HIV Medicine最新文献_第10页

Molecular epidemiological analysis and investigation of antiretroviral drug resistance profile, including capsid inhibitors, among treatment-naïve individuals with HIV-1 in Türkiye <s:1> rkiye地区treatment-naïve HIV-1患者（包括衣壳抑制剂）抗逆转录病毒耐药性的分子流行病学分析和调查

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-07 DOI: 10.1111/hiv.70109

Adem Özdemir, Tülin Demir, Ceylan Polat, Mertcan Uzun, Meliha Çağla Sönmezer, Koray Ergünay, Serhat Ünal, Ahmet Çağkan İnkaya, Ahmet Pınar

Introduction

Monitoring transmitted drug resistance is crucial for guiding first-line antiretroviral therapy (ART) and controlling the rising HIV epidemic in Türkiye. This study aimed to determine the prevalence of transmitted antiretroviral resistance to protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), integrase strand transfer inhibitors (INSTIs) and capsid assembly inhibitors (CAIs). We also assessed the distribution of HIV-1 subtypes and circulating recombinant forms (CRFs) at one of the main national referral centres in Türkiye.

Methods

We included 104 consecutive ART-naïve people living with HIV who presented at Hacettepe University Hospital in Ankara between November 2021 and November 2022. Demographic data, probable transmission routes and geographic origins were recorded. HIV-1 genotyping was performed to identify subtypes and resistance-associated mutations using standard methods.

Results

Of the 104 individuals, 97 were from 25 different cities in Türkiye, while 7 originated from 5 different countries. The most probable transmission routes were men who have sex with men (MSM) (64.42%), heterosexual contact (30.77%) and unknown (4.81%). Resistance-associated mutations were detected in 14.42% of individuals. Resistance rates were 1.92% for PI, 4.80% for NRTI and 7.69% for NNRTI. No resistance mutations were found against INSTI or CAI.

Conclusion

Transmitted resistance to PI, NRTI and NNRTI remains present in Türkiye, though at moderate levels. The absence of resistance to INSTI and CAI supports their potential utility as effective components of treatment regimens in Türkiye.

导言：监测传播的耐药性对于指导一线抗逆转录病毒治疗（ART）和控制泰国日益上升的艾滋病毒流行至关重要。本研究旨在确定对蛋白酶抑制剂（pi）、核苷类逆转录酶抑制剂（NRTIs）、非核苷类逆转录酶抑制剂（NNRTIs）、整合酶链转移抑制剂（insts）和衣壳组装抑制剂（CAIs）的传播性抗逆转录病毒耐药性的患病率。我们还评估了HIV-1亚型和循环重组形式（CRFs）在泰国一个主要国家转诊中心的分布情况。方法：我们纳入了2021年11月至2022年11月期间在安卡拉Hacettepe大学医院就诊的104名HIV感染者ART-naïve。记录了人口统计数据、可能的传播途径和地理来源。使用标准方法进行HIV-1基因分型以鉴定亚型和耐药性相关突变。结果：104人中，97人来自日本25个不同城市，7人来自5个不同国家。最可能的传播途径为男男性行为者（MSM）（64.42%）、异性接触（30.77%）和未知（4.81%）。14.42%的个体检测到耐药性相关突变。PI、NRTI和NNRTI的耐药率分别为1.92%、4.80%和7.69%。对INSTI和CAI均未发现耐药突变。结论：对PI、NRTI和NNRTI的传播性耐药在基耶病毒中仍然存在，但水平适中。对INSTI和CAI的无耐药性支持了它们作为治疗方案有效成分的潜在效用。

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引用次数: 0

Multidimensional frailty, sex differences, and quality of life among older Ugandans affected by HIV 受艾滋病毒影响的乌干达老年人的多维脆弱性、性别差异和生活质量。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-05 DOI: 10.1111/hiv.70111

Gideon Dzando, Paul R. Ward, Lillian Mwanri, Pascal Agbadi, Rachel C. Ambagtsheer

Background

Older people affected by HIV in sub-Saharan Africa are at increased risk of frailty and poor quality of life (QoL). However, the contributions of specific frailty domains to QoL and whether these associations differ by sex remain poorly understood.

