Current HIV/AIDS Reports最新文献

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.

Purpose of review: Doxycycline post-exposure prophylaxis (doxy PEP) has proven to be highly effective in reducing the incidence of sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender women. In response, the US Centers for Disease Control and Prevention (CDC) issued official clinical guidance on the use of doxy PEP as a preventive intervention in these populations. However, despite strong evidence supporting its use, the potential risks of antimicrobial resistance (AMR) along with its limited accessibility in other key populations, remain significant concerns with doxy PEP.

Recent findings: Real-world data show strong awareness, interest, and usage of doxy PEP among MSM and transwomen. Early ecological studies have revealed population-level reductions in chlamydia and early syphilis incidence following doxy PEP implementation. Ongoing research continues to explore its efficacy in other populations, as well as its impact on both individual and population-level AMR. Doxy PEP is a well-tolerated and inexpensive intervention that has the potential to substantially reduce bacterial STIs, particularly in priority populations. Its implementation will require careful assessment of equitable uptake, usage patterns, and long-term monitoring of STI incidence and AMR.

Purpose of review: Despite suppressive antiretroviral therapy (ART), HIV-1 reservoirs persist in various cell types and tissues and reignite active replication if therapy is stopped. Persistence of the viral reservoirs in people with HIV-1 (PWH) is the main obstacle to achieving a cure. Identification and characterization of cellular and tissue HIV-1 reservoirs is thus central to the cure research. Here, we discuss emerging insights into the phenotype of HIV-1 reservoir cells.

Recent findings: HIV-1 persists in multiple tissues, anatomic locations, and cell types. Although contributions of different CD4 + T-cell subsets to the HIV-1 reservoir are not equal, all subsets harbor a part of the viral reservoir. A number of putative cellular markers of the HIV-1 reservoir have been proposed, such as immune checkpoint molecules, integrins, and pro-survival factors. CD32a expression was shown to be associated with a very prominent enrichment in HIV-1 DNA, although this finding has been challenged. Recent technological advances allow unbiased single-cell phenotypic analyses of cells harbouring total or intact HIV-1 proviruses. A number of phenotypic markers have been reported by several independent studies to be enriched on HIV-1 reservoir cells. Expression of some of these markers could be mechanistically linked to the reservoir persistence, as they could for instance shield the reservoir cells from the immune recognition or promote their survival. However, so far no single phenotypic marker, or combination of markers, can effectively distinguish HIV-infected from uninfected cells or identify all reservoir cells.

Purpose of review: Antimicrobial resistance in sexually transmitted infections (STIs) has become an urgent global public health threat, raising the specter of untreatable infections. This review summarizes the determinants of resistance among the five most common curable STIs Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Treponema pallidum, and Trichomonas vaginalis, as well as strategies to mitigate the spread of resistance.

Recent findings: Genetic mutations are key drivers of resistance for N. gonorrhoeae and M. genitalium. Resistance in T. vaginalis can also occur because of genetic mutations, yet differential regulation of genes critical in antibiotic metabolism as well as co-infection with organisms that inactivate therapy play important roles. While resistance in C. trachomatis and T. pallidum has not been a substantial clinical concern, resistance selection via the continued widespread use of antimicrobials remains possible. While resistance determinants are diverse and differ by pathogen, the strategies required to mitigate the continued emergence of resistance are similar: prevention of infection and treatment diversification. Underpinning those strategies, surveillance remains essential for monitoring and responding to the threat of drug-resistant infections.