Pub Date : 2024-10-04DOI: 10.1097/QAI.0000000000003543
Janet Burnett, Evelyn Olansky, Amy R Baugher, Kathryn Lee, Steven Callens, Cyprian Wejnert
Background: Transgender women continue to face a significant burden of health disparities with HIV infection as a critical public health concern. Substance use is higher among transgender women compared to cisgender women. However, little is known about transgender women who inject drugs and risk for HIV in the United States. The objectives were to explore HIV prevalence, injection-related behaviors, and HIV prevention and care outcomes among transgender women who inject drugs and to compare transgender women to a general sample of people who inject drugs (PWID).
Methods: Participants from National HIV Behavioral Surveillance were recruited via respondent-driven sampling, interviewed, and tested for HIV infection in 2019-2020. Log-linked Poisson regression models were used to test for associations between injection drug use and selected characteristics.
Results: Among 1,561 transgender women, 7% injected drugs in the past 12 months. HIV prevalence was higher among transgender women who inject (aPR=1.5, 95%CI=1.2-1.8) than those who do not. Multiple psychosocial conditions were associated with injection drug use. Among transgender women with HIV, those who inject were less likely to take antiretroviral therapy (aPR=0.8, 95%CI=0.7-1.0) than those who do not. Methamphetamine was the most commonly injected drug (67%); most accessed a syringe services program (66%).
Conclusion: Transgender women who inject have substantial challenges related to health outcomes including high HIV prevalence and exposure to psychosocial conditions, such as homelessness, incarceration, and exchange sex, that may exacerbate risks associated with injection drug use. This population may benefit from increased access to non-judgmental and culturally competent harm reduction services.
背景：变性妇女在健康方面仍然面临着巨大的不平等，其中艾滋病毒感染是一个重要的公共卫生问题。与顺性别女性相比，变性女性使用药物的比例更高。然而，人们对美国注射毒品的变性女性以及她们感染 HIV 的风险知之甚少。研究目的是探讨注射毒品的变性女性中 HIV 感染率、注射相关行为以及 HIV 预防和护理结果，并将变性女性与注射毒品者（PWID）的一般样本进行比较：方法：通过受访者驱动的抽样调查从全国 HIV 行为监测中招募参与者，对其进行访谈，并在 2019-2020 年对其进行 HIV 感染检测。采用对数链接泊松回归模型检验注射吸毒与选定特征之间的关联：在 1561 名跨性别女性中，有 7% 在过去 12 个月中注射过毒品。注射毒品的变性女性的艾滋病感染率（aPR=1.5，95%CI=1.2-1.8）高于不注射毒品的变性女性。多种社会心理状况与注射吸毒有关。在感染艾滋病毒的变性女性中，注射吸毒者比不注射吸毒者更少可能接受抗逆转录病毒治疗（aPR=0.8，95%CI=0.7-1.0）。甲基苯丙胺是最常见的注射毒品（67%）；大多数人都参加了注射器服务计划（66%）：注射毒品的变性女性在健康结果方面面临巨大挑战，包括艾滋病毒的高流行率和社会心理状况，如无家可归、监禁和性交易，这些都可能加剧与注射毒品相关的风险。这部分人群可能会受益于更多的非评判性和文化上胜任的减低伤害服务。
{"title":"Intersecting structural and psychosocial conditions: investigating injection drug use and HIV among transgender women.","authors":"Janet Burnett, Evelyn Olansky, Amy R Baugher, Kathryn Lee, Steven Callens, Cyprian Wejnert","doi":"10.1097/QAI.0000000000003543","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003543","url":null,"abstract":"<p><strong>Background: </strong>Transgender women continue to face a significant burden of health disparities with HIV infection as a critical public health concern. Substance use is higher among transgender women compared to cisgender women. However, little is known about transgender women who inject drugs and risk for HIV in the United States. The objectives were to explore HIV prevalence, injection-related behaviors, and HIV prevention and care outcomes among transgender women who inject drugs and to compare transgender women to a general sample of people who inject drugs (PWID).</p><p><strong>Methods: </strong>Participants from National HIV Behavioral Surveillance were recruited via respondent-driven sampling, interviewed, and tested for HIV infection in 2019-2020. Log-linked Poisson regression models were used to test for associations between injection drug use and selected characteristics.</p><p><strong>Results: </strong>Among 1,561 transgender women, 7% injected drugs in the past 12 months. HIV prevalence was higher among transgender women who inject (aPR=1.5, 95%CI=1.2-1.8) than those who do not. Multiple psychosocial conditions were associated with injection drug use. Among transgender women with HIV, those who inject were less likely to take antiretroviral therapy (aPR=0.8, 95%CI=0.7-1.0) than those who do not. Methamphetamine was the most commonly injected drug (67%); most accessed a syringe services program (66%).</p><p><strong>Conclusion: </strong>Transgender women who inject have substantial challenges related to health outcomes including high HIV prevalence and exposure to psychosocial conditions, such as homelessness, incarceration, and exchange sex, that may exacerbate risks associated with injection drug use. This population may benefit from increased access to non-judgmental and culturally competent harm reduction services.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371854","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}
Pub Date : 2024-10-03DOI: 10.1097/QAI.0000000000003536
Brahm Coler, Gordon Honerkamp Smith, Anish K Arora, Adam Wells, Stephanie Solso, Cheryl Dullano, Susanna Concha-Garcia, Eddie Hill, Patricia K Riggs, Anastasia Korolkova, Robert Deiss, Davey Smith, Erin E Sundermann, Sara Gianella, Antoine Chaillon, Karine Dubé
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 six 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 BDI scores, with higher mean QOL scores being associated with lower mean BDI scores (p < 0.001).
