HIV Medicine最新文献_第5页

Clinical HIV outcome trajectories associated with a history of child protective service out-of-home care: Longitudinal cohort findings with women living with HIV in Canada 与儿童保护服务家庭外照料史相关的临床 HIV 结果轨迹：加拿大女性艾滋病感染者的纵向队列研究结果。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-05-17 DOI: 10.1111/hiv.13660

Carmen H. Logie, Nina Sokolovic, Andrea Casale, Mary Ndung'u, V. Logan Kennedy, Angela Underhill, Barbara Fallon, Claudette Cardinal, Kathleen Webster, Jasmine Cotnam, Angela Kaida, Alexandra de Pokomandy, Mona Loutfy

Objectives

Knowledge gaps exist regarding the effects of experiencing child protective services (CPS) out-of-home care (e.g. foster homes) among women with HIV. We examined whether CPS out-of-home care was associated with HIV clinical outcome trajectories among women with HIV in a longitudinal cohort study in Ontario, British Columbia, and Quebec, Canada.

Methods

At three timepoints across 5 years (2013–2018), we examined self-reported current antiretroviral therapy (ART) use and viral load (VL) detectability (>50 copies/mL). We used latent class growth analysis (LCGA) to identify trajectories of ART use and VL outcomes across study waves. LCGA identifies subgroups (classes) with similar trajectories within the sample. We assessed whether HIV outcome trajectories could be predicted by CPS history. We then conducted a mediation analysis to test whether a mental health latent construct mediated the association between CPS history and detectable VL.

Results

Nearly one-fifth (n = 272; 19%) of participants (n = 1422; mean age 42.8 years) reported CPS out-of-home care. Most participants (89%) were in classes that consistently used ART and had an undetectable VL. Individuals with CPS out-of-home care histories were twice as likely to have a consistently detectable VL (β = 0.72, p = 0.02); there were no differences in ART use trajectories. In mediation analyses, we found an indirect path from CPS history to a consistently detectable VL via baseline mental health status (β = 0.02, 95% confidence interval 0.005–0.04, p = 0.02), with a significant odds ratio (1.12, z = 2.43, p = 0.02).

Conclusion

Among women with HIV in Canada, experiencing childhood CPS out-of-home care was associated with a reduced likelihood of achieving viral suppression, via poorer mental health.

目标：关于儿童保护服务（CPS）家庭外护理（如寄养家庭）对女性艾滋病感染者的影响，目前还存在知识空白。我们在加拿大安大略省、不列颠哥伦比亚省和魁北克省开展了一项纵向队列研究，研究了 CPS 离家照顾是否与女性 HIV 感染者的 HIV 临床结果轨迹有关：在 5 年（2013-2018 年）的三个时间点上，我们检查了自我报告的当前抗逆转录病毒疗法（ART）使用情况和病毒载量（VL）可检测性（>50 copies/mL）。我们使用潜类增长分析（LCGA）来确定各次研究中使用抗逆转录病毒疗法和病毒载量结果的轨迹。LCGA 可识别样本中具有相似轨迹的亚组（类）。我们评估了 HIV 结果轨迹是否可由 CPS 历史预测。然后，我们进行了中介分析，以检验心理健康潜在结构是否对 CPS 历史与可检测到的 VL 之间的关联起中介作用：近五分之一（n = 272；19%）的参与者（n = 1422；平均年龄 42.8 岁）报告了 CPS 离家照料情况。大多数参与者（89%）所在的班级一直使用抗逆转录病毒疗法，且检测不到 VL。有 CPS 失管史的人持续检测到 VL 的可能性是其他人的两倍（β = 0.72，p = 0.02）；抗逆转录病毒疗法的使用轨迹没有差异。在中介分析中，我们通过基线心理健康状况（β = 0.02，95% 置信区间为 0.005-0.04，p = 0.02）发现了从 CPS 历史到持续检测到 VL 的间接路径，并发现了显著的几率比（1.12，z = 2.43，p = 0.02）：结论：在加拿大感染艾滋病病毒的妇女中，童年时期经历过 CPS 家庭外护理与通过较差的心理健康实现病毒抑制的可能性降低有关。

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引用次数: 0

Efficacy and safety of dolutegravir/lamivudine in virologically suppressed female participants: week 48 data from the pooled TANGO and SALSA studies 多罗替拉韦/拉米夫定对病毒学抑制女性参与者的疗效和安全性：TANGO 和 SALSA 研究第 48 周的汇总数据。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-05-17 DOI: 10.1111/hiv.13643

