Current HIV/AIDS Reports最新文献

Purpose of the review: Trauma is common among people living with or at risk for HIV and associated with increased HIV risk and worse HIV care outcomes. Trauma-informed care (TIC) may improve clinical interactions and support care engagement yet may be difficult to implement as a multi-component organizational intervention. We aimed to identify research on implementation of TIC in HIV prevention and treatment settings and assess barriers and facilitators to implementation.

Recent findings: We identified 13 peer-reviewed articles implementing trauma-informed HIV prevention or treatment in clinical settings. Barriers and facilitators to implementation were identified across all five Consolidated Framework for Implementation Research 2.0 domains, with most falling in inner and outer setting domains. We identified consistently influential system-level factors to enable deployment of targeted implementation strategies for TIC integration. Suggested strategies include training, capacity building, technical assistance, and workflow integration strategies that reduce resource strain.

Purpose of the review: Sexually transmitted infections (STIs) include a diverse set of bacteria, viruses, parasites, and other pathogens that can facilitate transmission of Human Immunodeficiency Virus (HIV). However, the extent to which STIs increase HIV risk and public health approaches to address this are still evolving.

Recent findings: Compelling evidence suggests STIs increase the risk of HIV acquisition and transmission. STIs may lead to higher rates of HIV infection through multiple mechanisms including inflammation and disruption of the epithelium, facilitating immune cells which are targets of HIV, and increased viral load shedding in those that have HIV. While previous STI control efforts have shown mixed effectiveness in reducing HIV incidence, the success of doxycycline prophylaxis for preventing bacterial STIs offers a promising approach that may help prevent HIV at the population-level. STIs significantly increase the risk of HIV acquisition and transmission. Increased understanding of public health approaches, which both contribute to STI control and also prevent HIV transmission, is needed.

Purpose of review: Low-level viremia (LLV) remains common in the modern HIV treatment era. We sought to clarify a unified definition of LLV, examine current LLV risk factors, assess outcomes for people with LLV, explore sex and gender differences, and evaluate management updates for people who develop LLV.

Recent findings: There continue to be varied definitions of LLV without standardization, making comparison of clinical research findings challenging. Potential LLV risk factors have expanded and early data suggest that poor antiretroviral therapy adherence is unlikely to be the cause of most LLV; further, integrase strand transfer inhibitor use may be protective. Recent studies confirm that LLV is associated with virologic failure among other negative outcomes including a trend toward development of non-AIDS comorbidities; these effects may be more pronounced among women. Additional research, including randomized clinical trials, evaluating different strategies for managing LLV is urgently needed to prevent negative outcomes in persons with HIV.

Purpose: This update addresses HIV/TB co-infection management in pregnancy, focusing on new treatment options.

Recent findings: Pregnancy with HIV increases TB risk and worsens treatment outcomes. While long-acting antiretroviral therapies (LA-ART) like cabotegravir/rilpivirine and lenacapavir exist, data on their safety and efficacy in pregnant individuals are limited. Treating both HIV and TB is crucial, but pregnancy's physiological changes complicate drug management. Standard ART and TB preventive therapy (TPT) with isoniazid are recommended after excluding active TB, despite some concerns about adverse outcomes when combined with ARV treatment. For active drug-resistant TB, the new 6-month BPaLM regimen (bedaquiline, pretomanid, linezolid, moxifloxacin) is not recommended in pregnancy due to limited safety data on pretomanid. Instead, a 9-month regimen is preferred, though bedaquiline and pretomanid are likely safe. More research on these new therapies in pregnant populations is needed. While standard ART remains the recommended approach for HIV/TB co-infection in pregnancy, further research is crucial to establish the safety and efficacy of newer LA-ART and bedaquiline-based TB regimens in this high-risk population. Concerns around the safety of TPT in pregnancy remain unanswered and further prospective research is urgently needed.

Purpose of review: The objective of this review is to examine the intersection of pregnancy and HIV, focusing on birthing person and fetal health outcomes, prevention of perinatal HIV transmission, and the latest advancements in treatment and care in the United States. It highlights current guidelines, challenges in management, and future directions for improving outcomes.

Recent findings: HIV treatment guidelines continue to highlight key principles for the choice of antiretroviral therapy in pregnancy, challenges, and strategies for adherence support. Guidelines have been updated to reflect patient-centered counseling to support shared decision making about infant feeding. Counseling should begin prior to pregnancy, and be reviewed throughout pregnancy, again at delivery, and throughout the periods when breast/chestfeeding occurs. ART use during pregnancy has significantly reduced perinatal HIV transmission. Ongoing research and collaboration are vital to addressing remaining challenges. Prioritizing maternal and infant health ensures that ART not only prevents transmission but also improves future health for families affected by HIV.