Conclusion: 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.
背景：随着艾滋病病毒感染者（PWH）年龄的增长，他们面临着新的挑战，这些挑战可能会对他们的生活质量（QOL）和心理健康产生负面影响：本研究招募了美国南加州积极参与治愈相关研究、处于生命末期（EOL）的艾滋病病毒感染者。生命末期被定义为预后可存活六个月或更短时间。我们研究了 QOL、心理健康和参与研究之间的关系：方法：采用结构化评估收集有关 QOL 和心理健康的综合数据：从 2017 年到 2023 年，有 35 名处于生命最后阶段、积极参与治愈相关研究的残疾人参加了研究。他们的中位年龄为 62.7 岁，大多数为白人或其他非西班牙裔/非拉丁裔（90.6%），男性（86.7%）。本研究评估的主要结果是 QOL 的变化以及是否存在神经和精神疾病，重点是抑郁和焦虑。在整个研究过程中，参与者的 QOL 分数保持稳定。QOL与BDI得分之间存在反比关系，QOL平均得分越高，BDI平均得分越低（p < 0.001）：结论：参与治愈相关研究的 PWH 在临终前的 QOL 保持稳定。QOL与抑郁症状之间的反比关系表明，参与治愈相关研究可改善该人群的QOL或减轻抑郁症状。未来的干预措施应研究如何通过研究和定制的心理健康干预措施来改善临终前残疾人的福祉。
{"title":"Quality of Life in People with HIV at the End of Life: Preliminary Results from the Last Gift Observational Cohort Study.","authors":"Brahm Coler, Gordon Honerkamp Smith, Anish K Arora, Adam Wells, Stephanie Solso, Cheryl Dullano, Susanna Concha-Garcia, Eddie Hill, Patricia K Riggs, Anastasia Korolkova, Robert Deiss, Davey Smith, Erin E Sundermann, Sara Gianella, Antoine Chaillon, Karine Dubé","doi":"10.1097/QAI.0000000000003536","DOIUrl":"10.1097/QAI.0000000000003536","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Setting: </strong>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 six months or less to live. We examined the relationship between QOL, mental health, and research participation.</p><p><strong>Methods: </strong>Structured assessments were used to collect comprehensive data on QOL and mental health.</p><p><strong>Results: </strong>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 BDI scores, with higher mean QOL scores being associated with lower mean BDI scores (p < 0.001).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365137","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}
Pub Date : 2024-10-01DOI: 10.1097/qai.0000000000003472
Bradley E Aouizerat,Josephine N Garcia,Carlos V Domingues,Ke Xu,Bryan C Quach,Grier P Page,Deborah Konkle-Parker,Hector H Bolivar,Cecile D Lahiri,Elizabeth T Golub,Mardge H Cohen,Seble G Kassaye,Jack DeHovitz,Mark H Kuniholm,Nancie M Archin,Phyllis C Tien,Dana B Hancock,Eric Otto Johnson
BACKGROUNDCocaine-one of the most frequently abused illicit drugs among persons living with HIV [people living with HIV (PLWH)]-slows the decline of viral production after antiretroviral therapy and is associated with higher HIV viral load, more rapid HIV progression, and increased mortality.SETTINGWe examined the impact of cocaine use on the CD4+ T-cell HIV latent reservoir (HLR) in virally suppressed PLWH participating in a national, longitudinal cohort study of the natural and treated history of HIV in the United States.METHODSCD4+ T-cell genomic DNA from 434 women of diverse ancestry (ie, 75% Black, 14% Hispanic, 12% White) who self-reported cocaine use (ie, 160 cocaine users, 59 prior users, 215 non-users) was analyzed using the Intact Proviral HIV DNA Assay, measuring intact provirus per 106 CD4+ T cells.FINDINGSHIV latent reservoir size differed by cocaine use (ie, median [interquartile range]: 72 [14-193] for never users, 165 [63-387] for prior users, 184 [28-502] for current users), which was statistically significantly larger in both prior (P = 0.023) and current (P = 0.001) cocaine users compared with never users.CONCLUSIONSCocaine use may contribute to a larger replication competent HLR in CD4+ T cells among virologically suppressed women living with HIV. Our findings are important because women are underrepresented in HIV reservoir studies and in studies of the impact of cocaine use on outcomes among PLWH.
