HIV Medicine最新文献_第5页

Comparing short-term mortality between people with and without HIV admitted to the intensive care unit: A single-centre matched cohort study (2000–2019) 比较入住重症监护室的艾滋病病毒感染者和非艾滋病病毒感染者的短期死亡率：单中心匹配队列研究（2000-2019 年）。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-11-20 DOI: 10.1111/hiv.13737

N. Bakewell, T. Kanitkar, O. Dissanayake, M. Symonds, S. Rimmer, A. Adlakha, M. C. Lipman, S. Bhagani, B. Agarwal, R. F. Miller, C. A. Sabin

Objectives

The survival rate of people with HIV admitted to intensive care units (ICUs) is approaching that of people without HIV. We conducted a matched-cohort study of people with and without HIV admitted to ICU at a large hospital to compare short-term mortality, during 2000–2019.

Methods

People with HIV were matched to people without HIV (1:2) on age, sex, admission year and Acute Physiology and Chronic Health Evaluation (APACHE)-II score. Applying logistic regression models fitted using independence estimating equations, we describe population-averaged associations of HIV with short-term (in-ICU, in-hospital) mortality during a patient's first admission to ICU, and explore whether these varied by year.

Results

A total of 177 people with HIV were matched to 354 people without HIV (71.2% vs. 71.2% male; median age: 47 vs. 48 years, median APACHE-II: 18 vs. 17, median admission year: 2013 vs. 2013). Among people with HIV, 73.4% were on antiretroviral therapy, 51.2% had HIV-RNA ≤50 copies/mL and median CD4 T-cell count was 132 cells/ $� � μ �$ L. People with HIV had higher in-ICU (24.3% vs. 15.3%) and in-hospital (31.6% vs. 20.1%) mortality. People with HIV had 1.69-fold higher odds (95% confidence interval: 1.03–2.76) of in-ICU mortality and 1.86 (1.19–2.91) higher odds of in-hospital mortality than people without HIV, adjusted for age, sex, year and APACHE-II. There was no evidence that these associations varied by year (p-interaction-in-ICU = 0.90; p-interaction-in-hospital = 0.46).

Conclusions

Our findings suggest that although outcomes have improved over time, people with HIV continue to have higher short-term in-ICU and in-hospital mortality following ICU admission compared with people without HIV with similar characteristics.

目的：入住重症监护室（ICU）的艾滋病病毒感染者的存活率已接近非艾滋病病毒感染者的存活率。我们对一家大型医院重症监护室收治的艾滋病病毒感染者和非艾滋病病毒感染者进行了配对队列研究，以比较 2000-2019 年间的短期死亡率：方法：根据年龄、性别、入院年份和急性生理学和慢性健康评估（APACHE）-II 评分，将艾滋病毒感染者与非艾滋病毒感染者进行配对（1:2）。通过使用独立估计方程拟合的逻辑回归模型，我们描述了艾滋病病毒感染者与患者首次入住重症监护室期间的短期（重症监护室内、院内）死亡率的人群平均关系，并探讨了这些关系是否因年份而异：共有 177 名艾滋病病毒感染者与 354 名非艾滋病病毒感染者进行了配对（71.2% 对 71.2%，男性；年龄中位数：47 岁对 48 岁，APACHE-II 中位数：18 对 17，入院年份中位数：2013 年对 2013 年）：2013年与2013年）。在艾滋病毒感染者中，73.4%的人正在接受抗逆转录病毒治疗，51.2%的人HIV-RNA ≤50 copies/mL，CD4 T细胞计数中位数为132 cells/ μ$ upmu $$ L。艾滋病毒感染者的ICU内死亡率（24.3% 对 15.3%）和院内死亡率（31.6% 对 20.1%）较高。经年龄、性别、年份和 APACHE-II 调整后，HIV 感染者在重症监护室内的死亡率比非 HIV 感染者高 1.69 倍（95% 置信区间：1.03-2.76），在医院内的死亡率比非 HIV 感染者高 1.86 倍（1.19-2.91）。没有证据表明这些关联因年份而异（p-交互作用-ICU = 0.90；p-交互作用-医院 = 0.46）：我们的研究结果表明，虽然随着时间的推移，结果有所改善，但与特征相似的非 HIV 感染者相比，HIV 感染者进入 ICU 后的短期 ICU 内和院内死亡率仍然较高。

