HIV Medicine最新文献_第9页

Durability of doravirine with dolutegravir dual regimen compared with other dolutegravir-based dual combinations 多拉韦林与多鲁曲韦双联疗法与其他基于多鲁曲韦的双联疗法的耐久性比较。

IF 3 3区医学 Q2 Medicine

HIV Medicine

Pub Date : 2024-01-23 DOI: 10.1111/hiv.13615

Roberto Rossotti, Federico D'Amico, Nicholas Brian Bana, Alice Nava, Leonardo Francesco Rezzonico, Alessandro Raimondi, Diana Fanti, Leonardo Gerolamo Chianura, Maria Cristina Moioli, Chiara Vismara, Massimo Puoti

Objectives

The availability of doravirine (DOR) allowed clinicians to prescribe a dolutegravir (DTG)-based two-drug regimen (2DR) in individuals not eligible to receive lamivudine (3TC) or rilpivirine (RPV). The aims of this study were to describe the durability of DTG + DOR compared with DTG/3TC and DTG/RPV and the rate of virological failure and target not-detected maintenance over time.

Methods

This retrospective, monocentric analysis included all subjects who started a DTG-based 2DR from 2018 to 2022 as a simplification. Descriptive statistics and non-parametric tests to describe and compare the groups were applied. Kaplan–Meier probability curves and Cox regression models for regimens durability were used.

Results

The study enrolled 710 individuals: 499 treated with DTG/3TC, 140 with DTG/RPV, and 71 with DTG + DOR. A 2DR with DOR was prescribed to older subjects who had a longer infection, greater exposure to different antiretroviral regimens, a higher proportion of resistance-associated mutations, and a worse immune-virologic status. Over a cumulative follow-up of 68 152 weeks, 42 discontinuations were registered (5.9%). DTG + DOR had a risk of treatment interruption of 7.8% at 48 weeks and 9.8% at 96 weeks, significantly higher than the other 2DRs. In the multivariate Cox model, DTG + DOR and DTG/RPV were significantly associated with discontinuation. The maintenance of target not detected during follow-up was similar among groups. The rate of virological failure was higher for DTG + DOR through different event definitions.

Conclusions

DTG + DOR durability was high over a long follow-up albeit lower than for other 2DRs. This combination might be an effective option in people with HIV that has proven difficult to treat.

目标：多拉韦林（DOR）的上市使临床医生能够为不符合接受拉米夫定（3TC）或利匹韦林（RPV）治疗条件的患者开具基于多鲁曲韦（DTG）的双药方案（2DR）处方。本研究的目的是描述 DTG + DOR 与 DTG/3TC 和 DTG/RPV 相比的耐久性，以及随着时间推移的病毒学失败率和未检测到的目标维持率：这项回顾性、单中心分析包括2018年至2022年开始使用基于DTG的2DR的所有受试者，以简化分析。应用描述性统计和非参数检验来描述和比较各组。使用了Kaplan-Meier概率曲线和Cox回归模型对治疗方案的耐久性进行分析：研究共招募了 710 人：499 人接受了 DTG/3TC 治疗，140 人接受了 DTG/RPV 治疗，71 人接受了 DTG + DOR 治疗。年龄较大的受试者感染时间较长，接触过不同的抗逆转录病毒疗法的机会较多，耐药相关突变的比例较高，免疫-病毒状态较差，因此被处方为使用DOR的2DR。在 68 152 周的累计随访中，有 42 例停药记录（5.9%）。DTG+DOR在48周和96周的治疗中断风险分别为7.8%和9.8%，明显高于其他2DRs。在多变量 Cox 模型中，DTG + DOR 和 DTG/RPV 与中断治疗显著相关。各组随访期间未检测到的目标维持率相似。通过不同的事件定义，DTG + DOR的病毒学失败率更高：DTG+DOR在长期随访中的耐久性较高，尽管低于其他2DRs。对于难以治疗的艾滋病病毒感染者来说，这种组合可能是一种有效的选择。

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引用次数: 0

The changing landscape of both causes and locations of death in a regional HIV population 2010–2021 2010-2021 年地区艾滋病毒感染者死亡原因和地点的变化情况。

IF 3 3区医学 Q2 Medicine

HIV Medicine

Pub Date : 2024-01-19 DOI: 10.1111/hiv.13610

Hartmut B. Krentz, Raynell Lang, Jacqueline McMillan, Meagan Ody, M. John Gill

Background

Although HIV-related deaths among people with HIV have dramatically decreased, deaths from other medical conditions and non-medical events have increased. The location of death among people with HIV remains underreported.

Objectives

We reviewed the deaths, causes of death, and reported location of death (i.e. within or outside of medical settings) of all people with HIV with the Southern Alberta Cohort, Calgary, Canada, between 1 January 2010 and 1 January 2022.

Methods

This was a retrospective longitudinal cohort study reviewing all deaths within a comprehensive geographically defined HIV cohort over 11 years.

Results

Deaths from HIV-related causes decreased from 52% of all deaths in 2010 to 14% in 2021. In 2021, non-HIV medical deaths increased from 38% to 44%, and non-medical deaths (e.g. violence, suicide, drug overdose) increased from 0.5% to 39%. Of non-medical deaths, 67% resulted from substance use/overdose. Overall, deaths in any medical setting decreased from 91% in 2010 to 39% in 2021; 61% of all deaths occurred in a medical setting (e.g. hospital/emergency department or supported/long-term/hospice care), 27% in a residence, and 9% in the community.

