Precious Kefilwe Motlokwa, Yann Ruffieux, Chido Chinogurei, Andreas D. Haas, Naomi Folb, Eliane Rohner
Objectives
To assess the association of HIV and overall survival among medically insured head and neck cancer (HNC) patients in South Africa and to examine factors associated with the type of treatment received.
Methods
We used reimbursement claims data from a South African medical insurance scheme database from 1 January 2011 to 1 July 2020. We included individuals with at least two International Classification of Diseases (ICD-10) codes for HNC and at least one cancer treatment code within 180 days of the HNC diagnosis. We used logistic regression to identify factors associated with receiving a specific type of cancer treatment and Cox proportional hazards models to examine factors associated with all-cause mortality.
Results
We included 566 HNC patients, 49 of whom lived with HIV and 383 were male. Patients with HIV were substantially younger at HNC diagnosis (median age: 52.5 years) than patients without HIV (median age: 61.6 years). We found no clear association between HIV status and the treatment type received. The median survival was 3.78 years (95% confidence interval [CI] 3.01–6.08) and the five-year survival was 46.0% (95% CI 41.2%–51.5%). The risk of death was higher among patients with HIV than those without HIV (adjusted hazard ratio 1.68; 95% CI 1.00–2.81).
Conclusion
Medically insured HNC patients in South Africa with HIV had higher mortality than those without HIV. This underscores the importance of tailored cancer care strategies for HNC patients with HIV.
目的：评估南非有医疗保险的头颈癌（HNC）患者中艾滋病毒与总体生存率的关系，并检查与所接受治疗类型相关的因素。方法：我们使用2011年1月1日至2020年7月1日来自南非医疗保险计划数据库的报销索赔数据。我们纳入了在HNC诊断后180天内具有至少两个国际疾病分类（ICD-10） HNC代码和至少一个癌症治疗代码的个体。我们使用逻辑回归来确定与接受特定类型癌症治疗相关的因素，并使用Cox比例风险模型来检查与全因死亡率相关的因素。结果：我们纳入了566例HNC患者，其中49例携带HIV病毒，383例为男性。HIV患者在HNC诊断时（中位年龄：52.5岁）比非HIV患者（中位年龄：61.6岁）年轻得多。我们发现艾滋病毒感染状况与接受的治疗类型之间没有明确的联系。中位生存期为3.78年（95%可信区间[CI] 3.01-6.08）， 5年生存率为46.0% （95% CI 41.2%-51.5%）。感染艾滋病毒的患者的死亡风险高于未感染艾滋病毒的患者（校正风险比1.68;95% CI 1.00-2.81）。结论：南非医疗保险的艾滋病毒感染者死亡率高于非艾滋病毒感染者。这强调了为艾滋病毒感染者量身定制癌症护理策略的重要性。
{"title":"Survival among medically insured and treated head and neck cancer patients with and without HIV in South Africa","authors":"Precious Kefilwe Motlokwa, Yann Ruffieux, Chido Chinogurei, Andreas D. Haas, Naomi Folb, Eliane Rohner","doi":"10.1111/hiv.70143","DOIUrl":"10.1111/hiv.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the association of HIV and overall survival among medically insured head and neck cancer (HNC) patients in South Africa and to examine factors associated with the type of treatment received.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used reimbursement claims data from a South African medical insurance scheme database from 1 January 2011 to 1 July 2020. We included individuals with at least two International Classification of Diseases (ICD-10) codes for HNC and at least one cancer treatment code within 180 days of the HNC diagnosis. We used logistic regression to identify factors associated with receiving a specific type of cancer treatment and Cox proportional hazards models to examine factors associated with all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 566 HNC patients, 49 of whom lived with HIV and 383 were male. Patients with HIV were substantially younger at HNC diagnosis (median age: 52.5 years) than patients without HIV (median age: 61.6 years). We found no clear association between HIV status and the treatment type received. The median survival was 3.78 years (95% confidence interval [CI] 3.01–6.08) and the five-year survival was 46.0% (95% CI 41.2%–51.5%). The risk of death was higher among patients with HIV than those without HIV (adjusted hazard ratio 1.68; 95% CI 1.00–2.81).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Medically insured HNC patients in South Africa with HIV had higher mortality than those without HIV. This underscores the importance of tailored cancer care strategies for HNC patients with HIV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 12","pages":"1973-1982"},"PeriodicalIF":3.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.70143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clare E F Dyer, Fengyi Jin, Jennifer M Roberts, I Mary Poynten, Philip H Cunningham, Andrew Carr, Gail V Matthews, Andrew E Grulich, Richard J Hillman
Background: People living with HIV are at the highest risk of anal cancer. Screening people living with HIV and treatment of identified anal high-grade squamous intraepithelial lesions (HSIL) are now recommended to reduce cancer incidence. We investigated the implementation of such a programme in a large HIV clinic in Sydney, Australia.
