HIV Medicine最新文献_第9页

Diagnostic accuracy of the WHO clinical staging system for detection of immunologically defined advanced HIV disease: A systematic review and meta-analysis WHO临床分期系统检测免疫定义的晚期HIV疾病的诊断准确性：系统回顾和荟萃分析。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-26 DOI: 10.1111/hiv.70122

Hussein H. Twabi, Akitoshi Ueno, Josephine Ives, Ross Murtagh, Madalo Mukoka, Seyed Alireza Mortazavi, David S. Lawrence, Augustine T. Choko, Robina Semphere, Kelvin Balakasi, Ajay Rangaraj, Nathan Ford, Joseph N. Jarvis, Peter MacPherson

Introduction

People with advanced HIV disease face high risks of severe illness and death. CD4 testing enables timely diagnosis and appropriate care, yet access remains limited in many settings. This review investigated the diagnostic accuracy of the WHO clinical staging for identifying advanced HIV disease.

Methods

We conducted a systematic review and meta-analysis of studies published between 1 January 1998 and 1 May 2024 that assessed both WHO clinical staging and CD4 counts in people living with HIV aged 5 years and older (PROSPERO: CRD42024558372). We pooled sensitivity and specificity estimates of WHO Stage 3/4 for detecting advanced HIV disease (CD4 <200 cells/μL) using bivariate random-effects meta-analysis. Risk of bias was assessed using QUADAS-2, and certainty of evidence was appraised using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).

Results

Of 15,194 studies screened, 335 relevant studies were identified, from which 25 were included in evidence synthesis and 21 in the meta-analysis. Most studies were from the WHO African (19/25) and South-East Asian (5/25) regions. Risk of bias was moderate to high in 88% of studies, primarily due to issues with clinical staging assessment. Pooled sensitivity and specificity of WHO Stage 3/4 were 60.7% (95% CI: 48.0%–72.1%) and 72.4% (95% CI: 61.4%–81.3%), respectively. Specificity was significantly higher outside the African region (p < 0.001). In a population of 100,000 people living with HIV with 30% advanced HIV disease prevalence, WHO staging would miss 11,700 true advanced HIV disease cases and misclassify 19,600.

Conclusions

WHO clinical staging alone shows low accuracy for detecting advanced HIV disease, risking both missed diagnoses and overtreatment. CD4 testing remains essential for accurately identifying and managing advanced HIV disease.

导言：艾滋病毒晚期患者面临严重疾病和死亡的高风险。CD4检测可实现及时诊断和适当护理，但在许多情况下获得检测的机会仍然有限。本综述调查了世卫组织临床分期识别晚期HIV疾病的诊断准确性。方法：我们对1998年1月1日至2024年5月1日发表的研究进行了系统回顾和荟萃分析，这些研究评估了5岁及以上艾滋病毒感染者的WHO临床分期和CD4计数（PROSPERO: CRD42024558372）。结果：在筛选的15,194项研究中，确定了335项相关研究，其中25项纳入证据综合，21项纳入荟萃分析。大多数研究来自世卫组织非洲（19/25）和东南亚（5/25）区域。88%的研究偏倚风险为中等至高，主要是由于临床分期评估的问题。WHO 3/4期的合并敏感性和特异性分别为60.7% （95% CI: 48.0% ~ 72.1%）和72.4% （95% CI: 61.4% ~ 81.3%）。结论：世卫组织单独的临床分期显示，检测晚期艾滋病毒疾病的准确性较低，存在漏诊和过度治疗的风险。CD4检测对于准确识别和管理晚期艾滋病毒疾病仍然至关重要。

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引用次数: 0

People living with HIV on modern antiretrovirals do not display a pro-atherogenic lipid profile and have similar body composition compared to healthy controls 与健康对照组相比，接受现代抗逆转录病毒治疗的艾滋病毒感染者没有显示出促动脉粥样硬化的脂质特征，并且具有相似的身体组成。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-24 DOI: 10.1111/hiv.70118

S. Savinelli, A. Heeney, W. Tinago, A. A. Garcia Leon, P. McGettrick, A. G. Cotter, I. Walsh, M. Fitzgibbon, C. A. Sabin, P. W. G. Mallon, E. R. Feeney, the HIV UPBEAT study group

Objectives

Alterations in lipids and apolipoproteins contribute to cardiovascular disease (CVD) and are common in people with HIV. The aim of our study was to compare lipid profiles and body composition between people with and without HIV and to explore whether any associations with HIV could be explained by socio-demographic, clinical characteristics and body composition.

Methods

Cross-sectional analysis of a cohort study enrolling people with HIV and HIV-negative controls. Apolipoproteins [ApoB-100, ApoA1, Lp(a)] were analysed by immunoturbidimetry. Lipids (total cholesterol [TC], low-density lipoprotein [LDL], high-density lipoprotein [HDL]), clinical/demographic data and dual-energy X-ray absorptiometry (DXA)-measured body composition parameters were collected. Between-group differences were assessed with Student's T-test. Linear regression models assessed associations of lipids and apolipoproteins with HIV status and associations with socio-demographic, clinical characteristics and body composition.