背景可卡因是艾滋病病毒感染者（PLWH）中最常滥用的非法药物之一，它能减缓抗逆转录病毒治疗后病毒产量的下降，并与更高的艾滋病病毒载量、更快的艾滋病进展和更高的死亡率有关。设置我们研究了使用可卡因对CD4+ T细胞HIV潜伏库（HLR）的影响，研究对象是参与美国HIV自然史和治疗史全国纵向队列研究的病毒已被抑制的艾滋病毒感染者。方法使用完整病毒 HIV DNA 检测法对 434 名不同血统（即 75% 黑人、14% 西班牙人、12% 白人）、自我报告使用过可卡因的女性（即 160 名可卡因使用者、59 名先前使用者、215 名非使用者）的 CD4+ T 细胞基因组 DNA 进行分析，测量每 106 个 CD4+ T 细胞中的完整病毒数量。结果艾滋病毒潜伏库的大小因使用可卡因而异（即，中位数[四分位数间距]：从未使用者 72 [14-193]，既往使用者 165 [63-387]，当前使用者 184 [28-502]），在统计学上，既往使用者（P = 0.结论可卡因的使用可能导致病毒学抑制的女性艾滋病毒感染者的 CD4+ T 细胞中 HLR 复制能力增强。我们的研究结果非常重要，因为在艾滋病毒储库研究以及可卡因使用对艾滋病毒感染者预后影响的研究中，女性所占比例较低。
{"title":"Frequent Cocaine Use is Associated With Larger HIV Latent Reservoir Size.","authors":"Bradley E Aouizerat,Josephine N Garcia,Carlos V Domingues,Ke Xu,Bryan C Quach,Grier P Page,Deborah Konkle-Parker,Hector H Bolivar,Cecile D Lahiri,Elizabeth T Golub,Mardge H Cohen,Seble G Kassaye,Jack DeHovitz,Mark H Kuniholm,Nancie M Archin,Phyllis C Tien,Dana B Hancock,Eric Otto Johnson","doi":"10.1097/qai.0000000000003472","DOIUrl":"https://doi.org/10.1097/qai.0000000000003472","url":null,"abstract":"BACKGROUNDCocaine-one of the most frequently abused illicit drugs among persons living with HIV [people living with HIV (PLWH)]-slows the decline of viral production after antiretroviral therapy and is associated with higher HIV viral load, more rapid HIV progression, and increased mortality.SETTINGWe examined the impact of cocaine use on the CD4+ T-cell HIV latent reservoir (HLR) in virally suppressed PLWH participating in a national, longitudinal cohort study of the natural and treated history of HIV in the United States.METHODSCD4+ T-cell genomic DNA from 434 women of diverse ancestry (ie, 75% Black, 14% Hispanic, 12% White) who self-reported cocaine use (ie, 160 cocaine users, 59 prior users, 215 non-users) was analyzed using the Intact Proviral HIV DNA Assay, measuring intact provirus per 106 CD4+ T cells.FINDINGSHIV latent reservoir size differed by cocaine use (ie, median [interquartile range]: 72 [14-193] for never users, 165 [63-387] for prior users, 184 [28-502] for current users), which was statistically significantly larger in both prior (P = 0.023) and current (P = 0.001) cocaine users compared with never users.CONCLUSIONSCocaine use may contribute to a larger replication competent HLR in CD4+ T cells among virologically suppressed women living with HIV. Our findings are important because women are underrepresented in HIV reservoir studies and in studies of the impact of cocaine use on outcomes among PLWH.","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"40 1","pages":"156-164"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142222903","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}
Pub Date : 2024-10-01DOI: 10.1097/qai.0000000000003494
{"title":"Brief Report: HIV-1 Resistance Analysis of Participants With HIV-1 and Hepatitis B Initiating Therapy With Bictegravir/Emtricitabine/Tenofovir Alafenamide or Dolutegravir Plus Emtricitabine/Tenofovir Disoproxil Fumarate: A Subanalysis of ALLIANCE Data: Erratum.","authors":"","doi":"10.1097/qai.0000000000003494","DOIUrl":"https://doi.org/10.1097/qai.0000000000003494","url":null,"abstract":"","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"4 1","pages":"202"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142222902","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}
BACKGROUNDSafety data from randomized trials of antiretrovirals in pregnancy are scarce. We evaluated maternal bone and renal data from the International Maternal Pediatric Adolescent AIDS Clinical Trials Network 2010 trial, which compared the safety and efficacy of 3 antiretroviral therapy regimens started in pregnancy: dolutegravir + emtricitabine/tenofovir alafenamide (DTG + FTC/TAF), dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG + FTC/TDF), and efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF).METHODSA subset of participants underwent dual-energy X-ray absorptiometry scans at postpartum week 50 only. Maternal bone mineral density (BMD) Z-scores were compared between arms. Maternal creatinine was measured at enrolment and periodically through week 50 postpartum, and by-arm differences in average weekly change in estimated creatinine clearance were compared.RESULTSSix hundred forty-three participants were randomized to DTG + FTC/TAF (N = 217) or DTG + FTC/TDF (N = 215) or EFV/FTC/TDF (N = 211). Median age = 27 years (IQR 23, 32), median CD4 count = 466 cells/mm3 (IQR 308, 624); 564 (88%) women enrolled in Africa and 479 (74%) breastfed. Week 50 postpartum dual-energy X-ray absorptiometry results from 154 women were included in the analysis. Hip and spine BMD was on average higher in women in the DTG + FTC/TAF and lower in the DTG + FTC/TDF and EFV/FTC/TDF arms, but no significant differences in BMD Z-scores were observed between treatment groups. The weekly rate of change in estimated creatinine clearance differed among treatment groups during the antepartum period, but not over the full study follow-up.CONCLUSIONSMarkers of bone and renal toxicity did not differ significantly through week 50 postpartum among women randomized to start DTG + FTC/TAF or DTG + FTC/TDF or EFV/FTC/TDF in pregnancy.
