Current HIV Research最新文献

The Human Immunodeficiency Virus (HIV) is the cause of Acquired Immunodefi-ciency Syndrome (AIDS). Preexposure Prophylaxis (PrEP) antiretroviral drugs to prevent HIV-1 infection are currently available in many countries. In Brazil, the recommended and approved regimen for PrEP is a daily Fixed-Dose Combination (FDC) tablet of Tenofovir Disoproxil Fumarate (TDF) with Emtricitabine (FTC) (300/200 mg), marketed as Truvada®. However, ad-herence to daily oral pill regimens remains one of the greatest challenges for the successful use of PrEP. Therefore, a Long-Acting Injectable (LAI) PrEP regimen, such as Cabotegravir (CAB), could significantly improve adherence to prophylaxis. The aim of this study was to compare the use of PrEP with TDF+FTC and the long-acting injectable cabotegravir, as well as to examine the mechanisms of action of the drugs involved in PrEP. In fact, the results confirmed the safety and efficacy of the use of CAB as an LAI PrEP. In June 2025, the FDA approved the use of LEN for PrEP, and it is expected that other regulatory agencies will follow suit by the end of the year. Emerging strategies under development include annual LEN formulations, the use of broadly Neutralizing Antibodies (bNAbs), and the Dapivirine Vaginal Ring (DPV), which has demon-strated greater convenience and improved adherence among pregnant women compared to oral PrEP. Additionally, digital monitoring tools are being explored, although their effectiveness relies on the implementation of equitable health policies. Thus, integrated prevention models that com-bine biomedical innovations with community-based interventions emerge as essential to expand-ing the reach and impact of PrEP.

Introduction: Human Immunodeficiency Virus (HIV) remains a global epidemic and is frequently associated with neurocognitive impairment, known as HIV-Associated Neurocognitive Disorder (HAND). Brain-Derived Neurotrophic Factor (BDNF), which regulates neuroplasticity, learning, and memory, may play a key role in this process. This study aimed to investigate the correlation between BDNF, CD4 levels, and cognitive function in patients with HIV.

Methods: We conducted a cross-sectional study at Adam Malik General Hospital, Medan, Indonesia, from July 2024 to January 2025. Fifty-eight HIV-positive patients aged 18-60 years with CD4 ≥200 cells/mm³ and on antiretroviral therapy for at least 4 months were included. Blood samples were analyzed for serum BDNF (ELISA) and CD4 counts. Cognitive function was assessed using the Stroop Test, and correlations were examined with Spearman's test Result: Participants had a mean age of 38.77 ± 9.28 years; 79.3% were male. The mean BDNF level was 1.08 ± 0.59 ng/mL, the mean CD4 count was 512.60 ± 331.08 cells/mm³, and the mean Stroop Test score was 68.75 ± 24.60 seconds. A significant negative correlation was observed between BDNF and Stroop performance (r = -0.288, p = 0.028), indicating that higher BDNF was associated with better cognitive function. No significant correlation was found between CD4 and cognitive function (p = 0.336) Discussion: These findings suggest that reduced BDNF may contribute to cognitive impairment in HIV, whereas CD4 levels may not directly reflect neurocognitive status, particularly in patients with CD4 ≥200.

Conclusion: BDNF levels are significantly correlated with cognitive function in HIV-positive patients, underscoring its potential role as a biomarker for HAND.

Introduction: Cancers remain a major cause of mortality among individuals with HIV infection. This study aimed to determine the incidence, prevalence, and mortality of AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) in people living with HIV (PLWH).

Methods: This retrospective, cross-sectional study was conducted in Istanbul. Among patients diagnosed with HIV/AIDS between January 2011 and December 2019, those who developed cancer were analyzed. To assess changes in cancer types over time, the study period was divided into three-year intervals.

