HIV Medicine最新文献

Objective: To evaluate the effectiveness and tolerability of dolutegravir/lamivudine (DTG/3TC) at 96 weeks in virologically suppressed persons with HIV, both overall and across subgroups, within CoRIS, a large multicenter cohort in Spain, in 2018-2023 METHODS: We included treatment-experienced adults with HIV who were virologically suppressed (viral load <50 copies/mL) when switching to DTG/3TC. We calculated the proportion maintaining viral suppression (VS), change in CD4 cell counts, virological failure (VF; two consecutive viral load (VL) ≥50 copies/mL or one ≥1000 copies/mL), and discontinuations due to adverse events (AEs) up to 96 weeks post-switch. Outcomes were stratified by sex, age, region of origin, antiretroviral regimen at switch, and previous VF RESULTS: Among 2058 participants (22.5% women), 95.9% maintained VS, 2.2% experienced VF, and 2.2% discontinued due to AEs. In multivariable analysis, no significant differences in VS, VF or CD4 change were observed across most subgroups. Participants aged ≥50 years were more likely to maintain VS, had lower VF risk, and a smaller CD4 increase compared with <50 years. Prior VF was associated with lower likelihood of maintaining VS and higher VF risk. Switching from 2NRTIs + PI or 2NRTIs + INSTI increased risk of VF compared with NRTIs+NNRTI CONCLUSIONS: DTG/3TC showed high effectiveness and tolerability at 96 weeks, with consistent outcomes across most subgroups. Previous VF reduced the likelihood of sustained VS.

Objectives: Indicator condition-based HIV testing is recommended by the British HIV Association in all clinical settings, including in primary care. We estimated the frequency of non-obstetric HIV testing in primary care in an area of Northeast England with a low prevalence of HIV and examined the effects of clinical and demographic indicators on testing rates.

Methods: We collated data from 358 603 patients across 54 general practices. Multilevel logistic regression modelling was used to identify associations between clinical and demographic indicators and non-obstetric HIV testing.

Results: People with any indicators for testing were more than four times as likely to be tested for HIV than those without (odds ratio [OR] 4.5; 95% confidence interval [CI] 4.10-4.94). Women were less likely than men to have been tested (OR 0.75; 95% CI 0.71-0.80). People aged 56-75 years were less likely to be tested (OR 0.67; 95% CI 0.62-0.72) compared to those aged 16-35; people of white ethnicity were less likely to be tested than those of non-white ethnicity (OR 0.66; 95% CI 0.59-0.73); there was a directional correlation between lower levels of deprivation and reduced likelihood of testing. The overall frequency of testing, however, was low (2.4% in whole study population; 4.9% in people with any indicators for testing).

Conclusion: Low rates of non-HIV testing in primary care, including where clinical and/or demographic indicators are present, represent a barrier to reducing late diagnoses and achieving the UK government's target of eliminating HIV transmission by 2030.

Objectives: SHIELD is a London-based study of engagement in HIV clinical care during and after the COVID-19 pandemic. We document the characteristics of service users who either re-engaged or disengaged with HIV care, together with reflections of HIV clinical service-providers to inform recommendations that address care retention for the long term.

Methods: Using an exploratory mixed methods approach, service-users aged ≥18 years who re-engaged (1 March 2020-31 August 2020) or disengaged from clinical care (no contact with service 1 March 2020-28 February 2021) at 8 London HIV services were identified by retrospective records review. Demographics and clinical data were summarized descriptively. For people who re-engaged, follow-up data were collected at 24 months and in those who disengaged, at a single timepoint (1 March 2023). Semi-structured interviews with clinic staff were analysed thematically.

Results: There were 122 people disengaged and 89 re-engaged. In those who re-engaged, a 24-month follow-up showed 71.3% on antiretrovirals, 63.6% virally suppressed and 67.9% had a future clinician appointment booked. For people who disengaged, by 1 March 2023, 21% were on antiretrovirals and 27% had a future appointment booked. Interviews with 11 service providers explored COVID-19's impact on clinical services, multilevel interactions that influenced engagement, and approaches to re-engaging people.

Conclusions: We found that COVID-19 exposed existing vulnerabilities deterring access to HIV clinical care, as well as being itself an additional factor. For some people, the pandemic provided an opportunity to re-engage. We recommend that retention in care is prioritized in policy and financially, that clinical services provide holistic person-centred care, and improve ways to identify those who leave care.