Results

We included 108 people with HIV on treatment (93.5% with viral suppression) and 96 controls. People with HIV were younger, more likely to be male, with obesity, of African ethnicity, smokers and with a higher representation of CVD, hypertension, diabetes and statin use. ApoB-100, TC, HDL and LDL were significantly lower in people with HIV, with no between-group difference in ApoA, Lp(a) and body composition. HIV infection remained independently associated with lower TC and LDL after adjustment for possible confounders.

Conclusions

People with HIV from a contemporary cohort had lower pro-atherogenic lipid parameters compared to controls, and no differences in body composition between people with HIV and controls were observed. Traditional risk factors for CVD and chronic inflammation might have a greater impact than dyslipidaemia itself on the increased CVD risk in people with HIV.

目的：脂质和载脂蛋白的改变与心血管疾病（CVD）有关，并且在HIV感染者中很常见。本研究的目的是比较HIV感染者和非HIV感染者的脂质特征和身体组成，并探讨是否有任何与HIV相关的因素可以用社会人口统计学、临床特征和身体组成来解释。方法：对一项纳入HIV感染者和HIV阴性对照的队列研究进行横断面分析。免疫比浊法分析载脂蛋白[ApoB-100， ApoA1, Lp(a)]。收集血脂（总胆固醇[TC]、低密度脂蛋白[LDL]、高密度脂蛋白[HDL]）、临床/人口统计学数据和双能x线吸收仪（DXA）测量的身体成分参数。组间差异采用学生t检验。线性回归模型评估了脂质和载脂蛋白与HIV状态的关系，以及与社会人口统计学、临床特征和身体组成的关系。结果：我们纳入了108例接受治疗的HIV感染者（93.5%采用病毒抑制）和96例对照组。艾滋病毒感染者更年轻，更可能是男性，肥胖，非洲裔，吸烟者，心血管疾病，高血压，糖尿病和他汀类药物使用的比例更高。HIV感染者的ApoB-100、TC、HDL和LDL显著降低，ApoA、Lp(a)和体成分组间无差异。在调整了可能的混杂因素后，HIV感染仍然与较低的TC和LDL独立相关。结论：与对照组相比，来自当代队列的HIV感染者具有较低的促动脉粥样硬化脂质参数，并且在HIV感染者和对照组之间的身体组成没有观察到差异。心血管疾病和慢性炎症的传统危险因素可能比血脂异常本身对艾滋病毒感染者心血管疾病风险增加的影响更大。

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引用次数: 0

Sexual dysfunction care needs of gay, bisexual, and other men who have sex with men living with HIV in Montreal, Canada 加拿大蒙特利尔同性恋者、双性恋者和其他与艾滋病毒携带者发生性行为的男性的性功能障碍护理需求

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-22 DOI: 10.1111/hiv.70115

Francesco Avallone, Kim Engler, Ford Hickson, Joseph Cox, Eric Fortin, Sean Yaphe, Bertrand Lebouché

Objectives

Sexual dysfunction (SD) is common among gay, bisexual and other men who have sex with men (GBM) with HIV, yet little is known about their views on SD care. We explored these views to inform patient-centred SD care to improve care delivery and sexual health outcomes.

Methods

Semi-structured interviews were conducted in 2024 with 31 Montreal-based GBM with HIV who experienced SD in the last 5 years (reduced libido, erectile dysfunction, premature/delayed ejaculation and/or pain during sex), covering SD care experiences and preferences. Thematic analysis was applied to interview transcripts.

Results

Participants mostly reported reduced libido (83.9%) and erectile dysfunction (ED(80.6%), with over half (58.0%) experiencing multiple SDs concurrently. Themes regarding SD care experiences were (1) costs and benefits of ED medication, (2) limited benefits of testosterone replacement therapy, (3) mixed views on talk therapy (and a preference for group therapy), and (4) not seeking care due to questions of SD definition and normalcy. SD care preferences concerned both provider characteristics (identity, approach to patients and expertise) and care delivery (information provision, involvement and respect and access to diverse resources).

Conclusions

Irrespective of the approach to SD care sought (medication or talk therapy), participants experienced limited success. For some, doubts about the severity of their SD impeded help-seeking. SD care preferences for the provider (e.g., expertise) and care provided (e.g., information, patient involvement) offer paths to more patient-centred care.

