HIV Medicine最新文献

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.

Introduction: The Joint United Nations Programme on HIV/AIDS (UNAIDS) Global 2025 targets prioritize action to overcome the collective barriers affecting the people and communities sitting on the outer margins of HIV care. Addressing the social and structural disparities that drive greater HIV prevalence and burden requires well-resourced, community-led responses that are fully integrated into national and global HIV initiatives.

Methods: The HIV Community Council (HCC), composed of 10 leaders from diverse global communities, convened to share their insights, amplify the community's voice, and identify barriers and solutions to empower all to live well with HIV through a dynamic, stepwise process of preparative work, deep discussion, prioritization, and consensus.

Results: The HCC created six recommendations to address two important barriers to living well with HIV: stigma and poor mental wellbeing. These recommendations are informed by best practice and community experience. They include suggestions for developing and delivering actionable solutions at the community level to prompt opportunities for support from existing global and regional organizations.

Conclusion: The HCC calls for action to implement community-endorsed, culturally appropriate, and practical solutions to tackle stigma and poor mental wellbeing and improve the long-term health of people with HIV.

Objective: To measure concentrations of tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) among individuals taking tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC) or tenofovir alafenamide plus emtricitabine (TAF/FTC) who were scheduled to undergo or had already undergone bariatric surgery.

Methods: We enrolled pre-exposure prophylaxis (PrEP) users attending clinics in Toronto or Ottawa who were undergoing or had undergone bariatric surgery. After participants completed a minimum of 7 days of consecutive PrEP dosing, we collected DBS samples immediately before they administered their next daily dose of PrEP. Participants who had already undergone bariatric surgery before enrolment provided a single sample at baseline only. One participant undergoing planned bariatric surgery provided samples preoperatively and on postoperative days 7, 28 and 84. TFV-DP was measured by liquid chromatography tandem mass spectrometry. We compared results against the population range TFV-DP at varying degrees of adherence and stratified by chronology of bariatric surgery, type of bariatric surgery and PrEP regimen.

Results: Of seven eligible participants, all were gay, cis-gender men. Median age was 48 years (Q1-Q3: 44-51). Six participants underwent bariatric surgery before enrolment: four Roux-en-Y gastric bypass (RYGB) and two sleeve gastrectomy (SG). Four were taking TDF/FTC and two were taking TAF/FTC. All had therapeutic TFV-DP concentrations, except for one TDF/FTC participant who underwent SG. One participant taking TAF/FTC enrolled before receiving RYGB and displayed a slight decrease in TFV-DP over time, although all concentrations remained in the therapeutic range.

Conclusions: Tenofovir diphosphate concentrations were at or near therapeutic values in this small sample of men using oral PrEP who underwent RYGB or SG.

Introduction: Antiretroviral treatment (ART) has significantly enhanced health outcomes for people living with HIV (PLWH). With the evolution of treatment options, there is an increasing interest in the development of long-acting injectable formulations of antiretroviral drugs. These formulations present a promising alternative to oral ART.

Methods: The methodology and reporting of this systematic review followed the guidance of the Joanna Briggs Institute Reviewer's Manual and Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). The comprehensive searches involved multiple databases, including PubMed, MEDLINE (Ovid), Embase (Ovid), CINHAL (EBSCO), ProQuest Dissertations and Theses, Web of Science, Wanfang (Chinese), CNKI (Chinese), Google Scholar and Baidu Scholar (Chinese).

Results: In all, 142 studies were identified and 20 eligible studies were included in the meta-aggregation. A total of 141 findings, 20 categories and nine synthesized findings were extracted from 20 studies. The nine synthesized findings identified from the 20 studies focused on the following topics: benefits, flexibility and practicality of long-acting injectable (LAI) treatment; scepticism about the use of LAI treatment; management challenges; logistical challenges; potential for protecting marginalized populations; concerns about side effects; financial issue; suggestions for improvement. PLWH's geographical distribution, backgrounds, demographics and clinical characteristics were limited.

Conclusion: We recommend considering the needs and experiences of PLWH in the transition from oral ART to LAI treatment. For marginalized populations, it is crucial to maintain regular communication with healthcare providers and institutions. Additionally, at the community level, engaging diverse stakeholders with valuable insights is vital, as is enhancing health education programmes and intensifying efforts to combat discrimination. These measures will play a key role in addressing the needs of PLWH, enhancing public awareness and promoting better understanding of LAI treatment.

Objectives: HIV is often under-recognized in older individuals, particularly women, despite a significant number of new cases being diagnosed in those aged >50 years. This review aimed to understand the age-related experiences and challenges faced by women aged ≥50 years living with HIV through an intersectional perspective.

Methods: We conducted a systematic scoping review using the framework by Arksey and O'Malley, refined by Levac, Colquhoun, and Peters, and informed by a Sex- and Gender-Based Analysis Plus (SGBA+) approach. The research questions were developed in consultation with community advisory stakeholders. A comprehensive search strategy was used, targeting categories related to 'aged,' 'HIV,' and 'women' based on scoping review and Peer Review of Electronic Search Strategies guidelines. We included peer-reviewed studies where at least 50% of participants were women aged ≥50 years and living with HIV, focusing on their age-related experiences in health or social contexts. Two independent reviewers applied inclusion criteria through a two-level screening process. Data extraction included details on publication type, study characteristics, participant recruitment, and results. Findings were synthesized and presented to a stakeholder advisory committee for additional insights. Stakeholder input from an advisory committee was incorporated into the findings, providing additional context and enhancing the interpretation of the results.

Results: The review included 21 articles. Key findings revealed the intersectional challenges faced by women aged ≥50 years living with HIV, such as stigma, emotional resilience, social support networks, and health management strategies. These findings highlight the complex interplay of factors influencing their lives, from concerns about sharing HIV status to strategies for managing health. The review also identified research gaps and underscored the need for comprehensive studies on the intersectional dynamics affecting health outcomes in this population.

Conclusions: This review underscores the complex challenges and strengths of women aged ≥50 years living with HIV, emphasizing the need for tailored interventions and support services that recognize their intersecting identities and unique needs. Addressing these issues is essential for ensuring equitable access to care and fostering resilience within this community.