Purpose of review: Stigma and discrimination remain critical determinants of HIV inequities among people with and vulnerable to HIV (PWAVH), as they are key drivers of HIV outcomes by restricting access to health-enabling resources.

Recent findings: As the preponderance of HIV-related stigma interventions have mostly targeted individual and/or interpersonal psycho-social spheres, there remains a critical need for increased HIV-related stigma interventions at community and structural levels concurrently. Structural and multi-level HIV stigma interventions, though challenging to implement and underfunded, may be more effective in reducing HIV-related stigma by targeting underlying systemic issues perpetuating inequitable access to social determinants of health. Eradicating HIV and overcoming HIV-related stigma will require systemic changes intended to pursue health equity. This commentary emphasizes expanding our focus from developing interventions that not only reduce the ramifications of stigma but also work to eradicate stigma through multi-level efforts, including structural change.

Purpose of review: Broadly neutralizing antibodies (bNAbs) represent a novel approach to HIV treatment, prevention, and cure strategies. As research advances, the clinical application of bNAbs continues to evolve. This review explores the potential role of bNAbs in HIV management, addressing their mechanisms of action, current limitations, and future directions.

Recent findings: Recent studies have demonstrated that bNAbs can effectively neutralize a broad range of HIV strains by targeting conserved epitopes on the viral envelope. Clinical trials have shown that bNAb combinations can maintain viral supression in the absence of antiretroviral therapy (ART), though pre-existing resistance remains a major challenge. Strategies such as Fc engineering and alternative delivery mechanisms (e.g., AAV, mRNA, DNA) are being explored to enhance bNAb efficacy and durability. Despite promising data, bNAbs have not yet demonstrated superior effectiveness compared to existing ART or pre-exposure prophylaxis (PrEP) options. While bNAbs offer exciting possibilities for long-acting HIV therapy, their widespread use is limited by logistical challenges, high production costs, and pre-existing viral resistance. The future of bNAbs may lie in combination strategies with small-molecule antiretrovirals in maintenance strategies, genetic delivery systems, and vaccine-based approaches to induce endogenous bNAb production. Further research is needed to refine these strategies and determine the optimal role of bNAbs in HIV care.

Background: Despite encouraging declines in the overall rate of new transmission globally, HIV prevention efforts targeting individuals in the criminal legal system continue to significantly lag behind rates identified in the general population. Prevention efforts targeting this group worldwide remain geographically uneven and differ across the continuum of legal system involvement (diversion, arrests, community supervision, and post-release), which is attributed to social, structural, and systemic barriers. These gaps are noted to disproportionately impact minoritized and other transmission-burdened populations within the criminal legal system (e.g., men who have sex with men).

Objective: Given these challenges, this literature review examines HIV prevention efforts targeting individuals in the criminal legal system across the globe.

Methods: This review identifies current reach and gaps in prevention care and proposes strategies for improvement.

Results: Recommendations include updating and utilizing long-term platforms for sustained HIV prevention interventions, developing a global compendium for regions outside the U.S., enhancing targeted interventions in high-risk areas, and integrating HIV prevention with other health services while addressing stigma.

Conclusions: These actions are critical for ensuring that interventions remain up-to-date, sustainable, and culturally responsive, effectively addressing the unique needs of diverse populations and criminal legal system contexts. These measures are also vital for meeting the U.N. 95-95-95 targets for HIV testing, treatment, and viral suppression, ultimately contributing to the goal of ending the HIV epidemic among this high-need population.

Purpose of review: Long-acting injectable (LAI) antiretroviral therapy (ART) for treatment of HIV-1 are approved both as a complete treatment regimen (cabotegravir/rilpivirine) and as an additional treatment option (lenacapavir) for those with multidrug resistant HIV-1. Here, we review the data supporting these approvals, pharmacokinetics, and additional patient populations that many benefit from LAI ART.

Recent findings: Persons with HIV and adherence challenges as well as those in low-and-middle income countries have high rates of adherence and viral suppression with LAI ART. LAI cabotegravir/rilpivirine (CAB/RPV) offers an alternative treatment approach to daily oral ART for people with HIV-1 infection that is associated with high rates of patient satisfaction when compared to daily oral ART. LAI CAB/RPV is currently only approved in those with HIV-1 viral suppression, however recent data support the use of LAI ART in populations with adherence challenges. Furthermore, given high rates of NNRTI resistance globally, CAB/RPV is not recommended in low-and-middle income countries presently, although this recommendation is likely to change based on recently published data. More research is needed among groups that may benefit from long-acting treatments for HIV-1.