Pub Date : 2025-08-27DOI: 10.1016/s2352-3018(25)00243-7
Peter Hayward
{"title":"Highlights of the 13th IAS Conference on HIV Science","authors":"Peter Hayward","doi":"10.1016/s2352-3018(25)00243-7","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00243-7","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"31 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144924693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-27DOI: 10.1016/s2352-3018(25)00244-9
The Lancet HIV
{"title":"A moment of reckoning","authors":"The Lancet HIV","doi":"10.1016/s2352-3018(25)00244-9","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00244-9","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"60 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144924700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-27DOI: 10.1016/s2352-3018(25)00184-5
Melanie A Gasper,Anna-Ursula Happel,Sonwabile Dzanibe,Jennifer Slyker,Heather B Jaspan
The introduction and programmatic scale-up of universal antiretroviral therapy in pregnancy (option B and option B+) and the subsequent universal test-and-treat approaches have dramatically reduced infant HIV-1 acquisitions globally, with a parallel increase in the number of infants who are HIV-exposed uninfected (HEU). Although infants who are HEU have historically had higher risk of morbidity and mortality than infants who are HIV unexposed, effective parental viral suppression has enabled people living with HIV to carry healthier pregnancies and realise the benefits of optimised feeding practices that support the transfer of key nutrients and immune factors through their parent's own milk. However, residual, heightened inflammation, altered gut microbiome, and differences in innate and adaptive immunology in infants who are HEU remain, and might contribute to persistent, heightened infectious morbidity. Parental HIV infection continues to influence child health in the option B and option B+ era; future research is needed to uncover underlying mechanisms and long-term implications of these strategies.
{"title":"Immunology of infants who are HIV-exposed uninfected in the parental combination antiretroviral therapy era.","authors":"Melanie A Gasper,Anna-Ursula Happel,Sonwabile Dzanibe,Jennifer Slyker,Heather B Jaspan","doi":"10.1016/s2352-3018(25)00184-5","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00184-5","url":null,"abstract":"The introduction and programmatic scale-up of universal antiretroviral therapy in pregnancy (option B and option B+) and the subsequent universal test-and-treat approaches have dramatically reduced infant HIV-1 acquisitions globally, with a parallel increase in the number of infants who are HIV-exposed uninfected (HEU). Although infants who are HEU have historically had higher risk of morbidity and mortality than infants who are HIV unexposed, effective parental viral suppression has enabled people living with HIV to carry healthier pregnancies and realise the benefits of optimised feeding practices that support the transfer of key nutrients and immune factors through their parent's own milk. However, residual, heightened inflammation, altered gut microbiome, and differences in innate and adaptive immunology in infants who are HEU remain, and might contribute to persistent, heightened infectious morbidity. Parental HIV infection continues to influence child health in the option B and option B+ era; future research is needed to uncover underlying mechanisms and long-term implications of these strategies.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"11 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-21DOI: 10.1016/s2352-3018(25)00234-6
Amanda Evangelista, Anderson Kirk Nigel G Tan, Adrian E Go
{"title":"The HIV care crisis in the Philippines","authors":"Amanda Evangelista, Anderson Kirk Nigel G Tan, Adrian E Go","doi":"10.1016/s2352-3018(25)00234-6","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00234-6","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"24 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144901739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-21DOI: 10.1016/s2352-3018(25)00235-8
David Jackson-Perry, Alain Amstutz
{"title":"Should we be paying more attention to HIV and adult ADHD?","authors":"David Jackson-Perry, Alain Amstutz","doi":"10.1016/s2352-3018(25)00235-8","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00235-8","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"24 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144901785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Globally, 16 million children are HIV-exposed but uninfected (HEU), with health disparities when compared with children who are HIV-unexposed. To identify current challenges, a research prioritisation exercise was conducted through an online survey and in-person workshop with diverse stakeholders, with the aim of identifying the top ten scientific priorities related to children who are HEU. Among 104 survey respondents (46% from Africa; 37% from Europe; 15% from the region of the Americas; and 2% from South-East Asia), 271 research questions were submitted. Workshop attendees (n=35) refined and prioritised questions through discussion and consensus. The highest research priority was identifying strategies to reduce morbidity and mortality and to improve growth and neurodevelopment among children who are HEU. Other research questions included: defining the underlying causes of health disparities; identifying clinically vulnerable mother-infant pairs through screening; documenting life course outcomes; defining the contribution of antiretrovirals to health disparities; identifying clinically important immune perturbations; understanding which infections should be prevented, and how; exploring intergenerational effects; defining meaningful health disparities; and characterising drivers of immune abnormalities. Participants also identified several methodological considerations and strategic approaches to advance the field. Coordinated action between communities, researchers, clinicians, policy makers, and funders is now required to conduct high-quality research to address these priority needs, with a particular focus on regions with high HIV prevalence.
