Current HIV/AIDS Reports最新文献

Purpose of review: Antiretroviral therapy has significantly improved the life expectancy of people with HIV (PWH), leading to an increased prevalence of comorbidities such as end-stage organ diseases. PWH with end-stage disease face a significantly higher risk of mortality compared to those without HIV, highlighting the urgent need to improve access to organ transplantation for this vulnerable group. This review examines barriers to organ transplantation for PWH, utilizing a modified five A's model (acceptability, availability, accessibility, affordability, accommodation).

Recent findings: Despite comparable post-transplant outcomes to the general population, PWH are less likely to receive organ transplants. The HIV Organ Policy and Equity (HOPE) Act has expanded the donor pool by permitting organ transplants from donors with HIV to recipients with HIV. However, factors limiting expansion include policy, logistical constraints, and HIV-related stigma. Despite pivotal advancements in HIV organ transplantation, multilevel challenges continue to limit access for PWH. Addressing these barriers is essential to ensuring equitable access to this life-saving therapy.

Purpose of review: Digital health interventions have demonstrated great potential to advance HIV prevention and care. However, their effectiveness in improving the pre-exposure prophylaxis (PrEP) care continuum has not yet been validated. This systematic review aimed to evaluate the effectiveness of digital health interventions in enhancing the PrEP care continuum among men who have sex with men (MSM) populations.

Recent finding: Following PRISMA guidelines, a comprehensive search was conducted across four databases-PubMed, Web of Science, Embase, and Cochrane Library-to identify randomized controlled trials (RCTs) published before July 2, 2024. Out of the 3,539 records initially identified, 12 RCTs met the inclusion criteria. The majority of the studies were conducted in the United States (10/12, 83.3%), with the remaining 2 studies conducted in China. Participant ages ranged from 18 to 65 years. The studies employed various digital health tools, including mobile apps, text message, and social media platforms. While digital health interventions were found to be feasible and acceptable, only a few studies demonstrated statistically significant increases in PrEP utilization and adherence. Digital health interventions have demonstrated potential to enhance the PrEP care continuum in MSM populations. Future research should focus on large-scale, multicenter trials that combine digital tools with personalized, culturally sensitive strategies to improve PrEP uptake and adherence. Integrating big data, artificial intelligence (AI), and non-digital approaches like community outreach and psychosocial support could further strengthen the effectiveness of these interventions.

Purpose of review: Chronic pain affects 25-85% of people living with HIV (PLWH), negatively impacting health behaviors and HIV health outcomes. While opioids are frequently prescribed for pain, there are concerns about side effects and addiction potential, and the current consensus guideline advises against their use as a first-line pain management for this population. Therefore, there is an increasing need for non-pharmacological alternatives and adjunctive interventions. This review aims to examine the characteristics, efficacy, and limitations of existing non-pharmacological approaches to chronic pain management in PLWH to inform clinical practices and future research.

Recent findings: A comprehensive literature search identified 13 clinical trials employing cognitive-behavioral techniques, stress management, positive affect enhancement, and complementary medicine approaches (e.g., yoga, acupuncture, hypnosis). These interventions generally showed significant effects with respect to reducing pain intensity and interference in PLWH, with some also addressing and improving depression, substance use, or antiretroviral medication adherence. However, some were pilot trials and others lacked robust methodologies or sufficient follow-up regarding the ability to definitively determine the durability of these benefits. Existing non-pharmacological interventions have potential in addressing pain and related functional impairment in PLWH, such as substance use and emotional well-being. Future research should explore the underlying mechanisms of these interventions and better understand strategies to optimize and establish durability. Incorporating adherence counseling into these interventions could further enhance HIV outcomes by addressing the interconnected challenges of chronic pain and adherence to antiretroviral therapy (ART), thereby supporting both pain management and overall HIV care.

Purpose of review: This review examines the growing need for alternative technologies to address the resurgence of syphilis, particularly its congenital and late-stage manifestations. It explores current treatment paradigms, highlights the limitations of penicillin, and evaluates emerging evidence on new therapies and diagnostics to inform future strategies.

Recent findings: Recent breakthroughs in Treponema pallidum culture techniques have enabled antibiotic susceptibility testing, expanding knowledge on both established and emerging treatment options. Alternatives like ceftriaxone, doxycycline, cefixime, and dalbavancin show promise, with other candidates in trials, though evidence is limited beyond early-stage syphilis. Shortened penicillin regimens also challenge historical assumptions about treatment duration. Advanced molecular diagnostics may complement currently limited serologic monitoring to improve evaluations in healthcare and research. While penicillin remains effective, its limitations necessitate alternatives. Emerging antibiotics and improved diagnostics offer opportunities to simplify treatment and enhance care. Future robust trials should validate new treatments, refine dosing strategies, and integrate innovative diagnostics, particularly including underserved and vulnerable populations.

Purpose of review: Despite the proliferation of evidence-based digital HIV prevention and care interventions for youth globally, their implementation remains suboptimal. This scoping review aimed to identify implementation strategies used to deliver digital HIV interventions to youth.

Recent findings: We reviewed studies published in PubMed between 2018-2024 that described the development or use of implementation strategies for digital HIV interventions for youth. We identified eight studies that reported on implementation strategies and an additional 37 studies that reported on implementation outcomes. The predominant strategy used was identifying and preparing champions, such as peer leaders. Most studies assessed implementation outcomes of acceptability and feasibility, while few evaluated long-term outcomes like cost or sustainability. This review highlights the emerging, under-researched state of implementation science around digital HIV interventions in both the United States and low- and middle-income countries. Further research is needed to develop and test implementation strategies aligned to digital interventions; otherwise, evidence-based digital HIV interventions will remain underused by broader youth populations.

