JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

Introduction: People living with mental illness (PLWMI) experience disproportionate HIV incidence. Research suggests use of HIV pre-exposure prophylaxis (PrEP) is low among PLWMI. This study was conducted to understand self-reported HIV vulnerability, previous experiences with PrEP, interest in using PrEP, and preferences for PrEP modality and prescribers among PLWMI.

Methods: We conducted a survey-based study among PLWMI seeking outpatient psychiatric care in Cook County, IL. The survey was completed online after a scheduled appointment with their psychiatric provider. Data were collected between February 2023 and February 2024. Only HIV-negative PLWMI who met at least 1 PrEP eligibility criteria were eligible for the survey (eg, condomless sex, injection drug use, sexually transmitted infection [STI] diagnosis). Outcomes were stratified by psychiatric diagnosis.

Results: A total of 417 PLWMI completed the study (response rate = 66.7%) representing a diversity of diagnoses, including depression (43.4%), bipolar disorder (24.9%), and schizophrenia/schizoaffective disorder (6.7%). Awareness of PrEP was 74.8%, and among those without prior PrEP use, 70.5% were interested. We found 27.6% of PLWMI had used PrEP previously. Long-acting injectable was equally preferable (58.2%) to daily oral PrEP (58.8%) among PLWMI. Primary care providers (94.6%) were the most acceptable PrEP prescriber and 47.6% indicated acceptability of a psychiatrist as a PrEP prescriber.

Conclusions: PLWMI were interested in PrEP, including both oral and long-acting injectable formulations. Psychiatric care may serve as an efficient point of integration for PrEP prescription including LAI-PrEP. Further research is needed to understand how to best implement PrEP prescription and management for PLWMI across clinical settings.

Background: Placental growth factor (PlGF) and soluble Fms-like tyrosine kinase 1 (sFlt-1) are angiogenic factors essential for placental and fetal growth. Associations between these factors and birth outcomes among pregnant women with HIV are limited.

Methods: PlGF and sFlt-1 levels were quantified by ELISA in plasma samples collected between gestational weeks 24-29 from 114 women (46 with HIV, 68 without HIV). PlGF and sFlt-1:PlGF ratios were assessed using cutoffs used for prediction of preeclampsia (PlGF <12 pg/mL, PlGF <100 pg/mL, sFlt-1:PlGF >85) and compared by HIV status using χ 2 testing. Logistic regression models were fit to assess associations of dichotomized PlGF and sFlt1:PlGF with preterm (<37 weeks) and small for gestational age (SGA) birth (<10 th percentile) in all participants and stratified by HIV status.

Results: Women with HIV were older than women without HIV. More women with HIV had low or very low PlGF levels (<100 pg/mL: 30.4% vs 7.4%, P = 0.001; <12 pg/mL: 17.4% vs 1.5%, P = 0.002) and sFlt-1:PlGF >85 (19.5% vs 2.9%, P = 0.0036) than women without HIV. Among all pregnancies, low PlGF and high sFlt-1:PlGF ratios were significantly associated with SGA (odds ratio [95% confidence interval] for PlGF <12 pg/mL: 10.3 [2.0-53], P = 0.005; PlGF <100 pg/mL: 5.9 [1.7-21], P = 0.006; sFlt-1:PlGF >85: 10.6 [2.5-46], P = 0.002), but not preterm birth. Associations remained significant after adjusting for maternal age, BMI, and elevated blood pressure. Stratification by maternal HIV status showed this association was limited to the women with HIV.

Conclusions: Low PlGF levels may be a good predictive biomarker of SGA specifically for pregnant women with HIV.

Background: Overall progress in getting to zero new HIV infections in San Francisco has been made since 2012. However, among people who inject drugs (PWID), there has been no clear downward trend in new HIV infections in recent years. Direct measures of the rate of HIV acquisition and characterization of factors associated with higher rates among PWID are needed to help achieve HIV elimination.

