Hepatitis B virus (HBV) infection remains a significant concern among people with HIV (PWH), who are at higher risk of acquiring HBV and often show suboptimal responses to vaccination. In this context, we aimed to update the incidence of acute hepatitis B (AHB) in a cohort of PWH, given recent epidemiological shifts including the increase in migrant populations and the wider use of antiretroviral therapy (ART) regimens lacking anti-HBV activity.
We conducted a retrospective single-centre study including PWH under follow-up between 2000 and 2024. AHB cases were confirmed based on the recent positivity of HBsAg and anti-HBc IgM. Demographic, clinical, serological and ART-related data were collected. Incidence was calculated as cases per 100 person-years, and trends were analyzed in both the overall population and the susceptible subgroup (anti-HBc-negative).
A total of 22 AHB cases were diagnosed among 5986 PWH. The overall incidence rate was 0.02 (0.01–0.15) cases per 100 person-years, and 0.05 (0.01–0.3) cases per 100 person-years in the susceptible subgroup. Incidence decreased over time, with no new cases from 2015 to 2022, and isolated cases re-emerged in 2023–2024. Most AHB cases (78.3%) were unvaccinated; 21.7% had received full vaccination but failed to develop a serologic response. Only 26.1% of cases were on ART at AHB diagnosis, and no one was receiving tenofovir. The rate of progression to chronic hepatitis B (CHB) was 17.4%, higher than in the general population; all CHB cases occurred in ART-naïve individuals.
AHB incidence among PWH has declined over the past 25 years but remains higher than in the general population. The recent reappearance of isolated cases may reflect changes in HBV exposure risk, suboptimal vaccination coverage, or the increasing use of ART regimens without anti-HBV activity. Universal HBV vaccination and the use of tenofovir-based therapies in non-responders remain critical strategies for prevention and control.
Evaluate factors associated with discontinuation of long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) and describe virologic outcomes in those that returned to oral antiretroviral therapy (ART).
This is a retrospective cohort study at a single-centre primary care HIV clinic. Included were adults who received at least one injection of LAI CAB/RPV between April 2021 and March 2024. Characteristics were compared between those that continued LAI CAB/RPV and those that discontinued treatment during the study period. HIV viral load (VL) outcomes were evaluated in those that returned to oral ART and included the most recent VL in the range of 1–24 weeks, 24–48 weeks and the most recently documented VL through September 2024.
A total of 92 and 346 patients were included in the discontinuation and continuation cohorts, respectively. Being male sex assigned at birth and having psychiatric disease was associated with continuing LAI CAB/RPV, whereas having active substance use and being on a multi-class regimen prior to initiation of LAI CAB/RPV was associated with discontinuation. In those with VL data after resuming oral ART, the percentage of those with HIV VL <50 copies per mL up to 24 weeks (n = 58) was 91.4%, up to 48 weeks (n = 53) was 90.6%, and using the most recent documented VL (n = 74) was 91.9%.
High viral suppression rates were observed in those that returned to oral therapy after discontinuing LAI CAB/RPV. Individuals with substance use demonstrated a higher rate of LAI discontinuation, despite the potential benefit from LAIs in this population.
Family caregivers of children living with HIV (CLHIV) in Indonesia navigate complex emotional and caregiving responsibilities amid stigma, isolation and limited support. This study aimed to explore the lived experiences of family caregivers in caring for children with HIV and to understand their perspectives on the potential use of mobile health (mHealth) applications to support paediatric HIV care in Indonesia.
A qualitative descriptive study was conducted using semi-structured interviews with fifteen purposively selected family caregivers at a national infectious disease referral hospital in Jakarta. Data were collected between June and August 2024, and analysed using conventional content analysis to inductively identify key themes.
Three overarching themes were identified: (1) The Silent Burden of Caregiving, encompassing stigma, fear of disclosure, emotional fatigue and uncertainty about the child's future, (2) Supportive and Enabling Conditions, reflecting the role of social and spiritual support alongside interest in mHealth applications and their desired features, and (3) Barriers to Digital Technology Use, highlighting concerns over privacy, confidentiality and limited digital literacy.
Caregiving for a child with HIV is emotionally taxing and often undertaken in silence. mHealth applications may offer meaningful support when designed to be user-informed, culturally relevant and integrated with broader psychosocial services. Contextualized digital solutions have the potential to enhance HIV care outcomes in low-resource settings.
To investigate the efficacy and safety of first-line antiretroviral treatment (ART) with 2DR dolutegravir/lamivudine (DTG/3TC) versus 3DR bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) in persons with low CD4 cell counts and/or an AIDS-defining disease.