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引用次数: 0

Rising mortality among people who inject drugs living with HIV in Scotland, UK: A 20-year retrospective cohort study 英国苏格兰注射毒品的艾滋病病毒感染者死亡率上升：一项为期 20 年的回顾性队列研究。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-11-18 DOI: 10.1111/hiv.13733

R. Metcalfe, R. Fraser, K. M. A. Trayner, M. Glancy, A. Yeung, L. Sills, T. Ritchie, S. Priyadarshi, S. E. Peters, A. McAuley, S. Hutchinson

Objectives

Our aim was to examine mortality trends in the era of antiretroviral therapy, among people who inject drugs (PWID) who are living with HIV. The study objectives were to assess and quantify mortality among PWID diagnosed with HIV over time in Scotland, in the context of a recent outbreak of HIV and rise in drug-related mortality.

Methods

This was a retrospective cohort study of those diagnosed with HIV in Scotland between January 2000 and February 2020, with acquisition related to injecting drug use, linked to mortality data. Factors associated with all-cause mortality were examined using Cox proportional hazards regression.

Results

Among 430 individuals with 3143 person-years (py) of follow-up, 88 (20.5%) died. Drug-related deaths accounted for 45.5% of all deaths, rising to 60% among those diagnosed in 2015–2020. The crude all-cause mortality was 28.00 per 1000 py overall and 37.62 per 1000 py within 5 years of diagnosis. Mortality risk was markedly higher among PWID diagnosed in 2015–2020 [adjusted hazard ratio (aHR) = 3.53], relative to those diagnosed in 2000–2004. Among those diagnosed in 2015–2020 (as part of the HIV outbreak), the mortality risk was higher among those not on, compared with those on, opioid agonist therapy (aHR = 3.87).

Conclusion

Mortality among PWID living with HIV in Scotland has risen substantially in the 21st century. Our findings highlight the important role of opioid-agonist therapy, alongside other prevention and treatment measures to address high levels of drug-related mortality for PWID living with HIV, including within HIV outbreaks in this population group.

目标：我们的目的是研究在抗逆转录病毒疗法时代，注射吸毒者（PWID）艾滋病毒感染者的死亡率趋势。研究目标是评估和量化苏格兰注射吸毒者中确诊感染艾滋病病毒后一段时间内的死亡率，同时考虑到最近艾滋病病毒的爆发和与毒品有关的死亡率的上升：这是一项回顾性队列研究，研究对象是 2000 年 1 月至 2020 年 2 月期间苏格兰确诊的艾滋病毒感染者，其感染与注射吸毒有关，并与死亡率数据相关联。研究采用 Cox 比例危险回归法检测了与全因死亡率相关的因素：在随访了3143人年（py）的430人中，有88人（20.5%）死亡。在所有死亡病例中，与药物相关的死亡占 45.5%，在 2015-2020 年确诊的病例中，与药物相关的死亡占 60%。总的粗略全因死亡率为 28.00‰，确诊后 5 年内的粗略全因死亡率为 37.62‰。与 2000-2004 年确诊的感染者相比，2015-2020 年确诊的感染者的死亡风险明显更高[调整后危险比 (aHR) = 3.53]。在 2015-2020 年（作为艾滋病毒爆发的一部分）确诊的感染者中，未接受阿片类受体激动剂治疗者的死亡风险高于接受阿片类受体激动剂治疗者（aHR = 3.87）：结论：21 世纪以来，苏格兰感染艾滋病毒的吸毒者死亡率大幅上升。我们的研究结果凸显了阿片类受体激动剂疗法以及其他预防和治疗措施的重要作用，以解决感染艾滋病毒的吸毒者与毒品相关的高死亡率问题，包括在这一人群中爆发艾滋病毒疫情时。

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引用次数: 0

In vitro and patient studies with platelets to explore off-target cardiovascular effects of integrase inhibitors 利用血小板进行体外和患者研究，探索整合酶抑制剂对心血管的脱靶效应。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-11-15 DOI: 10.1111/hiv.13738

R. Keniyopoullos, A. A. Khawaja, M. Boffito, M. Emerson

Introduction

People with HIV currently face a tenfold higher risk of developing cardiovascular disease (CVD) than those without HIV. Studies have shown various off-target effects of antiretroviral treatment (ART) on the cardiovascular system, but little is known about the effects of currently used integrase strand transfer inhibitors (INSTIs) on platelets. Platelet activation is associated with increased CVD, thrombus formation, and release of proinflammatory mediators, so exploring platelet effects from currently prescribed ART may contribute to the understanding of CVD etiopathogenesis in people with HIV.

