AIDS最新文献

Objective: The study aimed to assess the impact of smoking exposure on major clinical events (MCEs) in a real-life setting of people with HIV (PWH).

Design: An observational, longitudinal, multicenter cohort study from Italy.

Methods: Consecutive 983 PWH were enrolled in "STOP Smoking in HIV people" (STOPSHIV) projects and followed from July 2014 until September 2023. The observed MCE defined as cardiovascular events, neoplastic diseases, or death for any reason was assessed according to smoking status and related variables (number of cigarettes smoked daily, pack-years, Fagerström test) in participants. The association between exposure variables and the event was evaluated using the Cox proportional hazard model [hazard ratios, and 95% confidence interval (95% CI)].

Results: Over 6997.6 person-years of follow-up (PYFU), we found a total of 49 cardiovascular events, 61 neoplastic events, and 47 deaths. The overall incidence rate of MCE was 17.6 /1000 PYFU (95% CI 14.7-21.0). All-cause death rate was 6.7 (95% CI 5.0-8.9)/1000 PYFU. In a multivariate analysis, older age (hazard ratio 1.07, CI 1.05-1.09), high Fagerström Test for Nicotine Dependence (hazard ratio 1.09, CI 1.03-1.15), a low nadir CD4 + cell count less than 200 cells/μl (hazard ratio 1.63, CI 1.10-1.41), history of previous neoplasm (hazard ratio 2.41; CI 1.34-4.43), and IDU as a risk factor for HIV infection (hazard ratio 2.36; CI 1.52-3.68) were independent predictors of any MCE.

Conclusion: Non-AIDS clinical conditions are the most observed clinical events in PWH from Italy. Smoking exposure significantly increases the risk of MCE in PWH, and a high Fagerström Test for Nicotine Dependence is a predictor of MCE.

Objectives: To understand the extent of racial disparities in SARS-CoV-2 vaccination among PWH and those vulnerable to HIV infection and to estimate the contributions of medical mistrust and vaccine-hesitant attitudes to these disparities.

Design: Quantitative data analyses in a racially and gender-diverse, mixed-serostatus prospective cohort, the Multicenter AIDS Cohort Study (MACS)/Women's Interagency HIV Study (WIHS) Combined Cohort Study.

Methods: Interviewer-assisted questionnaires assessed SARS-CoV-2 vaccination, medical mistrust, and vaccine-hesitant attitudes from March 2021 to September 2022 ( n  = 3948). Longitudinal analyses assessed effects of sociodemographics on medical mistrust and vaccine-hesitant attitudes. A hierarchical multivariable logistic regression assessed effects of these co-factors on SARS-CoV-2 vaccination. Causal mediation models assessed whether medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, and vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 nonvaccination.

Results: Participants' mean age was 56.7; 55.3% were Black, 52.6% cisgender female, 62.6% PWH. 10.1% reported never receiving SARS-CoV-2 vaccinations (13.4% of Black and 4.5% of White participants). Black-identified participants had higher odds of nonvaccination than White participants [aOR = 1.72; 95% confidence interval (CI) 1.08-2.72]. Medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, accounting for 46% of the effect ( P  < 0.0001). Vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 nonvaccination to the extent that 57.7% (95% CI 25.3-90.1%) of the disparity would be eliminated if vaccine-hesitant attitudes among Black respondents were reduced to levels reported among other racial groups.

Conclusion: Findings indicate a profound need to build trustworthy healthcare environments to combat medical mistrust and vaccine-hesitant attitudes in Black communities in the United States, including those affected by HIV.

Background: Frailty occurs at higher rates and younger ages among people with HIV (PWH) compared with the general population and is often attributed to chronic inflammation and subsequent immune exhaustion. We assessed how inflammatory biomarkers are associated with frailty among PWH.

Methods: The Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort is comprised of adult PWH in care at 10 sites, and harmonizes demographic, clinical, and patient-reported outcomes (PRO) data. A panel of 13 inflammatory biomarkers was collected from a subset of virally suppressed PWH once per person between 2010 and 2018. Frailty was measured with a validated PRO phenotype, scored 0-4, from biomarker collection date through July 2022. With adjusted linear mixed models, we estimated longitudinal associations between standard deviation-scaled log 2 -transformed biomarkers and frailty score.

Results: Among 273 PWH, most were men (91%), average age at baseline was 45, 42% were non-Hispanic White whereas 35% were non-Hispanic Black, and average follow-up time was 5.5 years. Several biomarkers were associated with higher frailty, including those linked to microbial translocation (sCD14, LBP, KT ratio) and systemic inflammation (CRP, IL-6, suPAR, sTNFR1, sTNFR2). Higher IL-6 was associated with a 0.25-point higher frailty score [95% confidence interval (CI) 0.12-0.39]. Higher sTNFR1 [0.35 (0.13-0.56)], sCD14 [0.21 (0.11-0.31)], and suPAR [0.24 (0.11-0.36)] levels were also associated with higher frailty scores over follow-up.

Conclusion: Higher levels of biomarkers linked to microbial translocation and systemic inflammation are associated with higher average frailty scores over time in a cohort of virally suppressed PWH, highlighting these pathways as potential interventional targets for mitigating frailty in PWH.

Background: Characterizing HIV clustering rates and their trends over time can improve understanding a local epidemic and enhance its control.