Methods

We analysed cross-sectional data from 444 older people aged ≥50 years (mean age 64.6 years, 62% female) from the WHO SAGE-WOPS HIV sub-study in Uganda. Frailty was assessed using 15 items from the Frailty Instrument for Sub-Saharan Africa (FiSSA), and QoL with a 7-item composite index. We used multiple linear regression to examine the associations between overall and domain-specific frailty and QoL, including sex interaction terms.

Results

Higher overall frailty was associated with lower QoL (β = −0.63, p < 0.001). Among the frailty domains, the physical (β = −0.43, p < 0.001) and socioemotional (β = −0.18, p < 0.001) domains exceeded the minimally important difference (MID) threshold, indicating clinically meaningful associations with lower QoL, whereas the visual and psychological domains were below this threshold. A significant sex interaction was observed for the psychological domain (β = −0.25, p = 0.004), indicating a stronger negative association among women. No significant sex interactions were observed for the physical, socioemotional, or visual domains.

Conclusions

Frailty, particularly physical, socioemotional, and psychological domains, was associated with lower QoL among older Ugandans affected by HIV. Psychological frailty was more strongly associated with poorer QoL in women. Gender-sensitive, psychosocial interventions may help address these disparities and support healthy and equitable ageing in HIV-affected populations.

背景：撒哈拉以南非洲地区受艾滋病毒影响的老年人身体虚弱和生活质量差（QoL）的风险增加。然而，特定脆弱域对生活质量的贡献以及这些关联是否因性别而异仍然知之甚少。方法：我们分析了来自乌干达世卫组织SAGE-WOPS艾滋病亚研究的444名年龄≥50岁的老年人（平均年龄64.6岁，62%为女性）的横断面数据。脆弱性评估采用撒哈拉以南非洲脆弱性工具（FiSSA）中的15个项目，生活质量评估采用7个项目的综合指数。我们使用多元线性检验整体和特定领域脆弱性与生活质量之间的关系，包括性别相互作用术语。结果：总体虚弱程度较高与较低的生活质量相关（β = -0.63, p）。结论：虚弱，特别是身体、社会情感和心理领域，与感染艾滋病毒的乌干达老年人较低的生活质量相关。心理脆弱与女性较差的生活质量关系更大。对性别问题有敏感认识的社会心理干预措施可能有助于解决这些差异，并支持受艾滋病毒影响的人口健康、公平地步入老年。

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引用次数: 0

Dual drivers of polypharmacy in people with HIV: Quantifying the independent associations of aging and long-term antiretroviral therapy 艾滋病毒感染者多重用药的双重驱动因素：量化衰老和长期抗逆转录病毒治疗的独立关联。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-05 DOI: 10.1111/hiv.70106

Shigeru Hasebe, Taiki Kusaka, Masayuki Tanaka, Shiori Iwane, Toshikazu Tsuji, Hiroyuki Kushida, Mari Nakamura, Masahiro Nakamura, Takumi Fujiwara, Maho Kikuta

Objectives

This study aimed to disentangle the independent effects of aging and cumulative antiretroviral therapy (ART) duration on polypharmacy in people with HIV. While successful ART has led to an aging population with HIV, polypharmacy may stem from both aging and ART's cumulaftive toxicity. Quantitative evidence separating these effects is scarce, particularly in Japan.

Methods

In this retrospective study, we analysed a Japanese community pharmacy database (2014–2022) of 696 people on ART for ≥6 months. Using negative binomial regression, we assessed the independent effects of age and cumulative ART duration on the number of concomitant medications (a proxy for polypharmacy), adjusting for sex.

Results

Both advanced age and cumulative ART duration were significant independent risk factors for polypharmacy. A strong dose-dependent relationship was observed with age (incidence rate ratio [IRR] for 60–69 years: 9.61; 95% confidence interval [CI], 4.92–18.78 vs. <30 years). After adjusting for age and sex, a cumulative ART duration of ≥9 years remained an independent predictor of more concomitant medications (IRR: 1.81; 95% CI, 1.05–3.13 vs. <1 year).

Conclusions

We propose a “dual-structure model” for polypharmacy in people with HIV, comprising age-related multimorbidity and a distinct layer potentially linked to the long-term effects of ART. To our knowledge, this study provides the first quantitative evidence from Japan to statistically disentangle the associations with these two factors. Our findings highlight the need to integrate geriatric principles with HIV-specific toxicity management for optimal long-term strategies.