Methods

We aimed to identify potential effects of INSTIs on platelet aggregation and activation markers from individuals without HIV after in vitro treatment with clinically relevant drug concentrations. We used bictegravir (BIC) and dolutegravir (DTG) individually or in the therapeutic drug combinations BIC/emtricitabine (FTC)/tenofovir alafenamide fumarate (TAF) or DTG/lamivudine (3TC). Additionally, we conducted a pilot study to compare platelet activity profiles from people with HIV on BIC/FTC/TAF and DTG/3TC.

Results

Changes to in vitro platelet aggregation responses upon exposure to different INSTIs were observed both upon individual drug application and when using therapeutic combinations. However, these effects were not reflected in flow-cytometric evaluation of platelet degranulation. A pilot study in eight people with HIV and eight without HIV revealed no significant effects but established protocols for future patient studies.

Conclusion

There is currently no consistent evidence of an effect of INSTIs on platelet activation. Further study is warranted, focusing on models with more pathophysiological relevance, including extensive studies in people with HIV.

导言：目前，艾滋病病毒感染者罹患心血管疾病（CVD）的风险是未感染艾滋病病毒者的十倍。研究表明，抗逆转录病毒治疗（ART）对心血管系统有各种非目标效应，但目前使用的整合酶链转移抑制剂（INSTIs）对血小板的影响却鲜为人知。血小板活化与心血管疾病增加、血栓形成和促炎介质释放有关，因此探讨目前处方的抗逆转录病毒疗法对血小板的影响可能有助于了解艾滋病患者心血管疾病的发病机制：我们的目的是确定 INSTIs 对血小板聚集和活化标志物的潜在影响。我们单独使用了比特拉韦（BIC）和多罗替拉韦（DTG），或在治疗药物组合 BIC/ 恩曲他滨（FTC）/富马酸替诺福韦阿拉非酰胺（TAF）或 DTG/ 拉米夫定（3TC）中使用了这两种药物。此外，我们还进行了一项试验性研究，以比较服用 BIC/FTC/TAF 和 DTG/3TC 的 HIV 感染者的血小板活性特征：结果：在单独用药和使用治疗组合时，都观察到了接触不同 INSTIs 后体外血小板聚集反应的变化。然而，这些影响并没有反映在血小板脱颗粒的流式细胞计数评估中。在 8 名艾滋病病毒感染者和 8 名非艾滋病病毒感染者中进行的试验性研究表明，INSTI 没有明显的影响，但为今后的患者研究制定了方案：结论：目前没有一致的证据表明 INSTIs 对血小板活化有影响。结论：目前还没有一致的证据表明 INSTIs 对血小板活化有影响，需要进一步研究，重点放在病理生理学相关性更强的模型上，包括对 HIV 感染者进行广泛研究。

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引用次数: 0

Clinical staff attitudes towards opt-out consent for blood-borne virus screening in emergency departments in England 英格兰急诊科临床人员对血液传播病毒筛查选择不同意的态度。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-11-13 DOI: 10.1111/hiv.13735

Esther G. Blakey, Cassandra E. L. Fairhead, Alison J. Rodger, Fiona M. Burns, Lucie Ralph, David R. Chadwick

Objective

Opt-out screening for blood-borne viruses (BBVs) in emergency departments (EDs) has been established in areas with a high prevalence of HIV diagnoses in England. This multi-site study explored the attitudes of healthcare workers (HCWs) towards BBV screening in EDs post-implementation.

Design

This was a cross-sectional electronic survey of HCWs.

Methods

Between November 2023 and February 2024, HCWs across 33 EDs in England participating in opt-out BBV screening were invited to complete a survey about the feasibility and acceptability of screening, including the opt-out consent process. Factors independently associated with acceptability of opt-out screening were identified using multivariable logistic regression. Free-text responses were analysed thematically.