Conclusion

The shifting causes of death (i.e. fewer HIV-related deaths, more overdose deaths) and location of death (i.e. fewer in medical settings, more at home/in the community) requires close monitoring so future resources can be matched to predicted patient needs.

背景：尽管艾滋病病毒感染者中与艾滋病病毒相关的死亡人数大幅减少，但因其他疾病和非医疗事件导致的死亡人数却有所增加。艾滋病病毒感染者的死亡地点仍未得到充分报告：我们回顾了 2010 年 1 月 1 日至 2022 年 1 月 1 日期间加拿大卡尔加里南阿尔伯塔队列所有 HIV 感染者的死亡人数、死亡原因和报告的死亡地点（即在医疗机构内或医疗机构外）：这是一项回顾性纵向队列研究，回顾了 11 年间按地域划分的艾滋病毒队列中的所有死亡病例：与艾滋病毒相关的死亡占死亡总数的比例从 2010 年的 52% 降至 2021 年的 14%。2021 年，非艾滋病毒医疗死亡从 38% 增加到 44%，非医疗死亡（如暴力、自杀、吸毒过量）从 0.5% 增加到 39%。在非医疗死亡病例中，67%是药物使用/过量造成的。总体而言，在任何医疗环境中死亡的比例从2010年的91%降至2021年的39%；61%的死亡发生在医疗环境中（如医院/急诊科或辅助/长期/临终关怀），27%发生在住所，9%发生在社区：需要密切关注死亡原因的变化（即与 HIV 相关的死亡较少，而用药过量死亡较多）和死亡地点的变化（即在医疗场所死亡较少，而在家中/社区死亡较多），以便未来的资源能够与预测的患者需求相匹配。

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引用次数: 0

High prevalence of impaired glucose metabolism among children and adolescents living with HIV in Ghana 加纳感染艾滋病毒的儿童和青少年中糖代谢受损的发病率很高。

IF 3 3区医学 Q2 Medicine

HIV Medicine

Pub Date : 2024-01-19 DOI: 10.1111/hiv.13614

Ruth Ayanful-Torgby, Veronika Shabanova, Akosua A. Essuman, Emmanuel Boafo, Frank Aboagye, Yusuf Al-Mahroof, Jones Amponsah, John K. A. Tetteh, Linda E. Amoah, Elijah Paintsil

Background

Antiretroviral therapy (ART)-associated metabolic abnormalities, including impairment of glucose metabolism, are prevalent in adults living with HIV. However, the prevalence and pathogenesis of impaired glucose metabolism in children and adolescents living with HIV, particularly in sub-Saharan Africa, are not well characterized. We investigated the prevalence of impaired glucose metabolism among children and adolescents living with perinatally infected HIV in Ghana.

Methods

In this multicentre, cross-sectional study, we recruited participants from 10 paediatric antiretroviral treatment clinics from January to June 2022 in 10 facilities in Greater Accra and Eastern regions of Ghana. We determined impaired glucose metabolism in the study sample by assessing fasting blood sugar (FBS), insulin resistance as defined by the homeostatic model assessment for insulin resistance (HOMA-IR) index and glycated haemoglobin (HbA1c) levels. The prevalence of impaired glucose metabolism using each criterion was stratified by age and sex. The phenotypic correlates of glucose metabolism markers were also assessed among age, sex, body mass index (BMI) and waist-to-hip ratio (WHR).

Results

We analysed data from 393 children and adolescents living with HIV aged 6–18 years. A little over half (205/393 or 52.25%) of the children were female. The mean age of the participants was 11.60 years (SD = 3.50), with 122/393 (31.00%) aged 6–9 years, 207/393 (52.67%) aged 10–15 years, and 62/393 (15.78%) aged 16–18 years. The prevalence rates of glucose impairment in the study population were 15.52% [95% confidence interval (CI): 12.26–19.45], 22.39% (95% CI: 18.54–26.78), and 26.21% (95% CI: 22.10–30.78) using HbA1c, HOMA-IR, and FBS criteria, respectively. Impaired glucose metabolism detected by FBS and HOMA-IR was higher in the older age group, whereas the prevalence of abnormal HbA1c levels was highest among the youngest age group. Age and BMI were positively associated with FBS and HOMA-IR (p < 0.001). However, there was negative correlation of WHR with HOMA-IR (p < 0.01) and HbA1c (p = 0.01).

Conclusion

The high prevalence of impaired glucose metabolism observed among the children and adolescents living with HIV in sub-Saharan Africa is of concern as this could contribute to the development of metabolic syndrome in adulthood.

