Pub Date : 2023-04-01DOI: 10.1007/s11904-023-00648-y
Brandilyn A Peters, Robert D Burk, Robert C Kaplan, Qibin Qi
Purpose of review: To synthesize recent evidence relating the gut microbiome and microbial metabolites to cardiovascular disease (CVD) in people living with HIV (PLWH).
Recent findings: A few cross-sectional studies have reported on the gut microbiome and cardiovascular outcomes in the context of HIV, with no consistent patterns emerging. The largest such study found that gut Fusobacterium was associated with carotid artery plaque. More studies have evaluated microbial metabolite trimethylamine N-oxide with CVD risk in PLWH, but results were inconsistent, with recent prospective analyses showing null effects. Studies of other microbial metabolites are scarce. Microbial translocation biomarkers (e.g., lipopolysaccharide binding protein) have been related to incident CVD in PLWH. Microbial translocation may increase CVD risk in PLWH, but there is insufficient and/or inconsistent evidence regarding specific microbial species and microbial metabolites associated with cardiovascular outcomes in PLWH. Further research is needed in large prospective studies integrating the gut microbiome, microbial translocation, and microbial metabolites with cardiovascular outcomes in PLWH.
{"title":"The Gut Microbiome, Microbial Metabolites, and Cardiovascular Disease in People Living with HIV.","authors":"Brandilyn A Peters, Robert D Burk, Robert C Kaplan, Qibin Qi","doi":"10.1007/s11904-023-00648-y","DOIUrl":"https://doi.org/10.1007/s11904-023-00648-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>To synthesize recent evidence relating the gut microbiome and microbial metabolites to cardiovascular disease (CVD) in people living with HIV (PLWH).</p><p><strong>Recent findings: </strong>A few cross-sectional studies have reported on the gut microbiome and cardiovascular outcomes in the context of HIV, with no consistent patterns emerging. The largest such study found that gut Fusobacterium was associated with carotid artery plaque. More studies have evaluated microbial metabolite trimethylamine N-oxide with CVD risk in PLWH, but results were inconsistent, with recent prospective analyses showing null effects. Studies of other microbial metabolites are scarce. Microbial translocation biomarkers (e.g., lipopolysaccharide binding protein) have been related to incident CVD in PLWH. Microbial translocation may increase CVD risk in PLWH, but there is insufficient and/or inconsistent evidence regarding specific microbial species and microbial metabolites associated with cardiovascular outcomes in PLWH. Further research is needed in large prospective studies integrating the gut microbiome, microbial translocation, and microbial metabolites with cardiovascular outcomes in PLWH.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9620539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01Epub Date: 2023-02-21DOI: 10.1007/s11904-023-00651-3
Jennifer L McGuire, Judith B Grinspan, Kelly L Jordan-Sciutto
Purpose of review: : Behaviorally acquired (non-perinatal) HIV infection during adolescence and young adulthood occurs in the midst of key brain developmental processes such as frontal lobe neuronal pruning and myelination of white matter, but we know little about the effects of new infection and therapy on the developing brain.
Recent findings: Adolescents and young adults account for a disproportionately high fraction of new HIV infections each year. Limited data exist regarding neurocognitive performance in this age group, but suggest impairment is at least as prevalent as in older adults, despite lower viremia, higher CD4 + T cell counts, and shorter durations of infection in adolescents/young adults. Neuroimaging and neuropathologic studies specific to this population are underway. The full impact of HIV on brain growth and development in youth with behaviorally acquired HIV has yet to be determined; it must be investigated further to develop future targeted treatment and mitigation strategies.
