Hospices Civils de Lyon (HCL) is now able to produce therapeutic bacteriophages in-house to GMP standards and has obtained authorisation to manufacture them as active substances, according to Camille Merienne (HCL Pharmacy department and FRIPHARM®, Lyon).

Antimicrobial resistance is a growing global threat and could lead to 10 million deaths annually by 2050. Bacteriophages are a promising alternative to antibiotics but phage therapy medicinal products (PTMPs) are ultra-personalised treatments. They must be matched to each patient’s bacterial strain and continually adapted as new strains emerge. Dr Merienne explained that this requires vertical integration within a single institution, covering phage discovery, selection, production, purification, formulation, diagnosis and treatment. At the same time, the products must meet the same quality, safety and efficacy requirements as other medicines.

The team developed injectable suspensions of bacteriophages against Staphylococcus aureus, working closely with clinicians and patients. The French National Reference Centre for staphylococci collected and characterised multidrug-resistant S. aureus strains, and the most active phages were selected. Genomic sequencing ensured that only non-temperate phages and non-pathogenic host strains were used, and these were stored in a biobank compliant with ISO 20387. Phages were amplified to 10¹⁰ plaque-forming units/mL and filtered. They were then purified by tangential flow filtration and formulated with a patented excipient system. Finally, they were aseptically filled into Type I glass vials in a grade A environment.

Twelve pilot batches of four different phages were produced. Quality control criteria were defined by risk analysis in line with the European Pharmacopoeia chapter on phage therapy (5.31). They covered efficacy (titre and genomic identification), the requirements for a sterile injectable suspension, and process-related impurities such as host cell proteins and DNA, endotoxins and residual reagents. In total, 1,700 quality control points were assessed, including release tests and a two-year ICH stability study. A toxicity and tolerance study was also carried out in rabbits.

Development of the formulation, production process and quality control took three years, and GMP qualification took a further two. A dedicated team was recruited: a PhD student/project manager, a quality engineer and a laboratory technician. Five audits (two internal and three external) led to 95 corrective and preventive actions. All processes now comply with EU GMP Part II, the European Pharmacopoeia and EMA requirements. The French medicines agency (ANSM) has authorised the FRIPHARM platform to manufacture active substances for hospital preparations.

The authors concluded that this achievement means phage therapy can be offered to patients and that biotherapies can be integrated into the hospital’s pharmaceutical preparations. Phase I/II clinical trials are planned. Phages against Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae are being developed next.

Merienne C,Marchand C, Lapras B et al. Institutional hospital-based production of therapeutic bacteriophages. Short communication. GERPAC Congress 2026

Image: Camille Merienne

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During the 2025/26 RSV season, the number of hospital admissions among infants aged 0 to 5 months fell by 75 per cent compared with the average of the previous three seasons. While admissions averaged 1,128 in those years, only 296 infants were admitted between October and April in the most recent season.

‘That’s more than 800 infants who avoided hospital admission over the winter. For these very young children, RSV can be particularly serious and may cause severe breathing difficulties. It is a major strain on both children and their families, so this is a remarkable development,’ says Prof Thea Kølsen Fischer, Clinical Professor at the Department of Public Health and co-author of the study.

The findings are consistent with experiences from countries including Belgium, Spain, the Netherlands, France and England, all of which have introduced RSV vaccination programmes. As well as potential health outcomes, the programme may ease the burden on health services at a crucial time of year.

‘I work in a hospital every day, and colleagues from paediatric departments across the country tell me that the RSV season often places enormous pressure on their services. This year, they have not seen the usual surge in admissions,’ says Prof Kølsen Fischer.

RSV follows a clear seasonal pattern in Denmark, with most hospital admissions occurring between October and March. For that reason, the vaccine is offered to women due to give birth during or shortly before this period. In the first season, 72 per cent of eligible pregnant women accepted the offer of vaccination.

‘It is encouraging that so many women chose to be vaccinated in the first season,’ says Prof Kølsen Fischer.

Despite the sharp decline in admissions, RSV is unlikely ever to disappear completely because it is both widespread and highly infectious. However, researchers believe it may be possible to reduce the burden of severe disease to a much lower level than in previous years.

‘I expect at least as many people to accept the vaccine next season, both because of these early results and because it is a very safe vaccine with very few side effects,’ Prof Kølsen Fischer said.