目的：性功能障碍（SD）在男同性恋、双性恋和其他男男性行为者（GBM）中很常见，但他们对性功能障碍护理的看法却知之甚少。我们探讨了这些观点，为以患者为中心的可持续发展护理提供信息，以改善护理服务和性健康结果。方法：在2024年对31名在过去5年内经历过SD（性欲减退、勃起功能障碍、早泄/延迟射精和/或性交疼痛）的蒙特利尔HIV GBM患者进行半结构化访谈，涵盖SD护理经历和偏好。访谈笔录采用专题分析。结果：参与者大多报告性欲下降（83.9%）和勃起功能障碍（ED）（80.6%），超过一半（58.0%）的患者同时经历多重性勃起障碍。关于性功能障碍治疗经历的主题是(1)ED药物的成本和收益，(2)睾酮替代疗法的有限收益，(3)对谈话治疗的不同看法（以及对团体治疗的偏好），以及(4)由于性功能障碍定义和正常问题而不寻求治疗。可持续发展护理偏好涉及提供者特征（身份、对患者的态度和专业知识）和护理提供（信息提供、参与、尊重和获得各种资源）。结论：无论采用何种方法寻求SD治疗（药物治疗或谈话治疗），参与者的成功程度有限。对一些人来说，对SD严重程度的怀疑阻碍了他们寻求帮助。提供者的SD护理偏好（例如，专业知识）和所提供的护理（例如，信息，患者参与）为更加以患者为中心的护理提供了途径。

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引用次数: 0

Intersections of vitamin D deficiency, HIV and chronic liver diseases 维生素D缺乏、艾滋病毒和慢性肝病的交叉点。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-20 DOI: 10.1111/hiv.70117

Francesca Farina, Aurgho Datta, Suzanne N. Morin, Sahar Saeed, Bertrand Lebouche, Giovanni Guaraldi, Salvatore Petta, Giada Sebastiani

Objectives

Despite effective antiretroviral therapy (ART), chronic liver diseases remain a leading cause of morbidity and mortality among people with HIV, with metabolic dysfunction–associated steatotic liver disease (MASLD) now the predominant etiology. Vitamin D deficiency is also highly prevalent in this population. We synthesize current evidence on the interplay between HIV, liver disease, and vitamin D deficiency, and highlight implications for risk stratification and therapeutic research in this population.

Methods

A targeted PubMed search was conducted using terms for HIV, liver disease, fibrosis, and vitamin D, supplemented by reference screening. We prioritized peer-reviewed studies and guidelines addressing liver disease epidemiology and mechanisms in people with HIV, vitamin D biology, and associations between vitamin D status and hepatic injury. Comparative data from non-HIV populations were also reviewed.

Results

People with HIV face a high burden for chronic liver diseases due to MASLD, viral hepatitis coinfections, and hepatotoxic exposures such as alcohol and ART. Pathogenesis involve persistent immune activation, hepatic stellate cell activation, and systemic inflammation. Vitamin D deficiency is frequent in people with HIV and, in non-HIV populations, correlates with higher prevalence of MASLD and fibrosis. Emerging evidence suggests plausible links through immune modulation, oxidative stress, and fibrogenesis, though causality remains unproven.

Conclusions

The intersection of HIV, MASLD, and vitamin D deficiency is biologically plausible and clinically relevant yet underexplored. Longitudinal studies with standardized MASLD phenotyping and vitamin D assessment are warranted. Meanwhile, integrating metabolic risk assessment with vitamin D evaluation may support more holistic liver care in people with HIV, while interventional trials should clarify whether vitamin D optimization improves hepatic and extrahepatic outcomes.

尽管抗逆转录病毒治疗（ART）有效，慢性肝病仍然是艾滋病毒感染者发病和死亡的主要原因，代谢功能障碍相关的脂肪变性肝病（MASLD）现在是主要病因。维生素D缺乏症在这一人群中也非常普遍。我们综合了目前关于HIV、肝脏疾病和维生素D缺乏之间相互作用的证据，并强调了这一人群的风险分层和治疗研究的意义。方法：使用HIV、肝脏疾病、纤维化和维生素D进行有针对性的PubMed搜索，并辅以参考筛选。我们优先考虑同行评议的研究和指南，这些研究和指南涉及艾滋病毒感染者的肝脏疾病流行病学和机制、维生素D生物学以及维生素D状态与肝损伤之间的关系。还审查了非艾滋病毒人群的比较数据。结果：由于MASLD、病毒性肝炎合并感染和肝毒性暴露（如酒精和抗逆转录病毒治疗），HIV感染者面临慢性肝病的高负担。发病机制包括持续免疫激活、肝星状细胞激活和全身性炎症。维生素D缺乏症在艾滋病毒感染者中很常见，在非艾滋病毒人群中，维生素D缺乏症与MASLD和纤维化的高患病率相关。新出现的证据表明，免疫调节、氧化应激和纤维形成之间存在似是而非的联系，尽管因果关系尚未得到证实。结论：HIV、MASLD和维生素D缺乏症的交叉在生物学上是合理的，在临床上是相关的，但尚未得到充分的研究。有必要进行标准化MASLD表型和维生素D评估的纵向研究。与此同时，将代谢风险评估与维生素D评估相结合，可能会为艾滋病毒感染者提供更全面的肝脏护理，而干预性试验应阐明维生素D优化是否能改善肝脏和肝外预后。

