (COPD) patients were nearly eight times more likely to use antibiotics than the general population and received nearly twice as many antibiotic prescriptions, researchers reported late last week in the Journal of Antimicrobial Chemotherapy.

Using prescription data and survey responses from participants aged 40 years and older in a cohort of residents from Shanghai's Songjian District, researchers with Fudan University assessed correlations between COPD, the percentage of antibiotic use, and the average rate of prescribing of different types of antibiotics compared with the general population. While antibiotics are commonly used to manage acute exacerbations of COPD in China, there are concerns that some of this use is inappropriate and that frequent antibiotic use in COPD patients is creating a vicious cycle of antimicrobial-resistant infections that require more antibiotics.

High-priority group for stewardship efforts

A total of 34,576 people were included in the study, 1,594 (4.6%) of whom were COPD patients. Over 6 years of follow-up, the percentage of antibiotic use for COPD patients was 98.4%, which was 7.88 (95% confidence interval [CI], 5.24 to 11.85) times that for non-COPD patients after adjusting for potential confounders. The prescribing rate was 3,220 prescriptions per 1,000 person-years for COPD patients, which was 1.96 (95% CI, 1.87 to 2.06) times that for non-COPD patients.

Macrolides, lincosamides, streptogramins, quinolones, and other beta-lactams were the most commonly used antibiotics by COPD patients. Except for aminoglycosides, both the percentage of antibiotic use and the rate of antibiotic prescribing for all antibiotics were increased in COPD patients, who were 1.34 (95% CI, 1.20 to 1.50) times more likely to be prescribed a maximum of two antibiotics and 2.77 (95% CI, 2.47 to 3.11) times more likely to use antibiotics intravenously.

The study authors say the findings suggest COPD patients are a high-priority group for the management of antibiotic use in communities.

A large study in Spain finds that COVID-19 is associated with a 30% increased risk of major cardiovascular events in people with HIV during the year following infection. The study is published in Clinical Microbiology and Infection.

Using a population of people in Catalonia with HIV (PWH) who had a documented COVID-19 infection, plus PWH with no COVID infections, the authors of the study estimated the incidence rate (IR) of a first cardiovascular event (CVE) after COVID-19 during an average follow-up period of 243 days.

Included were 4,199 PWH with and 14,004 PWH without COVID-19 infections, 82% of all study subjects were men, and the average age was 47. Overall, 211 PWH with COVID-19 and 621 without developed CVE, the authors said, with an IR of 70.2 and 56.8 per 1,000 person-years, respectively.

Even mild infections pose risk

COVID-19 was associated with a 30% increased subsequent risk of CVE (adjusted hazard ratio, 1.30; 95% confidence interval, 1.09 to 1.55). Risk was highest in the 6 months following acute infection, and there was no association with COVID-19 severity and subsequent CVE, suggesting that even mild to moderate infections increased the risk.

"Even while the absolute rates of CVE in PWH have significantly declined in recent years, they continue to have a 1.5-2-fold greater relative risk compared to individuals without HIV," the authors wrote. "Therefore, the confirmation that the incidence of major CVE is increased the year following COVID-19 in PWH, including those non-hospitalized or without prior CVE, deserves major awareness."

The authors said reasons for the increased risk are unknown and multifactorial. Earlier studies have suggested PWH have elevated levels of T-cell and inflammatory markers after COVID-19.

An observational study in eClinicalMedicine suggests that the antiviral drugs azvudine and nirmatrelvir/ritonavir (Paxlovid) were similarly ineffective in preventing death in elderly patients hospitalized for COVID-19 in China, although the authors acknowledge that the findings may be subject to confounding factors and bias.

Azvudine has conditional approval for treatment of viral diseases such as COVID-19 and AIDS in China but isn't approved for use in the United States, where Paxlovid is approved for treatment of mild or moderate COVID-19 in high-risk adults.

Researchers from the Chinese PLA General Hospital in Beijing evaluated the electronic medical records of 249 COVID-19 patients with an average age of 91.4 years hospitalized in December 2022 and January 2023. Of all patients, 128 received azvudine, 66 were given Paxlovid, and 55 received no antiviral. Average follow-up was 84 days.

"The proportion of severe illness and death caused by COVID-19 among the elderly is the highest among all age groups, and elderly patients are commonly accompanied by multi-disease and multi-reuse drugs," the study authors noted, adding that caution must be taken when prescribing drugs for these patients.

Potential confounding factors, bias

A total of 77 patients (31%) died during follow-up. Neither antiviral demonstrated a survival benefit, with a Cox analysis of all-cause death showing a 0.73 risk of death in the azvudine group and 0.80 in Paxlovid recipients compared with no antiviral treatment.

The proportion of severe illness and death caused by COVID-19 among the elderly is the highest among all age groups, and elderly patients are commonly accompanied by multi-disease and multi-reuse drugs.

The researchers noted several potential reasons for the lack of clinical benefit, including the advanced age, chronic illness burden, and disease severity among participants and inadequate study power to detect differences.

"Finally, the cause of selection bias cannot be ruled out because patients with more severe clinical presentations may have been preferentially selected by clinicians to receive nirmatrelvir/ritonavir," they wrote. "In that case, patients who received nirmatrelvir/ritonavir would be expected to have worse outcomes, which could obscure a potential therapeutic benefit of nirmatrelvir/ritonavir."

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