Methods: This study is a secondary analysis of the National HIV Behavioral Surveillance survey of PWID in San Francisco in 2022. HIV incidence is estimated using age of first injection drug use and date of first HIV-positive test or interview date as the exposure period. Factors associated with HIV seroconversion were identified by Cox regression.

Results: Of 518 PWID, 12 newly tested HIV positive in the survey and 38 reported a prior positive test. HIV incidence was calculated as 0.46 per 100 person-years (95% confidence interval [CI]: 0.35 to 0.61). HIV incidence rates were significantly higher among PWID who were men who have sex with men (adjusted hazard ratio [aHR] 15.98, 95% Cl 7.77 to 32.87, P < 0.001), transgender (aHR 8.64, 95% Cl 2.76 to 27.08, P < 0.001), and Hispanic (aHR 2.85, 95% Cl 1.23 to 6.63, P < 0.001).

Conclusions: We found a moderate HIV incidence of ∼5 per 1000 person-years among PWID in San Francisco, with significantly higher rates among sexual, gender, and ethnic minority groups of PWID. Further progress in getting to zero new HIV infections will require more vigorous scale-up of effective prevention interventions, such as PrEP, specifically reaching vulnerable groups of PWID.

Introduction: The Ending the HIV Epidemic (EHE) in the US initiative was launched by the US Department of Health and Human Services in 2019 with the goal of decreasing new HIV infections 90% by 2030. Increasing the use of HIV preexposure prophylaxis (PrEP) is one of the EHE strategies. We assessed the impact of EHE activities on PrEP use.

Methods: Using IQVIA real-world longitudinal prescription data and the National HIV Surveillance System data, we calculated jurisdiction-level PrEP to diagnosis ratios (PDRs) in the United States from 2016 to 2023. We assessed impact of EHE with a difference-in-difference analysis.

Results: The PDR increased from 3.0 to 14.7 in EHE jurisdictions, from 1.2 to 7.2 in EHE states, and from 2.5 to 13.4 in non-EHE jurisdictions. On average, no additional increase in the PDR was found for EHE counties compared with matched non-EHE counties, (adjusted difference-in-difference: 0.2, 95% confidence interval: -1.0 to 1.3), or for EHE states (adjusted difference-in-difference: 0.4, 95% CI: -1.6 to 2.4).

Conclusions: Overall PrEP use increased markedly, with some EHE jurisdictions achieving greater increases than non-EHE jurisdictions with similar PDRs in 2019. The uneven increase in PrEP use in EHE jurisdictions underscores the need for jurisdiction-specific PrEP implementation strategies designed for the needs of each community. It also underscores the need for sufficient funding to accomplish EHE goals.

Background: Pain self-management (PSM) interventions are low risk, effective interventions for chronic pain that have high potential for scalability. Economic evaluations are a key component to assessing scalability. We evaluated the cost-effectiveness of a tailored PSM called Skills to Manage Pain (STOMP) as compared with enhanced usual care (EUC) among people with HIV and chronic pain.

Setting and methods: Data are from a randomized controlled trial of STOMP (N = 278). From a health care perspective, a Markov decision analysis model for a 12-month time horizon was used. Participants were recruited from 2 academic medical centers within the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. STOMP involves 6 individual sessions and 6 peer-led group sessions. The EUC control group received the STOMP treatment manual. The primary outcome was the incremental cost-effectiveness ratio, defined as US dollars per quality-adjusted life-year (QALY) gained derived from trial-based Medical Outcomes Study Short-Form 12 (SF-12) data. Sensitivity analyses examined the effects of parameters varied individually and collectively on model results.

Results: Participants were middle-aged (M = 53.5, SD = 10), male (53%), and Black/African American (81%). Model calculation of effectiveness for the 12-month time horizon resulted in 0.570 QALYs for EUC and 0.603 QALYs for the STOMP intervention, or 0.033 QALYs gained by STOMP compared with EUC. In probabilistic sensitivity analyses that varied all parameters simultaneously, the STOMP intervention was favored in 98.0% of 10,000 model iterations at a $100,000/QALY threshold.

