HIV Medicine最新文献

Introduction: A proportion of people living with HIV (PLWH) fail to restore their CD4 count or their CD4/CD8 ratio despite effective antiretroviral therapy (ART). PLWH with immune non-response (INR) are at a higher risk of both AIDS and non-AIDS events. The underlying mechanisms of INR remain unclear.

Objectives: This review aims to explore the potential mechanisms of INR, focusing on the production, maturation and early destruction of CD4 cells. Additional factors such as age, proinflammatory environment or persistent viral infections like HIV or CMV may also contribute to INR. Biomarkers, such as microRNA, IL-6, soluble CD14 and soluble GP120, may help better characterize INR in PLWH. Despite various therapeutic attempts - including ART intensification and IL-2 or IL-7 administration - no strategy has yet succeeded in restoring effective CD4 T-cell recovery in INR.

Conclusion: A lack of consensus on the definition and classification of INR limits research comparability and therapeutic progress. A standardized framework would facilitate mechanistic insights and guide the development of targeted treatments, including IL-7 therapy. In this review, we examine the putative mechanisms underlying INR in PLWH, prognostic markers and the therapeutic strategies that have been evaluated, albeit with limited success.

Introduction: People with HIV (PWH) have an elevated risk of major adverse cardiovascular events (MACE) compared to the general population. The independent contribution of hypertriglyceridaemia (HTG) to cardiovascular risk remains unclear, and it is not accounted for in the standard used risk scores. The aim of this study was to evaluate whether HTG is independently associated with MACE, beyond factors included in the Atherosclerotic Cardiovascular Disease (ASCVD) risk score. Moreover, we assessed whether the association between MACE and cardiovascular risk factors, including HTG, is modified by sex.

Methods: This was a retrospective longitudinal study including PWH followed at the San Raffaele Scientific Institute from January 2013 to January 2025. Baseline was defined as the first evaluation from 2013 onwards. A multivariate Cox regression model was used to assess the association between HTG and MACE, adjusting for ASCVD variables, statin use and HIV-related factors. Interaction terms were tested to explore sex-based modification of these associations.

Results: Over a median follow-up of 11.4 years, 187 MACE occurred. HTG was independently associated with MACE [hazard ratio 1.53 (1.03; 2.30), p = 0.042], along with variables included in ASCVD risk score, statin use and unsuppressed HIV viraemia. No significant interactions were found between sex and any of the variables, although a marginal interaction was observed for diabetes.

Conclusions: In this large cohort of PWH, HTG was independently associated with MACE, beyond traditional risk factors included in the ASCVD risk score. These findings suggest that triglycerides should be routinely considered in cardiovascular risk evaluation and targeted interventions-such as lifestyle changes and specific triglyceride-lowering therapies-may contribute to the reduction of residual cardiovascular risk.

Introduction: People with HIV experience a high rate of comorbidities that can complicate their health outcomes. Understanding the prevalence, interrelationships and temporal development of these comorbidities is crucial for improving health management and quality of life for people with HIV.

Methods: We used a population-based cohort extracted from statewide electronic health record (EHR) data in South Carolina (SC), including 18 649 people with HIV who survived at least 1 year after HIV diagnosis between January 1, 2005, and December 31, 2020. Comorbidities and organ systems were classified using ICD-10 codes. Network analysis was performed to assess the closeness centrality among comorbidities. Temporal network analysis was conducted every 3 years to compare the increases or decreases in comorbidities over time.

Results: The most common comorbidities included infectious diseases (74.4% such as candidiasis, Hepatitis C and other sexually transmitted infections [STIs]), digestive system disorders (67.9%), mental and behavioural disorders (65.0%), respiratory system disorders (62.9%) and musculoskeletal system disorders (62.3%). The most frequent non-communicable conditions were hypertensive disorders (54.7%), nicotine dependence (54.3%), back pain (41.1%), anaemias (39.7%) and gastro-oesophageal reflux disease (GERD) (26.0%). The temporal analysis showed a rise in 10 comorbidities from 2006 to 2020, including hypertensive disease (19.7% to 24.7%) and dyslipidaemia (4.5% to 11.2%). Nicotine dependence, hypertensive disease, anaemia and major depressive disorder were the most prevalent over time.

Conclusions: Our study underscores the high prevalence and complex interrelationships of comorbidities among people with HIV in SC. This emphasizes the need for ongoing monitoring and specific interventions to address comorbidities, focusing on shared risk factors and established pathological pathways.

Background: HIV/AIDS remains a global health crisis marked by profound regional disparities. Sub-Saharan Africa (SSA) bears the greatest burden but has achieved partial progress in reducing its impact. Within the region, however, heterogeneous patterns of progress and setbacks persist, underscoring ongoing challenges in epidemic control and suggesting potential misalignment in the focus of current interventions.

