HIV Medicine最新文献

Introduction: Timely diagnosis of HIV in children remains a challenge in all settings including low-prevalence, high-income countries (HIC). We aimed to characterize the prevalence of late diagnosis, and prior missed diagnostic opportunities among new presentations of paediatric HIV in HIC referred to an international Perinatal Virtual Clinic (PVC).

Methods: Retrospective analysis of new paediatric diagnoses in HIC, referred to the PVC between January 2018 and April 2025. Data on demographics, clinical features and HIV virology/immunology were extracted from standardized referral templates. Cases were categorized as late or non-late diagnosis by age-related CD4 thresholds, and the two groups compared.

Results: Among 45 new paediatric HIV diagnoses referred to the PVC from the European region (41), Australia (2) and Chile (2), the median age was 9 years (IQR 0.8-13); 66% (27/41) were migrants, predominantly from sub-Saharan Africa; 39% (16/41) were born in HIC. Most (27/45;60%) were tested due to symptoms; 21/45 (47%) were diagnosed with AIDS. The median CD4 count was 230 cells/mm³ (IQR 24.5-531), viral load (VL) 316 000 copies/mL (IQR 65 150-1 315  000) with 31/45 (69%) meeting criteria for late diagnosis. Late-diagnosed children had significantly higher VL (p = 0.02) and were more likely to have prior symptomatic healthcare encounters (p = 0.004).

Conclusions: Despite access to prevention and screening, late paediatric HIV diagnosis persists in HIC, with severe immunosuppression and missed opportunities for earlier recognition and treatment initiation. Improved implementation of family-based screening, particularly following parental/sibling diagnosis or migration from endemic areas, and education of healthcare providers regarding HIV indicator diseases in children are essential.

Objectives: The gp120-directed attachment inhibitor fostemsavir was effective in people with multidrug-resistant (MDR) HIV-1 in the BRIGHTE study. Understanding factors associated with virologic response can help clinicians optimize treatment and identify individuals for fostemsavir-based regimens. In previous multivariable analyses, baseline CD4+ T-cell count, baseline log₁₀ HIV-1 RNA and temsavir plasma concentration were associated with virologic response through 24 weeks. This expanded analysis evaluated predictors of the durability of response at Weeks 96 and 192.

Methods: BRIGHTE participant data (Randomized Cohort [RC], n = 272; Non-randomized Cohort, n = 99) were evaluated to examine baseline factors associated with virologic outcomes (HIV-1 RNA <40 copies/mL [Snapshot]; protocol-defined virologic failure [PDVF]) using linear/logistic regression with stepwise selection. A separate analysis evaluated baseline factors for association with treatment-adherent PDVF.

Results: In RC participants, higher baseline log₁₀ HIV-1 RNA, lower number of fully active available antiretrovirals in initial optimized background therapy (OBT) and a lower overall susceptibility score to newly used antiretrovirals in initial OBT were associated with lower odds of virologic response at Week 96. Baseline gp120 substitutions and dolutegravir use were additional factors through Week 192. Other baseline factors, including CD4+ T-cell count <20 cells/mm³, HIV-1 RNA ≥100 000 copies/mL, antiretroviral therapy duration >20 years or gp120 substitutions, had low predictive value for treatment-adherent PDVF in RC participants (Week 96, 35%; Week 192, 39%).

Conclusions: Multivariable analysis (MVA) identified several factors predictive of virologic response. No baseline factors were highly predictive of virologic failure at Weeks 96 or 192. Findings support the use of fostemsavir in diverse populations with MDR HIV-1.

Objectives: Initial HIV cure interventions may not meet expert-defined target product profiles (TPPs; desired treatment attributes). Understanding how people with HIV perceive ideal and likely HIV cure attributes is essential. This study examined which optimal TPP attributes people with HIV consider important and which minimum attributes and strategies they find acceptable. Additionally, it explored patterns of importance and their association with the acceptance of minimum attributes and cure strategies.

Methods: A cross-sectional survey (July 2023-March 2024) among 420 people with HIV assessed the importance of eight optimal attributes, the acceptability of fifteen minimum attributes, and five prominent cure strategies. Latent class analysis identified groups of people with different patterns of importance ratings.

Results: Optimal HIV cure attributes most frequently endorsed as important were 'no HIV transmission risk' (76.4%), 'immune system recovery' (66.4%), and 'protection from reinfection' (63.8%). Twelve of fifteen minimum attributes and all cure strategies were acceptable (mean > 3). Four latent classes of importance ratings emerged: exacting (N = 129, 30.7%; all attributes important), ambivalent (N = 121, 28.8%; neutral ratings), indifferent (N = 28, 6.7%; most attributes unimportant/neutral), and selective (N = 142, 35.2%; most attributes important except cure regimen-related factors). ANOVAs showed that participants with ambivalent importance patterns were less accepting of minimum attributes and strategies, while participants with indifferent importance patterns were more accepting of unacceptable minimum attributes.

Conclusions: People with HIV in the Netherlands find most HIV cure interventions acceptable, even if they do not meet optimal TPPs. However, perspectives differ across subgroups.

Introduction: HIV pre-exposure prophylaxis (PrEP) access still appears to be disproportionate, with existing barriers. This study aims to describe the characteristics, retention and feasibility of TelePrEP, Italy's first remote PrEP service, which was launched in February 2023 to address inequities in PrEP access.