Older adults at increased risk, including people over 60 with conditions such as chronic obstructive pulmonary disease (COPD), can also receive financial support for vaccination in Denmark which researchers say will have a longer-term impact on the burden of disease.

‘If fewer older people become seriously ill, I believe we will move much closer to controlling a virus that has traditionally caused a large number of sick days and hospital admissions,’ she says.

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In a paper published in The Lancet, the team found that the injections were more effective at keeping the virus suppressed than the tablets and called for efforts to make this treatment more accessible worldwide.

Although HIV is incurable, antiretrovirals can help people live long, healthy lives and greatly reduce the risk of the virus being transmitted to other people. About 1.6 million adolescents (aged 10 to 19 years of age) live with HIV.

Professor Sarah Pett (UCL Innovative Clinical Trials Unit), Chief Investigator of the LATA trial, said: “HIV-positive adolescents as a group have historically done worse on antiretrovirals compared to adults. There is bullying and stigma associated with taking pills every day. Long-acting injectables taken every two months can help young people to lead a more normal life.

“The benefits of this form of treatment for adolescents is stronger than we have seen for adults. Previous trials in adults have shown only that injectables are no less effective than tablets.

“Our results support making injectables more widely available to groups such as adolescents who may not do so well on daily tablets. Nine out of 10 adolescents with HIV live in Africa yet currently this treatment is not accessible to them.”

The LATA (Long-Acting Treatment in Adolescents) trial was conducted in five clinics in Kenya, South Africa, Uganda and Zimbabwe. It involved 476 adolescents aged 12 to 19 who were randomly assigned either a daily tablet, which is standard care, or a long-acting injectable (cabotegravir and rilpivirine), a relatively new way to treat HIV.

Those participating in the trial had been on tablet treatment for more than a year, had HIV that was fully suppressed (undetectable), and had not previously experienced treatment failure.  Almost all the participants in LATA had had HIV since birth.

The research team found that, after just under two years (96 weeks), only two adolescents (1%) on injectables experienced confirmed viral rebound (two viral load measurements, measured at least seven days apart), where the amount of virus in the blood increases, compared to 15 (6%) in the daily tablets group. Increases in viral load can harm people’s long-term health, increasing the number of dormant cells infected with HIV, and in some cases can lead to the infection being passed on to partners or offspring.

Nearly all (94%) adolescents in the long-acting injectables group said the eight-weekly injections were a lot easier than taking medicines daily.

A few challenges need careful consideration regarding the use of long-acting injectables in lower resource settings. The injectables are more expensive than standard daily tablets because the drugs are still on patent, and are more costly to make. In addition, rilpivirine needs to be kept refrigerated during its supply and storage. Skilled nursing staff are also required to administer the injections every eight weeks, whereas appointments for people taking tablets may be as infrequent as every three or six months. There is no agreement yet about a generic version of the injectable treatment.

Presently, adolescents aged 12 years and older as well as adults can be prescribed the injectables in the US, Europe and other high-income settings but in Africa, bar a few clinics, the treatment is not yet available.

The World Health Organization currently recommends the injectables as an “alternative” option for adults and adolescents on daily tablets who are successfully suppressing their virus and do not have active hepatitis B. This stance may be strengthened as a result of the LATA trial findings.

Corresponding author Dr Deborah Ford (UCL Innovative Clinical Trials Unit) said: “The lack of availability of injectable treatments in Africa risks increasing inequalities in HIV care, leaving most people living with HIV without access to treatments that are available in high-income settings.

“This gap may widen further with second- and third-generation injectables being trialled that may require doses just twice a year.”

Dr Mutsa Bwakura-Dangarembizi, trial physician and Principal Investigator of the site in Harare, Zimbabwe, said: “The LATA trial finding that the eight-weekly injections were much better for keeping the virus undetectable, were well tolerated and strongly preferred by adolescents, is really exciting news. But we have a major problem right now in Africa and in other low-and-middle income settings, where these long-acting injectables are simply not available for use. This problem needs to be addressed to enable us to use these injectables in the groups that need them the most, i.e. adolescents living with HIV.”

The trial received funding from the European Union through EDCTP-2 (the second European and Developing Countries Clinical Trials Partnership) and Johnson & Johnson Innovative Medicines. Johnson & Johnson Innovative Medicines provided the injectable rilpivirine and ViiV Healthcare provided injectable cabotegravir. The sponsor was UCL.