{"title":"Update on Central Nervous System Effects of HIV in Adolescents and Young Adults.","authors":"Jennifer L McGuire, Judith B Grinspan, Kelly L Jordan-Sciutto","doi":"10.1007/s11904-023-00651-3","DOIUrl":"10.1007/s11904-023-00651-3","url":null,"abstract":"<p><strong>Purpose of review: </strong>: Behaviorally acquired (non-perinatal) HIV infection during adolescence and young adulthood occurs in the midst of key brain developmental processes such as frontal lobe neuronal pruning and myelination of white matter, but we know little about the effects of new infection and therapy on the developing brain.</p><p><strong>Recent findings: </strong>Adolescents and young adults account for a disproportionately high fraction of new HIV infections each year. Limited data exist regarding neurocognitive performance in this age group, but suggest impairment is at least as prevalent as in older adults, despite lower viremia, higher CD4 + T cell counts, and shorter durations of infection in adolescents/young adults. Neuroimaging and neuropathologic studies specific to this population are underway. The full impact of HIV on brain growth and development in youth with behaviorally acquired HIV has yet to be determined; it must be investigated further to develop future targeted treatment and mitigation strategies.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10695667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9427177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1007/s11904-023-00652-2
Juliet Iwelunmor, Joseph D Tucker, Oliver Ezechi, Ucheoma Nwaozuru, Chisom Obiezu-Umeh, Titilola Gbaja-Biamila, David Oladele, Adesola Z Musa, Collins O Airhihenbuwa
Purpose of review: Sustaining evidence-based interventions in resource-limited settings is a perennial challenge. Despite growing research on the significance of sustainability, few frameworks describe why and how to plan for sustainability in settings limited with resources. Drawing on a synthesis of the literature on sustainability, including the Dynamic Sustainability Framework, we review lessons learned from research to date, to point out a path forward for sustaining evidence-based interventions in resource-limited settings.
Recent findings: We describe PLAN or why people learning, adapting, and nurturing the core values of an intervention can enhance its sustainability over time. PLAN is a dynamic framework that simplifies the process of planning for sustainability of evidence-based interventions throughout the lifecyle of an intervention, taking into consideration the people that matter as well as the learning, adaptation, and nurturing involved with understanding and studying the interactions between interventions/innovations, practice settings, intervention fit, and the broader ecological contexts in which implementation occurs. We use case-study data from our ongoing pragmatic HIV implementation trial, the 4 Youth by Youth project, to detail the value and implications of why people learning, adapting, and nurturing HIV interventions implemented in resource-limited settings matter. PLAN is designed to further the dialogue on ways research and practice teams can critically work to ensure the sustainability of their evidence-based interventions from the onset, particularly in settings and with populations limited with resources. It also illustrates how attention to sustainability from the beginning may foster actions necessary for sustained program → sustained benefits → sustained capacity → sustained value, but in the absence of early and active planning, none of this will occur. Ultimately, we hope to accelerate the sustainability of evidence-based HIV interventions, and making a PLAN at the bare minimum may ensure that the goals of continuing and maintaining desirable features of any evidence-based interventions can be realized.
综述目的:在资源有限的环境中维持循证干预是一个长期的挑战。尽管对可持续性重要性的研究越来越多,但很少有框架描述为什么以及如何在资源有限的情况下规划可持续性。我们综合了包括《动态可持续发展框架》在内的有关可持续发展的文献,回顾了迄今为止从研究中吸取的经验教训,指出了在资源有限的情况下维持循证干预措施的前进道路。最近的发现:我们描述了PLAN或为什么人们学习、适应和培养干预的核心价值可以随着时间的推移增强其可持续性。PLAN是一个动态框架,它简化了在干预的整个生命周期中以证据为基础的干预的可持续性规划过程,考虑到重要的人,以及涉及理解和研究干预/创新、实践环境、干预适合性和实施所处的更广泛的生态环境之间的相互作用的学习、适应和培养。我们利用正在进行的务实的艾滋病毒实施试验(4 Youth by Youth项目)的案例研究数据,详细说明在资源有限的环境中,人们学习、适应和培育艾滋病毒干预措施的重要性。计划旨在就研究和实践团队如何开展关键工作进行对话,以确保其基于证据的干预措施从一开始就具有可持续性,特别是在环境和人口资源有限的情况下。它还说明了从一开始就关注可持续性如何可能促进可持续方案→持续效益→持续能力→持续价值的必要行动,但如果没有早期和积极的规划,这一切都不会发生。最终,我们希望加速以证据为基础的艾滋病干预措施的可持续性,制定最低限度的计划可以确保延续和保持任何以证据为基础的干预措施的理想特征的目标能够实现。
