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HIV outcomes during the COVID-19 pandemic in people of Black ethnicities living with HIV in England 在 COVID-19 大流行期间，英格兰黑人艾滋病感染者的艾滋病治疗效果。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES
HIV Medicine
Pub Date : 2024-03-26 DOI: 10.1111/hiv.13640
Zoe Ottaway, Lucy Campbell, Julie Fox, Fiona Burns, Lisa Hamzah, Stephen Kegg, Melanie Rosenvinge, Sarah Schoeman, David Price, Rachael Jones, Robert F. Miller, Shema Tariq, Frank A. Post

Objectives

To describe HIV care outcomes in people of Black ethnicities living in England during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) pandemic.

Methods

This was an observational cohort study of people of self-reported Black ethnicities attending for HIV care at nine HIV clinics across England. The primary outcome was a composite of antiretroviral therapy (ART) interruption and HIV viraemia (HIV RNA ≥200 copies/mL) ascertained via self-completed questionnaires and review of medical records. We used multivariable logistic regression to explore associations between ART interruption/HIV viraemia and demographic factors, pre-pandemic HIV immunovirological control, comorbidity status, and COVID-19 disease and vaccination status.

Results

We included 2290 people (median age 49.3 years; 56% female; median CD4 cell count 555 cells/mm3; 92% pre-pandemic HIV RNA <200 copies/mL), of whom 302 (13%) reported one or more ART interruption, 312 (14%) had documented HIV viraemia ≥200 copies/mL, and 401 (18%) experienced the composite endpoint of ART interruption/HIV viraemia. In multivariable analysis, a pre-pandemic HIV RNA <200 copies/mL (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.15–0.30) and being vaccinated against SARS-CoV-2 (OR 0.41; 95% CI 0.30–0.55) were associated with reduced odds of ART interruption/HIV viraemia; pandemic-related disruptions to HIV care were common self-reported additional factors.

Conclusions

During the COVID-19 pandemic, one in six people of Black ethnicities in this HIV cohort experienced an ART interruption/HIV viraemia. Some of these episodes resulted from pandemic-related healthcare disruptions. Associations with suboptimal engagement in HIV care pre-pandemic and not being vaccinated against SARS-CoV-2 suggest that wider health beliefs and/or poor healthcare access may have been contributory factors.

目的描述严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2；冠状病毒病 2019 [COVID-19]）大流行期间居住在英格兰的黑人的艾滋病护理结果：这是一项观察性队列研究，研究对象是在英格兰九家艾滋病诊所接受艾滋病治疗的自称为黑人的人群。主要结果是抗逆转录病毒疗法（ART）中断和艾滋病毒病毒血症（艾滋病毒 RNA ≥200 copies/mL）的综合结果，通过自填问卷和查阅医疗记录确定。我们使用多变量逻辑回归法探讨了抗逆转录病毒疗法中断/HIV病毒血症与人口统计学因素、大流行前HIV免疫病学控制、合并症状况以及COVID-19疾病和疫苗接种状况之间的关联：我们共纳入了 2290 人（中位年龄 49.3 岁；56% 为女性；中位 CD4 细胞计数 555 cells/mm3；92% 在大流行前获得 HIV RNA 结论）：在 COVID-19 大流行期间，该艾滋病毒队列中每六个黑人中就有一人经历过抗病毒疗法中断/艾滋病毒病毒血症。其中一些情况是由于与大流行相关的医疗保健中断造成的。与大流行前未最佳参与艾滋病护理和未接种 SARS-CoV-2 疫苗有关的情况表明，更广泛的健康观念和/或医疗保健服务不完善可能是促成因素。
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引用次数: 0
Assessment of weight gain in adult patients living with HIV receiving first-line dolutegravir-based or efavirenz-based ART regimens in routine care clinics in Tshwane district, South Africa: An observational study 南非 Tshwane 地区常规护理诊所中接受基于多鲁特韦酯或依非韦伦的一线抗逆转录病毒疗法的成年 HIV 感染者体重增加情况评估：一项观察性研究。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES
HIV Medicine
Pub Date : 2024-03-22 DOI: 10.1111/hiv.13638
Shobna Sawry, Kassahun Ayalew, Gloria Maimela, Melissa Briggs-Hagen, Marelize van Wyk-Heath, Simangele Mthethwa, Sannie Shai, Nkululeko N. Mngomezulu, Lawrence Tlhowe, Josephine Achere-Darko, Jason Bedford, Catherine E. Martin, Lee Fairlie, John Imrie

Introduction

Although dolutegravir (DTG) is deemed stable, safe, cost-effective, and clinically beneficial, it also carries the risk of side effects, including observed weight gain among patients on DTG-based antiretroviral therapy (ART) regimens. We compared weight changes among adults (≥18 years) initiating tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, and efavirenz (TEE) regimens and those switching from TEE to TLD (TEE-to-TLD switchers) in three large primary care facilities in South Africa

Methods

We conducted a retrospective longitudinal record review using patient medical records, extracting relevant demographic and clinical data from October 2018 to June 2021 from randomly selected adults who initiated TLD or TEE (initiators) and adult TEE-to-TLD switchers. We assessed weight, body mass index (BMI), and percentage weight changes for both groups and fitted linear regression and generalized linear models to determine factors associated with weight and BMI change and percentage weight change ≥10%, respectively, among treatment initiators. We fitted linear mixed-effect models among TEE-to-TLD switchers to consider repeated measures.