{"title":"Research gaps for children who are HIV-exposed but uninfected: outcomes of a research prioritisation workshop.","authors":"Catherine J Wedderburn,Ceri Evans,Elaine J Abrams,Alasdair Bamford,Adrie Bekker,Madeleine J Bunders,Cristina Epalza,Caroline Foster,Lisa Frigati,Tessa Goetghebuer,Grace John-Stewart,Christian R Kahlert,Cinta Moraleda,Victor Musiime,Angelina Namiba,Eleni Nastouli,Irene Njuguna,Savita G Pahwa,Helena Rabie,Talía Sainz,Lena Serghides,Mercy Shibemba,Priscilla Tsondai,Kathleen Powis,Claire Thorne,Andrew J Prendergast","doi":"10.1016/s2352-3018(25)00166-3","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00166-3","url":null,"abstract":"Globally, 16 million children are HIV-exposed but uninfected (HEU), with health disparities when compared with children who are HIV-unexposed. To identify current challenges, a research prioritisation exercise was conducted through an online survey and in-person workshop with diverse stakeholders, with the aim of identifying the top ten scientific priorities related to children who are HEU. Among 104 survey respondents (46% from Africa; 37% from Europe; 15% from the region of the Americas; and 2% from South-East Asia), 271 research questions were submitted. Workshop attendees (n=35) refined and prioritised questions through discussion and consensus. The highest research priority was identifying strategies to reduce morbidity and mortality and to improve growth and neurodevelopment among children who are HEU. Other research questions included: defining the underlying causes of health disparities; identifying clinically vulnerable mother-infant pairs through screening; documenting life course outcomes; defining the contribution of antiretrovirals to health disparities; identifying clinically important immune perturbations; understanding which infections should be prevented, and how; exploring intergenerational effects; defining meaningful health disparities; and characterising drivers of immune abnormalities. Participants also identified several methodological considerations and strategic approaches to advance the field. Coordinated action between communities, researchers, clinicians, policy makers, and funders is now required to conduct high-quality research to address these priority needs, with a particular focus on regions with high HIV prevalence.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"10 29 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-06DOI: 10.1016/s2352-3018(25)00185-7
Gert U van Zyl,Helena Rabie
{"title":"Prioritising HIV drug resistance testing according to risk.","authors":"Gert U van Zyl,Helena Rabie","doi":"10.1016/s2352-3018(25)00185-7","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00185-7","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"739 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-06DOI: 10.1016/s2352-3018(25)00164-x
Emily P Hyle,Linda-Gail Bekker,Suzanne M McCluskey,Wanyi Chen,Paul E Sax,Mahomed-Yunus Moosa,Munashe Machoko,Audrey Bangs,Kim Steegen,Mark J Siedner,David A M C van de Vijver,Stephen C Resch,Anne M Neilan,Andrew Phillips,Rochelle P Walensky,Richard J Lessells,Milton C Weinstein,Caitlin M Dugdale,Robin Wood,Kenneth A Freedberg
BACKGROUNDPersistent virological non-suppression among people with HIV receiving tenofovir-lamivudine-dolutegravir (TLD) can result from poor adherence with or without resistance; however, genotypic resistance testing (GRT) is not recommended routinely in South Africa. We examined the clinical and economic effect of GRT for all South African adults diagnosed with persistent virological non-suppression on TLD.METHODSIn this modelling study, we used the previously validated Cost-Effectiveness of Preventing AIDS Complications-International microsimulation model to compare three strategies: (1) continued TLD (baseline); (2) immediate switch to tenofovir-lamivudine plus ritonavir-boosted darunavir; and (3) GRT prompting switch to tenofovir-lamivudine plus ritonavir-boosted darunavir for people with dolutegravir resistance or TLD continuation for people without dolutegravir resistance. We estimated that 2·3% and 28·5% of the baseline population have dolutegravir resistance and nucleoside reverse transcriptase inhibitor (NRTI) resistance, respectively. We also examined the effect of a low-cost, point-of-care urine tenofovir test in development to detect recent antiretroviral therapy use (84% sensitivity and 50% specificity), with GRT only when positive. Costs included GRT (US$157 per test), TLD ($45 per year), tenofovir-lamivudine plus ritonavir-boosted darunavir ($247 per year), and urine tenofovir testing ($2 per test). Outcomes included life-years, costs (provider perspective), and incremental cost-effectiveness ratios (ICERs; $ per disability-adjusted life-year [DALY]). We considered cost-effectiveness thresholds of less than $3310 per DALY (base case) and less than $1100 to $4250 per DALY.FINDINGSBased on our model, we estimated that continued TLD results in 14·11 undiscounted life-years and costs $5380 discounted at 3%; GRT results in 14·36 life-years and costs $5860 (0·14 discounted DALYs averted; ICER $3500 per DALY). Immediate switch results in fewer DALYs averted and higher costs. GRT has an ICER of $3310 per DALY or less when baseline dolutegravir resistance prevalence is ≥2·5% or genotypic resistance test costs ≤$147 per test. Urine tenofovir testing to identify GRT eligibility results in an ICER of $2300 per DALY; the ICER would be less than $1100 per DALY if urine test specificity is 0·87 or greater and costs $2 per test or test specificity is higher than 0·98 and costs $10 per test or less.INTERPRETATIONGRT could increase life expectancy for people with HIV and persistent virological non-suppression on TLD in South Africa and could be cost-effective, especially at lower test costs. At current effectiveness and costs of tenofovir-lamivudine plus ritonavir-boosted darunavir, an immediate switch would not be preferred.FUNDINGNational Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the MGH Jerome and Celia Reich Endowed Scholar in HIV/AIDS Research Award.