C. Katlama, F. Bisshop, J. Bogner, M. J. Pérez Elías, S. Di Giambenedetto, E. Clarke, S. Hodder, N. Nwokolo, M. Ait-Khaled, J. Oyee, R. Grove, B. Wynne, C. Okoli, B. Jones, M. Kisare

Objectives

Women represent >50% of people with HIV globally but have historically been underrepresented in clinical trials. We evaluated the efficacy and safety of switching to dolutegravir/lamivudine (DTG/3TC) vs continuing their current antiretroviral regimen (CAR) by sex assigned at birth (female and male) in virologically suppressed adults with HIV-1 without prior virological failure in a pooled analysis of two randomized controlled trials.

Methods

This analysis included 48-week data from the phase 3 TANGO and SALSA studies. Primary and key secondary endpoints included proportions of participants with HIV-1 RNA ≥50 and <50 copies/mL at week 48, respectively. Safety was also assessed.

Results

Of 1234 participants, 250 (DTG/3TC, n = 133; CAR, n = 117) were female at birth. Week 48 proportions of participants with Snapshot HIV-1 RNA ≥50 copies/mL were similar regardless of sex at birth (DTG/3TC vs CAR: female, <1% [1/133] vs 2% [2/117]; male, <1% [1/482] vs <1% [3/502]). Proportions with HIV-1 RNA <50 copies/mL were high across sexes and treatment groups (DTG/3TC vs CAR: female, 91% [121/133] vs 89% [104/117]; male, 94% [455/482] vs 94% [471/502]). Immunological response with DTG/3TC was slightly higher in female participants. Incidences of adverse events leading to withdrawal and serious adverse events were low and comparable between treatment groups and across sexes. Weight gain was higher with DTG/3TC than with CAR among female participants aged ≥50 years (treatment difference 2.08 kg [95% confidence interval 0.40–3.75]).

Conclusions

Results confirm the robustness of DTG/3TC as a switch option in virologically suppressed females with HIV-1, with outcomes similar to those in males.

目标：在全球艾滋病病毒感染者中，女性占 50% 以上，但在临床试验中的比例一直偏低。在两项随机对照试验的汇总分析中，我们评估了在既往未出现病毒学失败的病毒学抑制成人 HIV-1 感染者中，按出生时性别（女性和男性）转用多罗替韦/拉米夫定（DTG/3TC）与继续使用当前抗逆转录病毒疗法（CAR）的疗效和安全性：该分析包括 TANGO 和 SALSA 3 期研究的 48 周数据。主要和关键次要终点包括HIV-1 RNA≥50的参与者比例和结果：在 1234 名参与者中，有 250 人（DTG/3TC，n = 133；CAR，n = 117）出生时为女性。无论出生时的性别如何，第 48 周快照 HIV-1 RNA ≥50 copies/mL 的参与者比例相似（DTG/3TC vs CAR：女性；DTG/3TC vs CAR：女性；DTG/3TC vs CAR：女性；DTG/3TC vs CAR：女性）：结果证实，在病毒学抑制的女性 HIV-1 感染者中，DTG/3TC 是一种稳健的转换选择，其结果与男性相似。

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引用次数: 0

Trends in preterm birth in women living with HIV in Switzerland over the last three decades: A multicentric, prospective, cohort study 过去三十年瑞士感染艾滋病毒妇女的早产趋势：一项多中心、前瞻性、队列研究。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-05-16 DOI: 10.1111/hiv.13652

Marina Lumbreras Areta, Federico E. Migliorelli Falcone, Christoph Rudin, Christian R. Kahlert, Paolo Paioni, Marc U. Baumann, Katharine Darling, Christian Polli, Begoña Martinez de Tejada

Background

HIV infection and its management during pregnancy to reduce perinatal transmission has been associated with preterm birth (PTB). This management has drastically changed. We aimed to evaluate changes in rates of PTB over 34 years in women living with HIV (WLWH) in Switzerland, and to identify factors and interventions associated with these changes.

Methods

We analysed data from 1238 singleton pregnancies, prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS) between 1986 and 2020. Rates of PTB in this cohort were compared with that of the general Swiss population for three time periods according to changing treatment strategies recommended at the time. We evaluated the association of PTB with sociodemographic, HIV infection and obstetric variables in uni- and multivariate logistic regression.

