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Objectives: We described and compared infectious-cause hospitalisation outcomes among children born without HIV in the Western Cape (WC), South Africa, during the WHO Option B+ (2013-2015) and universal ART (2016-2018) eras by exposure to maternal HIV and ART.

Design: Retrospective cohort.

Methods: Using data from the WC Provincial Health Data Centre, we described rates, causes and risk factors of infectious-cause hospitalisations, up to age 3 years, among children born at a public WC health facility. We compared rates of and risk factors for admission, in children exposed to maternal HIV and uninfected (HEU) and children HIV unexposed and uninfected (HUU), in the neonatal, post-neonatal (age >28 days to ≤12 months), and age >12-36 month periods using mixed-effects Poisson regression. Regression models were adjusted for maternal age and suburb of residence.

Results: We included 398,334 mother-child pairs, 17.2% children HEU and 82.8% HUU. Infectious-cause hospitalisation, between birth and age 3 years, occurred in 11.5% vs. 10.9% of children HEU and HUU respectively. Children HEU experienced higher rates of hospitalisation than children HUU, irrespective of maternal ART history, during the neonatal period (adjusted incidence rate ratios, aIRRs: 1.34-1.66) and post-neonatal period (aIRRs: 1.13-1.42), but not during the >12-36 month period. Among children HEU, maternal VL ≥1000/mL vs. <1000/mL during pregnancy was associated with higher admission rates during the post-neonatal period (aIRR = 1.15; 95% CI:1.06-1.25).

Conclusions: Irrespective of timing of maternal ART start, children HEU vs. HUU had higher rates of infectious-cause hospitalisation during the first year of life, but not thereafter.

Objectives: People with HIV (PWH) are unable to get private disability insurance on a regular basis in contrast with individuals with other chronic diseases. We aimed to estimate the risk of public disability pension and work absence due to sickness for PWH compared with the background population in Denmark.

Design: Nationwide, population-based, matched cohort study of employed PWH with favorable disease characteristics. A comparison cohort of employed individuals was matched 10:1 to PWH by date of birth and sex from the general population.

Methods: We computed time to first date of 4 weeks of uninterrupted sick leave, 26 weeks of uninterrupted sick leave, and disability pension being granted. We used Cox regression to obtain hazard ratios (HRs) as a measure of relative risk and competing risk analysis to assess absolute risk.

Results: After 6 months of observation, PWH had an increased risk of 4-week sick leave, 26-week sick leave and disability pension compared with the comparison cohort (HR of 1.1 (95% CI: 1.0-1.2), 1.4 (95% CI: 1.1-1.6) and 2.0 (95% CI: 1.5-2.6), respectively). These risks were increased in most patient subgroups.

Conclusion: PWH have an increased risk of prolonged sick leave and disability pension, and a slightly increased risk of 4-week sick leave. These risks were within the range of what is described for other chronic diseases. PWH with contemporary cART and favorable disease characteristics should not be generally excluded from access to private disability insurance.

We assessed integrase resistance in 837 treatment-experienced people with HIV (PWH) with virological failure (2022-2024) in Portugal. Major resistance mutations were found in 5.5%, with N155H and R263K being the most common. Resistance was more frequent in non-B subtypes and often co-occurred with resistance to other antiretroviral classes. Though prevalence remains low, the findings highlight the need for continued surveillance to inform treatment decisions, especially as integrase inhibitors like dolutegravir, bictegravir and cabotegravir become more widely used.

Antiretroviral therapy (ART) effectively controls HIV replication but adherence in infants and children remains a challenge. This study analyzed broadly neutralizing antibody (bNAb) resistance in viral isolates from perinatally infected infants from Mozambique. We found high intra-individual bNAb resistance heterogeneity, unrelated to viral burden, and evidence for early or preexisting resistance. These findings underscore the importance of individualized resistance screening and reinforce the need for accessible, adherence-supportive ART strategies in pediatric HIV.

Background: Social determinants of health (SDoH) impact health outcomes and rarely exert their influence in isolation. We examined associations between SDoH patterns, multimorbidity and quality of life (QoL) in people of Black ethnicities with HIV in England.

Methods: This mixed-methods study comprised questionnaires, focus group discussions and semi-structured interviews with staff members from a community-based organization. We used principal component analysis to identify patterns of SDoH and z scores to describe the burden of each pattern. Associations between SDoH burden scores, multimorbidity and QoL (EQ-5D) were assessed using logistic regression, adjusting for sex and age.

