Pub Date : 2025-09-02DOI: 10.1016/s2352-3018(25)00168-7
Jiawei He,Edmond Brewer,Amanda Novotney,Austin Carter,Hilary Paul,Magdalene K Walters,Kemal Sherefa Oumer,Reshma Kassanjee,Joycelyn Dame,Sophie Desmonde,Brian Eley,Azar Kariminia,Denis Nash,Peter F Rebeiro,Vanessa Rouzier,Tavitiya Sudjaritruk,Kara Wools-Kaloustian,Constantin T Yiannoutsos,Marcel Yotebieng,Reed J D Sorensen,Christopher J L Murray,Simon I Hay,Aleksandr Aravkin,Abraham Flaxman,Peng Zheng,Hmwe H Kyu
BACKGROUNDPast cohort studies have examined mortality among children and young adolescents (aged 0-14 years) who have received antiretroviral therapy (ART), but no systematic reviews have been undertaken to synthesise these findings. Our study aims to provide the most comprehensive global estimates of paediatric mortality among children and adolescents receiving ART.METHODSFor this systematic review and meta-regression analysis, we searched PubMed and Embase from Jan 1, 1990 to July 31, 2024 for studies reporting mortality among children and young adolescents living with HIV who were on ART. We employed the meta-regression with Bayesian priors, regularisation, and trimming tool, developed for the Global Burden of Disease study 2019, for meta-regression analysis to estimate on-ART mortality by region, CD4 cell count or percentage, age, sex, and treatment duration. We assessed the robustness of our results by doing a sensitivity analysis, restricting it to studies of good quality using the quality assessment tool adapted from the Newcastle-Ottawa Scale and the National Heart, Lung, and Blood Institute. This study has been registered with PROSPERO (CRD42022382702).FINDINGSOur literature search identified 7588 records, of which 5853 were determined relevant for title and abstract review. Following screening, 1068 records were selected for full-text assessment. We included 84 studies in our systematic review, of which 66 were included in the meta-regression analysis. Our analysis indicated that HIV-related mortality for all children and young adolescents (aged 0-14 years) decreased over time, between 2000 and 2020 globally, after adjusting for region, baseline CD4 cell count, age, treatment duration, and sex. Additionally, HIV-related mortality decreased with increasing CD4 cell count at ART initiation and longer treatment duration. There have been considerable geographical variations in the risk of mortality. Among the high-mortality group in 2020 (ART duration <6 months, age <1 year, male, and the lowest CD4 cell counts), HIV-related mortality across regions ranged from 11·7 deaths (95% CI 8·3-15·4) per 100 person-years in eastern Sub-Saharan Africa to 72·0 deaths (47·1-98·1) per 100 person-years in Asia-Pacific. Among the low-mortality group in 2020 (ART duration ≥1 year, age 5-9 years, female, and the highest CD4 cell counts), HIV-related mortality ranged from 0·09 deaths (0·07-0·10) per 100 person-years in eastern Sub-Saharan Africa to 0·20 deaths (0·03-0·80) per 100 person-years in Latin America and the Caribbean.INTERPRETATIONA comprehensive approach to paediatric HIV care is essential to improving outcomes for children and young adolescents living with HIV. Clinically, this approach includes strengthening the prevention of vertical transmission, ensuring early diagnosis in infants, and initiating treatment promptly-ideally at higher CD4 cell counts. From a policy perspective, health systems need to address disparities in treatment access and o
{"title":"HIV-related mortality time trends among children and young adolescents on antiretroviral therapy by age, treatment duration, and region: a systematic review and meta-regression analysis.","authors":"Jiawei He,Edmond Brewer,Amanda Novotney,Austin Carter,Hilary Paul,Magdalene K Walters,Kemal Sherefa Oumer,Reshma Kassanjee,Joycelyn Dame,Sophie Desmonde,Brian Eley,Azar Kariminia,Denis Nash,Peter F Rebeiro,Vanessa Rouzier,Tavitiya Sudjaritruk,Kara Wools-Kaloustian,Constantin T Yiannoutsos,Marcel Yotebieng,Reed J D Sorensen,Christopher J L Murray,Simon I Hay,Aleksandr Aravkin,Abraham Flaxman,Peng Zheng,Hmwe H Kyu","doi":"10.1016/s2352-3018(25)00168-7","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00168-7","url":null,"abstract":"BACKGROUNDPast cohort studies have examined mortality among children and young adolescents (aged 0-14 years) who have received antiretroviral therapy (ART), but no systematic reviews have been undertaken to synthesise these findings. Our study aims to provide the most comprehensive global estimates of paediatric mortality among children and adolescents receiving ART.METHODSFor this systematic review and meta-regression analysis, we searched PubMed and Embase from Jan 1, 1990 to July 31, 2024 for studies reporting mortality among children and young adolescents living with HIV who were on ART. We employed the meta-regression with Bayesian priors, regularisation, and trimming tool, developed for the Global Burden of Disease study 2019, for meta-regression analysis to estimate on-ART mortality by region, CD4 cell count or percentage, age, sex, and treatment duration. We assessed the robustness of our results by doing a sensitivity analysis, restricting it to studies of good quality using the quality assessment tool adapted from the Newcastle-Ottawa Scale and the National Heart, Lung, and Blood Institute. This study has been registered with PROSPERO (CRD42022382702).FINDINGSOur literature search identified 7588 records, of which 5853 were determined relevant for title and abstract review. Following screening, 1068 records were selected for full-text assessment. We included 84 studies in our systematic review, of which 66 were included in the meta-regression analysis. Our analysis indicated