Results

Rate of PTB in WLWH was highest prior to 2010 (mean 20.4%), and progressively decreased since then (mean 11.3%), but always remained higher than in the general population (5%). Older maternal age, lower CD4 count and detectable viraemia at third trimester (T3), drug consumption and mode of delivery were all significantly associated with both PTB and period of study in univariate analysis. There was no association between PTB and type of antiretroviral regimen. No difference was found in the rate of spontaneous labor between PTB and term delivery groups. Only higher CD4 count at T3 and vaginal delivery were significantly associated with a decrease in PTB over time in multivariate analysis.

Conclusions

Preterm birth in WLWH in Switzerland has drastically decreased over the last three decades, but remains twice the rate of that in the general population. Improved viral control and changes in mode of delivery (vaginal birth recommended if viral loads are low near birth) have led to this progress.

背景：艾滋病病毒感染以及为减少围产期传播而采取的孕期管理措施与早产（PTB）有关。这种管理方式已经发生了巨大变化。我们旨在评估 34 年来瑞士女性艾滋病病毒感染者（WLWH）早产率的变化，并确定与这些变化相关的因素和干预措施：我们分析了瑞士母婴艾滋病群组研究（MoCHiV）和瑞士艾滋病群组研究（SHCS）在 1986 年至 2020 年间收集的 1238 例单胎妊娠的数据。根据当时推荐的治疗策略的变化，我们将该队列中的 PTB 发生率与三个时间段内瑞士普通人群的 PTB 发生率进行了比较。我们通过单变量和多变量逻辑回归评估了PTB与社会人口学、HIV感染和产科变量的关系：2010年之前，WLWH的PTB率最高（平均为20.4%），之后逐渐下降（平均为11.3%），但始终高于普通人群（5%）。在单变量分析中，高龄产妇、较低的 CD4 细胞数、怀孕三个月（T3）时检测到的病毒血症、服用药物和分娩方式均与肺结核和研究期间有显著相关性。PTB 与抗逆转录病毒疗法类型之间没有关联。初产妇组和足月分娩组的自然分娩率没有差异。在多变量分析中，只有T3时较高的CD4计数和阴道分娩与随着时间推移PTB的减少有明显关系：结论：过去三十年来，瑞士 WLWH 早产率大幅下降，但仍是普通人群早产率的两倍。病毒控制的改善和分娩方式的改变（如果临近分娩时病毒载量较低，建议采用阴道分娩）促成了这一进展。

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引用次数: 0

Mpox in people with HIV: A narrative review 艾滋病毒感染者的 Mpox：叙述性综述。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-05-15 DOI: 10.1111/hiv.13661

Hideta Nakamura, Kazuko Yamamoto

Objective

The 2022 global mpox outbreak disproportionately impacted people living with HIV. This review explores recent evidence on mpox in this group, focusing on clinical presentation, complications, treatment modalities and vaccine strategies.

Recent findings

Recent studies have suggested that people with HIV diagnosed with mpox have a greater risk of proctitis and hospitalization compared with people without HIV. In addition, those with advanced immunosuppression face an elevated risk of severe mpox infection, which can lead to mortality. Comprehensive and prompt supportive care using antiretrovirals and mpox antivirals is crucial in this group. Although results from randomized clinical trials are still forthcoming, recent studies suggest that early initiation of tecovirimat can prevent disease progression in people with HIV. The non-replicative attenuated smallpox vaccine is well tolerated and effective in preventing monkeypox virus infections in people with HIV. Further studies are needed regarding long-term vaccine effectiveness for this population.

Conclusion

Evaluating the risk of severe mpox in people living with HIV requires assessing the level of immune suppression and viral control. Universal access to vaccination is imperative to prevent the resurgence of future outbreaks.

目标：2022 年全球爆发的麻腮风对艾滋病毒感染者的影响尤为严重。本综述探讨了有关这一群体感染水痘的最新证据，重点关注临床表现、并发症、治疗方法和疫苗策略：最近的研究表明，与未感染艾滋病病毒的人相比，被诊断患有麻腮风的艾滋病病毒感染者患直肠炎和住院的风险更大。此外，晚期免疫抑制患者发生严重水痘感染的风险更高，可能导致死亡。使用抗逆转录病毒药物和麻腮风抗病毒药物进行全面、及时的支持性治疗对这类患者至关重要。尽管随机临床试验的结果还没有出来，但最近的研究表明，尽早开始使用替考韦利马特可以防止艾滋病病毒感染者的病情恶化。非复制减毒天花疫苗在预防艾滋病病毒感染者感染猴痘病毒方面具有良好的耐受性和有效性。关于疫苗对这一人群的长期有效性，还需要进一步研究：评估艾滋病毒感染者感染严重猴痘的风险需要评估免疫抑制和病毒控制水平。普及疫苗接种是防止未来疫情再次爆发的当务之急。