目的：本研究旨在阐明年龄和累计抗逆转录病毒治疗（ART）持续时间对HIV感染者多重用药的独立影响。虽然成功的抗逆转录病毒治疗导致艾滋病毒感染者人口老龄化，但多重用药可能源于老龄化和抗逆转录病毒治疗的累积毒性。区分这些影响的定量证据很少，尤其是在日本。方法：在这项回顾性研究中，我们分析了日本社区药房数据库（2014-2022）中696名接受抗逆转录病毒治疗≥6个月的患者。使用负二项回归，我们评估了年龄和累计抗逆转录病毒治疗持续时间对合并用药数量的独立影响，并对性别进行了调整。结果：高龄和累计抗逆转录病毒治疗时间是多重用药的重要独立危险因素。60-69岁的发病率比[IRR]为9.61；95%可信区间[CI]为4.92-18.78。结论：我们提出了HIV感染者多重用药的“双重结构模型”，包括与年龄相关的多重发病率和可能与ART长期效应相关的不同层次。据我们所知，这项研究提供了第一个来自日本的定量证据，以统计方式解开与这两个因素的关联。我们的研究结果强调需要将老年原则与艾滋病毒特异性毒性管理相结合，以获得最佳的长期策略。

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引用次数: 0

Examination of factors associated with mental health of people living with HIV in Kazakhstan: A cross-sectional study based on the two-continua model 对哈萨克斯坦艾滋病毒感染者心理健康相关因素的检查：基于双连续模型的横断面研究。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-05 DOI: 10.1111/hiv.70100

Adel Stoyanova, Faye Foster, Pavel Savin, Nurali Amanzholov, Raushan Alibekova

<div> <section> <h3> Introduction</h3> <p>Human immunodeficiency virus (HIV) remains a significant global health problem, and the number of new cases is increasing in Central Asia, including Kazakhstan. This study aimed to examine the association of a range of demographic, physical health and psychosocial factors with the mental health of people living with HIV in Kazakhstan, applying the two-continua model of mental health, which holds that mental wellbeing and mental illness are two distinct continua that are interrelated in their contributions to overall mental health. The study findings can inform future interventions aimed to prevent mental illness and promote the mental wellbeing of people living with HIV.</p> </section> <section> <h3> Methods</h3> <p>This cross-sectional study was conducted in collaboration with the Kazakhstan Union of people living with HIV. The online survey link was disseminated via social networks of people living with HIV in various regions of Kazakhstan from January to February 2024. The questionnaire included questions on sociodemographic characteristics, general health information and standardized validated scales to measure flourishing, depressive and anxiety symptoms, HIV-related stigma, and social support. Descriptive, bivariate and multivariate multinomial regression analyses were performed in STATA software version 18.</p> </section> <section> <h3> Results</h3> <p>A third of the sample was flourishing (33.53%) without depressive or anxiety symptoms, while 15.29% of participants were flourishing despite mental illness, 30.59% were not flourishing and had no mental illness, and 20.59% were experiencing mental illness and not flourishing. Participants with higher social support were more likely to flourish and have no symptoms of depression or anxiety, while flourishing despite mental illness was associated with the unemployment status of people living with HIV. High internalized stigma was associated with the increased risk of having depression or anxiety symptoms and low mental wellbeing, while better physical health and older age had a protective effect against mental illness and languishing.</p> </section> <section> <h3> Conclusions</h3> <p>Study findings suggest that enhancing access to social support and reducing HIV-related stigma are key to improving mental wellbeing among people living with HIV in Kazakhstan, especially among individuals of younger age, and those with worse physical condition. Applying the dual continuum model of mental health and integrating mental wellbeing scales in physical and psychol

