{"title":"Breastfeeding in women living with HIV in high-income countries: It's time to act.","authors":"Daniela Piacentini, Giangiacomo Nicolini, Daniela Bugana, Grazia Piccolin, Valeria Mondardini, Renzo Scaggiante, Massimiliano Lanzafame","doi":"10.1111/hiv.13692","DOIUrl":"https://doi.org/10.1111/hiv.13692","url":null,"abstract":"","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ditte Scofield, Morten Frisch, Mikael Andersson, Merete Storgaard, Gitte Pedersen, Isik S Johansen, Terese L Katzenstein, Christian Graugaard, Lars H Omland, Nina Weis, Ellen Moseholm
Objectives: The HIV/AIDS epidemic has disproportionately affected men who have sex with men (MSM) since its onset. Despite important medical advancements in treatment, the enduring effects of living with HIV continue to adversely impact the health and well-being of this population. This cross-sectional nationwide study examined psychosocial and sexual health among MSM in Denmark, comparing those living with and without HIV.
Methods: Data from MSM living with HIV were collected from the SHARE study, a Danish nationwide survey that investigated psychosocial, sexual and reproductive health among people with HIV, and compared with data from MSM without HIV, retrieved from the nationally representative cohort study, Project SEXUS. Associations between HIV status and psychosocial and sexual health outcomes were examined using logistic regression models while controlling for potentially confounding variables.
Results: Among 369 MSM with HIV and 1002 MSM without HIV, logistic regression analyses revealed that living with HIV was significantly associated with having current symptoms of anxiety and depression and greater dissatisfaction with one's body. Additionally, MSM with HIV significantly more often than MSM without HIV reported low sexual desire, sexual inactivity, a lack of sexual needs in the last year and erectile dysfunction. Having received payment for sex was more frequently reported by MSM with HIV, as was sexualised drug use, including chemsex drugs.
Conclusion: Compared with MSM without HIV, MSM with HIV in Denmark report a higher burden of mental health and sex life challenges.
目标:自艾滋病毒/艾滋病流行以来,男男性行为者(MSM)就受到了极大的影响。尽管在治疗方面取得了重大进展,但艾滋病病毒感染者的持久影响继续对这一人群的健康和福祉造成不利影响。这项全国性横断面研究对丹麦男男性行为者的社会心理和性健康进行了调查,并对感染和未感染 HIV 的男男性行为者进行了比较:从 SHARE 研究中收集了感染 HIV 的男男性行为者的数据,SHARE 研究是一项丹麦全国性调查,旨在调查 HIV 感染者的社会心理、性健康和生殖健康状况,并将这些数据与从具有全国代表性的队列研究 SEXUS 项目中获得的未感染 HIV 的男男性行为者的数据进行比较。在控制潜在混杂变量的情况下,我们使用逻辑回归模型研究了艾滋病病毒感染状况与社会心理和性健康结果之间的关系:在 369 名感染了艾滋病毒的男男性行为者和 1002 名未感染艾滋病毒的男男性行为者中,逻辑回归分析表明,感染艾滋病毒与当前的焦虑和抑郁症状以及对自己身体的更大不满显著相关。此外,感染了艾滋病毒的 MSM 比未感染艾滋病毒的 MSM 更经常报告性欲低下、性生活不活跃、去年缺乏性需求和勃起功能障碍。感染了艾滋病病毒的 MSM 更经常报告自己因性行为而获得报酬,也更经常报告使用性化药物,包括化学性毒品:结论:与未感染艾滋病毒的男男性行为者相比,丹麦感染艾滋病毒的男男性行为者在心理健康和性生活方面面临的挑战更大。
{"title":"Psychosocial and sexual health among men with and without HIV who have sex with men: A cross-sectional nationwide study in Denmark.","authors":"Ditte Scofield, Morten Frisch, Mikael Andersson, Merete Storgaard, Gitte Pedersen, Isik S Johansen, Terese L Katzenstein, Christian Graugaard, Lars H Omland, Nina Weis, Ellen Moseholm","doi":"10.1111/hiv.13688","DOIUrl":"https://doi.org/10.1111/hiv.13688","url":null,"abstract":"<p><strong>Objectives: </strong>The HIV/AIDS epidemic has disproportionately affected men who have sex with men (MSM) since its onset. Despite important medical advancements in treatment, the enduring effects of living with HIV continue to adversely impact the health and well-being of this population. This cross-sectional nationwide study examined psychosocial and sexual health among MSM in Denmark, comparing those living with and without HIV.</p><p><strong>Methods: </strong>Data from MSM living with HIV were collected from the SHARE study, a Danish nationwide survey that investigated psychosocial, sexual and reproductive health among people with HIV, and compared with data from MSM without HIV, retrieved from the nationally representative cohort study, Project SEXUS. Associations between HIV status and psychosocial and sexual health outcomes were examined using logistic regression models while controlling for potentially confounding variables.</p><p><strong>Results: </strong>Among 369 MSM with HIV and 1002 MSM without HIV, logistic regression analyses revealed that living with HIV was significantly associated with having current symptoms of anxiety and depression and greater dissatisfaction with one's body. Additionally, MSM with HIV significantly more often than MSM without HIV reported low sexual desire, sexual inactivity, a lack of sexual needs in the last year and erectile dysfunction. Having received payment for sex was more frequently reported by MSM with HIV, as was sexualised drug use, including chemsex drugs.</p><p><strong>Conclusion: </strong>Compared with MSM without HIV, MSM with HIV in Denmark report a higher burden of mental health and sex life challenges.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To estimate the prevalence and cumulative incidence of neuro-retinal-disorders (NRD) in HIV-controllers.
