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Real-world effectiveness and safety of switching to dolutegravir/lamivudine among people living with HIV-1 aged over 50 years who are virologically suppressed 50岁以上病毒学抑制的HIV-1感染者转用多鲁特韦/拉米夫定的实际有效性和安全性。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-09-06 DOI: 10.1111/hiv.13699
C. Piñeiro, S. Policarpo, C. Caldas, L. Santos, I. Augusto, V. P. DiMondi, R. Serrão

Objectives

People living with HIV face several challenges as they age, including the potential for polypharmacy and increased susceptibility to drug-related adverse effects. Thus, effective and well-tolerated regimens with minimal or no drug interactions would be useful in this population. We present real-world effectiveness and safety data for individuals aged >50 years who achieved virological suppression (HIV-1 RNA <50 copies/mL) and switched to dolutegravir/lamivudine (DTG/3TC).

Methods

This retrospective, observational, single-centre study conducted in Portugal included individuals aged >50 years who switched to DTG/3TC while virologically suppressed and had ≥12 months of follow-up. Proportions of individuals maintaining virological suppression were described at 12 months; CD4+ cell counts were described at baseline and 12 months. Descriptive subgroup analyses were performed based on age, sex assigned at birth, and availability of historical genotypic resistance results.

Results

Overall, 538 individuals aged >50 years were included (74% male; mean age, 62 years; mean time on previous therapy, 160 months). High proportions (intention-to-treat population, 97%; on-treatment population, 98%) of individuals who switched to DTG/3TC maintained virological suppression through 12 months of follow-up. CD4+ cell counts remained stable (mean baseline: 727 cells/mm3 [range 94–2371]; mean month 12: 742 cells/mm3 [range 99–2659]). No individuals experienced virological failure. Nine (2%) individuals discontinued DTG/3TC for non–treatment-related reasons. Proportions with virological suppression at month 12 were similar between on-treatment subgroups by age, sex assigned at birth, and historical genotypic resistance results availability.

Conclusions

DTG/3TC demonstrated robust effectiveness and a good safety profile in individuals aged >50 years with virological suppression in Portugal.

目标:随着年龄的增长,艾滋病病毒感染者面临着一些挑战,其中包括可能会使用多种药物以及更容易受到与药物相关的不良反应的影响。因此,有效且耐受性良好、药物相互作用极小或没有的治疗方案对这一人群非常有用。我们介绍了年龄大于 50 岁、达到病毒学抑制(HIV-1 RNA 方法)的患者的真实有效性和安全性数据:这项在葡萄牙进行的回顾性、观察性、单中心研究纳入了年龄大于 50 岁、在病毒学抑制期间转用 DTG/3TC 且随访时间≥12 个月的患者。维持病毒学抑制的人数比例在 12 个月时进行了描述;CD4+ 细胞计数在基线和 12 个月时进行了描述。根据年龄、出生时的性别以及历史基因型耐药性结果进行了描述性亚组分析:共纳入了 538 名年龄大于 50 岁的患者(74% 为男性;平均年龄 62 岁;既往接受治疗的平均时间为 160 个月)。改用 DTG/3TC 治疗的患者在 12 个月的随访中保持病毒抑制的比例很高(意向治疗人群,97%;治疗人群,98%)。CD4+ 细胞计数保持稳定(平均基线:727 cells/mm3 [range 94-2371];平均第 12 个月:742 cells/mm3 [range 99-2659])。没有人出现病毒学失败。有 9 人(2%)因与治疗无关的原因中断了 DTG/3TC。按年龄、出生时性别和历史基因型耐药性结果划分的治疗亚组中,第 12 个月时病毒学抑制的比例相似:在葡萄牙,DTG/3TC 在年龄大于 50 岁的病毒学抑制患者中显示出强大的有效性和良好的安全性。
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引用次数: 0
Evaluation of HIV antiretroviral treatment adherence in 2019 using anonymized data from the French national health insurance claims data base: The COCOVIH study 利用法国国家医疗保险报销数据库中的匿名数据,评估 2019 年艾滋病抗逆转录病毒治疗的依从性:COCOVIH 研究。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-09-05 DOI: 10.1111/hiv.13690
F. Prevoteau du Clary, C. Majerholc, D. Zucman, J.-M. Livrozet, A. Vallee, C. Laurendeau, S. Bouee

Objective

Adherence to antiretroviral treatment (ART) plays a key role in achieving viral suppression in people living with HIV. We aimed to quantify ART adherence in the entire French HIV-infected population treated in 2019 and to determine factors of influence.

Methods

People living with HIV were identified using HIV diagnosis according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria, HIV-specific laboratory tests, and prescription of antiretrovirals in 2019. Adherence was measured using the medication possession ratio (MPR; actual divided by theoretical number of tablets). Variables of interest included sex, age, type of ART, relevant comorbidities, and receiving supplementary universal health coverage for low-income citizens (CMUc).

