Lancet Hiv最新文献

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.

Background: Extreme weather events pose a risk to health and disproportionately affect vulnerable groups, such as people living with HIV. We aimed to investigate the effects of extreme weather events on HIV testing uptake, HIV treatment and care, and HIV transmission.

Methods: For this systematic review, we searched PubMed, Web of Science, and PsycINFO for peer-reviewed studies published between database inception and Aug 31, 2023. Eligible studies were English-language qualitative, quantitative observational (retrospective, prospective, cross-sectional, longitudinal, case-control, and cohort), and mixed-method studies, and randomised controlled trials related to HIV and extreme weather events. We excluded reviews, mathematical models, and case reports. After exporting the search results, two authors independently screened the titles and abstracts of identified articles, reviewing the full text of those that met the inclusion criteria. We used systems thinking to develop a framework linking extreme weather events and HIV and summarised the results using thematic narrative synthesis.

Findings: Of the 6126 studies identified by the search, 27 met the inclusion criteria and were eligible for analysis, of which 19 were quantitative, six were qualitative, and two were mixed-method studies. We identified five main themes linking extreme weather events to HIV: economic and livelihood conditions (12 studies), psychosocial factors (19 studies), infrastructure damage and operational challenges (17 studies), migration and displacement (ten studies), and associated medical conditions and health-care needs (12 studies). We showed how these themes interact in complex ways, resulting in a reduction in uptake of HIV testing, interruption of HIV care and subsequent disease progression, altered risk behaviours, and an increased prevalence of HIV.

Interpretation: Extreme weather events are associated with disruptions to HIV services. Owing to the design of the included studies, we could not establish a causal relationship between extreme weather events and HIV incidence, highlighting a research gap. Appropriate adaptations and mitigation policies that protect the health and wellbeing of people living with HIV during and after extreme weather events are warranted. Such actions will be crucial to achieving the UNAIDS goal of ending HIV as a public health threat by 2030.

Funding: None.