{"title":"Sustaining HIV Research in Resource-Limited Settings Using PLAN (People, Learning, Adapting, Nurturing): Evidence from the 4 Youth by Youth Project in Nigeria.","authors":"Juliet Iwelunmor, Joseph D Tucker, Oliver Ezechi, Ucheoma Nwaozuru, Chisom Obiezu-Umeh, Titilola Gbaja-Biamila, David Oladele, Adesola Z Musa, Collins O Airhihenbuwa","doi":"10.1007/s11904-023-00652-2","DOIUrl":"https://doi.org/10.1007/s11904-023-00652-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sustaining evidence-based interventions in resource-limited settings is a perennial challenge. Despite growing research on the significance of sustainability, few frameworks describe why and how to plan for sustainability in settings limited with resources. Drawing on a synthesis of the literature on sustainability, including the Dynamic Sustainability Framework, we review lessons learned from research to date, to point out a path forward for sustaining evidence-based interventions in resource-limited settings.</p><p><strong>Recent findings: </strong>We describe PLAN or why people learning, adapting, and nurturing the core values of an intervention can enhance its sustainability over time. PLAN is a dynamic framework that simplifies the process of planning for sustainability of evidence-based interventions throughout the lifecyle of an intervention, taking into consideration the people that matter as well as the learning, adaptation, and nurturing involved with understanding and studying the interactions between interventions/innovations, practice settings, intervention fit, and the broader ecological contexts in which implementation occurs. We use case-study data from our ongoing pragmatic HIV implementation trial, the 4 Youth by Youth project, to detail the value and implications of why people learning, adapting, and nurturing HIV interventions implemented in resource-limited settings matter. PLAN is designed to further the dialogue on ways research and practice teams can critically work to ensure the sustainability of their evidence-based interventions from the onset, particularly in settings and with populations limited with resources. It also illustrates how attention to sustainability from the beginning may foster actions necessary for sustained program → sustained benefits → sustained capacity → sustained value, but in the absence of early and active planning, none of this will occur. Ultimately, we hope to accelerate the sustainability of evidence-based HIV interventions, and making a PLAN at the bare minimum may ensure that the goals of continuing and maintaining desirable features of any evidence-based interventions can be realized.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10102056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9433505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1007/s11904-022-00643-9
Megan Rose Curtis, Catherine Chappell
Purpose of review: In the context of the opioid epidemic, hepatitis C virus (HCV) infection prevalence is increasing among women of reproductive age. Pregnant people with HIV/HCV coinfection may be at increased risk of adverse pregnancy and neonatal outcomes, although research in this key population is lacking.
Recent findings: Treatment with directly acting antivirals (DAAs) has transformed the clinical care for most patients with HCV. However, pregnant people were excluded from trials of these medications. A recent phase I study has shown promise with excellent safety profile for ledipasvir-sofosbuvir; demonstrating no episodes of perinatal transmission, 100% sustained virologic response, and no safety concerns. Pregnancy represents a time of maximal interaction with the healthcare system and therefore an ideal window of opportunity to cure HCV. Current observational data regarding pregnant people who are co-infected with HCV and HIV suggest poor outcomes such as increased risk of preterm birth; however, there are no prospective and well-controlled studies to fully understand the impact of HIV/HCV coinfection on pregnancy. Phase 1 studies suggest that DAAs are well-tolerated and effective during pregnancy. Only through large, prospective clinical trials will we be able to understand the interaction of HCV and HIV during pregnancy and to evaluate safety and efficacy of DAAs in this key population.