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引用次数: 0

The moderating effect of healthcare empowerment on the relationship between stigma and self-rated health in people living with HIV in Canada 保健赋权对加拿大艾滋病毒感染者耻辱与自评健康之间关系的调节作用。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-15 DOI: 10.1111/hiv.70108

Jason M. Lo Hog Tian, James R. Watson, Alex Tran, Robert G. Maunder, Janet A. Parsons, Bulent Turan, Mallory O. Johnson, Anthony R. Boni, Arthur Dave Miller, Danita Wahpoosewyan, Deborah Norris, George Da Silva, Kim Samson, Lynne Cioppa, Patricia Ukoli, Adrian Betts, Apondi J. Odhiambo, Catherine Pearl, Gordon Arbess, Jared Star, Jennifer Demchuk, Kristin McBain, Sean B. Rourke

Objective

To determine the moderating effect of healthcare empowerment on the relationship between enacted, internalized and anticipated stigma and self-rated health.

Methods

Participants (n = 1318) were recruited to complete the People Living with HIV Stigma Index, a community-based cross-sectional survey administered across all provinces in Canada from August 2018 to October 2024. The survey contained externally validated quantitative scales measuring stigma, healthcare empowerment and health. Healthcare empowerment was broken down into subscales of Informed, Committed, Collaborative, and Engaged (ICCE) and Tolerance of Uncertainty (TU). Moderation models were created for each type of stigma as the antecedent, healthcare empowerment (total, ICCE and TU) as the moderator, and self-rated health as the outcome.

Results

Total healthcare empowerment was a significant moderator for the relationship between enacted (b = 0.11, 95% CI: 0.00, 0.23) and internalized (b = 0.23, 95% CI: 0.09, 0.37) stigma and self-rated health. The ICCE subscale was a significant moderator for the relationship between internalized (b = 0.20, 95% CI: 0.08, 0.33) and anticipated (b = 0.17, 95% CI: 0.04, 0.31) stigma and self-rated health. Overall, for those with low levels of healthcare empowerment, greater enacted and internalized stigma resulted in worse self-rated health; however, high levels of healthcare empowerment buffered the negative impact of stigma.

Conclusion

Healthcare empowerment may have the potential to buffer or mitigate the negative effect of stigma. Understanding how to bolster levels of healthcare empowerment, specifically dimensions of ICCE, may be important for the development of interventions aiming to reduce the impact of stigma for people living with HIV.

目的：探讨医疗保健赋权对制定的、内化的和预期的病耻感与自评健康之间关系的调节作用。方法：招募参与者（n = 1318）完成艾滋病毒感染者污名指数，这是一项基于社区的横断面调查，于2018年8月至2024年10月在加拿大所有省份进行。该调查包含外部验证的量化量表，测量耻辱、医疗保健授权和健康。医疗保健授权被分解为知情、承诺、协作和参与（ICCE）和不确定性容忍（TU）的子量表。为每种类型的病耻感创建了调节模型作为前项，医疗保健授权（总、ICCE和TU）作为调节因子，自评健康作为结果。结果：总医疗保健授权是制定（b = 0.11, 95% CI: 0.00, 0.23）和内化（b = 0.23, 95% CI: 0.09, 0.37）污名与自评健康之间关系的显著调节因子。ICCE子量表对内化（b = 0.20, 95% CI: 0.08, 0.33）和预期（b = 0.17, 95% CI: 0.04, 0.31）病耻感与自评健康之间的关系具有显著调节作用。总体而言，对于那些卫生保健授权水平较低的人，更大的制定和内化耻辱导致更差的自评健康；然而，高水平的医疗保健赋权缓解了耻辱的负面影响。结论：医疗保健授权可能有缓冲或减轻耻辱的负面影响的潜力。了解如何提高医疗保健授权水平，特别是ICCE的维度，可能对制定旨在减少艾滋病毒感染者污名化影响的干预措施很重要。

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引用次数: 0

Outcomes of real-world initiation of long-acting injectable cabotegravir and rilpivirine (LA-I CAB + RPV) in individuals with viraemia: A systematic review of baseline characteristics, virological failure outcomes and discontinuations 病毒血症患者开始使用长效注射卡波特韦和利匹韦林（LA-I CAB + RPV）的结果：基线特征、病毒学失败结果和停药的系统回顾。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-13 DOI: 10.1111/hiv.70113

Alexa Elias, Chloé Pasin, Melanie Smuk, Amy Paterson, Chloe M. Orkin

Background

When using long-acting injectable cabotegravir and rilpivirine (CAB + RPV) in individuals with viraemia, beyond small cohorts, little is known about baseline characteristics, virological failure outcomes, resistance emergence, re-suppression and discontinuation.