Methods: Men who have sex with men (MSM) living with HIV aged 35+ were invited to participate in an anal screening programme. Following informed consent, participants underwent digital anorectal examination (DARE) and anal swabs (self- and clinician-collected) for HPV genotyping and cytological testing. Swab collection order was randomized. Positive results for HPV16, atypical squamous cells-cannot exclude HSIL (ASC-H), HSIL or abnormal DARE suspicious of anal cancer led to immediate referral for high-resolution anoscopy (HRA). The rest returned in 6 months for repeat tests. Screening logs captured reasons for declining screening.
Results: Of the 225 people invited to participate, 23.1% declined, 49.8% did not respond to repeated contact and 27.1% consented (median age 57.5 years). Of those who consented, 66.1% had high-risk HPV and 78.7% had cytological abnormalities of which 48.6% were HSIL or ASC-H. No differences in swab positivity were found between self- and clinician-collected specimens. Thirty-eight participants were referred for HRA with 100% attendance. Of these, 42.1% had histological HSIL. One had anal cancer.
Conclusions: Uptake of the screening programme was poor, with only a quarter agreeing to participate. Those who underwent screening had excellent adherence (100% HRA attendance) with substantial quantities of HSIL found. Further research is required to understand and address barriers to initial screening programme uptake.
{"title":"Anal cancer screening in men who have sex with men living with HIV: The pilot of anal screening study (PASS).","authors":"Clare E F Dyer, Fengyi Jin, Jennifer M Roberts, I Mary Poynten, Philip H Cunningham, Andrew Carr, Gail V Matthews, Andrew E Grulich, Richard J Hillman","doi":"10.1111/hiv.70151","DOIUrl":"https://doi.org/10.1111/hiv.70151","url":null,"abstract":"<p><strong>Background: </strong>People living with HIV are at the highest risk of anal cancer. Screening people living with HIV and treatment of identified anal high-grade squamous intraepithelial lesions (HSIL) are now recommended to reduce cancer incidence. We investigated the implementation of such a programme in a large HIV clinic in Sydney, Australia.</p><p><strong>Methods: </strong>Men who have sex with men (MSM) living with HIV aged 35+ were invited to participate in an anal screening programme. Following informed consent, participants underwent digital anorectal examination (DARE) and anal swabs (self- and clinician-collected) for HPV genotyping and cytological testing. Swab collection order was randomized. Positive results for HPV16, atypical squamous cells-cannot exclude HSIL (ASC-H), HSIL or abnormal DARE suspicious of anal cancer led to immediate referral for high-resolution anoscopy (HRA). The rest returned in 6 months for repeat tests. Screening logs captured reasons for declining screening.</p><p><strong>Results: </strong>Of the 225 people invited to participate, 23.1% declined, 49.8% did not respond to repeated contact and 27.1% consented (median age 57.5 years). Of those who consented, 66.1% had high-risk HPV and 78.7% had cytological abnormalities of which 48.6% were HSIL or ASC-H. No differences in swab positivity were found between self- and clinician-collected specimens. Thirty-eight participants were referred for HRA with 100% attendance. Of these, 42.1% had histological HSIL. One had anal cancer.</p><p><strong>Conclusions: </strong>Uptake of the screening programme was poor, with only a quarter agreeing to participate. Those who underwent screening had excellent adherence (100% HRA attendance) with substantial quantities of HSIL found. Further research is required to understand and address barriers to initial screening programme uptake.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540636","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}
Advancements in the management of HIV have resulted in an increasing aging population with rising rates of frailty. Frailty represents a state of vulnerability to stressor events. There is a lack of consensus regarding the most appropriate assessment tool for frailty in this population. Our aim was to compare a number of frailty assessment tools among a sample population of older people living with HIV.
Methods
Two hundred and fifty three participants aged over 50 years (median 59.6 years) were recruited between October 2014 and September 2015. Frailty was defined by modified Fried Frailty Phenotype (FFP). Participants were assessed via seven further screening tools (Clinical Frailty Scale, Edmonton Frailty Score, FRAIL scale, Gait Speed, SHARE-FI, Study of Osteoporotic Fractures Index and Timed Up and Go [TUG]). We evaluated the diagnostic performance of each tool by generating ROC curves and calculating specificity and sensitivity.
Results
Using the FFP tool, 48/253 met frailty criteria, reflecting a prevalence of 19% (95% CI 14.6–24.3). A total of 32% of individuals were identified as frail by any of the eight tools. Sensitivity of the tools was highly variable, though all showed good specificity. Timed Up and Go (TUG) assessment performed most closely to FFP (AUROC 0.82 [95% CI 0.753–0.889]).
