HIV Research & Clinical Practice最新文献

Background: Tuberculosis screening is recommended for people living with HIV. The QuantiFERON-TB test measures the cell-mediated response against M. Tuberculosis. The Gold-In-Tube measures the response of CD4+ T-cells, often leading to indeterminate results. The new Gold-Plus (QFT-GP) also measures CD8+ T-cells response, thus reducing uncertainties. However, studies on people living with HIV, that would benefit from a test independent from CD4+ T-cells, are scarce.

Objective: This study addresses this gap by evaluating the performance of QFT-GP specifically in a large cohort of people living with HIV in a low TB-endemic setting.

Methods: We retrospectively evaluated the frequency of indeterminate QFT-GP tests in a cohort of people living with HIV with at least one test. We collected demographic data, CD4+ and CD8+ T-cell count at nadir and at the time of testing, and history of prior TB infection or treatment. We correlated the QFT-GP results to the CD4+ T-cell count.

Results: Six hundred and ninety five patients were included (males/females 72.5/27.5%), median age was 51 ± 14 years. Only 1,2% of tests were indeterminate, and there was no association with the CD4+ or CD8+ T-cell count at the moment of the test or at the nadir.

Conclusions: QFT-GP has few indeterminate results, even in patients with a low CD4+ T-cell count.

Background: Despite recommendations for routine mental health screening in human immunodeficiency virus (HIV) care settings, screening uptake remains low. The brief Patient Health Questionnaire (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) are validated screeners for depression and anxiety symptoms with potential for integration into HIV primary care.

Objective: This study aimed to identify the optimal cut-off points for the PHQ-2 and GAD-2 among people with HIV at risk for mental health disorders (MHD) in comparison to the PHQ-8 and GAD-7.

Methods: Participants (N = 300) enrolled in a study evaluating a collaborative care intervention for substance use disorder and MHD care completed the PHQ-8 and GAD-7 at baseline. Sensitivity, specificity, and Youden's index were obtained for the PHQ-2 and GAD-2 at different scoring cut-off points against the PHQ-8 and GAD-7, which served as reference standards using recommended cut-off points of ≥10.

Results: A cut-off point of ≥3 on the PHQ-2 demonstrated a sensitivity of 0.79 and a specificity of 0.88, while a cut-off point of ≥2 had a sensitivity of 0.95 and a specificity of 0.68. A cut-off point of ≥3 on the GAD-2 had a sensitivity of 0.87 and a specificity of 0.92.

Conclusions: In the context of HIV care provision in busy clinical settings, our findings indicate that implementation of the PHQ-2 (cut point ≥ 2 or ≥3) and GAD-2 (cut point ≥ 3) detect depression and anxiety symptoms. The implementation of these brief screeners in routine health care settings has the potential for simplified detection of people with HIV who would benefit most from further evaluation for MHD.

Background: The relative contributions of HIV infection, antiretroviral therapy (ART), and classical metabolic risk factors to the link between gut permeability and insulin resistance (IR) remain unclear.

Aim: To examine the relationship between gut permeability, systemic inflammation, and insulin resistance among people with HIV in Mthatha, South Africa.

Methods: A cross-sectional study was conducted with 226 participants: 82 HIV^-, 64 HIV⁺ART^-, and 80 HIV⁺ART⁺. Anthropometry and lipid profiles were assessed to evaluate obesity and dyslipidaemia. Gut permeability (intestinal fatty acid binding protein, IFABP) and inflammation (soluble CD14, sCD14) were measured, alongside fasting insulin and glucose to calculate HOMA-IR.

Results: Overweight/obesity was more prevalent among ART-treated people with HIV (HIV⁺ART⁺) than ART-naïve participants (HIV⁺ART^-). Both HIV-positive groups showed increased gut permeability and inflammation compared with controls (p < 0.05). In ART-naïve people with HIV, gut permeability was associated with triglycerides, while in ART-treated people with HIV it was linked to gut-associated inflammation and markers of IR (fasting glucose, TG/HDL-c ratio). HOMA-IR correlated with obesity and dyslipidaemia (total cholesterol, LDL) in ART-naïve participants but was associated only with gut-associated inflammation in ART-treated participants (p < 0.05, respectively).