{"title":"Evidence for Implementation: HIV/HCV Coinfection and Pregnancy.","authors":"Megan Rose Curtis, Catherine Chappell","doi":"10.1007/s11904-022-00643-9","DOIUrl":"https://doi.org/10.1007/s11904-022-00643-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>In the context of the opioid epidemic, hepatitis C virus (HCV) infection prevalence is increasing among women of reproductive age. Pregnant people with HIV/HCV coinfection may be at increased risk of adverse pregnancy and neonatal outcomes, although research in this key population is lacking.</p><p><strong>Recent findings: </strong>Treatment with directly acting antivirals (DAAs) has transformed the clinical care for most patients with HCV. However, pregnant people were excluded from trials of these medications. A recent phase I study has shown promise with excellent safety profile for ledipasvir-sofosbuvir; demonstrating no episodes of perinatal transmission, 100% sustained virologic response, and no safety concerns. Pregnancy represents a time of maximal interaction with the healthcare system and therefore an ideal window of opportunity to cure HCV. Current observational data regarding pregnant people who are co-infected with HCV and HIV suggest poor outcomes such as increased risk of preterm birth; however, there are no prospective and well-controlled studies to fully understand the impact of HIV/HCV coinfection on pregnancy. Phase 1 studies suggest that DAAs are well-tolerated and effective during pregnancy. Only through large, prospective clinical trials will we be able to understand the interaction of HCV and HIV during pregnancy and to evaluate safety and efficacy of DAAs in this key population.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9846668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10766011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01Epub Date: 2022-11-23DOI: 10.1007/s11904-022-00642-w
Samuel S Bailin, John R Koethe
Purpose of review: The burden of metabolic diseases, including type 2 diabetes mellitus (T2DM), is rising among persons with HIV (PWH) on antiretroviral therapy (ART). This increase coincides with an aging population and a greater proportion who are overweight/obese. This review summarizes the changing epidemic of T2DM on contemporary ART, the role of weight gain, and therapeutic options.
Recent findings: Recent studies confirm that PWH face an epidemic of obesity and T2DM, similar to the general population. Contemporary ART is associated with greater weight gain and may contribute to the risk of T2DM. Recent advances in medical weight loss therapy offer a way forward in the prevention and treatment of weight-associated T2DM. Weight gain is one of the biggest contributors to T2DM in PWH. Future studies on the role of adipose tissue distribution, adipose tissue function and clinical use of effective weight loss medications may change the paradigm of care for PWH.
{"title":"Diabetes in HIV: the Link to Weight Gain.","authors":"Samuel S Bailin, John R Koethe","doi":"10.1007/s11904-022-00642-w","DOIUrl":"10.1007/s11904-022-00642-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>The burden of metabolic diseases, including type 2 diabetes mellitus (T2DM), is rising among persons with HIV (PWH) on antiretroviral therapy (ART). This increase coincides with an aging population and a greater proportion who are overweight/obese. This review summarizes the changing epidemic of T2DM on contemporary ART, the role of weight gain, and therapeutic options.</p><p><strong>Recent findings: </strong>Recent studies confirm that PWH face an epidemic of obesity and T2DM, similar to the general population. Contemporary ART is associated with greater weight gain and may contribute to the risk of T2DM. Recent advances in medical weight loss therapy offer a way forward in the prevention and treatment of weight-associated T2DM. Weight gain is one of the biggest contributors to T2DM in PWH. Future studies on the role of adipose tissue distribution, adipose tissue function and clinical use of effective weight loss medications may change the paradigm of care for PWH.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10184162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9518561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.1007/s11904-022-00644-8
Kawango Agot, Jacob Onyango, Marylyn Ochillo, Elijah Odoyo-June
Purpose of review: The Nyanza region of western Kenya is lauded for impressive coverage of voluntary medical male circumcision (VMMC) and remains the bedrock of the VMMC program in Kenya. We conducted literature review on programmatic successes and challenges of implementing VMMC program in the region.
Recent findings: Responsive stakeholders' engagement, robust policy environment, effective technical working groups, prompt capacity building of health facilities, government support, flexible implementation strategies, and sustained donor funding contributed to the successes of the program that saw circumcision prevalence in Nyanza reach between 75.6 and 85.3% among 15-29-year-olds by 2019. However, the lack of support for early infant circumcision, inadequate domestic financing, and slow pace of service integration into government health facilities continue to undermine the progress towards sustainability. While local ownership of the VMMC program has been demonstrated through its inclusion in county annual health workplans and progressive integration into routine health care, continued dependence on declining external funding threatens its sustainability. Furthermore, Kenya is experiencing a youth bulge with a projected high demand for VMMC which calls for increased resource inputs into the program. Strategies are therefore needed to increase domestic resource inflows into VMMC.
