HIV Medicine最新文献

Background: Discontinuation of antiretroviral therapy (ART) significantly contributes to the development of advanced HIV disease (AHD) and opportunistic infections. This study analyzed data from patients who re-engaged in care after ART interruption and compared the cohort with patients with newly diagnosed HIV, focusing on the burden of tuberculosis and histoplasmosis.

Methods: A diagnostic package for opportunistic infections was implemented in Guatemala in 2017, encompassing tuberculosis and histoplasmosis. From 2017 to 2019, we enrolled 1379 adults re-engaging in care and 3412 patients with newly diagnosed HIV across 13 healthcare facilities. Data collection included demographic information, laboratory test results, and patient outcomes.

Results: Among patients re-engaging in care, 54% (491 of 903) had AHD, which was comparable to the 50.1% (1349 of 2692) in newly diagnosed patients. Among the re-engaging cohort, 34.5% had not undergone CD4 testing, compared with 21.1% in the newly diagnosed group. This highlights a significant gap in assessing advanced HIV status through an objective, unbiased test. Among patients re-engaging in care, the incidence rates of tuberculosis and histoplasmosis were 9.7% and 8.3%, respectively, regardless of immune status. This indicated a high burden of opportunistic infections in this group, with newly diagnosed patients showing similar incidence rates of 8.5% for tuberculosis and 8.3% for histoplasmosis.

Conclusion: Patients re-engaging in care should follow a similar process to newly diagnosed patients. There is an urgent need for routine and immediate CD4 testing to identify AHD and implement the recommended comprehensive diagnostic and care package. Early detection and targeted interventions are crucial for reducing AIDS-related mortality.

Background: HIV-associated vasculopathy is known to cause stroke in people living with HIV (PLWH). The role of atherosclerosis is unclear. We assessed the aetiology of vasculopathy in PLWH and tested the utility of markers of subclinical atherosclerosis to distinguish atherosclerotic (AV) from non-atherosclerotic vasculopathy (NAV).

Methods: This cross-sectional study recruited PLWH with stroke at a hospital in Johannesburg, South Africa, from 2014 to 2017. Patients with meningitis were excluded. Cerebrospinal fluid (CSF) was tested for multi-viral polymerase chain reaction, including varicella zoster virus (VZV). Once an aetiological category was assigned, carotid intima-media thickness (cIMT) and aortic pulse wave velocity (PWV) were compared in AV and NAV, and to predetermined thresholds for subclinical atherosclerosis (cIMT≥0.70 mm, PWV≥10.00 m/s).

Results: Some 28/85 PLWH (32.9%) vs. 9/109 (8.3%, p < 0.0001) people-without-HIV had vasculopathy on computed tomography angiography. Only four PLWH had AV. Compared with NAV (n = 11), those with AV were older (50.0 ± 4.1 vs. 39.2 ± 9.2 years, p = 0.04) and had more cardiovascular risk factors (median 2.0 [IQR 1.5-2.5] vs. 0.0 [IQR 0.0-1.0], p = 0.02). cIMT in AV was higher than in NAV (1.01 ± 0.07 mm [n = 4] vs. 0.63 ± 0.04 mm [n = 9], p < 0.001). All with AV had cIMT and PWV above the predetermined thresholds, while all except one with NAV were below. We found evidence of VZV in eight PLWH and HIV-associated vasculitis in six.

Conclusions: Vasculopathy in PLWH in our region appears to be predominantly non-atherosclerotic. cIMT and PWV were useful adjuncts in distinguishing AV from NAV. Despite excluding meningitis, VZV was implicated in a large proportion, emphasizing the likely underdiagnosis of this treatable infection. We thus recommend CSF VZV testing in all PLWH with stroke.

Introduction: Our objective was to understand the current status of and factors influencing the quality of life and social skills of children living with HIV and to provide a reference for improving medical service management and formulating support policies.

Methods: A total of 183 children aged 7-14 years, living with HIV, and admitted to the Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention from March 2022 to February 2024 were included retrospectively. We used the children's basic information and their scores from the Quality of Life Scale for Children and Adolescents (QLSCA) and Normal Development of Social Skills From Infant to Junior High School Children (S-M scale) to explore their the status of their quality of life and social skills and the factors influencing both.

Results: Four factors (life satisfaction, socio-psychological functioning, physical and mental health, and living environment) and QLSCA T-scores in the case group were significantly lower than those in the control group (p < 0.01). S-M scale scores (self-help, locomotion, operation, communication, socialization, self-direction) in the case group were significantly lower than those in the control group (p < 0.001). The main factors affecting the social skills of children living with HIV were side effects from antiretroviral therapy (odds ratio [OR] 7.365, p < 0.003), comorbidities (OR 12.948, p < 0.006), intellectual development (OR 6.045, p < 0.027), and awareness of HIV infection status (OR 0.261, p < 0.014).