{"title":"Markers of Maternal Bone and Renal Toxicity Through 50 Weeks Postpartum: IMPAACT 2010 (VESTED) Trial.","authors":"Gaerolwe Masheto,Sean S Brummel,Lauren Ziemba,John Shepherd,Tapiwa Mbengeranwa,Laarni Igawa,Anne Coletti,Dorinda Mukura,Lindie Rossouw,Gerhard Theron,Chelsea Krotje,Patrick Jean-Philippe,Nahida Chakhtoura,Haseena Cassim,Sisinyana Ruth Mathiba,Joel Maena,William Murtaugh,Lee Fairlie,Judith Currier,Risa Hoffman,Lameck Chinula,Paul E Sax,Lynda Stranix-Chibanda,Shahin Lockman,","doi":"10.1097/qai.0000000000003478","DOIUrl":"https://doi.org/10.1097/qai.0000000000003478","url":null,"abstract":"BACKGROUNDSafety data from randomized trials of antiretrovirals in pregnancy are scarce. We evaluated maternal bone and renal data from the International Maternal Pediatric Adolescent AIDS Clinical Trials Network 2010 trial, which compared the safety and efficacy of 3 antiretroviral therapy regimens started in pregnancy: dolutegravir + emtricitabine/tenofovir alafenamide (DTG + FTC/TAF), dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG + FTC/TDF), and efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF).METHODSA subset of participants underwent dual-energy X-ray absorptiometry scans at postpartum week 50 only. Maternal bone mineral density (BMD) Z-scores were compared between arms. Maternal creatinine was measured at enrolment and periodically through week 50 postpartum, and by-arm differences in average weekly change in estimated creatinine clearance were compared.RESULTSSix hundred forty-three participants were randomized to DTG + FTC/TAF (N = 217) or DTG + FTC/TDF (N = 215) or EFV/FTC/TDF (N = 211). Median age = 27 years (IQR 23, 32), median CD4 count = 466 cells/mm3 (IQR 308, 624); 564 (88%) women enrolled in Africa and 479 (74%) breastfed. Week 50 postpartum dual-energy X-ray absorptiometry results from 154 women were included in the analysis. Hip and spine BMD was on average higher in women in the DTG + FTC/TAF and lower in the DTG + FTC/TDF and EFV/FTC/TDF arms, but no significant differences in BMD Z-scores were observed between treatment groups. The weekly rate of change in estimated creatinine clearance differed among treatment groups during the antepartum period, but not over the full study follow-up.CONCLUSIONSMarkers of bone and renal toxicity did not differ significantly through week 50 postpartum among women randomized to start DTG + FTC/TAF or DTG + FTC/TDF or EFV/FTC/TDF in pregnancy.","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"29 1","pages":"172-179"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142222920","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}
BACKGROUNDThe pathogenesis of HIV-associated neurocognitive (NC) impairment is multifactorial, and antiretroviral (ARV) neurotoxicity may contribute. However, interventional pharmacological studies are limited.METHODSSingle-blind, randomized (1:1), controlled trial to assess the change of NC performance (Global Deficit Score, GDS, and domain scores) in PLWH with NC impairment randomized to continue their standard of care treatment or to switch to a less neurotoxic ARV regimen: darunavir/cobicistat, maraviroc, emtricitabine (MARAND-X). Participants had plasma and cerebrospinal fluid HIV RNA< 50 copies/mL, R5-tropic HIV, and were on ARV regimens that did not include efavirenz and darunavir. The change of resting-state electroencephalography was also evaluated. The outcomes were assessed at week 24 of the intervention through tests for longitudinal paired data and mixed-effect models.RESULTSThirty-eight participants were enrolled and 28 completed the follow-up. Global Deficit Score improved over time but with no difference between arms in longitudinal adjusted models. Perceptual functions improved in the MARAND-X, while long-term memory improved only in participants within the MARAND-X for whom the central nervous system penetration-effectiveness (CNS penetration effectiveness) score increased by ≥3. No significant changes in resting-state electroencephalography were observed.CONCLUSIONSIn this small but well-controlled study, the use of less neurotoxic ARV showed no major beneficial effect over an unchanged regimen. The beneficial effects on the memory domain of increasing CNS penetration effectiveness score suggest that ARV neuropenetration may have a role in cognitive function.