Results

Of 860 initiators, 450 (52.3%) initiated on TEE and 410 (47.7%) on TLD, with median follow-up of 1.4 years and 1.0 year, respectively. At initiation, 43.3% on TEE and 40.8% on TLD were overweight or obese. TLD initiators had an adjusted higher mean weight gain of 1.6 kg (p < 0.001) and mean BMI gain of 0.51 kg/m2 (p < 0.001) than TEE initiators. Independent risk factors for higher mean weight and BMI included age ≥50 years, male, on ART for >12 months, initial BMI of <18.5 kg/m2, and CD4 counts <200 cells/μL.

Of 298 TEE-to-TLD switchers, 36.6% were overweight or obese at TEE initiation. Comparing before and after TLD switch, TEE-to-TLD switchers had an adjusted mean weight of 1.2 kg less while on TLD (p = 0.026). Being overweight and CD4 counts >350 cells/μL were independent risk factors for lower weight gain after TLD switch.

Conclusions

We report more weight gain among TLD than among TEE initiators, although to a lesser extent than previously reported. TEE-to-TLD switchers experienced less weight gain after TLD switch; return to health before receiving TLD may be a contributory factor. The current fin

简介尽管多鲁曲韦（DTG）被认为是稳定、安全、具有成本效益且对临床有益的药物，但它也有副作用的风险，包括在接受基于 DTG 的抗逆转录病毒疗法（ART）治疗的患者中观察到的体重增加。我们比较了南非三家大型基层医疗机构中开始接受富马酸替诺福韦二吡呋酯、拉米夫定和多罗替拉韦（TLD）或富马酸替诺福韦二吡呋酯、恩曲他滨和依非韦伦（TEE）治疗方案的成人（≥18 岁）和从 TEE 转为 TLD 的成人（TEE-to-TLD 转换者）的体重变化 方法：我们利用患者病历进行了一次回顾性纵向记录审查，提取了 2018 年 10 月至 2021 年 6 月期间随机抽取的启动 TLD 或 TEE 的成人（启动者）和从 TEE 转为 TLD 的成人的相关人口统计学和临床数据。我们评估了两组患者的体重、体重指数（BMI）和体重变化百分比，并分别拟合了线性回归模型和广义线性模型，以确定与治疗启动者的体重和BMI变化以及体重变化百分比≥10%相关的因素。我们在 TEE 到 TLD 转换者中建立了线性混合效应模型，以考虑重复测量：在 860 名初始治疗者中，450 人（52.3%）开始接受 TEE 治疗，410 人（47.7%）开始接受 TLD 治疗，随访中位数分别为 1.4 年和 1.0 年。开始时，43.3% 的 TEE 和 40.8% 的 TLD 患者超重或肥胖。TLD启动者的调整后平均体重增加较高，为1.6千克（p 2（p 12个月、初始BMI为2、CD4计数为350个细胞/μL是TLD转换后体重增加较低的独立风险因素：我们的报告显示，TLD 患者的体重增加多于 TEE 患者，但增加程度低于之前的报告。从 TEE 到 TLD 的转换者在转换 TLD 后体重增加较少；在接受 TLD 之前恢复健康可能是一个促成因素。目前的研究结果让那些改用基于 DTG 的治疗方案的患者感到放心。
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引用次数: 0
Microbiomes detected by cerebrospinal fluid metagenomic next-generation sequencing among patients with and without HIV with suspected central nervous system infection 通过脑脊液元基因组新一代测序技术检测疑似中枢神经系统感染者和非感染者的微生物组。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES
HIV Medicine
Pub Date : 2024-03-21 DOI: 10.1111/hiv.13634
Shi Zou, Zhong Chen, Yuting Tan, Miao Tan, Wei Guo, Songjie Wu, Jie Liu, Shihui Song, Yongquan Peng, Min Wang, Ke Liang

Background

Opportunistic infections in the central nervous system (CNS) can be a serious threat to people living with HIV. Early aetiological diagnosis and targeted treatment are crucial but difficult. Metagenomic next-generation sequencing (mNGS) has significant advantages over traditional detection methods. However, differences in the cerebrospinal fluid (CSF) microbiome profiles of patients living with and without HIV with suspected CNS infections using mNGS and conventional testing methods have not yet been adequately evaluated.

Methods

We conducted a retrospective cohort study in the first hospital of Changsha between January 2019 and June 2022 to investigate the microbiomes detected using mNGS of the CSF of patients living with and without HIV with suspected CNS infections. The pathogens causing CNS infections were concurrently identified using both mNGS and traditional detection methods. The spectrum of pathogens identified was compared between the two groups.

Results

Overall, 173 patients (140 with and 33 without HIV) with suspected CNS infection were enrolled in our study. In total, 106 (75.7%) patients with and 16 (48.5%) patients without HIV tested positive with mNGS (p = 0.002). Among the enrolled patients, 71 (50.7%) with HIV and five (15.2%) without HIV tested positive for two or more pathogens (p < 0.001). Patients with HIV had significantly higher proportions of fungus (20.7% vs. 3.0%, p = 0.016) and DNA virus (59.3% vs. 21.2%, p < 0.001) than those without HIV. Epstein–Barr virus (33.6%) was the most commonly identified potential pathogen in the CSF of patients living with HIV using mNGS, followed by cytomegalovirus (20.7%) and torque teno virus (13.8%). The top three causative pathogens identified in patients without HIV were Streptococcus (18.2%), Epstein–Barr virus (12.1%), and Mycobacterium tuberculosis (9.1%). In total, 113 patients living with HIV were diagnosed as having CNS infections. The rate of pathogen detection in people living with HIV with a CNS infection was significantly higher with mNGS than with conventional methods (93.8% vs. 15.0%, p < 0.001).