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引用次数: 0

Metabolic effects of switching to Biktarvy (B/F/TAF) in patients with HIV-1 treated with antiretroviral regimens that do not include tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF): The Metabic study 使用不包括富马酸替诺福韦二吡呋酯（TDF）或替诺福韦阿拉非酰胺（TAF）的抗逆转录病毒疗法治疗的 HIV-1 患者改用 Biktarvy（B/F/TAF）后的代谢影响：Metabic研究。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-05-15 DOI: 10.1111/hiv.13659

C. Busca-Arenzana, D. Ortega-González, M. Díaz-Almirón, M. L. Montes, Luz Martin-Carbonero, R. Mican, R. Montejano, L. Ramos-Ruperto, Eulalia Valencia, Ana Delgado-Hierro, Jose I. Bernardino

Background

Studies on switching to tenofovir alafenamide (TAF)-based regimens raise concerns about a worse metabolic profile in people with HIV, even though most received tenofovir disoproxil fumarate (TDF) in their previous regimen. This study aims to evaluate changes in lipid fractions, glucose, and serum markers for hepatic steatosis (HS) after switching from a TDF- or TAF-sparing regimen to bictegravir/emtricitabine/TAF (B/F/TAF).

Methods

We performed a retrospective cohort study of people with HIV who switched to B/F/TAF from TDF- or TAF-sparing regimens between January 2019 and May 2022 with at least 6 months of follow-up. The primary endpoint was the absolute change in lipid fractions at 6 months. Secondary outcomes were changes in lipid fractions at 12 months and changes in other metabolic parameters (glucose, creatinine, and HS based on the triglyceride-to-glucose [TyG] ratio at 6 and 12 months). Changes were analysed using mixed linear regression models with random intercept and time as a fixed effect.

Results

The study included 259 people with HIV (median age 55 [interquartile range (IQR) 47–60] years; 80% male; 88% Caucasian; CD4+ T-cell count 675 [IQR 450–880] cells/mm³; 84.3% HIV-RNA <50 copies/mL). In total, 63 patients (30%) had hypertension, 93 (44%) dyslipidaemia, 30 (14%) diabetes, and 45% obesity/overweight. Most (60%) switched from integrase inhibitor-based regimens, and 21% switched from a boosted regimen. At 6 months, significant reductions were observed in total cholesterol (−7.64 mg/dL [95% confidence interval (CI) −13.52 to −1.76; p = 0.002]), triglycerides (−23.4 [95% CI −42.07 to −4.65]; p = 0.003), and TyG ratio (−0.14 [95% CI −0.23 to −0.05]; p < 0.001).

Conclusion

In our real-life cohort, the effect of switching TDF-/TAF-sparing regimens to triple therapy with B/F/TAF improved total cholesterol, triglycerides, and serum markers of HS at 6 months and was neutral for the remaining metabolic parameters at 12 months.

背景：有关转用替诺福韦阿拉非酰胺（TAF）为基础的治疗方案的研究引起了人们对艾滋病患者代谢状况恶化的担忧，尽管大多数人在之前的治疗方案中接受的是富马酸替诺福韦二吡呋酯（TDF）。本研究旨在评估从TDF或TAF保留方案转为比特拉韦/恩曲他滨/TAF（B/F/TAF）方案后血脂、血糖和肝脂肪变性（HS）血清标志物的变化：我们对2019年1月至2022年5月期间从TDF或TAF保留方案转为B/F/TAF且随访至少6个月的HIV感染者进行了一项回顾性队列研究。主要终点是6个月时血脂分数的绝对变化。次要结局是 12 个月时血脂分数的变化以及其他代谢参数（6 个月和 12 个月时基于甘油三酯与葡萄糖 [TyG] 比值的葡萄糖、肌酐和 HS）的变化。采用随机截距和时间作为固定效应的混合线性回归模型对这些变化进行分析：研究纳入了 259 名艾滋病病毒感染者（中位年龄 55 [四分位距（IQR）47-60]岁；80% 为男性；88% 为白种人；CD4+ T 细胞计数 675 [IQR 450-880] cells/mm3; 84.3% HIV-RNA 结论：在我们的现实生活队列中，我们的研究结果表明，在 6 个月和 12 个月的时间内，我们的血脂与血糖（TyG）比值发生了变化：在我们的实际队列中，将TDF/TAF保留方案转换为B/F/TAF三联疗法的效果在6个月时改善了总胆固醇、甘油三酯和HS的血清标志物，在12个月时对其余代谢参数的影响为中性。

