Current HIV/AIDS Reports最新文献

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.

Purpose of review: HIV remains a significant global public health concern, affecting millions worldwide, including children. Disclosure of HIV status to infected children holds several benefits, yet rates of disclosure remain low, posing challenges globally. Whereas existing interventions and strategies offering insights into the process of HIV disclosure to pediatric populations are sparse, there is a gap in synthesizing these approaches comprehensively to shed light on effective practices and areas requiring further research and development. This study aims to address this gap by providing a narrative overview of interventions and strategies utilized to empower parents, caregivers, and healthcare providers in the process of disclosing HIV status to children living with HIV.

Recent findings: Our review of 26 publications identified various pediatric HIV disclosure interventions and strategies, including provider-informed frameworks, process-oriented models, and multidisciplinary approaches. Common themes that emerged include developmental appropriateness, gradual disclosure, education through visual aids, training and capacity building, cultural sensitivity, and post-disclosure monitoring and support. Overall, the majority of the interventions and strategies showed positive outcomes in improving disclosure rates and supporting children's well-being. This study provides valuable insights for policymakers, healthcare providers, and researchers, informing strategies to improve communication and support for children living with HIV and their families. By emphasizing the importance of age-appropriate and culturally sensitive disclosure methods, we can strive to enhance the well-being and quality of life for children living with HIV.

Background: There is an urgent need to improve interventions for HIV and syphilis in pregnancy to achieve elimination.

Results: The tenets of vertical transmission strategies for HIV and syphilis overlap but have varying success due to differences in their transmission dynamics, diagnoses, and treatment. Key principles include prevention of maternal infection, screening and diagnosis early and throughout antenatal care, curative treatment (syphilis), viral load suppression (HIV), early infant diagnosis and treatment (HIV and congenital syphilis). We recommend improved guidelines, provider training and focused research and surveillance, including implementation studies to align HIV and syphilis screening and treatment during pregnancy. Opportunities to integrate syphilis screening and treatment into antenatal and HIV care enable providers to offer comprehensive maternal care.

Conclusion: Integrated HIV/syphilis services ensure a cohesive and person-centered approach, improving health outcomes through streamlined, efficient, and family-centered care pathways. We recommend key interventions to reduce HIV and syphilis in pregnancy and prevent vertical transmission.

Purpose of review: Advances in HIV testing, prevention, and treatment, alongside increased awareness and harm reduction efforts for substance use disorder (SUD) have improved care and treatment access over the past decade. However, racial and ethnic minorities with SUD and HIV or at risk for HIV still face disproportionately high health disparities. Understanding and addressing the reasons behind these disparities is crucial.

Recent findings: Structural and systemic barriers continue to negatively impact minoritized communities, due to lack of access to care, mistrust, and feelings of ostracization. Disconnected systems for HIV and SUD treatment complicate combined care. Delays in HIV diagnosis and viral suppression reduce life expectancy for minority populations by around 10 years. Healthcare systems need to become more integrated, accessible, and culturally welcoming to marginalized communities. Promising interventions utilizing technology, harm reduction, and mobile service delivery can reduce barriers and improve outcomes for minority individuals.

Purpose of review: Syphilis is caused by Treponema Pallidum and continues to be a significant cause of morbidity across the world with an increase in prevalence over the past two decades. This review aims to highlight rapid, point-of-care (POC) syphilis testing, which offers an innovative approach to improve access to syphilis testing among underserved communities.

Recent findings: POC syphilis testing can potentially shorten the time to treatment. Currently available tests generally have high sensitivity and specificity and report the presence or absence of treponemal antibodies and are not designed to perform non-treponemal antibody testing. Therefore, the main challenge of POC syphilis testing is the inability to distinguish between current infection and a past treated infection. In real-world settings, syphilis POC testing has been acceptable and generally accurate. POC syphilis testing has significant potential to improve access to care and would be most effective in non-clinical settings without readily available access to clinical services. This includes rural settings and other areas that have populations with significant barriers to healthcare, and especially among populations with a historically lower rate of diagnosed syphilis, including pregnant women. Keys to successful implementation include awareness and education on how to perform the test and interpret results, as well as use in suitable settings and among appropriate populations.

Purpose of review: Rapid, simple, inexpensive tests that can be used to detect sexually transmitted infections (STI) in symptomatic patients and for asymptomatic screening, especially in women, is a global critical unmet need in all income settings. We sought to review the STI diagnostic unmet need and current landscape of diagnostic tests that are either approved or in development.

Recent findings: Diagnostic certainty will be required to decrease the global burden of STI's particularly in low-resource settings where empiric algorithmic care predominates. Lateral flow assays for syphilis and HIV have been successfully used in low- and middle-income countries. Although the performance of reference lab nucleic acid amplification tests is excellent for the detection of Neisseria gonorrhoeae and Chlamydia trachomatis, such tests remain expensive and globally unavailable due to lack of existing clinical lab infrastructure. Importantly, diagnostic innovations from the COVID-19 pandemic are being leveraged for developing molecular STI point-of-care tests and over-the-counter (OTC) self-tests. In the US and other high-income countries, point-of-care testing of both symptomatic and asymptomatic people would allow for a definitive STI diagnosis, appropriate treatment within a clinical encounter, and decreased antibiotic overuse, a significant global public health problem. Most exciting is the possibility for rapid, high performance self-tests. Inexpensive and rapid STI self-test could significantly increase access to STI care and help decrease health inequity.

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.