Conclusion

CSF microbiome profiles differ between patients living with and without HIV with suspected CNS infection. mNGS is a powerful tool for the diagnosis of CNS infection among people living with HIV, especially in those with mixed infections.

背景：中枢神经系统（CNS）的机会性感染对艾滋病毒感染者构成严重威胁。早期病原学诊断和针对性治疗至关重要，但却很困难。与传统检测方法相比，元基因组新一代测序（mNGS）具有显著优势。然而，使用 mNGS 和传统检测方法检测疑似中枢神经系统感染的 HIV 感染者和非 HIV 感染者的脑脊液（CSF）微生物组概况的差异尚未得到充分评估：2019年1月至2022年6月期间，我们在长沙市第一医院开展了一项回顾性队列研究，调查使用mNGS检测疑似中枢神经系统感染的艾滋病病毒感染者和非艾滋病病毒感染者CSF微生物组的情况。采用 mNGS 和传统检测方法同时鉴定了导致中枢神经系统感染的病原体。对两组患者鉴定出的病原体谱进行比较：共有 173 名疑似中枢神经系统感染患者（140 人感染 HIV，33 人未感染 HIV）参与了研究。共有 106 名（75.7%）艾滋病病毒感染者和 16 名（48.5%）非艾滋病病毒感染者的 mNGS 检测结果呈阳性（p = 0.002）。在登记的患者中，71 名艾滋病毒感染者（50.7%）和 5 名非艾滋病毒感染者（15.2%）对两种或两种以上的病原体检测呈阳性（P=0.002）：mNGS 是诊断 HIV 感染者（尤其是混合感染者）中枢神经系统感染的有力工具。
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引用次数: 0
Sexually transmitted and blood-borne infection risk reduction with methadone and buprenorphine/naloxone among people with prescription-type opioid use disorder: Findings from a Canadian pragmatic randomized trial 用美沙酮和丁丙诺啡/纳洛酮降低处方类阿片使用障碍患者的性传播和血液传播感染风险：加拿大实用随机试验的结果。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES
HIV Medicine
Pub Date : 2024-03-20 DOI: 10.1111/hiv.13636
M. Eugenia Socias, Zishan Cui, Bernard Le Foll, Jingxin Lei, Sherry Stewart, Rohan Anand, Didier Jutras-Aswad

Introduction

People who use drugs are disproportionally affected by sexually transmitted and blood-borne infections (STBBIs). While the benefits of methadone in reducing injecting-risk behaviours are well documented, less is known on its impacts on sexual-related risks, as well as its comparative effectiveness to buprenorphine/naloxone, particularly in the context of highly potent opioids. The aim of this study was to estimate the relative effects of buprenorphine/naloxone and methadone on injecting and STBBI risks among people with prescription-type opioid use disorder (POUD).

Methods

Secondary analysis of a pan-Canadian pragmatic 24-week randomized clinical trial comparing methadone and buprenorphine/naloxone models of care among 272 people with POUD (including licit or illicit opioid analgesics, fentanyl). The Risk Behaviour Survey was used to collect injecting and sexual risks at baseline, and weeks 12 and 24.

Results

In total, 210 participants initiated treatment (103 buprenorphine/naloxone and 107 methadone). At baseline, 113/205 (55.1%) participants reported recently injecting drugs, 37/209 (17.7%) unsafe injection practices and 67/162 (41.4%) high-risk sex. Both methadone and buprenorphine/naloxone were associated with reductions in the prevalence of injection drug use and high-risk sex at weeks 12 and 24 with no interactions between treatment arm and time.

Conclusion

Methadone and buprenorphine/naloxone were similarly effective in reducing injecting and sexual risk behaviours among people with POUD.

Clinical Trials Registration

clinicaltrials.gov NCT03033732.

导言：吸毒者受到性传播和血液传播感染（STBBIs）的影响尤为严重。尽管美沙酮在减少注射风险行为方面的益处有据可查，但人们对它对性相关风险的影响以及它与丁丙诺啡/纳洛酮的比较效果却知之甚少，尤其是在强效阿片类药物方面。本研究旨在估算丁丙诺啡/纳洛酮和美沙酮对处方类阿片使用障碍（POUD）患者注射和STBBI风险的相对影响：对一项为期 24 周的泛加拿大实用随机临床试验进行二次分析，该试验比较了美沙酮和丁丙诺啡/纳洛酮对 272 名处方类阿片使用障碍患者（包括合法或非法阿片类镇痛药、芬太尼）的护理模式。风险行为调查用于收集基线、第12周和第24周的注射风险和性风险：共有 210 人开始接受治疗（103 人使用丁丙诺啡/纳洛酮，107 人使用美沙酮）。在基线时，113/205（55.1%）名参与者报告最近注射过毒品，37/209（17.7%）人有不安全注射行为，67/162（41.4%）人有高风险性行为。在第12周和第24周，美沙酮和丁丙诺啡/纳洛酮都能降低注射吸毒和高危性行为的发生率，治疗方法和时间之间没有相互作用：美沙酮和丁丙诺啡/纳洛酮在减少POUD患者注射吸毒和高危性行为方面的效果相似。
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引用次数: 0
Availability and stock-outs of paediatric antiretroviral treatment formulations at health facilities in Kenya and Uganda 肯尼亚和乌干达医疗机构儿科抗逆转录病毒治疗配方的可用性和缺货情况。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES
HIV Medicine
Pub Date : 2024-03-18 DOI: 10.1111/hiv.13635
Tom G. Jacobs, Dorothy Okemo, Anthony Ssebagereka, Kenneth Mwehonge, Emily M. Njuguna, David M. Burger, Angela Colbers, Fatima Suleman, Aukje K. Mantel-Teeuwisse, Gaby I. Ooms

Introduction

The large number of deaths among children with HIV is driven by poor antiretroviral treatment (ART) coverage among this cohort. The aim of the study was to assess the availability and stock-outs of paediatric and adult ART formulations in Kenya and Uganda across various regions and types of health facilities.