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引用次数: 0

Severe ocular Mpox in person living with advanced HIV treated with extended course of tecovirimat 接受特考韦瑞延长疗程治疗的晚期艾滋病病毒感染者出现严重眼部脓疱疮。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-05-09 DOI: 10.1111/hiv.13656

Lottie Brown, Pippa Sargent, Meriam Islam, Catriona Downie, Ali Hassan, Geraldine O'Hara, Sam Douthwaite, Ranjababu Kulasegaram, Scott Robbie, Emma Aarons, Iain D. Milligan

Background

People living with HIV are disproportionately represented among people with severe mpox. Mild and self-limiting conjunctival involvement has been well-documented, and severe ocular complications, including keratitis, corneal scarring, and the associated loss of vision, are increasingly recognized. Tecovirimat is the first-line antiviral therapy for severe mpox, but data around the efficacy of systemic antiviral agents for mpox are limited, particularly in cases of ocular mpox.

Case Report

Here, we describe a case of sight-threatening necrotic blepharokeratoconjunctivitis in a person with advanced HIV, requiring an extended course of tecovirimat due to persistent mpox viral shedding for nearly 5 months.

背景：艾滋病毒感染者在严重水痘患者中所占比例过高。轻度和自限性结膜受累已得到充分证实，而严重的眼部并发症，包括角膜炎、角膜瘢痕和相关的视力丧失，则日益得到认可。特考韦瑞是治疗严重水痘的一线抗病毒药物，但有关全身性抗病毒药物对水痘疗效的数据有限，尤其是在眼部水痘病例中：在此，我们描述了一例晚期艾滋病病毒感染者危及视力的坏死性睑角膜结膜炎病例，由于痘病毒持续脱落近 5 个月，患者需要延长替考韦酯的疗程。

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引用次数: 0

Access to care and impact on HIV treatment interruptions during the COVID-19 pandemic among people living with HIV in British Columbia 不列颠哥伦比亚省艾滋病毒感染者在 COVID-19 大流行期间获得护理的情况及其对艾滋病毒治疗中断的影响。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-05-09 DOI: 10.1111/hiv.13654

Emma Finlayson-Trick, Clara Tam, Lu Wang, Nicole Dawydiuk, Kate Salters, Jason Trigg, Tatiana Pakhomova, Antonio Marante, Paul Sereda, Tim Wesseling, Julio S. G. Montaner, Robert Hogg, Rolando Barrios, David M. Moore

Introduction

The COVID-19 pandemic has changed healthcare service delivery. We examined the overall impact of COVID-19 on people living with HIV in British Columbia (BC), Canada, with a special focus on the potential impact of COVID-19 on antiretroviral treatment interruptions (TIs).

Methods

Purposive sampling was used to enrol people living with HIV aged ≥19 years across BC into the STOP HIV/AIDS Program Evaluation study between January 2016 and September 2018. Participants completed surveys at baseline enrolment and 18 and 36 months later. Additional COVID-19 questions were added to the survey in October 2020. TIs were defined as >60 days late for antiretroviral therapy (ART) refill using data from the BC HIV Drug Treatment Program. Generalized linear mixed models were used to examine trends in TIs over time and associations with reported health service access.

Results

Of 581 participants, 6.1%–7.7% experienced a TI during each 6-month period between March 2019 and August 2021. The frequency of TIs did not statistically increase during the COVID-19 epidemic. Among the 188 participants who completed the COVID-19 questionnaire, 32.8% reported difficulty accessing healthcare during COVID-19, 9.7% reported avoiding continuing a healthcare service due to COVID-19-related concerns, and 74.6% reported using virtual healthcare services since March 2020. In multivariable analysis, the odds of a TI in any 6-month period were not significantly different from March to August 2019. None of the reported challenges to healthcare services were associated with TIs.

Conclusions

Although some participants reported challenges to accessing services or avoidance of services due to COVID-19, TIs were not more likely during COVID-19 than before.