{"title":"VMMC Programmatic Successes and Challenges: Western Kenya Case Study.","authors":"Kawango Agot, Jacob Onyango, Marylyn Ochillo, Elijah Odoyo-June","doi":"10.1007/s11904-022-00644-8","DOIUrl":"https://doi.org/10.1007/s11904-022-00644-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>The Nyanza region of western Kenya is lauded for impressive coverage of voluntary medical male circumcision (VMMC) and remains the bedrock of the VMMC program in Kenya. We conducted literature review on programmatic successes and challenges of implementing VMMC program in the region.</p><p><strong>Recent findings: </strong>Responsive stakeholders' engagement, robust policy environment, effective technical working groups, prompt capacity building of health facilities, government support, flexible implementation strategies, and sustained donor funding contributed to the successes of the program that saw circumcision prevalence in Nyanza reach between 75.6 and 85.3% among 15-29-year-olds by 2019. However, the lack of support for early infant circumcision, inadequate domestic financing, and slow pace of service integration into government health facilities continue to undermine the progress towards sustainability. While local ownership of the VMMC program has been demonstrated through its inclusion in county annual health workplans and progressive integration into routine health care, continued dependence on declining external funding threatens its sustainability. Furthermore, Kenya is experiencing a youth bulge with a projected high demand for VMMC which calls for increased resource inputs into the program. Strategies are therefore needed to increase domestic resource inflows into VMMC.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10625019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.1007/s11904-022-00636-8
Todd Lucas, Caroline Cooney, Amber Prainito, Catherine Godfrey, Valerian Kiggundu, Anne Goldzier Thomas, Renee Ridzon, Carlos Toledo
Purpose of review: Through December 2020, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supported more than 25 million voluntary medical male circumcisions (VMMC) as part of the combined HIV prevention strategy in 15 African countries. PEPFAR monitors defined adverse events (AEs) occurring within 30 days of VMMC through its notifiable adverse event reporting system (NAERS). All NAERS reports through December 2020 were reviewed to quantify AE type, severity, and relation to the VMMC procedure. Interventions to improve client safety based on NAERS findings are described.
Recent findings: Fourteen countries reported 446 clients with notifiable adverse events (NAEs); 394/446 (88%) were determined VMMC-related, representing approximately 18 NAE reports per million circumcisions. Fatalities comprised 56/446 (13%) with 24/56 (43%) of fatalities determined VMMC-related, representing 0.96 VMMC-related fatalities per million circumcisions. The remaining 390 NAEs were non-fatal with 370/390 (95%) VMMC-related. Multiple programmatic changes have been made based on NAERS data to improve client safety. Client safety is paramount in this surgical program designed for individual and population-level benefit. Surveillance of rare but severe complications following circumcision has identified pre-existing or new safety concerns and guided continuous programmatic improvement.