Design: Prospective, single-centre, cohort study of people living with HIV (PLWH): elite-controllers, long-term-non-progressors and early diagnosed.
Methods: The study compared "HIV-controllers" (including elite-controllers and long-term-non-progressors), who were not on antiretroviral therapy (ART), and "HIV-treatment" (HIV-infected subjects with a recent diagnosis and on ART). A matched cohort of "non-HIV subjects" was created. NRD was defined as at least one altered (not normal) ophthalmological parameter (functional or structural). Functional (visual acuity, contrast sensitivity, chromatic vision, visual field) and structural parameters (ganglion cells, macular nerve fibre layer, peripapillary nerve fibre layers, vascular calibre) as well as quality of life (Medical Outcomes Study-HIV Short Form-30) were assessed.
Results: Between March 2012 and November 2015, the study included all HIV-controllers (16 elite-controllers, 1 long-term-non-progressor), 11 HIV-treatment and 16 non-HIV. Prevalence of NRD at baseline was 88.2% (15/17, 95% CI: 65.7%-96.7%), 90.9% (10/11, 95% CI: 62.3%-98.4%) and 56.3% (9/16, 95% CI: 33.2%-76.9%), respectively. Cumulative incidence at 3 years was 50% (1/2), 100% (1/1) and 33.3% (2/6), respectively. None of the participants manifested ocular clinical symptoms. Three years later, prevalence of NRD was 92.3% (12/13, 95% CI: 66.7%-98.6%), 75% (6/8, 95% CI: 40.9%-92.9%) and 50.0% (7/14, 95% CI: 26.8%-73.2%), respectively. Contrast sensitivity and structural parameters were globally the most affected among PLWH. Quality of life (total score) [median (interquartile range)] at baseline and 3 years was 82 (71-89) and 74 (63.5-79.25) in HIV-controllers and 80 (73-88) and 88 (83-92) in HIV-treatment.
Conclusions: HIV-controllers and those individuals on ART presented a higher percentage of NRD than non-HIV. Our results suggest that NRD could be a biomarker of ocular aging among PLWH.
目的估计 HIV 控制者中神经视网膜障碍(NRD)的流行率和累积发病率:设计:对 HIV 感染者(PLWH):精英控制者、长期未进展者和早期诊断者进行前瞻性、单中心、队列研究:研究比较了未接受抗逆转录病毒疗法(ART)的 "HIV 控制者"(包括精英控制者和长期未进展者)和 "HIV 治疗者"(近期诊断并接受抗逆转录病毒疗法的 HIV 感染者)。我们还建立了一个 "非 HIV 受试者 "的匹配队列。NRD定义为至少一项眼科参数(功能性或结构性)发生改变(不正常)。对功能参数(视力、对比敏感度、色觉、视野)和结构参数(神经节细胞、黄斑神经纤维层、毛细血管周围神经纤维层、血管口径)以及生活质量(医疗结果研究-HIV简表-30)进行了评估:2012年3月至2015年11月期间,研究对象包括所有HIV控制者(16名精英控制者、1名长期未进展者)、11名HIV治疗者和16名非HIV治疗者。基线NRD患病率分别为88.2%(15/17,95% CI:65.7%-96.7%)、90.9%(10/11,95% CI:62.3%-98.4%)和56.3%(9/16,95% CI:33.2%-76.9%)。3年的累计发病率分别为50%(1/2)、100%(1/1)和33.3%(2/6)。所有参与者均未出现眼部临床症状。三年后,NRD发病率分别为92.3%(12/13,95% CI:66.7%-98.6%)、75%(6/8,95% CI:40.9%-92.9%)和50.0%(7/14,95% CI:26.8%-73.2%)。总体而言,对比敏感度和结构参数对 PLWH 的影响最大。基线和 3 年的生活质量(总分)[中位数(四分位间距)]在 HIV 控制者中分别为 82(71-89)和 74(63.5-79.25),在 HIV 治疗者中分别为 80(73-88)和 88(83-92):结论:HIV 控制者和接受抗逆转录病毒疗法治疗者的 NRD 百分比高于非 HIV 患者。我们的研究结果表明,NRD可能是艾滋病病毒感染者眼部老化的生物标志物。
{"title":"Functional and structural neuroretinal disorders in HIV Controllers. Prospective cohort study.","authors":"Susana Ruiz-Bilbao, Sebastian Videla, Ester Pascual, Montse Soler, Puig Jordi, Stefano Grizolli, Eugènia Negredo, Jordi Castellvi-Manent","doi":"10.1111/hiv.13685","DOIUrl":"https://doi.org/10.1111/hiv.13685","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the prevalence and cumulative incidence of neuro-retinal-disorders (NRD) in HIV-controllers.</p><p><strong>Design: </strong>Prospective, single-centre, cohort study of people living with HIV (PLWH): elite-controllers, long-term-non-progressors and early diagnosed.