Retrospective, multicentre, multinational study.
We conducted a retrospective, multicentre, multinational analysis to investigate the virological response and discontinuation rate in people living with HIV starting first-line ART with a CD4 cell count <200/μL and/or an AIDS-defining condition. Proportions of discontinuations were compared using univariate analysis. Virological response was analyzed using FDA snapshot analysis (HIV-1 RNA <50 copies/mL at week 48).
Two hundred and fifty-nine people who were diagnosed late with HIV were included in the study. Sixty-nine of them were started on 2DR DTG/3TC and 190 on 3DR BIC/TAF/FTC. After matching 1 to 1 (matching criteria: age, sex, CD4 cell count, HI-viral load, Centers for Disease Control and Prevention (CDC) stage, n = 62 per group), the mean baseline CD4 cell count was 121/μL (standard deviation [SD] 65), including 21% presenting with an AIDS-defining condition. 96.2% and 91.8% of people living with HIV on 2DR and 3DR, respectively, had a viral load <50 copies/mL at week 48 (p = 0.244). No significant differences in discontinuation rates were observed at week 48 (5.5% in the 2DR and 9.4% in the 3DR group; p = 0.301).
In a European cohort of people diagnosed late with HIV who started first-line ART either with 2DR DTG/3TC or 3DR BIC/TAF/FTC, there were no significant differences in virological response and discontinuation rates after 48 weeks of treatment. With respect to the relatively small sample size and the inherent constraints of the study design, the possibility of establishing causal inference remains limited, and prospective studies are needed to further investigate on this topic.
Suicidal ideation (SI) is highly prevalent among people living with HIV (PWH) and those with chronic hepatitis C virus (HCV) infection. Individuals with long-term HIV–HCV co-infection face specific health challenges, including heightened physical pain. We aimed to assess whether disabling physical pain is associated with SI in aging PWH who have been cured of HCV, after controlling for potential correlates or confounders such as depression and psychoactive substance use.
We analysed data from HCV-cured PWH who participated in a multi-center cross-sectional survey embedded within the French ANRS CO13 HEPAVIH cohort. We performed a multivariable logistic regression model with SI (score >0 for the ninth item of the Patient Health Questionnaire-9) as the outcome. Disabling physical pain was assessed using an answer ≥'very much' to the third item from the WHOQOL-HIV BREF questionnaire.
Study population comprised 396 HCV-cured PWH (73.2% male), among whom 17.7% reported SI and 11.9% reported disabling physical pain. Participants reporting disabling physical pain had a three-fold higher risk of SI (adjusted odds ratio [95% confidence interval]: 3.07 [1.29–7.34]), after adjustment for depression (5.52 [2.66–11.43]), substance use, and lower social relationships-related quality of life (0.72 [0.64–0.80]).
These findings highlight that disabling physical pain should be systematically addressed among PWH cured of HCV, given its independent association with SI. Routine HIV follow-up care should integrate systematic screening for pain, mental health problems, and lack of social support. Timely referral to specialized services may help prevent future suicidal behaviours in this population.
Doravirine is among the first-line recommended treatments for people living with HIV (PLHIV) in the 2025 EACS guidelines. As opposed to tenofovir alafenamide or anti-integrase, its use was not associated with weight gain in clinical trials, but limited data are currently available in real life. In this cohort study, we investigated weight variation in PLHIV switching to doravirine.
A retrospective cohort analysis was conducted in two Parisian hospitals, including all PLHIV switching to doravirine between January 2019 and September 2022. Body Mass Index (BMI) variation was calculated from 48 months before to 36 months after the switch.
Between January 2019 and December 2022, 300 patients were included, with 220 men (73%) and 185 (62%) patients born in France. The main antiretroviral combination before the switch was TAF/FTC/BIC (n = 47, 16%), and after the switch, doravirine with TDF and 3TC (n = 202, 67%). Twenty-eight patients (9.3%) discontinued doravirine after a median duration of 17.5 months. At 12 and 24 months after the switch, the median BMI variation was 0.0 kg/m2, and this variation remained unchanged regardless of the pre-switch treatment. These results were less pronounced in subgroups of patients originating from sub-Saharan Africa (+0.2 and +0.4 kg/m2) and in women (+0.3 and 0.5 kg/m2).
Switching to doravirine led to a weight stabilisation, without reversal of the previously gained weight. In PLHIV at higher risk of weight gain, there was still a slight increase in BMI after the doravirine switch.
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