{"title":"Consolidated Overview of Notifiable Adverse Events in the U.S. President's Emergency Plan for AIDS Relief's Voluntary Medical Male Circumcision Program Through 2020.","authors":"Todd Lucas, Caroline Cooney, Amber Prainito, Catherine Godfrey, Valerian Kiggundu, Anne Goldzier Thomas, Renee Ridzon, Carlos Toledo","doi":"10.1007/s11904-022-00636-8","DOIUrl":"https://doi.org/10.1007/s11904-022-00636-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Through December 2020, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supported more than 25 million voluntary medical male circumcisions (VMMC) as part of the combined HIV prevention strategy in 15 African countries. PEPFAR monitors defined adverse events (AEs) occurring within 30 days of VMMC through its notifiable adverse event reporting system (NAERS). All NAERS reports through December 2020 were reviewed to quantify AE type, severity, and relation to the VMMC procedure. Interventions to improve client safety based on NAERS findings are described.</p><p><strong>Recent findings: </strong>Fourteen countries reported 446 clients with notifiable adverse events (NAEs); 394/446 (88%) were determined VMMC-related, representing approximately 18 NAE reports per million circumcisions. Fatalities comprised 56/446 (13%) with 24/56 (43%) of fatalities determined VMMC-related, representing 0.96 VMMC-related fatalities per million circumcisions. The remaining 390 NAEs were non-fatal with 370/390 (95%) VMMC-related. Multiple programmatic changes have been made based on NAERS data to improve client safety. Client safety is paramount in this surgical program designed for individual and population-level benefit. Surveillance of rare but severe complications following circumcision has identified pre-existing or new safety concerns and guided continuous programmatic improvement.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9643893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10633664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01Epub Date: 2022-10-29DOI: 10.1007/s11904-022-00634-w
Jessica L Prodger, Ronald M Galiwango, Aaron A R Tobian, Daniel Park, Cindy M Liu, Rupert Kaul
Purpose of review: Voluntary medical male circumcision (VMMC) is a surgical procedure that reduces HIV acquisition risk by almost two-thirds. However, global implementation is lagging, in part due to VMMC hesitancy. A better understanding of the mechanism(s) by which this procedure protects against HIV may increase acceptance of VMMC as an HIV risk reduction approach among health care providers and their clients.
Recent findings: HIV acquisition in the uncircumcised penis occurs preferentially across the inner foreskin tissues, due to increased susceptibility that is linked to elevated inflammatory cytokine levels in the sub-preputial space and an increased tissue density of HIV-susceptible CD4 + T cells. Inflammation can be caused by sexually transmitted infections, but is more commonly induced by specific anaerobic components of the penile microbiome. Circumcision protects by both directly removing the susceptible tissues of the inner foreskin, and by inducing a less inflammatory residual penile microbiome. VMMC reduces HIV susceptibility by removing susceptible penile tissues, and also through impacts on the penile immune and microbial milieu. Understanding these mechanisms may not only increase VMMC acceptability and reinvigorate global VMMC programs, but may also lead to non-surgical HIV prevention approaches focused on penile immunology and/or microbiota.
审查目的:自愿包皮环切术(VMMC)是一种外科手术,可将感染艾滋病毒的风险降低近三分之二。然而,该手术在全球的实施进度缓慢,部分原因是人们对包皮环切术犹豫不决。如果能更好地了解该手术预防艾滋病病毒感染的机制,可能会提高医疗服务提供者及其客户对无包皮环切术作为降低艾滋病病毒感染风险方法的接受度:未实施包皮环切术的阴茎感染艾滋病毒的几率较高,这主要是由于包皮内层组织的易感性增加,而这与包皮下腔炎性细胞因子水平升高以及组织中易感染艾滋病毒的 CD4 + T 细胞密度增加有关。炎症可由性传播感染引起,但更常见的是由阴茎微生物群中的特定厌氧成分诱发。包皮环切术通过直接切除包皮内侧的易感组织和诱导炎症较少的残余阴茎微生物群来保护阴茎。阴茎包皮环切术通过切除易感染的阴茎组织,以及对阴茎免疫和微生物环境的影响,降低对艾滋病毒的易感性。了解这些机制不仅可以提高人们对阴茎包皮环切术的接受度,为全球阴茎包皮环切术项目注入新的活力,还可以开发出以阴茎免疫学和/或微生物群为重点的非手术艾滋病预防方法。