Methods

We identified evidence from PubMed, EMBASE, Cochrane and conference abstract databases through 17 March 2025 to synthesize data from observational cohort studies (OCS) that reported on virological failure (VF) events in individuals with viraemia at initiation of LA-I CAB + RPV. We extracted data on baseline clinical and socio-demographic characteristics, VF, resistance-associated mutations (RAMs) at VF, post-VF regimen choice, re-suppression and discontinuation.

Results

Across 14 cohorts including 561 individuals, there were 36 VF events (OCS-level VF rate 0% (n/N = 0/12, 0/12 and 0/10) to 25% (n/N = 3/12)). VF definitions varied. 6/14 OCS (n = 436) reported on baseline CD4 count, 13/14 (n = 543) on baseline viral load and 7/14 (n = 459) on socio-demographic characteristics. Among the 14 VF events with genotypic information available at VF, NNRTI RAMs were identified in 13/14 individuals, INI RAMs in 9/14 and dual-class resistance in 8/14 individuals. Post-VF regimens were reported for 16/36 individuals with VF and included lenacapavir (LEN)-based regimens, protease inhibitor (PI)-based regimens or LA-I CAB + RPV continuation. Re-suppression outcomes were described in 10 VF events: re-suppression occurred in 5/10.

Conclusions

In OCS, the follow-up duration was short and VF definitions were highly variable, with few cohorts reporting VF outcomes in people with baseline VL >10 000 c/mL. VF was frequently accompanied by resistance. Post-VF regimens varied, and their success was unclear due to the small sample size.

背景：在病毒血症患者中使用长效注射cabotegravir和rilpivirine （CAB + RPV）时，除了小队列外，对基线特征、病毒学失败结果、耐药出现、再抑制和停药知之甚少。方法：我们从PubMed、EMBASE、Cochrane和会议摘要数据库中检索到截至2025年3月17日的证据，以综合来自观察性队列研究（OCS）的数据，这些研究报告了LA-I CAB + RPV开始时病毒血症患者的病毒学失败（VF）事件。我们提取了基线临床和社会人口学特征、VF、VF时耐药性相关突变（RAMs）、VF后方案选择、再抑制和停药的数据。结果：在14个队列中包括561个人，有36个VF事件（ocs水平VF率0% （n/ n = 0/12, 0/12和0/10）至25% (n/ n = 3/12)）。VF的定义各不相同。6/14名OCS （n = 436）报告了基线CD4计数，13/14 （n = 543）报告了基线病毒载量，7/14 （n = 459）报告了社会人口统计学特征。在VF可获得基因型信息的14例VF事件中，13/14例发现NNRTI拉姆，9/14例发现INI拉姆，8/14例发现双级耐药。36例VF患者中有16例报告了VF后治疗方案，包括lenacapavir （LEN）为基础的治疗方案、蛋白酶抑制剂（PI）为基础的治疗方案或LA-I CAB + RPV继续治疗方案。10个VF事件描述了再抑制结果：5/10发生了再抑制。结论：在OCS中，随访时间短，VF定义变化很大，很少有队列报告基线VL低于10 000 c/mL的人的VF结果。VF常伴有抵抗。vf后的治疗方案各不相同，由于样本量小，它们的成功与否尚不清楚。

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引用次数: 0

Evaluating birth outcomes following oral rilpivirine use in pregnancy in the United States: Findings from the antiretroviral pregnancy registry 评估美国妊娠期口服利匹韦林后的出生结局：来自抗逆转录病毒妊娠登记的发现。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-11 DOI: 10.1111/hiv.70112

William R. Short, Corinne Willame, Henry Nguyen, Bohui Zhang, Ping Xu, Eileen Birmingham, Rodica Van Solingen-Ristea, Bryan Baugh

Introduction

The Antiretroviral Pregnancy Registry (APR) is designed to detect major teratogenic effects of antiretroviral medications; other pregnancy outcomes are also recorded when reported. We compared available pregnancy and birth outcomes of women exposed to oral rilpivirine-containing regimens (oral-RPV cohort) versus non-rilpivirine regimens (non-RPV cohort) over the period 2011 to 2023.

Methods

Maternal age-adjusted prevalence ratio (aPR) of pregnancy and birth outcomes was compared for prospectively reported pregnancies; aPR of birth defects was compared between first-trimester exposures and combined second/third-trimester exposures.

Results

In total, 6937 pregnancies were recorded, including 4617 (oral-RPV cohort, 781 [16.9%]; non-RPV cohort, 3836 [83.1%]) from the United States. Among live births, the prevalence of birth defects was lower in the oral-RPV cohort (1.6% versus 3.8%; aPR: 0.4 [95% confidence interval (CI): 0.2–0.8]). The prevalence of birth defects in the first-trimester oral-RPV exposure versus second/third-trimester exposure did not differ (aPR: 3.4 [95% CI: 0.4–26.3]). The aPR of induced abortions (1.1 [0.6–1.9]), stillbirths (0.6 [0.2–1.6]) and premature birth (0.8 [0.7–1.1]) were similar between cohorts. Prevalences for spontaneous abortion were 5.8% (oral-RPV cohort) versus 3.2% (non-RPV cohort) below the expected background rate (15%–20%). Low birth weights were less reported in oral-RPV, while very low birth weights were similar between cohorts.

