JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

Background: Pre-exposure prophylaxis for HIV prevention (PrEP) prescriptions in the U.S. 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 U.S. state, with over 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 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%). 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, though 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.

Conclusion: 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.

Objective: The objective of this study is to define the neuropsychiatric challenges including developmental delay, cognitive impairment and psychiatric illness faced by children with perinatally acquired HIV.

Data sources: Nine databases were searched on 30/05/2023: MEDLINE, Embase, and PsycINFO (all via Ovid SP); CINAHL and Child Development and Adolescent Studies (via EBSCO); the Web of Science Core Collection; Scopus; ProQuest Dissertations and Theses Global; and WHO Global Index Medicus. No limits were applied. Search strategies incorporated keywords and thesaurus headings to describe children and adolescents aged 0-25 with perinatally acquired HIV and terms to describe the spectrum of neuropsychiatric impairment.

Study selection: Entries were reviewed by two independent reviewers. Studies were included if they involved a population of children with perinatally acquired HIV and investigated a neurological or psychiatric outcome.

Main outcome measures: Hypothesis that children with pHIV would have more neuropsychiatric challenges than children without pHIV was formulated before the study. Main outcome measures include incidence and severity of cognitive impairment, developmental delay and psychiatric illness in children with pHIV.

Results: 45 studies on cognitive impairment were included of which eight studies were included for meta-analysis and demonstrated a standardised mean difference of -0.508 where children without HIV had higher cognitive scores (95% CI -0.7903; -0.2272). 15 studies on developmental delay were included of which nine were included for meta-analysis and demonstrated, for motor delay, a standardised mean difference (SMD) of -0.794 where children without HIV achieved higher motor function scores (95% CI: -0.9986 to -0.590; ) and for cognitive delay a SMD of -0.697 where children without HIV achieved higher cognitive function scores (CI -0.976 to -0.417;). 39 studies on psychiatric illness were included with an odds ratio for anxiety and depression of 1.105, suggesting that children with HIV had slightly higher odds of developing anxiety or depression, however this result was not significant (CI: 0.778 - 1.571).

Conclusions: Children with perinatally acquired HIV may have a greater cognitive impairment, motor and cognitive delay and would likely benefit from tailored approaches to improve their outcomes.

Background: Loss to follow-up to HIV care following delivery puts birthing parents with HIV at higher risk of loss of viral suppression, disease progression, and HIV partner transmission. This study assessed factors associated with retention in postpartum HIV care.

Methods: This is a retrospective cohort study at a single academic medical center and included patients followed from January 2014 to December 2022. The primary outcome was retention in postpartum HIV care (any healthcare encounter discussing HIV medication adherence or viral load within 12 months postpartum). Data was analyzed using Chi-square and student T-test for discrete and continuous variables. Univariate and multivariable log regressions were used to measure independent associations on care retention and healthcare utilization outcomes.

Results: Of the 111 patients with planned follow up at our facility, 93 (83.8%) of participants had ≥ 1 HIV care encounter within 12 months of delivery. Participants had a mean age of 31.2 (± 5.84), were predominantly Black (79.3%), non-Hispanic (91%), non-U.S. born (57.5%) with substantial exposure of prior IPV (29.6%). Participants retained in care were more likely to use ART during pregnancy (92/99% vs 16/94.2%, P=0.01) and have viral suppression at delivery (n= 83/90% vs 12/67%, P=.02). Retention in care was negatively associated with substance use during pregnancy (aOR 0.29, 95% CI 0.09-0.95) following adjustment for social health covariates.

Conclusion: While almost 84% of participants were retained in HIV care within 12 months of delivery, substance use in pregnancy was a significant risk factor for HIV care attrition postpartum.

Introduction: We assessed the risk of adverse pregnancy and birth outcomes and birth defects among women living with HIV (WLHIV) on antiretroviral therapy (ART) and HIV-negative women.

Methods: We analyzed data on live births, stillbirths, and spontaneous abortions during 2015-2021 from a hospital-based birth defects surveillance system in Kampala, Uganda. ART regimens were recorded from hospital records and maternal self-reports. Using a log-binomial regression model, we compared the prevalence of 16 major external birth defects and other adverse birth outcomes among WLHIV on ART and HIV-negative women.

Results: A total of 203,092 births were included from 196,373 women of which 15,020 (7.6%) were WLHIV on ART. During pregnancy, 15,566 infants were primarily exposed to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART (n=13,614; 87.5%). After adjusting for maternal age, parity, and number of antenatal care (ANC) visits, WLHIV on NNRTI were more likely than HIV-negative women to deliver preterm (adjusted prevalence ratio [aPR]=1.27, 95% confidence interval [CI]: 1.21,1.32), post-term (aPR=1.23, 95% CI: 1.16,1.32), or small for gestational age infants (aPR=1.35, 95% CI: 1.30,1.40). Spina bifida was more prevalent among infants born to WLHIV on ART periconceptionally compared to HIV-negative women (aPR=2.45, 95% CI 1.27,4.33). The prevalence of the other selected birth defects were similar between infants from WLHIV on ART and HIV-negative women.