</p><p><strong>Methods: </strong>The study compared \"HIV-controllers\" (including elite-controllers and long-term-non-progressors), who were not on antiretroviral therapy (ART), and \"HIV-treatment\" (HIV-infected subjects with a recent diagnosis and on ART). A matched cohort of \"non-HIV subjects\" was created. NRD was defined as at least one altered (not normal) ophthalmological parameter (functional or structural). Functional (visual acuity, contrast sensitivity, chromatic vision, visual field) and structural parameters (ganglion cells, macular nerve fibre layer, peripapillary nerve fibre layers, vascular calibre) as well as quality of life (Medical Outcomes Study-HIV Short Form-30) were assessed.</p><p><strong>Results: </strong>Between March 2012 and November 2015, the study included all HIV-controllers (16 elite-controllers, 1 long-term-non-progressor), 11 HIV-treatment and 16 non-HIV. Prevalence of NRD at baseline was 88.2% (15/17, 95% CI: 65.7%-96.7%), 90.9% (10/11, 95% CI: 62.3%-98.4%) and 56.3% (9/16, 95% CI: 33.2%-76.9%), respectively. Cumulative incidence at 3 years was 50% (1/2), 100% (1/1) and 33.3% (2/6), respectively. None of the participants manifested ocular clinical symptoms. Three years later, prevalence of NRD was 92.3% (12/13, 95% CI: 66.7%-98.6%), 75% (6/8, 95% CI: 40.9%-92.9%) and 50.0% (7/14, 95% CI: 26.8%-73.2%), respectively. Contrast sensitivity and structural parameters were globally the most affected among PLWH. Quality of life (total score) [median (interquartile range)] at baseline and 3 years was 82 (71-89) and 74 (63.5-79.25) in HIV-controllers and 80 (73-88) and 88 (83-92) in HIV-treatment.</p><p><strong>Conclusions: </strong>HIV-controllers and those individuals on ART presented a higher percentage of NRD than non-HIV. Our results suggest that NRD could be a biomarker of ocular aging among PLWH.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dalit Zajdman-Faitelson, Miren Lorea Cárdenas-Hernández, Simón Guzmán-Bucio, Antonio Camiro-Zuñiga, Maria Elisa Vega Memije
Objective: To describe the frequency and clinicopathological concordance of mucocutaneous manifestations in people living with HIV (PLWH) and its correlation with CD4+ T lymphocyte count and HIV viral load.
Methods: Cross-sectional study of patients diagnosed with HIV infection who underwent skin biopsy for histopathological study from 1992 to 2022. Skin diseases were categorized as opportunistic and sexually transmitted infections, inflammatory dermatoses, benign cutaneous neoplasms, and premalignant and malignant cutaneous neoplasms. Clinicopathological concordance was classified as complete, partial or discordant. Frequency of skin diseases are presented by category and according to lymphocyte CD4+ count and HIV viral load.
Results: A total of 659 patients were included of whom 88.5% (n = 583) were male. The most frequent diagnostic category was opportunistic or sexually transmitted infections in 34% (n = 224) and the most frequently found condition was Kaposi sarcoma in 17% (n = 112). Clinicopathological concordance was complete in 53.7% (n = 354) of cases, partial in 26.7% (n = 176) and discordant in 19.6% (n = 129). Among the 282 patients with available serological data, 58.9% (n = 166), 23.8% (n = 67) and 17.4% (n = 49) had CD4+ counts below 200, between 200 and 499, and above 500 cells/μl, respectively.
Conclusions: Although there is a high variability in skin conditions which people with HIV may present, there was a high rate of clinicopathological concordance (80.4%). We emphasize the importance of diagnostic skin biopsies due to their diverse morphological presentation. The frequency of skin diseases in PLWH depending on different clinical settings should aid the clinician in reaching an adequate diagnosis in this population.
