HIV Medicine最新文献

Objectives: To explore missed opportunities for PrEP use among people with recently acquired HIV in the United Kingdom.

Methods: Data were derived from CASCADE, an international, longitudinal, mixed-methods study of adults (≥16 years) with recently acquired HIV (≤12 months). Individuals were recruited from nine UK clinics (08/2022-09/2024) to self-complete a questionnaire; a subset participated in semi-structured interviews (SSIs).

Results: 46 questionnaires were completed (39 cisgender men and 7 women, including 2 transgender women) and 11 SSIs (1 cisgender woman). Among men, 22 perceived HIV risk before diagnosis; 21 had ≥5 sexual partners and 17 reported group sex in the 3 months before diagnosis. Thirty (29 men and 1 woman) reported sexualized drug use. Twenty men had ever used PrEP; seven of them had not used it in the 6 months prior to diagnosis. No women had ever used PrEP. Most gay, bisexual and other men who have sex with men (GBMSM) were aware of PrEP; however, risk perception, social meanings of PrEP and concerns about side effects hindered utilization. Among five men using event-based dosing (EBD), three described difficulty predicting sexual activity that led to missed or mistimed pre-/post-sex doses - while others were reluctant to take daily PrEP. For women, the biggest barrier was lack of awareness.

Conclusions: PrEP barriers vary by population. For GBMSM, addressing barriers to uptake/adherence (e.g., EBD challenges) are key, highlighting the potential benefit of long-acting injectables. However, awareness of PrEP remains a key challenge for women to achieve equity in prevention.

Objective: Adherence to cervical cancer screening reduces cervical cancer mortality, particularly in settings with high HIV prevalence. We conducted the first nationwide study examining adherence to cervical cancer screening following first HIV testing in Eswatini, a country with the highest HIV prevalence globally.

Methods: We analysed data of 18 989 women between 2019 and 2023 who underwent first-time HIV testing, with follow-up for cervical cancer screening until 2024 using Eswatini Client Management Information System. Cervical cancer screening adherence was defined per national guidelines: undergoing screening within one year for HIV-positive testers and within two years for HIV-negative testers. Poisson regression with robust variance assessed crude and adjusted associations between HIV test status and screening adherence and evaluated predictors of screening adherence by HIV test status.

Results: HIV-positive test status was associated with significantly lower screening adherence (adjusted risk ratio = 0.67, 95% CI: 0.65-0.70). When applying the screening guideline for HIV-negative testers to HIV-positive testers, the association was not significant (adjusted risk ratio = 0.98, 95% CI: 0.96-1.01). For women with either HIV test result, older age (≥50 years) and care at mission hospitals or private clinics were linked to lower adherence, whereas urban residence increased adherence. Marriage was associated with higher adherence only among HIV-negative women.

Conclusions: Cervical cancer screening adherence remains suboptimal in Eswatini, particularly among HIV-positive women. Strengthening integration of HIV testing and cervical cancer screening, alongside targeted interventions for low-adherence subgroups, is needed to reduce screening disparities and improve cervical cancer prevention and prognosis.

Background: HIV remains a major global burden, with 2.4 million children and adolescents affected, 84% living in sub-Saharan Africa. As adolescents age, transitioning from paediatric to adult HIV care represents a critical period that may significantly affect antiretroviral therapy (ART) adherence, retention in care and virological suppression. A systematic evaluation of evidence from sub-Saharan Africa is essential to quantify the effects of healthcare transition on virological outcomes, especially viral suppression.

Methods: We systematically searched three electronic databases: PubMed, Scopus and Embase for studies published between January 1, 2015, and March 5, 2025, using keywords HIV, adolescents, transition to adult care and virological outcome. A narrative synthesis was used to summarize the findings, and meta-analyses were conducted using random-effects models to estimate pooled proportions with corresponding 95% confidence intervals. Heterogeneity between studies was quantified using the I² statistic, and potential sources of variability were explored through subgroup analyses based on study characteristics. The risk of bias for the included studies was assessed according to the study design using the Newcastle-Ottawa Scale. This review was registered with PROSPERO (CRD420251005361).

Results: The systematic search identified 1324 articles, of which 8 met the predefined inclusion criteria and were included in the final analysis. These studies consisted of 13 819 adolescents and young adults aged between 10 and 26 years. The pooled proportions of viral suppression were 75% (95% confidence interval [CI]: 68%-81%, I²: 89.2%, p < 0.0001) before transition and 67% (95% CI: 44%-84%, I²: 95.7%, p < 0.0001) after transition.