Results

Of the n = 211 124 people living with HIV identified between 2006 and 2019, we included n = 140 607 on ART with two or more prescription fills in 2019 in this analysis. In total, 87.5% of people living with HIV were receiving ART in 2019. Mean ± standard deviation MPR was 82.5 ± 22.7%; 57% of people living with HIV had an MPR ≥90%, and 12.7% had an MPR <50%. Those with an MPR ≥90% significantly differed between males and females (59.1% and 52.8%, respectively; p < 0.001), and between CMUc recipients and non recipients (54.1% and 57.6%, respectively; p < 0.001). MPR ≥90% rate was lower for those with chronic nephropathy (50.2%), renal failure (46.6%), and tuberculosis (50.1%), and for those using psychoactive substances (52.3%). Factors associated with MPR ≥90% in multivariable analysis were older age, male sex, not receiving CMUc, more recent HIV diagnosis, and triple (vs. dual) ART.

Conclusion

In 2019, the average MPR in people living with HIV was 82.5% according to the comprehensive French health care database. Besides sociodemographic variables such as older age, male sex, and not being a CMUc recipient (i.e. of low socioeconomic status), more recent HIV diagnosis and triple therapy were independently associated with better adherence, possibly reflecting advances in ART tolerability and dosing.

目的:坚持抗逆转录病毒治疗(ART)对实现艾滋病病毒感染者的病毒抑制起着关键作用。我们旨在量化 2019 年接受治疗的所有法国艾滋病病毒感染者坚持抗逆转录病毒疗法的情况,并确定影响因素:根据《国际疾病和相关健康问题统计分类》第十次修订版标准、艾滋病特异性实验室检测结果和2019年抗逆转录病毒药物处方,对艾滋病病毒感染者进行诊断。依从性采用药物持有率(MPR;实际药片数除以理论药片数)来衡量。相关变量包括性别、年龄、抗逆转录病毒疗法的类型、相关合并症以及接受低收入公民补充全民医保(CMUc)的情况:在 2006 年至 2019 年间发现的 n = 211 124 名艾滋病病毒感染者中,我们将 n = 140 607 名在 2019 年接受抗逆转录病毒疗法且有两次或两次以上处方配药的患者纳入了本次分析。2019年,共有87.5%的艾滋病病毒感染者接受了抗逆转录病毒疗法。平均±标准差 MPR 为 82.5 ± 22.7%;57% 的 HIV 感染者的 MPR ≥90%,12.7% 的 MPR 结论:2019年,根据法国综合医疗数据库的数据,艾滋病病毒感染者的平均MPR为82.5%。除了年龄较大、性别为男性、不是CMUc接受者(即社会经济地位较低)等社会人口学变量外,较新的HIV诊断和三联疗法也与较好的依从性独立相关,这可能反映了抗逆转录病毒疗法耐受性和剂量方面的进步。
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引用次数: 0
Therapeutic failure reported with HIV long-acting injectables: An analysis of the FDA Adverse Event Reporting System from 2021 to 2024 艾滋病长效注射剂治疗失败的报告:对 2021 年至 2024 年 FDA 不良事件报告系统的分析。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-09-05 DOI: 10.1111/hiv.13709
Kenneth L. McCall, Danielle L. Cabral, Jamie F. Coghlan, Ashante M. Concepcion, Kristine E. Denimarck, Shawn S. Shalumov

Objectives

We examined adverse event (AE) reports relating to cabotegravir/rilpivirine (CAB/RPV) in the US FDA Adverse Event Reporting System (FAERS), focusing on therapeutic failure (TF) and non-therapeutic failure (NTF) outcomes.

Methods

FAERS is a database of AE and medication error reports from post-marketing surveillance. The study was granted exempt approval by the Binghamton University Institutional Review Board. We queried reports for CAB/RPV in the FAERS system from 1 January 2021 to 31 March 2024. TFs were defined as involving any of the following terms: viral load increased, virological failure, pathogen resistance, blood HIV RNA increased, treatment failure, drug ineffective, viral mutation identified, viraemia, and therapy non-responder. The top 20 most common AEs were also identified. Means, standard deviations, and percentages were used to characterize the sample.

Results

The study cohort consisted of 2605 reports. The reported sex of the study cohort was 50% male (n = 1295), 19% female (n = 505), and 31% unspecified (n = 805), with a mean ± standard deviation (SD) age of 46.9 ± 12.4 years (n = 378). The top three most reported AEs were TFs, product dose omissions, and injection site pain, with 377 (14.5%), 354 (13.6%), and 331 (12.7%) cases, respectively. The mean ± SD weight of people with a report of TF versus NTF was 101.8 ± 33.4 kg and 87.7 ± 26.7 kg, respectively (p = 0.0175).