背景：与抗逆转录病毒疗法（ART）相关的代谢异常，包括糖代谢障碍，在成年 HIV 感染者中十分普遍。然而，在儿童和青少年艾滋病病毒感染者中，尤其是在撒哈拉以南非洲地区，糖代谢受损的发病率和发病机制尚不十分明确。我们调查了加纳围产期感染艾滋病毒的儿童和青少年中糖代谢受损的发病率：在这项多中心横断面研究中，我们于 2022 年 1 月至 6 月在加纳大阿克拉和东部地区的 10 个机构的 10 个儿科抗逆转录病毒治疗诊所招募了参与者。我们通过评估空腹血糖 (FBS)、胰岛素抵抗（根据胰岛素抵抗的稳态模型评估 (HOMA-IR) 指数和糖化血红蛋白 (HbA1c) 水平定义）来确定研究样本中糖代谢受损的情况。根据年龄和性别对每种标准下糖代谢受损的发生率进行了分层。我们还评估了糖代谢指标在年龄、性别、体重指数（BMI）和腰臀比（WHR）之间的表型相关性：我们分析了 393 名 6-18 岁感染艾滋病毒的儿童和青少年的数据。女性略高于半数（205/393 或 52.25%）。参与者的平均年龄为 11.60 岁（SD = 3.50），其中 122/393 人（31.00%）的年龄在 6-9 岁之间，207/393 人（52.67%）的年龄在 10-15 岁之间，62/393 人（15.78%）的年龄在 16-18 岁之间。根据 HbA1c、HOMA-IR 和 FBS 标准，研究人群中糖代谢障碍的患病率分别为 15.52% [95% 置信区间 (CI)：12.26-19.45]、22.39% (95% CI：18.54-26.78) 和 26.21% (95% CI：22.10-30.78)。通过 FBS 和 HOMA-IR 检测到的糖代谢受损在年龄较大的人群中发生率较高，而 HbA1c 水平异常在年龄最小的人群中发生率最高。年龄和体重指数与 FBS 和 HOMA-IR 呈正相关（p 结论：年龄和体重指数与 FBS 和 HOMA-IR 呈正相关：在撒哈拉以南非洲地区感染艾滋病毒的儿童和青少年中，发现糖代谢受损的发生率很高，这令人担忧，因为这可能会导致成年后出现代谢综合征。

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引用次数: 0

Screening and prevention of HPV-related anogenital cancers in women living with HIV in Europe: Results from a systematic review 欧洲感染艾滋病毒妇女的 HPV 相关肛门癌筛查与预防：系统综述的结果。

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine

Pub Date : 2024-01-18 DOI: 10.1111/hiv.13602

Dagny Krankowska, Maria Mazzitelli, Hazal Albayrak Ucak, Eva Orviz, Hanife Nur Karakoc, Harriet Mortimer, Karoline Aebi-Popp, Yvonne Gilleece

Background

Women living with HIV (WLWH) are at increased risk of human papillomavirus (HPV)-related cancers. Throughout Europe, there is great heterogeneity among guidelines for screening programmes, access to HPV testing and HPV vaccination. The aim of this systematic review is to summarize available data on screening and prevention measures for HPV-related anogenital cancers in WLWH across the WHO European Region (WER).

Methods

The systematic review followed the PRISMA guidelines and was registered on Prospero. PubMed, Embase and Web of Science databases were searched to identify available studies, written in English and published between 2011 and 2022. A metanalysis was conducted using random-effects models to calculate pooled prevalence of HPV. Subgroup analyses were conducted according to country and HPV testing.

Results

Thirty-four articles involving 10 336 WLWH met the inclusion criteria. Studies were heterogenous in their methodology and presentation of results: 73.5% of studies focused on cervical cancer prevention, and only 4.4% on anal cancer; 76.5% of studies conducted HPV testing as a routine part of screening. The prevalence of high-risk HPV was 30.5–33.9% depending on the detection method used. A total of 77% of WLWH had cervical cytology results reported. Six studies reported the positive association of CD4 cell count <200 cells/μL with HPV prevalence and cervical abnormalities. Anal HPV testing was conducted in <8% of participants. HPV vaccination was completed in 5.6% of women (106/1902) with known vaccination status. There was no information about the vaccination status of the majority of women in the analysed studies (8434/10336).

Conclusion

Data about screening of HPV-related anogenital cancer in WLWH in Europe are heterogenous and lacking, especially in relation to anal cancer. HPV DNA testing is not routinely done as part of screening for HPV-related cancer; guidelines should include indications for when to use this test. Low CD4 count is a risk factor for HPV infection and cytological abnormalities. HPV vaccination data are poor and, when available, vaccination rates are very low among WLWH in Europe. This review concludes that significant improvements are required for data and also consistency on guidelines for HPV screening, prevention and vaccination in WLWH.

背景：感染艾滋病毒的妇女（WLWH）罹患人乳头瘤病毒（HPV）相关癌症的风险增加。在整个欧洲，筛查计划、HPV 检测和 HPV 疫苗接种指南之间存在很大差异。本系统性综述旨在总结世界卫生组织欧洲地区（WER）WLWH中与HPV相关的肛门癌筛查和预防措施的现有数据：本系统综述遵循 PRISMA 指南，并在 Prospero.对 PubMed、Embase 和 Web of Science 数据库进行了检索，以确定 2011 年至 2022 年间发表的英文研究。采用随机效应模型进行了荟萃分析，以计算HPV的总体流行率。根据国家和HPV检测情况进行了分组分析：共有 34 篇文章符合纳入标准，涉及 10 336 名妇女和儿童。这些研究在方法和结果呈现方面存在差异：73.5%的研究侧重于宫颈癌预防，只有4.4%的研究侧重于肛门癌；76.5%的研究将HPV检测作为筛查的常规部分。根据检测方法的不同，高危 HPV 的流行率为 30.5%-33.9%。共有 77% 的 WLWH 报告了宫颈细胞学检查结果。六项研究报告了 CD4 细胞计数的正相关性：在欧洲，有关WLWH中HPV相关肛门癌筛查的数据既不统一也很缺乏，尤其是与肛门癌相关的数据。HPV DNA 检测并不是筛查 HPV 相关癌症的常规方法；指南中应包括何时使用该检测的指征。低 CD4 细胞数是 HPV 感染和细胞学异常的风险因素。HPV疫苗接种数据较少，在欧洲，WLWH的疫苗接种率非常低。本综述的结论是，需要对数据进行重大改进，并对WLWH的HPV筛查、预防和疫苗接种指南进行统一。

