JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

Introduction: Adolescents and young adults living with HIV (AYAWH) encounter unique barriers affecting their adherence to treatment and overall health outcomes. Differentiated care for AYAWH has been suggested as a strategy to improve treatment outcomes for this demographic. This study evaluated the evidence on antiretroviral treatment outcomes of a differentiated care model with designated space or service time for AYAWH.

Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. A literature search was conducted using PubMed and Embase and included peer-reviewed articles published in English. Articles comparing retention and viral suppression rates at differentiated adolescent or young adult-specific services with those at local standards of care facilities were included in the analysis. Differentiated care encompassed separate spaces (such as dedicated rooms or buildings) or operating hours designated exclusively for AYAWH. A random-effects meta-analysis was conducted to generate pooled risk ratios (RR) to evaluate the effectiveness of these tailored care models.

Results: We identified 11 eligible articles, 10 of which from resource-limited settings in Africa. The meta-analysis revealed that differentiated time or space care for AYAWH significantly increases rates of retention (pooled RR 1.19, 95%CI 1.13-1.26) and viral suppression (pooled RR 1.11, 95%CI 1.05-1.17) among AYAWH, although moderate heterogeneity was observed in both outcomes (I2 of 69.5% and 57.3% for retention and viral suppression, respectively).

Conclusion: Implementation of differentiated time or space for adolescent and young adult HIV care significantly improves retention and viral suppression rates among AYAWH.

Introduction: We evaluated the association between pre-ART immune dysfunction and inflammation markers and the risk of non-AIDS cancer (NAC) in people with HIV (PWH) after starting ART.

Methods: In a case-cohort study nested within CoRIS, a cohort of ART-naïve PWH, who started ART during 2004-2020, we included 113 NAC cases and a random subcohort of 512 individuals without prior cancers and with at least one pre-ART blood sample. We assessed immune dysfunction (CD4+ and CD8+ cell count, CD4/CD8 ratio) and inflammation markers (interleukin-6 [IL-6], high-sensitivity C-reactive protein, D-Dimer, and soluble CD14). We estimated hazard ratios (HRs) for the association between markers quartiles and NAC risk using Prentice-weighted Cox models separately for each marker and including all markers simultaneously.

Results: Among 614 participants (87.1% men; median age 37.3 years; 23.8% with CD4+ ≥ 500 cells/µL), we observed that NAC risk was not associated with immune dysfunction markers, and it was positively associated with IL-6 and D-dimer. Adjusted HRs for IL-6 ranged from 1.77 (95%CI 0.75, 4.16) to 2.73 (1.09, 6.86), while HRs for D-dimer were 3.93 (1.75, 8.84) for the third and 2.94 (1.26, 6.86) for the fourth compared to the first quartile. When all markers were included, only D-dimer confirmed its association with NAC.

Conclusions: Pre-ART inflammation and altered coagulation, but not immune dysfunction markers, were associated with risk of NAC. Limitations include the low number of cancer cases, precluding cancer-specific analyses, and lack of information on relevant confounders, like oncogenic coinfections. Further research is needed to validate these findings.

Background: Black or African American and Hispanic/Latino gay, bisexual, and other men who have sex with men (BMSM and HLMSM) in the United States (US) are disproportionately affected by HIV. We analyze the cost and cost-effectiveness of HIV self-testing through online recruitment of BMSM and HLMSM into an HIV self-testing study.

Setting: 11 US states, February 2020-February 2021.

Methods: BMSM and HLMSM aged ≥18 years without previous HIV diagnosis or current pre-exposure prophylaxis use were recruited through dating and general interest websites/apps (sites). Using the healthcare provider perspective and a 16-month timeframe, we assessed economic costs (2022 US Dollars) of online recruitment, HIV self-test (HIVST) distribution, and participant support. A time-motion study tracked staff time spent on study implementation activities. We reported incremental program cost, cost per HIVST used, and cost per new HIV diagnosis comparing recruitment via dating versus general interest sites.

Results: The total cost was $275,776 to enroll 1,306 participants through dating sites, and support 1,005 MSM who used an HIVST (11.74% positivity). The total cost was $168,099 to enroll 600 participants through general interest sites, and support 511 MSM who used an HIVST (5.48% positivity). Recruitment via dating versus general interest sites was more costly and more effective, with incremental cost-effectiveness ratios (ICERs) of $218/HIVST used and $1,196/new diagnosis, relatively low cost per new HIV diagnosis compared with those estimated in other HIV testing interventions. ICERs were higher for HLMSM versus BMSM.

Conclusions: HIV self-testing through dating and general interest site recruitment may be an effective and cost-effective approach to increase new HIV diagnoses.

Background: We assessed the association of polyunsaturated fatty acids (PUFAs) in pregnant people with HIV (PWH) with pregnancy outcomes and offspring anthropometrics.

Setting: This is a cohort of 264 pregnant PWH, and their HIV-exposed uninfected children, enrolled in the Pediatric HIV/AIDS Cohort Study Nutrition sub-study from 2009-2011.