Conclusion

Our findings suggest that healthcare professionals should have a heightened awareness of potential challenges with CAB/RPV administration, including TFs and dose omissions in real-world settings.

研究目的我们研究了美国FDA不良事件报告系统(FAERS)中与卡博替拉韦/利匹韦林(CAB/RPV)相关的不良事件(AE)报告,重点关注治疗失败(TF)和非治疗失败(NTF)结果:FAERS是一个上市后监测的AE和用药错误报告数据库。该研究获得了宾汉姆顿大学机构审查委员会的豁免批准。我们在 FAERS 系统中查询了 2021 年 1 月 1 日至 2024 年 3 月 31 日的 CAB/RPV 报告。TFs定义为涉及以下任一术语:病毒载量增加、病毒学失败、病原体耐药、血液HIV RNA增加、治疗失败、药物无效、病毒变异鉴定、病毒血症和治疗无反应。此外,还确定了最常见的前 20 种 AE。平均值、标准差和百分比用于描述样本的特征:研究队列包括 2605 份报告。研究队列中报告的性别为男性占 50%(n = 1295),女性占 19%(n = 505),未指定性别占 31%(n = 805),平均年龄为 46.9 ± 12.4 岁(n = 378)。报告最多的前三位不良反应是TFs、产品剂量遗漏和注射部位疼痛,分别为377例(14.5%)、354例(13.6%)和331例(12.7%)。报告TF与NTF的平均±标清体重分别为101.8±33.4千克和87.7±26.7千克(P = 0.0175):我们的研究结果表明,医护人员应提高对 CAB/RPV 给药潜在挑战的认识,包括实际环境中的 TF 和剂量遗漏。
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引用次数: 0
Trajectories of CD4 T-cell count, CD8 T-cell count, and CD4/CD8 ratio in patients with HIV and long-term virological suppression based on Yunnan HIV cohort 基于云南艾滋病队列的艾滋病病毒感染者 CD4 T 细胞计数、CD8 T 细胞计数和 CD4/CD8 比率的变化轨迹及长期病毒学抑制情况。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-09-02 DOI: 10.1111/hiv.13707
Yuanlu Shu, Mi Zhang, Jianjian Li, Xuemei Deng, Jiafa Liu, Cuixian Yang, Xingqi Dong

Objective

Our objective was to evaluate the trajectory of immunology in patients with HIV with different baseline CD4 T-cell count strata after antiretroviral therapy (ART) under long-term viral suppression.

Methods

This was a sub-analysis focused on patients with virological suppression for at least 5 years after ART. Data were obtained from the Yunnan HIV cohort in China. Patients were categorized according to prespecified baseline CD4 T-cell counts. The trajectories of CD4 T-cell count, CD8 T-cell count, and CD4/CD8 ratio changing over time were fitted using a B-spline regression model. The Cox proportional hazards regression model was used to assess the association of baseline CD4 T-cell count with the risk of both immunological responder (IR) and CD4/CD8 ratio normalization.

Results

A total of 2618 patients with a median follow-up of 7.25 years (interquartile range [IQR] 5.92–8.75) were included. Over a period of 12 years, the mean CD4 T-cell count remained above 500 cells/μL in all groups. The mean CD4/CD8 ratio was solely normalized in patients whose baseline CD4 T-cell counts were above 350 cells/μL. Patients with higher baseline CD4 T-cell counts showed higher risks of both IR and CD4/CD8 ratio normalization than those with the lowest (all p trend <0.001). A higher baseline CD4 T-cell count predicted a shorter time for both IR and CD4/CD8 ratio normalization.

Conclusions

Long-term, sustained viral suppression may not be able to fully normalize immunological functions in patients with HIV. A high baseline CD4 T-cell count benefits IR and CD4/CD8 ratio normalization.

