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Study Type: Systematic review and meta-analysis

Key Question: What is the safety, in terms of adverse-event-related discontinuation, of tuberculosis preventive treatment (TPT) regimens among patients receiving or about to start immunosuppressive therapy?

Key Findings:

• Pooled AE-related discontinuation: 5.3% (95% CI 3.1–8.9%) for mono-isoniazid, 4.4% (0.1–75.4%) for mono-rifamycin, 2.0% (1.0–4.1%) for isoniazid-rifamycin combinations, and 6.9% (0–92.3%) for fluoroquinolone-based regimens.
• Isoniazid-rifamycin combinations had lowest discontinuation with narrowest CI and no heterogeneity (I²=0%); other regimens showed substantial heterogeneity.
• Rifamycin-containing regimens were only studied prior to immunosuppressive initiation, not during concurrent use.

Clinical Relevance: UK clinicians managing patients on biologics or awaiting transplant should note that shorter rifamycin-based TPT regimens appear well-tolerated pre-immunosuppression, supporting NICE/BTS-aligned shift away from prolonged isoniazid monotherapy, though evidence during concurrent immunosuppression remains limited to isoniazid.

Limitations: Substantial heterogeneity and wide confidence intervals for non-isoniazid regimens, with no direct data on rifamycin-based TPT safety during concurrent immunosuppressive therapy.

Study Type: Retrospective cohort study

Key Question: Do gender-based disparities exist in the HCV care cascade, particularly on-site treatment initiation, among incarcerated individuals in the NYC jail system?

Key Findings:

• Among 71,100 individuals (7.1% women), women had higher prevalence of HIV, mental health needs, substance use disorders, and homelessness, but shorter jail stays (19 vs 30 days, p<.0001).
• Among those with active HCV seen by a clinician, women had roughly half the odds of on-site treatment initiation compared to men (AOR 0.561, 95% CI 0.335–0.925), despite comparable engagement with care.

Clinical Relevance: Highlights a modifiable, gender-based inequity in carceral HCV treatment access relevant to UK prison health services pursuing HCV micro-elimination targets, particularly given shorter remand stays and complex comorbidities among women in custody.

Limitations: Findings are from a single US urban jail system with shorter incarceration periods, limiting generalisability to UK custodial settings with different sentencing structures and healthcare delivery models.

Study Type: Multi-centre cross-sectional observational study

Key Question: Does timely hepatitis B birth dose vaccination (HepB-BD) reduce mother-to-child transmission (MTCT) of HBV in Ethiopia compared with delayed vaccination starting at 6 weeks?

Key Findings:

• Overall MTCT risk was 5.2% (95% CI 3.4–7.8) among 387 infants of HBsAg-positive mothers.
• MTCT was 0% with HepB-BD alone (0/39) and 0% with HepB-BD plus HBIg (0/217), versus 15.3% (20/131) with no birth-dose immunoprophylaxis (p=0.009).
• High maternal viral load (>200,000 IU/mL; AOR 16.6) and HBeAg positivity (AOR 4.21) independently predicted MTCT in unprotected infants.

Clinical Relevance: Supports UK/NHS antenatal screening and neonatal hyperimmunoglobulin/vaccination pathways by reinforcing that birth-dose timing is critical, with direct implications for global health policy and UK clinicians advising on prevention strategies in high-prevalence settings or migrant populations.

Limitations: Cross-sectional design with non-randomised allocation to vaccination strategy risks confounding by indication and selection bias.

Study Type: Commentary/ethical analysis (not original research)

Key Question: How should solid organ transplant programmes approach *Candida auris* screening given the absence of national guidelines and uncertain clinical implications of colonisation?

Key Findings:

• No US national or professional consensus exists on who, how, or when to screen transplant candidates for *C. auris*, nor how results should influence transplant candidacy decisions.
• The authors reject both universal screening and no screening, instead proposing a risk-based screening approach as a pragmatic, evidence-informed middle ground.
• Screening should serve harm reduction via preparedness and individualised risk assessment, not act as a surrogate for institutional risk aversion or become an arbitrary artefact of local policy.