导言：COVID-19 大流行改变了医疗保健服务的提供。我们研究了 COVID-19 对加拿大不列颠哥伦比亚省（BC 省）艾滋病感染者的总体影响，特别关注 COVID-19 对抗逆转录病毒治疗中断（TIs）的潜在影响：方法：2016 年 1 月至 2018 年 9 月期间，不列颠哥伦比亚省各地年龄≥19 岁的艾滋病病毒感染者参加了 STOP 艾滋病项目评估研究。参与者在基线注册以及 18 个月和 36 个月后完成了调查。2020 年 10 月，调查中增加了 COVID-19 问题。根据不列颠哥伦比亚省艾滋病药物治疗计划的数据，TI 被定义为抗逆转录病毒疗法（ART）补药逾期 60 天以上。我们使用广义线性混合模型来研究 TI 随时间变化的趋势以及与所报告的医疗服务获取情况之间的关联：在 581 名参与者中，6.1%-7.7% 的人在 2019 年 3 月至 2021 年 8 月的每 6 个月期间经历过一次 TI。在 COVID-19 流行期间，发生 TI 的频率在统计学上没有增加。在完成 COVID-19 问卷调查的 188 名参与者中，32.8% 表示在 COVID-19 期间难以获得医疗保健服务，9.7% 表示由于 COVID-19 相关的担忧而避免继续接受医疗保健服务，74.6% 表示自 2020 年 3 月以来使用过虚拟医疗保健服务。在多变量分析中，2019 年 3 月至 8 月期间任何 6 个月内发生 TI 的几率均无显著差异。所报告的医疗保健服务挑战均与技术倡议无关：尽管一些参与者报告称，由于 COVID-19 的原因，他们在获取服务或避免服务方面遇到了挑战，但在 COVID-19 期间，发生 TI 的可能性并不比之前高。

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引用次数: 0

De-simplifying antiretroviral therapy from a single-tablet to a two-tablet regimen: Acceptance, patient-reported outcomes, and cost savings in a multicentre study 将抗逆转录病毒疗法从单药片疗法简化为双药片疗法：多中心研究中的接受度、患者报告结果和成本节约。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-05-07 DOI: 10.1111/hiv.13655

P. Oosterhof, B. G. J. A. de Zoete, J. W. Vanhommerig, N. Langebeek, E. H. Gisolf, A. G. W. van Hulzen, A. J. J. Lammers, A. M. Weijsenfeld, M. van der Valk, K. Grintjes, R. van Crevel, M. van Luin, K. Brinkman, D. M. Burger

Background

Antiretroviral therapy (ART), which is increasingly used by people with HIV, accounts for significant care costs, particularly because of single-tablet regimens (STRs). This study explored de-simplification to a two-tablet regimen (TTR) for cost reduction. The objectives of this study were: (1) acceptance of de-simplification, (2) patient-reported outcomes, and (3) cost savings.

Methods

All individuals on Triumeq®, Atripla® or Eviplera® in five HIV clinics in the Netherlands were eligible. Healthcare providers informed individuals of this study. After inclusion, individuals were free to de-simplify. An electronic questionnaire was sent to assess study acceptance, adherence, quality of life (SF12) and treatment satisfaction (HIVTSQ). After 3 and 12 months, questionnaires were repeated. Cost savings were calculated using Dutch drug prices.

Results

In total, 283 individuals were included, of whom 55.5% agreed to de-simplify their ART, with a large variability between treatment centres: 41.1–74.2%. Individuals who were willing to de-simplify tended to be older, had a longer history of HIV diagnosis, and used more co-medication than those who preferred to remain on an STR regimen. Patient-reported outcomes, including quality of life and treatment satisfaction, showed no significant difference between people with HIV who switched to a TTR and those who remained on an STR regimen. Furthermore, we observed a 17.8% reduction in drug costs in our cohort of people with HIV who were initially on an STR.

Conclusions

De-simplification from an STR to a TTR within the Dutch healthcare setting has been demonstrated as feasible, leads to significant cost reductions and should be discussed with every eligible person with HIV in the Netherlands.