目的我们的目的是评估在长期病毒抑制下接受抗逆转录病毒疗法(ART)后,不同基线CD4 T细胞计数分层的HIV患者的免疫学轨迹:这是一项子分析,主要针对抗逆转录病毒疗法后病毒学抑制至少 5 年的患者。数据来自中国云南艾滋病队列。根据预设的基线 CD4 T 细胞计数对患者进行分类。CD4 T细胞计数、CD8 T细胞计数和CD4/CD8比值随时间变化的轨迹采用B-样条回归模型进行拟合。Cox比例危险回归模型用于评估基线CD4 T细胞计数与免疫应答者(IR)和CD4/CD8比值正常化风险的相关性:共纳入了 2618 名患者,中位随访时间为 7.25 年(四分位数间距 [IQR] 5.92-8.75)。在长达 12 年的时间里,各组患者的 CD4 T 细胞平均数量均保持在 500 cells/μL 以上。基线 CD4 T 细胞计数高于 350 cells/μL 的患者的平均 CD4/CD8 比值完全正常。基线 CD4 T 细胞计数较高的患者出现 IR 和 CD4/CD8 比率正常化的风险均高于基线 CD4 T 细胞计数最低的患者(均为 p 趋势结论):长期、持续的病毒抑制可能无法使艾滋病患者的免疫功能完全正常化。高基线 CD4 T 细胞计数有利于 IR 和 CD4/CD8 比率正常化。
{"title":"Trajectories of CD4 T-cell count, CD8 T-cell count, and CD4/CD8 ratio in patients with HIV and long-term virological suppression based on Yunnan HIV cohort","authors":"Yuanlu Shu,&nbsp;Mi Zhang,&nbsp;Jianjian Li,&nbsp;Xuemei Deng,&nbsp;Jiafa Liu,&nbsp;Cuixian Yang,&nbsp;Xingqi Dong","doi":"10.1111/hiv.13707","DOIUrl":"10.1111/hiv.13707","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our objective was to evaluate the trajectory of immunology in patients with HIV with different baseline CD4 T-cell count strata after antiretroviral therapy (ART) under long-term viral suppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a sub-analysis focused on patients with virological suppression for at least 5 years after ART. Data were obtained from the Yunnan HIV cohort in China. Patients were categorized according to prespecified baseline CD4 T-cell counts. The trajectories of CD4 T-cell count, CD8 T-cell count, and CD4/CD8 ratio changing over time were fitted using a B-spline regression model. The Cox proportional hazards regression model was used to assess the association of baseline CD4 T-cell count with the risk of both immunological responder (IR) and CD4/CD8 ratio normalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2618 patients with a median follow-up of 7.25 years (interquartile range [IQR] 5.92–8.75) were included. Over a period of 12 years, the mean CD4 T-cell count remained above 500 cells/μL in all groups. The mean CD4/CD8 ratio was solely normalized in patients whose baseline CD4 T-cell counts were above 350 cells/μL. Patients with higher baseline CD4 T-cell counts showed higher risks of both IR and CD4/CD8 ratio normalization than those with the lowest (all <i>p</i> trend &lt;0.001). A higher baseline CD4 T-cell count predicted a shorter time for both IR and CD4/CD8 ratio normalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Long-term, sustained viral suppression may not be able to fully normalize immunological functions in patients with HIV. A high baseline CD4 T-cell count benefits IR and CD4/CD8 ratio normalization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 1","pages":"70-80"},"PeriodicalIF":2.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106950","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
Cardiovascular disease risk in people of African ancestry with HIV in the United Kingdom 英国非洲裔艾滋病毒感染者的心血管疾病风险。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-08-29 DOI: 10.1111/hiv.13706
Stephanie Ko, Lourdes Dominguez-Dominguez, Zoe Ottaway, Lucy Campbell, Julie Fox, Fiona Burns, Lisa Hamzah, Andrew Ustianowski, Amanda Clarke, Stephen Kegg, Sarah Schoeman, Rachael Jones, Sarah L. Pett, Jonathan Hudson, Frank A. Post

Objectives

Our objective was to describe the prevalence of cardiovascular disease (CVD) risk factors in people of African ancestry with HIV in the UK.

Methods

We conducted a cross-sectional analysis of CVD risk factors in Black people with HIV aged ≥40 years and estimated the 10-year CVD risk using QRISK®3-2018. Correlations between body mass index (BMI) and CVD risk factors were described using Pearson correlation coefficients, and factors associated with 10-year CVD risk ≥5% were described using logistic regression.

Results

We included 833 Black people with HIV and a median age of 54 years; 54% were female, 50% were living with obesity (BMI ≥30 kg/m2), 61% had hypertension, and 19% had diabetes mellitus. CVD risk >5% ranged from 2% in female participants aged 40–49 years to 99% in men aged ≥60 years, and use of statins ranged from 7% in those with CVD risk <2.5% to 64% in those with CVD risk ≥20%. BMI was correlated (R2 0.1–0.2) with triglycerides and diastolic blood pressure in women and with glycated haemoglobin, systolic and diastolic blood pressure, and total:high-density lipoprotein (HDL) cholesterol ratio in men. In both female and male participants, older age, blood pressure, diabetes mellitus, and kidney disease were strongly associated with CVD risk ≥5%, whereas obesity, total:HDL cholesterol, triglycerides, and smoking status were variably associated with CVD risk ≥5%.

Conclusions

We report a high burden of CVD risk factors, including obesity, hypertension, and diabetes mellitus, in people of African ancestry with HIV in the UK. BMI-focused interventions in these populations may improve CVD risk while also addressing other important health issues.

