AIDS patient care and STDs最新文献

The anatomical site of gluteal administration may influence the pharmacokinetics and tolerability of long-acting cabotegravir (CAB) plus rilpivirine (RPV), but direct comparisons between dorsogluteal (DG) and ventrogluteal (VG) injections are limited. In this prospective intra-individual crossover study, 152 adults with HIV receiving injectable CAB and RPV were switched from DG to VG administration. A total of 842 trough and 131 one-month postinjection plasma samples were analyzed. VG delivery was associated with higher one-month post-dose concentrations for both drugs (median CAB 1280 vs. 834 ng/mL, p < 0.001; RPV 148 vs. 126 ng/mL, p = 0.043). At trough, CAB concentrations were lower with VG injections (573 vs 664 ng/mL, p < 0.001), whereas RPV levels did not differ significantly (131 vs 123 ng/mL, p = 0.461). Although uncommon, a higher proportion (6.9% vs. 1.5%, p = 0.001) of CAB trough samples fell below the protein-adjusted inhibitory concentration 90 threshold in the VG group. VG administration resulted in lower variability in pooled CAB and RPV trough concentrations, both intra-patient (standard deviation ratio 0.92; p = 0.041) and inter-patient (0.80; p = 0.001), compared with DG injections. Detectable HIV-1 RNA (≥50 copies/mL) was rare and comparable between injection sites, with no confirmed virologic failures. Participants reported better tolerability with VG injections, which were associated with fewer local symptoms and were preferred by 67% of respondents. Ventrogluteal administration is associated with more consistent pharmacokinetics and improved tolerability, supporting its use as the preferred site for long-acting CAB/RPV. Although CAB trough levels were modestly lower and occasionally fell below predefined thresholds with VG injection, this did not impact virologic outcomes, reinforcing its clinical suitability in most settings.

The presence of chlamydia, gonorrhea, or syphilis infection is a significant risk factor for HIV acquisition and transmission and disproportionately impacts men who have sex with men (MSM) and transgender women. While HIV preexposure prophylaxis (PrEP) reduces HIV risk, its use may influence sexual behaviors, potentially increasing sexually transmitted infection (STI) exposure. Conversely, PrEP users are often more engaged in care, regularly screened and treated for STIs, and may access other prevention tools such as doxycycline postexposure prophylaxis. Studies on the relationship between PrEP use and STIs have shown mixed results. This cross-sectional analysis included 392 participants (381 cisgender MSM; 11 transgender women) enrolled in the US-based Multicenter AIDS Cohort Study/WIHS Combined Cohort Study between 2021 and 2024 who were sexually active in the year prior to STI testing and HIV negative at their most recent study visit. We assessed whether bacterial STI positivity (i.e., laboratory-confirmed chlamydia and gonorrhea at the urethral, pharyngeal, and/or rectal sites and/or current/past syphilis infection) differed by current PrEP use (yes/no). Multi-variable logistic regression models included sociodemographic and behavioral covariates that were associated with bacterial STI positivity at p < 0.05, with the most parsimonious models selected based on the lowest Akaike Information Criterion. Overall, 32.7% reported current PrEP use. Syphilis was the most prevalent STI (6.8%), followed by chlamydia (3.2%) and gonorrhea (2.1%); 11.7% of PrEP users tested positive for at least one STI, compared with 6.1% of non-PrEP users. Among PrEP users, 37.9% reported stopping or decreasing condom use, and 31.6% reported an increased number of sex partners after initiating PrEP. In both bivariate and multi-variable models, PrEP use was associated with higher odds of gonorrhea positivity (adjusted odds ratio = 4.70, 95% confidence interval [CI]: 1.10-20.04, p = 0.037) and greater odds of being positive for at least one STI (crude odds ratio = 1.94, 95% CI: 1.06-3.90, p = 0.041). No significant differences were observed for chlamydia and syphilis by PrEP use status. Overall, these findings suggest that current PrEP users (vs. non-PrEP users) have an increased odds of bacterial STI positivity, particularly gonorrhea, in a diverse, multi-city cohort of HIV negative, sexually active MSM and transgender women in the United States PrEP remains highly effective in preventing HIV, and our results underscore the importance of integrated sexual health services that support ongoing STI screening and prevention alongside PrEP use among sexual and gender minorities.