that HIV-related mortality for all children and young adolescents (aged 0-14 years) decreased over time, between 2000 and 2020 globally, after adjusting for region, baseline CD4 cell count, age, treatment duration, and sex. Additionally, HIV-related mortality decreased with increasing CD4 cell count at ART initiation and longer treatment duration. There have been considerable geographical variations in the risk of mortality. Among the high-mortality group in 2020 (ART duration <6 months, age <1 year, male, and the lowest CD4 cell counts), HIV-related mortality across regions ranged from 11·7 deaths (95% CI 8·3-15·4) per 100 person-years in eastern Sub-Saharan Africa to 72·0 deaths (47·1-98·1) per 100 person-years in Asia-Pacific. Among the low-mortality group in 2020 (ART duration ≥1 year, age 5-9 years, female, and the highest CD4 cell counts), HIV-related mortality ranged from 0·09 deaths (0·07-0·10) per 100 person-years in eastern Sub-Saharan Africa to 0·20 deaths (0·03-0·80) per 100 person-years in Latin America and the Caribbean.INTERPRETATIONA comprehensive approach to paediatric HIV care is essential to improving outcomes for children and young adolescents living with HIV. Clinically, this approach includes strengthening the prevention of vertical transmission, ensuring early diagnosis in infants, and initiating treatment promptly-ideally at higher CD4 cell counts. From a policy perspective, health systems need to address disparities in treatment access and o","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"72 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003208","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 : 2025-09-01Epub Date: 2025-06-05DOI: 10.1016/S2352-3018(25)00137-7
Marco Vitoria, Graeme Meintjes, Nathan Ford, Lisa Frigati, Nandita Sugandhi, Alexandra Calmy
{"title":"Retiring the language of first-line and second-line ART.","authors":"Marco Vitoria, Graeme Meintjes, Nathan Ford, Lisa Frigati, Nandita Sugandhi, Alexandra Calmy","doi":"10.1016/S2352-3018(25)00137-7","DOIUrl":"10.1016/S2352-3018(25)00137-7","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e608-e610"},"PeriodicalIF":13.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-05-29DOI: 10.1016/S2352-3018(25)00134-1
Roger Pebody
{"title":"Activists step in to deliver PEP and PrEP in Mexico.","authors":"Roger Pebody","doi":"10.1016/S2352-3018(25)00134-1","DOIUrl":"10.1016/S2352-3018(25)00134-1","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e614"},"PeriodicalIF":13.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200578","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)00130-4
Patrice Severe MD, Samuel Pierre MD, Fabienne Homeus MD, Jean Bernard Marc MD, Letizia Trevisi PhD, Maria Linda Aristhomene BS, Guirlaine R Bernadin BS, Kerlyne Lavoile BS, Vanessa Rivera BS, Carl Frederic Duchatellier MD, Marie Josee Joseph BS, John Wu MBA, Vanessa Rouzier MD, Fabiola Preval BS, Evens Jean BS, Jodany Bernadin BS, Abigail Zion BS, Guyrlaine Pierre Louis Forestal PharmD, Santiago Avila-Rios PhD, Claudia Garcia Morales PhD, Adina Zhang MS, Dennis Israelski MD, Alexandra Apollon BS, Emelyne Dumont BS, Elizabeth Fox PhD, Pierre-Yves Cremieux PhD, Prof Jean W Pape MD, Sean E Collins MD, Bernard Liautaud MD, Prof Paul E Sax MD, Serena P Koenig MD
Patients on second-line protease inhibitor-based regimens in low-income and middle-income countries have high rates of nucleoside reverse transcriptase inhibitor (NRTI) resistance, but access to testing is scarce. We aimed to assess the efficacy of combination oral bictegravir, emtricitabine, and tenofovir alafenamide in this population.
{"title":"Bictegravir, emtricitabine, and tenofovir alafenamide versus ritonavir-boosted protease inhibitor-based antiretroviral therapy in people with HIV and viral suppression on second-line therapy in Haiti: an open-label, randomised, non-inferiority trial","authors":"Patrice Severe MD, Samuel Pierre MD, Fabienne Homeus MD, Jean Bernard Marc MD, Letizia Trevisi PhD, Maria Linda Aristhomene BS, Guirlaine R Bernadin BS, Kerlyne Lavoile BS, Vanessa Rivera BS, Carl Frederic Duchatellier MD, Marie Josee Joseph BS, John Wu MBA, Vanessa Rouzier MD, Fabiola Preval BS, Evens Jean BS, Jodany Bernadin BS, Abigail Zion BS, Guyrlaine Pierre Louis Forestal PharmD, Santiago Avila-Rios PhD, Claudia Garcia Morales PhD, Adina Zhang MS, Dennis Israelski MD, Alexandra Apollon BS, Emelyne Dumont BS, Elizabeth Fox PhD, Pierre-Yves Cremieux PhD, Prof Jean W Pape MD, Sean E Collins MD, Bernard Liautaud MD, Prof Paul E Sax MD, Serena P Koenig MD","doi":"10.1016/s2352-3018(25)00130-4","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00130-4","url":null,"abstract":"Patients on second-line protease inhibitor-based regimens in low-income and middle-income countries have high rates of nucleoside reverse transcriptase inhibitor (NRTI) resistance, but access to testing is scarce. We aimed to assess the efficacy of combination oral bictegravir, emtricitabine, and tenofovir alafenamide in this population.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"33 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144924697","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)00186-9
Nicholas I Paton
{"title":"Optimised second-line regimens in the public health approach","authors":"Nicholas I Paton","doi":"10.1016/s2352-3018(25)00186-9","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00186-9","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"25 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144924694","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)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}
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