Results: Amongst 340 participants [median (interquartile range, IQR) age 52 (45-57) years, 54% women, 95% HIV RNA <200 copies/ml], we identified three SDoH patterns: livelihood (food, employment and financial insecurity, loneliness and isolation), shelter/displacement (housing, migration and food insecurity) and social exclusion (discrimination, loneliness and isolation). An increase in SDoH z scores was associated with higher odds of multimorbidity [livelihood: adjusted odds ratio (aOR) 2.09 (1.63-2.69), shelter/displacement: 1.41 (1.12-1.78), social exclusion: 1.78 (1.40-2.26)]. Higher livelihood and social exclusion z scores correlated with all QoL domains ( P  < 0.001), and shelter/displacement was associated with problems with usual activity [aOR 1.29 (1.04-1.61), P  = 0.02] and pain/discomfort [1.29 (1.05-1.58), P  = 0.02]. Qualitative findings supported the quantitative findings whilst providing further context on how SDoH intersect and shape health.

Conclusion: This study highlights how SDoH intersect and are associated with multimorbidity and lower QoL in people of Black ethnicities living with HIV. These findings emphasize the need for comprehensive, biopsychosocial interventions to address health inequities in this population.

Objective: France provides universal health coverage to all residents, including undocumented migrants. Most transgender women with HIV (TWH) in France are migrants from Latin America. This study aimed to describe the rate of viral suppression among TWH in France and identify structural factors influencing this outcome.

Design: Trans&HIV is a French, nationwide, cross-sectional, retrospective life-event survey and community-based research study conducted between August 2020 and June 2022. Community-based interviewers recruited and administered questionnaires to 536 TWH in 36 different HIV care units.

Methods: We calculated the rate of viral suppression in TWH on antiretroviral therapy (ART) for at least 1 year using data from medical records, and identified associated structural factors, adjusting for clinical factors, using Firth's penalized logistic regression.

Results: Of the 506 participants with complete data, 86% were non-French nationals, most (83%) were born in Latin America. Thirty percent of participants were undocumented and 75% did not have gender-concordant identity documents. Eighty-eight percent ( N  = 486) had achieved viral suppression. After adjustment for clinical factors, structural factors negatively associated with viral suppression included a lack of healthcare coverage [aOR = 3.32, 95% confidence interval (95% CI) 1.23-8.66] and not having gender-concordant identity documents [aOR = 2.05, 95% CI (1.00-4.64)]. TWH receiving state medical assistance for undocumented migrants had similar viral suppression levels to those with general public health insurance.

Conclusion: Although TWH in France have a high rate of viral suppression, barriers to comprehensive health and social inclusion persist, particularly access to healthcare coverage and legal recognition of their self-identified gender. Addressing these structural obstacles through inclusive policies is essential to improve health outcomes for this population.

Objective: Dyslipidemia is common in severe infections, but its role in patients with HIV and talaromycosis (PWHT) remains unclear.

Design and methods: Three hundred and eighty-seven PWHT were enrolled in present study. Furthermore, 267 of 387 PWHT, 267 people with HIV but without talaromycosis (PWH), and 267 healthy controls were selected to compare the lipid profiles by propensity score matching (PSM) method on sex, age, body mass index (BMI), comorbidities and hepatitis B virus (HBV) infection.

Results: PWHT showed significantly lower total cholesterol [2.9 (2.2-3.5) vs. 3.5 (2.9-4.0) vs. 4.6 (4.0-5.2) mmol/l, P  < 0.001], LDL [1.5 (0.9-2.0) vs. 1.9 (1.5-2.4) vs. 2.5 (2.1-3.1) mmol/l, P  < 0.001] and HDL [0.5 (0.3-0.7) vs. 0.7 (0.6-0.9) vs. 1.2 (1.0-1.4) mmol/l, P  < 0.001], but higher triglycerides [1.6 (1.2-2.0) vs. 1.3 (1.0-1.7) vs. 1.2 (0.9-1.7) mmol/l, P  < 0.001] than PWH and healthy controls at admission. Multivariate Cox analysis identified triglycerides at least 2 mmol/l [adjusted odds ratio (AOR) (95% confidential interval, CI): 2.5 (1.3-4.7), P  = 0.005], HDL less than 0.3 mmol/l [AOR:2.7 (1.4-5.3), P  = 0.004], age at least 35 years [AOR:3.2 (1.6-6.4), P  = 0.001], BMI less than 18.0 kg/m 2 [AOR:2.0 (1.0-3.8), P  = 0.036), WBC at least 5 × 10 9 /l [AOR:2.4 (1.3-4.6), P  = 0.006], albumin less than 27 g/l [AOR: 2.7 (1.2-6.3), P  = 0.018], and nonamphotericin B therapy [AOR: 2.2 (1.1-4.5), P  = 0.028] as independent mortality risk factors. The 30-day overall mortality was higher in patients with triglycerides at least 2 mmol/l (24.0 vs. 7.6%, Log-rank P  < 0.001) or HDL less than 0.3 mmol/l (27.1 vs. 6.5%, Log-rank P < 0.001) among PWHT.