{"title":"Clinicopathological concordance of mucocutaneous manifestations in people living with HIV: A cross-sectional study.","authors":"Dalit Zajdman-Faitelson, Miren Lorea Cárdenas-Hernández, Simón Guzmán-Bucio, Antonio Camiro-Zuñiga, Maria Elisa Vega Memije","doi":"10.1111/hiv.13686","DOIUrl":"https://doi.org/10.1111/hiv.13686","url":null,"abstract":"<p><strong>Objective: </strong>To describe the frequency and clinicopathological concordance of mucocutaneous manifestations in people living with HIV (PLWH) and its correlation with CD4+ T lymphocyte count and HIV viral load.</p><p><strong>Methods: </strong>Cross-sectional study of patients diagnosed with HIV infection who underwent skin biopsy for histopathological study from 1992 to 2022. Skin diseases were categorized as opportunistic and sexually transmitted infections, inflammatory dermatoses, benign cutaneous neoplasms, and premalignant and malignant cutaneous neoplasms. Clinicopathological concordance was classified as complete, partial or discordant. Frequency of skin diseases are presented by category and according to lymphocyte CD4+ count and HIV viral load.</p><p><strong>Results: </strong>A total of 659 patients were included of whom 88.5% (n = 583) were male. The most frequent diagnostic category was opportunistic or sexually transmitted infections in 34% (n = 224) and the most frequently found condition was Kaposi sarcoma in 17% (n = 112). Clinicopathological concordance was complete in 53.7% (n = 354) of cases, partial in 26.7% (n = 176) and discordant in 19.6% (n = 129). Among the 282 patients with available serological data, 58.9% (n = 166), 23.8% (n = 67) and 17.4% (n = 49) had CD4+ counts below 200, between 200 and 499, and above 500 cells/μl, respectively.</p><p><strong>Conclusions: </strong>Although there is a high variability in skin conditions which people with HIV may present, there was a high rate of clinicopathological concordance (80.4%). We emphasize the importance of diagnostic skin biopsies due to their diverse morphological presentation. The frequency of skin diseases in PLWH depending on different clinical settings should aid the clinician in reaching an adequate diagnosis in this population.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amogh Verma, Manu Pant, Mahalaqua Nazli Khatib, Mahendra Pratap Singh
{"title":"Commentary on ‘Impact of hormonal therapy on HIV-1 immune markers in cis women and gender minorities’","authors":"Amogh Verma, Manu Pant, Mahalaqua Nazli Khatib, Mahendra Pratap Singh","doi":"10.1111/hiv.13687","DOIUrl":"10.1111/hiv.13687","url":null,"abstract":"","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Simões, Dorthe Raben, Alejandro Bertó Moran, Arkaitz Imaz, Annemarie Rinder Stengaard, Anne Raahauge, Ann K Sullivan, Elena Vaughan, Johanna Brännström, Irith De Baetselier, Tom Platteau, Jordi Casabona, Julia Del Amo
Introduction and objectives: The HepHIV 2023 Conference, held in Madrid in November 2023, highlighted how Europe is not on track to meet the United Nations (UN) sustainable development goals and Joint UN Programme on HIV/AIDS (UNAIDS) targets. This article presents the outcomes of the conference, which focus on ways to improve testing and linkage to care for HIV, viral hepatitis, and other sexually transmitted infections. HIV-related stigma and discrimination, a major barrier to progress, was a key concept of the conference and on the agenda of the Spanish Presidency of the European Union.
Methods: The HepHIV 2023 organizing committee, alongside the Spanish Ministry of Health, oversaw the conference organization and prepared the scientific programme based on abstract rankings. Key outcomes are derived from conference presentations and discussions.
Results: Conference presentations covered the obstacles that HIV-related stigma and discrimination continue to pose to access to services, models for data collection to better monitor progress in the future, and examples of legislative action that can be taken at national levels. Diversification of testing approaches was also highlighted, to reach key populations, (e.g. migrant populations), to increase testing offered in healthcare settings (e.g. emergency departments), and to account for different stages of epidemics across the region.
Conclusion: With a strong call for intensified action to address the impact of HIV-related stigma and discrimination on testing uptake, the conference concluded that strengthened collaboration is required between governments and implementers around testing and linkage to care. There is also an ongoing need to ensure sustainable political commitment and appropriate resource allocation to address gaps and inequalities in access for key populations and to focus on the implementation of integrated responses to HIV, viral hepatitis, and sexually transmitted infections.
