HIV Medicine最新文献

Objectives: The goal of this study was to explore current barriers and mitigating strategies to routine HIV screening in emergency departments (EDs) using a national sample of ED leadership, including both physician and non-physician providers.

Methods: We employed an exploratory research design informed by the consolidated criteria for reporting qualitative research. Participants were recruited from a comprehensive database of US EDs, targeting directors from diverse urban, suburban and rural settings. Data were collected from semi-structured interviews conducted during May 2023 to July 2024. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

Results: Twenty-one individuals participated in the study. Five key themes were identified: (1) The role of the ED within HIV screening; (2) Adequate resources and buy-in-from staff to administration-are crucial for successful screening programmes; (3) Institutional and structural determinants shape ED HIV screening; (4) HIV stigma persists; and (5) Operationalization of ED HIV testing is crucial. The participants highlighted the strategic potential of EDs for HIV screening, the need for institutional support and challenges posed by staffing, logistical issues and stigma.

Conclusions: This study provides an in-depth exploration of the barriers and mitigating strategies to HIV screening in US EDs through the lens of directors around the country. Despite the capacity and strategic potential of EDs to contribute to HIV prevention, significant challenges persist, including staffing, logistical issues and stigma. Institutional investment in staff support systems, integration of HIV screening into electronic medical records and efforts to normalize HIV screening are essential to enhance the efficacy of screening programmes.

Introduction: People with tuberculosis-HIV coinfection face multiple barriers to effective treatment, including social vulnerability, stigma and limited access to healthcare. This study examined factors associated with loss to follow-up and death among individuals with tuberculosis-HIV in Brazil.

Methods: We conducted a longitudinal study using a nationally linked database from surveillance systems. Poisson regression models with robust variance were applied to identify factors associated with unfavourable outcomes, guided by a theoretical-conceptual hierarchical framework.

Results: We analysed data from 54 516 individuals. The median time to loss to treatment follow-up was 115 days, with a cumulative proportion of 29.56%. Among the most consistent predictors of loss to follow-up were homelessness (relative risk, RR 1.18; 95% confidence interval, 95% CI 1.16-1.19), tuberculosis retreatment (RR 1.16; 95% CI 1.15-1.17) and drug use (RR 1.15; 95% CI 1.14-1.16), whereas antiretroviral therapy use (RR 0.95; 95% CI 0.95-0.96) showed a negative association. The median time to death during tuberculosis treatment was 27 days, with a cumulative proportion of 27.54%. Higher risk of death was observed among individuals with CD4 counts <350 cells/mm³ (RR 1.09; 95% CI 1.08-1.10), those experiencing homelessness (RR 1.08; 95% CI 1.06-1.10) and those with rifampicin resistance (RR 1.11; 95% CI 1.07-1.15).

Conclusion: Key social, clinical and programmatic factors were associated with loss to follow-up and death during tuberculosis treatment among people with HIV. Addressing these vulnerabilities is essential to improving treatment outcomes and advancing progress towards the 2030 targets.

Introduction: Long-acting injectable antiretroviral therapy (ART) with Cabotegravir (CAB) and Rilpivirine (RPV) offers an alternative to daily oral regimens, improving adherence and patient satisfaction. However, its impact on body composition and metabolism remains underexplored.

Methods: We conducted a prospective cohort study involving 29 people with HIV initiating CAB + RPV LA at a single centre in Italy. Body composition was assessed using dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) at baseline, 24 and 48 weeks. Anthropometrics, laboratory parameters and patient-reported outcomes were also collected. Statistical comparisons across time points were performed using paired tests (p < 0.05 considered significant).

Results: At 48 weeks, weight and BMI remained stable. Waist circumference significantly decreased (median 97 (IQR 91-102) to 94 (IQR 89-98) cm, p = 0.026), with no significant change in total fat percentage or visceral adipose tissue. A modest but statistically significant increase in trunk/limb fat ratio (mean 1.19 (SD 0.39) to 1.25 (SD 0.41), p = 0.035). Lean mass and muscle function were unchanged. BIA findings confirmed stable fat mass and body water compartments. Virologic suppression was maintained in all participants throughout follow-up. High-density lipoprotein (HDL) cholesterol increased significantly, accompanied by a rise in total cholesterol, while low-density lipoprotein (LDL) cholesterol, triglycerides and the total cholesterol/HDL ratio remained stable. Serum creatinine significantly decreased, mainly among individuals switching from bictegravir- or dolutegravir-based regimens. Glycaemia, insulin, HOMA-IR, Metabolic Score for Insulin Resistance (METS-IR), liver enzymes and hepatic steatosis and fibrosis indices remained stable. Adverse events, mostly injection-site reactions, decreased over time. Only one participant discontinued treatment. Treatment satisfaction improved throughout the study.