Results: Cancer was diagnosed in 57 (3.9%) of the 1,438 patients. The mean CD4 count was 272.3/mm³. Patients in the cancer group had significantly higher mean age at HIV diagnosis, higher HIV RNA levels, and lower CD4+ T lymphocyte counts. A notably high rate (72%) of simultaneous diagnosis of cancer and HIV was observed in the ADCs group. Kaposi sarcoma was identified in 23 (71.8%) patients, and non-Hodgkin lymphoma (NHL) in 9 patients. Hodgkin lymphoma and lung cancer were the most common cancers in the NADCs group.

Discussion: People living with HIV are experiencing longer life expectancy due to ART; however, this also increases cancer risk, emphasizing the need for national screening guidelines that consider age, gender, and immune status. A multidisciplinary approach is essential for effective prevention and treatment strategies. Since cancer risk is multifactorial, larger prospective and multicenter studies are needed to strengthen and expand these findings.

Conclusions: These findings highlight that AIDS-defining cancers continue to be a significant clinical concern in Turkey. Cancer screening should be integrated both at the time of HIV diagnosis and during routine follow-up of PLWH.

Introduction: While care for people with HIV has significantly improved, opportunistic infections remain a risk for patients. Antiretrovirals can interact with the drugs used to treat opportunistic infections, and care must be taken to minimize these interactions.

Methodology: We completed a narrative review of medications to treat opportunistic infections in people with HIV and antiretrovirals.

Results: Here we review the risks of opportunistic infections, most notably hepatitis B, hepatitis C, tuberculosis, cryptococcal meningitis, and pneumocystis pneumonia, in people with HIV, including known and potential interactions between antiretrovirals and the treatments for opportunistic infections, and the mechanisms of these interactions. We also discuss immune reconstitution inflammatory syndrome, an inflammatory response due to immune rebound, which can occur in people treated with antiretrovirals, particularly in patients who have active opportunistic infections.

Discussion: While the risk of IRIS has decreased for many opportunistic infections, it can still occur, particularly in patients who are infected with Cryptococcus neoformans. Treating opportunistic infections in people with HIV requires considerable care and expertise.

Conclusion: While advancements in care have simplified treatment for these patients, there is still a considerable risk of interactions between antiretrovirals and opportunistic infections, as well as the drugs used to treat them. Future strategies, including newer agents, regimen simplification, and comprehensive management strategies, can further decrease the risk of interactions between antiretrovirals and opportunistic infection agents, as well as further decrease the risk of IRIS.

Introduction: The introduction of pre-exposure prophylaxis (PrEP) has significantly improved HIV prevention among men who have sex with men (MSM). Vaccination against hep-atitis A (HAV), hepatitis B (HBV), human papillomavirus (HPV), and monkeypox (Mpox) is strongly advised for MSM, yet coverage remains suboptimal. Recent studies suggest moderate effectiveness against gonorrhoea infection from the 4-component MenB vaccine (4CMenB). This study evaluates the impact of targeted counselling strategies on the uptake of STI-preventive vac-cines in a cohort of MSM on PrEP at Policlinico Umberto I, Rome.

Methods: This retrospective observational cohort study analysed 511 MSM receiving PrEP be-tween January 2021 and December 2024. Participants were assessed for baseline vaccination sta-tus and uptake over an 18-month period. The primary outcome was vaccination coverage at fol-low-up, while the secondary outcome was STI incidence. Statistical analyses included chi-square tests and t-tests to compare vaccination rates across time points and age groups.

Results: At baseline, vaccination coverage was low for HAV (9.8%), HPV (17.6%), 4CMenB (5.9%), HBV (52.6%), and Mpox (48.9%). After 18 months, significant increases were observed (HAV: 56.4%, HPV: 63.6%, 4CMenB: 20.3%, HBV: 86.1%, and Mpox: 65.6%, p<0.05 for all). STI incidence remained high, with syphilis (11.35/100 person-years of follow-up) and Neisseria gonorrhoeae/Chlamydia trachomatis (NG/CT) urethritis (9.35/100 person-years of follow-up) be-ing the most frequent infections.

Discussion: Targeted vaccination counselling integrated with PrEP care significantly increased vaccine uptake among MSM. Structured interventions led to substantial improvements across all age groups. Persistent high STI incidence highlights the need for combined pharmacological and non-pharmacological strategies to optimize STI prevention in this population.