Conclusion: Gut permeability is linked to insulin resistance in ART-treated people with HIV, independent of obesity and dyslipidaemia. This highlights a novel pathway for intervention to reduce NCD burden.

Background: Effective antiretroviral therapy (ART) has significantly improved outcomes for individuals living with HIV, who may develop chronic co-morbidities, including inflammatory arthritis (IA).

Objective: This study aimed to a) determine the spectrum of new-onset IA in people living with HIV on ART and b) compare the presentation of rheumatoid arthritis (RA) in virally suppressed people with HIV with HIV-negative RA controls.

Methods: We enrolled people living with HIV on ART presenting with new-onset IA and recorded their medical history, clinical findings, disease activity, and laboratory results. The disease activity measures in virally suppressed people living with HIV with RA were compared to HIV-negative RA controls.

Results: The study comprised 57 people living with HIV with IA, of whom 45 (78.9%) had suppressed viral loads at presentation. These 45 patients comprised 24 (53.3%) with HIV-RA, 2 (4.4%) with spondyloarthritis (SpA) and the remaining 19 (42.2%) included 12 with undifferentiated polyarthritis (UPA) and 7 with undifferentiated oligoarthritis (UOA), The 12 people living with HIV who were not virally suppressed, included 5 UPA, 3 HIV-RA, and 4 SpA. Comparison of virally suppressed patients with new-onset RA and HIV-negative RA controls showed no differences in the Clinical Disease Activity Index, Simplified Disease Activity Index, or their components.

Conclusion: When people living with HIV under clinical care develop IA, they may be referred earlier with UPA or UOA. SpA is uncommon due to the low frequency of the HLA-B27 allele. The disease activity of RA in people living with HIV is like RA in HIV-negative people.

Introduction: Despite youth representing a large proportion of incident human immunodeficiency virus (HIV) infections in the United States, uptake and retention of youth on pre-exposure prophylaxis (PrEP) remain low. This study evaluated the feasibility and effectiveness of a telehealth model for youth PrEP (TelePrEP) among individuals assigned male at birth at risk for HIV in Colorado.

Methods: A mixed-methods pilot feasibility trial of telehealth-delivered PrEP services was conducted between January 2023 and December 2024. Youths 14-24 years of age eligible for PrEP using oral tenofovir alafenamide and emtricitabine (F/TAF) were enrolled in a prospective type 1 hybrid effectiveness implementation study. The primary effectiveness outcome was retention, defined as having either a PrEP visit or a PrEP prescription refill 12 months after study enrollment (+/- three months). Additional youth 18-24 years and PrEP providers were recruited for interviews or focus groups to explore implementation determinants such as youth PrEP and service model preferences, facilitators, and barriers. Rapid qualitative analysis was employed to summarize qualitative findings.

Results: Among 44 eligible survey respondents, 21 enrolled in the study, with a median age of 22 years (interquartile range (IQR) 21-24). Eleven (52.4%) of the 21 participants initiated PrEP, and five (23.8%, 95% confidence interval 19.5%-43.3%) were retained per the study definition at 12 months. PrEP persistence (time to first discontinuation) was a median of 33 weeks (IQR 21-57). TelePrEP usage, assessed by the percentage of participants having at least 2 telehealth visits, was ten (47.6%) out of 21 enrolled participants and ten (90.1%) out of 11 participants who initiated PrEP. Qualitative findings among youth were favorable to the study recruitment approaches, including social media use, primary care providers referrals and youth-serving organizations, and community events. Both youth and PrEP providers support a TelePrEP care model.