{"title":"The HepHIV 2023 Madrid conference: A call to action for political leadership in reaching the sustainable development goals on earlier testing and linkage to care for HIV, viral hepatitis, and sexually transmitted infections.","authors":"Daniel Simões, Dorthe Raben, Alejandro Bertó Moran, Arkaitz Imaz, Annemarie Rinder Stengaard, Anne Raahauge, Ann K Sullivan, Elena Vaughan, Johanna Brännström, Irith De Baetselier, Tom Platteau, Jordi Casabona, Julia Del Amo","doi":"10.1111/hiv.13683","DOIUrl":"https://doi.org/10.1111/hiv.13683","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The HepHIV 2023 Conference, held in Madrid in November 2023, highlighted how Europe is not on track to meet the United Nations (UN) sustainable development goals and Joint UN Programme on HIV/AIDS (UNAIDS) targets. This article presents the outcomes of the conference, which focus on ways to improve testing and linkage to care for HIV, viral hepatitis, and other sexually transmitted infections. HIV-related stigma and discrimination, a major barrier to progress, was a key concept of the conference and on the agenda of the Spanish Presidency of the European Union.</p><p><strong>Methods: </strong>The HepHIV 2023 organizing committee, alongside the Spanish Ministry of Health, oversaw the conference organization and prepared the scientific programme based on abstract rankings. Key outcomes are derived from conference presentations and discussions.</p><p><strong>Results: </strong>Conference presentations covered the obstacles that HIV-related stigma and discrimination continue to pose to access to services, models for data collection to better monitor progress in the future, and examples of legislative action that can be taken at national levels. Diversification of testing approaches was also highlighted, to reach key populations, (e.g. migrant populations), to increase testing offered in healthcare settings (e.g. emergency departments), and to account for different stages of epidemics across the region.</p><p><strong>Conclusion: </strong>With a strong call for intensified action to address the impact of HIV-related stigma and discrimination on testing uptake, the conference concluded that strengthened collaboration is required between governments and implementers around testing and linkage to care. There is also an ongoing need to ensure sustainable political commitment and appropriate resource allocation to address gaps and inequalities in access for key populations and to focus on the implementation of integrated responses to HIV, viral hepatitis, and sexually transmitted infections.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141456440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dimitris Basoulis, Elpida Mastrogianni, Irene Eliadi, Martha Papadopoulou, Mina Psichogiou
ObjectivesHIV/hepatitis C virus (HCV) co‐infection among people who inject drugs (PWID) remains a global health problem. The goal of our study was to evaluate, in a real‐world setting, success rates of sustained virological response (SVR) using direct‐acting antivirals (DAAs) to treat a population of PWID living with HCV/HIV.MethodsThis was a prospective single‐center observational study. We collected demographic, socioeconomic, and clinical data pertaining to HIV and HCV infection in PWID with several barriers to care. We identified risk factors for SVR failure.ResultsAmong 130 individuals retained to HIV care, we planned HCV treatment in 119/130 (91.5%); 106/119 (89.1%) started treatment with DAAs and 100/106 (94.3%) completed treatment. People not starting treatment were more often in active opioid drug use (odds ratio [OR] 0.25; 95% confidence interval [CI] 0.07–0.97, p = 0.045) and benzodiazepine abuse (OR 0.25; 95% CI 0.07–0.95, p = 0.042). Only 86/100 (86%) were tested for SVR at 12 weeks (SVR12) and 72/86 (83.7%) achieved SVR. PWID in opioid substitution programmes tended to return for SVR12 testing more often (54.7% vs. 30%, p = 0.081). Individuals in active opioid drug use (OR 0.226; 95% CI 0.064–0.793, p = 0.02) or with poor adherence (OR 0.187; 95% CI 0.043–0.814, p = 0.025) were less likely to achieve SVR. At the end of our study period, 113/119 (95%) treatment‐eligible patients remained alive. HCV infection was cured in 68/113 (61.1%) people.ConclusionsOur findings underscore the importance of prioritizing combatting substance use to achieve HCV elimination goals. A systematic approach with effort to overcome barriers to receiving and completing treatment and encourage to enrol in opioid substitution programmes if not possible to completely abstain from use, can help increase chances of HCV cure.