Conclusions

Review of available data from the APR does not indicate an association between adverse pregnancy or birth outcomes and oral-RPV exposure, overall or by timing of exposure. Since APR targets primarily teratogenic effects, findings for non-teratogenic effects should be interpreted with caution.

简介：抗逆转录病毒妊娠登记（APR）旨在检测抗逆转录病毒药物的主要致畸作用；报告时也记录其他妊娠结局。我们比较了2011年至2023年期间口服含利匹韦林方案（口服rpv队列）与非利匹韦林方案（非rpv队列）的妇女的妊娠和分娩结果。方法：比较前瞻性报告妊娠的产妇年龄调整患病率（aPR）和分娩结局；比较妊娠早期暴露和妊娠中期/晚期联合暴露的出生缺陷aPR。结果：共记录6937例妊娠，其中4617例（口服rpv队列，781例[16.9%]；非rpv队列，3836例[83.1%]）来自美国。在活产婴儿中，口腔- rpv组的出生缺陷患病率较低（1.6%对3.8%;aPR: 0.4[95%可信区间（CI）： 0.2-0.8]）。妊娠早期口服rpv暴露与妊娠中期/晚期暴露的出生缺陷发生率无差异（aPR: 3.4 [95% CI: 0.4-26.3]）。人工流产（1.1[0.6-1.9]）、死产（0.6[0.2-1.6]）和早产（0.8[0.7-1.1]）的aPR在队列间相似。自然流产的患病率为5.8%（口服rpv组）和3.2%（非rpv组），低于预期背景率（15%-20%）。低出生体重在口服rpv中较少报道，而非常低的出生体重在队列之间相似。结论：对APR现有数据的回顾并未表明不良妊娠或分娩结果与口服rpv暴露之间存在关联，无论是总体上还是暴露时间上。由于APR主要针对致畸效应，因此对非致畸效应的研究结果应谨慎解释。

{"title":"Evaluating birth outcomes following oral rilpivirine use in pregnancy in the United States: Findings from the antiretroviral pregnancy registry","authors":"William R. Short, Corinne Willame, Henry Nguyen, Bohui Zhang, Ping Xu, Eileen Birmingham, Rodica Van Solingen-Ristea, Bryan Baugh","doi":"10.1111/hiv.70112","DOIUrl":"10.1111/hiv.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Antiretroviral Pregnancy Registry (APR) is designed to detect major teratogenic effects of antiretroviral medications; other pregnancy outcomes are also recorded when reported. We compared available pregnancy and birth outcomes of women exposed to oral rilpivirine-containing regimens (oral-RPV cohort) versus non-rilpivirine regimens (non-RPV cohort) over the period 2011 to 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Maternal age-adjusted prevalence ratio (aPR) of pregnancy and birth outcomes was compared for prospectively reported pregnancies; aPR of birth defects was compared between first-trimester exposures and combined second/third-trimester exposures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 6937 pregnancies were recorded, including 4617 (oral-RPV cohort, 781 [16.9%]; non-RPV cohort, 3836 [83.1%]) from the United States. Among live births, the prevalence of birth defects was lower in the oral-RPV cohort (1.6% versus 3.8%; aPR: 0.4 [95% confidence interval (CI): 0.2–0.8]). The prevalence of birth defects in the first-trimester oral-RPV exposure versus second/third-trimester exposure did not differ (aPR: 3.4 [95% CI: 0.4–26.3]). The aPR of induced abortions (1.1 [0.6–1.9]), stillbirths (0.6 [0.2–1.6]) and premature birth (0.8 [0.7–1.1]) were similar between cohorts. Prevalences for spontaneous abortion were 5.8% (oral-RPV cohort) versus 3.2% (non-RPV cohort) below the expected background rate (15%–20%). Low birth weights were less reported in oral-RPV, while very low birth weights were similar between cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Review of available data from the APR does not indicate an association between adverse pregnancy or birth outcomes and oral-RPV exposure, overall or by timing of exposure. Since APR targets primarily teratogenic effects, findings for non-teratogenic effects should be interpreted with caution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"27 1","pages":"33-41"},"PeriodicalIF":3.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040013","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

Cytokine biomarkers and their relationship to symptoms and quality of life in people with HIV-associated Kaposi sarcoma 细胞因子生物标志物及其与hiv相关卡波西肉瘤患者症状和生活质量的关系

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-10 DOI: 10.1111/hiv.70107

Fahmida Shaik, Thomas Smith Uldrick, Mikateko Mazinu, Nomonde Gwebushe, Anisa Mosam

Introduction

Quality of life (QOL) is an essential component of care in people with HIV-associated Kaposi sarcoma (HIV-KS). Kaposi sarcoma herpes virus (KSHV) promotes cytokine expression and a dysfunctional inflammatory environment, contributing to KS pathogenesis and progression. However, disease-related inflammatory factors influencing QOL and symptoms remain underexplored. This study examines the relationship between baseline QOL parameters and inflammatory cytokine biomarkers in treatment-naïve Africans with HIV-KS participating in the randomized controlled KAART study. We hypothesized that inflammatory cytokines are linked with reduced QOL and symptom burden.