Results

Responses from 610 HCWs in 19 EDs were provided: 50.4% were nurses, 43.1% doctors, and 6.5% other healthcare professionals. Acceptability of the screening programme and opt-out consent was high (90.3% and 77.7%, respectively), with some variation between EDs. Acceptability of opt-out consent was greater among doctors than among other HCWs, and among HCWs who proactively discussed screening further with patients who opted out. However, 50.8% of HCWs felt that patients should be verbally reminded at blood draw, and 44.3% of HCWs wanted more training in discussing opt-out screening with patients. Free-text answers suggested changes to test-ordering systems, including simple integration of tick boxes to document whether patients opted out and to block repeated testing.

Conclusions

There was substantial support from ED HCWs for routine opt-out ED BBV screening, including opt-out consent. Key areas suggested for improvement included changes to test-ordering systems and additional training for HCWs. Frequent preference for verbal reminders at the point of blood draw suggests continued HIV testing exceptionalism.

目的：在英国艾滋病诊断率较高的地区，急诊科（ED）中的血液传播病毒（BBV）筛查已被取消。这项多站点研究探讨了急诊科实施血液传播病毒筛查后，医护人员（HCWs）对筛查的态度：设计：这是一项针对医护人员的横断面电子调查：在 2023 年 11 月至 2024 年 2 月期间，英格兰 33 家参与选择不接受 BBV 筛查的急诊科医护人员受邀完成了一项关于筛查可行性和可接受性的调查，其中包括选择不接受筛查的同意程序。采用多变量逻辑回归法确定了与选择不接受筛查的可接受性独立相关的因素。对自由文本回复进行了专题分析：结果：19 家急诊室的 610 名医护人员提供了回复：50.4%为护士，43.1%为医生，6.5%为其他医护人员。筛查计划和选择不同意的接受度较高（分别为 90.3% 和 77.7%），但不同急诊室之间存在一定差异。与其他医护人员相比，医生和主动与选择不接受筛查的患者进一步讨论筛查的医护人员对选择不接受筛查同意书的接受度更高。然而，50.8% 的医护人员认为应在抽血时口头提醒患者，44.3% 的医护人员希望在与患者讨论选择不接受筛查时接受更多培训。自由文本答案建议对检测下单系统进行更改，包括简单地整合勾选框，以记录患者是否选择退出并阻止重复检测：结论：急诊科医护人员非常支持常规的选择不接受急诊科BBV筛查，包括选择不接受同意。建议改进的主要方面包括改变检测下单系统和对医护人员进行额外培训。抽血时口头提醒的频繁出现表明，HIV 检测仍然是例外情况。

{"title":"Clinical staff attitudes towards opt-out consent for blood-borne virus screening in emergency departments in England","authors":"Esther G. Blakey, Cassandra E. L. Fairhead, Alison J. Rodger, Fiona M. Burns, Lucie Ralph, David R. Chadwick","doi":"10.1111/hiv.13735","DOIUrl":"10.1111/hiv.13735","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Opt-out screening for blood-borne viruses (BBVs) in emergency departments (EDs) has been established in areas with a high prevalence of HIV diagnoses in England. This multi-site study explored the attitudes of healthcare workers (HCWs) towards BBV screening in EDs post-implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This was a cross-sectional electronic survey of HCWs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between November 2023 and February 2024, HCWs across 33 EDs in England participating in opt-out BBV screening were invited to complete a survey about the feasibility and acceptability of screening, including the opt-out consent process. Factors independently associated with acceptability of opt-out screening were identified using multivariable logistic regression. Free-text responses were analysed thematically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Responses from 610 HCWs in 19 EDs were provided: 50.4% were nurses, 43.1% doctors, and 6.5% other healthcare professionals. Acceptability of the screening programme and opt-out consent was high (90.3% and 77.7%, respectively), with some variation between EDs. Acceptability of opt-out consent was greater among doctors than among other HCWs, and among HCWs who proactively discussed screening further with patients who opted out. However, 50.8% of HCWs felt that patients should be verbally reminded at blood draw, and 44.3% of HCWs wanted more training in discussing opt-out screening with patients. Free-text answers suggested changes to test-ordering systems, including simple integration of tick boxes to document whether patients opted out and to block repeated testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was substantial support from ED HCWs for routine opt-out ED BBV screening, including opt-out consent. Key areas suggested for improvement included changes to test-ordering systems and additional training for HCWs. Frequent preference for verbal reminders at the point of blood draw suggests continued HIV testing exceptionalism.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 2","pages":"326-332"},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619302","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}

