Current HIV/AIDS Reports最新文献

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.

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.