Evidence from real-world studies suggests that 3-monthly screening for asymptomatic chlamydia/gonorrhea is not reducing incidence and is driving increased antibiotic use and antimicrobial resistance (AMR). While some countries are recommending less screening, changes to guidelines require clinician buy-in. This study explored the views of Australian sexual health clinicians on changing practices around asymptomatic screening for chlamydia/gonorrhea in gay, bisexual, and other men-who-have-sex-with-men and attitudes to not automatically treating positive diagnoses. Between September and December 2024, we conducted thematic analysis of semi-structured interviews with 12 physicians (including 8 general practitioners) and 4 nurse practitioners working in sexual health centers, hospitals, Aboriginal health services, general practice, and nongovernmental organizations. Clinicians had variable knowledge about the limited effectiveness of asymptomatic screening. Many were open to reduced screening if provided supporting evidence. Given challenges in reducing medical interventions, they recommended public education to drive changes. While some clinicians supported patient dialogue in treatment decision-making, most felt uncomfortable not treating. Key concerns included ideas about their role as doctors, onward transmission (particularly to women), and complications/uncomfortable symptoms/patient psychological well-being. AMR considerations were less salient. While the "test and treat" paradigm is engrained, clinicians were open to reduced screening if provided with clear evidence but were generally reluctant to not treat. A flexible approach that supports patient empowerment in decision-making about screening frequency and choices around treatment could present a way forward. Changing practice requires education to shift patient/clinician mindsets around what it means to have a positive chlamydia/gonorrhea diagnosis.

Although transgender, nonbinary, and intersex (TNI) people are at greater risk for HIV acquisition than their cisgender counterparts, the research on HIV testing frequencies and predictors in this population is limited. Research focused on identifying HIV testing differences by gender among TNI people is especially lacking. This secondary data analysis examined differences in HIV testing frequencies by gender and identified the factors significantly associated with lifetime and recent HIV testing in a statewide convenience sample of TNI adults in the Mountain West region of the United States. Although chi-square test results indicated no significant gender differences in lifetime HIV testing, a significantly smaller proportion of nonbinary individuals reported receiving an HIV test in the last year when compared with transmasculine, transfeminine, and intersex individuals (Fisher's exact p = 0.04). Multi-variable logistic regression results revealed that having to educate medical providers about transgender-related care was significantly associated with a higher likelihood of ever receiving an HIV testing (AOR = 2.82, 95% CI (confidence interval): [1.56-5.07], p < 0.01). Moreover, nonbinary individuals were significantly less likely to have received an HIV test in the last year (AOR = 0.30, 95% CI: [0.11-0.81], p < 0.05). These findings point to the potentially important role that provider factors may play in HIV testing for TNBI persons. Alongside recognition of the need for more empirical work to understand complex relationships identified in this study, the study results suggest that HIV testing efforts may need to focus more on expanding access to TNI individuals, including those who identify as nonbinary.

Use of two-drug regimens (2DR) can reduce lifetime exposure to antiretroviral drugs while maintaining viral suppression. We aim to assess the real-life durability of 2DR in treatment-experienced people living with HIV (PLWH) who are virologically suppressed. We conducted a monocentric retrospective study in a referral center for PLWH in Northern France. PLWH who received 2DR as maintenance therapy (viral load <50 copies/mL at initiation) anytime between 1 January 2011 and 1 May 2023 were included. The duration of 2DR, reasons for and factors associated with switching to 3DR were analyzed. A total of 579 PLHIV were included. Dolutegravir (DTG) or ritonavir-boosted protease inhibitor (PI/r)-based 2DR were the most frequently prescribed regimens, respectively, in 64% and 16% of cases. Sixty-nine patients (12%) received injectable long-acting cabotegravir-rilpivirine. Reasons for initiating 2DR were mainly drug reduction (61%). Median follow-up time on 2DR was 20.4 months (IQR: 7.9-36.4) with 110 patients (19%) switching to 3DR after a median duration of 10.1 months (IQR: 2.7-26.5). Sixteen patients returned to a 3DR because of virological failure leading to one new onset of resistance-associated mutation. 2DR durability was significantly longer with the DTG-based regimen (p < 0.0001). History of CD4⁺ T cell count <200/mm3 (HR: 1.64, 95% CI: [1.09-2.47], p = 0.018) and number of previous antiretroviral regimen (HR: 1.92, 95% CI: [1.74-2.12], p < 0.001) were associated with a return to a 3DR. Our study showed that 2DR was a sustainable simplification strategy in a real-life setting. The return to 3DR was significantly impacted by the prescription of 2DR in patients heavily pre-treated.