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引用次数: 0

Correction to ‘Abstracts of the 19th European AIDS Conference (#EACS2023), October 18–21, 2023, Warsaw, Poland’ 对 "第 19 届欧洲艾滋病大会（#EACS2023）摘要，2023 年 10 月 18-21 日，波兰华沙 "的更正

IF 3 3区医学 Q2 Medicine

HIV Medicine

Pub Date : 2024-01-15 DOI: 10.1111/hiv.13613

(2023), EACS Abstracts. HIV Med, 24: 3–675. https://doi.org/10.1111/hiv.13572

(2023), Late breaker abstracts. HIV Med, 24: 676–708. https://doi.org/10.1111/hiv.13573

(2023), Clinical Case Abstracts. HIV Med, 24: 709–788. https://doi.org/10.1111/hiv.13574

The EACS abstracts listed below were inadvertently included, but were initially rejected from the programme by the scientific committee. These have been withdrawn and removed from online publication.

We apologize for these errors.

p.6, EACS2023: 47 | Association between depression and consistency of condom use among female sex workers in Blantyre: The case of a commercial city of Malawi.

p.6, EACS2023: 59 | Formation of public health policy on HIV treatment issues: Asian perspectives.

p.7, EACS2023: 81 | Prevalence and impact of mental health disorders on people living with HIV/AIDS in Nigeria: A systematic review.

p.7, EACS2023: 120 | Demand for HIV prevention, treatment and care services in a developing country like India.

p.8, EACS2023: 129 | Assessing the landscape and implementation of HIV-relevant policies on uptake of prevention and testing services among key populations in the WHO European Region.

p. 13, EACS2023: 256 | Pregnancy in women living with HIV in Latin America: A multi-centre crosssectional analysis across seven countries.

p.14, EACS2023: 277 | Patients' and healthcare providers' views on screening for cognitive impairment in people living with HIV: A qualitative study.

p.20, EACS2023: 533 | A survey report on the acceptance of vaginal delivery among HIV-infected pregnant women in Japan (especially about the impact of the role of midwives).

p.21, EACS2023: 562 | Cost dynamics of ARV therapy in resource limited southern countries: What needs to be done.

p.40, EACS2023: 770 | How can your pharmacist save you?

p.46–7, EACS2023: 882 | A friendly, rapid testing and counselling approach to improve linkage to care: Our experience at Latina Checkpoint and hospital Center.

p.49, EACS2023: 952 | The role of belief and knowledge in overcoming vaccination hesitancy. An HPV vaccination campaign using a ‘point of care’ friendly model.

p.53, EACS2023: 177 | Antiretroviral treatment failure for adolescents living with HIV in East African Community: A review of literature.

p.53, EACS2023: 994 | Unlocking adherence and sexual reproductive health for adolescents living with HIV in Kenya.

p.59, EACS2023: 570 | Impact of loneliness on frailty among people with HIV aged above 45 years in Taiwan.

p. 70, EACS2023: 53 | Assessing the adherence of antiretroviral therapy among pregnant women.

p.73–5, EACS2023: 170 | Adherence to antiretroviral therapy and associated factors among HIV positive adults attending care and treatment in HIV clinic at Al-Jomhoria hospital—Benghazi/Libya.

p.76–7, EACS2023: 215 | Didanosine, fatty liver and Lipodystrophy.

<

(2023), EACS Abstracts.HIV Med, 24: 3-675. https://doi.org/10.1111/hiv.13572(2023), Late breaker abstracts.https://doi.org/10.1111/hiv.13573(2023), Clinical Case Abstracts.https://doi.org/10.1111/hiv.13574The 以下列出的 EACS 摘要无意中被收录，但最初被科学委员会拒绝列入该计划。我们对这些错误表示歉意。

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引用次数: 0

Perspectives of people with HIV and HIV clinicians on characteristics of antiretroviral treatment and HIV-related symptoms 艾滋病病毒感染者和艾滋病临床医生对抗逆转录病毒治疗特点和艾滋病相关症状的看法。

IF 3 3区医学 Q2 Medicine

HIV Medicine

Pub Date : 2024-01-12 DOI: 10.1111/hiv.13609

M. José Galindo Puerto, J. Puig, J. A. Pérez-Molina, M. J. Fuster-Ruiz de Apodaca

Objectives

We aimed to assess HIV symptoms from the perspective of both patients and HIV specialists and the impact of discontinuing antiretroviral treatment (ART) on symptomology. We gathered opinions from HIV specialists and people living with HIV about ideal ART parameters and treatment satisfaction.

Methods

Ex post-facto cross-sectional surveys were administered to 502 people living with HIV and 101 HIV clinicians in Spain (18 sites).

Results

The median age of participants with HIV was 43.2 years, 74.5% were male, and 91.6% had an undetectable viral load. The mean time since initiation of ART was 10.2 years. Between 54% and 67% of people living with HIV reported experiencing nervousness or anxiety, sadness, fatigue, sleep problems, or muscle/joint pain during the preceding 4 weeks. However, only 22%–27% of specialists acknowledged the presence of these symptoms. The most bothersome symptoms were related to mental health or the central nervous system. There were significant differences between the burden of symptoms reported by people living with HIV and those acknowledged by specialists. The symptoms that more frequently caused ART discontinuation were depression, dizziness, and sleep problems. Both people living with HIV and specialists prioritized ART efficacy and low toxicity, but their importance ratings differed for 5 of the 11 ART characteristics assessed. People living with HIV rated their satisfaction with ART at a mean (± standard deviation) of 8.9 ± 1.5 out of 10, whereas HIV specialists rated it lower, at 8.3 ± 0.7 (p < 0.001).