导言：人类免疫缺陷病毒（艾滋病毒）仍然是一个重大的全球健康问题，在中亚，包括哈萨克斯坦，新病例的数量正在增加。本研究旨在研究哈萨克斯坦艾滋病毒感染者的一系列人口、身体健康和社会心理因素与精神健康之间的关系，采用精神健康的双连续体模型，该模型认为，精神健康和精神疾病是两个不同的连续体，它们对整体精神健康的贡献是相互关联的。研究结果可以为未来的干预措施提供信息，旨在预防精神疾病，促进艾滋病毒感染者的心理健康。方法：这项横断面研究是与哈萨克斯坦艾滋病毒感染者联盟合作进行的。在线调查链接于2024年1月至2月通过哈萨克斯坦各地区艾滋病毒感染者的社交网络传播。问卷包括社会人口学特征、一般健康信息和标准化的有效量表，以衡量繁荣、抑郁和焦虑症状、艾滋病毒相关的耻辱和社会支持。在STATA软件18版中进行描述性、双变量和多变量多项式回归分析。结果：三分之一的人（33.53%）没有抑郁或焦虑症状，15.29%的人虽然有精神疾病，但生活很好，30.59%的人没有精神疾病，20.59%的人有精神疾病但生活不幸福。拥有较高社会支持的参与者更有可能成功，没有抑郁或焦虑的症状，而尽管患有精神疾病，但成功与艾滋病毒感染者的失业状况有关。高度内化的耻辱与抑郁或焦虑症状的风险增加以及精神健康状况不佳有关，而更好的身体健康和年龄的增长对精神疾病和萎靡有保护作用。结论：研究结果表明，增加获得社会支持的机会和减少与艾滋病毒相关的耻辱感是改善哈萨克斯坦艾滋病毒感染者心理健康的关键，特别是在年轻人和身体状况较差的人群中。建议在艾滋病毒感染者的身体和心理检查中应用精神健康双连续体模型和整合精神健康量表，以更好地确定他们的服务需求，并为最需要的人提供量身定制的干预措施。

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引用次数: 0

Suppressed switch to Bictegravir/emtricitabine/tenofovir alafenamide compared with dolutegravir/lamivudine: Real-world evidence from the OPERA cohort 与多替重力韦/拉米夫定相比，抑制比替重力韦/恩曲他滨/替诺福韦阿拉芬胺切换：来自OPERA队列的真实证据。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-08-30 DOI: 10.1111/hiv.70105

Gerald Pierone Jr, Laurence Brunet, Jennifer S. Fusco, Michael G. Sension, Megan S. Dunbar, Joshua Gruber, Douglas T. Dieterich, Gregory P. Fusco

Objectives

To compare the virologic effectiveness and discontinuation of the commonly prescribed fixed-dose combination 3-drug and 2-drug regimens, bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) and dolutegravir/lamivudine (DTG/3TC), in virologically suppressed individuals in routine clinical care in the US.

Methods

From the OPERA cohort, ART-experienced, virologically suppressed (viral load <200 copies/mL) adults with HIV who switched to B/F/TAF or DTG/3TC (01AUG2020-30JUN2022) were followed through 31DEC2022, death, loss to follow-up or discontinuation. Cox proportional hazard models with stabilized inverse probability of treatment weights were used to assess the association between regimen and time to confirmed virologic failure (cVF₂₀₀; 2 viral loads ≥200 copies/mL or 1 viral load ≥200 copies/mL + discontinuation) or time to discontinuation.

Results

A total of 3512 B/F/TAF users were followed for a median of 16 months (IQR: 11, 22); 2327 DTG/3TC users were followed for a median of 15 months (IQR: 10, 21). cVF₂₀₀ was observed among 2% of B/F/TAF and 3% of DTG/FTC users, for an adjusted hazard ratio of 0.84 (95% CI: 0.59, 1.18) for B/F/TAF compared with DTG/3TC. Regimen discontinuation was observed among 17% of B/F/TAF and 19% of DTG/3TC users, for an adjusted hazard ratio of 0.83 (95% CI: 0.73, 0.94) for B/F/TAF compared with DTG/3TC. Treatment-related reasons for discontinuation represented 6% of B/F/TAF and 9% of DTG/3TC discontinuations.

Conclusions

In this large US cohort, both B/F/TAF and DTG/3TC were well tolerated and effective treatment options among virologically suppressed individuals in routine clinical care, although DTG/3TC tended to be discontinued faster than B/F/TAF.