Conclusions
TUG is a potentially useful frailty screening tool in the assessment of older people living with HIV. Strengths include an objective measure with high sensitivity and specificity and relatively low resource cost. Further exploration in this field is required to assess the correlation between frailty assessment and clinically significant outcomes, including morbidity and mortality.
目的：艾滋病毒管理的进步导致人口老龄化和虚弱率上升。脆弱代表一种易受压力事件影响的状态。对于这一人群中最合适的虚弱评估工具缺乏共识。我们的目的是在携带艾滋病毒的老年人样本人群中比较一些虚弱评估工具。方法：2014年10月至2015年9月招募了253名年龄在50岁以上（中位年龄59.6岁）的参与者。通过改良的Fried脆性表型（FFP）来定义脆性。通过七个进一步的筛选工具（临床虚弱量表、埃德蒙顿虚弱评分、虚弱量表、步态速度、SHARE-FI、骨质疏松性骨折指数研究和Timed Up and Go [TUG]）对参与者进行评估。我们通过生成ROC曲线和计算特异性和敏感性来评估每种工具的诊断性能。结果：使用FFP工具，48/253符合衰弱标准，反映患病率为19% （95% CI 14.6-24.3）。总共有32%的人被这八种工具中的任何一种确定为虚弱。这些工具的灵敏度变化很大，但都显示出良好的特异性。time Up and Go （TUG）评估最接近FFP （AUROC 0.82 [95% CI 0.753-0.889]）。结论：TUG是评估老年HIV感染者的潜在有用的衰弱筛查工具。优点是客观测量，灵敏度和特异性高，资源成本相对较低。需要在这一领域进行进一步的探索，以评估衰弱评估与临床显著结果（包括发病率和死亡率）之间的相关性。
{"title":"A cross-sectional comparison of the use of frailty assessment tools in older people living with HIV","authors":"Chloe Knox, Juliet Wright, Tom Levett","doi":"10.1111/hiv.70125","DOIUrl":"10.1111/hiv.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Advancements in the management of HIV have resulted in an increasing aging population with rising rates of frailty. Frailty represents a state of vulnerability to stressor events. There is a lack of consensus regarding the most appropriate assessment tool for frailty in this population. Our aim was to compare a number of frailty assessment tools among a sample population of older people living with HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two hundred and fifty three participants aged over 50 years (median 59.6 years) were recruited between October 2014 and September 2015. Frailty was defined by modified Fried Frailty Phenotype (FFP). Participants were assessed via seven further screening tools (Clinical Frailty Scale, Edmonton Frailty Score, FRAIL scale, Gait Speed, SHARE-FI, Study of Osteoporotic Fractures Index and Timed Up and Go [TUG]). We evaluated the diagnostic performance of each tool by generating ROC curves and calculating specificity and sensitivity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using the FFP tool, 48/253 met frailty criteria, reflecting a prevalence of 19% (95% CI 14.6–24.3). A total of 32% of individuals were identified as frail by any of the eight tools. Sensitivity of the tools was highly variable, though all showed good specificity. Timed Up and Go (TUG) assessment performed most closely to FFP (AUROC 0.82 [95% CI 0.753–0.889]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TUG is a potentially useful frailty screening tool in the assessment of older people living with HIV. Strengths include an objective measure with high sensitivity and specificity and relatively low resource cost. Further exploration in this field is required to assess the correlation between frailty assessment and clinically significant outcomes, including morbidity and mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"27 1","pages":"146-155"},"PeriodicalIF":3.2,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145503635","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}
Yunqing Ma, Matthew Lohman, Monique J. Brown, Yichen Li, Xiaoming Li, Bankole Olatosi, Jiajia Zhang
Introduction
People with HIV experience a high rate of comorbidities that can complicate their health outcomes. Understanding the prevalence, interrelationships and temporal development of these comorbidities is crucial for improving health management and quality of life for people with HIV.
Methods
We used a population-based cohort extracted from statewide electronic health record (EHR) data in South Carolina (SC), including 18 649 people with HIV who survived at least 1 year after HIV diagnosis between January 1, 2005, and December 31, 2020. Comorbidities and organ systems were classified using ICD-10 codes. Network analysis was performed to assess the closeness centrality among comorbidities. Temporal network analysis was conducted every 3 years to compare the increases or decreases in comorbidities over time.