Methods

A survey on availability and stock-outs of paediatric ART at health facilities was adapted from the standardized Health Action International–WHO Medicine Availability Monitoring Tool. All preferred and limited-use formulations, and three phased-out formulations according to the 2021 WHO optimal formulary list were included in the survey, as well as a selection of adult ART formulations suitable for older children, adolescents, and adults. Availability data were collected in June–July 2022 and stock-out data were obtained over the previous year from randomly selected public and private-not-for-profit (PNFP) facilities registered to dispense paediatric ART across six districts per country. All data were analysed descriptively.

Results

In total, 144 health facilities were included (72 per country); 110 were public and 34 PNFP facilities. Overall availabilities of preferred paediatric ART formulations were 52.2% and 63.5% in Kenya and Uganda, respectively, with dolutegravir (DTG) 10 mg dispersible tablets being available in 70.2% and 77.4% of facilities, respectively, and abacavir/lamivudine dispersible tablets in 89.8% and 98.2% of facilities. Of note, availability of both formulations was low (37.5% and 62.5%, respectively) in Kenyan PNFP facilities. Overall availabilities of paediatric limited-use products were 1.1% in Kenya and 1.9% in Uganda. At least one stock-out of a preferred paediatric ART formulation was reported in 40.0% of Kenyan and 74.7% of Ugandan facilities. Nevirapine solution stock-outs were reported in 43.1% of Ugandan facilities, while alternative formulations for postnatal HIV prophylaxis were not available.

Conclusions

Recommended DTG-based first-line ART for children across all ages was reasonably available at health facilities in Kenya and Uganda, with the exception of Kenyan PNFP facilities. Availability of paediatric ART formulations on the limited-use list was extremely low across both countries. Stock-outs were reported regularly, with the high number of reported stock-outs of neonatal ART formulations in Uganda being most concerning.

导言：由于抗逆转录病毒疗法（ART）在感染艾滋病毒儿童中的覆盖率较低，导致大量儿童死亡。本研究旨在评估肯尼亚和乌干达不同地区和不同类型医疗机构的儿科和成人抗逆转录病毒疗法制剂的供应和缺货情况：方法：根据标准化的国际健康行动组织-世界卫生组织药品供应监测工具，对医疗机构儿科抗逆转录病毒疗法的供应和缺货情况进行了调查。根据 2021 年世卫组织最佳处方集清单，所有首选和限用制剂以及三种逐步淘汰的制剂都被纳入了调查范围，同时还选择了一些适合年龄较大儿童、青少年和成人的成人抗逆转录病毒疗法制剂。2022年6月至7月收集了可用性数据，前一年的缺货数据则是从每个国家6个地区中随机抽取的注册配发儿科抗逆转录病毒疗法的公立和私营非营利（PNFP）机构中获得的。对所有数据进行了描述性分析：结果：共纳入 144 家医疗机构（每个国家 72 家），其中 110 家为公立医疗机构，34 家为私营非营利医疗机构。在肯尼亚和乌干达，首选儿科抗逆转录病毒疗法制剂的总体供应率分别为 52.2% 和 63.5%，分别有 70.2% 和 77.4% 的医疗机构提供 10 毫克多托曲韦分散片，89.8% 和 98.2% 的医疗机构提供阿巴卡韦/拉米夫定分散片。值得注意的是，在肯尼亚的 PNFP 机构中，这两种制剂的供应率较低（分别为 37.5% 和 62.5%）。在肯尼亚和乌干达，儿科限用产品的总体供应率分别为 1.1%和 1.9%。据报告，40.0% 的肯尼亚医疗机构和 74.7% 的乌干达医疗机构至少出现过一次首选儿科抗逆转录病毒疗法制剂缺货的情况。据报告，43.1% 的乌干达医疗机构出现了奈韦拉平溶液缺货的情况，而用于产后艾滋病预防的替代制剂则无法获得：除肯尼亚的 PNFP 机构外，肯尼亚和乌干达的医疗机构均可合理地为所有年龄段的儿童提供推荐的基于 DTG 的一线抗逆转录病毒疗法。在这两个国家，有限使用清单上的儿科抗逆转录病毒疗法制剂供应量极低。经常有缺货的报告，其中乌干达新生儿抗逆转录病毒疗法制剂缺货的报告数量之多最令人担忧。
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引用次数: 0
Efficacy of dolutegravir + lamivudine q.d. with food in people with TB/HIV using a rifampicin-based regimen: A retrospective observational case series 多罗替拉韦+拉米夫定 q.d. 与食物一起服用对使用利福平方案的结核病/艾滋病患者的疗效：回顾性观察病例系列。
IF 3 3区 医学 Q2 Medicine
HIV Medicine
Pub Date : 2024-03-17 DOI: 10.1111/hiv.13632
Yanyun Dou, Ruichao Lu, Lingsong Su, Ke Lan, Zhihao Meng, Shanfang Qin, Liling Huang, Wei Huang, Yuanlong Xu, Yu Lv, Yuhong Wen, Shuanglai Lan, Yong Zuo, Yong Zhang

Objectives

Dolutegravir + lamivudine (DTG + 3TC) is a first-line regimen for people with HIV. However, there are still concerns about its efficacy in people with tuberculosis (TB)/HIV due to the lack of available evidence and drug–drug interaction with rifampicin.