目的：比较美国常规临床护理中病毒学抑制个体中常用的3药和2药固定剂量联合方案，比替格拉韦/恩曲他滨/替诺福韦拉米夫定（B/F/TAF）和多替格拉韦/拉米夫定（DTG/3TC）的病毒学有效性和停药情况。方法：来自OPERA队列，art经历，病毒学抑制（病毒载量200；2个病毒载量≥200拷贝/mL或1个病毒载量≥200拷贝/mL +停药）或停药时间。结果：共有3512名B/F/TAF使用者接受了中位16个月的随访（IQR: 11,22）；2327名DTG/3TC患者的随访时间中位数为15个月（IQR: 10,21）。在2%的B/F/TAF和3%的DTG/FTC用户中观察到cVF200，与DTG/3TC相比，B/F/TAF的校正风险比为0.84 （95% CI: 0.59, 1.18）。17%的B/F/TAF患者和19%的DTG/3TC患者停药，与DTG/3TC相比，B/F/TAF的校正风险比为0.83 （95% CI: 0.73, 0.94）。治疗相关的停药原因占B/F/TAF停药的6%，占DTG/3TC停药的9%。结论：在这个庞大的美国队列中，B/F/TAF和DTG/3TC在常规临床护理中对病毒学抑制的个体具有良好的耐受性和有效的治疗选择，尽管DTG/3TC往往比B/F/TAF更快地停止治疗。

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引用次数: 0

Cellular and humoral response after mRNA SARS-CoV-2 vaccination in kidney transplant recipients living with HIV: A cross-sectional study 携带HIV病毒的肾移植受者接种mRNA SARS-CoV-2疫苗后的细胞和体液反应：一项横断面研究

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-08-25 DOI: 10.1111/hiv.70087

Judit Cacho, Daniel K. Nomah, Natalia Egri, Frederic Cofán, María Ángeles Marcos, María-Mar Mosquera, Sonsoles Sanchez-Palomino, Andreu Bruguera, Nuria Esforzado, Marta Bodro, Cristina Rovira, Carmen Hurtado, Anna Vilella, Fritz Diekmann, Asunción Moreno, José M. Miro, David Cucchiari, COVIHVAC investigators

Introduction

No data exists on responses to mRNA vaccines in kidney transplant recipients (KTRs) with HIV. We compared these responses in HIV-positive (HIV+KTR+) and negative KTRs (HIV-KTR+), and in people living with HIV (PLWH) without kidney transplantation (HIV+KTR-).

Methods

In across-sectional study of 33 patients receiving mRNA SARS-CoV-2 vaccination, we evaluated the humoral response to mRNA SARS-CoV-2 vaccination using a Luminex platform (IgG and IgM), and cellular response with specific T cell response (S-and N- protein) by ELISpot. We used logistic regression models to assess associated factors.

Results

The study comprised 11 HIV-KTR+, 11 HIV+KTR+, and 11 HIV+KTR-. PLWH had suppressed viral load on ART. Seroconversion rates were 72.7% among KTRs, with no significant differences between HIV-KTR+ (81.8%) and HIV+KTR+ (63.6%) (P = 0.338). In HIV+KTR-, seroconversion was 100%, higher than HIV+KTR+ (P = 0.027). Cellular response against protein S occurred in 63.6% of cases, regardless of HIV, transplantation, or dose number. Higher age negatively influenced cellular response in HIV+KTR- (OR 0.77, 95%CI 0.60-0.99).

Conclusion

Although cellular immune response was similar across all groups, humoral response was reduced in HIV+KTR+. In HIV+KTR-, age reduced cellular response. These findings enhance our understanding of vaccine response in immunosuppressed populations and aid in optimizing vaccination strategies.

没有关于肾移植受者（KTRs）对mRNA疫苗反应的数据。我们比较了HIV阳性（HIV+KTR+）和阴性KTR （HIV-KTR+）以及未进行肾移植的HIV感染者（PLWH）（HIV+KTR-）的这些反应。方法：对33例接受mRNA - cov -2疫苗接种的患者进行横断面研究，采用Luminex平台评估mRNA - cov -2疫苗接种后的体液反应（IgG和IgM），并通过ELISpot评估特异性T细胞反应（- N蛋白）的细胞反应。我们使用逻辑回归模型来评估相关因素。结果：共纳入11例HIV-KTR+、11例HIV+KTR+和11例HIV+KTR-。PLWH抑制抗逆转录病毒载量。KTR血清转换率为72.7%,HIV-KTR+(81.8%)与HIV+KTR+(63.6%)之间无显著差异（P = 0.338）。HIV+KTR-血清转换率为100%，高于HIV+KTR+ (P = 0.027)。63.6%的病例发生了针对蛋白S的细胞反应，与HIV、移植或剂量无关。较高的年龄对HIV+KTR-的细胞反应有负面影响（OR 0.77, 95%CI 0.60-0.99）。结论：虽然细胞免疫反应在所有组中相似，但HIV+KTR+的体液反应降低。在HIV+KTR-中，年龄降低了细胞反应。这些发现增强了我们对免疫抑制人群中疫苗反应的理解，并有助于优化疫苗接种策略。

