HIV Medicine最新文献

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.

Objectives: To compare HIV diagnosis pathways, baseline clinical characteristics and treatment outcomes among cis-gender and trans-gender women newly diagnosed with HIV at two European centres-Padua University Hospital (Italy) and 56 Dean Street, Chelsea and Westminster Hospital (London, UK).

Methods: A retrospective observational study was conducted including cis-gender and trans-gender women diagnosed with HIV between 2017 and 2024. Demographic, clinical and virological parameters were collected at baseline and during follow-up. Outcomes included baseline CD4 count, HIV-RNA, antiretroviral therapy (ART) regimen, time to ART initiation and time to viral suppression (<200 copies/mL). Comparisons were made by gender identity and by clinical centre.

Results: A total of 115 women were included (74 cis-gender, 41 trans-gender). Trans-gender women were older and more frequently of non-European origin. First-time HIV testing was significantly more common in Padua, where both cis- and trans-gender women presented with lower CD4 counts and higher HIV-RNA, indicating later diagnosis compared with London. Prior engagement with HIV prevention (PrEP/PEP and routine screening) was more frequent at 56 Dean Street. Despite baseline differences, ART regimens-predominantly integrase inhibitor-based-were similar across centres. Time to ART initiation and time to viral suppression did not differ significantly between groups or settings.

Conclusions: Cis- and trans-gender women face persistent disparities in HIV diagnosis across European healthcare settings. Later presentation was more common in Padua, reflecting gaps in screening and prevention coverage. Once linked to care, treatment outcomes were similar. Strengthening gender-affirming, context-specific HIV testing and prevention strategies is essential to reduce diagnostic inequities.

Objectives: Pre-exposure prophylaxis (PrEP) with antiretroviral drugs (ARVs) is a highly effective HIV prevention strategy. Although the European Medicines Agency approved oral PrEP in 2016 and the World Health Organization (WHO) has since recommended simplified and person-centred delivery models, implementation remains inconsistent across Europe. In Greece, national PrEP guidelines were issued in 2022, but public sector access has not yet been established.

Methods: We report on informal PrEP use in 2024 among men who have sex with men (MSM) and transgender women (TGW) attending a private sexual health clinic in Athens.

Results: Among 547 MSM and TGW (mean age 36 ± 9 years), 308 (56.3%) were suitable for PrEP, 47 were already on PrEP and 134 initiated PrEP using generic formulations purchased online (39.6% daily, 60.4% on demand). Among 181 individuals on PrEP, 79.6% were retained in care, and no seroconversions were recorded over 2423 person-months of follow-up. Sexually transmitted infections (STIs) were diagnosed in 30.3%, indicating elevated HIV risk. Barriers to uptake included cost, online procurement concerns and limited awareness.

Conclusions: These findings highlight the urgent need for formally implemented, accessible PrEP services in Greece. Integration within broader sexual health frameworks, aligned with WHO recommendations, is essential to improve access, monitoring and HIV prevention in high-risk populations.

Background: Hepatitis B virus (HBV) infection remains a significant concern among people with HIV (PWH), who are at higher risk of acquiring HBV and often show suboptimal responses to vaccination. In this context, we aimed to update the incidence of acute hepatitis B (AHB) in a cohort of PWH, given recent epidemiological shifts including the increase in migrant populations and the wider use of antiretroviral therapy (ART) regimens lacking anti-HBV activity.

Methods: We conducted a retrospective single-centre study including PWH under follow-up between 2000 and 2024. AHB cases were confirmed based on the recent positivity of HBsAg and anti-HBc IgM. Demographic, clinical, serological and ART-related data were collected. Incidence was calculated as cases per 100 person-years, and trends were analyzed in both the overall population and the susceptible subgroup (anti-HBc-negative).