Methods

A single-centre retrospective observational case series was conducted in Guangxi Zhuang Autonomous Region, China. We included all people with TB/HIV on combined use of once-daily (q.d.) dosing DTG + 3TC and rifampicin (RIF)-containing anti-TB regimens between 2020 and 2022. HIV-RNA, CD4 cell counts were collected and analysed.

Results

In all, 21 people with HIV (PWH) were included in this study. All the PWH were treatment-naïve and told to take DTG + 3TC q.d. with food. The median age was 53 years, and 71.43% were male. A total of 71.43% PWH had baseline viral load (VL) > 100 000 copies/mL, and 33.33% had baseline VL greater than 500 000 copies/mL. Only one PWH had CD4 cell count greater than 200 cells/μL, and the median CD4 count was 20 cells/μL. A total of 16 PWH started DTG + 3TC after initiation of the RIF-based anti-TB regimen, and the other five PWH initiated DTG + 3TC before the treatment of TB. All the PWH had at least 24 weeks of follow-up visits and all of the TB treatments were successful. A total of 20 PWH (95.24%) achieved viral suppression (VL <50 copies/mL). All detected viral loads between weeks 24 and 48 were less than 200 copies/mL. Among the PWH who started DTG + 3TC after the initiation of RIF-based anti-TB regimen, all achieved viral suppression by week 24 except the non-suppressed PWH. CD4 counts were greatly improved after antiretroviral treatment: the median CD4 counts were raised from 20 to 171 cells/μL at week 48. No serious adverse events were reported.

Conclusions

This case series preliminarily validates the efficacy of DTG + 3TC q.d. with food when combined with RIF-based anti-TB regimens in people with TB/HIV.

目标多托曲韦+拉米夫定（DTG+3TC）是艾滋病病毒感染者的一线治疗方案。然而，由于缺乏可用证据以及与利福平的药物相互作用，人们对其在结核病（TB）/艾滋病患者中的疗效仍存在担忧：方法： 在中国广西壮族自治区开展了一项单中心回顾性观察病例系列研究。我们纳入了 2020 年至 2022 年期间联合使用每日一次（q.d.）剂量 DTG + 3TC 和利福平（RIF）抗结核方案的所有结核病/艾滋病毒感染者。收集并分析了 HIV-RNA 和 CD4 细胞计数：本研究共纳入 21 名艾滋病病毒感染者（PWH）。所有艾滋病病毒感染者均未接受过治疗，并被告知要在饭后服用 DTG+3TC q.d.。年龄中位数为 53 岁，71.43% 为男性。共有 71.43% 的 PWH 基线病毒载量（VL）大于 100 000 拷贝/毫升，33.33% 的 PWH 基线病毒载量大于 500 000 拷贝/毫升。只有一名 PWH 的 CD4 细胞计数大于 200 cells/μL，CD4 细胞计数中位数为 20 cells/μL。共有 16 名感染者在接受以 RIF 为基础的抗结核治疗后开始服用 DTG + 3TC，另外 5 名感染者在接受结核病治疗前开始服用 DTG + 3TC。所有感染者都接受了至少 24 周的随访，所有结核病治疗都取得了成功。共有 20 名感染者（95.24%）实现了病毒抑制（VL 结论）：本系列病例初步验证了 DTG + 3TC q.d. 与食物一起服用与基于 RIF 的抗结核治疗方案相结合对结核病/艾滋病毒感染者的疗效。
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引用次数: 0
Early HIV viral suppression associated with subsequent 12-month treatment success among people living with HIV in South Africa 早期艾滋病毒病毒抑制与南非艾滋病毒感染者随后 12 个月的成功治疗有关。
IF 3 3区 医学 Q2 Medicine
HIV Medicine
Pub Date : 2024-03-15 DOI: 10.1111/hiv.13633
Lauren R. Violette, Katherine K. Thomas, Jienchi Dorward, Justice Quame-Amaglo, Nigel Garrett, Paul K. Drain

Background

We analyzed the STREAM (Simplifying HIV TREAtment and Monitoring) study to determine risk factors associated with HIV viraemia and poor retention 18 months after initiation of antiretroviral therapy (ART).

Methods

The STREAM study was an open-label randomized controlled trial in Durban, South Africa, that enrolled 390 people living with HIV presenting for their first HIV viral load measurement ~6 months after ART initiation. We used modified Poisson regression with robust standard errors to describe associations between baseline characteristics and three HIV outcomes 18 months after ART initiation: HIV viraemia (>50 copies/mL), poor retention in HIV care, and a composite outcome of poor retention in care and/or HIV viraemia.

Results

Approximately 18 months after ART initiation, 45 (11.5%) participants were no longer retained in care and 43 (11.8%) had viraemia. People with CD4 counts <200 and those with viraemia 6 months after ART initiation were significantly more likely to have viraemia 18 months after ART initiation (adjusted relative risk [aRR] 4.0; 95% confidence interval [CI] 2.1–7.5 and aRR 5.5; 95% CI 3.3–9.0, respectively). People who did not disclose their HIV status and had viraemia after ART initiation were more likely to not be retained in care 12 months later (aRR 2.6; 95% CI 1.1–6.1 and aRR 2.2; 95% CI 1.0–4.8). People with a CD4 count <200 and those with viraemia were more likely to not achieve the composite outcome 18 months after ART initiation.

