Current HIV/AIDS Reports最新文献

Purpose of the review: This article presents an overview of the global consensus of the management of pregnant women living with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) co-infection. We summarise findings from the most recent and relevant literature on this topic with a focus on epidemiology, obstetric and pharmacological management and neonatal care.

Recent findings: Guidelines have been revised to reflect the most recent evidence published on the safety and efficacy of both dolutegravir and tenofovir alafenamide in pregnancy. There are encouraging data to suggest that obstetric outcomes in women with HIV/HBV co-infection are comparable to those with HIV or HBV mono-infection. Recent advances in our understanding of the safety profile and efficacy of tenofovir disoproxil/alafenamide and dolutegravir has resulted in these being recommended as first line antiretrovirals, alongside Lamivudine, for HIV/HBV co-infection in pregnancy in United Kingdom, European and the United States guidelines. Appropriate antiretroviral therapy in pregnancy, along with prompt treatment of the neonate, combine to ensure very low rates of perinatal transmission of both HIV and HBV.

Purpose of review: Stimulant use, which includes use of cocaine and methamphetamine, is known to worsen care outcomes among people living with HIV (PLWH). The rise of stimulant use in the United States (US) in the last decade is a threat to the US plan of Ending the HIV Epidemic. Digital interventions - including those delivered through web- and mobile phone-based modalities - may mitigate the scale of stimulant use among PLWH, thereby disrupting HIV transmission attributable to it. We sought to understand the state of digital interventions for stimulant use among populations of PLWH, with the goal of highlighting opportunities to expand such public health responses to stimulant use.

Recent findings: Overall, digital interventions for stimulant use among PLWH appear feasible, clinically effective, and cost-effective. The state of these advancements has not been thoroughly examined or summarized to date. Since 2010, 17 publications have examined the feasibility, acceptability, and/or effectiveness of digital interventions for stimulant use among PLWH. The ubiquity of smartphones and opportunity to offer such interventions alongside HIV care services highlight the need for future research in this area, particularly those that target populations with suboptimal HIV care outcomes and who may benefit most from digital intervention modalities.

Purpose: This review highlights the importance of Hepatitis B virus (HBV) integrated into the host genome (iDNA) to functional cure and how human immunodeficiency virus (HIV) may affect HBV integration.

Recent findings: Functional cure of chronic hepatitis B infection is characterized by durable loss of hepatitis B surface antigen (HBsAg) from blood after treatment discontinuation. Because HBsAg is transcribed from two intrahepatic sources, covalently closed circular DNA (cccDNA) or iDNA, functional cure requires elimination or silencing of both sources. It is not clear how HIV affects HBV integration, but since HIV enhances HBV replication and leads to increased DNA breaks through oxidative stress, people with HIV and HBV may have more integration events. HBV integration into the human genome is a random and ongoing process that occurs during all phases of chronic HBV infection (CHB). iDNA is important for maintaining HBsAg expression despite antiviral therapy. In studies without HIV, higher levels of HBV replication are associated with increased integration events. Higher HBV DNA levels in HIV/HBV co-infected individuals may contribute to increased HBV integration. HIV worsens CHB by weakening immune responses, promoting oxidative stress, and activating cellular pathways that enhance HBV replication and integration.

Purpose of review: People with HIV and HBV coinfection have increased risk of developing liver fibrosis and hepatocellular carcinoma (HCC) compared to either infection alone. We review current and emerging tools for HCC diagnosis and prediction in the context of HIV-HBV coinfection.

Recent findings: Treatment with antiviral therapy and the goal of full viral suppression of both HBV and HIV remains foundational to care for people with HIV-HBV coinfection. All patients with chronic HBV and elevated risk, including cirrhosis or HIV infection, should undergo HCC screening. Tools exist to risk stratify patients with HBV without cirrhosis include PAGE-B, AFP-based tests, GALAD, and ct-DNA liquid biopsy. A limitation is that only PAGE-B has been validated in people with HIV-HBV coinfection. Current tools for HCC detection in people with HIV-HBV coinfection are generally limited to those developed in people with HBV monoinfection, with exception of PAGE-B. Future development of tools to predict and diagnose HCC are needed for people with HIV-HBV coinfection.

Purpose of review: Coinfection with HIV-HBV results in increased rate of liver disease progression through immune and metabolic dysfunction. Additional metabolic risks in ageing people with HIV (PwHIV) contribute to hepatic necroinflammation and fibrogenesis. There are now several blood-based and imaging non-invasive tests (NIT) that are increasingly available as an alternative to biopsy to estimate hepatic fibrosis.