Methods: We analysed HIV/AIDS disability-adjusted life years (DALYs) from 2016 to 2021, disaggregated at subregional and local levels across continents using Global Burden of Disease (GBD) estimates. This high-resolution analytical approach enabled the identification of nuanced temporal trends and geographic hotspots requiring urgent intervention, with particular emphasis on SSA.

Findings: Southern SSA recorded a 20.8% decline in DALY rates, from 18 280 to 14 470 per 100 000 population, while eastern, western and central SSA each achieved reductions exceeding 27%. Despite these gains, some areas maintained alarmingly high burdens, including Lesotho (26 516), eastern Cape, South Africa (25 004), Eswatini (22 944) and Homa Bay, Kenya (21 747). Outside Africa, the Caribbean achieved a 29% decline, whereas North America and Europe registered more modest improvements. In Asia, several Indian states recorded up to 27% reductions, contrasted by increases in parts of Pakistan, Mongolia, China and Yemen.

Interpretation: Marked regional contrasts highlight the need to reframe HIV/AIDS control strategies at the subregional level. Despite setbacks linked to the COVID-19 pandemic, targeted, data-driven interventions in persistent high-burden areas remain essential to sustain progress and accelerate the global HIV/AIDS response. Yet, just as encouraging transitions are beginning to take hold across several parts of SSA, the continent is now confronted-suddenly and unprepared-for a renewed challenge: a decline in HIV/AIDS funding.

Objective: To examine the prevalence of current substance and hazardous alcohol use in people with HIV and tuberculosis (TB) disease and its impact on TB treatment outcomes.

Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, EMBASE, Scopus, PsycInfo and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to 3 April 2025. Risk of bias was assessed using the ROBINS-E tool. Prevalence estimates were synthesized using a random-effects model with between-study heterogeneity assessed via the I² statistic.

Results: Eighteen studies were included. Prevalence of current hazardous alcohol use ranged from 7.4% to 33.7%, with a pooled estimate of 19.1% (95% CI [16.1%-22.5%], I² = 92.5%) across 5310 individuals. Current substance use (excluding alcohol) ranged from 1.2% to 90.9%, with a pooled prevalence of 25.1% (95% CI [15.3%-38.8%], I² = 96.8%) among 3709 individuals. Pooled prevalence estimates varied across WHO regions, with the Western Pacific Region reporting the highest prevalence of hazardous alcohol use (20.4%) and the Region of the Americas leading in substance use (29.9%). Only three studies assessed TB treatment, all showing poorer outcomes among people with substance use disorders. Heterogeneity and small sample size precluded pooled analysis. Most studies had high or very high risk of bias, primarily due to confounding, missing data and inconsistent definitions of substance and hazardous alcohol use.

Conclusion: Current substance and hazardous alcohol use occurs frequently among people with HIV and TB, varying widely depending on the population. However, current substance and hazardous alcohol use, as opposed to any history of substance use, is rarely assessed systematically.

Objective: Evaluate factors associated with discontinuation of long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) and describe virologic outcomes in those that returned to oral antiretroviral therapy (ART).

Methods: This is a retrospective cohort study at a single-centre primary care HIV clinic. Included were adults who received at least one injection of LAI CAB/RPV between April 2021 and March 2024. Characteristics were compared between those that continued LAI CAB/RPV and those that discontinued treatment during the study period. HIV viral load (VL) outcomes were evaluated in those that returned to oral ART and included the most recent VL in the range of 1-24 weeks, 24-48 weeks and the most recently documented VL through September 2024.

Results: A total of 92 and 346 patients were included in the discontinuation and continuation cohorts, respectively. Being male sex assigned at birth and having psychiatric disease was associated with continuing LAI CAB/RPV, whereas having active substance use and being on a multi-class regimen prior to initiation of LAI CAB/RPV was associated with discontinuation. In those with VL data after resuming oral ART, the percentage of those with HIV VL <50 copies per mL up to 24 weeks (n = 58) was 91.4%, up to 48 weeks (n = 53) was 90.6%, and using the most recent documented VL (n = 74) was 91.9%.

Conclusions: High viral suppression rates were observed in those that returned to oral therapy after discontinuing LAI CAB/RPV. Individuals with substance use demonstrated a higher rate of LAI discontinuation, despite the potential benefit from LAIs in this population.