{"title":"The clinical and economic impact of genotypic resistance testing for people diagnosed with persistent virological non-suppression on tenofovir-lamivudine-dolutegravir in South Africa: a modelling study.","authors":"Emily P Hyle,Linda-Gail Bekker,Suzanne M McCluskey,Wanyi Chen,Paul E Sax,Mahomed-Yunus Moosa,Munashe Machoko,Audrey Bangs,Kim Steegen,Mark J Siedner,David A M C van de Vijver,Stephen C Resch,Anne M Neilan,Andrew Phillips,Rochelle P Walensky,Richard J Lessells,Milton C Weinstein,Caitlin M Dugdale,Robin Wood,Kenneth A Freedberg","doi":"10.1016/s2352-3018(25)00164-x","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00164-x","url":null,"abstract":"BACKGROUNDPersistent virological non-suppression among people with HIV receiving tenofovir-lamivudine-dolutegravir (TLD) can result from poor adherence with or without resistance; however, genotypic resistance testing (GRT) is not recommended routinely in South Africa. We examined the clinical and economic effect of GRT for all South African adults diagnosed with persistent virological non-suppression on TLD.METHODSIn this modelling study, we used the previously validated Cost-Effectiveness of Preventing AIDS Complications-International microsimulation model to compare three strategies: (1) continued TLD (baseline); (2) immediate switch to tenofovir-lamivudine plus ritonavir-boosted darunavir; and (3) GRT prompting switch to tenofovir-lamivudine plus ritonavir-boosted darunavir for people with dolutegravir resistance or TLD continuation for people without dolutegravir resistance. We estimated that 2·3% and 28·5% of the baseline population have dolutegravir resistance and nucleoside reverse transcriptase inhibitor (NRTI) resistance, respectively. We also examined the effect of a low-cost, point-of-care urine tenofovir test in development to detect recent antiretroviral therapy use (84% sensitivity and 50% specificity), with GRT only when positive. Costs included GRT (US$157 per test), TLD ($45 per year), tenofovir-lamivudine plus ritonavir-boosted darunavir ($247 per year), and urine tenofovir testing ($2 per test). Outcomes included life-years, costs (provider perspective), and incremental cost-effectiveness ratios (ICERs; $ per disability-adjusted life-year [DALY]). We considered cost-effectiveness thresholds of less than $3310 per DALY (base case) and less than $1100 to $4250 per DALY.FINDINGSBased on our model, we estimated that continued TLD results in 14·11 undiscounted life-years and costs $5380 discounted at 3%; GRT results in 14·36 life-years and costs $5860 (0·14 discounted DALYs averted; ICER $3500 per DALY). Immediate switch results in fewer DALYs averted and higher costs. GRT has an ICER of $3310 per DALY or less when baseline dolutegravir resistance prevalence is ≥2·5% or genotypic resistance test costs ≤$147 per test. Urine tenofovir testing to identify GRT eligibility results in an ICER of $2300 per DALY; the ICER would be less than $1100 per DALY if urine test specificity is 0·87 or greater and costs $2 per test or test specificity is higher than 0·98 and costs $10 per test or less.INTERPRETATIONGRT could increase life expectancy for people with HIV and persistent virological non-suppression on TLD in South Africa and could be cost-effective, especially at lower test costs. At current effectiveness and costs of tenofovir-lamivudine plus ritonavir-boosted darunavir, an immediate switch would not be preferred.FUNDINGNational Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the MGH Jerome and Celia Reich Endowed Scholar in HIV/AIDS Research Award.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"33 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05DOI: 10.1016/s2352-3018(25)00222-x
Ed Holt
{"title":"Elton John AIDS Foundation plugging gaps in HIV funding.","authors":"Ed Holt","doi":"10.1016/s2352-3018(25)00222-x","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00222-x","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"106 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：