背景：艾滋病病毒感染者越来越多地使用抗逆转录病毒疗法（ART），但这种疗法的护理成本很高，尤其是单药疗法（STR）。本研究探讨了去简化为双药治疗方案（TTR）以降低成本的问题。本研究的目标是(方法：所有在荷兰五家艾滋病诊所接受 Triumeq®、Atripla® 或 Eviplera® 治疗的患者均符合条件。医疗服务提供者向患者告知了这项研究。纳入后，患者可自由去简化。研究人员发送了一份电子问卷，以评估研究接受度、依从性、生活质量（SF12）和治疗满意度（HIVTSQ）。3 个月和 12 个月后，再次进行问卷调查。根据荷兰的药品价格计算了节省的成本：共纳入 283 人，其中 55.5% 的人同意简化抗逆转录病毒疗法，不同治疗中心之间的差异很大：41.1%-74.2%。愿意放弃简化疗法的患者往往年龄较大、艾滋病确诊时间较长，而且与愿意继续接受STR疗法的患者相比，他们使用更多的联合用药。患者报告的结果（包括生活质量和治疗满意度）显示，改用 TTR 方案的 HIV 感染者与仍采用 STR 方案的患者之间没有显著差异。此外，我们还观察到，在最初使用 STR 方案的 HIV 感染者队列中，药物成本降低了 17.8%：结论：在荷兰的医疗环境中，从 STR 方案简化为 TTR 方案已被证明是可行的，可显著降低成本，应与荷兰所有符合条件的 HIV 感染者进行讨论。

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引用次数: 0

The prevalence of major depressive disorder in people with HIV: Results from the All of Us Research Program 艾滋病病毒感染者中重度抑郁障碍的患病率：我们所有人研究计划的结果。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-05-07 DOI: 10.1111/hiv.13653

Joshua J. Matacotta, Derek Tran, Sonyeol Yoon

Objectives

The All of Us (AoU) Research Program is a national-scale effort to build a dataset to help transform the future of health research by equipping researchers with comprehensive health data from diverse populations, especially those underrepresented in biomedical research. Our objectives were to evaluate the burden of HIV and major depressive disorder (MDD) in underrepresented groups and the frequency of the HIV/MDD comorbidity.

Methods

We conducted a cross-sectional analysis combining collected survey and electronic health record (EHR) data. We ascertained HIV and MDD cases using Observational Medical Outcomes Partnership codes. We used multivariable logistic regression to obtain the odds ratio of HIV in AoU participants and MDD in AoU participants with HIV.

Results

The latest AoU data release includes 412 211 participants: 254 700 have at least one medical condition concept in their EHR, of whom 5193 (1.3%) had HIV, and 2238 (43%) of those with HIV had a diagnosis of MDD. Black AoU participants had approximately 4.58 times the odds of having an HIV diagnosis compared with the combined odds of all other racial groups. AoU participants with HIV were more likely to have MDD (p = 0.001) than were participants without HIV.

Conclusion

Among AoU participants, Black individuals have a disproportionately high burden of HIV, pointing to underlying factors such as social determinants of health, limited access to healthcare or prevention resources, and potential systemic biases that contribute to these differences. In addition, HIV is a risk factor for mental health issues like MDD. Further data collection from people with HIV will elucidate contributing factors and the need for interventions.

目标：我们所有人（AoU）研究计划是一项全国性计划，旨在建立一个数据集，通过为研究人员提供来自不同人群，尤其是在生物医学研究中代表性不足的人群的全面健康数据，帮助改变未来的健康研究。我们的目标是评估艾滋病毒和重度抑郁症（MDD）在代表性不足群体中的负担以及艾滋病毒/MDD合并症的发生频率：我们结合收集到的调查和电子健康记录（EHR）数据进行了横断面分析。我们使用观察性医疗结果合作组织的代码确定了 HIV 和 MDD 病例。我们使用多变量逻辑回归法得出了 AoU 参与者感染 HIV 的几率比例和 AoU 参与者感染 HIV 的 MDD 的几率比例：最新发布的 AoU 数据包括 412 211 名参与者：254 700 名参与者的电子病历中至少有一个医疗条件概念，其中 5193 人（1.3%）感染了 HIV，2238 人（43%）感染了 HIV，并被诊断为 MDD。与所有其他种族群体相比，黑人 AoU 参与者被诊断出感染 HIV 的几率大约是后者的 4.58 倍。与未感染艾滋病毒的参与者相比，感染艾滋病毒的青奥会参与者更有可能患有 MDD（p = 0.001）：结论：在 AoU 参与者中，黑人感染 HIV 的比例过高，这表明造成这些差异的潜在因素包括健康的社会决定因素、获得医疗保健或预防资源的机会有限，以及潜在的系统性偏见。此外，HIV 也是导致 MDD 等精神健康问题的一个风险因素。进一步收集艾滋病毒感染者的数据将有助于阐明导致这些问题的因素以及干预措施的必要性。

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引用次数: 0

Prevalence of people living with multidrug-resistant HIV and limited treatment options in Spain 西班牙耐多药艾滋病毒感染者的流行情况和有限的治疗方案

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-04-30 DOI: 10.1111/hiv.13650

Josep M. Llibre, Federico García, José Luis Blanco, Esmeralda Palmier Peláez, Álvaro Mena de Cea, Luis López Cortés, Marta Montero Alonso, Miguel Pascual Bernáldez, Melanie Schroeder, Silvia Esteban Sánchez, Felipe Rodríguez Alcántara

Objectives

Our aim was to determine the prevalence and characteristics of people with HIV on antiretroviral therapy (ART) with multidrug resistance (MDR; confirmed resistance to three or more [or resistance to two or more plus contraindication to one or more] core ART classes) and limited treatment options (LTOs) in Spain.

