HIV Research & Clinical Practice最新文献

Background: Seborrheic dermatitis is a common inflammatory skin condition which disproportionately impacts persons with HIV (PWH). Non-dermatologists, including primary care and HIV clinicians, are often the first providers to diagnose and manage inflammatory dermatoses. Data is lacking regarding the quality of management of such common dermatoses by non-dermatologist compared to dermatologic specialists.

Methods: We evaluated the treatment of and referral patterns for seborrheic dermatitis relative to accepted standards of care among outpatient dermatologists and non-dermatologists in a regional healthcare system. Using a cross-sectional design, we analyzed a random sample of 100 persons 18 years or older with a diagnosis of HIV and more than one visit to a regional primary care or HIV clinician with an ICD code for treatment of seborrheic dermatitis.

Results: Seborrheic dermatitis was the most common specific inflammatory dermatosis among PWH in the healthcare system. Non-dermatologists were significantly more likely to prescribe one medication compared to dermatologists (62.2% vs. 50.9%, p = 0.05). 28.9% of persons initially diagnosed by a non-dermatologist were referred to a dermatology specialist. When considering immediate initiation of treatment as optimal management, 33/45 (73.3%) of non-dermatologists had optimal management compared with 53/55 (96.4%) of dermatologists (p < 0.01). However, when considering referral as optimal management, then 86.7% of patients initially diagnosed by non-dermatologists were optimally managed.

Discussion: Seborrheic dermatitis remains a common issue among PWH in a multispeciality ambulatory setting. Non-dermatologists appear significantly less likely to provide optimal initial management which may affect quality of life given potential for delayed treatment in settings with limited specialists. Additional training should be provided to non-dermatologists to facilitate appropriate treatment of common inflammatory dermatological conditions.

Background: Advancements in antiretroviral therapy (ART) have significantly increased the life expectancy of people living with HIV, shifting the clinical focus from AIDS-related complications to the management of chronic conditions common in aging populations. Organ donation by people living with HIV has emerged as a promising option to address the growing need for transplants among this population. Although Canadian policies have permitted this practice under 'exceptional medical circumstances' for almost a decade, no Canadian studies have assessed how aware people living with HIV are of this.

Methods: A cross-sectional, questionnaire-based survey was conducted with a convenience sample of 200 people living with HIV attending a single HIV clinic in Ottawa, Canada. Participants completed a questionnaire featuring 10 close-ended questions assessing awareness of organ donation options (transplant, education, research) and five demographic and HIV status questions at the end. Additional sociodemographic and clinical data were gathered via chart review, and chi-square tests were used to analyse the associations between participants' characteristics and their knowledge of organ donation.

Results: Only 20.6% (n = 41) of respondents were aware that people living with HIV could donate organs for transplantation, 39.0% (n = 78) knew of the possibility of donation for educational purposes, and 32.8% (n = 65) recognized their ability to donate for research purposes. Awareness was strongly correlated with the likelihood of being registered as an organ donor: 20.5% of those who knew about the transplantation option were registered donors, versus 7.4% of those who were unaware.

Conclusions: Our findings revealed a general lack of awareness among Canadians with HIV of the possibilities of post-mortem organ and tissue donation. Since awareness is a key determinant of registration, future efforts should be made to include accurate and up-to-date information on organ donation from people living with HIV in regular HIV care. By ensuring frequent and transparent communication, we open the door to new opportunities for transplantation while also addressing misconceptions and reducing the stigma surrounding HIV care.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has a greater prevalence in people living with human immunodeficiency virus (HIV) than in the general population. Reasons for this are connected with the presence of additional risk factors in people living with HIV, such as the infection itself with chronic immune system stimulation and HIV therapy adverse effects.

Objective: We aimed to compare metabolic syndrome components and MASLD-related parameters between people living with HIV on antiretroviral treatment at the clinic in Wroclaw and controls.

Methods: We conducted a case-control observational study on patients scheduled for visits from April to October 2021. We gathered blood samples and surveys from the patients and checked for metabolic and liver-related parameters.