Conclusions: PrEP uptake and retention remain challenging for youth at risk for HIV. Further tailoring of PrEP models of care is needed to achieve risk reduction goals for youth.

Background: Breastfeeding is lifesaving against child malnutrition, yet exclusive breastfeeding (EBF) rates remain low, particularly among mothers with HIV.

Objective: We compared the prevalence of EBF between mothers with and without HIV and explored factors associated with breastfeeding.

Methods: A cross-sectional design was used to investigate 151 mother-child dyads; mothers with HIV (n = 73) and without HIV: (n = 78). Structured and previously used questionnaire was used to collect sociodemographic and breastfeeding practices data of mothers of children aged 6-12 months, during routine postnatal care at selected primary healthcare facilities in Maseru.

Results: All mothers had similar sociodemographic characteristics, with EBF prevalence of 40.4%. Mothers with HIV had lower rates of EBF than their counterparts (28.8% vs. 51.3%, p = 0.005), despite 98.6% achieving viral suppression. Most mothers with HIV introduced complementary feeding as early as 1-3 months (19.2% vs. 9.0%) and above half of them started giving solid foods from 4-5 months (52.1% vs. 39.7%); p = 0.012). Above a quarter of all mothers received EBF support from healthcare facility, spouse and other family members. Only 40.4% of mothers were encouraged to EBF, while 70.9% believed that breastmilk is sufficient during first six months, and a strong positive correlation was found between EBF and mothers' beliefs (mother with HIV: r = 0.5, p < 0.001; mothers without HIV, r = 0.4; p = 0.001).

Conclusion: Despite ongoing efforts to promote breastfeeding among mothers with HIV, EBF rates remain low, regardless suppressed viral loads. The belief in breastmilk adequacy during first six months was a key determinant of EBF, underscoring need for targeted education on breastmilk composition and sufficiency.

Background: In Peru, the HIV epidemic is primarily concentrated among men who have sex with men (MSM), with an estimated prevalence exceeding 10%. This study aimed to assess the interaction between alcohol use and suboptimal adherence to antiretroviral therapy (ART) on AIDS risk and oral health among Peruvian MSM living with HIV.

Methods: We recruited 398 MSM living with HIV from two urban HIV treatment clinics in Lima. Alcohol use disorder (AUD) was assessed using the standard Alcohol Use Disorders Identification Test (AUDIT). ART adherence was self-reported. AIDS risk was defined as a history of having a CD4 count below 200 cells/mm ³ . A joint model was used to estimate the association between AIDS risk and oral conditions. Independent variables included alcohol consumption (binge drink and heavy use), suboptimal ART adherence (not 100% use), and their interaction, controlling for age and education.

Results: Almost 53% of MSM reported that they had ever had a CD4 count lower than 200 cells/mm ³ , and 38% reported that they were not 100% adherent to ART in the past month. Additionally, 42% reported being at a hazardous or harmful level of AUD risk, with 78% being binge drinkers and 12% heavy drinkers. The interactions in the joint model indicated that suboptimal ART adherence and binge drinking are associated with an increased risk of developing AIDS (p = 0.0287), while suboptimal ART adherence and heavy drinking are associated with an increased number of self-reported oral diseases (p = 0.0231). This association also holds when modeling the two outcomes separately.

Conclusions: Interaction of suboptimal ART adherence and AUD is strongly associated with increased risk of AIDS and poor oral health among Peruvian MSM with HIV. Our findings support the need for longitudinal studies to better understand the complexity of alcohol consumption, ART adherence, AIDS risk, and oral diseases in this vulnerable population.

Introduction: Chemsex drugs are psychoactive substances used to facilitate and enhance sexual activity. Their use is frequent among men who have sex with men (MSM). Synthetic cathinones have been the most common drugs recently used in chemsex practice. After their intake, the clinical spectrum may include tachycardia, hypertension, hallucinations, seizures, hyperthermia, rhabdomyolysis with resulting nephrotoxicity, and potentially life-threatening multiorgan failure.