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引用次数: 0

European Guidelines on HIV and breastfeeding: “Same, same, but different” - Results from a WAVE survey 欧洲艾滋病毒和母乳喂养指南：“相同，相同，但不同”——来自WAVE调查的结果。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-08-25 DOI: 10.1111/hiv.70072

Amy Keane, Lila Haberl, Inka Aho, Stefania Bernardi, Mariana Mărdărescu, Anna Hermine Markowich, Angelina Namiba, Nneka Nwokolo, Keren Olshtain-Pops, Annette Haberl, WAVE (Women Against Viruses in Europe), European AIDS Clinical Society

Introduction

A notable gap exists in research on HIV and breastfeeding in high-income settings with continuous access to antiretroviral therapy (ART) and suppressed HIV viral loads. The Women Against Viruses in Europe (WAVE) initiative aimed to consolidate European guidelines on HIV and breastfeeding to better inform medical staff and people living with HIV in the decision-making process for breastfeeding.

Methods

Representatives from 23 countries were contacted by WAVE to submit their guidelines on HIV and breastfeeding, translated into English. The initial contact was made on 20 April 2023, and the final response was received on 26 May 2023. The WAVE breastfeeding group summarized the guidelines into key topics related to breastfeeding for the purpose of this manuscript.

Results

A total of 19 guidelines from 20 countries were included in the review. While the majority of countries recommend formula feeding as the preferred feeding for infants born to mothers living with HIV, most provide recommendations to support parents who choose to breastfeed if certain criteria are met.

Conclusion

Despite recommendations being based on the same research, there is variation across guidelines. This review consolidates European guidelines, enabling us to learn from each other and pool our experiences to create a robust cohort for further research and guideline development for parents living with HIV and their infants.

在持续获得抗逆转录病毒治疗（ART）和抑制艾滋病毒载量的高收入环境中，艾滋病毒和母乳喂养的研究存在显著差距。欧洲妇女防治病毒倡议旨在巩固欧洲关于艾滋病毒和母乳喂养的指导方针，以便在母乳喂养的决策过程中更好地向医务人员和艾滋病毒感染者提供信息。方法：WAVE联系了来自23个国家的代表，提交了他们的艾滋病和母乳喂养指南，并翻译成英文。初步联系于2023年4月20日进行，最终答复于2023年5月26日收到。WAVE母乳喂养小组将指南总结为与母乳喂养相关的关键主题。结果：共有来自20个国家的19项指南被纳入审查。虽然大多数国家建议将配方奶喂养作为艾滋病毒感染母亲所生婴儿的首选喂养方式，但大多数国家也提出建议，支持符合某些标准的选择母乳喂养的父母。结论：尽管建议是基于相同的研究，但不同的指南存在差异。这篇综述巩固了欧洲的指南，使我们能够相互学习，并汇集我们的经验，为进一步研究和为感染艾滋病毒的父母及其婴儿制定指南创建一个强大的队列。

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引用次数: 0

Exploring the influence of age, gender, stigma, and years living with HIV on mental health outcomes 探讨年龄、性别、耻辱感和艾滋病毒感染年限对心理健康结果的影响。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-08-19 DOI: 10.1111/hiv.70098

Guilherme Welter Wendt, Lara Wiehe Chaves, Angelo Brandelli Costa

Background

People living with HIV/AIDS face a myriad of discrimination and social stigma experiences. As a result of progress observed throughout the HIV epidemic, an ageing population of people living with HIV/AIDS exists, potentially facing greater mental health challenges from combined chronic conditions and stigma. Hence, this research aims to determine the additional value of age, years living with HIV, and gender, in conjunction with overall and internalized stigma in predicting clinically significant symptoms of depression and anxiety.

Methods

The sample consists of 1666 people living with HIV PLHA, aged between 18 and 76 years who participated in a community-based study across Brazil. Participants provided responses on HIV-related stigma, Internalized AIDS-Related Stigma, and to the Patient Health Questionnaire, which demonstrated excellent psychometric proprieties.