The LATA trial scientific collaboration included researchers from all four participating countries and participants were enrolled and followed from five trial sites: Baylor College of Medicine Children’s Foundation, Uganda; Joint Clinical Research Centre (JCRC), Uganda; University of Zimbabwe Clinical Research Centre (UZCRC), Zimbabwe; Moi University Clinical Research Centre, Kenya; and Durban International Clinical Research Site – Enhancing Care Foundation, South Africa.

The study also involved social science, pharmacology and health economic researchers at the London School of Hygiene and Tropical Medicine, Radboud University Medical Center, and the University of York respectively.

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The reactions experienced by some people after vaccination are, in most cases, mild and temporary. They result from activation of the immune system by the vaccine, enabling the body to learn to recognise antigens – characteristic molecules of the virus present in the vaccine – and thereby prepare to better fight off any future infection. This activation can cause local inflammation at the injection site (redness and swelling) or more peripheral symptoms such as fatigue or fever. However, the response varies considerably from person to person, ranging from no reaction at all to pronounced flu-like symptoms.

“Whilst we know that older people tend to experience fewer reactions to vaccination because of age-related declines in immune function, and that the vaccine dose can influence the severity of side effects, the biological mechanisms underlying these individual differences in symptoms have remained poorly understood,” explains Arnaud Didierlaurent, Associate Professor at the Center for Vaccinology (UNIGE/HUG) and in the Department of Pathology and Immunology at the Faculty of Medicine, UNIGE.

The role of our immune ‘‘capital’’

To investigate these differences, the researcher and his team monitored the immune systems of 51 healthy individuals recruited at HUG who received two doses of an mRNA vaccine against COVID-19. As side effects generally occur one to two days after vaccination, particularly after the second dose, participants were monitored for seven days following each injection.

“This study allowed us to identify an important role for an interferon-related antiviral defence system in explaining differences in side effects between individuals. This innate immune defence system helps us, in particular, to fight viral infections. The more active a person’s natural interferon response is, even before vaccination, the more pronounced their reactions to vaccination are likely to be,” explains Natacha Madelon, Senior Research and Teaching Assistant at the Center for Vaccinology and first author of the study.

Interferon is produced by cells when they are infected with a virus, alerting neighbouring cells and preparing them to defend themselves. But not everyone starts from the same ‘baseline’. “For reasons we do not yet fully understand – but which may be linked to genetic factors, a particular microbiome or a previous inflammatory episode – some individuals have a stronger  interferon-related immune signature before receiving the vaccine, which appears to influence how strongly they react to vaccination,” explains Arnaud Didierlaurent.

Differences emerge after the second dose

The research team identified a second potential mechanism in an animal model. Following the first vaccination, the body develops antibodies and T cells capable of recognising the vaccine antigen. When a subsequent dose is administered, this acquired immunity can rapidly amplify the activation of certain innate immune cells, notably monocytes, a type of white blood cell. These cells then react more strongly, attracting more inflammatory cells to the injection site.

These findings open up new avenues for vaccine research. In particular, they suggest that it may eventually be possible to better distinguish between the mechanisms needed to generate a robust immune response and those that primarily contribute to the symptoms experienced following vaccination. Prof. Didierlaurent’s team is now seeking to determine whether these same mechanisms occur with other types of vaccines.

In the long term, this research could contribute to the development of vaccines that are better tolerated while remaining just as effective. “In any case, a mild reaction, or even the absence of symptoms following vaccination, does not in any way mean that the vaccine is ineffective. The severity of side effects is therefore not, in itself, an indicator of how well a vaccine is working” concludes Arnaud Didierlaurent.

This research was supported by the HUG Private Foundation, the Giorgio Cavaglieri Foundation and Moderna.

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Compared with no vaccination, completion of the initial series, booster vaccination, and updated vaccination were associated with 41%, 71%, and 69% lower adjusted odds of COVID-19-related hospitalization, respectively. Among patients who had received only the initial vaccine series versus booster/updated vaccine, the absolute risk reduction was 5.6%.

“Our findings provide important real-world evidence that updated vaccines continue to offer substantial protection in this medically vulnerable population,” said corresponding author Maria I. Danila, MD, MSc, MSPH, of the University of Alabama at Birmingham. “These results underscore the need for continued efforts by clinicians, policymakers, and patient advocacy groups to help ensure that these patients remain current with updated COVID-19 vaccines,” added first author Lesley E. Jackson, MD, MSPH, also of the University of Alabama at Birmingham.