Results: Sixty patients treated at an outpatient clinic in Wroclaw were enrolled into the study. Thirty controls were picked from healthy volunteers. People living with HIV had normal liver function parameters and HbA1c levels; they had a greater prevalence of dyslipidaemia (68.33% vs. 40%, p = 0.01), and higher homeostatic model assessment for insulin resistance (HOMA-IR) (2.16 vs. 1.24; p = 0.001). There was a difference between people living with HIV and controls in several MASLD-predictive models (FIB-4, NFS, NAFLD-LFS, Forns, TyG, MACK-3); however, it did not exceed the lower cut-off values for defining the risk of steatosis/fibrosis among people living with HIV.

Conclusions: We found people living with HIV to be more burdened by metabolic issues than our controls; however, people living with HIV did not appear to be more metabolically ill than the general Polish population.

Background: People with HIV can survive decades on antiretroviral therapy (ART), but an increasing burden of metabolic disease, including diabetes mellitus (DM), threatens these gains. Prior studies found race and sex disparities in HIV treatment outcomes, but data on comorbid conditions remains scarce. We assessed whether disparities by race, sex, body mass index (BMI), and other factors existed in DM screening, incidence, and treatment outcomes in a large HIV care center in the southeastern US.

Methods: We conducted a retrospective analysis of people with HIV enrolled at the Vanderbilt Comprehensive Care Clinic between 2007-2022 on ART without prevalent DM. We assessed factors associated with DM screening by hemoglobin A1c (HbA1c), DM diagnosis, treatment, and achieving HbA1c ≤7.0%. We used modified Poisson regression to estimate adjusted risk ratios (RRs) to achieve the next step of the care continuum.

Results: Older, Black, and overweight or obese people with HIV were more likely to be screened (range of RRs = 1.0-1.1, p < 0.05 each) and diagnosed with DM (range of RRs = 1.8-2.8, p < 0.05 each) compared to reference groups, but there was no significant sex difference after adjusting for other factors. Among those screened and diagnosed with DM, there were no differences in initiating treatment or achieving A1c goals by key characteristics in adjusted models.

Conclusions: Older, Black, and overweight/obese people with HIV were more likely to be screened and diagnosed with DM by their HIV care providers. However, age, BMI, and sex did not affect the initiation of DM medications or achieving A1c goals in this cohort.

Background: Despite advances in antiretroviral therapy (ART), resistance remains a barrier to effective HIV treatment. Objective: This study evaluated associations between ART drug resistance and treatment adherence, health care resource utilisation (HCRU), and quality of life (QoL) among people with HIV. Methods: A retrospective, observational study was conducted using the Adelphi HIV Disease Specific Programme^™ (DSP) between 2021 and 2023 across the United States and Europe. Data were collected via physician surveys, patient record forms, and patient self-completion forms. Results: Data for 2006 people with HIV and resistance testing were contributed by 290 physicians, and 586 people with HIV provided patient data. Overall, 286 people with HIV (14%) had documented resistance. People with HIV with resistance had received more ART regimens than those without resistance (p < 0.0001) and had lower viral suppression rates (p = 0.004) and lower CD4 counts (p = 0.032). People with HIV with resistance reported lower treatment adherence (p = 0.017) but similar QoL compared to those without resistance. People with HIV with resistance also had significantly more HIV-related hospitalisations than those without resistance (p = 0.022). Conclusions: ART resistance was associated with higher HCRU and poorer health outcomes in people with HIV, underscoring the need for continued focus on adherence and resistance management.

Introduction: The coexistence of common and rare conditions in a single person may represent a diagnostic challenge. We herein report the case of a young gentleman diagnosed with an acute HIV infection who had a history of myalgias and exercise intolerance and experienced elevated creatinine and phosphokinase enzyme levels.