Conclusion: There is a decline in viral suppression following the transition from paediatric to adult HIV care in sub-Saharan Africa, indicating the need for targeted strategies to sustain suppression post-transition. Future large-scale longitudinal studies should use standardized transition age definitions, consistent follow-up durations and uniform virological suppression thresholds to ensure robust and comparable evidence.

Introduction: Children are a priority group for HIV prevention and control. However, limited data exist regarding disease burden and temporal trends among this population. This study aimed to evaluate the burden of HIV, as well as trends in health inequalities, among children aged 0-14 years between 1990 and 2021.

Methods: Age-standardised incidence, prevalence, disability-adjusted life years (DALYs) and death rates related to HIV among children aged 0-14 years were examined. Long-term trends and estimated annual percentage changes (EAPC) were calculated. Decomposition, health inequality, and frontier analyses were further conducted by Socio-demographic Index (SDI).

Results: From 1990 to 2021, the age-standardised incidence rate (ASIR), age-standardised deaths rate (ASDR), and age-standardised DALYs rate (ASR-DALYs) of HIV among children aged 0-14 years all showed a statistically significant decline, with EAPCs of -4.60 (95% CI: -5.97, -3.21), -2.09 (95% CI: -3.74, -0.41), and -2.14 (95% CI: -3.79, -0.46), respectively. In contrast, the age-standardised prevalence rate (ASPR) increased significantly, with an EAPC of 3.16 (95% CI: 1.66, 4.68). The HIV burden was greatest among children aged 0-5 years, particularly those under 1 year. South Asia experienced the most significant increases in ASPR, ASDR, and ASR-DALYs.

Conclusions: The global HIV disease burden in children aged 0-14 years trended downward overall but remained substantial, especially in the 0-5 age group. Health inequalities persisted across SDI regions, underscoring the need for targeted public health interventions in high-burden areas, particularly South Asia.

Objective: To examine temporal changes in late diagnosis of HIV (LD) among migrant and non-migrant people with HIV in Sweden 2003-2023 and to assess demographic and socioeconomic risk factors for LD in these two populations.

Methods: People with HIV diagnosed with HIV-1 in Sweden 2003-2023 were included (n = 6278). LD was defined as a first CD4+ T-cell count <350 cells/μL or an AIDS-defining event within 3 months of diagnosis. People with HIV with evidence of recent infection were reclassified as non-late. Temporal changes in LD were examined using descriptive statistics and regression analyses. To assess risk factors for LD, modified Poisson regression was employed. Risk factor analyses were restricted to 2010-2020 when complete sociodemographic data were available (n = 2778). Data were obtained from Swedish national registries.

Results: The absolute incidence of total and late HIV diagnoses decreased over the study period, whereas the annual proportion of LD varied between 46% and 60% and trended upwards. LD occurred in 41% of non-migrant people with HIV and 58% of migrant people with HIV. Among non-migrant people with HIV, having an upper secondary education or less was associated with LD compared to post-secondary education, as was male sex with heterosexual HIV acquisition and higher age. For migrant people with HIV, neither lower education nor income was statistically significantly associated with LD. Instead, higher age, certain birth regions, heterosexual acquisition and male sex with acquisition through injection drug use were associated with LD.

Conclusions: LD declined in absolute terms yet constituted a high and increasing proportion of new HIV cases in Sweden 2003-2023, with differing sociodemographic determinants by migrant status.

Objectives: To characterize real-world treatment switching in France to bictegravir (BIC or B) or dolutegravir (DTG)-based regimens with a focus on treatment persistence, effectiveness (HIV-1 RNA ≤50 copies/ml) and particular attention to the prevalence and incidence of comorbidities.

Methods: People living with HIV from the prospective ANRS-CO3-AquiVIH-NA cohort, who switched from effective antiretroviral treatment (ART) to a BIC- or DTG-based regimen between 2018 and 2021, were eligible for analysis.

Results: A total of 2275 people living with HIV were included (52% receiving B/F/TAF, 8% DTG/3TC/ABC, 18% DTG/RPV, 22% DTG/3TC) with a median age of 53-56 years and a comorbidity prevalence of 71%-75% across treatment groups (chronic kidney disease (CKD) 15%-25%, diabetes mellitus 15%-19%, hypertension 57%-64%). Viral suppression rates at month 18 (LOCF, last observation carried forward) using a missing-equals-excluded (M = E) approach were 97% on B/F/TAF, 95% on DTG/3TC/ABC, 97% on DTG/RPV and 96% on DTG/3TC. Discontinuation rates were 16.5% for B/F/TAF, 37.5% for DTG/3TC/ABC, 16.7% for DTG/RPV and 17.3% for DTG/3TC, driven by adverse events in 5.6%, 12.5%, 5.6% and 6.1%, respectively. Comorbidity incidence rates/1000 person years in those free of the respective disease were 39 for hypertension, 22 for diabetes mellitus, 13 for cardiovascular events and 5 for CKD.