Results
The most common comorbidities included infectious diseases (74.4% such as candidiasis, Hepatitis C and other sexually transmitted infections [STIs]), digestive system disorders (67.9%), mental and behavioural disorders (65.0%), respiratory system disorders (62.9%) and musculoskeletal system disorders (62.3%). The most frequent non-communicable conditions were hypertensive disorders (54.7%), nicotine dependence (54.3%), back pain (41.1%), anaemias (39.7%) and gastro-oesophageal reflux disease (GERD) (26.0%). The temporal analysis showed a rise in 10 comorbidities from 2006 to 2020, including hypertensive disease (19.7% to 24.7%) and dyslipidaemia (4.5% to 11.2%). Nicotine dependence, hypertensive disease, anaemia and major depressive disorder were the most prevalent over time.
Conclusions
Our study underscores the high prevalence and complex interrelationships of comorbidities among people with HIV in SC. This emphasizes the need for ongoing monitoring and specific interventions to address comorbidities, focusing on shared risk factors and established pathological pathways.
{"title":"Temporal network analysis of comorbidities among people with HIV in South Carolina","authors":"Yunqing Ma, Matthew Lohman, Monique J. Brown, Yichen Li, Xiaoming Li, Bankole Olatosi, Jiajia Zhang","doi":"10.1111/hiv.70147","DOIUrl":"10.1111/hiv.70147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People with HIV experience a high rate of comorbidities that can complicate their health outcomes. Understanding the prevalence, interrelationships and temporal development of these comorbidities is crucial for improving health management and quality of life for people with HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a population-based cohort extracted from statewide electronic health record (EHR) data in South Carolina (SC), including 18 649 people with HIV who survived at least 1 year after HIV diagnosis between January 1, 2005, and December 31, 2020. Comorbidities and organ systems were classified using ICD-10 codes. Network analysis was performed to assess the closeness centrality among comorbidities. Temporal network analysis was conducted every 3 years to compare the increases or decreases in comorbidities over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The most common comorbidities included infectious diseases (74.4% such as candidiasis, Hepatitis C and other sexually transmitted infections [STIs]), digestive system disorders (67.9%), mental and behavioural disorders (65.0%), respiratory system disorders (62.9%) and musculoskeletal system disorders (62.3%). The most frequent non-communicable conditions were hypertensive disorders (54.7%), nicotine dependence (54.3%), back pain (41.1%), anaemias (39.7%) and gastro-oesophageal reflux disease (GERD) (26.0%). The temporal analysis showed a rise in 10 comorbidities from 2006 to 2020, including hypertensive disease (19.7% to 24.7%) and dyslipidaemia (4.5% to 11.2%). Nicotine dependence, hypertensive disease, anaemia and major depressive disorder were the most prevalent over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study underscores the high prevalence and complex interrelationships of comorbidities among people with HIV in SC. This emphasizes the need for ongoing monitoring and specific interventions to address comorbidities, focusing on shared risk factors and established pathological pathways.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"27 2","pages":"257-269"},"PeriodicalIF":3.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12861128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145503659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mailin Waldecker, Katayoun Taghavi, Chloe Pasin, Philip E. Tarr, Anna Hachfeld, Aline Munting, Irene A. Abela, Maja Weisser, Bettina Schlatter, Olivier Nawej, Enos Bernasconi, Eliane Rohner, Karoline Aebi-Popp, the Swiss HIV Cohort Study (SHCS)
Objectives
We assessed factors associated with attendance at gynaecological visits and cervical cancer screening, and estimated the incidence of cervical dysplasia and cancer among women with HIV (WWH) in Switzerland over two decades.
Methods
We used self-reported gynaecological information, collected biannually, in the Swiss HIV Cohort Study between April 2001 and June 2022. We used mixed-effects logistic regression to examine factors associated with attending yearly gynaecological visits and having cervical smears performed. We estimated cervical dysplasia and cancer incidence rates per 100 000 person-years and used Cox regression to assess factors associated with incident dysplasia and cancer.
Results
Among 4052 included WWH, cervical smears were collected in 83% of 33 097 pregnancy-unrelated visits. Gynaecological visits were less common among older women, among those with lower education, or with a history of intravenous drug use. If a gynaecological visit occurred, cervical smears were less common among women of Black than White ethnicity. Among 3970 women included in the incidence analysis, 218 cervical dysplasias (crude rate: 466/100 000 person-years) and 14 cervical cancers (crude rate: 28/100 000 person-years) were recorded. Women who had cervical smears documented in a higher proportion of time periods were more likely to have a cervical dysplasia diagnosis but less likely to have a cervical cancer diagnosis documented.
Conclusions
We found substantial disparities in the uptake of gynaecological visits and cervical smears by age, education level, ethnicity and intravenous drug use. Implementing more targeted and integrated cervical cancer screening and gynaecological care models may help reduce these disparities and improve prevention of cervical cancer among WWH in Switzerland.