Conclusion: CAB + RPV LA was not associated with significant weight gain, clinically relevant changes in body composition or adverse metabolic effects over 48 weeks. Virologic suppression was maintained, renal laboratory parameters improved in prior INSTI users and treatment was well tolerated with increasing satisfaction. These findings support CAB + RPV LA as a safe, effective and metabolically neutral alternative to daily oral ART.

Background: Long-acting antiretroviral therapy (LA-ART) is emerging as a promising strategy to enhance treatment satisfaction and improve the quality of life for people living with HIV (PLWH). A comprehensive understanding of treatment preferences is essential for effectively addressing the needs and expectations of PLWH.

Objective: This review intends to delineate and assess the evidence gathered from discrete choice experiments, aiming to unravel the preferences of PLWHs towards LA-ART.

Data source: PubMed, Web of Science, Cochrane Library, APA PsychInfo, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) are the data sources.

Methods: A comprehensive literature search was performed in six databases from inception to 4 January 2026. The PREFS (Purpose, Respondents, Explanation, Findings, Significance) and the International Society for Pharmacoeconomics and Outcomes Research checklist were used to evaluate the quality of the included studies. Data were synthesized narratively. Thematic analysis was applied to categorize attributes into groups. Frequency, significance, relative importance and willingness-to-pay were analysed.

Results: Ten studies from six countries were included. In total, 62 individual attributes were extracted and grouped into three broad categories and eight sub-categories. Among the two studies that included cost, cost ranked highest. Preferences also vary among LA-ARTs at different stages of technical maturity and among PLWH with differing characteristics.

Conclusion: In high-income country settings, cost and administration regimens are significant factors influencing PLWH preferences for LA-ART. However, the importance of cost depends on the specific context: it presents a direct barrier in systems with patient co-payments but is less pronounced in publicly funded treatment systems. Current evidence base originates exclusively from high-income countries, limiting the generalizability of these findings to low- and middle-income nations where diverse healthcare system constraints are more prevalent.

Registration: The protocol for this study was registered with PROSPERO (registration number: CRD420251149075).

Introduction: Long-acting injectable cabotegravir and rilpivirine (LAI CAB + RPV) is a well-established regimen for people with HIV (PWH) that offers high efficacy and tolerability. However, data are limited for obese individuals with a body mass index (BMI) ≥ 30 kg/m², which may represent a potential risk factor for virologic failure (VF).

Methods: We conducted a multicentre, ambispective study (RELATIVITY cohort, Spain) of virologically suppressed PWH with BMI ≥ 30 kg/m² who switched to LAI CAB + RPV. This study characterized this population and evaluated the factors associated with virologic outcomes, tolerability and adherence using Kaplan-Meier analysis.

Results: Among the 3,203 individuals recruited in the RELATIVITY cohort, 57 were excluded due to detectable HIV RNA at the time of switching to LAI CAB+RPV, and 3,146 were finally included, all of whom had HIV RNA levels <50 copies/mL at baseline. BMI data were available for 2,736 participants, of whom 362 (11.5%) had a BMI ≥30 kg/m² and 2,374 had a BMI <30 kg/m². Obese participants were older (median age 48 vs. 45 years) and included a higher proportion of women (21.9% vs. 13.7%). Comorbidities included dyslipidaemia (36.7%), hypertension (22.9%), diabetes (11.6%), chronic lung disease (6.4%), MASLD (5.5%) and coronary disease (3.3%). The main reasons for switching included quality-of-life improvement (49.2%), patient requests (35.4%), and therapy simplification (26%). VF was rare, occurring in 1.1% of obese individuals and 0.6% of non-obese participants over a median follow-up of 13.8 months (p = 0.284). Emergent resistance mutations were detected in 2/4 VF in obese participants. The discontinuation rate was low across all study groups. Among participants with obesity, local adverse events accounted for 1.9% of discontinuations, systemic adverse events for 0.8%, and other causes for 3.9% of discontinuations. In this subgroup, 72.9% of injections were administered using a 38-mm needle. Injection adherence was excellent, with 83.1% of participants with obesity achieving full (100%) coverage and an additional 16.3% maintaining 90-99.9% coverage.

Conclusions: In this real-world cohort, LAI CAB + RPV was safe and effective in PWH with obesity, with comparable VF rates, tolerability, and adherence to participants without obesity. These findings support the use of LAI CAB + RPV across diverse PWH populations, including those with a BMI ≥ 30 kg/m², and highlight its feasibility in PWH with multiple comorbidities.