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/art.70290

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The research was presented by Dr Lisa Steen Duus from Gentofte Hospital, Copenhagen, Denmark. She said: “Flu can be particularly serious for older people with chronic lung disease, such as asthma and COPD. They are more likely to develop complications, including pneumonia, worsening of their existing lung disease, and hospitalisation.

“Although high-dose flu vaccines are designed to produce a stronger immune response in older adults, there has been limited randomised evidence specifically showing whether they provide better protection against serious illness in people with chronic lung disease. We therefore wanted to investigate whether a high-dose vaccine could reduce hospitalisations in this particularly vulnerable group.”

The new research combines the results of two gold-standard randomised controlled trials comparing a high-dose flu vaccine with a standard-dose in people aged 65 and older. One trial ran in Denmark over three flu seasons (2022-23, 2023-24 and 2024-25) and one ran in Galicia, Spain over two flu seasons (2023-24 and 2024-25). Analysis of these trials has already shown that the high-dose vaccine is beneficial in older people overall [2].

In the new study, researchers looked specifically at trial participants who had a chronic lung disease, including asthma, bronchiectasis, bronchitis, chronic obstructive pulmonary disease (COPD), cystic fibrosis, emphysema, interstitial pulmonary disease, lung transplantation, respiratory tuberculosis and sarcoidosis. Between the two studies, this was 31,976 people, just under seven per cent of the total 466,320 trial participants.

Around half of the participants were randomly allocated to receive a standard dose of flu vaccine. The other half received a flu vaccine containing four times as much of the active ingredient that stimulates the immune response.

Researchers monitored the participants and recorded any who were hospitalised from 14 days after their vaccination until the following May when the flu season is largely over in Europe.

The high-dose flu vaccine reduced hospital admissions for flu or pneumonia by 8.8% compared with the standard-dose vaccine. The high-dose vaccine also reduced hospitalisations for several other conditions, including cardiorespiratory disease, and hospitalisation from any cause, compared to the standard-dose vaccine.

Dr Duus said: “For older people with chronic lung disease and their families, these findings provide reassurance that high-dose flu vaccination can offer better protection against serious illness requiring hospital treatment than a standard-dose vaccine.

“Being hospitalised creates a considerable burden on patients, families and healthcare systems, so even a modest reduction could have meaningful public health benefits. For that reason, these results support considering high-dose flu vaccines for older adults, including those with chronic lung disease, when developing vaccination recommendations.”

Professor Thomas Wilkinson, Chair of the European Respiratory Society’s Group on Respiratory Infections and Immunology and based at University of Southampton, UK, who was not involved in the research said: “A flu infection is unpleasant for anyone, but for some people it can be a serious health risk. Older people with lung disease have a greater risk of severe illness, hospitalisation and death from flu, which is why the European Respiratory Society recommends annual flu vaccination for this group.

“This research combines the results of two large and well-run studies comparing the standard-dose flu vaccine with a high-dose flu vaccine in people aged 65 and above. Researchers have looked specifically at people on the trial who had also been diagnosed with a lung disease, such as COPD or asthma. Their analysis shows that a high-dose flu vaccine could be even more beneficial in this group.”

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“Always finish your antibiotics” is no longer considered medical best practice for all conditions.

Surprised? You’re not alone.

A new study has found that almost 90% of Americans believe that it’s always best to take the full course of antibiotics, even when you feel better—consistent with long-running but now outdated health campaigns. The reality is more complicated. Sometimes shorter courses are safer, and sometimes longer courses are best.

The survey demonstrates a need for better communication between doctors and patients about what’s healthiest.

“Historically, there was very strong guidance by major health organizations and clinicians that you must always finish the course,” says Alistair Thorpe, PhD, research assistant professor of population health sciences at University of Utah Health and first author on the study. “Now, we’re seeing a growing body of evidence saying that that is not always the case. And oftentimes, shorter durations of antibiotics are as effective and safe as longer alternatives.”

The results are published in Open Forum Infectious Diseases.