Methods: Leveraging an academic-public health partnership in Rhode Island, we explored longitudinal dynamics of statewide clustering rates among key populations from 1991 to 2023. Partial HIV-1 pol sequences were grouped by year of HIV-1 diagnosis. Molecular clusters were identified in cumulative annual phylogenies. Overall clustering rates, and clustering rates of newly diagnosed and prevalent infections, and of specific sociodemographic characteristics of key populations over time were determined. Mann-Kendall statistics were used to estimate clustering rate trends and relationships among groups.

Results: By the end of 2023, 2630 individuals with sequences represented the statewide epidemic in Rhode Island. Overall clustering rates increased from 7% in 1991 to 46% in 2023, correlating with cumulative sequence increase. Clustering rates of newly diagnosed and prevalent infections significantly increased over time, higher in newly diagnosed individuals since the early 2000s. Increases were also observed among groups defined by gender, age, transmission risks, race, mental illness, HIV-1 subtypes, and country of birth, with some crossovers and divergence patterns over time.

Conclusion: Exploring dynamics of HIV clustering rates over three decades in a statewide HIV-1 epidemic expanded its characterization and provided insight into its evolving changes. These dynamics may indicate a gradual shift towards a more concentrated and localized HIV-1 epidemic, highlighting important opportunities for targeted interventions to effectively prevent new HIV transmissions.

A segment of people with HIV on effective antiretroviral therapy (ART) continue to experience poor immune recovery, leaving them at heightened risk of non-AIDS-defining events (NAEs). The production of anti-CD4 IgG autoreactive antibodies is suggested as one contributing mechanism to these complications. Here, we found that plasma anti-CD4 levels do not discriminate immunological responders from nonresponders nor predict the occurrence of NAEs, suggesting it is unlikely a contributing immunopathological factor associated with these complications.

Objective: To evaluate the association between increased epicardial fat thickness (EFT) and liver stiffness measurement (LSM), as assessed by elastography in people with human immunodeficiency virus type 1 (HIV-1) infection (PWH).

Methods: Ninety-one PWH on effective antiretroviral treatment (ART) were enrolled. EFT was measured by transthoracic echocardiography. Liver steatosis was evaluated by ultrasound Hamaguchi criteria and LSM by elastography with acoustic radiation force impulse (ARFI) technique. LSM ≥8 kPa was suggestive of clinically relevant fibrosis.

Results: Mean age was 54.3 years and 27.5% were women. EFT correlated with HIV-1 infection duration (rS 0.252, P  = 0.016), age at study entry (rS 0.527, P  < 0.001), BMI (rS 0.363, P  < 0.001), waist circumference (rS 0.549, P  < 0.001), HDL (rS -0.391, P  < 0.001), triglycerides (rS 0.375, P  < 0.001), Hamaguchi score (rS 0.279, P  = 0.007), right lobe of the liver (rS 0.259, P  = 0.014), left ventricular mass/body surface area (rS 0.220, P  = 0.036).A LSM ≥8 kPa was found in 20.9% of PWH, more commonly in those with EFT above the median >5.6 mm (30.4% vs. 11.1%, P  = 0.038). LSM significantly correlated with EFT (rS 0.274, P  = 0.009), CD4 + cells (rS -0.320, P  = 0.003) and nadir of CD4 + cells (rS -0.292, P  = 0.007).In a subgroup ( n  = 53), a homeostasis model assessment of insulin resistance (HOMA-IR) index >2.33 identified increased EFT, [area under the curve (AUC) 0.73, 95% confidence interval (CI) 0.59-0.84, P  = 0.001) while an HOMA-IR >3.27 predicted increased LSM (AUC 0.76, 95% CI 0.62-0.87, P  = 0.005).

Conclusions: PWH with increased EFT have worse metabolic profile and a high proportion of clinically relevant fibrosis at ARFI elastography, despite normal liver function tests. The HOMA-IR index might be used to identify PWH with increased EFT and liver fibrosis.

Background: People with HIV (PWH) are at an increased risk of tuberculosis (TB). New TB vaccines may help reduce this burden. New TB vaccine candidates are well tolerated and immunogenic in PWH. There are currently limited data on vaccine efficacy in this population.

Methods: Using mathematical modeling, we explored the potential impact of a novel TB vaccine on TB burden in PWH in South Africa between 2030 and 2050. We compared the impact of a vaccine delivered irrespective of HIV status to vaccination of either PWH or people without HIV. We explored the impact of reduced vaccine efficacy and duration of protection in PWH relative to people without HIV on our model predictions.

Results: Vaccination irrespective of HIV status, with a vaccine with equal efficacy and duration in PWH, could avert up to 1.01 (95% range: 0.96-1.22) million TB cases in PWH. Restricting vaccination to PWH or people without HIV would achieve 65% (60-70) and 48% (46-53) of the total impact, respectively. These results are strongly dependent on the assumed efficacy and duration of protection in PWH. Further information on these characteristics is important to identify the most efficient use of new vaccines to reduce TB burden in PWH.

Conclusion: Our results suggest that new vaccines could play an important role in reducing the TB burden in PWH. Vaccines targeted at people without HIV could provide significant indirect benefit to PWH, but vaccines which are well tolerated and effective in PWH will be critical to maximizing the impact in this population.