引用次数: 0

Implementation of patient-reported outcomes for people living with HIV: Insights from patients and healthcare providers in a Danish outpatient clinic 对艾滋病毒感染者实施患者报告结果：丹麦一家门诊诊所的患者和医疗服务提供者的见解。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-11-13 DOI: 10.1111/hiv.13734

Lotte Ørneborg Rodkjær, Merete Storgaard, Liv Marit Valen Schougaard

Objectives

Patient-reported outcomes (PROs) have emerged as a valuable tool for aligning HIV care with patient needs and priorities. This study aimed to explore patient and healthcare provider (HCP) experiences of integrating a PRO solution into standard clinical care for HIV in a Danish outpatient clinic.

Methods

A tailored PRO solution for people living with HIV was developed in a Danish outpatient clinic. Patients were eligible if they were aged >18 years, spoke Danish, had been on effective antiretroviral therapy for 2 years, and had no additional health issues. Patients completed an electronic questionnaire 14 days before in-clinic consultations. HCPs reviewed patients' responses before these consultations. We assessed the usability, acceptability, and relevance of the PRO solution by conducting semi-structured interviews with 24 patients (12 responders and 12 non-responders) and six HCPs. A further 95 non-responders were interviewed over the phone. Data were analysed using thematic analysis.

Results

Respondents found that PROs improved patient–provider communication, treatment planning, and self-management. Non-respondents faced barriers such as health literacy, cultural beliefs, and access to technology, necessitating alternative delivery methods. HCPs found that PROs facilitated person-centred care and symptom management, but HCPs faced challenges such as insufficient training, resources, and organizational support.

Conclusions

Implementing PROs in HIV care is challenging because of the patient diversity, clinician training needs, and organizational adaptations. Nevertheless, the use of PROs is associated with enhanced person-centred care. Future recommendations include tailored use of PROs, better understanding of the impact on patient groups, on-site questionnaire completion, and emphasis on shared decision-making between patients and HCPs.

目的：患者报告结果（PROs）已成为根据患者需求和优先事项调整艾滋病护理的重要工具。本研究旨在探讨丹麦一家门诊诊所将患者报告结果（PRO）解决方案整合到艾滋病标准临床治疗中的患者和医疗服务提供者（HCP）的经验：方法：在丹麦一家门诊诊所为艾滋病感染者量身定制了一个 PRO 解决方案。年龄大于 18 岁、会讲丹麦语、接受有效抗逆转录病毒治疗 2 年且无其他健康问题的患者均符合条件。患者在门诊就诊前 14 天填写一份电子问卷。在就诊前，保健医生会查看患者的回答。我们对 24 名患者（12 名应答者和 12 名未应答者）和 6 名高级保健人员进行了半结构化访谈，评估了 PRO 解决方案的可用性、可接受性和相关性。另外还通过电话采访了 95 名未应答者。采用主题分析法对数据进行了分析：受访者发现，PROs 改善了患者与医护人员之间的沟通、治疗规划和自我管理。非应答者面临着健康知识普及、文化信仰和技术获取等障碍，因此需要采用其他方法。HCPs发现PROs促进了以人为本的护理和症状管理，但HCPs面临着培训、资源和组织支持不足等挑战：结论：由于患者的多样性、临床医生的培训需求以及组织机构的适应性，在艾滋病护理中实施PROs具有挑战性。尽管如此，PROs 的使用与加强以人为本的护理有关。未来的建议包括有针对性地使用PROs，更好地了解PROs对患者群体的影响，现场填写问卷，以及强调患者和HCP共同决策。

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引用次数: 0

AI in medicine: No longer the future, but the present 人工智能在医学中的应用：不再是未来，而是现在。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-11-11 DOI: 10.1111/hiv.13732