Clinical presentation: A 24-year-old gentleman was diagnosed with an acute HIV in May 2023 (HIV-RNA > 10.000.000 copies/ml, CD4+ count 417 cell/L) and started same-day combinarion antiretroviral therapy, cART, with darunavir/cobicistat/tenofovir alafenamide/emtricitabine+dolutegravir), switching to dolutegravir/lamivudine once undetectable, 6 weeks after. After 5 months, he was hospitalized with fever, headache, and acute renal failure (creatinine 500 umol/L). Later, CPK peaked at >22,000 mg/dl. He denied chemsex/drug use and had recently started exercising on a regular basis. HIV-RNA was undetectable, cerebrospinal fluid (CSF) examination was unremarkable. cART was temporarily stopped with the normalization of labs. After 20 days, cART was restarted, as well as physical activity, with relapse of the symptoms requiring rehospitalization. Workups for autoimmune and infectious causes were negative. Suspecting drug-related myositis (data on myopathies under integrase inhibitors have been reported), muscle MRI, muscle biopsy, genetic analyses, hair analysis were performed. He tested positive for cocaine and amphetamines. Muscle biopsy showed type 1 fiber atrophy while muscle magnetic resonance imaging was unremarkable. In January 2025, genetic testing came back confirming type VII glycogenosis.

Discussion: This case highlights the diagnostic complexity of rare metabolic disorders, especially when coexisting with acute HIV, continuous medication use and drug exposure. It allows us to highlight the importance of considering rare metabolic disorders as differential diagnoses, as they can mimic systemic illnesses or drug-related effects.

Background: Pediatric (age, 0-13 y), adolescent (age, 13-19 y), and young adult (age, 20-24 y) (AYA) patients living with human immunodeficiency virus (HIV) face numerous barriers to adherence to antiretroviral therapy (ART). Suboptimal adherence to ART leads to increased drug resistance, poor quality of life, and increased long-term morbidity and mortality.

Objective: This study evaluates the effects of implementing a specialty pharmacy model on adherence and virological suppression in pediatric and AYA individuals living with HIV.

Methods: Specialty pharmacy operations began at St. Jude Children's Research Hospital in July 2020. Before then, ART was dispensed to patients in a traditional hospital outpatient pharmacy model. A single-center, retrospective analysis was conducted on 38 individuals living with HIV from 1 July 2019, through 1 July 2021, to capture one year of data pre-implementation and one year of data post-implementation of the specialty pharmacy model. Proportion of days covered (PDC) was used to measure adherence. Viral loads were obtained from laboratory samples as part of routine care.

Results: The mean PDC appeared to increase after specialty pharmacy implementation (82.3% vs. 80.3%), but the change in mean did not reach statistical significance (p = 0.07). Nevertheless, of the patients who were below the 80% PDC threshold before implementation, more reached or exceeded the 80% benchmark after intervention than not (60.0% versus 40.0%) (p = 0.03). Of the patients who were already ≥80% adherent, most remained that way (82.6% versus 17.4%) (p < 0.001). Sixty percent of patients whose viral loads were > 200 copies/mL experienced undetectable viral loads after intervention (p = 0.05).

Conclusions: Specialty pharmacy services may help pediatric and AYA patients adhere to ART, which can lead to higher rates of virological suppression.

Background: TDF/3TC/DTG (TLD) has been adopted as the first-line therapy for all people with HIV according to the WHO 2019 and Thai HIV guidelines. As a result, people with HIV in Thailand on TDF/FTC/EFV are switched to TLD. However, increasing data demonstrate the efficacy and renal safety of the TDF-sparing dual therapy with DTG + 3TC compared with TDF-based combination ART (cART) as a switching therapy. A direct comparison of estimated glomerular filtration rates (eGFR) among people with HIV treated with TDF-based regimens who switch to TLD vs. DTG + 3TC is yet to be made.

Methods: We enrolled virologically suppressed people with HIV aged ≥18 years currently on TDF + FTC + EFV to either switch to TLD or DTG + 3TC at two tertiary care hospitals. The switching regimen was chosen at the physicians' discretion. The primary outcome was the change in eGFR, calculated by creatinine at 24 weeks. Secondary outcomes included changes in LDL, body weight, and BMI at 24 weeks.

Results: Among 53 recruited participants, 28 and 15 completed the second follow-up in the TLD and DTG + 3TC groups, respectively. The mean age was higher in the TLD group compared to the DTG + 3TC group (Table 1). The median time from HIV diagnosis to switching was 8.5 years. The eGFR reduction was significantly greater in the TLD group than in the DTG + 3TC group: -17.24 ± 9.24 vs. -8.4 ± 9.03 mL/min/1.73 m² (p = 0.004). All participants in both groups achieved virological suppression. There was no significant change in CD4 counts between the two groups. Switching to DTG + 3TC was associated with a significantly smaller decline in eGFR post-switch (mean difference: 6.216 mL/min/1.73 m²; 95% CI 0.169-12.263; p = 0.044) compared to those who switched to TLD.