Conclusion: PWHT exhibited distinct dyslipidemia patterns from PWH and healthy control. Elevated triglycerides and reduced HDL independently predicted poor outcomes of PWHT.

Objective: Food insecurity is a risk factor for metabolic dysfunction-associated steatotic liver disease in the general population. However, little is known about the impact of food insecurity on hepatic steatosis among women with HIV (WWH) and women without HIV (WWOH).

Design: We assessed hepatic steatosis by controlled attenuated parameter (CAP) in decibels/meter (dB/m) and food security status using the U.S. Household Food Security Survey in women without viral hepatitis. Women were categorized as being food secure vs. food insecure.

Methods: We performed multivariable linear regression analyses to examine the association of food security status with hepatic steatosis.

Results: Among 1473 women (1064 WWH, 409 WWOH), 20% reported food insecurity. Food insecurity was associated with lower CAP after adjustment for age, race-ethnicity, income, alcohol intake, BMI, insulin resistance, and HIV [CAP difference: -8.6 dB/m, 95% confidence interval (95% CI): -16.7 to -0.5, P  = 0.037]. Each 5 kg/m 2 BMI increase was associated with an 18.4 dB/m CAP increase (95% CI: 16.4-20.3, P  < 0.001); there was no association of HIV serostatus with steatosis. Additionally, there was a significant interaction between food insecurity and BMI: among women experiencing food insecurity, for every 5 kg/m 2 BMI increase, CAP decreased by 6.6 dB/m (95% CI: -12.2 to -1.1, P  = 0.02).

Conclusion: Food insecurity is prevalent in WWH and, unexpectedly, is associated with less steatosis, in contrast with findings observed in the general population. Additionally, while obesity remains a strong driver of steatosis, food insecurity attenuates the association of BMI with steatosis, particularly at higher BMIs. This study lays the groundwork for future efforts exploring potential mechanistic pathways.

Africa is home to the majority of people with HIV (PWH) worldwide. Improved availability and access to antiretroviral treatment (ART) has improved survival, resulting in an ageing population now facing long-term HIV-associated morbidity, including musculoskeletal conditions. There is growing evidence on the impact of chronic HIV infection and ART on muscle and bone health. Musculoskeletal complications among PWH increase the risk of injury, disability, pain, reduces quality of life, and incurs substantive healthcare and economic costs. This review discusses mechanisms by which HIV may affect bone and muscle, including direct cellular stress, indirect chronic inflammation, immunosenescence and hormonal dysregulation, as well as ART-related effects. It appraises evidence for bone and muscle health among PWH across different age groups and populations in Africa. Potential interventions such as improved nutrition, physical activity, vitamin D and calcium supplementation, and use of bisphosphonates to attenuate musculoskeletal morbidity are discussed. Musculoskeletal health services need to be integrated into core HIV-care services. Routine fracture risk assessments and robust preventive management strategies should become the norm, to reduce musculoskeletal morbidity among PWH in Africa.

Objective: Lopinavir/ritonavir (LPV/r) remains a much used drug combination for treatment of children with HIV, but pharmacokinetic data when the adult formulation (LPV/r 200/50 mg) is used for children weighing 25-34.9 kg, or when combined with tenofovir alafenamide/emtricitabine (TAF/FTC), is currently lacking.

Design: We aim to provide this data by an intensive LPV/r pharmacokinetic sub-study nested within the CHAPAS-4 trial (#ISRCTN22964075).

Methods: Children (3-15 years), weighing 14-24.9 kg received 200/50 mg LPV/r orally twice daily; those weighing 25-34.9 kg received 400/100 mg LPV/r in the morning and 200/50 mg in the evening; and those weighing at least 35 kg received 400/100 mg LPV/r twice daily. LPV/r was used in combination with either TAF/FTC or standard-of-care backbone (abacavir/lamivudine or zidovudine/lamivudine). Pharmacokinetic parameters were compared to those reported in children receiving WHO-recommended dosages.

Results: We enrolled 40 children from Uganda, Zambia, and Zimbabwe. The geometric mean area under the concentration-time curve (AUC 0-12h ) for LPV was 116.2 h mg/l [coefficient of variation (CV%), 37%], comparable to children receiving WHO-recommended dosages. The geometric mean trough concentration was 7.7 mg/l (52%), 57% higher than the reference value of 4.9 mg/l (95% confidence interval, 4.14-5.80), mainly caused by higher exposure in children 25-34.9 kg. There were no differences in LPV AUC 0-12h or Ctrough between backbones.

Conclusion: Children (3-15 years), weighing at least 14 kg and taking LPV/r in second-line treatment achieve adequate exposure of LPV within limits reported to be safe and well tolerated. These data support the use of a LPV/r-based regimen and the adult formulation of 200/50 mg in children 25-34.9 kg.