Conclusions

Despite advances in HIV care and treatment, a large proportion of patients still experience symptoms. HIV specialists may not be fully aware of these. People living with HIV and HIV specialists are, overall, satisfied with ART. However, the importance they place on different ART characteristics may vary.

目的：我们旨在从患者和艾滋病专家的角度评估艾滋病症状，以及停止抗逆转录病毒疗法对症状的影响：我们旨在从患者和艾滋病专家的角度评估艾滋病症状，以及停止抗逆转录病毒疗法（ART）对症状的影响。我们收集了艾滋病专家和艾滋病感染者对理想抗逆转录病毒疗法参数和治疗满意度的意见：我们对西班牙（18 个地点）的 502 名艾滋病病毒感染者和 101 名艾滋病临床医生进行了事后横断面调查：结果：HIV 感染者的中位年龄为 43.2 岁，74.5% 为男性，91.6% 检测不到病毒载量。开始接受抗逆转录病毒疗法的平均时间为 10.2 年。54%至 67% 的艾滋病病毒感染者表示在过去 4 周内出现过紧张或焦虑、悲伤、疲劳、睡眠问题或肌肉/关节疼痛。然而，只有 22%-27% 的专家承认存在这些症状。最令人烦恼的症状与精神健康或中枢神经系统有关。艾滋病毒感染者报告的症状负担与专家承认的症状负担之间存在明显差异。更常导致抗逆转录病毒疗法中断的症状是抑郁、头晕和睡眠问题。艾滋病病毒感染者和专科医生都将抗逆转录病毒疗法的疗效和低毒性放在首位，但在评估的 11 项抗逆转录病毒疗法特征中，他们对其中 5 项特征的重要性评价有所不同。艾滋病病毒感染者对抗病毒疗法的满意度平均值（± 标准差）为 8.9 ± 1.5（满分 10 分），而艾滋病专家的满意度较低，为 8.3 ± 0.7（P 结论：艾滋病病毒感染者对抗病毒疗法的满意度为 8.9 ± 1.5（满分 10 分）：尽管在艾滋病护理和治疗方面取得了进步，但仍有很大一部分患者会出现症状。艾滋病专家可能并不完全了解这些症状。总体而言，艾滋病病毒感染者和艾滋病专家对抗病毒疗法感到满意。但是，他们对不同抗逆转录病毒疗法特点的重视程度可能有所不同。

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引用次数: 0

Impact of social determinants of health on time to antiretroviral therapy initiation and HIV viral undetectability for migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite B/F/TAF: ‘The ASAP study’ 健康的社会决定因素对移民开始接受抗逆转录病毒治疗的时间和艾滋病毒检测不到的影响："ASAP 研究"。

IF 3 3区医学 Q2 Medicine

HIV Medicine

Pub Date : 2024-01-11 DOI: 10.1111/hiv.13608

Anish K. Arora, Serge Vicente, Kim Engler, David Lessard, Edmundo Huerta, Joel Ishak, Jean-Pierre Routy, Marina Klein, Nadine Kronfli, Joseph Cox, Benoit Lemire, Alexandra de Pokomandy, Lina Del Balso, Giada Sebastiani, Isabelle Vedel, Amélie Quesnel-Vallée, ASAP Migrant Advisory Committee, Bertrand Lebouché

Objective

Multidisciplinary care with free, rapid, and on-site bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) dispensation may improve health outcomes among migrants living with HIV. However, models for rapid B/F/TAF initiation are not well studied among migrants living with HIV, and an understanding of how social determinants of health (SDH) may affect HIV-related health outcomes for migrants enrolled in such care models is limited.

Methods

Within a 96-week pilot feasibility prospective cohort study at a multidisciplinary HIV clinic, participants received free B/F/TAF rapidly after care linkage. The effects of SDH (i.e., birth region, sexual orientation, living status, education, employment, French proficiency, health coverage, use of a public health facility outside our clinic for free blood tests, and time in Canada) and other covariates (i.e., age, sex) on median time to antiretroviral therapy (ART) initiation and HIV viral undetectability from care linkage were calculated via survival analyses.

Results

Thirty-five migrants were enrolled in this study. Median time to ART initiation and HIV undetectability was 5 days (range 0–50) and 57 days (range 5–365), respectively. Those who took significantly longer to initiate ART were aged <35 years, identified as heterosexual, had less than university-level education, or were unemployed. No factor was found to significantly affect time to undetectability.

Conclusion

Despite the provision of free B/F/TAF, several SDH were linked to delays in ART initiation. However, once initiated and engaged, migrants living with HIV reached HIV undetectability efficiently. Findings provide preliminary support for adopting this care model with migrants living with HIV and suggest that SDH should be considered when designing clinical interventions for more equitable outcomes.