Abiu Sempere, Xoan González-Rioja, Esteban Martinez

引用次数: 0

Burden of liver steatosis and liver fibrosis in a large cohort of people living with HIV 一大批艾滋病病毒感染者的肝脏脂肪变性和肝纤维化负担。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-11-07 DOI: 10.1111/hiv.13730

Montserrat Laguno, Elisa de Lazzari, Leire Berrocal, Alexy Inciarte, Maria Martínez-Rebollar, Lorena de la Mora, Berta Torres, Ana Gonzalez-Cordón, Ivan Chivite, Alberto Foncillas, Júlia Calvo, Abiu Sempere, Juan Ambrosioni, Jose Luís Blanco, J. M. Miro, Josep Mallolas, Esteban Martínez

Background

Liver steatosis (LS) and liver fibrosis (LF) can increase the risk of cardiovascular disease in people with HIV, but their prevalence and associated factors are poorly understood. This study aimed to assess the prevalence of and factors associated with LS and LF in a large cohort of people with HIV.

Methods

We conducted a cross-sectional study of consecutive people with HIV attending the Clinic of Barcelona from September 2022 to September 2023, excluding those with chronic B or/and C hepatitis virus coinfection. LS was assessed using the Hepatic Steatosis Index (HSI) and Fatty Liver Index (FLI), and LF was assessed using the Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS), Fibrosis-4 score (FIB-4), and the European AIDS Clinical Society (EACS) algorithm in both the whole cohort (cohort 1) and in a specific cohort more susceptible to liver disease (cohort 2). We identified independent variables associated with LS and LF using logistic regression.

Results

Cohort 1 included 4664 people with HIV; 76% and 37% of them had available HSI and FLI data, LS was present in 28% and 19%, respectively. LF risk was present in 1%, 2%, and 1% of people with HIV according to NFS, FIB-4, and EACS algorithm scores, respectively. Cohort 2 included 1345 people with HIV; 60% and 30% of them had available HSI and FLI data, LS affected 55% and 43% and LF 2%, 5%, or 3%, respectively. Factors associated with LS included current CD4 cell count, diabetes, and hypertension, whereas LF was associated with previous exposure to dideoxynucleoside drugs and current CD4 to LF. Current integrase strand transfer inhibitor (INSTI) therapy appeared protective for LF in cohort 1.

Conclusions

In this study, one in four people with HIV had LS, and the prevalence rose to one in two in those with cardiovascular risk factors. The prevalence of LF was low, but it should be considered in older people with HIV with low CD4 counts or high aspartate transaminase levels. A possible protective effect from INSTIs deserves further investigation.

背景：肝脏脂肪变性（LS）和肝纤维化（LF）会增加艾滋病病毒感染者罹患心血管疾病的风险，但人们对它们的患病率和相关因素知之甚少。本研究旨在评估一大批艾滋病病毒感染者中肝脏脂肪变性和肝纤维化的患病率及其相关因素：我们对 2022 年 9 月至 2023 年 9 月期间在巴塞罗那诊所就诊的连续 HIV 感染者进行了横断面研究，其中不包括慢性乙型或/和丙型肝炎病毒合并感染者。在整个队列（队列 1）和更易患肝病的特定队列（队列 2）中，使用肝脏脂肪变性指数（HSI）和脂肪肝指数（FLI）评估 LS，使用非酒精性脂肪肝纤维化评分（NFS）、纤维化-4 评分（FIB-4）和欧洲艾滋病临床协会（EACS）算法评估 LF。我们利用逻辑回归确定了与 LS 和 LF 相关的独立变量：队列 1 包括 4664 名艾滋病毒感染者；其中 76% 和 37% 的人有 HSI 和 FLI 数据，分别有 28% 和 19% 的人存在 LS。根据NFS、FIB-4和EACS算法评分，分别有1%、2%和1%的HIV感染者存在LF风险。队列2包括1345名HIV感染者；其中60%和30%的人有HSI和FLI数据，LS感染率分别为55%和43%，LF感染率分别为2%、5%或3%。与LS相关的因素包括目前的CD4细胞计数、糖尿病和高血压，而LF则与以前接触过二脱氧核苷类药物和目前的CD4与LF相关。在队列1中，目前的整合酶链转移抑制剂（INSTI）治疗似乎对LF有保护作用：在这项研究中，每四名艾滋病病毒感染者中就有一人患有LS，而在有心血管风险因素的人群中，患病率上升到每两人中就有一人患有LS。LF的发病率较低，但对于CD4计数低或天门冬氨酸转氨酶水平高的老年HIV感染者来说，应考虑LF。INSTIs可能产生的保护作用值得进一步研究。