Conclusions

Viraemia after ART initiation was the strongest predictor of subsequent viraemia and poor care retention. Understanding early indicators can help target our interventions to better engage people who may be more likely to experience persistent viraemia or disengage from HIV care.

背景：我们对 STREAM（简化艾滋病病毒载量检测和监控）研究进行了分析，以确定与艾滋病病毒血症和开始抗逆转录病毒疗法（ART）18 个月后留观不良有关的风险因素：STREAM 研究是在南非德班进行的一项开放标签随机对照试验，共招募了 390 名艾滋病病毒感染者，他们在开始接受抗逆转录病毒疗法 6 个月后进行了首次艾滋病病毒载量测量。我们使用带稳健标准误差的修正泊松回归来描述基线特征与开始抗逆转录病毒疗法 18 个月后三种艾滋病结果之间的关系：HIV病毒血症（>50拷贝/毫升）、HIV治疗效果不佳以及治疗效果不佳和/或HIV病毒血症的综合结果：结果：开始接受抗逆转录病毒疗法约 18 个月后，45 名参与者（11.5%）不再继续接受护理，43 名参与者（11.8%）出现病毒血症。CD4 细胞计数开始接受抗逆转录病毒疗法后出现的病毒血症是随后出现病毒血症和继续接受护理情况不佳的最有力预测因素。了解早期指标有助于我们有针对性地采取干预措施，让那些更有可能出现持续病毒血症或脱离艾滋病护理的人更好地参与进来。
{"title":"Early HIV viral suppression associated with subsequent 12-month treatment success among people living with HIV in South Africa","authors":"Lauren R. Violette,&nbsp;Katherine K. Thomas,&nbsp;Jienchi Dorward,&nbsp;Justice Quame-Amaglo,&nbsp;Nigel Garrett,&nbsp;Paul K. Drain","doi":"10.1111/hiv.13633","DOIUrl":"10.1111/hiv.13633","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We analyzed the STREAM (Simplifying HIV TREAtment and Monitoring) study to determine risk factors associated with HIV viraemia and poor retention 18 months after initiation of antiretroviral therapy (ART).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The STREAM study was an open-label randomized controlled trial in Durban, South Africa, that enrolled 390 people living with HIV presenting for their first HIV viral load measurement ~6 months after ART initiation. We used modified Poisson regression with robust standard errors to describe associations between baseline characteristics and three HIV outcomes 18 months after ART initiation: HIV viraemia (&gt;50 copies/mL), poor retention in HIV care, and a composite outcome of poor retention in care and/or HIV viraemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Approximately 18 months after ART initiation, 45 (11.5%) participants were no longer retained in care and 43 (11.8%) had viraemia. People with CD4 counts &lt;200 and those with viraemia 6 months after ART initiation were significantly more likely to have viraemia 18 months after ART initiation (adjusted relative risk [aRR] 4.0; 95% confidence interval [CI] 2.1–7.5 and aRR 5.5; 95% CI 3.3–9.0, respectively). People who did not disclose their HIV status and had viraemia after ART initiation were more likely to not be retained in care 12 months later (aRR 2.6; 95% CI 1.1–6.1 and aRR 2.2; 95% CI 1.0–4.8). People with a CD4 count &lt;200 and those with viraemia were more likely to not achieve the composite outcome 18 months after ART initiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Viraemia after ART initiation was the strongest predictor of subsequent viraemia and poor care retention. Understanding early indicators can help target our interventions to better engage people who may be more likely to experience persistent viraemia or disengage from HIV care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Growth of infants delivered by mothers with HIV in Guangxi, China: An 18-month longitudinal follow-up study, 2015–2021 中国广西艾滋病病毒感染母亲所生婴儿的生长情况：2015-2021年为期18个月的纵向随访研究。
IF 3 3区 医学 Q2 Medicine
HIV Medicine
Pub Date : 2024-03-13 DOI: 10.1111/hiv.13624
Jiangyang Zhao, Lingling Zhang, Linlin Li, Xiaohua Xie, Jianjun Li, Yuchen Wei, Yuanyuan Feng, Aidan Huang, Haifeng Huang, Qinghua Qin

Objectives

The prevention of mother-to-child transmission of HIV has been a global success. But little is known about the growth parameters of infants delivered by mothers with HIV or the drug resistance of infants with HIV in China. The study aimed to assess growth parameters and drug resistance in Chinese infants exposed to HIV.

Methods

We conducted an 18-month longitudinal follow-up study of 3283 infants (3222 without HIV; 61 with HIV) born to mothers with HIV in the Guangxi Zhuang Autonomous Region between January 2015 and December 2021. The weight and length of all participants was recorded. In addition, genetic subtypes and drug resistance analysis were performed for infants with HIV.

Results

Compared with infants without HIV, those with HIV had significantly lower weight/length Z-scores, except at 18 months of age. The length/age Z-scores of infants with HIV was significantly reduced, except at 1 month of age. The weight/age Z-scores of infants with HIV were significantly lower at all follow-up time points. The weight/length Z-scores of male infants without HIV were significantly lower than for female infants without HIV at all follow-up time points. Male infants without HIV had lower length/age and weight/age Z-scores than female infants at the remaining follow-up points, except at 1 month of age. Of a total of 61 infants with HIV, subtype and drug-resistance data were obtained from 37 (60.66%) samples. Infants with HIV were dominated by the CRF01_AE genotype and showed a diversity of mutation sites dominated by non-nucleoside reverse transcriptase inhibitor resistance.

