Paediatric Infectious Diseases, St George's Hospital.
MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London.
Section of Paediatrics, Imperial College, London, UK.
PURPOSE OF REVIEW:
Advances in diagnostic methods mean that coinfections are increasingly being detected in clinical practice, yet their significance is not always obvious. In parallel, basic science studies are increasingly investigating interactions between pathogens to try to explain real-life observations and elucidate biological mechanisms.
Coinfections may be insignificant, detrimental, or even beneficial, and these outcomes can occur through multiple levels of interactions which include modulation of the host response, altering the performance of diagnostic tests, and drug-drug interactions during treatment. The harmful effects of chronic coinfections such as tuberculosis or Hepatitis B and C in association with HIV are well established, and recent studies have focussed on strategies to mitigate these effects. However, consequences of many acute coinfections are much less certain, and recent conflicting findings simply highlight many of the challenges of studying naturally acquired infections in humans.
Tackling these challenges, using animal models, or careful prospective studies in humans may prove to be worthwhile. There are already tantalizing examples where identification and treatment of relevant coinfections seems to hold promise for improved health outcomes.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.