目的：免费、快速、现场发放比特格韦/恩曲他滨/替诺福韦-阿拉非酰胺（B/F/TAF）的多学科护理可改善感染 HIV 的移民的健康状况。然而，在感染艾滋病病毒的移民中，对 B/F/TAF 快速启动模式的研究并不充分，而且对健康的社会决定因素（SDH）如何影响加入此类护理模式的移民的艾滋病相关健康结果的了解也很有限：方法：在一家多学科艾滋病诊所进行的一项为期 96 周的试点可行性前瞻性队列研究中，参与者在建立关怀联系后迅速接受了免费的 B/F/TAF 治疗。通过生存分析计算了 SDH（即出生地区、性取向、生活状况、教育、就业、法语水平、医疗保险、使用诊所外的公共卫生机构进行免费血液检测以及在加拿大的时间）和其他协变量（即年龄、性别）对开始抗逆转录病毒疗法（ART）的中位时间和护理连接后 HIV 病毒检测不到的影响：本研究共招募了 35 名移民。开始接受抗逆转录病毒疗法和检测不到 HIV 病毒的中位时间分别为 5 天（0-50 天）和 57 天（5-365 天）。开始接受抗逆转录病毒疗法所需的时间明显更长的移民年龄介于 19 至 30 岁之间：尽管提供了免费的 B/F/TAF，但一些 SDH 与抗逆转录病毒疗法的启动延迟有关。然而，一旦开始接受抗逆转录病毒疗法并参与其中，感染艾滋病毒的移民就能有效地达到艾滋病毒检测不到的水平。研究结果初步支持对感染 HIV 的移民采用这种护理模式，并建议在设计临床干预措施时考虑 SDH，以取得更公平的结果。

{"title":"Impact of social determinants of health on time to antiretroviral therapy initiation and HIV viral undetectability for migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite B/F/TAF: ‘The ASAP study’","authors":"Anish K. Arora, Serge Vicente, Kim Engler, David Lessard, Edmundo Huerta, Joel Ishak, Jean-Pierre Routy, Marina Klein, Nadine Kronfli, Joseph Cox, Benoit Lemire, Alexandra de Pokomandy, Lina Del Balso, Giada Sebastiani, Isabelle Vedel, Amélie Quesnel-Vallée, ASAP Migrant Advisory Committee, Bertrand Lebouché","doi":"10.1111/hiv.13608","DOIUrl":"10.1111/hiv.13608","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Multidisciplinary care with free, rapid, and on-site bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) dispensation may improve health outcomes among migrants living with HIV. However, models for rapid B/F/TAF initiation are not well studied among migrants living with HIV, and an understanding of how social determinants of health (SDH) may affect HIV-related health outcomes for migrants enrolled in such care models is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Within a 96-week pilot feasibility prospective cohort study at a multidisciplinary HIV clinic, participants received free B/F/TAF rapidly after care linkage. The effects of SDH (i.e., birth region, sexual orientation, living status, education, employment, French proficiency, health coverage, use of a public health facility outside our clinic for free blood tests, and time in Canada) and other covariates (i.e., age, sex) on median time to antiretroviral therapy (ART) initiation and HIV viral undetectability from care linkage were calculated via survival analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-five migrants were enrolled in this study. Median time to ART initiation and HIV undetectability was 5 days (range 0–50) and 57 days (range 5–365), respectively. Those who took significantly longer to initiate ART were aged <35 years, identified as heterosexual, had less than university-level education, or were unemployed. No factor was found to significantly affect time to undetectability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite the provision of free B/F/TAF, several SDH were linked to delays in ART initiation. However, once initiated and engaged, migrants living with HIV reached HIV undetectability efficiently. Findings provide preliminary support for adopting this care model with migrants living with HIV and suggest that SDH should be considered when designing clinical interventions for more equitable outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.13608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139424675","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

Clinical epidemiology of COVID-19 in people of black ethnicity living with HIV in the UK 英国感染艾滋病毒的黑人中 COVID-19 的临床流行病学。

IF 3 3区医学 Q2 Medicine

HIV Medicine

Pub Date : 2024-01-11 DOI: 10.1111/hiv.13611

Zoe Ottaway, Lucy Campbell, Laura R. Cechin, Nisha Patel, Julie Fox, Fiona Burns, Lisa Hamzah, Stephen Kegg, Melanie Rosenvinge, Sarah Schoeman, David Price, Rachael Jones, Amanda Clarke, Irfaan Maan, Andrew Ustianowski, Denis Onyango, Shema Tariq, Robert F. Miller, Frank A. Post, the COVID-AFRICA study group

Objectives

To describe the clinical epidemiology of COVID-19 in people of black ethnicity living with HIV in the UK.

Methods

We investigated the incidence and factors associated with COVID-19 in a previously established and well-characterized cohort of black people with HIV. Primary outcomes were COVID-19 acquisition and severe COVID-19 disease (requiring hospitalization and/or resulting in death). Cumulative incidence was analysed using Nelson–Aalen methods, and associations between demographic, pre-pandemic immune-virological parameters, comorbidity status and (severe) COVID-19 were identified using Cox regression analysis.

Results

COVID-19 status was available for 1847 (74%) of 2495 COVID-AFRICA participants (median age 49.6 years; 56% female; median CD4 cell count = 555 cells/μL; 93% HIV RNA <200 copies/mL), 573 (31%) of whom reported at least one episode of COVID-19. The cumulative incidence rates of COVID-19 and severe COVID-19 were 31.0% and 3.4%, respectively. Region of ancestry (East/Southern/Central vs. West Africa), nadir CD4 count and kidney disease were associated with COVID-19 acquisition. Diabetes mellitus [adjusted hazard ratio (aHR) = 2.39, 95% confidence interval (CI): 1.26–4.53] and kidney disease (aHR = 2.53, 95% CI: 1.26–4.53) were associated with an increased risk, and recent CD4 count >500 cells/μL (aHR = 0.49, 95% CI: 0.25–0.93) with a lower risk of severe COVID-19.