Background: Literature on vulvar cancer (VC) and vulvar intraepithelial neoplasia (VIN) in women living with HIV (WLWH) is scarce with no data on human papillomavirus (HPV) genotyping.

Methods: We compared disease characteristics and HPV genotyping on biopsies from WLWH and HIV-negative women (HNW) followed for VIN2+ (VIN2/3 and VC) at Saint-Pierre Hospital between 2000 and 2022. Then, a case control study identified VIN2+ risk factors among WLWH with VIN2+ (cases) and WLWH without VIN followed at the same period (controls), matched for age, ethnicity, and HIV follow-up duration.

Results: Compared to 65 HNW (28 VC/37 VIN), 25 WLWH (4 VC/21 VIN) were younger at time of VIN2+ diagnosis (48 vs. 58.7 years, p < 0.001), had more frequently cervical or anal (multicentric) dysplasia (52% vs. 22%, p = 0.02) and non-excisional treatments, and less often healthy margins in excisions (14% vs. 43%, p = 0.02). In WLWH, high-risk HPV was found in 100% (vs. 85% in HNW) with more multiple genotype infections (40% vs. 13%); HPV16 was found in 80% of VC and 73% of VIN in WLWH versus 91% and 79% in HNW. Compared to 75 controls, 25 cases had significantly more frequently prior cervical high-grade intraepithelial lesion (HSIL) (40%), lower median CD4-lymphocyte count (382/μL), and shorter duration of undetectable HIV viremia (4.8 years) than controls (respectively 0%, p = 0.001; 770 CD4/μL, p = 0.021; 10.6 years, p = 0.04).

Conclusions: WLWH develop VIN2+ younger than HNW, with more multiple HPV infections but less HPV 16, more multicentric lesions, and less excisions with negative margins. Risk factors for developing VIN2+ in WLWH include lack of viremia control and immunosuppression.

Objectives: Despite advances in HIV/AIDS treatment and prevention, persistent knowledge gaps and stigmatizing attitudes among healthcare trainees emphasize the need for early educational interventions to promote ethical and non-discriminatory care for people living with HIV/AIDS (PLWHA). This study aimed to assess and compare HIV-related knowledge and attitudes among clinical medical and dental students.

Methods: A cross-sectional, questionnaire-based survey was conducted among clinical-level students at a public university in Türkiye. Participants included fourth- to sixth-year medical students and fourth- to fifth-year dental students. The questionnaire assessed general HIV/AIDS knowledge, transmission routes, post-exposure prophylaxis and attitudes toward PLWHA. Data were analysed using descriptive statistics, independent samples t-test, Mann-Whitney U test and chi-square tests.

Results: Of 528 eligible students, 504 completed the survey (260 medical, 244 dental). Medical students scored significantly higher than dental students across all knowledge domains (p < 0.001) and demonstrated more positive attitudes (p < 0.001). However, both groups' overall knowledge levels were categorized as "weak," and their attitudes remained "negative." Common misconceptions included limited awareness of the "Undetectable = Untransmittable" principle, with only 11.5% of all students answering this item correctly, and false beliefs about transmission via casual contact, saliva, or shared utensils.

Conclusions: While medical students performed better, widespread deficiencies and stigmatizing beliefs across both groups indicate a need for curriculum reform. HIV-related education should integrate biomedical content with ethical reasoning, stigma reduction, and patient-centred approaches. Early, experiential learning may help foster more informed and inclusive attitudes among future healthcare professionals.

Background: Vertical transmission is the leading mode of HIV-1 acquisition in children and is largely preventable through timely diagnosis and treatment of the mother. However, late diagnosis of HIV-1 in children and young adults highlights systemic failures in prevention and diagnostics. This study aimed to characterize HIV-1 transmission pathways and identify diagnostic gaps through the analysis of mother-child pairs living with HIV-1.

Setting: The study focused on four mother-child pairs, all of Ethiopian origin, identified in Israel after the children reached young adulthood. All mothers were unaware of their HIV-1 status prior to migration to Israel.

Methods: A multidisciplinary approach integrating phylogenetic analysis of HIV-1 pol sequences, molecular clock techniques and demographic and clinical data was used to investigate sources and timing of HIV-1 transmission.

Results: Two children had strains distinct from their mothers' viruses, including one case of a different subtype, suggesting horizontal transmission. Two other children harboured viruses closely related to their mothers', consistent with perinatal vertical transmission. Molecular clock analysis dated the transmission to the year of birth. One young adult exhibited undetectable viral load without treatment, classifying them as an HIV-1 elite controller.