Conclusion

Our study demonstrates the growth of infants exposed to HIV in southwest China and provides detailed information on subtype distribution and drug resistance of those with HIV. Nutritional support and drug-resistance surveillance for infants exposed to HIV need to be strengthened.

目标：预防艾滋病母婴传播已在全球取得成功。但是，人们对中国艾滋病病毒感染母亲所生婴儿的生长参数和艾滋病病毒感染婴儿的耐药性知之甚少。本研究旨在评估中国艾滋病病毒感染婴儿的生长参数和耐药性：我们对 2015 年 1 月至 2021 年 12 月期间广西壮族自治区感染 HIV 的母亲所生的 3283 名婴儿（3222 名未感染 HIV；61 名感染 HIV）进行了为期 18 个月的纵向随访研究。研究记录了所有参与者的体重和身长。此外，还对感染艾滋病毒的婴儿进行了基因亚型和耐药性分析：结果：与未感染艾滋病毒的婴儿相比，感染艾滋病毒的婴儿体重/身长 Z 值明显较低，18 个月大的婴儿除外。除 1 个月大的婴儿外，感染艾滋病毒的婴儿的身长/年龄 Z 值明显降低。感染艾滋病毒的婴儿在所有随访时间点的体重/年龄 Z 值都明显较低。在所有随访时间点，未感染艾滋病毒的男婴的体重/身长 Z 值都明显低于未感染艾滋病毒的女婴。除 1 个月大的婴儿外，未感染艾滋病毒的男婴在其余随访时间点的身长/年龄 Z 值和体重/年龄 Z 值均低于女婴。在总共 61 名感染艾滋病毒的婴儿中，37 个样本（60.66%）获得了亚型和耐药性数据。感染艾滋病毒的婴儿以 CRF01_AE 基因型为主，并显示出以非核苷类逆转录酶抑制剂耐药性为主的突变位点多样性：我们的研究显示了中国西南地区暴露于艾滋病病毒的婴儿的生长情况，并提供了关于艾滋病病毒感染者亚型分布和耐药性的详细信息。需要加强对艾滋病病毒感染婴儿的营养支持和耐药性监测。
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引用次数: 0
The effect of HIV and mpox co-infection on clinical outcomes: Systematic review and meta-analysis HIV 和 mpox 合并感染对临床结果的影响：系统回顾与荟萃分析。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES
HIV Medicine
Pub Date : 2024-03-05 DOI: 10.1111/hiv.13622
Amira Mohamed Taha, Amr Elrosasy, Abdelrahman Mohamed Mahmoud, Sara Adel Abdelkader Saed, Wesam Abd El-Tawab Moawad, Esraa Hamouda, Dang Nguyen, Van Phu Tran, Hoang Tran Pham, Sanjit Sah, Joshuan J. Barboza, Ranjit Sah

Introduction

Co-infection with HIV and mpox is a significant issue for public health because of the potential combined impact on clinical outcomes. However, the existing literature lacks a comprehensive synthesis of the available evidence. The purpose of this meta-analysis is to provide insight into the impact of HIV and mpox co-infection on clinical outcomes.

Methods

We systematically searched major electronic databases (PubMed, Embase, Cochrane Central, and Web of Science) for pertinent studies published up to June 2023. Included were studies that described the clinical outcomes of people who had both mpox and HIV. We performed the analysis using OpenMeta and STATA 17 software.

Results

With an overall number of participants of 35 207, 21 studies that met the inclusion criteria were considered. The greatest number of the studies (n = 10) were cohort designs, with three being cross-sectional and eight being case series studies. The meta-analysis found that people who had both HIV and mpox had a higher hospitalization rate than those who only had mpox (odds ratio [OR] 1.848; 95% confidence interval [CI] 0.918–3.719, p = 0.085, I2 = 60.19%, p = 0.020). Furthermore, co-infected patients had higher mortality rates than those who did not have HIV co-infection (OR 3.887; 95% CI 2.272–6.650, p < 0.001). Meta-regression analysis showed that CD4 levels can significantly predict the risk of hospitalization (p = 0.016) and death (p = 0.031).

Discussion

HIV causes immunosuppression, making it difficult for the body to mount an effective immune response against pathogens such as mpox. Individuals who are co-infected are at a higher risk of severe disease and death, according to our findings. Although hospitalization rates did not differ significantly between the two groups, it is critical to prioritize interventions and improve management strategies tailored specifically for people living with HIV.

Conclusion

This meta-analysis provides substantial evidence that HIV and mpox co-infection has a negative impact on clinical outcomes. Co-infected individuals had higher hospitalization and significantly higher mortality rates. These findings highlight the significance of early diagnosis, prompt treatment initiation, and effective management strategies for people living with HIV and mpox.