Methods

Twenty-eight cytokines were measured from stored baseline serum using the Milliplex® multiplex assay. QOL was assessed using the validated EORTC QLQ-C30. Spearman Rho-Rank correlation was used to assess relationships between cytokine levels and QOL parameters, with p ≤ 0.01 considered statistically significant.

Results

Paired cytokine and QOL data were available for 68 participants. IL-8 showed significant negative correlations with summary scores, a reliable indicator of overall QOL (r_s = −0.35, p = 0.005). Increased IL-8 also correlated significantly with reduced emotional functioning scales (r_s = −0.33, p = 0.01) and increased pain (r_s = 0.32, p = 0.01). By contrast, increased IL-10 correlated significantly with reduced pain (r_s = −0.31, p = 0.01). VEGF and MCP-1 levels correlated negatively with role functioning (r_s = −0.32, p = 0.01; r_s = −0.30, p = 0.01).

Conclusion

IL-8 is a key cytokine affecting QOL in HIV-KS. Elevations have a negative impact on pain, emotional functioning and overall QOL. IL-10, VEGF and MCP-1 perturbations also impact QOL. These findings enhance understanding of cytokine involvement in KS pathogenesis.

生活质量（QOL）是hiv相关卡波西肉瘤（HIV-KS）患者护理的重要组成部分。卡波西肉瘤疱疹病毒（KSHV）促进细胞因子表达和功能失调的炎症环境，促进KS的发病和进展。然而，影响生活质量和症状的疾病相关炎症因素仍未得到充分探讨。本研究探讨了参与随机对照KAART研究的treatment-naïve非洲HIV-KS患者的基线生活质量参数与炎症细胞因子生物标志物之间的关系。我们假设炎症细胞因子与生活质量降低和症状负担有关。方法：使用Milliplex®多重检测法从储存的基线血清中检测28种细胞因子。使用经验证的EORTC QLQ-C30评估生活质量。采用Spearman Rho-Rank相关评价细胞因子水平与生活质量参数的关系，p≤0.01认为有统计学意义。结果：获得68例受试者的配对细胞因子和生活质量数据。IL-8与综合评分呈显著负相关（rs = -0.35, p = 0.005），综合评分是总体生活质量的可靠指标。IL-8的升高与情绪功能量表的降低（rs = -0.33, p = 0.01）和疼痛的增加（rs = 0.32, p = 0.01）也显著相关。相比之下，IL-10升高与疼痛减轻显著相关（rs = -0.31, p = 0.01）。VEGF和MCP-1水平与角色功能呈负相关（rs = -0.32, p = 0.01; rs = -0.30, p = 0.01）。结论：IL-8是影响HIV-KS患者生活质量的关键细胞因子。血压升高对疼痛、情绪功能和总体生活质量有负面影响。IL-10、VEGF和MCP-1的扰动也会影响生活质量。这些发现增强了对细胞因子参与KS发病机制的理解。

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引用次数: 0

Molecular epidemiological analysis and investigation of antiretroviral drug resistance profile, including capsid inhibitors, among treatment-naïve individuals with HIV-1 in Türkiye <s:1> rkiye地区treatment-naïve HIV-1患者（包括衣壳抑制剂）抗逆转录病毒耐药性的分子流行病学分析和调查

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-07 DOI: 10.1111/hiv.70109

Adem Özdemir, Tülin Demir, Ceylan Polat, Mertcan Uzun, Meliha Çağla Sönmezer, Koray Ergünay, Serhat Ünal, Ahmet Çağkan İnkaya, Ahmet Pınar

Introduction

Monitoring transmitted drug resistance is crucial for guiding first-line antiretroviral therapy (ART) and controlling the rising HIV epidemic in Türkiye. This study aimed to determine the prevalence of transmitted antiretroviral resistance to protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), integrase strand transfer inhibitors (INSTIs) and capsid assembly inhibitors (CAIs). We also assessed the distribution of HIV-1 subtypes and circulating recombinant forms (CRFs) at one of the main national referral centres in Türkiye.

Methods

We included 104 consecutive ART-naïve people living with HIV who presented at Hacettepe University Hospital in Ankara between November 2021 and November 2022. Demographic data, probable transmission routes and geographic origins were recorded. HIV-1 genotyping was performed to identify subtypes and resistance-associated mutations using standard methods.

Results

Of the 104 individuals, 97 were from 25 different cities in Türkiye, while 7 originated from 5 different countries. The most probable transmission routes were men who have sex with men (MSM) (64.42%), heterosexual contact (30.77%) and unknown (4.81%). Resistance-associated mutations were detected in 14.42% of individuals. Resistance rates were 1.92% for PI, 4.80% for NRTI and 7.69% for NNRTI. No resistance mutations were found against INSTI or CAI.