Case presentation: Here, we report the case of a gentleman with HIV who came to observe severe rhabdomyolysis and acute kidney injury (AKI) following the use of Khat.

Conclusion: This case highlights that clinicians need to be vigilant about the adverse effects of synthetic cathinones used in the context of chemsex as a possible cause of AKI. To the best of our knowledge, this is the first reported case of AKI caused by cathinone toxicity successfully treated in Italy.

Background: Predicting which people with HIV are at risk for coronary artery disease (CAD) would facilitate the targeted use of preventative strategies.

Objectives: This project investigated novel biomarkers of CAD and determined the longitudinal pattern of change approaching CAD.

Methods: A retrospective single-centre case‒control study of samples from people with HIV and with CAD (cases, n = 64) matched by age (±5 years) and sex with people with HIV without CAD (n = 63). Demographics, cardiovascular risk factors, and HIV characteristics were collected. The samples were analysed immediately before and at 6, 12, 24, and 36 months prior to CAD. The biomarkers measured included soluble CD14, lipopolysaccharide binding protein [LBP], C-X-C motif chemokine ligand 10, high-sensitivity c-reactive protein [hsCRP], interleukin-1 receptor antagonist [IL-1RA], interleukin-6 [IL-6], D-dimer, lipoprotein-associated phospholipase A2, vascular cell adhesion molecule 1, and soluble glycoprotein VI. Analyses were adjusted for the presence of HIV viraemia.

Results: Immediately prior to CAD diagnosis, cases had higher D-dimer, hsCRP and, IL-6. Twelve months prior to the event, the only biomarker with a significant difference was IL-6 (2.4 pg/mL [1.6, 3.4] compared with 1.8 pg/mL [1.1, 33]). LBP, IL-1RA, D-dimer, hsCRP, and IL-6 demonstrated statistically significant increases in cases compared with controls 12 months prior to CAD, but all were stable in the period before this. Inflammatory biomarkers were strongly correlated and correlated with markers of HIV control (CD4 cell count and HIV VL).

Conclusions: IL-6, hsCRP, and D-dimer were associated with CAD and increased in the 12 months prior to the event. Further work is needed to determine whether an increase in these biomarkers could be used to prompt further investigation for CAD in people with HIV.

Background: Analytical treatment interruptions (ATIs) are increasingly used in HIV cure-related trials to assess intervention efficacy.

Objective: To assess the impact of participation in ATI-inclusive trials on sexual behaviors and transmission risks among women in Durban, South Africa, and to develop recommendations for safer trial design.

Methods: From 2022-2025, we conducted a mixed-methods socio-behavioral study embedded within a Phase 2A ATI-inclusive HIV cure-related trial. Nineteen participants completed surveys at four trial timepoints, baseline (T1), pre-ATI (T2), post-ATI (T3), and end of trial (T4), and in-depth interviews at the first three (T1-T3). We summarized quantitative data using medians and percentages and used the Theory of Planned Behavior to analyze the qualitative data.

Results: Participants had strong intentions toward HIV prevention; however, behaviors were inconsistently enacted during the trial. Condom use was highest during the ATI; however, 40% of participants reported never using condoms. Abstinence was not considered an acceptable option within relationships. Disclosure of HIV and ATI participation facilitated prevention behavior but was undermined by HIV-related stigma, while non-disclosure and new sexual behaviors created relationship instability. Prevention was supported by trial staff's responsiveness and close monitoring, which helped build participants' trust.

Conclusions: For ATI-inclusive trials to reduce HIV transmission risk and social harms, investigators must understand contextual barriers perceived by participants who are expected to enact protective behaviors. Adaptive trial designs that incorporate participant-centered behavioral support, monitor and address emergent harms and facilitate prevention through access to HIV testing and PrEP for partners, must align with participants' evolving realities.