Conclusions

Region of ancestry was associated with COVID-19 acquisition, and immune and comorbidity statuses were associated with COVID-19 disease severity in people of black ethnicity living with HIV in the UK.

目的：描述 COVID-19 在英国黑人 HIV 感染者中的临床流行病学：描述英国黑人 HIV 感染者中 COVID-19 的临床流行病学：我们调查了以前建立的、特征明确的黑人 HIV 感染者队列中 COVID-19 的发病率和相关因素。主要结果是 COVID-19 感染和严重 COVID-19 疾病（需要住院治疗和/或导致死亡）。采用 Nelson-Aalen 方法分析了累积发病率，并采用 Cox 回归分析确定了人口统计学、流行前免疫-病毒学参数、合并症状况与（严重）COVID-19 之间的关系：在 2495 名 COVID-AFRICA 参与者中，有 1847 人（74%）具有 COVID-19 状态（中位年龄 49.6 岁；56% 为女性；中位 CD4 细胞计数 = 555 cells/μL；93% HIV RNA 500 cells/μL（aHR = 0.49，95% CI：0.25-0.93）），且发生严重 COVID-19 的风险较低）：结论：英国黑人艾滋病病毒感染者的祖籍地区与 COVID-19 的获得有关，免疫和合并症状况与 COVID-19 的疾病严重程度有关。

{"title":"Clinical epidemiology of COVID-19 in people of black ethnicity living with HIV in the UK","authors":"Zoe Ottaway, Lucy Campbell, Laura R. Cechin, Nisha Patel, Julie Fox, Fiona Burns, Lisa Hamzah, Stephen Kegg, Melanie Rosenvinge, Sarah Schoeman, David Price, Rachael Jones, Amanda Clarke, Irfaan Maan, Andrew Ustianowski, Denis Onyango, Shema Tariq, Robert F. Miller, Frank A. Post, the COVID-AFRICA study group","doi":"10.1111/hiv.13611","DOIUrl":"10.1111/hiv.13611","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To describe the clinical epidemiology of COVID-19 in people of black ethnicity living with HIV in the UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated the incidence and factors associated with COVID-19 in a previously established and well-characterized cohort of black people with HIV. Primary outcomes were COVID-19 acquisition and severe COVID-19 disease (requiring hospitalization and/or resulting in death). Cumulative incidence was analysed using Nelson–Aalen methods, and associations between demographic, pre-pandemic immune-virological parameters, comorbidity status and (severe) COVID-19 were identified using Cox regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>COVID-19 status was available for 1847 (74%) of 2495 COVID-AFRICA participants (median age 49.6 years; 56% female; median CD4 cell count = 555 cells/μL; 93% HIV RNA <200 copies/mL), 573 (31%) of whom reported at least one episode of COVID-19. The cumulative incidence rates of COVID-19 and severe COVID-19 were 31.0% and 3.4%, respectively. Region of ancestry (East/Southern/Central vs. West Africa), nadir CD4 count and kidney disease were associated with COVID-19 acquisition. Diabetes mellitus [adjusted hazard ratio (aHR) = 2.39, 95% confidence interval (CI): 1.26–4.53] and kidney disease (aHR = 2.53, 95% CI: 1.26–4.53) were associated with an increased risk, and recent CD4 count >500 cells/μL (aHR = 0.49, 95% CI: 0.25–0.93) with a lower risk of severe COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Region of ancestry was associated with COVID-19 acquisition, and immune and comorbidity statuses were associated with COVID-19 disease severity in people of black ethnicity living with HIV in the UK.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.13611","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139424674","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

Barriers to HIV testing and possible interventions to improve access to HIV healthcare among migrants, with a focus on migrant women: Results from a European survey 艾滋病毒检测的障碍以及改善移民（重点是移民妇女）获得艾滋病毒医疗服务的可能干预措施：一项欧洲调查的结果。

IF 3 3区医学 Q2 Medicine

HIV Medicine

Pub Date : 2024-01-10 DOI: 10.1111/hiv.13606

Dagny C. Krankowska, Panagiota Lourida, Siobhan M. Quirke, Melvina Woode Owusu, Nina Weis, EACS/WAVE Migrant Women Working Group

Background

According to European Centre for Disease Prevention and Control (ECDC) reports, women and migrants are more likely to have delayed HIV diagnosis (CD4 <350 cells/mm³). As a follow-up to a previously published systematic review revealing a range of barriers to HIV testing among migrant women, the aim of the present study was to identify barriers to HIV testing from the perspective of service providers and to formulate possible interventions to improve access to HIV healthcare among migrants in Europe, with an emphasis on migrant women.

Methods

Between November 2021 and February 2022 an online survey, consisting of 20 questions, was forwarded to 178 stakeholders and non-governmental organizations (NGOs) working with migrant populations in 33 countries from the World Health Organization (WHO) European region.

Results

Forty-three responses from 14 countries were analysed. Most respondents (70%) judged migrants’ access to healthcare as worse than that for the resident native population. Only 2/11 prevention interventions were available to all in at least 50% of participating countries. The three main barriers to accessing healthcare for migrant women and reasons for late HIV diagnosis among migrant women were stigma and discrimination, language barriers, and cultural barriers.