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引用次数: 0

Viral rebound on antiretroviral therapy in France according to region of origin, sex, and HIV acquisition group. Results from the French Hospital Database on HIV (ANRS CO4-FHDH) 法国抗逆转录病毒疗法的病毒反弹情况（按原籍地区、性别和艾滋病感染群体分列）。法国医院艾滋病数据库（ANRS CO4-FHDH）的结果。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-11-04 DOI: 10.1111/hiv.13729

S. Abgrall, H. Selinger-Leneman, E. Lanoy, A. Becker, S. Matheron, P. de Truchis, J. Pavie, A. Canestri, M. A. Khuong, D. Rey, F. Caby, P. Tattevin, R. Palich, S. Grabar, ANRS CO4-FHDH

Background

Assessing the potential increased risk of viral rebound (VR) in migrants requires adequate control for sex and acquisition risk groups.

Methods

People living with HIV1, enrolled in the ANRS CO4-French Hospital Database on HIV, who achieved virological suppression with antiretroviral therapy (ART) initiated between 2006 and 2016 were included. We first compared the risk of VR, with loss to follow-up and death considered as competing events, across origin among the HIV acquisition groups, then across acquisition groups among the different origins, and finally across modality of a variable combining sex, acquisition group, and origin. Models were adjusted for clinical and biological confounding factors.

Results

We included 21 571 French natives (FRA), 10 148 migrants from sub-Saharan Africa (SSA), 1137 migrants from the non-French West Indies (NFWI), and 4205 other migrants (OTHER). The 5-year probability of VR was 19% (95% confidence interval [CI] 19–20) overall, 15% in FRA, 21% in OTHER, 26% in SSA, and 34% in NFWI (p < 0.0001). It was 14% in men who have sex with men (MSM), 23% in heterosexual men, and 23% in women (p < 0.0001). After adjustment, all acquisition groups had a higher risk of VR than MSM from FRA, with men and women from NFWI having the highest risk (adjusted hazard ratio [aHR] 2.46; 95% CI 2.12–2.86 and aHR 2.59; 95% CI 2.20–3.04, respectively). Within each acquisition group, all groups of origin had a higher risk of VR than FRA. Within each region of origin, except the NFWI, heterosexual men had a higher risk of VR than MSM.

Conclusions

After accounting for sex and acquisition group, migration, especially from NFWI, remains prognostic of VR.

背景：评估移民中可能增加的病毒反弹（VR）风险需要充分控制性别和感染风险群体：评估移民中潜在的病毒反弹（VR）风险增加需要对性别和感染风险群体进行充分控制：我们纳入了ANRS CO4--法国医院艾滋病数据库中登记的艾滋病病毒感染者1，他们在2006年至2016年期间开始接受抗逆转录病毒疗法（ART），并实现了病毒学抑制。我们首先比较了不同艾滋病病毒感染者群体的VR风险（随访丧失和死亡被视为竞争事件），然后比较了不同艾滋病病毒感染者群体的VR风险，最后比较了不同性别、艾滋病病毒感染者群体和艾滋病病毒感染者群体的VR风险。根据临床和生物学混杂因素对模型进行了调整：我们纳入了 21 571 名法国本地人（FRA）、10 148 名来自撒哈拉以南非洲的移民（SSA）、1137 名来自非法属西印度群岛的移民（NFWI）和 4205 名其他移民（OTHER）。总体而言，5 年 VR 概率为 19%（95% 置信区间 [CI]19-20），FRA 为 15%，OTHER 为 21%，SSA 为 26%，NFWI 为 34%（P 结论）：在考虑了性别和获得群体后，移民，尤其是从 NFWI 移民，仍然是 VR 的预后因素。