Conclusions: In this real-world cohort, treatment persistence 18 months after therapy switch was similar for B/F/TAF, DTG/RPV and DTG/3TC, but significantly lower for DTG/3TC/ABC. All regimens maintained high levels of viral suppression. Furthermore, the cohort illustrates the disease burden experienced by middle-aged and elderly people living with HIV and highlights the importance of adapting ART to the specific needs of this population.

Objectives: Men who have sex with men living with HIV (MSMLWH) are at highest risk for human papillomavirus (HPV)-associated anal cancer, which may originate from the anal canal, verge or perianal skin. Perianal lesions are frequently overlooked during examination, and their (pre)malignant burden in this population remains poorly characterized.

Methods: A total of 308 MSMLWH who underwent high-resolution anoscopy (HRA)-guided perianal biopsy between 2018 and 2024 were analysed. Demographics, clinical HIV parameters, smoking history, HPV vaccination status, anal cytology, high-risk HPV test results and histologic diagnoses were collected. Risk factors for perianal (pre)cancer were assessed using chi-square and rank-sum tests.

Results: Median age was 52 years (range 27-72). Prevalence of abnormal anal cytology (atypical squamous cells of undetermined significance [ASCUS] or worse), high-risk HPV and HPV16 was 85%, 77% and 30%, respectively. Intra-anal high-grade squamous intraepithelial lesion (HSIL) was detected in 48%. Histologic diagnoses of perianal lesions included negative (n = 12, 4%), low-grade squamous intraepithelial lesions (LSIL) (n = 236, 77%), HSIL (n = 55, 18%), basal cell carcinoma (n = 1, <1%) and superficially invasive squamous cell carcinoma (SISCCA, n = 4, 1%). Perianal HSIL without intra-anal HSIL occurred in 8% of participants, with 82% of HSILs found in verrucous lesions. Perianal HSIL/SISCCA was strongly associated with high-risk HPV, HPV16 and intra-anal HSIL (p = 0.002). HPV16 was the strongest predictor (odds ratio [OR] 5.6; 95% CI 2.9-10.8).

Conclusions: Perianal lesions in MSMLWH have significant (pre)malignant potential, particularly in the context of HPV16 infection. Thorough examination and low threshold for biopsy are essential for effective cancer prevention.

Objectives: To measure disability and frailty and assess measurement properties of the HIV Disability Questionnaire (HDQ) in outer regional Australian people living with human immunodeficiency virus (HIV).

Methods: This cross-sectional, validity and reliability study included community-dwelling outer regional Australian adults with HIV. Participants completed the self-reported World Health Organization Disability Assessment Schedule 2.0 (WHODAS; scored 0-100), 5-Question Frail Scale (scored 0-5) and HDQ (scored 0-100). Median scores (Q1, Q3) for disability (WHODAS) and frailty (Frail Scale) were reported. HDQ validity was tested based on 16 a priori hypothesized relationships between WHODAS, Frail Scale and HDQ scores (threshold ≥75% confirmed), and HDQ internal consistency with Cronbach's alpha (acceptability threshold ≥ 0.70). Seven days after the initial completion, the HDQ was re-administered for test-retest reliability (intraclass correlation coefficient, acceptability threshold ≥ 0.75).

Results: Fifty participants were recruited, with a median age 55. Eighty-eight percent were male, and 38 participants completed the second HDQ. The median (Q1, Q3) scores were: WHODAS 9 (3,17), with domain scores ranging from 0 to 56. Pre-frailty (score 1-2) and Frailty (score 3-5) were present in 27% and 13% of participants, respectively. The HDQ demonstrated construct validity (81% hypotheses confirmed), internal consistency (Cronbach's alpha ≥ 0.79), except in the Episodic scale-Social inclusion domain (alpha = 0.34), and good test-retest reliability for all Presence and Severity domains (ICC range: 0.77-0.94).

Conclusions: Disability, frailty and pre-frailty exist in this sample of outer regional Australians living with HIV. The HDQ showed acceptable construct validity, internal consistency and test-retest reliability to measure disability in this population.

Clinical trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12623000090617).