Objective: Prevalence of geriatric syndromes including frailty among people living with HIV is increasing and at younger ages. There is no gold standard model of care for people with HIV and frailty. This study aimed to determine the acceptability of a comprehensive geriatric assessment and management plan, delivered jointly by a geriatrician and HIV physician (the Silver Clinic) in outpatient HIV services, and also the feasibility of conducting a randomized controlled trial (RCT) of the Silver Clinic compared with standard care.

Design: Mixed-methods single-centre, parallel, two-arm feasibility RCT.

Methods: People living with HIV ≥50 years old, who screened as frail using the FRAIL scale were randomized to: usual care or the Silver Clinic. Randomization was stratified by age and sex, target N = 84. The primary objective was to determine whether a definitive trial is feasible.

Results: Twenty-five participants (46% of n = 55 eligible patients) were randomized. One hundred percent of participants attended their 6-month follow-up and 91% at 12 months. More than 90% of the outcome measures were completed at all time points. Interviews revealed study processes and outcome measures were acceptable, and that the intervention was valued by people living with HIV and frailty.

Conclusions: Delivering a comprehensive geriatric assessment jointly by a geriatrician and HIV physician was feasible and acceptable. Retention and completion of outcome measures were high, although recruiting sufficient frail individuals from one site was challenging. A RCT to determine the effectiveness of the Silver Clinic is warranted, but will require a multicentre design and an extended recruitment period to address recruitment challenges.

Objectives and design: We aimed to describe pregnancies among women who were diagnosed with HIV during pregnancy in a multicentre cohort.

Methods: We included antiretroviral (ART)-naïve women, aged 18-50 years, who were recruited into the Spanish CoRIS cohort between 2004 and 2022 and had been diagnosed with HIV during pregnancy.

Results: Of 2102 women, 185 (8.8%) were diagnosed with HIV during pregnancy, 51.2% of which were late presenters, and 25.4% and 9.2% were diagnosed during the second and third trimester, respectively. Women from Latin America (adjusted odds ratio [OR]: 4.97, 95% CI: 1.72; 14.35) and Sub-Saharan Africa (3.07, 1.11; 8.52) were more likely to be diagnosed after the first trimester compared to Spanish women. Overall, 95.7% initiated ART during pregnancy, at a median time of 2 days (interquartile range [IQR]: 0; 14) from enrolment. Over time, the use of emtricitabine+tenofovir disoproxil fumarate (and later emtricitabine+tenofovir alafenamide), as well as integrase strand transfer inhibitors, increased. Overall, 95.1% of pregnancies resulted in delivery (46.0% caesarean). At 36 weeks of pregnancy, 82.8% of women had an undetectable viral load (VL), rising from 71.7% in 2004-2008 to over 95% after 2013. Preterm birth and low birth weight occurred in 10% and 9.8% of deliveries, respectively, with one HIV perinatal transmission.

Conclusions: Among women diagnosed with HIV during pregnancy, half were late presenters, and one-third were diagnosed after the first trimester, with higher percentages among African and Latin American women. There was a high proportion of caesarean deliveries. Most women initiated ART promptly after cohort enrolment and achieved undetectable VL at the end of pregnancy.

Purpose: Cardiovascular disease (CVD) is an emerging health concern among people living with HIV (PLHIV), particularly in Asian settings where evidence remains limited. We aimed to estimate the cumulative risk of CVD among PLHIV in Malaysia, in the presence of competing risk from non-CVD deaths, and to identify associated risk factors.

Methods: We conducted a retrospective cohort study using data from the Malaysian Antiretroviral Therapy Cohort (MATCH), including adults diagnosed with HIV between 2007 and 2023. Individuals with prior CVD were excluded. The primary outcome was a composite of CVD events, with non-CVD death treated as a competing risk. We estimated cumulative incidence functions (CIFs) and incidence rates (IRs) per 1000 person-years (PYs), and assessed associations using Fine and Grey subdistribution hazard models, with cause-specific Cox models as secondary analysis.

Results: Among 7098 PLHIV, 287 (4.0%) developed CVD over 61 936 PY (IR: 4.63 per 1000 PY; 95% CI: 4.11-5.20). The cumulative CVD risk was 1.9% at 5 years, 3.8% at 10 years, and 7.1% at 15 years post-diagnosis. Older age (subdistribution hazard ratio (sHR): 1.07 per year), Indian (sHR: 2.27), and Malay ethnicity (sHR: 1.81) were associated with a higher risk. Abacavir use was significantly associated with CVD (sHR: 2.48). PI use showed a borderline association in the main model (sHR: 1.47) but was significant in the secondary analysis (aHR: 1.86). Other antiretroviral classes were not significant.

Conclusion: CVD risk among PLHIV is non-negligible. Integrating CVD prevention into HIV care is critical, particularly for older adults and those on specific ART regimens.