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引用次数: 0

Effectiveness, safety, and patient-reported outcomes of emtricitabine/tenofovir alafenamide-based regimens for the treatment of HIV-1 infection: Final 24-month results from the prospective German TAFNES cohort study 基于恩曲他滨/替诺福韦-阿拉非那胺的方案治疗 HIV-1 感染的有效性、安全性和患者报告结果：德国 TAFNES 前瞻性队列研究 24 个月的最终结果。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-10-30 DOI: 10.1111/hiv.13728

Christoph Stephan, Christoph D. Spinner, Ansgar Rieke, Stefan Christensen, Stefan Mauss, Sandra Schreiber, Boris Albuquerque, Marion Heinzkill, Heribert Ramroth, Hans-Jürgen Stellbrink

Background

Tenofovir alafenamide (TAF) was introduced in the European Union in 2015 as a novel prodrug of tenofovir showing similar efficacy in clinical trials and a more favorable safety profile than tenofovir disoproxil fumarate (TDF). The German TAFNES cohort study (2016–2019) was conducted to generate real-world evidence.

Methods

Treatment-naïve (TN) and treatment-experienced (TE) people with HIV (PWH) receiving elvitegravir/cobicistat/emtricitabine/TAF (E/C/F/TAF), rilpivirine/F/TAF (R/F/TAF) or F/TAF + 3rd agent were included. Month (M) 24 outcomes included virologic effectiveness (HIV RNA <50 copies/mL), treatment persistence, adverse drug reactions (ADRs) and patient-reported outcomes, using the HIV Symptom Index (HIV-SI), 36-Item Short Form Health Survey (SF-36) and HIV Treatment Satisfaction (HIVTSQ) questionnaires.

Results

The study included 767 PWH (92% men, median age 46 years; 301 TN, 466 TE; E/C/F/TAF [n = 318], R/F/TAF [n = 192], F/TAF + 3rd agent [n = 257]). Among TN, 35% had late HIV diagnosis (CD4 < 350/μL and/or AIDS). Of TE, 95% were on suppressive antiretroviral therapy (ART) before switching. D:A:D (Data Collection on Adverse Effects of Anti-HIV Drugs) 5-year risks for chronic kidney disease were high for about 1 in 10 TN and 4 in 10 TE. Overall treatment persistence at M24 was 81% (E/C/F/TAF: 88%; R/F/TAF: 86%; F/TAF + 3rd agent: 70%, with ART simplification of multiple-tablet regimens in 13%). M24 viral suppression (missing = excluded) was 96% (479/501). Discontinuations due to virologic failure or ADRs were rare, 2% (12/767) and 4% (30/767), respectively. HIV-SI and SF-36 summary scores improved in TN; HIVTSQ change scores showed an improvement in treatment satisfaction in TE.

Conclusion

Real-world data confirmed a favorable safety profile and high virologic effectiveness with high treatment satisfaction on F/TAF-based ART.

背景：替诺福韦-阿拉非那胺（TAF）作为一种新型替诺福韦原药于2015年引入欧盟，在临床试验中显示出与富马酸替诺福韦二吡呋酯（TDF）相似的疗效和更有利的安全性。德国TAFNES队列研究（2016-2019年）旨在获得真实世界的证据：方法：纳入接受埃替拉韦/考比司他/恩曲他滨/TAF（E/C/F/TAF）、利匹韦林/F/TAF（R/F/TAF）或F/TAF+第3种药物治疗的艾滋病病毒感染者（PWH）。第 24 个月的结果包括病毒学有效性（HIV RNA 结果）：研究纳入了 767 名 PWH（92% 为男性，中位年龄 46 岁；301 名 TN，466 名 TE；E/C/F/TAF [n = 318]，R/F/TAF [n = 192]，F/TAF + 第 3 种药物 [n = 257]）。在 TN 患者中，35% 的人晚期确诊了 HIV（CD4 结论）：真实世界的数据证实，基于 F/TAF 的抗逆转录病毒疗法具有良好的安全性、高病毒学有效性和高治疗满意度。

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引用次数: 0

Cardiovascular prevention: Statins and beyond–A message from the editors of the special issue of HIV medicine 预防心血管疾病：他汀类药物及其他--来自《艾滋病医学》特刊编辑的信息。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-10-29 DOI: 10.1111/hiv.13731

Laura Waters, Esteban Martinez

引用次数: 0