{"title":"How Does Voluntary Medical Male Circumcision Reduce HIV Risk?","authors":"Jessica L Prodger, Ronald M Galiwango, Aaron A R Tobian, Daniel Park, Cindy M Liu, Rupert Kaul","doi":"10.1007/s11904-022-00634-w","DOIUrl":"10.1007/s11904-022-00634-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>Voluntary medical male circumcision (VMMC) is a surgical procedure that reduces HIV acquisition risk by almost two-thirds. However, global implementation is lagging, in part due to VMMC hesitancy. A better understanding of the mechanism(s) by which this procedure protects against HIV may increase acceptance of VMMC as an HIV risk reduction approach among health care providers and their clients.</p><p><strong>Recent findings: </strong>HIV acquisition in the uncircumcised penis occurs preferentially across the inner foreskin tissues, due to increased susceptibility that is linked to elevated inflammatory cytokine levels in the sub-preputial space and an increased tissue density of HIV-susceptible CD4 + T cells. Inflammation can be caused by sexually transmitted infections, but is more commonly induced by specific anaerobic components of the penile microbiome. Circumcision protects by both directly removing the susceptible tissues of the inner foreskin, and by inducing a less inflammatory residual penile microbiome. VMMC reduces HIV susceptibility by removing susceptible penile tissues, and also through impacts on the penile immune and microbial milieu. Understanding these mechanisms may not only increase VMMC acceptability and reinvigorate global VMMC programs, but may also lead to non-surgical HIV prevention approaches focused on penile immunology and/or microbiota.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9617235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10429045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01Epub Date: 2022-11-11DOI: 10.1007/s11904-022-00638-6
Supriya D Mehta
Purpose of review: Voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition by 60% among heterosexual men, provides protection against certain sexually transmitted infections (STI), and leads to penile microbiome composition changes associated with reduced risk of HIV infection. Intuitively, the benefits of VMMC for female sex partners in relation to STI are likely and have been evaluated. The purpose of this review is to examine emerging findings of broader sexual and reproductive health (SRH) benefits of VMMC for female sex partners.
Recent findings: Systematic reviews find strong evidence for beneficial effects of VMMC on female sex partners risk of HPV, cervical dysplasia, cervical cancer, and with likely protection against trichomoniasis and certain genital ulcerative infections. Few studies assess the direct impact of VMMC on the vaginal microbiome (VMB), though several studies demonstrate reductions in BV, which is mediated by the VMB. Studies are lacking regarding male circumcision status and outcomes associated with non-optimal VMB, such as female infertility and adverse pregnancy outcomes. VMMC has positive effects on women's perceptions of sexual function and satisfaction, and perceptions of disease risk and hygiene, without evidence of risk compensation. VMMC has consistent association with a broad range of women's SRH outcomes, highlighting the biological and non-biological interdependencies within sexual relationships, and need for couples-level approaches to optimize SRH for men and women. The paucity of information on VMMC and influence on VMB is a barrier to optimizing VMB-associated SRH outcomes in female partners.
审查目的:男性自愿包皮环切术(VMMC)可将异性恋男性感染 HIV 的风险降低 60%,可预防某些性传播感染(STI),并导致与 HIV 感染风险降低相关的阴茎微生物组构成变化。直觉上,VMMC 对女性性伴侣在性传播感染方面的益处是可能的,并且已经进行了评估。本综述的目的是研究 VMMC 对女性性伴侣更广泛的性健康和生殖健康(SRH)益处的新发现:系统综述发现,有确凿证据表明女性性伴侣感染人类乳头瘤病毒、宫颈发育不良和宫颈癌的风险会因女性子宫内膜异位症而降低,同时还可能预防滴虫病和某些生殖器溃疡感染。很少有研究评估包皮环切术对阴道微生物群(VMB)的直接影响,不过有几项研究表明,阴道微生物群介导的阴道乳头瘤病毒(BV)有所减少。目前还缺乏有关男性包皮环切情况以及与非最佳阴道微生物组相关的结果(如女性不孕和不良妊娠结果)的研究。包皮过长和包茎对女性的性功能和满意度以及疾病风险和卫生观念有积极影响,但没有证据表明存在风险补偿。女性性传播疾病与妇女性健康和生殖健康的广泛结果有着一致的联系,这突出表明了性关系中生物和非生物的相互依存关系,以及需要采取夫妻层面的方法来优化男性和女性的性健康和生殖健康。有关自愿性生育和对自愿性生育的影响的信息很少,这阻碍了优化自愿性生育对女性伴侣性健康和生殖健康影响的工作。
{"title":"The Effects of Medical Male Circumcision on Female Partners' Sexual and Reproductive Health.","authors":"Supriya D Mehta","doi":"10.1007/s11904-022-00638-6","DOIUrl":"10.1007/s11904-022-00638-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>Voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition by 60% among heterosexual men, provides protection against certain sexually transmitted infections (STI), and leads to penile microbiome composition changes associated with reduced risk of HIV infection. Intuitively, the benefits of VMMC for female sex partners in relation to STI are likely and have been evaluated. The purpose of this review is to examine emerging findings of broader sexual and reproductive health (SRH) benefits of VMMC for female sex partners.