{"title":"Switching to Low Neurotoxic Antiretrovirals to Improve Neurocognition Among People Living With HIV-1-Associated Neurocognitive Disorder: The MARAND-X Randomized Clinical Trial.","authors":"Alessandro Lazzaro,Daniela Vai,Ambra Barco,Giacomo Stroffolini,Veronica Pirriatore,Giulia Guastamacchia,Marco Nigra,Valeria Ghisetti,Maria Cristina Tettoni,Giuseppe Noce,Claudia Giaccone,Mattia Trunfio,Alice Trentalange,Stefano Bonora,Giovanni Di Perri,Andrea Calcagno","doi":"10.1097/qai.0000000000003480","DOIUrl":"https://doi.org/10.1097/qai.0000000000003480","url":null,"abstract":"BACKGROUNDThe pathogenesis of HIV-associated neurocognitive (NC) impairment is multifactorial, and antiretroviral (ARV) neurotoxicity may contribute. However, interventional pharmacological studies are limited.METHODSSingle-blind, randomized (1:1), controlled trial to assess the change of NC performance (Global Deficit Score, GDS, and domain scores) in PLWH with NC impairment randomized to continue their standard of care treatment or to switch to a less neurotoxic ARV regimen: darunavir/cobicistat, maraviroc, emtricitabine (MARAND-X). Participants had plasma and cerebrospinal fluid HIV RNA< 50 copies/mL, R5-tropic HIV, and were on ARV regimens that did not include efavirenz and darunavir. The change of resting-state electroencephalography was also evaluated. The outcomes were assessed at week 24 of the intervention through tests for longitudinal paired data and mixed-effect models.RESULTSThirty-eight participants were enrolled and 28 completed the follow-up. Global Deficit Score improved over time but with no difference between arms in longitudinal adjusted models. Perceptual functions improved in the MARAND-X, while long-term memory improved only in participants within the MARAND-X for whom the central nervous system penetration-effectiveness (CNS penetration effectiveness) score increased by ≥3. No significant changes in resting-state electroencephalography were observed.CONCLUSIONSIn this small but well-controlled study, the use of less neurotoxic ARV showed no major beneficial effect over an unchanged regimen. The beneficial effects on the memory domain of increasing CNS penetration effectiveness score suggest that ARV neuropenetration may have a role in cognitive function.","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"60 1","pages":"180-191"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142222937","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}
Pub Date : 2024-10-01DOI: 10.1097/qai.0000000000003481
Jeremy E Orr,Jazmin Velazquez,Christopher N Schmickl,Naa-Oye Bosompra,Pamela N DeYoung,Dillon Gilbertson,Atul Malhotra,Igor Grant,Sonia Ancoli-Israel,Maile Young Karris,Robert L Owens
BACKGROUNDPeople living with HIV (PLWH) often report fatigue even when viral load is suppressed. Obstructive sleep apnea (OSA), which is often associated with fatigue, is common in PLWH, but whether OSA explains fatigue in this population is unknown.SETTINGAcademic university-affiliated HIV and Sleep Medicine Clinics.METHODSPLWH, aged 18-65 years, with a body mass index of 20-35 kg/m2 and viral suppression (RNA <200 copies per mL), were recruited to undergo daytime questionnaires, including the Functional Assessment of Chronic Illness Therapy Fatigue Scale and Epworth Sleepiness Scale, 7 days of actigraphy (to determine daily sleep duration and activity amplitude and rhythms), and an in-laboratory polysomnography to assess for the presence and severity of OSA.RESULTSOf 120 subjects with evaluable data, 90 (75%) had OSA using the American Academy of Sleep Medicine 3% desaturation or arousal criteria, with an apnea-hypopnea index >5/h. There was no difference in Functional Assessment of Chronic Illness Therapy scores between those with and without OSA, although those with OSA did report more daytime sleepiness as measured using the Epworth Sleepiness Scale. In a multivariable model, predictors of fatigue included more variable daily sleep durations and decreased mean activity counts. Sleepiness was predicted by the presence of OSA.CONCLUSIONOSA was very common in our cohort of PLWH, with those with OSA reporting more sleepiness but not more fatigue. Variability in sleep duration was associated with increased fatigue. Further study is needed to determine if treatment of OSA, or an emphasis on sleep consistency and timing, improves symptoms of fatigue in PLWH.