Conclusions: The integration of structured vaccine counselling within PrEP care significantly increased vaccination uptake in MSM.

Background: In their struggle with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, physicians are intensively focused on high-risk patient groups. One such group includes immunosuppressed people living with HIV (PLWH). This study considers the most vulnerable cohort of advanced HIV patients in order to identify potential risk factors for unfavorable SARS-CoV-2 disease (COVID-19) outcomes.

Method: This study analyzed data from a census-based sample of 500 patients. The sample en-compassed all consecutive patients during the study period (2020-2022) who met the inclusion and exclusion criteria. All selected patients, aged over 18 years, were hospitalized with confirmed advanced HIV and moderate to severe COVID-19 coinfection at the Infectious Disease Hospital (IDH) in Moscow from 2020 to 2022.

Results: The overall mortality rate reached 27.0% (135 deaths; 95% CI 23.3-30.9%). Primary analysis identified three key independent predictors of mortality: mechanical ventilation demon-strated the strongest association (aOR 4.29, 95% CI 3.15-5.84, p < 0.001), followed by profound immunosuppression (CD4+ counts below 50 cells/mm³; aOR 3.28, 95% CI 2.41-4.47, p < 0.001) and high HIV viral load exceeding 20,000 copies/mL (aOR 3.37, 95% CI 2.52-4.51, p = 0.003). Secondary outcomes revealed important clinical patterns: oxygen support requirements showed a graded mortality risk from low-flow systems (aOR 3.40, p < 0.001) to mechanical ventilation (aOR 4.29, p < 0.001), while newly diagnosed HIV patients faced significantly higher mortality (46.2%) compared to known HIV cases (24.6%). Opportunistic infections substantially worsened prognosis, particularly Kaposi's sarcoma (aOR 3.17, 95% CI 2.28-4.41, p < 0.001), pneumocystis pneumonia (aOR 2.74, 95% CI 1.98-3.79, p < 0.001), and CMV pneumonitis (aOR 2.56, 95% CI 1.85-3.54, p < 0.001). Protective factors included preserved immunity (CD4+ >500 cells/mm³; aOR 2.77, 95% CI 2.08-3.69, p = 0.03) and virological suppression (aOR 2.22, 95% CI 1.67-2.95, p = 0.001). Ferritin levels above 600 ng/mL emerged as an additional risk marker (aOR 1.73, 95% CI 1.32-2.27, p = 0.0006), though with less robust association than primary predictors.

Conclusion: These findings can provide physicians with a risk-based prioritization algorithm for patients with COVID-19 and advanced HIV coinfection. Identifying patients at highest risk for unfavorable outcomes ensures timely ICU admission, faster patient examination, and initiation of dedicated treatment.

Introduction: A growing link is observed between cardiovascular disease (CVD) and human immunodeficiency virus (HIV), with more results demonstrating a higher CVD incidence among the HIV population. As the life span of HIV patients rises due to the availability of antiviral treatment, more CVDs and their complications keep unfolding.

Methods: This study followed a retrospective cohort study design and implemented the CDC WONDER (Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research) platform from 2004 to 2020. It assessed deaths caused by HIV alone and deaths where CVD co-occurred with HIV as per the International Classification of Diseases -10th Revision (ICD-10). The dataset included death certificates from all 50 states and the District of Columbia, involving adults aged 25 years and older. The HIV-related crude and age-adjusted mortality rate (AAMR) per 1,000,000 people was calculated to examine national trends in mortality.

Results: Our study unveiled that CVD and HIV-related deaths reached 50,132 deaths in total, while CVD-related deaths were 24,314,677 in number. The overall age-adjusted mortality rate (AAMR) for CVD and HIV-related deaths among adults decreased from 18.85 (95% CI: 18.23 to 19.47) per 1 million individuals in 2004 to 13.73 (95% CI: 13.27-14.20) per 1 million individ-uals in 2020, with an average annual percentage change (AAPC) of -2.36 (95% CI: -3.13 to -1.91) (p value<0.00001). AAMRs were highest among Black or African Americans, followed by Hispanic or Latinos and Whites, where the AAMR of all the races decreased to variable degrees from 2004 to 2020, with the decrease most pronounced in Black patients.