Pre-exposure prophylaxis (PrEP) has shifted the paradigm of condom use and perceived risks for HIV and sexually transmitted infections (STIs) among men who have sex with men (MSM). We identified factors associated with inconsistent condom use and reasons for non-use among German MSM, with and without HIV, from two clinics in Germany between 2018 and 2024. Participants completed a questionnaire by computer-assisted self-interview every 6 months for up to 24 months. Multivariable robust Poisson regression models were fitted to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for the associations between factors of interest and inconsistent condom use and reasons for non-use. Inconsistent condom use was reported by 81% and 66% of 122 MSM during insertive and receptive anal sex, respectively. Inconsistent condom use was associated with (aPR [95% CI]) age >30 years (insertive: 31-40, 1.34 [1.13, 1.59]; ≥41, 1.27 [1.02, 1.58]), living without HIV (insertive: 1.28 [1.11, 1.47]; receptive: 1.32 [1.17, 1.49]), sex under the influence of drugs (insertive: 1.20 [1.04, 1.38]; receptive: 1.16 [1.03, 1.31]), and not worrying about STIs (insertive: 1.20 [1.06, 1.36]). Living with HIV, preference for condomless sex, and partner's HIV suppression were the most frequent reasons for non-use among participants with HIV. Using PrEP, preference for condomless sex, and partner's HIV status were the most frequent reasons for non-use among participants without HIV. Novel interventions tailored to specific high-risk subgroups, adjusted to address reasons for non-use, and adapted to mitigate risk compensation among MSM using PrEP are needed.

Over 7000 youth ages 13-24 are diagnosed annually with HIV-1 in the United States despite the 2018 approval of oral pre-exposure prophylaxis (PrEP) for adolescents, highlighting the need for more research on provider prescribing practices in pediatric populations. Prior research chiefly focuses on patient barriers to accessing PrEP, and thus, our study explored provider barriers. From August to December of 2023, we conducted a survey of medical providers in pediatrics, family medicine (FM), and internal medicine (IM)/pediatrics. A 5-point Likert scale (0-4) assessed comfort in providing adolescent sexual health care and potential barriers to PrEP prescription, including discussions around sexual activity, gender identity, sexual orientation, sexually transmitted infections, and PrEP. In total, 158 responses were received. FM providers were more familiar with PrEP (3.4 to 1.5, 76.4% difference) and with prescribing PrEP (3.4-0.7, 131.2%) than pediatric providers. Logistic regression analysis found that FM providers were 32 times more likely to prescribe PrEP than pediatric providers. Pediatric providers were 3.4 times more likely than FM providers to identify barriers to PrEP prescription, notably "lack of time to counsel on risk reduction", "lack of capacity for follow-up", "lack of knowledge," and "lack of comfort" and non-prescribers were 2.7 times more likely than prior prescribers to identify barriers, notably "lack of knowledge" and "lack of comfort". This study highlights the crucial need for educational interventions for pediatric providers around PrEP provision, but also adolescent sexual health care more widely.

Cisgender women face significant HIV risks in the United States yet retention in prevention research is challenging. The same factors that increase HIV vulnerability also create barriers to research participation. This qualitative study explored multilevel barriers and facilitators to retaining cisgender women with increased HIV prevention needs in research using the social ecological model (SEM). Semi-structured interviews were conducted from August 2023 to February 2024 with 114 participants across three groups: HIV-negative cisgender women with increased HIV prevention needs (n = 34), cisgender women living with HIV (n = 40), and HIV prevention/treatment stakeholders (n = 40). Participants were recruited nationally through convenience sampling via social media and organizations. Directed content analysis was used to identify retention factors across individual, environmental, intervention, and structural levels. Barriers included substance use affecting contact maintenance, concerns about study time commitments, frustrations with unclear study procedures, poor staff rapport, safety concerns around intimate partner violence, historical research mistrust, and systemic vulnerabilities like housing instability. Facilitators included creating affirming environments that fostered purpose, flexible scheduling with incremental compensation, clear study expectations and health education/support, authentic staff relationships, discrete communication methods, transparent study procedures and approaches, virtual visit options, and availability of multiple contact methods. Findings corroborated a key paradox: those most vulnerable to HIV acquisition may be least likely to complete longitudinal studies due to structural barriers. Successful retention requires flexible approaches that address barriers at all SEM levels. These findings provide strategies for researchers to improve retention among cisgender women with increased HIV prevention needs, strengthening research representativeness and effectiveness.