Conclusion: In Uganda, WLHIV on ART were more likely than HIV-negative women to experience selected adverse birth outcomes. Further surveillance of maternal ART exposure, including by drug class and ART regimen, is needed to monitor and prevent adverse birth outcomes in WLHIV.

Background: HIV drug resistance can reduce the effectiveness of antiretroviral drugs in preventing morbidity and mortality, limit options for treatment, and prevention. Our study aimed to assess HIV-1 subtypes and HIV drug resistance among key populations in HIV Sentinel Surveillance Plus Behavior in 2018 and 2020.

Methods: One-stage venue-based cluster sampling was used to recruit participants at hotspots identified for men who have sex with men (MSM) in 7 provinces and sexual minority females and female sex workers (FSW) in 13 provinces. Participants completed a standard questionnaire about risk and preventive behaviors, and antiretroviral therapy history, and provided intravenous blood for HIV testing. HIV drug resistance testing was conducted on HIV-positive samples with viral load >1000 copies/mL.

Results: A total of 185 of 435 (42.5%) HIV-positive samples had viral load ≥1000 copies/mL, of which 130 of 136 from MSM and 26 of 49 from FSW were successfully sequenced. Six HIV-1 subtypes were detected (CRF01_AE, A, CRF07/08_BC, B, C, CRF25_cpx), with CRF01_AE (82.7%, 129/156) the most common. Drug resistance mutations were detected in 16.7% of participants overall (26/156), in 15.4% (20/130) of MSM, and in 23.1% (6/26) of FSW. Mutations associated with resistance to non-nucleoside reverse transcriptase inhibitor (NNRTI) were the most frequently detected (73.1%, 19/26). The high level of resistance was presented in NNRTI and nucleoside reverse transcriptase inhibitors classes. There are 10 major resistance mutations detected with nucleoside reverse transcriptase inhibitors (M184VI-25.0%, K65KR-50.0%, Y115F-25%), NNRTI (K103N-21.1%, E138A-10.5%, V106M-5.3%, K101E-5.3%, G190A-5.3%), protease inhibitors (L33F-40.0%, M46L-20.0%).

Conclusions: Vietnam's HIV Sentinel Surveillance Plus system identified an emerging strain of HIV-1 and mutations associated with resistance to multiple drug classes among MSM and FSW.

Background: Case identification remains a challenge to reaching the United Nations 95-95-95 targets for children with HIV. Although the World Health Organization approved oral mucosal HIV self-testing (HIVST) for children older than 2 years in 2019, there is little information on HIVST for pediatric case identification in Ethiopia.

Setting: Nine health facilities across Ethiopia.

Methods: We implemented a pilot program from November 2021 to April 2022 to assess acceptability and feasibility of using HIVST to screen children 2-14 years of adult index clients, (ie, parents/caregivers living with HIV and on antiretroviral therapy). HIV-positive adults who had children with unknown HIV status were given HIVST kits (OraQuick) to screen their children at home. Parents/caregivers were asked to report results telephonically and bring children screening positive to the health facility for confirmatory HIV testing. We defined HIVST acceptability as ≥50% of parents/caregivers accepting testing and ≥50% reporting results within 7 days of receiving a test kit. Feasibility was defined as ≥60% of children with a reactive HIVST receiving confirmatory testing and <5 serious social harms reported per 1000 kits distributed.

Results: Overall, 1496 of 1651 (91%) parents/caregivers accepted HIVST kits to test their children at home and 1204 (71%) reported results within 7 days. Of 17 children (1%) with reactive results, 13 (76%) received confirmatory testing; of which 7 (54%) were confirmed to be HIV positive. One serious social harm was reported.

Conclusions: Providing adult parents/caregivers with HIVST kits to screen their children at home is an acceptable and feasible strategy to reach untested children and improve pediatric case finding in a low prevalence setting.

Background: As people living with HIV (PWH) age, they face new challenges that can have a negative impact on their quality of life (QOL) and mental health.

Setting: This study enrolled PWH at the end of life (EOL) who were actively engaged in cure-related research in Southern California, United States. EOL was defined as having a prognosis of 6 months or less to live. We examined the relationship between QOL, mental health, and research participation.

Methods: Structured assessments were used to collect comprehensive data on QOL and mental health.

Results: From 2017 to 2023, 35 PWH in their final stages of life who were actively engaged in cure-related research were enrolled. Their median age was 62.7 years, and most were White or otherwise non-Hispanic/non-Latino (90.6%), and male (86.7%). Changes in QOL and the presence of neurologic and psychiatric conditions, with a focus on depression and anxiety, were the primary outcomes assessed in this study. Participants had stable QOL scores throughout the study. There was an inverse relationship between QOL and Beck Depression Inventory scores, with higher mean QOL scores being associated with lower mean Beck Depression Inventory scores ( P < 0.001).

Conclusions: QOL remained stable among PWH who participate in cure-related research at EOL. The inverse relationship between QOL and depressive symptoms suggests that participation in cure-related research may improve QOL or reduce depressive symptoms in this population. Future interventions should look into ways to improve the well-being of PWH at EOL through research and customized mental health interventions.

