Lancet Hiv最新文献

Background: Lesotho has made substantial efforts to control its HIV epidemic. We aimed to assess progress towards UNAIDS 95-95-95 targets in Lesotho by comparing data from the Lesotho Population-based HIV Impact Assessments conducted in 2016-17 (LePHIA 2016) and 2019-20 (LePHIA 2020).

Methods: The LePHIA surveys used a cross-sectional, two-stage, stratified cluster sampling design to obtain a nationally representative sample of adults aged 15-59 years (LePHIA 2016) or aged 15 years and older (LePHIA 2020) from all ten districts of Lesotho. From November, 2016 to May, 2017 (LePHIA 2016) and from December, 2019 to March, 2020 (LePHIA 2020), consenting participants from randomly selected households provided demographic and clinical information and blood samples for household HIV testing according to national guidelines. HIV-reactive test results were confirmed by a laboratory assay. We estimated HIV status awareness and antiretroviral therapy (ART) use on the basis of self-reports or detection of antiretroviral drugs in blood samples. Viral load suppression was defined as HIV-1 RNA less than 1000 copies per mL. We applied Poisson regression models using survey weights and estimated variances using the Taylor series linearisation approach.

Findings: 11 682 participants were enrolled in LePHIA 2016 and 12 718 participants were enrolled in LePHIA 2020. Overall HIV incidence decreased significantly from 1·10% (95% CI 0·68-1·52) in 2016 to 0·50% (0·26-0·74) in 2020 (p=0·026). Among adults who tested positive for HIV, awareness of HIV status improved from 81·0% (79·6-82·3) in 2016 to 89·6% (88·3-90·8) in 2020 (p<0·0001). Furthermore, between the two surveys, the proportion on ART among those aware of their HIV status increased from 91·8% (90·5-93·0) to 96·9% (95·9-97·6; p<0·0001) and the prevalence of viral load suppression among those on ART increased from 87·7% (86·1-89·1) to 90·8% (89·5-91·9; p<0·0020). After adjusting for demographic covariates, adults living with HIV were significantly more likely in 2020 than in 2016 to know their HIV status (adjusted prevalence ratio 1·09, 95% CI 1·07-1·12, p<0·0001), to be on ART if aware of their status (1·05, 1·03-1·07, p<0·0001), and to be virally suppressed if on ART (1·03, 1·01-1·06, p=0·0045).

Interpretation: Between 2016 and 2020, Lesotho made significant progress towards the UNAIDS 95-95-95 targets, surpassing the second target (ART coverage) and showing improvements in HIV status awareness and viral load suppression (the first and third targets) as well as declines in HIV prevalence and incidence. Lesotho's experience provides valuable insights for other countries working to control their HIV epidemics.

Funding: The US President's Emergency Plan for AIDS Relief.

Prevalence and incidence of HIV among people aged 50 years and older continue to rise worldwide, generating increasing awareness among care providers, scientists, and the HIV community about the importance of brain health in older adults with HIV. Many age-related factors that adversely affect brain health can occur earlier and more often among people with HIV, including epigenetic ageing, chronic medical conditions (eg, cardiovascular disease), and age-related syndromes (eg, frailty). Extensive dialogue between HIV community leaders, health-care providers, and scientists has led to the development of a multidimensional response strategy to protect and enhance brain health in people ageing with HIV that spans across public health, clinical spaces, and research spaces. This response strategy was informed by integrated ageing care frameworks and is centred on prevention, early detection, and management of brain health issues associated with HIV (eg, neurocognitive disorders), with specific considerations for low-resource or middle-resource countries. A collaborative, international, and data-informed update of the diagnostic criteria for HIV-associated neurocognitive disorders is a cornerstone of the proposed response strategy. The proposed response strategy includes a dynamic, international, online knowledge hub that will provide a crucial community resource for emerging evidence on the brain health of people ageing with HIV.

The sex of people living with HIV-1 infection, schistosome infection, or both, is a fundamental determinant of their clinical outcomes and of how these two infections interact in the host. Data from longitudinal and cross-sectional human studies and animal models indicate that males with HIV-1 and schistosome co-infection excrete fewer schistosome eggs and might have higher HIV-1 RNA viral loads and greater liver damage. Females with schistosome infection appear to have higher risk of HIV-1 acquisition than females without, particularly in Schistosoma haematobium infection, and a greater risk of death in HIV-1 and schistosome co-infection. Greater transmission of HIV-1 to partners has been shown in both sexes in those with schistosome infection. Biological sex is a consequential factor affecting pathophysiological and clinical responses in HIV-1 and schistosome co-infection. Designing future analyses to incorporate sex is vital to optimise research and care for people living with HIV-1, schistosomes, and HIV-1 and schistosome co-infection.