Results: A total of 22 AHB cases were diagnosed among 5986 PWH. The overall incidence rate was 0.02 (0.01-0.15) cases per 100 person-years, and 0.05 (0.01-0.3) cases per 100 person-years in the susceptible subgroup. Incidence decreased over time, with no new cases from 2015 to 2022, and isolated cases re-emerged in 2023-2024. Most AHB cases (78.3%) were unvaccinated; 21.7% had received full vaccination but failed to develop a serologic response. Only 26.1% of cases were on ART at AHB diagnosis, and no one was receiving tenofovir. The rate of progression to chronic hepatitis B (CHB) was 17.4%, higher than in the general population; all CHB cases occurred in ART-naïve individuals.

Conclusions: AHB incidence among PWH has declined over the past 25 years but remains higher than in the general population. The recent reappearance of isolated cases may reflect changes in HBV exposure risk, suboptimal vaccination coverage, or the increasing use of ART regimens without anti-HBV activity. Universal HBV vaccination and the use of tenofovir-based therapies in non-responders remain critical strategies for prevention and control.

Background: Darunavir-based antiretroviral therapy (ART) is commonly used in people with HIV who experience adherence challenges and/or have complex resistance patterns. Changes in ART commissioning have led to an increased use of Bictegravir/Emtricitabine/Tenofovir alafenamide (B/F/TAF) in these populations despite limited real-world outcome data.

Methods: Single centre, retrospective analysis of virological outcomes in individuals previously treated with Darunavir who initiated B/F/TAF before 01/01/2025. Logistic regression was used to analyse associations with sustained virological suppression (HIV RNA <200 copies/mL) on B/F/TAF.

Results: Of the 223 individuals who initiated B/F/TAF, 207 (median age 52 [40-58] years, 38% female, 69% Black ethnicity, 24% with CD4 < 200 cells/mm³ and 36% with HIV RNA ≥200 copies/mL) contributed virological outcome data. Over a median of 2.4 [1.3-3.3] years, 153 (74%) maintained or achieved sustained virological suppression, 11 (5.3%) had a single viral load ≥200 copies/mL and 43 (20.8%) experienced virological failure. Participants with CD4 < 200 cells/mm³ (aOR 0.15 [95%CI 0.07-0.33]) and HIV RNA ≥200 copies/mL (aOR 0.17 [0.08-0.34]) at B/F/TAF initiation were less likely to achieve sustained virological suppression; historical resistance-associated mutations (RAMs) were not associated with virological outcome. Of the 32 participants successfully genotyped, 3 had novel INSTI mutations (E157Q, L74LM) and 4 had not previously documented NRTI mutations (M184V/I, D67DN, Y115F) mutations.

Conclusions: Substituting of Darunavir-based ART with B/F/TAF in this challenging population was associated with treatment-emergent INSTI and NRTI resistance. Historical resistance did not predict virological outcomes and treatment-emergent resistance did not preclude re-suppression on B/F/TAF, suggesting that adherence remains a major barrier to achieving long-term virological success.

Polypharmacy, the concurrent use of multiple medications, presents a growing challenge in HIV care as people living with HIV age and experience earlier onset of age-related co-morbidities. However, how polypharmacy is defined and assessed in HIV research remains inconsistent. The commonly used threshold of five or more medications, often derived from geriatric medicine, may not adequately reflect the clinical complexity of HIV care, where lifelong antiretroviral therapy (ART) forms the foundation of treatment. This review examines how polypharmacy has been defined and operationalized in HIV studies and compares this to approaches in geriatric research, where tools (e.g., STOPP/START and the Beers criteria) have been more systematically applied. We argue that HIV care can benefit from, but must also adapt, these frameworks to address the unique pharmacologic, psychosocial and adherence-related considerations faced by people with HIV. We also review emerging evidence linking polypharmacy in HIV with negative outcomes, including increased risk of drug-drug interactions, hospitalization, reduced quality of life, and associated healthcare costs. At the same time, polypharmacy is not inherently inappropriate, as many regimens may reflect guideline-concordant care. Rather than focusing on medication count alone, attention should shift toward evaluating appropriateness, safety and alignment with the individual's evolving health needs. Finally, we explore the role of deprescribing in HIV care, acknowledging both its promise and the challenges it presents, particularly in preserving ART stability and supporting shared decision-making. Reframing polypharmacy through an HIV-specific lens can support safer prescribing and improve outcomes as the HIV population continues to age.