Background: The aim of this study is to assess the acceptability of HIV preexposure prophylaxis (PrEP) among individuals eligible for prophylaxis.

Setting: Retrospective study of individuals receiving their first HIV test at the Infectious Diseases Unit of IRCCS San Raffaele Scientific Institute, Milan, Italy.

Methods: People (1) who received their first HIV test (baseline date) between January 2018 (availability of PrEP in Italy) and December 2023 (data lock) and (2) with an indication for PrEP based on condomless sex were included; those already on PrEP were excluded. Individuals with a negative HIV test result were offered PrEP counseling and prescription according to guidelines. Characteristics of people who accepted or declined HIV PrEP were compared using Mann-Whitney or χ 2 tests, as appropriate.

Results: A total of 2627 people were tested for HIV: 175 (6.6%) were diagnosed with HIV. Of the 2452 people with negative HIV test results, 2165 (88.3%) were men; median age was 34.3 years (interquartile range = 28.7-42.4). Sexually transmitted infections were detected in 478 of 2452 (19.5%) people, most commonly gonorrhea (206/2452, 8.4%). Overall, 982 of 2452 (40.0%) people accepted PrEP, including only 3 women. Nonacceptance was higher among women ( P < 0.001) and non-White ( P < 0.001). Of those who did not accept PrEP, 260 (17.7%) were diagnosed with at least 1 sexually transmitted infection at the time of HIV testing.

Conclusions: Low PrEP acceptance was observed, particularly among women and people of non-White origin. Nonacceptance of PrEP was also observed among individuals diagnosed with an sexually transmitted infection.

Background: Maternal and pregnancy outcomes among women with perinatally acquired HIV (PHIV) versus women with HIV acquired through other routes (NPHIV) are not fully understood.

Setting: US-born women during 2005-2015 in New York City.

Methods: We used data from the New York City HIV surveillance registry, Expanded Perinatal Surveillance database, and Vital Statistics, to compare pregnancy and all-cause mortality outcomes among women with PHIV versus NPHIV delivering infants during 2005-2015.

Results: There were 186 deliveries among 137 women with PHIV and 1188 deliveries among 910 women with NPHIV. Women with PHIV were younger at delivery, more likely to be aware of their HIV status, and less likely to use substances or be incarcerated. At the time of delivery, women with PHIV were more likely to have HIV RNA >1000 copies/mL (34% vs. 19%), CD4 <200 cells/µL (18% vs. 7%; median CD4 300 cells/µL vs. 435 cells/µL), to have adequate prenatal care (43% vs. 35%), and to deliver by elective C-section (63% vs. 49%). There were no differences in intrapartum and neonatal antiretroviral therapy use, perinatal transmission, gestational age, and birth weight of the infants, nor infant mortality. Women with NPHIV had higher survival than women with PHIV (RR = 2.29, P = 0.004; age-adjusted risk ratio = 3.23, P < 0.001; age and CD4 adjusted risk ratio = 2.09, P = 0.046).

Conclusions: Women with PHIV had lower long-term survival after delivery likely because of limited HIV treatment options in childhood and a longer duration of HIV infection, underscoring the importance of close follow-up and tailored support services beyond the postpartum period.

Background: The COVID-19 pandemic had great impact on HIV care and prevention worldwide, including in Brazil. We compared HIV testing, recent infection, and annualized incidence according to the COVID-19 pandemic period among cisgender men who have sex with men (MSM) and transgender women (TGW).

Setting: HIV and sexually transmitted infection testing, prevention, and treatment referral service in Rio de Janeiro, Brazil.

Methods: We used Maxim HIV-1 Limiting Antigen Avidity EIA as part of a recent infection testing algorithm to identify recent HIV infection cases and estimate annualized HIV incidences in the pre- (March 2018-February 2020) and post-COVID-19 pandemic onset period (March 2020-January 2022). Multivariable logistic regression model assessed factors associated with recent HIV infection.

Results: Among 3814 MSM and 776 TGW, 593 (12.9%) tested positive for HIV and 119 (2.6%) were identified as having recent infection. Percentage of recent HIV infection did not differ between the COVID-19 periods. Overall annualized HIV incidence rates were 6.0% (95% confidence interval [CI]: 4.2 to 7.7) and 6.6% (95% CI: 4.3 to 9.0) in the pre- and post-COVID-19 periods, respectively. During the post-COVID-19 period, higher incidence rates were observed among TGW (8.4% [95% CI: 2.9 to 13.9]), those aged 18-24 years (7.8% [95% CI: 4.0 to 11.7]), of Black race (7.9% [95% CI: 3.8 to 12.0]), and those with <12 years of schooling (7.8% [95% CI: 4.8 to 10.8]). Compared to the pre-COVID-19 period, incidence rates were significantly higher in the post-COVID-19 period for those aged >30 years and TGW, while being lower for those with more years of schooling.

Conclusion: HIV incidence estimates remain high among MSM and TGW in Brazil, especially among the most vulnerable. The consequences of the COVID-19 pandemic on the HIV epidemic will likely persist and contribute to worsening HIV outcomes.