目标注射吸毒者(PWID)中的艾滋病毒/丙型肝炎病毒(HCV)合并感染仍然是一个全球性的健康问题。我们的研究旨在评估在现实环境中使用直接作用抗病毒药物(DAAs)治疗感染 HCV/HIV 的注射吸毒者的持续病毒学应答(SVR)成功率。我们收集了感染 HIV 和 HCV 的 PWID 的人口统计学、社会经济学和临床数据,这些数据表明这些 PWID 在接受治疗时存在一些障碍。结果在130名接受HIV治疗的患者中,我们计划对119/130(91.5%)人进行HCV治疗;106/119(89.1%)人开始接受DAAs治疗,100/106(94.3%)人完成了治疗。未开始治疗的患者更多使用阿片类药物(几率比 [OR] 0.25;95% 置信区间 [CI]0.07-0.97,P = 0.045)和滥用苯二氮卓(OR 0.25;95% CI 0.07-0.95,P = 0.042)。只有 86/100 人(86%)在 12 周时接受了 SVR12 检测,72/86 人(83.7%)获得了 SVR。参加阿片类药物替代计划的感染者往往更经常返回接受 SVR12 检测(54.7% 对 30%,p = 0.081)。阿片类药物使用活跃者(OR 0.226; 95% CI 0.064-0.793, p = 0.02)或依从性差者(OR 0.187; 95% CI 0.043-0.814, p = 0.025)获得 SVR 的可能性较低。研究结束时,113/119(95%)名符合治疗条件的患者仍然存活。68/113(61.1%)名患者的 HCV 感染得到治愈。采取系统的方法,努力克服接受和完成治疗的障碍,并鼓励患者在无法完全戒断使用阿片类药物的情况下参加阿片类药物替代计划,有助于增加治愈 HCV 的机会。
{"title":"HCV‐HIV co‐infection in people who inject drugs: Barriers to treatment and cure of HCV infection in the era of DAAs, a prospective study in Athens, Greece","authors":"Dimitris Basoulis, Elpida Mastrogianni, Irene Eliadi, Martha Papadopoulou, Mina Psichogiou","doi":"10.1111/hiv.13681","DOIUrl":"https://doi.org/10.1111/hiv.13681","url":null,"abstract":"ObjectivesHIV/hepatitis C virus (HCV) co‐infection among people who inject drugs (PWID) remains a global health problem. The goal of our study was to evaluate, in a real‐world setting, success rates of sustained virological response (SVR) using direct‐acting antivirals (DAAs) to treat a population of PWID living with HCV/HIV.MethodsThis was a prospective single‐center observational study. We collected demographic, socioeconomic, and clinical data pertaining to HIV and HCV infection in PWID with several barriers to care. We identified risk factors for SVR failure.ResultsAmong 130 individuals retained to HIV care, we planned HCV treatment in 119/130 (91.5%); 106/119 (89.1%) started treatment with DAAs and 100/106 (94.3%) completed treatment. People not starting treatment were more often in active opioid drug use (odds ratio [OR] 0.25; 95% confidence interval [CI] 0.07–0.97, <jats:italic>p</jats:italic> = 0.045) and benzodiazepine abuse (OR 0.25; 95% CI 0.07–0.95, <jats:italic>p</jats:italic> = 0.042). Only 86/100 (86%) were tested for SVR at 12 weeks (SVR12) and 72/86 (83.7%) achieved SVR. PWID in opioid substitution programmes tended to return for SVR12 testing more often (54.7% vs. 30%, <jats:italic>p</jats:italic> = 0.081). Individuals in active opioid drug use (OR 0.226; 95% CI 0.064–0.793, <jats:italic>p</jats:italic> = 0.02) or with poor adherence (OR 0.187; 95% CI 0.043–0.814, <jats:italic>p</jats:italic> = 0.025) were less likely to achieve SVR. At the end of our study period, 113/119 (95%) treatment‐eligible patients remained alive. HCV infection was cured in 68/113 (61.1%) people.ConclusionsOur findings underscore the importance of prioritizing combatting substance use to achieve HCV elimination goals. A systematic approach with effort to overcome barriers to receiving and completing treatment and encourage to enrol in opioid substitution programmes if not possible to completely abstain from use, can help increase chances of HCV cure.","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141547045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salim A. Barquet‐Muñoz, Roxana A. López‐Morales, Elizabeth A. Stier, Emmanuel Mejorada‐Pulido, Diego Solís‐Ramírez, Naomi Jay, Paulina Moctezuma, Mariel Morales‐Aguirre, Alejandro García‐Carrancá, Rocío Méndez‐Martínez, Alexandra Martin‐Onraët, Delia Pérez‐Montiel, María José Mendoza‐Palacios, Patricia Volkow
This study aimed to describe the prevalence of high‐risk human papillomavirus (HR‐HPV) types in the anal canal in a cohort of people living with HIV (PLWHIV) with a history of malignancy.SettingReferral tertiary care hospital for adult patients with cancer.MethodsWe reviewed data of patients from the AIDS Cancer Clinic on antiretroviral therapy in chronic control who were consecutively referred for high‐resolution anoscopy (HRA), where they underwent anal evaluation, collection of specimens for anal cytology and anal human papillomavirus (HPV) followed by HRA with directed biopsy if needed.ResultsA total of 155 patients were included; 149 (96.1%) were men, all of them men who have sex with men (MSM); the median age was 39 (IQR 32‐47) years; 105 (67.7%) with Kaposi sarcoma, 40 (25.8%) with non‐Hodgkin lymphoma and 10 (6.4%) with other neoplasms; only 7 (4.5%) had active cancer. The prevalence of HR‐HPV infection was 89% (n=138) (95% CI 83–93) with at least one HR‐HPV infection, and 62% (96) had coinfection with at least two types; the median HR‐HPV types of coinfection were 3 (IQR 2–4). The number of patients infected with HPV 16 was 64 (41.3%, 95% CI 33.8–49.3), HPV 18 was 74 (47.7%, 95% CI 39.9–55.7) and with both 35 (22.6%). Some 59 patients (38%) had high‐grade squamous intraepithelial lesions (HSIL) and 49 (31.6%) had low‐grade squamous intraepithelial lesions (LSIL). The prevalence of HR‐HPV and HSIL among patients aged ≤35 and >35 years was the same.ConclusionsIn this cohort of PLWHIV with a history of malignancy we found a high prevalence of HR‐HPV 16 and 18 and anal HSIL, even in persons aged ≤35 years. These data highlight the importance of anal cancer screening in PLWHIV and history of malignancy.
