HIV Medicine最新文献

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.

Objectives

To develop Australian anal cancer screening guidelines for people living with HIV.

Methods

In 2023, ASHM Health assembled a committee to create guidelines, based on existing international guidelines and utilizing data from the Study of the Prevention of Anal Cancer (SPANC). SPANC provided Australian-specific data on different screening methodologies for the detection of anal high-grade squamous intraepithelial lesions.

Results

The guidelines were released in March 2025. They recommend primary high-risk human papillomavirus (HRHPV) testing with cytology triage for high-resolution anoscopy. Gay, bisexual and other men who have sex with men (GBM) and trans-women living with HIV should be offered screening from 35 years of age. Cis-women, trans-men and other cis-men (not GBM) living with HIV should be offered screening from 45 years of age. All anal cancer screening should include annual digital ano-rectal examination, examination of the peri-anal region and a thorough medical history. Screening should be repeated every 3 years for those who screen negative.

Screening should be discontinued, with shared decision-making, at age 75 years and/or in individuals with two consecutive negative screening visits who are not currently sexually active.

Conclusions

These are the first guidelines to recommend primary HRHPV testing with cytology triage as the screening modality. They will assist clinicians in identifying and screening people living with HIV at higher risk of anal cancer and will enable screening and referral of people living with HIV at highest risk for high-resolution anoscopy, while screening and treatment services capacity are expanded in Australia.

Background

Long-acting injectable cabotegravir and rilpivirine (LAI CAB + RPV) is an established maintenance strategy for people with HIV who are virologically suppressed, providing high efficacy and convenience in treatment. However, evidence in older adults (≥60 years), a growing and complex population, is limited.

Methods

We conducted an ambispective real-world sub-analysis of the Spanish RELATIVITY cohort, including people with HIV aged ≥60 years who initiated LAI CAB + RPV across 58 centres. Outcomes (virological suppression, safety, discontinuation and adherence) were compared with those <60 years of age using Kaplan–Meier and Cox models.

Results

Among the 3146 participants, 370 (11.8%) were aged ≥60 years (median age 63.0 [61.0, 67.0]; 78.3% male). Older adults had longer ART exposure (median 18.0 [11.0, 25.0] years), more comorbidities (79.5%) and lower historical CD4 nadirs than younger adults. After 15 months of follow-up, the rates of virological suppression remained high and comparable between the groups (97.3% in those aged ≥60 years vs. 96.8% in those <60 years), with very low protocol-defined virological failure rates (0.3% vs. 0.7%). Discontinuations (7.8% vs. 6.1%) and adverse events (1.6% vs. 0.8%) were infrequent and showed no significant differences between age groups. Adherence to injection visits was excellent, with >89% of the participants aged ≥60 years demonstrating perfect adherence.

Conclusion

In this large multicentre real-world sub-study, LAI CAB + RPV maintained virological control and showed good tolerability in older people with HIV despite high multi-morbidity and long-term ART exposure. These findings extend the evidence from previous trials and support LAI CAB + RPV as a feasible option for geriatric HIV care. Longer follow-up will provide further insights into durability and quality-of-life benefits.

Objective

With increasing life expectancy among HIV-positive persons in China, comorbidities, polypharmacy and potential drug–drug interactions (DDIs) present growing challenges. We evaluated these issues in the integrase strand transfer inhibitor (INSTI) era of antiretroviral therapy (ART).

Methods

In this multi-site, cross-sectional study, we enrolled 5238 HIV-positive persons from four geographically diverse regions of China. Using the University of Liverpool HIV Drug Interactions Database, we categorized potential DDIs as follows: no interaction (green), weak interaction (yellow), interaction requiring dose adjustment/monitoring (amber) or contraindicated (red).

Results

The mean age of participants was 41.7 years; 1121 (21.4%) had at least one comorbidity. Notable treatment gaps were observed: 516 (46.0%) comorbid cases received no treatment, with particularly low treatment rates for hypertension (21.8%, 81/372), dyslipidaemia (45.3%, 86/190), diabetes (15.2%, 24/158), cardiovascular disease (23.0%, 20/87) and endocrine/metabolic disorders (58.6%, 85/142). Non-ART medication use was reported by 604 (11.5%), most commonly antihypertensives (6.1%, 320/5238), antidiabetics (3.4%, 176/5238). Among medication users, 253 (41.8%) had potential DDIs: red-flagged (1.0%, 4/604), amber-flagged (32.5%, 198/604) and yellow-flagged (8.3%, 51/604). Multivariable analysis revealed older age, overweight/obesity, urban insurance, lower income, lower CD4 counts and INSTI-based regimens were positively associated with comorbidities and comedication use. Potential DDI risk increased with older age, longer ART duration, smoking, polypharmacy and non-nucleoside reverse transcriptase inhibitors/protease inhibitor-based regimens.

Conclusions

Our findings reveal high comorbidity prevalence with significant treatment gaps and frequent potential DDIs among Chinese HIV-positive persons, particularly involving cardiometabolic medications and non-INSTI ART regimens. These results underscore the urgent need for integrated HIV/chronic care models incorporating routine DDI screening to improve clinical outcomes.

Background

The European AIDS Clinical Society (EACS) guidelines were revised for the 21st time in 2025, with updates covering all aspects of HIV care.

Key Points of the Guidelines Update

The structure of the guidelines has been reorganized into two parts: Part I focuses on the management and prevention of HIV and related infections, and Part II addresses comorbidities and other relevant topics. In Part I, Version 13.0 recommends the following first-line regimens for adults with HIV-1: tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) with either lamivudine or emtricitabine (XTC), in combination with dolutegravir (DTG), bictegravir (BIC), or doravirine (DOR); or a dual therapy option consisting of XTC plus DTG. Version 13.0 introduces a completely new section on HIV-2. The preferred first-line regimens for HIV-2 include triple therapy with a second-generation integrase inhibitor: either TAF/FTC/BIC or TDF/XTC + DTG. The PrEP section has been updated to include the use of long-acting injectable antiretrovirals. Drug–drug interaction (DDI) tables have been updated to include long-acting antiretrovirals and considerations related to substance use, including drugs used to enhance or prolong sexual activity (chemsex). Tables for preferred and alternative ART regimens in children and adolescents have been updated, with particular attention to neonates. A new section on transition to adult care has also been included. The co-infections section has undergone extensive revision, especially regarding HBV, sexually transmitted infections, opportunistic infections (particularly tuberculosis, leishmaniasis, and cryptococcosis) and mpox, incorporating recent clinical trial data on tecovirimat. In Part II, Version 13.0 introduces major updates to the comorbidities section. In the cancer section, screening recommendations for anal and breast cancer have been updated. Cardiovascular and metabolic health sections have been significantly modified, reflecting recent advances and the use of statins in people with HIV. Topics such as kidney and liver complications, mental health, travel and solid organ transplantation have been thoroughly revised. New sections on sleep health and a unified substance use section have been added.

Conclusions

In 2025, the EACS Guidelines underwent a comprehensive update and restructuring. They now consist of two distinct parts and include several new sections. The recommendations are available as a free mobile app and in an interactive web format.