Conclusions

Many HIV prevention interventions are not free of charge for all within Europe. The results of this survey show that migrant women face many barriers to accessing healthcare and that these might contribute to late HIV diagnosis. Simplification of access to free healthcare for all, more awareness raising about HIV screening and prevention among migrant women, and more migrant-focused outreach programmes are suggested to improve migrant women's access to HIV healthcare in Europe.

背景：根据欧洲疾病预防与控制中心（ECDC）的报告，妇女和移民更有可能被延迟诊断为艾滋病病毒感染者（CD4 3）。之前发表的一篇系统综述揭示了移民妇女在接受 HIV 检测时遇到的一系列障碍，作为该综述的后续研究，本研究旨在从服务提供者的角度确定 HIV 检测的障碍，并制定可能的干预措施，以改善欧洲移民（重点是移民妇女）获得 HIV 医疗保健的机会：在 2021 年 11 月至 2022 年 2 月期间，我们向世界卫生组织（WHO）欧洲地区 33 个国家的 178 个利益相关者和从事移民人口工作的非政府组织发送了一份在线调查，其中包括 20 个问题：对来自 14 个国家的 43 份答复进行了分析。大多数受访者（70%）认为，移民获得医疗保健的情况比本地常住人口差。在至少 50%的参与国中，只有 2/11 项预防干预措施可供所有人使用。移民妇女在获得医疗服务方面的三大障碍以及移民妇女艾滋病毒诊断较晚的原因分别是耻辱和歧视、语言障碍以及文化障碍：在欧洲，许多艾滋病预防干预措施并非对所有人都是免费的。这项调查的结果表明，移民妇女在获得医疗保健服务方面面临着许多障碍，而这些障碍可能会导致艾滋病诊断的延迟。建议简化所有人获得免费医疗服务的程序，提高移民妇女对艾滋病筛查和预防的认识，并开展更多针对移民的外展项目，以改善欧洲移民妇女获得艾滋病医疗服务的情况。

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引用次数: 0

Factors associated with sex differences in viral non-suppression in the Swedish InfCareHIV cohort: An observational real-world study 瑞典 InfCareHIV 队列中与病毒不抑制性别差异相关的因素：一项观察性真实世界研究。

IF 3 3区医学 Q2 Medicine

HIV Medicine

Pub Date : 2024-01-09 DOI: 10.1111/hiv.13607

Maria Lindh, Johanna Brännström, Anton Reepalu, Veronica Svedhem, Åsa Mellgren

Objectives

Women living with HIV are underrepresented in clinical trials assessing outcomes of antiretroviral treatment (ART), justifying the need for observational studies. We investigated differences in viral non-suppression between women and men in the Swedish InfCareHIV cohort and analysed results in relation to biological and socio-demographic variables and patient-reported outcome measures (PROMs).

Methods

The study included people living with HIV (PLWH) aged ≥18 years, who initiated ART at least 6 months prior to inclusion. Data from the InfCareHIV registry 2011–2018 were collected. Associations between variables and HIV RNA ≥50 copies/mL were investigated in uni- and multivariable analyses using generalized estimating equations, providing relative risks (RRs) as effect size.

Results

The study included 38% (n = 2981) women. Women were more likely to have HIV RNA ≥50 copies/mL than were men [RR = 1.20, 95% confidence interval (CI): 1.10–1.31]. After adjusting for origin and route of transmission, sex at birth was no longer associated with viral non-suppression. PROMs were available in 52.4% of PLWH, and items associated with viral non-suppression were impaired adherence in women (RR = 2.38, 95% CI: 1.79–3.17) and men (RR 1.84, 95% CI: 1.40–2.42), and experience of side effects in women (RR = 1.49, 95% CI: 1.10–2.02).

Conclusions

This observational study found a 20% higher relative risk of viral non-suppression in women than in men and the difference was associated with socio-demographic factors. The associations between PROMs and viral non-suppression varied between women and men. PROMs are important health outcomes that may identify PLWH in need of support to achieve viral non-suppression.

目的：在评估抗逆转录病毒疗法（ART）疗效的临床试验中，女性艾滋病感染者所占比例较低，因此有必要开展观察性研究。我们调查了瑞典 InfCareHIV 队列中女性和男性在病毒未抑制方面的差异，并分析了与生物和社会人口学变量及患者报告结果测量指标（PROMs）相关的结果：研究对象包括年龄≥18 岁、至少在纳入前 6 个月开始接受抗逆转录病毒疗法的 HIV 感染者（PLWH）。研究收集了2011-2018年InfCareHIV登记数据。使用广义估计方程进行单变量和多变量分析，研究变量与HIV RNA ≥50 copies/mL之间的关系，提供相对风险（RR）作为效应大小：研究中女性占 38%（n = 2981）。与男性相比，女性感染 HIV RNA≥50 copies/mL 的几率更高[RR = 1.20，95% 置信区间 (CI)：1.10-1.31]。在对来源和传播途径进行调整后，出生时的性别与病毒未抑制不再相关。52.4%的 PLWH 可以提供 PROMs，与病毒抑制相关的项目包括女性（RR = 2.38，95% CI：1.79-3.17）和男性（RR 1.84，95% CI：1.40-2.42）的依从性受损，以及女性（RR = 1.49，95% CI：1.10-2.02）的副作用体验：这项观察性研究发现，女性病毒不抑制的相对风险比男性高 20%，而这种差异与社会人口因素有关。女性和男性的 PROMs 与病毒不耐受之间的关系各不相同。PROMs是重要的健康结果，可识别出需要支持以实现病毒无抑制的 PLWH。

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引用次数: 0