背景艾滋病病毒感染者（PLWH）即使在病毒载量得到抑制的情况下也经常报告疲劳。阻塞性睡眠呼吸暂停（OSA）通常与疲劳有关，在艾滋病病毒感染者中很常见，但 OSA 是否能解释这一人群的疲劳问题尚不清楚。患有和未患有 OSA 的患者在慢性疾病治疗功能评估得分上没有差异，但使用 Epworth 嗜睡量表测量，患有 OSA 的患者白天嗜睡程度更高。在一个多变量模型中，疲劳的预测因素包括每日睡眠时间更长和平均活动次数减少。结论 在我们的 PLWH 群体中，OSA 非常常见，OSA 患者嗜睡程度更高，但疲劳程度并不更高。睡眠时间的不稳定性与疲劳的增加有关。需要进一步研究以确定治疗 OSA 或强调睡眠的连贯性和时间安排是否能改善 PLWH 的疲劳症状。
{"title":"Sleep, Sleep Apnea, and Fatigue in People Living With HIV.","authors":"Jeremy E Orr,Jazmin Velazquez,Christopher N Schmickl,Naa-Oye Bosompra,Pamela N DeYoung,Dillon Gilbertson,Atul Malhotra,Igor Grant,Sonia Ancoli-Israel,Maile Young Karris,Robert L Owens","doi":"10.1097/qai.0000000000003481","DOIUrl":"https://doi.org/10.1097/qai.0000000000003481","url":null,"abstract":"BACKGROUNDPeople living with HIV (PLWH) often report fatigue even when viral load is suppressed. Obstructive sleep apnea (OSA), which is often associated with fatigue, is common in PLWH, but whether OSA explains fatigue in this population is unknown.SETTINGAcademic university-affiliated HIV and Sleep Medicine Clinics.METHODSPLWH, aged 18-65 years, with a body mass index of 20-35 kg/m2 and viral suppression (RNA <200 copies per mL), were recruited to undergo daytime questionnaires, including the Functional Assessment of Chronic Illness Therapy Fatigue Scale and Epworth Sleepiness Scale, 7 days of actigraphy (to determine daily sleep duration and activity amplitude and rhythms), and an in-laboratory polysomnography to assess for the presence and severity of OSA.RESULTSOf 120 subjects with evaluable data, 90 (75%) had OSA using the American Academy of Sleep Medicine 3% desaturation or arousal criteria, with an apnea-hypopnea index >5/h. There was no difference in Functional Assessment of Chronic Illness Therapy scores between those with and without OSA, although those with OSA did report more daytime sleepiness as measured using the Epworth Sleepiness Scale. In a multivariable model, predictors of fatigue included more variable daily sleep durations and decreased mean activity counts. Sleepiness was predicted by the presence of OSA.CONCLUSIONOSA was very common in our cohort of PLWH, with those with OSA reporting more sleepiness but not more fatigue. Variability in sleep duration was associated with increased fatigue. Further study is needed to determine if treatment of OSA, or an emphasis on sleep consistency and timing, improves symptoms of fatigue in PLWH.","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"60 1","pages":"192-201"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142222904","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}
Pub Date : 2024-10-01DOI: 10.1097/qai.0000000000003470
Raiza M Beltran,Lauren A Hunter,Laura J Packel,Loriann De Martini,Ian W Holloway,Betty J Dong,Jerika Lam,Sandra I McCoy,Ayako Miyashita Ochoa
BACKGROUNDPre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP.METHODSIn 2022-2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios (PRs) comparing survey participants' willingness to provide LAI-PrEP by pharmacy- and individual-level characteristics. Qualitative interview data were analyzed using Rapid Qualitative Analysis to identify factors that may affect pharmacists' provision of LAI-PrEP.RESULTSHalf of the survey participants (53%) indicated that they would be willing to administer LAI-PrEP using gluteal injection in their pharmacy. Willingness was higher among participants who worked in pharmacies that provided vaccinations or other injections (56% vs. 46%; PR: 1.2; 95% confidence interval: 1.0-1.4) and/or oral PrEP under Senate Bill 159 (65% vs. 51%; PR: 1.3; 95% confidence interval: 1.1-1.5) than among participants whose pharmacies did not. Interviewed participants reported barriers to LAI-PrEP provision, including the need for increased training and staffing, a private room for gluteal injections, better medication access, and payment for services.CONCLUSIONPharmacies offer a promising setting for increased LAI-PrEP access. However, pharmacists may require additional training, resources, and policy changes to make implementation feasible.