Methods: TelePrEP provides online PrEP counselling, prescriptions and follow-ups via community healthcare workers and infectious disease physicians, targeting individuals unable to attend in-person services in existing local services. Between February 2023 and April 2025, all enrolled clients underwent baseline risk assessment, laboratory testing at local facilities, remote clinical evaluation and follow-up every 3 months. Descriptive statistics analysed demographics, retention and clinical outcomes.

Results: Of the 434 individuals who sought information about PrEP, 187 (43.1%) enrolled in TelePrEP, while 93 (21.4%) were directly referred to existing local PrEP services. The majority were assigned male at birth (97.3%), were identified as MSM (75.9%) and were 29-40 years old (43.9%). Of these, 57.2% held a university degree, and two-thirds (66.8%) lived in rural areas or small towns. The most common reasons for choosing TelePrEP were convenience and safety: 22.9% cited long hospital waiting times and 27.8% cited distance. Follow-up visits were completed by 104 individuals (55.6%), of whom 43.3% took daily oral PrEP and 52.9% on-demand. No HIV infections were recorded during the follow-up period. Of the 115 clients who discontinued the programme, 44 were linked to local PrEP services after starting PrEP remotely. Overall satisfaction was high, with 92.3% agreeing that PrEP improved their sexual well-being.

Conclusions: TelePrEP is a feasible, acceptable model overcoming systemic barriers to PrEP access in Italy, effectively reaching underserved populations, with no evidence of breakthrough HIV infections. Integration into national HIV strategies might improve equity and reduce healthcare burden.

Background: Despite the growing burden of comorbidities, including cancer, among people with HIV, there is a lack of empirical evidence on cancer-related mortality in this vulnerable population in Vietnam.

Objectives: This study aimed to examine cancer mortality rates among people with HIV in Vietnam by cancer type, age and sex and compare them with those in the general population.

Methods: We analysed nationally representative mortality data from 2005 to 2021, collected via Vietnam's mandatory mortality registration system. Cancer deaths and HIV status were identified using the ICD-10 codes. People with HIV data were linked to the Vietnam Ministry of Health HIV/AIDS registry. Mortality rates (per 100 000 person-years) and mortality rate ratios (MRRs) with 95% confidence intervals (CIs) were calculated, stratified by age and sex and age-standardized using the World Health Organization standards.

Results: Among people with HIV, 253 cancer deaths occurred across 523709 person-years (crude rate 48.3 per 100 000 person-years), compared to 173 592 cancer deaths over 272 million person-years in the general population (crude rate 63.8 per 100 000 person-years) between 2005 and 2021. The age-standardized cancer mortality rate among people with HIV was 50.5 per 100 000 person-years, compared with 110.2 per 100 000 person-years in the general population. However, age-specific analysis revealed that cancer mortality rates among people with HIV under age 50 were significantly higher than those in the general population (MRR = 2.29; 95% CI: 2.01-2.59), predominantly for lung cancer (MRR = 10.5; 95% CI: 8.89, 12.41) and liver cancer (MRR = 1.82; 95% CI: 1.38, 2.40). The highest MRR was observed in the youngest age group (1-29 years; MRR = 5.67; 95% CI: 4.63, 6.93).

Conclusion: Although the age-standardized cancer mortality rate among people with HIV was lower than in the general population, people with HIV experience substantially higher cancer mortality among those under age 50, particularly from lung and liver cancers. These findings emphasize the urgent need for integrated cancer prevention, early detection and treatment strategies for people with HIV in Vietnam.

Introduction: Oral HIV pre-exposure prophylaxis (PrEP) is highly effective, but adherence and persistence are often limited by side effects, pill fatigue and stigma. Long-acting injectable cabotegravir (CAB-LA) offers a discreet, convenient alternative with the potential to improve user experience and HIV protection. Data on real-world use in Europe remain limited. The aim is to describe user-reported outcomes from individuals initiating CAB-LA PrEP.

Methods: This is a prospective cohort study enrolling participants receiving CAB-LA between November 2024 and July 2025 at a large teaching hospital in Milan, Italy (San Raffaele Institute). At each injection visit, user-reported outcomes on satisfaction, adherence, perceived protection, quality of life and adverse events, including injection site reactions (ISRs) using a self-reported survey developed for the study were collected.

Results: Eighty-two participants (97.6% cis-MSM, median age 41.4 years) were included (median injections 4, range 2-5). Most (95.1%) had prior oral PrEP experience; 26.9% reported previous oral PrEP side effects, and 15.4% poor adherence. CAB-LA satisfaction remained high: at the fourth injection, 90.9% reported a positive overall opinion, and 84.4% felt more protected than on oral PrEP. Convenience and elimination of daily pill-taking were valued by >94%. Self-reported adherence improved in 75.3%. Side effects were mostly mild or unchanged compared with oral PrEP; systemic adverse events were uncommon and ISRs were generally minimal.

Conclusions: In this real-world cohort, CAB-LA PrEP was highly acceptable, well tolerated and associated with improved perceived adherence, convenience and HIV protection. These findings support CAB-LA as a promising, user-centred HIV prevention strategy, potentially overcoming key limitations of daily oral PrEP.