A complex reality

The research team surveyed 1,475 people across the country on their attitudes about antibiotic course length. They asked participants whether they’d feel more comfortable taking a three- to five-day course of antibiotics if they had pneumonia, as is recommended by current guidelines, or if they’d prefer an antibiotic course of a week or more, which is recommended by outdated guidelines. While shorter courses of antibiotics are as effective and safer for pneumonia than longer ones, about 60% of people said they’d rather take the longer course.

One of the main reasons people gave for preferring longer antibiotic courses was that they had been told to “always finish their antibiotic course”—88% of respondents had heard of, and agreed with, this common mantra. Most had been told this by their clinician, and many had also heard it via a public health campaign.

A strong body of scientific evidence shows that, for many common infections, shorter courses of antibiotics work as well as longer courses and are less likely to cause side effects. Still, there are some cases, like tuberculosis, where longer courses are most effective.

The study authors suggest that doctors and public health campaigns use several evidence-informed strategies to better communicate the complex reality of antibiotic course length—for instance, avoiding overly simplistic claims that either shorter or longer courses are universally better, and acknowledging that as scientific evidence accumulates over time, health recommendations can change.

To patients who have been prescribed antibiotics, Thorpe recommends having an open conversation with your doctor about the appropriate course length and adherence plan to get health advice that’s specific to your situation.

“Discuss with your clinician what the right duration is for you and when the right time is to stop your course,” Thorpe says. “Getting advice directly from a clinician on a one-to-one basis about what is most appropriate for you in that situation is the right way to go.”

Thorpe emphasizes that the changing recommendations are a positive outcome of increasing knowledge.

“Evidence is growing and guidance is evolving on antibiotic use, which is a normal process and a good sign that we are working to improve how we provide care,” he says. “Our knowledge about how best to use antibiotics has changed, but it has changed because we’re learning more, and it’s important that we make sure we are communicating this well to the public.”

This research is published in Open Forum Infectious Diseases as “US Adults’ Perspectives on Antibiotic Durations and Adherence to Therapy for Common Bacterial Respiratory Infections: A National Survey.”

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Studies in humans show that disrupting the body’s internal clock can weaken immune responses and increase susceptibility to infections. During the COVID-19 pandemic, a study in UK found that sleep disturbances were linked to a higher risk of SARS-CoV-2 infection. “However, no previous study had evaluated whether disrupting the body’s biological clock also increases the risk of developing long COVID”, says first author Kyriaki Papantoniou, Associate Professor at the Medical University of Vienna and Associated Researcher at ISGlobal.

Night shift workers at increased risk of long COVID

In this study, the research team followed 2,941 adults in the population-based COVICAT cohort in Catalonia between 2021 and 2023. Among the 1,899 participants who became infected with SARS-CoV-2, 284 developed long COVID – defined as having persistent symptoms lasting for more than three months after the infection – during the 2-year follow-up.

Compared with day workers, those working night shifts had an 88% higher risk (i.e. almost double) of developing long COVID after accounting for other risk factors such as vaccination history or chronic diseases. This association was stronger in night workers with obesity. Moreover, the increased risk was observed both in current and former night workers, suggesting that it reflects longer-term effects of circadian disruption rather than short-term changes.

In contrast, night shift work was not associated with a higher risk of becoming infected, suggesting that disruption of the biological clock may influence how the body recovers from infection rather than the likelihood of catching the virus.

“Our findings suggest that circadian disruption plays a role in the transition from acute infection to persistent symptoms,” says ISGlobal researcher Manolis Kogevinas, who coordinated the study.

Poor sleep further amplifies the risk

The researchers found that chronic insomnia also increased the risk of long COVID by 42%, independently of night shift work. Together, the two factors had a synergistic effect: night shift workers with chronic insomnia were 2.7 times more likely to develop long COVID than day workers without insomnia.

The biological mechanisms involved are not yet fully understood, but the time of day when the body encounters a pathogen may influence the immune response. In addition, disruption of the body’s biological clock can impair the immune system’s ability to clear the infection.

Improving sleep as a preventive strategy

Given the increase of insomnia prevalence in the general population, the authors underline the need to understand the short and long-term effects of disturbed sleep on infection-related outcomes. In any case, the findings point to sleep as a potentially modifiable factor in preventing long COVID and other post-infectious conditions.

“Promoting healthy sleep habits and minimising circadian disruption could represent simple, low-cost strategies to reduce the long-term consequences of viral infections, particularly among people who work night shifts,” concludes Kogevinas.