{"title":"Factors associated with uptake of gynaecological care and cervical cancer screening among women in the Swiss HIV Cohort Study","authors":"Mailin Waldecker, Katayoun Taghavi, Chloe Pasin, Philip E. Tarr, Anna Hachfeld, Aline Munting, Irene A. Abela, Maja Weisser, Bettina Schlatter, Olivier Nawej, Enos Bernasconi, Eliane Rohner, Karoline Aebi-Popp, the Swiss HIV Cohort Study (SHCS)","doi":"10.1111/hiv.70137","DOIUrl":"10.1111/hiv.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We assessed factors associated with attendance at gynaecological visits and cervical cancer screening, and estimated the incidence of cervical dysplasia and cancer among women with HIV (WWH) in Switzerland over two decades.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used self-reported gynaecological information, collected biannually, in the Swiss HIV Cohort Study between April 2001 and June 2022. We used mixed-effects logistic regression to examine factors associated with attending yearly gynaecological visits and having cervical smears performed. We estimated cervical dysplasia and cancer incidence rates per 100 000 person-years and used Cox regression to assess factors associated with incident dysplasia and cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 4052 included WWH, cervical smears were collected in 83% of 33 097 pregnancy-unrelated visits. Gynaecological visits were less common among older women, among those with lower education, or with a history of intravenous drug use. If a gynaecological visit occurred, cervical smears were less common among women of Black than White ethnicity. Among 3970 women included in the incidence analysis, 218 cervical dysplasias (crude rate: 466/100 000 person-years) and 14 cervical cancers (crude rate: 28/100 000 person-years) were recorded. Women who had cervical smears documented in a higher proportion of time periods were more likely to have a cervical dysplasia diagnosis but less likely to have a cervical cancer diagnosis documented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found substantial disparities in the uptake of gynaecological visits and cervical smears by age, education level, ethnicity and intravenous drug use. Implementing more targeted and integrated cervical cancer screening and gynaecological care models may help reduce these disparities and improve prevention of cervical cancer among WWH in Switzerland.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 12","pages":"1963-1972"},"PeriodicalIF":3.2,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Juul Christensen, Laura Risbjerg Omann, Jessica Carlsson, Joseph Baruch Baluku, Ole Kirk, Per Kallestrup, Christian Kraef
Objective
To examine the prevalence of current substance and hazardous alcohol use in people with HIV and tuberculosis (TB) disease and its impact on TB treatment outcomes.
Methods
A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, EMBASE, Scopus, PsycInfo and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to 3 April 2025. Risk of bias was assessed using the ROBINS-E tool. Prevalence estimates were synthesized using a random-effects model with between-study heterogeneity assessed via the I2 statistic.
Results
Eighteen studies were included. Prevalence of current hazardous alcohol use ranged from 7.4% to 33.7%, with a pooled estimate of 19.1% (95% CI [16.1%–22.5%], I2 = 92.5%) across 5310 individuals. Current substance use (excluding alcohol) ranged from 1.2% to 90.9%, with a pooled prevalence of 25.1% (95% CI [15.3%–38.8%], I2 = 96.8%) among 3709 individuals. Pooled prevalence estimates varied across WHO regions, with the Western Pacific Region reporting the highest prevalence of hazardous alcohol use (20.4%) and the Region of the Americas leading in substance use (29.9%). Only three studies assessed TB treatment, all showing poorer outcomes among people with substance use disorders. Heterogeneity and small sample size precluded pooled analysis. Most studies had high or very high risk of bias, primarily due to confounding, missing data and inconsistent definitions of substance and hazardous alcohol use.
Conclusion
Current substance and hazardous alcohol use occurs frequently among people with HIV and TB, varying widely depending on the population. However, current substance and hazardous alcohol use, as opposed to any history of substance use, is rarely assessed systematically.