Conclusions: There was a significant reduction in eGFR among people with HIV who switched to TLD compared to those switched to DTG + 3TC. Changes in LDL and BMI were comparable between groups. Dual therapy with DTG + 3TC may be a preferred switching option over TLD for individuals with renal safety concerns. Further randomized prospective trials with longer follow-up are warranted to confirm these findings.

Background: Virological failure (VF) significantly threatens the efficacy of antiretroviral therapy (ART) programs in East Africa. This systematic review and meta-analysis assess the prevalence and predictors of VF among individuals living with HIV.

Methods: We searched PubMed, Web of Science, African Journals Online, and EMBASE for relevant studies. Heterogeneity was assessed using the I² statistic, and random-effects models addressed between-study variability. Publication bias was examined through funnel plots, Egger's regression, and Begg's tests. Subgroup analyses and meta-regression explored heterogeneity sources and potential VF predictors. Analyses were conducted using MedCalc version 20.010, adhering to PRISMA 2020 guidelines.

Results: Twenty-five records were included, with a sample size of 29,829 people living with HIV on ART. The pooled prevalence of VF in East Africa was 19.4% (95% CI: 15.2%-24.0%), with substantial heterogeneity across studies. Sociodemographic predictors of VF included male sex (30.9%, p < .001), unmarried status (28.2%, p < .001), lower educational attainment (33.0%, p < .001), non-formal employment (47.2%, p < .001), and urban residence (51.2%, p < .001). Clinical factors associated with higher VF rates were ambulatory status (44.7%, p < .001), low CD4 count (35.1%, p < .001), low haemoglobin (52.2%, p < .001), advanced HIV stage III/IV (44.2%, p < .001), HIV/TB co-infection (24.3%, p < .001), and other opportunistic infections (20.5%, p = .008). Treatment-related factors associated with VF were first-line nevirapine-based regimen (27.7%, p = .009) and poor ART adherence (41.76%, p < .001).

Conclusion: Sociodemographic factors, advanced HIV disease, co-morbidities, poor adherence, and specific first-line ART regimens are key predictors of virological failure. Targeted, multidisciplinary interventions focusing on routine viral load monitoring, adherence support, and addressing socioeconomic barriers are essential to improve ART outcomes in East Africa.

Introduction: The BIC-T&T study aimed to determine the efficacy of bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) and darunavir/cobicistat/emtricitabine/tenofovir alafenamide (DRV/c/F/TAF) at suppressing viral load in a two-arm, open-label, multi-centre, randomised trial under a UK test-and-treat setting. This sub-study aimed to evaluate potential off-target cardiovascular impact by examining ex vivo platelet function.

Methods: Platelets were isolated by centrifugation of citrated blood from participants attending Chelsea and Westminster Hospital or St Mary's Hospital at Week 48 following enrolment. Platelet activation was assessed by real-time flow cytometry to examine integrin activation and granule release and platelet aggregation was evaluated by light transmission aggregometry. Statistical significance was determined by 2-way ANOVA with a Šidák's multiple comparisons post-test.

Results: An analysis of 21 participants was performed at Week 48 (96% male and 48% white; mean (range) age was 37 (23-78) years). No difference between arms was observed in ADP-, collagen- or thrombin receptor activator for peptide (TRAP)-6-evoked platelet α_IIbβ₃ integrin activation, granule release or platelet aggregation in response to any of the agonists tested. Despite differences in the demographics between treatment arms, the presence of an unboosted integrase inhibitor or boosted protease inhibitor in a test-and-treat setting did not impact platelet function.

Conclusions: Our study provides no evidence of differences in downstream platelet responses between participants taking BIC/F/TAF compared to DRV/c/F/TAF following 48 wk of treatment. Further data are required to explore whether there are biologically significant off-target effects, including effects on platelets and other components of the cardiovascular system between these two test-and-treat regimens.

Clinical trial number: NCT04653194.