The researchers note that the study’s strengths include the use of a well-characterised population-based cohort with detailed information on work schedules, sleep habits and health, as well as an internationally recognised definition of long COVID. However, the participants were aged 40 to 65 years, so the findings may not necessarily apply to younger or older populations, and other occupational factors, such as work-related stress, cannot be completely ruled out.

Reference

K. Papantoniou, A. Espinosa, M Karachaliou, C Lassale, G Castaño-Vinyals, B Harding, De Matteis S, Straif K, E Alonso, C Dobaño, G Moncunill, N Blay, S Iraola-Guzmán, R de Cid, J Garcia-Aymerich, M Kogevinas. Night work, sleep disruption and long-COVID risk: a population-based cohort study. SJWEH. 2026. Doi: 10.5271/sjweh.4318

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Q: What challenges or unmet needs make this study important?

Survival among people with HIV in the United States continues to improve due to highly effective antiretroviral therapy (ART), a lifelong treatment. As a result, costs to Medicare are expected to rise substantially as more adults with HIV live long enough to age into the program. However, it’s been largely unknown just how extensive the increase in Medicare beneficiaries may be over the next decade and how much the program’s spending could rise.

Q: What central question(s) were you investigating?

Our team used simulation modeling to answer these three main questions:

• Over the next decade, how many people with HIV (who are receiving HIV care) over the age of 65 are likely to be enrolled in Medicare?
• How much is Medicare estimated to spend on this population over this time period?
• How might policies or strategies to reduce the cost of ART impact these projections?

Q: What methods or approach did you use?

We developed and populated a new model called CHARMED with projections from the previously validated CEPAC model, Medicare claims data, and publicly available data. Our aim was to simulate a population of Medicare beneficiaries with HIV, aged 65+ and being treated with ART, and their associated costs.

To address uncertainty in model estimates and trends, we examined scenarios where the size and associated costs of this group varied—for example, by assessing the potential impact of policies to reduce the cost of ART. Such policies included the Inflation Reduction Act (IRA), which allows Medicare to negotiate the cost of Biktarvy, the most prescribed ART regimen in the United States, with lower prices to take effect in 2028. Additionally, generic dolutegravir is expected to become available in 2031, thereby enabling a highly effective, well-tolerated, fully generic ART regimen.

Q: What did you find?

Our projections show that nearly 122,000 older adults receiving HIV care may be enrolled in Medicare by the end of 2026—a number that may increase to about 193,600 by the end of 2035. We also estimated that annual Medicare spending for this population may increase from $10.9 billion at the end of 2026 to $27.3 billion at the end of 2035.

Cumulative 10-year costs may reach $187.2 billion, with 63% attributable to ART costs alone. If ART costs were reduced by 60%, Medicare could potentially save $70.3 billion over the next decade. Moreover, if current prescribing patterns remain unchanged, policies such as the IRA and the availability of generic HIV medications could save Medicare approximately $19 billion between 2026 and 2035.

Q: What are the real-world implications, particularly for patients?

Our findings demonstrate that the number of older adults living with HIV is likely to increase substantially over the next decade, driving up Medicare enrollment. Clinicians and healthcare systems must be prepared to address the medical needs of this growing population through comprehensive, person-centered care—especially given these individuals’ increased risk of comorbidities and polypharmacy (taking several medications regularly).

We also conclude that policymakers for Medicare and other public programs will likely seek out ways to reduce the cost of HIV care. While recent proposals have included higher Medicare premiums, drug coverage reductions, and stricter eligibility for drug assistance programs, our paper points to other promising strategies to reduce ART costs without increasing patient costs or limiting access.

Authorship: In addition to Hyle and Freedberg, Mass General Brigham authors include Luke Ang, Grace Luu, Florence Ebem, Satoshi Koiso, Paul E. Sax, John Giardina, E. John Orav, Anne M. Neilan, and Jose F. Figueroa. Additional authors include Parastu Kasaie, Dannie Dai, Jessica Phelan, Ciara Duggan, Elizabeth Humes, Dori Molozanov, Lucas Gerace, Tim Horn, Ankur Pandya, and Keri N. Althoff.

Paper cited: Hyle, EP., et al. “Ten-Year Cost Projections for Medicare Beneficiaries 65 Years or Older with HIV.” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2026.21966

Funding: This research was funded by the National Institutes of Health (R01 AG069575, R01 AI042006, R01 AG081151, U01 AI069918, R01 AG053100, R01 AI179776) and the Massachusetts General Hospital Jerome and Celia Reich HIV Scholar Award.