{"title":"Prevalence of anal high‐risk human papillomavirus (HR‐HPV) types in people living with HIV and a history of cancer","authors":"Salim A. Barquet‐Muñoz, Roxana A. López‐Morales, Elizabeth A. Stier, Emmanuel Mejorada‐Pulido, Diego Solís‐Ramírez, Naomi Jay, Paulina Moctezuma, Mariel Morales‐Aguirre, Alejandro García‐Carrancá, Rocío Méndez‐Martínez, Alexandra Martin‐Onraët, Delia Pérez‐Montiel, María José Mendoza‐Palacios, Patricia Volkow","doi":"10.1111/hiv.13684","DOIUrl":"https://doi.org/10.1111/hiv.13684","url":null,"abstract":"<jats:label/>This study aimed to describe the prevalence of high‐risk human papillomavirus (HR‐HPV) types in the anal canal in a cohort of people living with HIV (PLWHIV) with a history of malignancy.SettingReferral tertiary care hospital for adult patients with cancer.MethodsWe reviewed data of patients from the AIDS Cancer Clinic on antiretroviral therapy in chronic control who were consecutively referred for high‐resolution anoscopy (HRA), where they underwent anal evaluation, collection of specimens for anal cytology and anal human papillomavirus (HPV) followed by HRA with directed biopsy if needed.ResultsA total of 155 patients were included; 149 (96.1%) were men, all of them men who have sex with men (MSM); the median age was 39 (IQR 32‐47) years; 105 (67.7%) with Kaposi sarcoma, 40 (25.8%) with non‐Hodgkin lymphoma and 10 (6.4%) with other neoplasms; only 7 (4.5%) had active cancer. The prevalence of HR‐HPV infection was 89% (<jats:italic>n</jats:italic>=138) (95% CI 83–93) with at least one HR‐HPV infection, and 62% (96) had coinfection with at least two types; the median HR‐HPV types of coinfection were 3 (IQR 2–4). The number of patients infected with HPV 16 was 64 (41.3%, 95% CI 33.8–49.3), HPV 18 was 74 (47.7%, 95% CI 39.9–55.7) and with both 35 (22.6%). Some 59 patients (38%) had high‐grade squamous intraepithelial lesions (HSIL) and 49 (31.6%) had low‐grade squamous intraepithelial lesions (LSIL). The prevalence of HR‐HPV and HSIL among patients aged ≤35 and >35 years was the same.ConclusionsIn this cohort of PLWHIV with a history of malignancy we found a high prevalence of HR‐HPV 16 and 18 and anal HSIL, even in persons aged ≤35 years. These data highlight the importance of anal cancer screening in PLWHIV and history of malignancy.","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141547046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer O Lam, Craig E Hou, Stacey Alexeeff, Tory Levine, Varada Sarovar, Alexandra N Lea, Verena E Metz, Michael A Horberg, Derek D Satre, Michael J Silverberg
Objective: Despite recognition that people with HIV (PWH) are more vulnerable to sleep issues, there is limited understanding of clinically recognized sleep disorders in this population. Our objective was to evaluate the full spectrum of sleep disorder types diagnosed among PWH in care.
Methods: We conducted a retrospective cohort study of PWH, and a comparator group of people without HIV (PWoH), in a large healthcare system. The incidence of clinically diagnosed sleep disorders was calculated using Poisson regression for three outcomes: any type of sleep disorder, insomnia, and sleep apnea. Incidence was compared between PWH and PWoH by computing the adjusted incidence rate ratio (aIRR), accounting for sleep disorder risk factors. Comparisons to PWoH were made for all PWH combined, then with PWH stratified by HIV management status (well-managed HIV defined as being on antiretroviral therapy, HIV RNA <200 copies/mL, and CD4 count ≥500 cells/μL).
Results: The study included 9076 PWH and 205 178 PWoH (mean age 46 years, 90% men). Compared with PWoH, sleep disorder incidence was greater among PWH overall [aIRR = 1.19, 95% confidence interval (CI): 1.12-1.26], particularly for insomnia (aIRR = 1.56, 95% CI: 1.45-1.67). Sleep apnea incidence was lower among PWH (aIRR = 0.90, 95% CI: 0.84-0.97). In HIV management subgroups, PWH without well-managed HIV had lower sleep apnea incidence (vs. PWoH: aIRR = 0.79, 95% CI: 0.70-0.89) but PWH with well-managed HIV did not (vs. PWoH: aIRR = 0.97, 95% CI: 0.89-1.06).
Conclusions: PWH have high sleep disorder incidence, and insomnia is the most common clinical diagnosis. Lower sleep apnea incidence among PWH may reflect underdiagnosis in those with sub-optimally treated HIV and will be important to investigate further.