Methods: We measured third-trimester plasma omega-6 and omega-3 PUFA content, each as a percentage of total fatty acid content, via esterification and gas chromatography. Omega-6:omega-3 ratios were calculated. Pregnancy outcomes were hypertensive disorders of pregnancy, preterm birth (<37 weeks' gestation), and small-for-gestational age (birthweight <10th percentile). Childhood anthropometrics outcomes were Z-scores for age and sex: 1) weight and length/height (birth to 5 years of age), 2) head circumference (1-2 years), and 3) triceps skinfold thickness (2-5 years). Log-binomial regression models estimated pregnancy outcome prevalence ratios by omega-6:omega-3 ratios as a continuous variable. Linear regression models using generalized estimating equations assessed childhood anthropometric outcomes in those with omega-6:omega-3 ratios >25th versus ≤25th percentile.

Results: Each 1% increase in the omega-6:omega-3 ratio was associated with a 25% (95% confidence interval [CI] 8-43%) and 10% (95% CI 3-18%) higher prevalence of hypertensive disorders of pregnancy and preterm birth, respectively, and 13% (95% CI 1-23%) lower prevalence of small-for-gestational age. A difference in childhood anthropometric outcomes was not identified at any time point between exposure groups.

Conclusion: Higher omega-6:omega-3 ratios in pregnant PWH were positively associated with hypertensive disorders of pregnancy and preterm birth, inversely associated with small-for-gestational age birth, and not associated with childhood anthropometric trajectories.

Background: Effective implementation of evidence-based HIV prevention interventions continues to be a challenge in the United States, and the field is increasingly turning to implementation science for solutions. As such, it is critical to expand the current implementation science vocabulary-and its taxonomy of implementation strategies-to increase its relevance and utility for front-line implementers.

Setting: Community-based health centers providing HIV prevention services in the southeastern United States.

Methods: We conducted a collective case-study analysis, combining document review and qualitative interviews with program directors, clinicians, and other providers (N = 30) at 5 sites. We used an inductive and iterative analytic approach to specify and categorize strategies, and then conducted in-depth cross-case analysis to derive a practice-driven taxonomy of HIV prevention implementation strategies.

Results: From an initial matrix of 264 activities, we identified 50 strategies common across sites. In contrast to existing implementation science frameworks, most (68%, n = 34) strategies were designed to affect implementation outcomes (eg, acceptability, adoption, feasibility) for patients. We present a practice-driven taxonomy of these strategies, operationalized according to implementation science literature, but with terminology that more directly relates to implementers.

Conclusions: Findings demonstrate the feasibility and utility of this method for developing a practice-driven implementation science vocabulary for HIV prevention. Our evidence-based taxonomy provides a framework for implementers seeking data about the universe of strategies they might consider for their own programs, and increases researchers' ability to measure and evaluate the effectiveness of implementation strategies being enacted in practice settings.

Background: Pre-exposure prophylaxis for HIV prevention (PrEP) prescriptions in the United States have increased, yet only 15% of individuals assigned female at birth who could benefit from PrEP had received prescriptions as of 2022, with marked racial disparities.

Setting: Georgia has the highest HIV incidence of any United States state, with more than half of new cases occurring in Atlanta. Accounting for approximately 1-in-5 cases, cisgender women living in Atlanta may benefit from clinic-based efforts to increase PrEP uptake.

Methods: We enrolled 102 women from PrEP-providing family planning clinics in the Atlanta metro area. After the clinic visit, women self-completed a questionnaire and a staff-administered questionnaire. Surveys were repeated at 3 and 6 months; using baseline data only, we conducted bivariate analyses to determine factors associated with willingness to use PrEP.

Results: Participants were primarily Black (87.5%) and aged ≥24 (54.5%) years. Women considered their risk of next-year HIV diagnosis (70%) and HIV risk (85.8%) to be low, despite 45% endorsing perception of at least slightly risky sexual behavior. Most women (59.4%) were willing to take PrEP, although few were planning or had started to take PrEP. Lifetime gonorrhea or Trichomonas diagnosis, perceived sexual risk, perceived high/moderate HIV risk, and more positive PrEP attitudes scores were associated with PrEP willingness, as were individual PrEP attitudes, concerns/barriers, and stigma items.

Conclusions: Findings suggest modifiable constructs that could be used by providers as interventional targets with patients to increase PrEP uptake. We provide suggestions mapped onto the Stages of Change Model and PrEP care and motivation continua.

Background: The best therapeutic management for people with HIV (PWH) who have a history of preexposure prophylaxis (PrEP) is still debated.

Objectives: The aim of this study was to describe recent HIV infections in PrEP users compared with people never exposed to PrEP.

Methods: Multicentre retrospective analysis evaluating all recent HIV infections from 2018 to 2021 within the Italian Cohort Naive Antiretrovirals. PWH, PrEP experienced or not, were compared using χ2 test and Wilcoxon rank-sum test for categorical and continuous variables, respectively. A mixed linear model was used to estimate the change of the estimated mean HIV-RNA in the first year after ART initiation, according to PrEP exposure.