Disclosures: Hyle, Humes, Giardina, Neilan, Figueroa, Althoff and Freedberg reported receiving grants from the National Institute of Health (NIH).

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‘It’s very important that the problem is recognised and that we show that it can be measured by objective testing,’ says Prof Neil Lagali, professor of experimental ophthalmology at Linköping University, who led the study published in Nature Communications. ‘Patients don’t have access to that [testing] today. We’ve studied people in Sweden, but believe that many people around the world are experiencing these problems.’

The study originated with people seeking care for eye problems following a mild COVID-19 infection. They were experiencing a lot of discomfort, sensitivity to light and in many cases severe eye pain, difficulty reading and focusing their gaze.

The researchers examined 100 people with eye problems following COVID-19 who had not been hospitalised. They had suffered from eye problems for between three months and three years, and one in three were on full or part-time sick leave. The researchers compared the affected group with a control group of 32 people, who had also had mild COVID-19 but without eye problems.

‘We found that the problems experienced by those affected were not detectable by standard tests. We had to perform specialised examinations to detect deviations. The puzzle pieces then fell into place, and we found explanations for the symptoms,’ says Neil Lagali.

In their study, the researchers found long-term inflammation and deterioration of several eye functions controlled by the nerves in the brain.

One of the advanced tests involved proteomics, where a variety of proteins in the tear fluid are analysed. In those with eye problems, the researchers found an abnormal pattern of proteins regulating nerves and immune cells, so-called T cells. The findings were consistent with advanced eye microscopy that they used to measure the T cells and nerves in the eye. Strikingly, the same protein pattern has been found in blood and tissue in cases of severe and fatal COVID in other studies.

‘Our findings suggest that these people have suffered a severe reaction to COVID-19 manifested in the eyes, with long-term inflammation and an impact on the nerves that control multiple eye functions,’ says Dr Petros Moustardas, senior research associate at Linköping University and lead author of the study.

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The study explored whether prophylactic (shortly before or after exposure) administration of the recently developed clinical candidate GHP-88310 (described in Science Advances²), a broad-spectrum inhibitor of the viral polymerase, prevents virus transmission through close contact or through the air. The results demonstrate that GHP-88310 efficiently blocks both forms of viral spread. In addition, the study showed that treatment of infected animals shortened the time period in which infected animals could transmit the virus.

“Silencing measles outbreaks quickly is essential to reestablish control over the virus,” said senior author Richard Plemper, a Regents’ Professor and director of the CTAR. “This study follows our recent development of the drug candidate GHP-88310. It demonstrates that the drug is suitable to augment traditional ring vaccination against measles.”

Since 2025, measles has reemerged in the United States with thousands of cases across multiple states, hundreds of hospitalizations and three confirmed deaths. Large outbreaks in Canada and Mexico with multiple deaths have challenged the measles elimination status of North America.

“We were very excited to see that GHP-88310 given by mouth completely prevented airborne transmission in our ferret model of measles,” said first author Carolin Lieber, a senior postdoctoral fellow in the Plemper lab. “This finding is unprecedented for a viral polymerase inhibitor and demonstrates the extraordinary antiviral potency of this drug.”

To explore relevant conditions of viral transmission, the researchers developed a system that allowed them to pair infected and uninfected animals in direct physical contact or shared airspace, each under controlled environmental parameters.

“We designed the study to recapitulate viral spread between people with direct contact, for instance in a household, and between more distant social contacts, for example in classrooms or other indoor settings that bring people into proximity without direct interaction,” said Plemper. “In addition to this prophylactic benefit, GHP-88310 used therapeutically shortened the duration of disease in our model. If equally applicable to human hosts, it may shorten the severe social and economic burden of prolonged quarantine of patients and further aid outbreak management.”

The investigators are now readying GHP-88310 for formal clinical testing.

Additional authors of the study include Josef Wolf, Claire Ruckel and Lauren Harrison of the Center for Translational Antiviral Research in the Institute for Biomedical Sciences at Georgia State.

The study was funded by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH).