{"title":"Clinically recognized sleep disorders in people living with HIV.","authors":"Jennifer O Lam, Craig E Hou, Stacey Alexeeff, Tory Levine, Varada Sarovar, Alexandra N Lea, Verena E Metz, Michael A Horberg, Derek D Satre, Michael J Silverberg","doi":"10.1111/hiv.13682","DOIUrl":"https://doi.org/10.1111/hiv.13682","url":null,"abstract":"<p><strong>Objective: </strong>Despite recognition that people with HIV (PWH) are more vulnerable to sleep issues, there is limited understanding of clinically recognized sleep disorders in this population. Our objective was to evaluate the full spectrum of sleep disorder types diagnosed among PWH in care.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of PWH, and a comparator group of people without HIV (PWoH), in a large healthcare system. The incidence of clinically diagnosed sleep disorders was calculated using Poisson regression for three outcomes: any type of sleep disorder, insomnia, and sleep apnea. Incidence was compared between PWH and PWoH by computing the adjusted incidence rate ratio (aIRR), accounting for sleep disorder risk factors. Comparisons to PWoH were made for all PWH combined, then with PWH stratified by HIV management status (well-managed HIV defined as being on antiretroviral therapy, HIV RNA <200 copies/mL, and CD4 count ≥500 cells/μL).</p><p><strong>Results: </strong>The study included 9076 PWH and 205 178 PWoH (mean age 46 years, 90% men). Compared with PWoH, sleep disorder incidence was greater among PWH overall [aIRR = 1.19, 95% confidence interval (CI): 1.12-1.26], particularly for insomnia (aIRR = 1.56, 95% CI: 1.45-1.67). Sleep apnea incidence was lower among PWH (aIRR = 0.90, 95% CI: 0.84-0.97). In HIV management subgroups, PWH without well-managed HIV had lower sleep apnea incidence (vs. PWoH: aIRR = 0.79, 95% CI: 0.70-0.89) but PWH with well-managed HIV did not (vs. PWoH: aIRR = 0.97, 95% CI: 0.89-1.06).</p><p><strong>Conclusions: </strong>PWH have high sleep disorder incidence, and insomnia is the most common clinical diagnosis. Lower sleep apnea incidence among PWH may reflect underdiagnosis in those with sub-optimally treated HIV and will be important to investigate further.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kyle Ring, Melanie Smuk, Moses Shongwe, Leroy Okonta, Nicola E Mackie, Sara Ayres, Tristan J Barber, Jane Akodu, Filippo Ferro, Daniella Chilton, Eliot Hurn, Bhavna Halai, Will Barchi, Asim Ali, Sandra Darko, Gemma White, Emily Clarke, Fiona Clark, Bazga Ali, Joseph Arumainayagam, Gaynor Quinn, Marta Boffito, Ruth Byrne, Nadia Naous, Suki Leung, Athavan Umaipalan, Brian Thornton, David Bayliss, Catherine McLoughlin, Jonathan Foster, Laura Waters, Chloe Orkin
Introduction: Long-acting injectable cabotegravir + rilpivirine (CAB + RPV LAI) was approved for use in virally suppressed adults in the England and Wales national health service in November 2021. We describe a service evaluation of delivery processes and outcomes in 12 clinics.
Methods: Centres populated a database using information from local policies and clinical records. Services were asked to describe approval processes, clinic pathways, and adherence to national guidelines. Additional data were collected on reasons for regimen choice, treatment discontinuations, and management of viraemia.
Results: In total, 518 adults from 12 clinics were approved for CAB + RPV LAI between February 2022 and December 2023. Of the 518 people approved for CAB + RPV LAI, 423 received at least one injection. Median duration on CAB + RPV was 7.5 months (interquartile range 3.7-11.3). In total, 97% of injections were administered within the ±7-day window. Virological failure occurred in 0.7%, and 6% discontinued CAB + RPV.
Conclusion: In this large UK-based cohort, robust approval processes and clinic protocols facilitated on-time injections and low rates of both discontinuation and virological failure.
{"title":"Multicentre service evaluation of injectable cabotegravir and rilpivirine delivery and outcomes across 12 UK clinics (SHARE LAI-net).","authors":"Kyle Ring, Melanie Smuk, Moses Shongwe, Leroy Okonta, Nicola E Mackie, Sara Ayres, Tristan J Barber, Jane Akodu, Filippo Ferro, Daniella Chilton, Eliot Hurn, Bhavna Halai, Will Barchi, Asim Ali, Sandra Darko, Gemma White, Emily Clarke, Fiona Clark, Bazga Ali, Joseph Arumainayagam, Gaynor Quinn, Marta Boffito, Ruth Byrne, Nadia Naous, Suki Leung, Athavan Umaipalan, Brian Thornton, David Bayliss, Catherine McLoughlin, Jonathan Foster, Laura Waters, Chloe Orkin","doi":"10.1111/hiv.13679","DOIUrl":"https://doi.org/10.1111/hiv.13679","url":null,"abstract":"<p><strong>Introduction: </strong>Long-acting injectable cabotegravir + rilpivirine (CAB + RPV LAI) was approved for use in virally suppressed adults in the England and Wales national health service in November 2021. We describe a service evaluation of delivery processes and outcomes in 12 clinics.</p><p><strong>Methods: </strong>Centres populated a database using information from local policies and clinical records. Services were asked to describe approval processes, clinic pathways, and adherence to national guidelines. Additional data were collected on reasons for regimen choice, treatment discontinuations, and management of viraemia.</p><p><strong>Results: </strong>In total, 518 adults from 12 clinics were approved for CAB + RPV LAI between February 2022 and December 2023. Of the 518 people approved for CAB + RPV LAI, 423 received at least one injection. Median duration on CAB + RPV was 7.5 months (interquartile range 3.7-11.3). In total, 97% of injections were administered within the ±7-day window. Virological failure occurred in 0.7%, and 6% discontinued CAB + RPV.</p><p><strong>Conclusion: </strong>In this large UK-based cohort, robust approval processes and clinic protocols facilitated on-time injections and low rates of both discontinuation and virological failure.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}