目的：了解艾滋病毒和结核病（TB）患者当前物质和有害酒精使用的患病率及其对结核病治疗结果的影响。方法：按照系统评价和荟萃分析（PRISMA）指南的首选报告项目进行系统评价。我们检索了MEDLINE， EMBASE, Scopus， PsycInfo和Cochrane Central Register of Controlled Trials （Central）从成立到2025年4月3日。使用ROBINS-E工具评估偏倚风险。患病率估计采用随机效应模型合成，并通过I2统计量评估研究间异质性。结果：纳入18项研究。目前危险酒精使用的流行率从7.4%到33.7%不等，在5310个人中，汇总估计为19.1% （95% CI [16.1%-22.5%], I2 = 92.5%）。目前的物质使用（不包括酒精）范围为1.2%至90.9%，3709人的总患病率为25.1% （95% CI [15.3%-38.8%], I2 = 96.8%）。世卫组织各区域的综合流行率估计值各不相同，西太平洋区域报告的有害酒精使用流行率最高（20.4%），美洲区域报告的物质使用流行率最高（29.9%）。只有三项研究评估了结核病治疗，所有研究都表明，药物使用障碍患者的治疗效果较差。异质性和小样本量妨碍了合并分析。大多数研究存在很高或非常高的偏倚风险，主要是由于混淆、数据缺失以及对物质和有害酒精使用的定义不一致。结论：目前在艾滋病毒和结核病患者中经常发生物质和有害酒精使用，根据人群差异很大。然而，目前的物质和有害酒精使用情况，而不是任何物质使用史，很少得到系统评估。
{"title":"Prevalence of current substance and hazardous alcohol use among people with HIV and tuberculosis disease and its impact on tuberculosis treatment outcomes: A systematic review","authors":"Anna Juul Christensen, Laura Risbjerg Omann, Jessica Carlsson, Joseph Baruch Baluku, Ole Kirk, Per Kallestrup, Christian Kraef","doi":"10.1111/hiv.70139","DOIUrl":"10.1111/hiv.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the prevalence of current substance and hazardous alcohol use in people with HIV and tuberculosis (TB) disease and its impact on TB treatment outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, EMBASE, Scopus, PsycInfo and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to 3 April 2025. Risk of bias was assessed using the ROBINS-E tool. Prevalence estimates were synthesized using a random-effects model with between-study heterogeneity assessed via the <i>I</i><sup>2</sup> statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen studies were included. Prevalence of current hazardous alcohol use ranged from 7.4% to 33.7%, with a pooled estimate of 19.1% (95% CI [16.1%–22.5%], <i>I</i><sup>2</sup> = 92.5%) across 5310 individuals. Current substance use (excluding alcohol) ranged from 1.2% to 90.9%, with a pooled prevalence of 25.1% (95% CI [15.3%–38.8%], <i>I</i><sup>2</sup> = 96.8%) among 3709 individuals. Pooled prevalence estimates varied across WHO regions, with the Western Pacific Region reporting the highest prevalence of hazardous alcohol use (20.4%) and the Region of the Americas leading in substance use (29.9%). Only three studies assessed TB treatment, all showing poorer outcomes among people with substance use disorders. Heterogeneity and small sample size precluded pooled analysis. Most studies had high or very high risk of bias, primarily due to confounding, missing data and inconsistent definitions of substance and hazardous alcohol use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current substance and hazardous alcohol use occurs frequently among people with HIV and TB, varying widely depending on the population. However, current substance and hazardous alcohol use, as opposed to any history of substance use, is rarely assessed systematically.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"27 2","pages":"200-216"},"PeriodicalIF":3.2,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444727","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}
John Andoh, Katayoun Taghavi, Misinzo Moono, Partha Basu, Thamsanqa Madliwa, Mulindi H. Mwanahamuntu, Nicola Low, Albert Manasyan, Eliane Rohner
Objectives
Cervical screening and precancer treatment are less effective in women living with HIV (WLWH) than in women without HIV. We assessed high-risk human papillomavirus (HR-HPV) infection and cervical disease progression among screened WLWH in Zambia.
Methods
Participants underwent visual inspection with acetic acid (VIA), HR-HPV testing and cervical biopsies at baseline and at follow-up 30–36 months later. Women with positive VIA results or high-grade histology were offered treatment. We assessed HR-HPV and cervical disease prevalence at both timepoints and used multivariable logistic regression to identify factors associated with cervical disease progression and regression.
Results
Among 241 included women, HR-HPV prevalence declined from 44% (95% confidence interval [CI]: 39%–49%) at baseline to 24% (95% CI: 19%–31%) at follow-up. High-grade disease decreased from 25% (95% CI: 20%–31%) to 9% (95% CI: 5%–13%). In analyses adjusted for age, CD4 cell count, HIV RNA viral load, HR-HPV infection and histological results at baseline, precancer treatment was associated with increased odds of disease regression (adjusted odds ratio [aOR]: 2.74, 95% CI: 1.08–7.06) and reduced odds of progression (aOR: 0.45, 95% CI: 0.11–1.64). One-third of women with high-grade disease at follow-up (7/21) had previously undergone precancer treatment.
Conclusions
Cervical screening and precancer treatment are key to reducing cervical disease progression among WLWH and ultimately achieving cervical cancer elimination, but efforts to improve treatment effectiveness among WLWH must be balanced with the risk of overtreatment.