Purpose of review: The purpose of this narrative review is to delineate the challenges of transitioning young people living with HIV (YPLHIV) to adult-based care and to review recent literature including both qualitative and interventional studies focused on the process of transitioning.

Methods: A search in PubMed and Embase was conducted using the key words "adolescent." "young adult," "transition to adult care," "HIV," and "AIDS," including only articles published from 2019 onwards. Conference proceedings from major peer-reviewed conferences focused on YPLHIV were manually searched for studies from January 2021 to December 2023. Data extraction included variables such as study type, participant ages, location, and, for intervention studies, detailed descriptions and outcomes, which were further categorized into themes. Results are included in Table 1 and Table 2.

Recent findings: Experts still debate about what a successful transition means which makes studying it harder. Challenges to successful transition include heterogeneity of the population, inconsistency with transition timing, mobility, and stigma. Recent qualitative studies that elicit feedback from stake holders reveal individual barriers such as lack of self-efficacy and fears of successive disclosures. A major facilitator to successful transition is having youth-friendly services in the adult clinic. Interventional studies emphasize the evidence for transition readiness assessments, transition protocols, mobile health engagement, transition clinics, and health care transition navigation. Health care teams who care for YPLHIV before, during, and after transition need to recognize how vulnerable this population can be. Therefore, transition must be formally addressed and grounded in the local settings and needs. Simple interventions have the potential to improve transition outcomes.

Purpose: This perspective explores the impact of home-based sexual health services on accessibility to STI and HIV testing for priority populations. This study evaluates home-based services as independent care options and as complementary components of traditional clinic-based care.

Recent findings: Challenges for persons to attend clinic-based sexual health care can be overcome by offering lower threshold home-based sexual health care. Implementing home-based services has successfully reached priority populations, including previously untested men who have sex with men (MSM) and individuals with a high exposure risk for sexually transmitted infections (STI) including human immunodeficiency virus (HIV), attending location-based sexual health care. A challenge in home-based services is to ensure equitable care, such as for individuals with limited access to digital resources or low health literacy. While home-based sexual health services enhance the accessibility of sexual healthcare, to ensure equitable care, research into the needs of still underserved populations and subsequent tailoring of the care offered, is needed. Continuous monitoring and evaluation of the implementation of home-based services may maximize the advantages of this promising type of care.

Purpose of review: This review explores how cannabis impacts the gut microbiome, immune system, and ART outcomes in people with HIV (PWH). Given the increasing prevalence of cannabis use among PWH, we investigated its potential to reduce chronic inflammation and enhance gut health, both of which can influence HIV pathogenesis.

Recent findings: Cannabis has immunomodulatory and anti-inflammatory effects, including reducing systemic inflammatory biomarkers (such as MCP-1 and IP-10) and improving gut barrier integrity through increased short-chain fatty acid (SCFA) production. Studies have shown that cannabis use is associated with increased gut mucosal immunity, decreased immune activation, and a unique microbiome composition. Preliminary evidence indicates that cannabis may influence HIV reservoirs, although the results remain inconclusive. Cannabis shows promise in managing inflammation, gut dysbiosis, and immune dysfunction in PWH. However, its effects on HIV reservoirs, adherence to antiretroviral therapy, and long-term outcomes need further investigation through rigorous clinical trials using standardized formulations.

Purpose of review: Cervical cancer burden is disproportionately higher in low to middle income countries, especially in countries with a high human immunodeficiency virus (HIV) burden. This review investigates barriers to implementation and assesses current progress in cervical cancer screening in lower resource settings by reviewing technologies and strategies that have already been implemented in low to middle income countries.

Recent findings: Several novel innovations embrace the recent World Health Organization (WHO) update to screening guidelines that recommends a "screen and treat" approach rather than a "screen, triage and treat" approach. Innovations include human papillomavirus (HPV) self-sampling, portable cervical visualization devices, and creative large-scale approaches to increase screening accessibility. Overall, a low-cost, accurate, point-of-care screening test could alleviate most of the barriers associated with cervical cancer screening in lower resource settings. Further research into the development of a low-cost HPV test in conjunction with the HPV vaccine and other screening tools could expedite progress.

Purpose of review: Vaccination recommendations for people with HIV (PWH) differ from the general population given potential for diminished immune responses as well as increased risk for infection or more severe disease. This review highlights updated vaccine recommendations, summarizes available data informing use of vaccines, and identifies areas in need of additional study for adults with HIV.

Recent findings: Vaccine recommendations differ for PWH in terms of timing, dosing, and need to check for serological response. New vaccines are available and recommended for PWH for prevention of invasive pneumococcal disease, respiratory syncytial virus (RSV), COVID-19, mpox, and hepatitis B virus (HBV). People with HIV experience persistent immune dysfunction, characterized by chronic immune activation and increased susceptibility to certain infections. To optimize potential of vaccines to reduce infection and infection-associated malignancies in PWH, strategies to improve vaccine responses and reduce vaccine hesitancy are necessary. While newer adjuvants show promise in enhancing immunogenicity, key questions remain regarding the durability of vaccine-induced protection and the ideal timing and necessity of booster doses for many vaccines.