目的我们的目的是描述英国感染艾滋病毒的非洲裔人群中心血管疾病(CVD)风险因素的流行情况:我们对年龄≥40 岁的黑人 HIV 感染者的心血管疾病风险因素进行了横断面分析,并使用 QRISK®3-2018 估算了 10 年的心血管疾病风险。使用皮尔逊相关系数描述了身体质量指数(BMI)与心血管疾病风险因素之间的相关性,使用逻辑回归描述了与 10 年心血管疾病风险≥5% 相关的因素:我们纳入了 833 名感染艾滋病毒的黑人,中位年龄为 54 岁;54% 为女性,50% 患有肥胖症(体重指数≥30 kg/m2),61% 患有高血压,19% 患有糖尿病。心血管疾病风险大于 5% 的女性参与者占 40-49 岁的 2%,而年龄≥60 岁的男性参与者占 99%,使用他汀类药物的女性参与者占心血管疾病风险为 2 0.1-0.2% 的 7%,使用他汀类药物的男性参与者占甘油三酯和舒张压的 7%,使用他汀类药物的男性参与者占糖化血红蛋白、收缩压和舒张压以及总胆固醇:高密度脂蛋白胆固醇比率的 7%。在女性和男性参与者中,年龄较大、血压、糖尿病和肾脏疾病与心血管疾病风险≥5%密切相关,而肥胖、总胆固醇:高密度脂蛋白胆固醇、甘油三酯和吸烟状况与心血管疾病风险≥5%有不同程度的相关性:我们报告了英国非洲裔艾滋病感染者心血管疾病风险因素的高负担,包括肥胖、高血压和糖尿病。在这些人群中开展以 BMI 为重点的干预措施可在改善心血管疾病风险的同时解决其他重要的健康问题。
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引用次数: 0
Increased incidence of diabetes in people living with HIV treated with first-line integrase strand transfer inhibitors: A French multicentre retrospective study 接受一线整合酶链转移抑制剂治疗的艾滋病病毒感染者糖尿病发病率增加:一项法国多中心回顾性研究。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-08-28 DOI: 10.1111/hiv.13698
Axel Ursenbach, Antoine Sireyjol, Cyrille Delpierre, Claudine Duvivier, Laurent Hocqueloux, David Rey, the Dat'AIDS Study Group

Introduction

Prevention of cardiovascular disease is a major issue in the current management of people living with HIV. Concern is growing about the metabolic impact of integrase strand transfer inhibitors (INSTIs), which could lead to an increased risk of diabetes, but the data are conflicting. This is an updated version of our previous analysis, with longer follow-up and new molecules.

Methods

We retrospectively evaluated the incidence of new-onset diabetes in people living with HIV starting combined antiretroviral therapy with an INSTI compared with non-nucleoside reverse transcriptase inhibitors and protease inhibitors. Data were collected from the Dat'AIDS cohort study, a collaboration of 30 HIV treatment centres in France. We used a propensity score-based inverse probability of treatment weighting approach to adjust for baseline characteristics between the two groups (INSTI and non-INSTI).

Results

Between 2009 and 2021, a total of 12 150 people living with HIV were included. The incidence of diabetes was higher in the INSTI group than in the non-INSTI group (hazard ratio 1.38; 95% confidence interval 1.07–1.77; p = 0.012). Regardless of the third drug, but to a greater extent for INSTIs, we observed a peak of new-onset diabetes in the year following initiation of combined antiretroviral therapy.

Conclusions

The incidence of diabetes was higher in people treated with integrase inhibitors than in those receiving other third agents. This increased risk occurred both during the first year of treatment and in the longer term.