Background: Long-acting injectable cabotegravir/rilpivirine (LA-CAB/RPV) is an effective maintenance strategy for virologically suppressed people with HIV, though virologic failure with resistance remains uncommon and incompletely understood.

Methods: We describe a case of virologic failure in an HIV-infected patient receiving LA-CAB/RPV who developed intensive daily intravenous (IV) chemsex. Clinical history, virologic data, resistance testing, and potential contributing factors were reviewed.

Results: The patient had sustained viral suppression on prior oral antiretroviral therapy and remained on time with all LA-CAB/RPV injections. Despite this, viral rebound occurred with emergence of the Y181C mutation, conferring high-level resistance to RPV, leading to treatment discontinuation. No clinically relevant drug-drug interactions were identified. Plasma concentrations of CAB and RPV were not available. Severe behavioural dysregulation associated with intensive IV stimulant use may have contributed, although causality cannot be established and alternative explanations cannot be excluded.

Conclusions: This case highlights that unexpected resistance can emerge during adequately administered LA-CAB/RPV therapy. Careful clinical evaluation is warranted when virologic failure occurs, particularly in the presence of extreme behavioural or physiological stressors.

Introduction: Weight gain associated with antiretroviral therapy, particularly second-generation integrase strand transfer inhibitors (INSTIs), is an increasingly recognized concern. However, literature remains mixed regarding whether these effects differ by sex/gender. This scoping review aims to map the pattern, timing, severity and risk factors for weight gain among cis and trans women initiating or switching to second-generation INSTIs, such as dolutegravir, bictegravir or cabotegravir.

Methods: Four databases (EMBASE, MEDLINE, Web of Science and CINAHL) were searched for studies reporting on weight gain after initiating or switching to second-generation INSTIs in cis and trans women or mixed cohorts with data disaggregated by sex/gender between 2010 and 2024. Three reviewers independently conducted the screening, and two reviewers extracted data.

Results: Forty articles were included. Most studies reported trends of increased and excessive weight gain in cis women compared to cis men taking dolutegravir or bictegravir-based regimens, although findings were inconsistent and the extent of weight gain varied. Weight gain was particularly pronounced among treatment-naive cis women, those of Black ethnicity or in African settings, and participants receiving dolutegravir in combination with tenofovir alafenamide. Studies on weight gain in cis women taking cabotegravir-based regimens and trans women on any regimen were scarce.

Conclusion: Second-generation INSTIs, especially dolutegravir, appear to be associated with greater average and excessive weight gain among cis women, although this effect varies by setting, regimen and clinical context. Further research, especially in diverse populations, is needed to explore underlying mechanisms, determine risk factors and evaluate these trends in newer antiretroviral medications.

Aim: This study compared acute psychological responses to a single session of low-volume high-intensity interval exercise (HIIE-LV), high-volume high-intensity interval exercise (HIIE-HV), and moderate-intensity continuous exercise (MICE) in people living with HIV, and healthy controls using a randomized, counterbalanced crossover design.

Methods: The participants (people living with HIV, and healthy controls) completed three exercise sessions in randomized order: HIIE-HV (4 × 4 min at 80% of maximal power output [W_max]), HIIE-LV (10 × 60 s at 90% W_max), and MICE (30 min at 60% W_max). Psychological outcomes included affective response assessed by the Feeling Scale, exercise enjoyment and future exercise intention (FEI), while rating of perceived exertion (RPE) was recorded throughout the exercise. Data were analysed using repeated-measures ANOVA with the group as a between-subject factor.

Results: All participants completed the three exercise conditions and were included in the analyses (11 people living with HIV and 11 healthy controls). In people living with HIV, exercise enjoyment was higher following HIIE-HV compared with healthy controls (p = 0.031). No between-condition differences were observed for affective response or FEI in people living with HIV. During exercise, affective responses did not differ between exercise modalities in people living with HIV, whereas healthy controls reported lower affective responses during HIIE-HV compared with HIIE-LV and MICE. RPE was significantly higher during HIIE-HV compared with HIIE-LV and MICE in both groups (p < 0.05).

Conclusion: People living with HIV demonstrated similar affective responses and FEI following MICE and HIIE compared with healthy adults, despite higher perceived exertion during HIIE-HV. Notably, people living with HIV reported higher exercise enjoyment following HIIE-HV, suggesting that this exercise modality may be particularly well tolerated and positively perceived in this population.