{"title":"A Mixed Methods Evaluation of Pharmacists' Readiness to Provide Long-Acting Injectable HIV Pre-exposure Prophylaxis in California.","authors":"Raiza M Beltran,Lauren A Hunter,Laura J Packel,Loriann De Martini,Ian W Holloway,Betty J Dong,Jerika Lam,Sandra I McCoy,Ayako Miyashita Ochoa","doi":"10.1097/qai.0000000000003470","DOIUrl":"https://doi.org/10.1097/qai.0000000000003470","url":null,"abstract":"BACKGROUNDPre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP.METHODSIn 2022-2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios (PRs) comparing survey participants' willingness to provide LAI-PrEP by pharmacy- and individual-level characteristics. Qualitative interview data were analyzed using Rapid Qualitative Analysis to identify factors that may affect pharmacists' provision of LAI-PrEP.RESULTSHalf of the survey participants (53%) indicated that they would be willing to administer LAI-PrEP using gluteal injection in their pharmacy. Willingness was higher among participants who worked in pharmacies that provided vaccinations or other injections (56% vs. 46%; PR: 1.2; 95% confidence interval: 1.0-1.4) and/or oral PrEP under Senate Bill 159 (65% vs. 51%; PR: 1.3; 95% confidence interval: 1.1-1.5) than among participants whose pharmacies did not. Interviewed participants reported barriers to LAI-PrEP provision, including the need for increased training and staffing, a private room for gluteal injections, better medication access, and payment for services.CONCLUSIONPharmacies offer a promising setting for increased LAI-PrEP access. However, pharmacists may require additional training, resources, and policy changes to make implementation feasible.","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"113 1","pages":"142-149"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142222933","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}
Pub Date : 2024-10-01DOI: 10.1097/qai.0000000000003471
Andrew Mujugira,Beyonce Karungi,Agnes Nakyanzi,Monica Bagaya,Rogers Nsubuga,Timothy Sebuliba,Olivia Nampewo,Faith Naddunga,Juliet E Birungi,Oliver Sapiri,Kikulwe R Nyanzi,Felix Bambia,Timothy Muwonge,Monica Gandhi,Jessica E Haberer
BACKGROUNDPeer-delivered HIV self-testing (HIVST) and sexually transmitted infection self-sampling (STISS) may promote adherence to oral pre-exposure prophylaxis (PrEP), but no studies have analyzed this approach among transgender women (TGW) in sub-Saharan Africa.SETTINGThe Peer study was a cluster randomized trial in Uganda (October 2020-July 2022; NCT04328025).METHODSTen TGW peer groups, each with 1 TGW peer and 8 TGW, were randomized 1:1 to receive quarterly in-clinic HIV testing with PrEP refills as standard-of-care (SOC) or SOC plus monthly peer delivery of oral-fluid HIVST, STISS, and PrEP refills (intervention). Participants were followed for 12 months. The primary outcome was PrEP adherence.RESULTSWe screened 85 TGW and enrolled 82 (41 per arm). The median age was 22 years (interquartile range [IQR] 20-24). Twelve-month retention was 88% (72/82). At the 3, 6, 9, and 12-month clinic visits, 10%, 5%, 5%, and 0% of TGW in the intervention arm had TFV-DP levels ≥700 fmol/punch, versus 7%, 15%, 7%, and 2% in the SOC arm, respectively (P = 0.18). At all visits, any detectable TFV-DP levels were significantly higher in SOC than the peer delivery group (P < 0.04). PrEP adherence was associated with sex work (incidence rate ratio 6.93; 95% CI: 2.33 to 20.60) and >10 years of schooling (incidence rate ratio 2.35; 95% CI: 1.14 to 4.84). There was a strong correlation between tenofovir detection in dried blood spots and urine (P < 0.001). No HIV seroconversions occurred.CONCLUSIONSPeer-delivered HIVST and STISS did not increase low levels of oral PrEP adherence among TGW in Uganda. Long-acting PrEP formulations should be considered for this population.
{"title":"Peer-Delivered HIV Self-Testing, Sexually Transmitted Infection Self-Sampling, and Pre-exposure Prophylaxis for Transgender Women in Uganda: A Randomized Trial.","authors":"Andrew Mujugira,Beyonce Karungi,Agnes Nakyanzi,Monica Bagaya,Rogers Nsubuga,Timothy Sebuliba,Olivia Nampewo,Faith Naddunga,Juliet E Birungi,Oliver Sapiri,Kikulwe R Nyanzi,Felix Bambia,Timothy Muwonge,Monica Gandhi,Jessica E Haberer","doi":"10.1097/qai.0000000000003471","DOIUrl":"https://doi.org/10.1097/qai.0000000000003471","url":null,"abstract":"BACKGROUNDPeer-delivered HIV self-testing (HIVST) and sexually transmitted infection self-sampling (STISS) may promote adherence to oral pre-exposure prophylaxis (PrEP), but no studies have analyzed this approach among transgender women (TGW) in sub-Saharan Africa.SETTINGThe Peer study was a cluster randomized trial in Uganda (October 2020-July 2022; NCT04328025).METHODSTen TGW peer groups, each with 1 TGW peer and 8 TGW, were randomized 1:1 to receive quarterly in-clinic HIV testing with PrEP refills as standard-of-care (SOC) or SOC plus monthly peer delivery of oral-fluid HIVST, STISS, and PrEP refills (intervention). Participants were followed for 12 months. The primary outcome was PrEP adherence.RESULTSWe screened 85 TGW and enrolled 82 (41 per arm). The median age was 22 years (interquartile range [IQR] 20-24). Twelve-month retention was 88% (72/82). At the 3, 6, 9, and 12-month clinic visits, 10%, 5%, 5%, and 0% of TGW in the intervention arm had TFV-DP levels ≥700 fmol/punch, versus 7%, 15%, 7%, and 2% in the SOC arm, respectively (P = 0.18). At all visits, any detectable TFV-DP levels were significantly higher in SOC than the peer delivery group (P < 0.04). PrEP adherence was associated with sex work (incidence rate ratio 6.93; 95% CI: 2.33 to 20.60) and >10 years of schooling (incidence rate ratio 2.35; 95% CI: 1.14 to 4.84). There was a strong correlation between tenofovir detection in dried blood spots and urine (P < 0.001). No HIV seroconversions occurred.CONCLUSIONSPeer-delivered HIVST and STISS did not increase low levels of oral PrEP adherence among TGW in Uganda. Long-acting PrEP formulations should be considered for this population.","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"40 1","pages":"125-132"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142222930","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}