Results: Fifty-one recent HIV diagnoses were identified, 9 in PrEP-experienced people, with an increasing temporal trend over the study period. Clinicians often initiated four-drug ART or NRTI-avoiding regimens in PrEP-experienced individuals, but this approach did not result in better viral decay or faster virologic suppression compared with traditional three-drug regimens. All achieved viral suppression during follow-up, within a median of 5.1 (IQR, 3.2-8.7) months in PWH never exposed to PrEP and 5.2 (IQR 3.2-9.4) months in PrEP-experienced PWH (P = 0.937). M184I/V was the most common mutation in PrEP-experienced individuals (37.5%).

Conclusions: An increasing number of people newly diagnosed with HIV report previous use of PrEP. All PrEP-experienced PWH in ICONA cohort have achieved rapid virologic suppression, even in cases with the presence of transmitted viral mutations.

Background: HIV/AIDS has been a global health crisis for over 4 decades. Network models, which simulate human behavior and intervention impacts, have become an essential tool in guiding HIV prevention strategies and policies. However, no comprehensive survey of network models in HIV research has been conducted. This article fills that gap, offering a summary of past work and future directions to engage more researchers and inform policy related to eliminating HIV.

Setting: Network models explicitly represent interactions between individuals, making them well-suited to study HIV transmission dynamics. Two primary modeling paradigms exist: a mechanistic approach from applied mathematics and a statistical approach from the social sciences. Each has distinct strengths and weaknesses, which should be understood for effective application to HIV research.

Methods: We conducted a systematic review of network models used in HIV research, detailing the model types, populations, interventions, behaviors, datasets, and software used, while identifying potential future research directions.

Results: Network models are particularly valuable for studying behaviors central to HIV transmission, such as partner selection and treatment adherence. Unlike traditional models, they focus on individual behaviors, aligning them with clinical practice. However, more accurate network data are needed for better model calibration and actionable insights.

Conclusions: This article serves as a point of reference for HIV researchers interested in applying network models and understanding their limitations. To our knowledge, this is the most comprehensive review of HIV network models to date.

Background: Adolescent girls and young women (AGYW) aged 15-24 years are more likely to acquire HIV than their male counterparts, and well-targeted prevention interventions are needed. We developed a method to quantify the risk of HIV acquisition based on individual risk factors and population viral load (PVL) to improve targeting of prevention interventions.

Setting: This study is based on household health survey data collected in 13 sub-Saharan African countries, 2015-2019.

Methods: We developed a Bayesian spatial model which jointly estimates district-level PVL and the probability of infection among individual AGYW, aged 15-24 years, based on individual behavioral/demographic risk factors and area-level PVL. The districts (second subnational level) typically comprise the areas of estimation. The model borrows strength across countries by incorporating random effects, which quantify country-level differences in HIV prevalence among AGYW.

Results: The combined survey data provided 52,171 questionnaire responses and blood tests from AGYW, and 280,323 blood samples from all respondents from which PVL was estimated. PVL was-by far-the most important predictor of test positivity [adjusted odds ratio (aOR) = 70.6; 0.95-probability credible interval 20.7-240.5]. Having a partner with HIV increased the odds of testing positive among AGYW who were never (aOR = 12.1; 7.5-19.6) and ever pregnant (aOR = 32.1; 23.7-43.4). The area under the cross-validated receiver-operating characteristic curve for classification of test positivity was 82%.

Conclusion: The fitted model provides a statistically principled basis for priority enrollment in HIV prevention interventions of those AGYW most at risk of HIV infection and geographic placement of prevention services.

Background: Although 30-day hospital readmission is a widely followed quality measure, there are limited US nationwide data to evaluate its trends among people with HIV (PWH) and the sex disparity over time. We describe the 30-day all-cause unplanned readmission trends among PWH and people without HIV (PWoH) in the United States.

Setting: Adult participants in the 2010-2020 Nationwide Readmissions Database, which weighted represents all US hospitalizations each year.

Methods: We defined index admission and unplanned readmission using the US Centers for Medicare & Medicaid Services criteria. Overall and sex-specific readmission risks were tabulated among the index admissions from adult PWH and PWoH each year in the 2010-2020 Nationwide Readmissions Database. Random effect linear and Poisson regressions were used to estimate risk difference and annual percentage change of the trend. We added a spline in 2015 and additionally stratified the analysis by age and patient's zip code median household income. All analyses were weighted to generate national estimates.

Results: Approximately 140,000 index admissions from PWH and 25 million from PWoH were included each year. For PWoH between 2010 and 2020, annual readmission risk was stable at ∼12%. For PWH, readmission risk was stable at ∼22% during 2010-2015 and decreased from 22.0% in 2016 to 20.1% in 2020 (RD= -1.60 [95% CI: -2.24,-0.95]). Nonpregnant female PWH continued to have higher readmission risk than male PWH for all subgroups and all years. Nonpregnant female PWH <40 years had no reduction in readmission risk between 2016 and 2020 (RD= -0.45 [95% CI: -2.43, 1.53]).

Conclusions: There remains strong need for readmission reduction interventions focusing on PWH, especially for young female PWH.