Conclusion: Although the size of our sample was small, this study demonstrates the challenges in HIV-1 diagnosis in migrant populations. HIV-1 transmission pathways among migrant families show heterogeneity, with gaps in prevention and diagnostics. Targeted policies and improved diagnostic frameworks are essential to address under-diagnosis and late detection, particularly in migrant and priority populations.

Objectives: People with HIV frequently experience gastrointestinal symptoms linked to dysbiosis, impaired mucosal barrier integrity and persistent immune activation. Cannabis is widely used for symptom management by people with HIV, but its effects on the gut microbiome are unclear.

Methods: We conducted a cross-sectional analysis of 63 people with HIV (mean age 59.4 years; 71.4% Black or Hispanic) enrolled in the Marijuana Associated Planning and Long-term Effects study and its microbiome and Alzheimer's substudies, which included participants with and without mild cognitive impairment (MCI). Participants provided faecal samples for 16S rRNA sequencing. Cannabis use was quantified using a validated Timeline Followback. Alpha diversity was estimated using the Shannon index, beta diversity with Bray-Curtis dissimilarity and permutational multivariate analysis of variance (PERMANOVA), and genus-level abundance using the IFAA method. All models were adjusted for age, sex and education.

Results: Higher cannabis consumption showed a statistically significant association with reduced alpha diversity (β = -0.062 per 50-mg Tetrahydrocannabinol (THC) per use-day; 95% confidence interval [CI]: -0.12 to -0.004; p = 0.038). No statistically significant differences in beta diversity were observed between high and low-to-no groups (p = 0.35). At the genus level, Dialister abundance showed a statistically significant dose-dependent association with cannabis use, with a 14.4% reduction in abundance per 50-mg increase in THC per use-day (q = 0.034).

Conclusion: Cannabis consumption in older people with HIV, including those with and without MCI, was associated with lower microbial diversity and reduced Dialister abundance, a taxon with dual roles in mucosal integrity and gastrointestinal symptom modulation. Reduced alpha diversity and Dialister depletion are notable given links to impaired mucosal barrier integrity, microbial translocation and systemic immune activation in HIV. These findings suggest cannabis may modify HIV-associated dysbiosis, warranting further longitudinal studies to disentangle symptomatic benefits from long-term impacts on mucosal health and systemic inflammation.

Objective: To evaluate real-world outcomes of dolutegravir (DTG)-based first-line antiretroviral therapy (ART) among people with HIV in Thailand, where baseline HIV-1 RNA and resistance testing is not routinely available.

Methods: This retrospective cohort study enrolled ART-naive Thai people with HIV aged ≥15 years who initiated DTG-based ART between 2020 and 2023 under the national Universal Health Coverage programme. People with HIV with ≥1 post-baseline HIV viral load (VL) measurement were included. Virological non-suppression (VNS) was defined as VL ≥1000 copies/mL after ≥6 months of ART. The primary outcome was the proportion achieving virological suppression (VL <50 copies/mL). Competing-risk regression was used to identify factors associated with VNS, accounting for death and loss to follow-up (LTFU). Mortality data were confirmed via the national death registry.

Results: Of 10 475 people with HIV initiating DTG-based ART, 84.5% achieved virological suppression and 95.3% achieved VL < 200 copies/mL within 1 year. The cumulative VNS incidence was 10.1% (95% confidence interval [CI]: 9.6%-10.5%), and highest among those with late ART initiation (10.6% [95% CI: 7.4%-14.3%]). VNS was significantly associated with younger age, 15-24 years (aSHR 2.28, 95% CI:1.66-3.12), 25-34 years (aSHR1.43, 95% CI:1.07-1.90), baseline CD4 < 100 cells/mm³ (aSHR 2.11, 95% CI: 1.36-3.27) and residence in northern (aSHR 1.64, 95% CI: 1.12-2.40) or southern Thailand (aSHR 1.99, 95%: 1.30-3.04). Same-day/rapid ART initiation, sex and WHO HIV clinical staging were not associated with VNS.

Conclusions: Nationwide rollout of DTG-based ART achieved excellent virological outcomes in Thailand. However, higher VNS risk among adolescents, individuals with advanced HIV disease and those in specific regions underscores the need for targeted interventions to improve treatment equity and long-term viral suppression.