导言：艾滋病毒和麻疹的双重感染是公共卫生的一个重要问题，因为这两种疾病会对临床结果产生潜在的综合影响。然而，现有文献缺乏对现有证据的全面综合。本荟萃分析旨在深入探讨 HIV 和 mpox 合并感染对临床结果的影响：我们系统地检索了主要电子数据库（PubMed、Embase、Cochrane Central 和 Web of Science）中截至 2023 年 6 月发表的相关研究。纳入的研究描述了同时感染麻疹和艾滋病病毒的患者的临床结果。我们使用 OpenMeta 和 STATA 17 软件进行了分析：在 35 207 名参与者中，有 21 项研究符合纳入标准。其中最多的研究（n = 10）是队列研究，3 项是横断面研究，8 项是病例系列研究。荟萃分析发现，同时感染艾滋病毒和麻疹的患者住院率高于仅感染麻疹的患者（几率比 [OR] 1.848；95% 置信区间 [CI] 0.918-3.719，P = 0.085，I2 = 60.19%，P = 0.020）。此外，合并感染的患者死亡率高于未合并感染艾滋病毒的患者（OR 3.887; 95% CI 2.272-6.650, p 讨论）：艾滋病毒会导致免疫抑制，使机体难以对麻疹病毒等病原体产生有效的免疫反应。根据我们的研究结果，合并感染者罹患严重疾病和死亡的风险更高。虽然两组患者的住院率没有显著差异，但确定干预措施的优先次序并改进专为艾滋病病毒感染者量身定制的管理策略至关重要：这项荟萃分析提供了大量证据，证明艾滋病病毒和麻疹病毒合并感染会对临床结果产生负面影响。合并感染者的住院率更高，死亡率也明显更高。这些发现凸显了早期诊断、及时开始治疗和有效管理策略对艾滋病病毒感染者和水痘患者的重要性。
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引用次数: 0
SARS-CoV-2 testing, positivity, and factors associated with COVID-19 among people with HIV across Europe in the multinational EuroSIDA cohort 多国 EuroSIDA 队列中欧洲艾滋病毒感染者的 SARS-CoV-2 检测、阳性率以及与 COVID-19 相关的因素。
IF 3 3区 医学 Q2 Medicine
HIV Medicine
Pub Date : 2024-03-03 DOI: 10.1111/hiv.13620
O. Fursa, W. Bannister, B. Neesgaard, D. Podlekareva, J. Kowalska, T. Benfield, J. Gerstoft, J. Reekie, L. D. Rasmussen, I. Aho, G. Guaraldi, T. Staub, J. M. Miro, J. M. Laporte, D. Elbirt, T. Trofimova, D. Sedlacek, R. Matulionyte, C. Oprea, E. Bernasconi, V. Hadžiosmanović, A. Mocroft, L. Peters, EuroSIDA Study Group

Background

Although people with HIV might be at risk of severe outcomes from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus 2019 [COVID-19]), regional and temporal differences in SARS-CoV-2 testing in people with HIV across Europe have not been previously described.

Methods

We described the proportions of testing, positive test results, and hospitalizations due to COVID-19 between 1 January 2020 and 31 December 2021 in the EuroSIDA cohort and the factors associated with being tested for SARS-CoV-2 and with ever testing positive.

Results

Of 9012 participants, 2270 (25.2%, 95% confidence interval [CI] 24.3–26.1) had a SARS-CoV-2 polymerase chain reaction test during the study period (range: 38.3% in Northern to 14.6% in Central-Eastern Europe). People from Northern Europe, women, those aged <40 years, those with CD4 cell count <350 cells/mm3, and those with previous cardiovascular disease or malignancy were significantly more likely to have been tested, as were people with HIV in 2021 compared with those in 2020. Overall, 390 people with HIV (4.3%, 95% CI 3.9–4.8) tested positive (range: 2.6% in Northern to 7.1% in Southern Europe), and the odds of testing positive were higher in all regions than in Northern Europe and in 2021 than in 2020. In total, 64 people with HIV (0.7%, 95% CI 0.6–0.9) were hospitalized, of whom 12 died. Compared with 2020, the odds of positive testing decreased in all regions in 2021, and the associations with cardiovascular disease, malignancy, and use of tenofovir disoproxil fumarate disappeared in 2021. Among study participants, 58.9% received a COVID-19 vaccine (range: 72.0% in Southern to 14.8% in Eastern Europe).

Conclusions

We observed large heterogeneity in SARS-CoV-2 testing and positivity and a low proportion of hospital admissions and deaths across the regions of Europe.

背景：尽管艾滋病病毒感染者可能会因感染严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2；冠状病毒 2019 [COVID-19]）而面临严重后果的风险，但欧洲地区艾滋病病毒感染者接受 SARS-CoV-2 检测的地区性和时间性差异尚未得到描述：我们描述了 2020 年 1 月 1 日至 2021 年 12 月 31 日期间 EuroSIDA 队列中的检测比例、检测结果呈阳性以及因 COVID-19 而住院的情况，以及与接受 SARS-CoV-2 检测和检测结果呈阳性相关的因素：在 9012 名参与者中，有 2270 人（25.2%，95% 置信区间 [CI] 24.3-26.1）在研究期间接受了 SARS-CoV-2 聚合酶链反应检测（范围：北欧 38.3%，中东欧 14.6%）。来自北欧的人群、女性、年龄在 3 岁以下的人群以及曾患有心血管疾病或恶性肿瘤的人群接受检测的几率明显高于 2021 年的艾滋病病毒感染者和 2020 年的艾滋病病毒感染者。总体而言，390 名艾滋病病毒感染者（4.3%，95% CI 3.9-4.8）检测结果呈阳性（范围：北欧 2.6%，南欧 7.1%），所有地区检测结果呈阳性的几率均高于北欧，2021 年高于 2020 年。共有 64 名艾滋病毒感染者（0.7%，95% CI 0.6-0.9）住院治疗，其中 12 人死亡。与 2020 年相比，2021 年所有地区的阳性检测几率都有所下降，与心血管疾病、恶性肿瘤和使用富马酸替诺福韦二吡呋酯的关联在 2021 年消失。在研究参与者中，58.9%的人接种了COVID-19疫苗（范围：南欧为72.0%，东欧为14.8%）：我们观察到，在欧洲各地区，SARS-CoV-2 的检测和阳性率存在很大的异质性，入院和死亡的比例较低。
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