导言:预防心血管疾病是目前艾滋病病毒感染者管理中的一个主要问题。人们越来越关注整合酶链转移抑制剂(INSTIs)对新陈代谢的影响,它可能导致糖尿病风险增加,但相关数据并不一致。本文是我们之前分析的更新版,采用了更长的随访时间和新的分子:我们回顾性地评估了开始使用 INSTI 与非核苷类逆转录酶抑制剂和蛋白酶抑制剂进行联合抗逆转录病毒治疗的 HIV 感染者中新发糖尿病的发病率。数据来自Dat'AIDS队列研究,该研究由法国30个艾滋病治疗中心合作开展。我们采用了基于倾向得分的逆概率治疗加权法来调整两组(INSTI 和非 INSTI)之间的基线特征:结果:2009 年至 2021 年间,共纳入了 12 150 名艾滋病病毒感染者。INSTI 组的糖尿病发病率高于非 INSTI 组(危险比 1.38;95% 置信区间 1.07-1.77;P = 0.012)。无论使用哪种第三种药物,我们都观察到,在开始联合抗逆转录病毒疗法后的一年中,新发糖尿病的发病率达到高峰,但 INSTI 的发病率更高:结论:接受整合酶抑制剂治疗的患者的糖尿病发病率高于接受其他第三种药物治疗的患者。结论:接受整合酶抑制剂治疗的患者的糖尿病发病率高于接受其他第三类药物治疗的患者,这种风险的增加既发生在治疗的第一年,也发生在长期治疗中。
{"title":"Increased incidence of diabetes in people living with HIV treated with first-line integrase strand transfer inhibitors: A French multicentre retrospective study","authors":"Axel Ursenbach,&nbsp;Antoine Sireyjol,&nbsp;Cyrille Delpierre,&nbsp;Claudine Duvivier,&nbsp;Laurent Hocqueloux,&nbsp;David Rey,&nbsp;the Dat'AIDS Study Group","doi":"10.1111/hiv.13698","DOIUrl":"10.1111/hiv.13698","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Prevention of cardiovascular disease is a major issue in the current management of people living with HIV. Concern is growing about the metabolic impact of integrase strand transfer inhibitors (INSTIs), which could lead to an increased risk of diabetes, but the data are conflicting. This is an updated version of our previous analysis, with longer follow-up and new molecules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated the incidence of new-onset diabetes in people living with HIV starting combined antiretroviral therapy with an INSTI compared with non-nucleoside reverse transcriptase inhibitors and protease inhibitors. Data were collected from the Dat'AIDS cohort study, a collaboration of 30 HIV treatment centres in France. We used a propensity score-based inverse probability of treatment weighting approach to adjust for baseline characteristics between the two groups (INSTI and non-INSTI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2009 and 2021, a total of 12 150 people living with HIV were included. The incidence of diabetes was higher in the INSTI group than in the non-INSTI group (hazard ratio 1.38; 95% confidence interval 1.07–1.77; <i>p</i> = 0.012). Regardless of the third drug, but to a greater extent for INSTIs, we observed a peak of new-onset diabetes in the year following initiation of combined antiretroviral therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The incidence of diabetes was higher in people treated with integrase inhibitors than in those receiving other third agents. This increased risk occurred both during the first year of treatment and in the longer term.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 1","pages":"166-172"},"PeriodicalIF":2.8,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092817","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}
引用次数: 0
Optimizing statin prescriptions for people living with HIV: Evidence for improved communication and shared care between primary care and specialist HIV services 优化艾滋病毒感染者的他汀类药物处方:改善初级保健和艾滋病专科服务之间的沟通和共同护理的证据。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-08-26 DOI: 10.1111/hiv.13704
N. Li, L. Thomas, A. Allan, B. John, S. Creighton

Objectives

Our objective was to assess the numbers of eligible people living with HIV attending one HIV clinic and receiving statins, the factors increasing the likelihood of statin prescription, the knowledge and involvement of primary care in cardiovascular risk prevention in people living with HIV, and the barriers to and drivers of shared care between general practitioners (GPs) and an HIV centre.

Methods

This was a retrospective case note review identifying cardiovascular risk, medications, and communication between the HIV clinic and GPs via an electronic survey of GPs identifying their knowledge about statin indications in people living with HIV.

Results

In total, 62% of GPs were unaware of the indication for statins in people living with HIV aged >40 years. A total of 33% of patients received statins, rising to 61% of patients with independent indications for statins. 92% of all statin prescriptions were provided by the GP. Statins were recommended in 25% of clinic letters but were not prescribed in 72% of these cases. There was discordance between antiretrovirals prescribed by the HIV clinic and those documented on the GP record in 60% of cases and in 40% of non-antiretroviral medications.

Conclusions

Our results indicate that GPs can engage people living with HIV in cardiovascular risk reduction measures but may not consider HIV a cardiovascular risk. Written communication alone is insufficient to improve safe patient care. Shared HIV care needs bidirectional shared medical records. Ongoing work needs to ensure that HIV is recognized as an independent cardiovascular risk factor.