Results

Gender and stigma increased the likelihood of significant symptoms of anxiety, accounting for the influence of age and years of living with HIV. Odds were higher among those who reported transgender identity (OR^a = 2.05; 95% CI: 1.13, 3.70). Also, women reported significantly higher chances for anxiety (OR^a = 1.36; 95% CI: 1.05, 1.76). Both HIV-related (OR^a = 1.05; 95% CI: 1.01, 1.08) and internalized stigma (OR^a = 1.30; 95% CI: 1.21, 1.40) were associated with anxiety. General and internalized stigma were the unique predictors for depression, with adjusted OR ranging from 1.07 (95% CI: 1.03, 1.10) to 1.41 (95% CI: 1.31, 1.53), respectively.

Conclusions

Stigma constitutes a significant obstacle for initiatives aimed at HIV prevention and therapeutic programmes, and the main findings of this study revealed that factors associated with clinically significant symptoms of depression and anxiety were predominantly allied with psychosocial stressors and gender identity indicators. Limitations, implications for practice and policy are addressed.

背景：艾滋病毒/艾滋病感染者面临着无数的歧视和社会耻辱经历。由于在整个艾滋病毒流行过程中取得了进展，艾滋病毒/艾滋病感染者的人口出现老龄化，慢性病和污名化可能使他们面临更大的心理健康挑战。因此，本研究旨在确定年龄、艾滋病毒感染年限和性别的附加价值，并结合整体和内化的耻辱感来预测临床显著的抑郁和焦虑症状。方法：样本包括1666名年龄在18至76岁之间的艾滋病毒感染者，他们参加了巴西各地的社区研究。参与者在hiv相关的污名、艾滋病相关的内化污名和患者健康问卷上提供了回答，显示出良好的心理测量性。结果：性别和耻辱增加了显著焦虑症状的可能性，解释了年龄和艾滋病毒感染年限的影响。报告跨性别身份的人患病几率更高（ORa = 2.05; 95% CI: 1.13, 3.70）。此外，女性报告焦虑的几率明显更高（ORa = 1.36; 95% CI: 1.05, 1.76）。hiv相关（比值比= 1.05;95% CI: 1.01, 1.08）和内化耻辱（比值比= 1.30;95% CI: 1.21, 1.40）均与焦虑相关。一般病耻感和内化病耻感是抑郁症的唯一预测因子，调整后的OR分别为1.07 （95% CI: 1.03, 1.10）至1.41 （95% CI: 1.31, 1.53）。结论：耻辱感对艾滋病毒预防和治疗方案构成重大障碍，本研究的主要发现表明，与临床显著抑郁和焦虑症状相关的因素主要与社会心理压力源和性别认同指标相关。讨论了局限性、对实践和政策的影响。

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引用次数: 0

Solid organ transplantation in people with HIV: Outcomes, obstacles and opportunities 艾滋病毒感染者的实体器官移植：结果、障碍和机会。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-08-15 DOI: 10.1111/hiv.70099

David W. J. Griffin, J. H. McMahon, D. A. Ruschena, J. F. Hoy

Objective

People with HIV experience disparate access to solid organ transplantation (SOT), despite mounting evidence for comparable outcomes. This review aims to understand the outcomes following SOT, obstacles to SOT and opportunities to improve access and outcomes following SOT.

Methods

We conducted a narrative review of the literature.

Results

SOT is safe and effective for people with HIV, and increasing evidence indicates that people with HIV may safely donate organs to others with HIV. People with HIV experience a higher risk of acute rejection following SOT, without a higher risk of graft loss or death, when compared with appropriately matched controls. Those with HIV experience systemic and structural barriers to SOT, in addition to barriers that occur at the level of healthcare providers and consumers. Opportunities exist to improve access to SOT, and to improve SOT-related care for people with HIV.

Conclusion

SOT should be considered standard of care for people with HIV when indicated. Further efforts are required to identify and address gaps in the SOT-related cascade of care; and to improve SOT outcomes for people with HIV.