{"title":"Cervical intraepithelial neoplasia progression and regression among women living with HIV in Zambia","authors":"John Andoh, Katayoun Taghavi, Misinzo Moono, Partha Basu, Thamsanqa Madliwa, Mulindi H. Mwanahamuntu, Nicola Low, Albert Manasyan, Eliane Rohner","doi":"10.1111/hiv.70134","DOIUrl":"10.1111/hiv.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Cervical screening and precancer treatment are less effective in women living with HIV (WLWH) than in women without HIV. We assessed high-risk human papillomavirus (HR-HPV) infection and cervical disease progression among screened WLWH in Zambia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants underwent visual inspection with acetic acid (VIA), HR-HPV testing and cervical biopsies at baseline and at follow-up 30–36 months later. Women with positive VIA results or high-grade histology were offered treatment. We assessed HR-HPV and cervical disease prevalence at both timepoints and used multivariable logistic regression to identify factors associated with cervical disease progression and regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 241 included women, HR-HPV prevalence declined from 44% (95% confidence interval [CI]: 39%–49%) at baseline to 24% (95% CI: 19%–31%) at follow-up. High-grade disease decreased from 25% (95% CI: 20%–31%) to 9% (95% CI: 5%–13%). In analyses adjusted for age, CD4 cell count, HIV RNA viral load, HR-HPV infection and histological results at baseline, precancer treatment was associated with increased odds of disease regression (adjusted odds ratio [aOR]: 2.74, 95% CI: 1.08–7.06) and reduced odds of progression (aOR: 0.45, 95% CI: 0.11–1.64). One-third of women with high-grade disease at follow-up (7/21) had previously undergone precancer treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cervical screening and precancer treatment are key to reducing cervical disease progression among WLWH and ultimately achieving cervical cancer elimination, but efforts to improve treatment effectiveness among WLWH must be balanced with the risk of overtreatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 12","pages":"1939-1949"},"PeriodicalIF":3.2,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.70134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebekka Mispelbaum, Tessa Hattenhauer, Christian Hoffmann, Clara Lehmann, Franz-Georg Bauernfeind, Peter Brossart, Maximilian Christopeit, Winfried Alsdorf, Carsten Bokemeyer, Julian P. Layer, Julia Roider, Marcus Hentrich, Malte Benedikt Monin
Objectives
With the near normalization of life expectancy in people living with HIV through antiretroviral therapy, the management of age-related comorbidities has become increasingly important. Non-AIDS-defining cancers now contribute significantly to both morbidity and mortality in this population, with non-small cell lung cancer (NSCLC) being one of the leading causes of cancer-related deaths among people living with HIV.
Methods
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of NSCLC in the general population. However, people living with HIV have been largely excluded from pivotal clinical trials, resulting in limited evidence regarding safety and efficacy in this population. This review summarizes the main available literature on ICI therapy in people living with HIV with NSCLC.
Results
The presented data from retrospective analyses and cohort studies suggest that people living with HIV benefit from ICI therapy, with similar response rates and survival outcomes as people living without HIV. The risk of immune-related adverse events in people living with HIV was reported to be comparable to people living without HIV. Importantly, no significant effects of ICI on HIV viral load or CD4+ T cell count were reported.
Conclusions
ICI therapy appears to be both safe and effective in people living with HIV with NSCLC. Optimal management of this patient population requires close interdisciplinary collaboration between oncologists and HIV care specialists. To enhance our understanding, broader inclusion of people living with HIV in clinical trials and the conduct of dedicated HIV-specific studies would be essential.