Conclusions: STOMP is a cost-effective and scalable PSM intervention for people with HIV and chronic pain.

Trial registration: Clinical Trials Registration #NCT03692611.

Introduction: Rwanda has initiated recency testing alongside existing HIV testing services of provider-initiated testing, partner notification services (PNSs), and of prevention of mother-to-child HIV transmission. We aimed to determine characteristics of the newly diagnosed population using a nationwide cohort.

Methods: We included all newly diagnosed patients with HIV aged 15 and above who consented to recency testing and assessed patient- and health center-related predictors of recent HIV infection using multivariable logistic regression models.

Results: We obtained data from 485 of 565 health facilities in Rwanda that introduced PNS and recency testing alongside preexisting testing services. From October 2018 to February 2024, 8940 individuals consented to HIV recency testing. Among them, 537 (6.0%) were recently infected. The odds of detecting a recent HIV infection increased by 1% for each month of experience in PNS. Patient-related factors associated with recent infections included female sex, younger age (15-24 years), residing in southern or northern provinces compared with the western province, and self-reported sex with a known HIV-infected person or unprotected sex outside of a relationship in the last 12 months.

Conclusions: Only 6% of newly diagnosed HIV infections were characterized as recent. Public health interventions targeting younger females may assist in reducing new infections in this group.

Background: Dolutegravir (DTG), an integrase strand transfer inhibitor, is recommended as the preferred first-line HIV medication globally because of higher efficacy, better tolerability, and higher genetic barrier to resistance compared with other antiretroviral therapy (ART) drug classes. However, little is known about the comparative effectiveness of DTG in sustaining durable viral suppression (VS) in real-world settings.

Methods: We analyzed data from electronic health records of a retrospective cohort of ART-naïve (N = 3793) and ART-experienced (N = 14,367) people receiving HIV treatment in Ukraine between October 2017 and September 2018, comparing incidence of viral rebound (viral load ≥ 200 HIV RNA copies/mL) after the first documented VS among participants on DTG-, ritonavir-boosted lopinavir-, and efavirenz-based regimens. Participants were followed until June 2019. Interval censoring survival analysis with cluster-robust standard errors was used to estimate the effects of ART regimen on viral rebound adjusting for demographic and clinical characteristics.

Results: N = 714 (3.9%) participants experienced viral rebound during follow-up. In the ART-naïve cohort, the incidence of rebound was 6.9 events [95% confidence interval (CI): 5.9 to 8.0] per 100 person-years. Ritonavir-boosted lopinavir-based regimens were associated with higher hazard of rebound compared with DTG-based regimens: adjusted hazard ratio = 1.8 (95% CI: 1.3 to 2.4). Efavirenz-based regimens had similar incidence of rebound compared with DTG: adjusted hazard ratio = 1.1 (95% CI: 0.9 to 1.3).

Conclusions: Favorable performance of DTG compared with other first-line ART options in sustaining VS supports continued roll-out of DTG-based regimens. High overall incidence of viral rebound, including on DTG-based regimens, calls for targeted evidence-based adherence support interventions and improved viral load and drug resistance monitoring, especially among high-risk populations.

Background: Poor sleep and frailty are prevalent among aging women with HIV (WWH). Although poor sleep quality has been associated with frailty in general aging populations, these relationships are not well characterized among WWH.

Methods: Among 1001 WWH and 371 women without HIV (WWoH) aged older than 40 years with Pittsburgh Sleep Quality Index (PSQI) and Fried Frailty Phenotype data, we analyzed relationships of poor sleep quality (PSQI>5) and sleep quality components with frailty. Separate hierarchical regression models evaluated associations between sleep and frailty status (prefrail vs. robust, frail vs robust) adjusting for the following: (1) study site and HIV status, (2) demographics, (3) substance use/central nervous system-active medications, (4) comorbidities, and (5) depressive symptoms.