Conclusion: Children living with HIV have low quality of life and poor social skills. Clinicians should pay attention to side effects from antiretroviral therapy, comorbidities, children's intellectual development, and their awareness of their HIV infection status.

Objectives: This study aimed to evaluate the HIV virological efficacy of two-drug regimens (2DR) with lamivudine (3TC) and dolutegravir (DTG) in people with HIV (PWH), classified by their hepatitis B virus (HBV) serological status. Specifically, it explored whether isolated anti-hepatitis B core (anti-HBc) positivity impacts virological outcomes.

Methods: A retrospective observational study was conducted at Fondazione Policlinico Universitario Agostino Gemelli IRCCS, enrolling 606 virologically suppressed (HIV-RNA < 50 copies/mL) PWH who switched to a 2DR regimen with 3TC/DTG. Participants were categorized into four groups based on their HBV serological status: hepatitis B surface antibody (HBsAb)-positive/hepatitis B core antibody (HBcAb)-positive, HBsAb-negative/HBcAb-negative, HBsAb-positive/HBcAb-negative, and isolated HBcAb positivity. Viral failure (VF) was defined as two consecutive HIV viral loads above 50 copies/mL or a single HIV viral load above 1000 copies/mL, and viral blips (VBs) as a single HIV-RNA measurement between 50 and 200 copies/mL followed by suppression.

Results: During 2216.4 patient-years of follow-up (PYFU), we observed 30 VFs (1.3 per 100 PYFU) and 63 VBs (2.9 per 100 PYFU). No statistically significant differences in VF or VB were noted between the serological groups. Additionally, no significant alanine aminotransferase (ALT) flares or HBV-DNA breakthroughs were observed, with HBV-DNA remaining undetectable throughout.

Conclusions: The study supports the virological efficacy of 3TC/DTG-based 2DR in PWH, regardless of HBV serological status. Isolated anti-HBc positivity did not influence virological outcomes independently. Larger studies are warranted to further investigate HIV-HBV interactions in this context.

Introduction: The HIV/AIDS epidemic, with 85.6 million infections and 40.4 million AIDS-related deaths globally, remains a critical public health challenge. Current diagnostic methods, primarily fourth-generation immunoassays, have limitations due to their long window periods, and most viral load assays require centralized testing protocols that result in delays, especially in remote regions.

Nucleic acid testing: Point-of-care (POC) nucleic acid amplification testing (NAAT) presents a transformative approach by reducing the window period for detection to one week and significantly shortening turnaround times for viral load monitoring.

Discussion: This review highlights the clinical utility of POC NAAT for acute HIV infection diagnosis, its role in timely combination antiretroviral therapy adjustments, and its potential to reduce the basic reproduction number (R₀), a critical threshold for suppressing the epidemic.

Conclusion: By improving early detection and facilitating faster clinical decisions, POC NAAT enhances the effectiveness of HIV prevention and treatment programmes, particularly in high-risk and remote communities, and supports the global effort to achieve the ambitious UNAIDS 95-95-95 targets.

Introduction: Dolutegravir is now extensively used in sub-Saharan Africa as a preferred component of antiretroviral therapy (ART). There is a paucity of large studies using routinely collected data from African people living with HIV on dolutegravir-based regimens to inform HIV programmes. We reviewed data in a large programme clinic of people living with HIV on dolutegravir to determine the real-world safety and tolerability of dolutegravir and to describe drivers of treatment discontinuation.

Methods: We carried out a retrospective dynamic cohort analysis of people living with HIV who started on or switched to dolutegravir-based ART at the Infectious Diseases Institute in Kampala, Uganda, between February 2017 and December 2020. Types of adverse events (AEs) were classified according to the Medical Dictionary for Regulatory Activities. Incident rates for AEs and treatment discontinuation were determined using Cox proportional hazard methods.

Results: Of 4529 people living with HIV started on or switched to dolutegravir, 2094 (45.9%) were female, and the median age was 49 years (interquartile range [IQR] 41-56). During 8907.93 person-years (PY) of follow-up, 1069 (23.6%; 95% confidence interval [CI] 22.4-24.8) people living with HIV had an AE, at a rate of 10.43 per 1000 PY (95% CI 9.77-11.14). Neuropsychiatric, gastrointestinal, and endocrine AEs were most common. The main AEs driving dolutegravir discontinuation were hyperglycaemia (140/356; 39.3%) and erectile dysfunction (19/356; 5.3%). Only 1.2% (4/356) of the dolutegravir discontinuations were because of neuropsychiatric AEs. Being female (adjusted hazard ratio [aHR] 1.35; 95% CI 1.02-1.78) and previous use of stavudine (aHR 1.46; 95% CI 1.04-2.05) were the main predictors of neuropsychiatric AEs. Risk factors for hyperglycaemia included being overweight (aHR 1.66; 95% CI 1.11-2.47) or obese (aHR 1.84; 95% CI 1.12-3.05), having hypertension (aHR 1.92; 95% CI 1.35-2.73), having diabetes mellitus (aHR 12.6; 95% CI 8.34-19.1), and taking previous ART containing zidovudine (aHR 1.76; 95% CI 1.19-2.59) or stavudine (aHR 1.68; 95% CI 1.15-2.44). These risk factors for hyperglycaemia were also the main drivers of dolutegravir discontinuation.