{"title":"Effective and safe use of immune checkpoint inhibitors for non-small cell lung cancer in people living with HIV","authors":"Rebekka Mispelbaum, Tessa Hattenhauer, Christian Hoffmann, Clara Lehmann, Franz-Georg Bauernfeind, Peter Brossart, Maximilian Christopeit, Winfried Alsdorf, Carsten Bokemeyer, Julian P. Layer, Julia Roider, Marcus Hentrich, Malte Benedikt Monin","doi":"10.1111/hiv.70136","DOIUrl":"10.1111/hiv.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>With the near normalization of life expectancy in people living with HIV through antiretroviral therapy, the management of age-related comorbidities has become increasingly important. Non-AIDS-defining cancers now contribute significantly to both morbidity and mortality in this population, with non-small cell lung cancer (NSCLC) being one of the leading causes of cancer-related deaths among people living with HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of NSCLC in the general population. However, people living with HIV have been largely excluded from pivotal clinical trials, resulting in limited evidence regarding safety and efficacy in this population. This review summarizes the main available literature on ICI therapy in people living with HIV with NSCLC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The presented data from retrospective analyses and cohort studies suggest that people living with HIV benefit from ICI therapy, with similar response rates and survival outcomes as people living without HIV. The risk of immune-related adverse events in people living with HIV was reported to be comparable to people living without HIV. Importantly, no significant effects of ICI on HIV viral load or CD4<sup>+</sup> T cell count were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ICI therapy appears to be both safe and effective in people living with HIV with NSCLC. Optimal management of this patient population requires close interdisciplinary collaboration between oncologists and HIV care specialists. To enhance our understanding, broader inclusion of people living with HIV in clinical trials and the conduct of dedicated HIV-specific studies would be essential.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 12","pages":"1909-1919"},"PeriodicalIF":3.2,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simon Boni, Pierre Debaudrap, Firmin N. Kabore, Evelyne Kasile-Pooda, Armel Poda, Belarsi Ouattara, Eugene Messou, Brahima Doukoure, Antoine Jaquet, Apollinaire Horo, on behalf IeDEA West Africa Collaboration
Introduction
Mounting evidence supports the use of thermal ablation in women positively screened with high-risk Human Papillomaviruses (hrHPV) but limited data are available on the long-term post-treatment outcomes in women living with HIV (WLHIV). We aimed to estimate the persistence of hrHPV infection amongst WLHIV ≥24 months post treatment in West Africa.
Methods
From October 2019 to October 2024, a cohort study was conducted amongst WLHIV in two HIV clinics in Burkina Faso and Cote d'Ivoire. All WLHIV with a positive hrHPV test who received thermal ablation were followed up ≥24 months. During follow-up visits, DNA HPV testing, visual inspection and biopsy were systematically performed. Factors associated with ≥24 months hrHPV positivity were assessed through a logistic regression model.
Results
A total of 200 WLHIV, aged 42 years [Interquartile range (IQR): 38–45], with a nadir CD4 of 365 [IQR: 168–616] cell/mm3 received thermal ablation and were followed for a median time of 42 [IQR: 29–48] months. A positive hrHPV was detected in 40.5% of women ≥24 months post treatment. WLHIV who had a nadir CD4 count ≤200 cell/mm3 (aOR = 3.06 [95% CI: 1.23–7.59]) or had no or a primary school level (aOR = 2.25 [95% CI: 1.13–4.49]) were more likely to present at ≥24 months with hrHPV infection.
Conclusion
Post-therapeutic hrHPV infection remains high beyond 2 years in WLHIV stressing the need for long-term follow-up, especially when diagnosed with advanced HIV disease. Future implementation research should focus on the contribution of additional tools to better track those in need of additional treatment.
{"title":"Long-term risk and predictors of high-risk human papillomavirus persistence after thermal ablation amongst women living with HIV in West Africa","authors":"Simon Boni, Pierre Debaudrap, Firmin N. Kabore, Evelyne Kasile-Pooda, Armel Poda, Belarsi Ouattara, Eugene Messou, Brahima Doukoure, Antoine Jaquet, Apollinaire Horo, on behalf IeDEA West Africa Collaboration","doi":"10.1111/hiv.70138","DOIUrl":"10.1111/hiv.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Mounting evidence supports the use of thermal ablation in women positively screened with high-risk Human Papillomaviruses (hrHPV) but limited data are available on the long-term post-treatment outcomes in women living with HIV (WLHIV). We aimed to estimate the persistence of hrHPV infection amongst WLHIV ≥24 months post treatment in West Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From October 2019 to October 2024, a cohort study was conducted amongst WLHIV in two HIV clinics in Burkina Faso and Cote d'Ivoire. All WLHIV with a positive hrHPV test who received thermal ablation were followed up ≥24 months. During follow-up visits, DNA HPV testing, visual inspection and biopsy were systematically performed. Factors associated with ≥24 months hrHPV positivity were assessed through a logistic regression model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 200 WLHIV, aged 42 years [Interquartile range (IQR): 38–45], with a nadir CD4 of 365 [IQR: 168–616] cell/mm<sup>3</sup> received thermal ablation and were followed for a median time of 42 [IQR: 29–48] months. A positive hrHPV was detected in 40.5% of women ≥24 months post treatment. WLHIV who had a nadir CD4 count ≤200 cell/mm<sup>3</sup> (aOR = 3.06 [95% CI: 1.23–7.59]) or had no or a primary school level (aOR = 2.25 [95% CI: 1.13–4.49]) were more likely to present at ≥24 months with hrHPV infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Post-therapeutic hrHPV infection remains high beyond 2 years in WLHIV stressing the need for long-term follow-up, especially when diagnosed with advanced HIV disease. Future implementation research should focus on the contribution of additional tools to better track those in need of additional treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 12","pages":"1950-1962"},"PeriodicalIF":3.2,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.70138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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