Results: The median age was 53 years; 9.2% were frail while 52.8% were prefrail. Poor sleep quality was frequent (52% WWH vs. 47% WWoH; P = 0.07) and associated with double the frailty odds independent of HIV status, after adjusting for depressive symptoms (fully adjusted odds ratio AOR 1.99, 95% CI: 1.14 to 3.50, P = 0.016). Sleep-associated daytime dysfunction and very poor sleep efficiency were independently associated with being frail. Poor self-rated sleep quality and higher use of sleep medications were independently associated with being prefrail.

Conclusions: Among midlife WWH and WWoH, poor subjective sleep measures are independently associated with higher frailty odds. Longitudinal studies are needed to understand how aspects of sleep may affect progression from prefrailty to frailty after accounting for comorbidities and to elucidate the complex relationships between comorbidities and frailty, with sleep quality among midlife PWH.

Background: Effective antiretroviral therapy to maintain durable viral suppression is key to ending the HIV epidemic in the United States. We evaluated the ability of machine learning algorithms to predict people with HIV (PWH) at risk of unsuppressed viral load.

Setting: Retrospective study among PWH from San Diego County (n = 18,916). The study used reported public health HIV data (2017-2022) to predict the outcome of HIV viral load >200 copies/mL during a year-long prediction window.

Methods: The data was partitioned by calendar date into two training and one validation datasets to accurately assess performance for predicting future observations. A random forest model was used to generate outcome predictions for the overall population and stratified by race. Mediation analysis was undertaken to assess underlying causality.

Results: The model had an area under the receiver operating characteristic curve of 82.2 (95% CI: 79.3 to 85.0), a sensitivity of 33.8% (95% CI: 28.6 to 39.0), and specificity of 96.9% (95% CI: 95.7 to 97.2) corresponding to a positive predictive value of 55.7% (95% CI: 48.7 to 62.8) and negative predictive value of 91.7% (95% CI: 90.6 to 92.8). The area under the receiver operating characteristic was similar across races. Prior viral load characteristics were identified as the most important variables; however, they partially acted as mediators of underlying demographic (eg, race) and HIV infection risk (eg, injection drug use).

Conclusions: Machine learning algorithms using mandatory reported public health HIV data can predict which PWH will have future unsuppressed viral load. Future work will assess its clinical utility compared to existing data-to-care initiatives.

Background: People living with, or at risk of acquiring, HIV-1 may use hormonal long-acting reversible contraceptives (LARCs). Islatravir is a nucleoside reverse transcriptase translocation inhibitor in development for the treatment of HIV-1. We aimed to evaluate the effects of once-monthly oral islatravir on the pharmacokinetics of LARCs.

Setting: This was an exploratory substudy of a double-blind, randomized, placebo-controlled, phase 2a trial of once-monthly oral islatravir in adults at low risk of HIV-1 infection (MK-8591-016; NCT04003103).

Methods: Participants were randomized 2:2:1 to receive 6 once-monthly doses of oral islatravir 60 mg, oral islatravir 120 mg, or placebo. At randomization, participants using an etonogestrel-releasing implant, injectable medroxyprogesterone acetate, or injectable norethindrone enanthate could enroll in the LARC substudy. LARC use was not a stratification factor. Plasma samples for hormone concentrations were collected at normally scheduled study visits and assayed using high-performance liquid chromatographic-tandem mass spectrometric methods.

Results: The analyses included 36 participants (etonogestrel, n = 8; medroxyprogesterone acetate, n = 20; norethindrone enanthate, n = 9; 1 participant was in 2 groups because of contraceptive change midstudy). No differences in hormone concentrations were observed between islatravir groups and placebo. Although sampling was insufficient to characterize full pharmacokinetics parameters, hormone concentrations were above the thresholds for contraceptive effectiveness for 94.4% (34/36) of participants.

Conclusions: Coadministration with once-monthly islatravir does not seem to affect exposure to LARCs in people at low risk of HIV-1 infection. Owing to the exploratory nature of this substudy, prospective studies are needed to verify these findings.