Conclusion

Transmitted resistance to PI, NRTI and NNRTI remains present in Türkiye, though at moderate levels. The absence of resistance to INSTI and CAI supports their potential utility as effective components of treatment regimens in Türkiye.

导言：监测传播的耐药性对于指导一线抗逆转录病毒治疗（ART）和控制泰国日益上升的艾滋病毒流行至关重要。本研究旨在确定对蛋白酶抑制剂（pi）、核苷类逆转录酶抑制剂（NRTIs）、非核苷类逆转录酶抑制剂（NNRTIs）、整合酶链转移抑制剂（insts）和衣壳组装抑制剂（CAIs）的传播性抗逆转录病毒耐药性的患病率。我们还评估了HIV-1亚型和循环重组形式（CRFs）在泰国一个主要国家转诊中心的分布情况。方法：我们纳入了2021年11月至2022年11月期间在安卡拉Hacettepe大学医院就诊的104名HIV感染者ART-naïve。记录了人口统计数据、可能的传播途径和地理来源。使用标准方法进行HIV-1基因分型以鉴定亚型和耐药性相关突变。结果：104人中，97人来自日本25个不同城市，7人来自5个不同国家。最可能的传播途径为男男性行为者（MSM）（64.42%）、异性接触（30.77%）和未知（4.81%）。14.42%的个体检测到耐药性相关突变。PI、NRTI和NNRTI的耐药率分别为1.92%、4.80%和7.69%。对INSTI和CAI均未发现耐药突变。结论：对PI、NRTI和NNRTI的传播性耐药在基耶病毒中仍然存在，但水平适中。对INSTI和CAI的无耐药性支持了它们作为治疗方案有效成分的潜在效用。

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引用次数: 0

Multidimensional frailty, sex differences, and quality of life among older Ugandans affected by HIV 受艾滋病毒影响的乌干达老年人的多维脆弱性、性别差异和生活质量。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2025-09-05 DOI: 10.1111/hiv.70111

Gideon Dzando, Paul R. Ward, Lillian Mwanri, Pascal Agbadi, Rachel C. Ambagtsheer

Background

Older people affected by HIV in sub-Saharan Africa are at increased risk of frailty and poor quality of life (QoL). However, the contributions of specific frailty domains to QoL and whether these associations differ by sex remain poorly understood.

Methods

We analysed cross-sectional data from 444 older people aged ≥50 years (mean age 64.6 years, 62% female) from the WHO SAGE-WOPS HIV sub-study in Uganda. Frailty was assessed using 15 items from the Frailty Instrument for Sub-Saharan Africa (FiSSA), and QoL with a 7-item composite index. We used multiple linear regression to examine the associations between overall and domain-specific frailty and QoL, including sex interaction terms.

Results

Higher overall frailty was associated with lower QoL (β = −0.63, p < 0.001). Among the frailty domains, the physical (β = −0.43, p < 0.001) and socioemotional (β = −0.18, p < 0.001) domains exceeded the minimally important difference (MID) threshold, indicating clinically meaningful associations with lower QoL, whereas the visual and psychological domains were below this threshold. A significant sex interaction was observed for the psychological domain (β = −0.25, p = 0.004), indicating a stronger negative association among women. No significant sex interactions were observed for the physical, socioemotional, or visual domains.

Conclusions

Frailty, particularly physical, socioemotional, and psychological domains, was associated with lower QoL among older Ugandans affected by HIV. Psychological frailty was more strongly associated with poorer QoL in women. Gender-sensitive, psychosocial interventions may help address these disparities and support healthy and equitable ageing in HIV-affected populations.

背景：撒哈拉以南非洲地区受艾滋病毒影响的老年人身体虚弱和生活质量差（QoL）的风险增加。然而，特定脆弱域对生活质量的贡献以及这些关联是否因性别而异仍然知之甚少。方法：我们分析了来自乌干达世卫组织SAGE-WOPS艾滋病亚研究的444名年龄≥50岁的老年人（平均年龄64.6岁，62%为女性）的横断面数据。脆弱性评估采用撒哈拉以南非洲脆弱性工具（FiSSA）中的15个项目，生活质量评估采用7个项目的综合指数。我们使用多元线性检验整体和特定领域脆弱性与生活质量之间的关系，包括性别相互作用术语。结果：总体虚弱程度较高与较低的生活质量相关（β = -0.63, p）。结论：虚弱，特别是身体、社会情感和心理领域，与感染艾滋病毒的乌干达老年人较低的生活质量相关。心理脆弱与女性较差的生活质量关系更大。对性别问题有敏感认识的社会心理干预措施可能有助于解决这些差异，并支持受艾滋病毒影响的人口健康、公平地步入老年。

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引用次数: 0