目标:我们的目的是评估在一家艾滋病诊所就诊并接受他汀类药物治疗的合格艾滋病病毒感染者人数、增加开具他汀类药物处方可能性的因素、初级保健对艾滋病病毒感染者心血管风险预防的了解和参与程度,以及全科医生(GPs)和艾滋病中心之间共享护理的障碍和驱动因素:这是一项回顾性病例回顾,通过对全科医生进行电子调查,了解他们对他汀类药物在艾滋病病毒感染者中的适应症的认识,从而确定心血管风险、用药以及艾滋病诊所与全科医生之间的沟通:结果:总共有 62% 的全科医生不了解他汀类药物在年龄大于 40 岁的 HIV 感染者中的适应症。共有 33% 的患者接受了他汀类药物治疗,其中 61% 的患者有他汀类药物的独立适应症。92%的他汀类药物处方由全科医生开具。25%的门诊信中推荐使用他汀类药物,但其中72%的病例并未开具他汀类药物处方。艾滋病诊所开具的抗逆转录病毒药物处方与全科医生记录不一致的情况占 60%,非抗逆转录病毒药物处方与全科医生记录不一致的情况占 40%:我们的研究结果表明,全科医生可以让艾滋病病毒感染者参与降低心血管风险的措施,但他们可能并不认为艾滋病是一种心血管风险。仅靠书面交流不足以改善对患者的安全护理。共同的艾滋病护理需要双向共享医疗记录。需要持续开展工作,确保艾滋病被视为一个独立的心血管风险因素。
{"title":"Optimizing statin prescriptions for people living with HIV: Evidence for improved communication and shared care between primary care and specialist HIV services","authors":"N. Li,&nbsp;L. Thomas,&nbsp;A. Allan,&nbsp;B. John,&nbsp;S. Creighton","doi":"10.1111/hiv.13704","DOIUrl":"10.1111/hiv.13704","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Our objective was to assess the numbers of eligible people living with HIV attending one HIV clinic and receiving statins, the factors increasing the likelihood of statin prescription, the knowledge and involvement of primary care in cardiovascular risk prevention in people living with HIV, and the barriers to and drivers of shared care between general practitioners (GPs) and an HIV centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective case note review identifying cardiovascular risk, medications, and communication between the HIV clinic and GPs via an electronic survey of GPs identifying their knowledge about statin indications in people living with HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 62% of GPs were unaware of the indication for statins in people living with HIV aged &gt;40 years. A total of 33% of patients received statins, rising to 61% of patients with independent indications for statins. 92% of all statin prescriptions were provided by the GP. Statins were recommended in 25% of clinic letters but were not prescribed in 72% of these cases. There was discordance between antiretrovirals prescribed by the HIV clinic and those documented on the GP record in 60% of cases and in 40% of non-antiretroviral medications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results indicate that GPs can engage people living with HIV in cardiovascular risk reduction measures but may not consider HIV a cardiovascular risk. Written communication alone is insufficient to improve safe patient care. Shared HIV care needs bidirectional shared medical records. Ongoing work needs to ensure that HIV is recognized as an independent cardiovascular risk factor.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"25 12","pages":"1325-1329"},"PeriodicalIF":2.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072599","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
What have we learned from the REPRIEVE trial and where do we go from here? 我们从 REPRIEVE 试验中学到了什么?
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-08-25 DOI: 10.1111/hiv.13703
Steven K. Grinspoon, Michael T. Lu, Markella V. Zanni, Marissa R. Diggs, Sarah M. Chu, Heather J. Ribaudo, Pamela S. Douglas
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引用次数: 0
Assessment of targeted intervention programme under the National AIDS Control Program among men who have sex with men in India 对印度国家艾滋病控制计划下针对男男性行为者的干预计划进行评估。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-08-25 DOI: 10.1111/hiv.13702
Shruti Vashisht, Nishakar Thakur, Shashi Kant, Sanjay Rai, Shreya Jha

Introduction

The population of men who have sex with men (MSM) in India is vulnerable to HIV/AIDS. India instituted a targeted intervention (TI) programme to reduce this vulnerability. We aimed to measure the assessment of the TI programme for MSM.

Materials and Methods

The national Integrated Biological and Behavioural Survey (IBBS) was carried out in 2014–2015. We analysed MSM data from the IBBS and used bivariate and multivariate logistic regression to calculate the unadjusted and adjusted odds ratios with 95% confidence intervals. The use of a condom during their last sexual intercourse and consistent condom use during the previous month were considered indicators of programme effectiveness. The propensity score matching method was used to assess the effectiveness of the TI programme.

Results

The matched-samples estimate (i.e., average treatment effect on treated) for the use of condoms during their last sexual intercourse increased by 10.0% (0.10; 95% confidence interval [CI] 0.08–0.12), and consistent condom use during the previous month increased by 9.0% (0.09; 95% CI 0.07–0.10) among those who had received condoms from the peer educator/outreach worker compared with those who had not received condoms.

Conclusions

The TI programme intervention among MSM was effective in reducing HIV risk behaviours, as evidenced by an increase in the use of condoms during their last sexual intercourse and consistent condom use during the last month.