目的：尽管有越来越多的证据表明可比较的结果，但艾滋病毒感染者获得实体器官移植（SOT）的机会不同。本综述旨在了解定点治疗后的结果、定点治疗的障碍以及改善定点治疗后的可及性和结果的机会。方法：我们对文献进行叙述性回顾。结果：SOT对艾滋病毒感染者是安全有效的，越来越多的证据表明，艾滋病毒感染者可以安全地将器官捐献给其他艾滋病毒感染者。与适当匹配的对照组相比，HIV感染者在SOT后出现急性排斥反应的风险更高，但移植物丢失或死亡的风险不高。除了卫生保健提供者和消费者层面上的障碍外，艾滋病毒感染者在SOT方面还面临系统性和结构性障碍。有机会改善获得SOT的机会，并改善对艾滋病毒感染者的SOT相关护理。结论：SOT应作为HIV感染者的标准治疗方法。需要作出进一步努力，以查明和解决与特殊技能问题有关的级联护理方面的差距；并改善艾滋病毒感染者的SOT结果。

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引用次数: 0

Strategies to achieve the UNAIDS 95% HIV diagnosis target in Australia: Insights from a multidisciplinary roundtable 在澳大利亚实现联合国艾滋病规划署95%艾滋病毒诊断目标的战略：来自多学科圆桌会议的见解。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-08-15 DOI: 10.1111/hiv.70083

Brent Clifton, Phillip Keen, Janine Trevillyan, Nikki Sullivan, Karl Johnson, Melissa Warner, Cara Taheny, Heather Ellis, Jack Freestone, Brent Allan, Beau Newham

Introduction

In 2022, Australia met the global UNAIDS 95% targets for treatment and viral suppression. Achieving 95% of people knowing their HIV status requires implementation of a wider mix of HIV testing types and access points.

Methods

In October 2023, a community-led HIV testing roundtable meeting of 34 participants was convened to better understand current barriers and enablers to foster HIV testing equity. Delegates participated in data-informed discussions and a facilitated workshop. Outputs were collated and independently analysed to identify HIV testing barriers and potential actionable strategies.

Results

Current best practices for HIV testing are targeted towards at-risk populations and limited by funding and capacity constraints. Identified barriers to testing include ongoing stigma, cultural barriers, structural barriers to accessing and navigating the healthcare system, clinical reticence among non-expert practitioners and the need to expand access beyond at-risk groups. Current HIV testing practices are limited by a lack of provider-initiated (opt-out) testing, contributing to late diagnoses among people with high barriers to testing. Awareness of and access to HIV testing resources need to be expanded and should be underpinned by healthcare education. Wider exploration of opt-out testing is warranted, but requires consideration of jurisdictional infrastructure/funding differences and determination of optimal settings.

Conclusions

To achieve the UNAIDS 95% diagnosis target, we recommend three key strategies: implementing opt-out testing in selected settings, expanding access to self-testing and reducing barriers to point of care testing. These strategies should be supported by enhanced healthcare provider education and actions to reduce structural barriers to testing access.

澳大利亚在2022年实现了联合国艾滋病规划署95%的治疗和病毒抑制目标。要实现95%的人了解自己的艾滋病毒状况，需要实施更广泛的艾滋病毒检测类型和接入点。方法：2023年10月，召集了一个由34人参加的社区主导的艾滋病毒检测圆桌会议，以更好地了解当前促进艾滋病毒检测公平的障碍和推动因素。代表们参加了了解数据的讨论和一个便利的讲习班。对产出进行了整理和独立分析，以确定艾滋病毒检测障碍和可能的可行战略。结果：目前艾滋病毒检测的最佳做法针对的是高危人群，受到资金和能力限制的限制。已确定的检测障碍包括持续的污名化、文化障碍、获取和利用卫生保健系统的结构性障碍、非专业从业人员的临床沉默以及需要将获取范围扩大到风险群体之外。目前的艾滋病毒检测实践由于缺乏由提供者发起的（选择退出）检测而受到限制，导致检测障碍高的人群诊断较晚。需要扩大对艾滋病毒检测资源的认识和获取，并应以卫生保健教育为基础。有必要对选择退出测试进行更广泛的探索，但需要考虑管辖基础设施/资金差异并确定最佳设置。结论：为了实现联合国艾滋病规划署95%的诊断目标，我们建议三项关键战略：在选定的环境中实施选择退出检测，扩大自我检测的可及性，减少护理点检测的障碍。这些战略应得到加强医疗保健提供者教育和行动的支持，以减少获得检测的结构性障碍。

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引用次数: 0