Pub Date : 2024-10-01DOI: 10.1097/qai.0000000000003479
Scott A McDonald,Alan Yeung,Rak Nandwani,Daniel Clutterbuck,Lesley A Wallace,Beth L Cullen,Samantha J Shepherd,Kirsty Roy,Kimberly Marsh,Rory Gunson,Sharon J Hutchinson
BACKGROUNDTo inform global ambitions to end AIDS, evaluation of progress toward HIV incidence reduction requires robust methods to measure incidence. Although HIV diagnosis date in routine HIV/AIDS surveillance systems are often used as a surrogate marker for incidence, it can be misleading if acquisition of transmission occurred years before testing. Other information present in data such as antibody testing dates, avidity testing result, and CD4 counts can assist, but the degree of missing data is often prohibitive.METHODSWe constructed a Bayesian statistical model to estimate the annual proportion of first ever HIV diagnoses in Scotland (period 2015-2019) that represent recent HIV infection (ie, occurring within the previous 3-4 months) and incident HIV infection (ie, infection within the previous 12 months), by synthesizing avidity testing results and surveillance data on the interval since last negative HIV test.RESULTSOver the 5-year analysis period, the model-estimated proportion of incident infection was 43.9% (95% CI: 40.9 to 47.0), and the proportion of recent HIV infection was 21.6% (95% CI: 19.1 to 24.1). Among the mode of HIV acquisition categories, the highest proportion of recent infection was estimated for people who inject drugs: 27.4% (95% CI: 20.4 to 34.4).CONCLUSIONSThe Bayesian approach is appropriate for the high prevalence of missing data that can occur in routine surveillance data sets. The proposed model will aid countries in improving their understanding of the number of people who have recently acquired their infection, which is needed to progress toward the goal of HIV transmission elimination.
背景为了向全球终结艾滋病的雄心壮志提供信息，评估降低艾滋病发病率的进展需要强有力的方法来衡量发病率。虽然常规艾滋病监测系统中的艾滋病诊断日期通常被用作发病率的替代标记，但如果在检测前数年就已感染，则可能会产生误导。方法我们构建了一个贝叶斯统计模型，通过综合抗体检测结果和上次阴性 HIV 检测后间隔时间的监测数据，估算苏格兰首次确诊 HIV 感染者（2015-2019 年）中近期 HIV 感染（即在前 3-4 个月内感染）和偶发 HIV 感染（即在前 12 个月内感染）的年度比例。结果在 5 年的分析期内，模型估计的偶发感染比例为 43.9%（95% CI：40.9 至 47.0），近期感染 HIV 的比例为 21.6%（95% CI：19.1 至 24.1）。在艾滋病毒感染方式类别中，注射吸毒者的近期感染比例估计最高：27.4%（95% CI：20.4 至 34.4）。所提出的模型将有助于各国更好地了解近期感染者的人数，而这正是实现消除艾滋病传播目标所必需的。
{"title":"A Statistical Model for Inference of Recent and Incident HIV Infection Using Surveillance Data on Individuals Newly Diagnosed With HIV Infection in Scotland.","authors":"Scott A McDonald,Alan Yeung,Rak Nandwani,Daniel Clutterbuck,Lesley A Wallace,Beth L Cullen,Samantha J Shepherd,Kirsty Roy,Kimberly Marsh,Rory Gunson,Sharon J Hutchinson","doi":"10.1097/qai.0000000000003479","DOIUrl":"https://doi.org/10.1097/qai.0000000000003479","url":null,"abstract":"BACKGROUNDTo inform global ambitions to end AIDS, evaluation of progress toward HIV incidence reduction requires robust methods to measure incidence. Although HIV diagnosis date in routine HIV/AIDS surveillance systems are often used as a surrogate marker for incidence, it can be misleading if acquisition of transmission occurred years before testing. Other information present in data such as antibody testing dates, avidity testing result, and CD4 counts can assist, but the degree of missing data is often prohibitive.METHODSWe constructed a Bayesian statistical model to estimate the annual proportion of first ever HIV diagnoses in Scotland (period 2015-2019) that represent recent HIV infection (ie, occurring within the previous 3-4 months) and incident HIV infection (ie, infection within the previous 12 months), by synthesizing avidity testing results and surveillance data on the interval since last negative HIV test.RESULTSOver the 5-year analysis period, the model-estimated proportion of incident infection was 43.9% (95% CI: 40.9 to 47.0), and the proportion of recent HIV infection was 21.6% (95% CI: 19.1 to 24.1). Among the mode of HIV acquisition categories, the highest proportion of recent infection was estimated for people who inject drugs: 27.4% (95% CI: 20.4 to 34.4).CONCLUSIONSThe Bayesian approach is appropriate for the high prevalence of missing data that can occur in routine surveillance data sets. The proposed model will aid countries in improving their understanding of the number of people who have recently acquired their infection, which is needed to progress toward the goal of HIV transmission elimination.","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"5 1","pages":"117-124"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142222932","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}
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