</p><p><strong>Recent findings: </strong>Systematic reviews find strong evidence for beneficial effects of VMMC on female sex partners risk of HPV, cervical dysplasia, cervical cancer, and with likely protection against trichomoniasis and certain genital ulcerative infections. Few studies assess the direct impact of VMMC on the vaginal microbiome (VMB), though several studies demonstrate reductions in BV, which is mediated by the VMB. Studies are lacking regarding male circumcision status and outcomes associated with non-optimal VMB, such as female infertility and adverse pregnancy outcomes. VMMC has positive effects on women's perceptions of sexual function and satisfaction, and perceptions of disease risk and hygiene, without evidence of risk compensation. VMMC has consistent association with a broad range of women's SRH outcomes, highlighting the biological and non-biological interdependencies within sexual relationships, and need for couples-level approaches to optimize SRH for men and women. The paucity of information on VMMC and influence on VMB is a barrier to optimizing VMB-associated SRH outcomes in female partners.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9759499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10632897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01Epub Date: 2022-10-19DOI: 10.1007/s11904-022-00628-8
Patricia K Riggs, Antoine Chaillon, Guochun Jiang, Scott L Letendre, Yuyang Tang, Jeff Taylor, Andrew Kaytes, Davey M Smith, Karine Dubé, Sara Gianella
Purpose of review: Deep tissue HIV reservoirs, especially within the central nervous system (CNS), are understudied due to the challenges of sampling brain, spinal cord, and other tissues. Understanding the cellular characteristics and viral dynamics in CNS reservoirs is critical so that HIV cure trials can address them and monitor the direct and indirect effects of interventions. The Last Gift program was developed to address these needs by enrolling altruistic people with HIV (PWH) at the end of life who agree to rapid research autopsy.
Recent findings: Recent findings from the Last Gift emphasize significant heterogeneity across CNS reservoirs, CNS compartmentalization including differential sensitivity to broadly neutralizing antibodies, and bidirectional migration of HIV across the blood-brain barrier. Our findings add support for the potential of CNS reservoirs to be a source of rebounding viruses and reseeding of systemic sites if they are not targeted by cure strategies. This review highlights important scientific, practical, and ethical lessons learned from the Last Gift program in the context of recent advances in understanding the CNS reservoirs and key knowledge gaps in current research.
{"title":"Lessons for Understanding Central Nervous System HIV Reservoirs from the Last Gift Program.","authors":"Patricia K Riggs, Antoine Chaillon, Guochun Jiang, Scott L Letendre, Yuyang Tang, Jeff Taylor, Andrew Kaytes, Davey M Smith, Karine Dubé, Sara Gianella","doi":"10.1007/s11904-022-00628-8","DOIUrl":"10.1007/s11904-022-00628-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Deep tissue HIV reservoirs, especially within the central nervous system (CNS), are understudied due to the challenges of sampling brain, spinal cord, and other tissues. Understanding the cellular characteristics and viral dynamics in CNS reservoirs is critical so that HIV cure trials can address them and monitor the direct and indirect effects of interventions. The Last Gift program was developed to address these needs by enrolling altruistic people with HIV (PWH) at the end of life who agree to rapid research autopsy.</p><p><strong>Recent findings: </strong>Recent findings from the Last Gift emphasize significant heterogeneity across CNS reservoirs, CNS compartmentalization including differential sensitivity to broadly neutralizing antibodies, and bidirectional migration of HIV across the blood-brain barrier. Our findings add support for the potential of CNS reservoirs to be a source of rebounding viruses and reseeding of systemic sites if they are not targeted by cure strategies. This review highlights important scientific, practical, and ethical lessons learned from the Last Gift program in the context of recent advances in understanding the CNS reservoirs and key knowledge gaps in current research.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9701587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}