Clinical Relevance: As *C. auris* cases rise in UK hospitals and ICUs, transplant teams face similar unresolved questions about screening thresholds and candidacy decisions, making this framework relevant to developing local/NHS policy pending national guidance. *(Limitations section omitted as this is an ethics commentary, not original data.)*

Study Type: Target trial emulation using a case-cohort design (observational)

Key Question: Does long-term ART use reduce anogenital cancer risk in people with HIV compared to HIV-negative individuals?

Key Findings:

• Among 14,312 participants (1,045 incident anogenital cancers), relative risk of anogenital cancer versus HIV-negative adults increased with ART duration, from RR 4.0 (<5 years) to RR 7.4 (≥10 years; 95% CI 6.8–8.1).
• ART ≥10 years carried markedly elevated risk across cancer sites: penile RR 102 (42–250), vulvar RR 36 (22–57), anal RR 15 (11–20), cervical RR 4.4 (4.0–4.8).
• Prior advanced HIV disease contributed relatively little to overall risk once on ART.

Clinical Relevance: Despite successful ART, PWH remain at persistently elevated—and possibly increasing—anogenital cancer risk, reinforcing the need for enhanced HPV vaccination and anogenital cancer screening pathways within UK HIV services.

Limitations: Observational design with residual confounding by indication and HPV exposure despite g-computation adjustment limits causal inference.

Study Type: Prospective pharmacokinetic study

Key Question: Is it safe, from a drug-exposure standpoint, for breastfeeding infants when lactating mothers are treated with glecaprevir/pibrentasvir for chronic hepatitis C?

Key Findings:

• Mean breastmilk-to-plasma concentration ratios were low: 0.63% for glecaprevir and 4.23% for pibrentasvir.
• Mean relative infant dose was minimal: 0.02% (glecaprevir) and 0.06% (pibrentasvir), far below the 10% threshold generally considered safe for breastfeeding.

Clinical Relevance: These data support continued breastfeeding during glecaprevir/pibrentasvir therapy, informing UK hepatitis C treatment pathways where postpartum women are increasingly identified and treated through NHS blood-borne virus screening programmes.

Limitations: Small pharmacokinetic sample size limits generalisability, and clinical infant safety/outcome data were not assessed.

Study Type: Test-negative design case-control study (multistate hospital-based surveillance)

Key Question: How effective was the 2024–2025 seasonal influenza vaccine against influenza A-related hospitalisation and severe in-hospital outcomes in US adults?

Key Findings:

• VE against influenza-associated hospitalisation was 40% (95% CI 32–47%), consistent across age groups and A subtypes despite H3N2 antigenic drift.
• VE against severe outcomes was higher: ICU admission 58% (47–67%), invasive organ support 58% (44–69%), death 52% (18–71%), standard oxygen therapy 41% (31–50%), non-invasive respiratory support 38% (19–52%).

Clinical Relevance: Reinforces the value of annual influenza vaccination for UK clinicians advising patients ahead of NHS seasonal campaigns, particularly given evidence of protection against severe outcomes even amid circulation of drifted H3N2 strains, relevant to UK vaccine strain-selection discussions.

Limitations: Observational test-negative design in a single country's hospitalised adult population limits generalisability to UK vaccine formulations, population immunity, and outpatient/community settings, and residual confounding cannot be excluded.

Study Type: Retrospective spatiotemporal ecological analysis (surveillance data, 2005–2024)

Key Question: What spatial, environmental, and host-related factors drive persistent clustering of human echinococcosis transmission in Xinjiang, China?

Key Findings:

• 21,822 human echinococcosis cases reported over 20 years, with significant spatial clustering identified via global autocorrelation analysis.
• High-incidence hotspots persisted in the Yili River Valley (north) and Wuqia County (south), predicted by Bayesian modelling to remain major transmission centres.
• Heterogeneous disease risk was linked to environmental and animal host factors, mapped using Kriging interpolation of host infection rates.

Clinical Relevance: Although UK-specific transmission is negligible, this informs risk assessment and pre-travel advice for patients with occupational/travel links to Central Asia, and illustrates a One Health surveillance model relevant to zoonotic disease control planning in NHS public health and ID practice.

Limitations: Ecological-level analysis cannot establish individual-level causal relationships between environmental/host factors and human infection risk.