HIV Medicine最新文献

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.

Objectives: This study assessed real-world effectiveness and safety of switching to dual therapy regimens consisting of an integrase inhibitor (INSTI), and reverse transcriptase inhibitor (RTI), among suppressed people living with HIV in Europe.

Methods: This observational cohort enrolled adults with HIV from 28 sites across Europe who were switching to a two-drug regimen of an INSTI plus a nucleoside reverse transcriptase inhibitor or non-nucleoside reverse transcriptase inhibitor while suppressed [viral load (VL) <50 copies/mL]. Participants were followed from regimen start date (baseline) until the earliest of 96 weeks, regimen discontinuation, loss to follow-up, or death. The primary endpoints were suppression, low-level viraemia (VL ≥50 to <200 copies/mL), and high-level viraemia (VL ≥200 copies/mL) at 24-, 48- and 96-weeks post-baseline, and virologic failure (VF) within 96 weeks (2 consecutive VLs ≥50 copies/mL or 1 VL ≥50 copies/mL followed by regimen discontinuation). Adverse events and discontinuations were also described.

Results: 737 individuals switched to DTG + 3TC (536, 72.7%), DTG + RPV (186, 25.2%) and other INSTI+RTI regimens (15, 2.0%). At 24-,48-, and 96 weeks of follow up, >98% of individuals with VL data maintained suppression; among VLs ≥50 copies/mL, most (19/23; 82.6%) were low-level viraemia. Five individuals (<1%, DTG + 3TC:2; DTG + RPV:3) experienced VF. Forty-seven non-serious drug-related AEs were reported by 38 participants (5.4%); 2 people experienced serious AEs (0.3%). Regimen discontinuations were infrequent (n = 39, 5.3%) and most commonly attributed to tolerability issues (n = 17).

Conclusions: Among suppressed people living with HIV in a real-world setting, INSTI+RTI two-drug regimens were highly effective and well tolerated over 96 weeks of follow-up.

Background: Treatment interruptions (TIs) may lead to adverse health outcomes for people living with HIV. This study explores individual characteristics as well as proximal factors associated with TIs among people living with HIV in British Columbia (BC), Canada.

Methods: Between January 2016 and September 2018, eligible people living with HIV aged ≥19 years across BC completed three surveys, 18 months apart, assessing demographics, health behaviours and healthcare engagement. TIs (≥60 days late for ART refills) were identified through the BC HIV Drug Treatment Program database from enrolment until December 2020. We used Cox proportional hazards models to analyse baseline factors associated with time-to-first TI and generalized linear mixed models to examine time-updated factors related to TIs within 3 months of a study visit.

Results: Among 639 participants receiving antiretroviral therapy (ART) at enrolment, 21.3% were women, 59% were men who have sex with men and 24.1% had ≥1 TI over the study period. Factors associated with time-to-first TI included history of incarceration (adjusted hazard ratio [AHR] = 1.97; p < 0.001), experiencing violence (AHR = 1.94; p = 0.019) and age ≥ 60 years (AHR = 0.39; p = 0.007); 50-59 years (AHR = 0.63; p = 0.038) and 40-49 years (AHR = 0.61; p = 0.036) versus <40 years. TIs within 3 months of a study visit were associated with being single (adjusted odds ratio [AOR] = 3.63; p = 0.005), recent homelessness (AOR = 2.29; p = 0.049) and recent injection drug use (AOR = 3.55; p <0.001) measured at the time of the visit.

Conclusion: Analysing TIs using a time-to-event approach identified non-modifiable risk markers (history of incarceration, experiencing violence and age), whereas our time-updated analysis found modifiable factors (being single, recent homelessness and recent injection drug use). The latter should be examined further as potential targets for therapeutic interventions.

Objectives: This study aimed to characterize long-term immune reconstitution trajectories and influencing factors in people living with HIV exhibiting suboptimal early immune responses after 24 months of antiretroviral therapy (ART).

Methods: We conducted a retrospective multicentre study from January 2016 to October 2024. Eligible participants achieved sustained virological suppression within six months of ART but maintained CD4⁺ T cell counts <350 cells/μL at 24 months. Demographic and clinical characteristics were analysed, and Cox regression models were used to identify factors associated with different long-term immune reconstitution patterns.

Results: Among 5272 virologically suppressed individuals, 348 were included in the final analysis. The median age was 48 years (IQR 38.0-57.0), and the median duration of ART was 4.5 years (IQR 4.0-6.0). The overall median CD4⁺ T cell counts increased gradually during the first four years after ART initiation, followed by an annual growth <10 cells/μL thereafter. Three distinct immune recovery trajectories were identified: progressively increasing (37.1%), minor fluctuating (56.9%) and progressively declining (6.0%). Among the increasing group, 62.0% eventually achieved immune reconstitution. Cox regression analysis showed that baseline CD4⁺ T cell counts ≥200 cells/μL were strongly associated with successful long-term immune reconstitution (HR = 1.9, 95% CI: 1.2-2.9), whereas transient viremia increased the risk of both fluctuating (HR = 2.3, 95% CI: 1.2-4.8) and declining trajectories (HR = 2.5, 95% CI: 1.1-6.0).

Conclusion: People living with HIV with suboptimal early immune responses exhibit three distinct immune recovery trajectories. Higher baseline CD4⁺ T cell levels favour long-term reconstitution, whereas transient viremia may predict persistent immune failure.

Objectives: Health-related quality of life (HRQoL) is a key patient-reported outcome in people living with HIV, reflecting physical, psychological and social well-being. This study aimed to evaluate HRQoL among people living with HIV in Türkiye using the PozQoL scale and to examine sociodemographic, clinical and treatment-related factors associated with HRQoL.

Methods: This cross-sectional, hospital-based study was conducted between May and August 2025 among 299 people living with HIV followed at the Tepecik Training and Research Hospital HIV Clinic in Izmir. The validated Turkish version of the PozQoL scale was administered to assess psychological, social, health concerns and functional domains. Sociodemographic and clinical variables, including comorbidities and polypharmacy, were analysed using t tests, Mann-Whitney U tests and multiple linear regression.

Results: Participants had a mean age of 39.0 ± 11.8 years; 88.3% were male and 86.4% had virological suppression. The mean total PozQoL score was 47.83 ± 11.83. Multivariable analyses showed that depression was the only variable independently associated with lower total PozQoL scores (p = 0.009). In the psychological domain model, gender (p = 0.031), marital status (p = 0.022) and depression (p = 0.014) remained significantly associated with psychological well-being. Overall, unmarried participants, women/trans participants and those with depression had lower psychological domain scores. No significant associations were observed with HIV RNA suppression or transmission route.

Conclusions: Among virologically suppressed people living with HIV, higher PozQoL scores indicate better HRQoL. In this virologically suppressed cohort, HRQoL was primarily associated with social factors (gender, marital status), psychosocial factors (e.g., depression) and comorbidity burden rather than immunovirological indicators. Routine use of patient-reported outcome measures such as PozQoL can help identify treatable factors-including depression and polypharmacy-and support the integration of mental health and multimorbidity management into person-centred HIV care.