Conclusion: AEs were common in this African cohort, and dolutegravir discontinuation was driven by hyperglycaemia and erectile dysfunction. Previous use of older ART with known mitochondrial toxicity was associated with neuropsychiatric AEs and hyperglycaemia. African countries used these drugs for longer periods, and this may contribute to this risk.

Objectives: We aimed to describe health-related quality of life (HRQoL), overall and across its dimensions, identify associated factors, and assess changes over time among people with HIV (PWH) from the Spanish multicentre CoRIS cohort.

Methods: We developed a mobile app to collect HRQoL data every 3 months using the WHOQOL-HIV-BREF questionnaire (31 items across six domains), among PWH followed in CoRIS in 2021-2023. Factors associated with good/very good global HRQoL and with domain-specific mean scores were identified using multivariable logistic and linear regression, respectively.

Results: Of 414 PWH (94.2% on antiretroviral treatment, 91.1% virally suppressed), 51.2% reported good/very good HRQoL. Latin American migrants (adjusted OR: 0.60 [95% CI: 0.36; 1.00]), and participants with lower educational level (0.36 [0.21; 0.64]), a previous AIDS diagnosis (0.56 [0.29; 1.11]) and a history of non-AIDS-related cancers (0.40 [0.14; 1.14]) were less likely to report good/very good global HRQoL. The most affected items included sexual satisfaction, forgiveness and blame, sleep and rest, and concerns about the future, with spirituality, religion and personal beliefs as the most affected domain. Latin American origin, lower educational level and shorter (<2 years) or longer (>15 years) time since HIV diagnosis were associated with poorer HRQoL in specific domains. No significant changes in HRQoL were observed after 12 months except slightly higher scores in physical health.

Conclusions: Only half of PWH reported good/very good global HRQoL. This highlights the need to develop targeted strategies to improve HRQoL among PWH, focusing on addressing the most affected dimensions and supporting the most vulnerable groups.

A wide spectrum of non-tuberculous mycobacteria (NTM) has been reported as isolates from or causes of disease in people living with human immunodeficiency virus (HIV). This is typically in the context of very advanced immunosuppression (CD4 count <50 cells/mm³) in the absence of virological suppression [1] and most individuals have presented with disseminated disease. Effective antiretroviral therapy (ART) has permitted control of viral replication, improvement in immune function and a significant decrease in the incidence of severe opportunistic infections [2-4], including disseminated Mycobacterium avium complex (DMAC) disease [3, 5, 6].

NTM are environmental organisms. Therefore it is important to determine, prior to treatment initiation, whether the organism is the cause of the disease process rather than a reflection of colonisation. With the exception of M. avium complex (MAC), there is limited evidence to guide the choice or duration of treatment and expert opinion should be sought from a clinician experienced in managing mycobacterial disease in the context of HIV or, if not available, in the context of immunosuppression or dissemination. Advice should also be sought from microbiologists (for drug susceptibility testing and interpretation), pharmacists or people with expertise and experience of managing mycobacterial disease in people without HIV. Also with the exception of MAC, most of the recommendations for the treatment of NTM have been extrapolated from trials of treatment for NTM pulmonary disease in individuals without HIV, although some evidence from early trials in populations with advanced HIV disease has added to this guidance.

Guidance on supporting people living with HIV with opportunistic infections, including NTM infections, can be found on the British HIV Association (BHIVA) website (https://www.bhiva.org/file/6225e44b53c49/OI-guidelines-supporting-patients.pdf).

A full review of these guidelines is due in 2029, with interim updates only if recommendations need updating in line with new data.

The scope, purpose and guideline topics were agreed by the writing group. The search (population, intervention, comparator and outcome [PICO]) questions were set and an independent systematic literature review performed. The Medline, Embase and Cochrane Library databases were searched and the literature reviewed to address each question. The PICO questions and search strategies are outlined in Appendix 1.

Further details of the methodology can be found on the BHIVA website (https://www.bhiva.org/file/5d514ec9b503d/OI-guidelines-methods-general.pdf), including the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess and grade the evidence.