Recent findings: There are few studies for NITs and fibrosis in PwHIV-HBV. Simple tests such as FIB-4 and APRI have poor diagnostic utility for significant fibrosis or disease monitoring in PwHIV-HBV. Transient elastography (TE) has less variability, and may be useful to exclude advanced fibrosis in patients with low viral load and normal liver enzymes. Combination TE and blood-based NITs with concordant results may be useful, but optimal diagnostic test thresholds have not been established. Interpretation of current NITs in PwHIV-HBV should consider context of use, along with clinical and biochemical variables that limit diagnostic accuracy.

Purpose of review: Liver biopsy and FNA in persons with HIV-HBV coinfection can aid in the assessment of intrahepatic milieu, direct functional cure strategies, and facilitate development of novel therapeutics.

Recent findings: Liver tissue sampling provides important insight into the intrahepatic viral reservoir and complex immune microenvironment in HIV-HBV coinfection. Additionally, the development of tissue-based viral markers, specifically cccDNA and integrated HBV DNA, paired with novel, noninvasive biomarkers and advanced techniques for tissue processing and analysis have been instrumental in this process. Hepatic tissue sampling also offers unique insights into treatment responses and understanding deficiencies of existing therapies that cannot be assessed by noninvasive means alone, which informs the development of novel therapeutics. Liver biopsy and liver tissue fine needle aspiration represent important modalities that will continue to drive research and innovation leading to HBV cure strategies.

Purpose of review: This review explores the promise and challenges of integrating long-acting antiretroviral agents-cabotegravir, lenacapavir, and cabotegravir-rilpivirine-into HIV prevention and treatment programs for pregnant and breastfeeding populations. It aims to examine current evidence, implementation experiences, and barriers to equitable access.

Recent findings: Emerging data support the efficacy and safety of long-acting agents during pregnancy and breastfeeding. Recent clinical trials have begun to include pregnant women by design, and national demonstration projects have successfully introduced injectable PrEP in maternal health settings. These developments signal growing recognition of the need for inclusive research and service delivery models. Long-acting antiretrovirals have the potential to transform maternal HIV prevention and treatment. However, challenges such as delayed inclusion in trials, policy constraints, limited product choice, high costs, and funding limitations persist. Addressing these gaps is critical to ensuring equitable access and informing future research and implementation strategies.

Purpose of review: Big Data sources, specifically electronic health records (EHR) and insurance claims data, are key in advancing HIV research. This scoping review summarizes recent research using EHR/claims to understand the evolving relationship between HIV and comorbidities.

Recent findings: Data sources ranged from individual health system EHR to multi-system integrated datasets. Datasets that linked insurance claims or EHR with external sources (e.g. public health HIV surveillance, social systems) had the richest findings. PLWH who maintained care for HIV and comorbidities, including COVID-19, had similar health outcomes to peers living without HIV. Mental health, substance use disorders, and HPV-related cancers remain prevalent in PLWH. HIV stigma and racial disparities in non-HIV comorbidity care were detected. These findings reinforce evidence of improving general health for PLWH as research and evidence-based treatment progress, and the utility of Big Data for PLWH in public health emergencies like COVID-19. There is continued need for tailored interventions for co-morbid mental health and some cancers. Linking EHR/claims data to external sources are critical to research and practice innovations in approaching whole-person care on the path to HIV elimination.

Purpose of review: Death following hospitalization remains strikingly high for people living with HIV (PLHIV) in sub-Saharan Africa. Hospitalization represents a key opportunity for targeted interventions, yet evidence for effective approaches remains limited. We conducted a best-evidence narrative review, framed by the Andersen Model of Health Care Utilization, to examine factors contributing to post-hospital mortality and assess recent interventions.

Recent findings: PLHIV in sub-Saharan Africa have a 12-26% risk of death within 3-6 months of discharge. Social and structural barriers-including poverty, stigma, food insecurity, and low self-efficacy-are central mediating factors. We reviewed three disease-neutral interventions (HomeLink, Daraja, ReCharge) providing home-based support, counseling, and care linkage. While feasible and acceptable, mortality impact was mixed due to small sample sizes and advanced illness. The hospital-to-home transition is a critical window for intensified differentiated services to reduce mortality among PLHIV. Further research is needed to define scalable and cost-effective models to improve survival and close gaps in HIV care.