To read the studies, visit

¹ DOI 10.1038/s41564-026-02419-y. Once published online, it will be available at URL: https://www.nature.com/articles/s41564-026-02419-y

² DOI: 10.1126/sciadv.aef1594. URL: https://www.science.org/doi/10.1126/sciadv.aef1594?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

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The study, published in The Lancet Infectious Diseases journal and funded by the National Institute for Health and Care Research (NIHR), involved nearly 800 adults in England with long Covid who were randomly assigned either usual care or one of three types of drugs: a combination of antihistamines (allergy medicines), an anti-inflammatory drug called colchicine (used to treat gout), or a blood thinner called rivaroxaban (typically used to prevent blood clots and strokes).

The research team found that all groups experienced a meaningful reduction in their self-reported fatigue over 12 weeks (improving an average of 4.3 points on a 40-point scale), supporting the idea that specialist long Covid care can lead to important improvements in symptoms.

Those taking antihistamines and colchicine, but not the blood thinner rivaroxaban, saw a small additional benefit in fatigue reduction at 12 weeks (an extra 1.5 point improvement on the scale). However, this benefit was not sustained at 24 weeks (12 weeks after the participants stopped taking the drugs).

The trial was conducted by a national team of researchers, clinicians and patients across 12 clinics in England and Scotland led by co-chief investigators Professor Amitava Banerjee at UCL and Dr Melissa Heightman at UCLH. More than 30 organisations were involved, with UCLH recruiting around half the patients on this trial and the University of Lancashire Clinical Trials Unit co-ordinating all of the recruiting sites.

Professor Banerjee (UCL Institute of Health Informatics), the corresponding author, said: “We tested potential medicines based on the most promising theories of how to improve long Covid when we started out in 2021. Our findings suggest these drugs alone are unlikely to be the answer to long Covid fatigue. Antihistamines and the anti-inflammatory drug, colchicine, did provide a small benefit, but this did not last once participants stopped taking them and so they are unlikely to improve symptoms over the long term on their own.

“Both antihistamines and colchicine affect the immune system and it may be that they address the immune dysregulation that long Covid has been linked to, but further research is needed to understand the possible mechanism.

“The blood thinner, rivaroxaban, had no benefit and so our results do not support the use of anti-coagulation medicine for long Covid.”

Dr Melissa Heightman, clinical lead for the post-Covid service at UCLH, said: “It is heartening that people had a significant reduction in fatigue across all arms of the trial. This is more than you would expect based on time alone, given that participants had severe fatigue at recruitment and been ill for more than a year on average.

“This level of improvement shows the importance of specialist long Covid care. These services in England offer integrated care from a range of specialties with community-based rehabilitation to develop a plan for a person based on their symptoms and all of the ways the condition affects them.”

Participants of the trial were adults with long Covid who had not been hospitalised. The 12 long Covid clinics ranged from Hull and the Highlands to Leicester and London. Fatigue was assessed with a questionnaire at the start of the trial and then after 12 and 24 weeks.

The trial was open-label, meaning participants knew which drug they were taking (there was no placebo in the non-drug group), and so the researchers were unable to rule out a placebo effect. However, they said the benefit seen in two of the drug groups was unlikely to be caused by placebo alone, given that no such benefit was found for the other drug group (rivaroxaban).

Professor Banerjee said: “We have shown it is possible to conduct a large clinical trial for long Covid and to test treatments as we would for any other condition.”

Professor Danny McAuley, Scientific Director for NIHR Programmes, said: “The NIHR is proud to have funded this vital trial, which highlights the value of specialist care in delivering meaningful relief for long Covid patients. Finding even modest benefits for these inexpensive drugs, which are safe and commonly used for other conditions, is incredibly important to improve the evidence-based treatment of this complex condition. By providing the high-quality data needed to refine clinical approaches, this research ensures that the NIHR is helping to build a clearer, safer path forward for patient care which can be provided in the community.”

Professor Emma Wall, Clinical Research Group Leader at the Crick, Professor of Infectious Diseases at Queen Mary University of London, and academic consultant in Infectious Diseases and Acute Medicine for UCLH, said: “Because long Covid is such a new and complex condition, when it came to designing the trial, we started by listening to what patients were telling us about their symptoms and experiences, then looking for biological signals that might explain them and treatments that might help.

“The value of these results is not only that they suggest a potential treatment approach, but that they help us understand the biology of long Covid itself. Every signal we see in the trial helps us refine our understanding of the immune and inflammatory mechanisms that may be driving the disease, to develop new, better targeted treatments for future trials.”

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