导言:印度的男男性行为者(MSM)群体很容易感染艾滋病毒/艾滋病。印度制定了一项有针对性的干预(TI)计划,以降低这种易感性。我们的目的是对男男性行为者针对性干预计划进行评估:2014-2015 年开展了全国生物和行为综合调查(IBBS)。我们分析了 IBBS 中的 MSM 数据,并使用双变量和多变量逻辑回归计算了未调整和调整后的几率比率及 95% 的置信区间。在最后一次性交中使用安全套以及在前一个月中持续使用安全套被认为是计划有效性的指标。采用倾向得分匹配法评估了技术倡议计划的有效性:配对样本估计值(即对受治疗者的平均治疗效果)显示,与未获得安全套的受治疗者相比,从同伴教育者/外展工作者处获得安全套的受治疗者在最近一次性交中使用安全套的比例提高了 10.0% (0.10; 95% 置信区间 [CI] 0.08-0.12),在上个月持续使用安全套的比例提高了 9.0% (0.09; 95% CI 0.07-0.10):男男性行为者中的 TI 项目干预措施能有效减少 HIV 风险行为,这体现在他们在最近一次性交中使用安全套的比例有所提高,并且在最近一个月中坚持使用安全套。
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引用次数: 0
Immunological and virological response to fostemsavir in routine US clinical care: An OPERA cohort study 美国常规临床治疗中对福斯替沙韦的免疫学和病毒学反应:OPERA 队列研究。
IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-08-25 DOI: 10.1111/hiv.13700
Ricky K. Hsu, Laurence Brunet, Philip C. Lackey, Gerald Pierone Jr, Brooke Levis, Jennifer S. Fusco, Cassidy Henegar, Vani Vannappagari, Andrew Clark, Gregory P. Fusco

Objectives

Fostemsavir is a novel attachment inhibitor used with other antiretrovirals in heavily treatment-experienced (HTE) adults with multidrug-resistant HIV-1. Real-world immunological and virological responses were assessed in individuals starting fostemsavir in the OPERA cohort.

Methods

Among adults with HIV-1 starting fostemsavir between 2 July 2020 and 1 September 2022, 6-month and 12-month changes in CD4 T-cell count and CD4%, and maintenance/achievement of viral load (VL) <50 copies/mL were described and stratified by baseline VL (suppressed: <50 copies/mL; viraemic: ≥50 copies/mL) and CD4 count (high: ≥350 cells/μL; low: <350 cells/μL).

Results

Of 182 individuals starting fostemsavir, 64% were viraemic (34% low CD4, 30% high CD4) and 36% were suppressed (16% low CD4, 20% high CD4). The suppressed/low CD4 group had the largest median increases in CD4 count (6-month: 30 cells/μL [interquartile range {IQR} 9–66], 12-month: 66 cells/μL [IQR 17–125]), and CD4% (6-month: 1.0% [IQR −0.3–2.8], 12-month: 1.9% [IQR 1.3–3.9]). Regardless of baseline VL, those with a high baseline CD4 count experienced a greater variability in immunological response than those with low CD4 counts (12-month standard deviation range 172–231 cells/μL vs. 69–90 cells/μL). VL <50 copies/mL was maintained in most suppressed individuals; nearly half of the viraemic/high CD4 group and a third of the viraemic/low CD4 group achieved a VL <50 copies/mL at either timepoint.

Conclusions

After 6 or 12 months of fostemsavir use, virological response was low in viraemic individuals, although most suppressed individuals did maintain suppression. While immunological response varied across individuals, virologically suppressed HTE individuals with low CD4 counts may benefit from immunological improvements with fostemsavir.

研究目的福斯替沙韦是一种新型附着抑制剂,可与其他抗逆转录病毒药物一起用于耐多药HIV-1重度治疗经验(HTE)成人患者。我们对 OPERA 队列中开始服用福斯替沙韦的患者进行了真实世界免疫学和病毒学反应评估:在 2020 年 7 月 2 日至 2022 年 9 月 1 日期间开始服用 fostemsavir 的 HIV-1 成人中,CD4 T 细胞计数和 CD4% 的 6 个月和 12 个月变化以及病毒载量(VL)的维持/达标情况:在182名开始服用福替沙韦的患者中,64%有病毒血症(34%低CD4,30%高CD4),36%受到抑制(16%低CD4,20%高CD4)。抑制/低 CD4 组的 CD4 细胞数中位数增幅最大(6 个月:30 个细胞/μL [中间值]):30 cells/μL [四分位数间距 {IQR} 9-66],12 个月:66 cells/μL [IQR 17-125]),CD4%(6 个月:1.0% [IQR -0.3-2.8],12 个月:1.9% [IQR 1.3-3.9])。无论基线 VL 如何,基线 CD4 细胞数高的患者比 CD4 细胞数低的患者的免疫反应变化更大(12 个月的标准偏差范围为 172-231 cells/μL 对 69-90 cells/μL)。VL 结论:使用福斯替沙韦 6 个月或 12 个月后,病毒血症患者的病毒学应答较低,尽管大多数被抑制的患者确实保持了抑制状态。虽然免疫反应因人而异,但病毒学抑制的 HTE 感染者 CD4 细胞计数较低,使用福司替沙韦后可能会从免疫改善中获益。
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引用次数: 0
期刊
HIV Medicine
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