Discussion: CVD and HIV-related versus CVD-related AAMR varied based on geographical regions, with the highest CVD and HIV mortality observed in the Northeast. Metropolitan areas exhibited higher CVD and HIV-related AAMRs than non-metropolitan areas throughout the study.

Conclusion: Our study highlighted rising mortality rates associated with HIV and CVD-related deaths. These can have multifactorial causes that require prompt investigation. The identification of high-risk communities can provide a general framework for targeted interventions and policies that can mitigate the escalating disease burden and mortality linked with HIV and CVD.

Background: Valaciclovir, a prodrug of acyclovir, is used to treat herpes simplex virus infections. The pharmacokinetics of the drug, namely, low oral bioavailability and short half-life, demands an alternative drug delivery system. Since the drug normally targets virus-infected cells and is metabolized into active acyclovir, its therapeutic effect can be achieved through both local and systemic action when administered vaginally. The innate physiological characteristics of the vagina limit long-term drug availability in the vaginal region.

Objective: This study aimed to propose a nanoparticle-loaded in situ gel as a drug delivery system to achieve both local and systemic effects of the drug.

Methods: Ionotropic gelation-high-speed homogenization was adopted to prepare xanthan gum nanoparticles, where crosslinking agents consisted of a combination of sodium citrate and aluminum chloride. Design Expert Software V13 was used to screen the formulation and processing variables. The nanoparticles were characterized by particle size, zeta potential, morphology, drug loading, and in vitro drug release. The selected nanoparticles were combined with 20% w/v poloxamer 407 and 2% w/v HPMC to produce an in situ mucoadhesive gel, and ex vivo drug permeation was established.

Results: Drug loading ranged from 79.92±0.11 to 95.52±0.11%. During the 12-hour investigation, drug release was promising. The optimum formula exhibited a zeta potential of -18.6 mV and an average particle size of 117.0 nm. The optimized nanoparticle permeability coefficient was fourfold higher than that of the drug-embedded gel. The in situ gel's adhesion strength (0.784 N) revealed adequate mucoadhesive properties.

Conclusion: Nanoparticulate mucoadhesive gels are a promising approach for the management of genital herpes infection.

Introduction: Co-infections with human cytomegalovirus (HCMV), hepatitis B virus (HBV), hepatitis C virus (HCV), and Toxoplasma gondii (T. gondii) pose clinical challenges in human immunodeficiency virus-1 (HIV-1)-infected individuals by complicating disease progression and management. This study aimed to investigate the serological and molecular prevalence of HCMV, HBV, HCV, and T. gondii co-infections among treatment-naive HIV-infected individuals.

Methods: A cross-sectional study was conducted from March 2022 to August 2024 on 203 treatment-naive HIV-1-infected individuals. Plasma samples were analyzed using ELISA for serological markers and real-time PCR for molecular detection. Statistical analyses were performed to assess demographic and clinical variables associated with co-infections.

Results: Among the 203 participants, the prevalence of anti-HCV antibodies, HBsAg, HCMV IgM, and T. gondii IgM was 9.9%, 2.5%, 1.5%, and 0.5%, respectively. Molecular detection confirmed active HBV, HCV, and HCMV infections in 40%, 60%, and 66.7% of seropositive individuals, respectively, while T. gondii DNA was undetected. HCV genotyping revealed subtype 1a as the most common (50%), followed by 3a (37.5%) and 1b (12.5%).

Discussion: The findings indicate a moderate prevalence of HBV and HCV co-infections and a low prevalence of HCMV and T. gondii co-infections in treatment-naive HIV patients.

Conclusion: These results highlight the need for targeted public health interventions, including vaccination and screening strategies, to reduce the risk of co-infections in HIV-infected individuals.