Methods

This was an observational, retrospective, multicentre, cross-sectional chart review study undertaken in five reference Spanish centres. Participants were people with HIV on ART with MDR and LTOs (detectable viral load [HIV-RNA >200 copies/mL], treatment-limiting drug–drug interaction [DDI], or intolerance precluding the use of one or more ART classes). Prevalence, demographic/clinical characteristics, and treatment options were assessed. Logistic regression analyses were used to identify MDR-associated variables.

Results

Of 14 955 screened people with HIV, 69 (0.46%) presented with MDR and 23 (0.15%) had LTOs. The population analysed was 73.9% male with a median age of 54.0 years; the median time since HIV diagnosis was 26.5 years, and median CD4+ cell count was 511.0 cells/μL. The only factor significantly associated with MDR (univariate analysis) was CD4+ cell count. Injection drug use was the most common transmission route. Comorbidities (mainly endocrine and cardiovascular disorders; 34.8% affecting HIV management) and concomitant treatments were frequent. No recent opportunistic infections were reported. Patients had been exposed to the following ART: nucleoside analogue reverse transcriptase inhibitors (100%), protease inhibitors (95.6%), non-nucleoside analogue reverse transcriptase inhibitors (87.0%), and integrase strand transfer inhibitors (82.6%). The available fully active drugs were dolutegravir (39.1%), bictegravir (30.4%), and raltegravir (21.7%).

Conclusions

The prevalence of people with HIV with MDR and LTOs in Spain is very low, with approximately half of those studied not exhibiting virological suppression. Low CD4+ cell counts were associated with MDR. These findings may help address the impact and treatment needs of these patients and prevent clinical progression and transmission of MDR HIV.

目的我们的目的是确定西班牙接受抗逆转录病毒疗法（ART）并伴有多药耐药性（MDR；对三种或三种以上[或对两种或两种以上]核心抗逆转录病毒疗法类药物耐药并对一种或一种以上]核心抗逆转录病毒疗法类药物有禁忌症）和有限治疗方案（LTO）的艾滋病病毒感染者的患病率和特征。方法这是一项观察性、回顾性、多中心、横断面图表回顾研究，在西班牙的五个参考中心进行。研究对象为接受抗逆转录病毒疗法的艾滋病病毒感染者，他们都患有 MDR 和 LTO（可检测到的病毒载量 [HIV-RNA >200 copies/mL]、限制治疗的药物相互作用 [DDI]，或因不耐受而无法使用一种或多种抗逆转录病毒疗法）。对患病率、人口学/临床特征和治疗方案进行了评估。结果在 14 955 名接受筛查的 HIV 感染者中，69 人（0.46%）出现 MDR，23 人（0.15%）出现 LTO。接受分析的人群中，73.9%为男性，中位年龄为 54.0 岁；确诊为艾滋病病毒感染者的中位时间为 26.5 年，CD4+细胞计数中位数为 511.0 cells/μL。唯一与 MDR 明显相关的因素（单变量分析）是 CD4+ 细胞计数。注射吸毒是最常见的传播途径。合并症（主要是内分泌和心血管疾病；34.8%的合并症影响了艾滋病的治疗）和并发症治疗很常见。近期没有机会性感染的报告。患者曾接受过以下抗逆转录病毒疗法：核苷类似物逆转录酶抑制剂（100%）、蛋白酶抑制剂（95.6%）、非核苷类似物逆转录酶抑制剂（87.0%）和整合酶链转移抑制剂（82.6%）。结论在西班牙，MDR 和 LTOs 艾滋病毒感染者的发病率非常低，约有一半的研究对象未表现出病毒学抑制。低 CD4+ 细胞计数与 MDR 相关。这些发现可能有助于解决这些患者的影响和治疗需求，并防止 MDR HIV 的临床进展和传播。

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引用次数: 0