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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.

Objective: To compare dementia incidence and prevalence by HIV status, race/ethnicity, and sex.

Design: Retrospective cohort, 2000-2023.

Methods: Adults with HIV aged ≥50 years and 1:20 matched individuals without HIV from Kaiser Permanente, a U.S. healthcare system, were included. Dementia diagnoses were identified via electronic health records. We estimated rates of incident dementia diagnoses and prevalence, overall and by time period (2000-2004, 2005-2009…2020-2023) using Poisson regression, and assessed trends using Joinpoint regression. Covariate-adjusted rate ratios compared dementia by HIV status, with sub-analyses stratified by race/ethnicity and sex.

Results: Among 24,762 people with HIV and 494,963 people without HIV (86.9% men, 45.5% White, 23.1% Black, 20.3% Hispanic), incident dementia diagnoses declined from 2000-2023 in both people with and without HIV (-7.68% and -2.70% per period, respectively). Overall, the incidence of dementia diagnosis was higher in people with HIV (adjusted incidence rate ratio [aIRR]=1.72, 95% CI=1.59-1.85). In the most recent period (2020-2023), this difference was not statistically significant (aIRR=1.16, 95% CI=0.99-1.35), partly due to increases in diagnoses among people without HIV during this period. Dementia prevalence remained higher in people with HIV, overall (adjusted prevalence ratio [aPR]=1.71, 95% CI=1.61-1.82) and in 2020-2023 (aPR=1.59, 95% CI=1.46-1.73), with similar patterns by race/ethnicity and sex.

Conclusions: Incident dementia diagnoses have declined in people with HIV and are approaching those of people without HIV, with consistent trends across demographic subgroups. However, prevalence remains elevated, likely reflecting excess risk from earlier years. These findings highlight the need for sustained attention to cognitive health and the integration of dementia-related services in HIV care.

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: 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.

Objective: Government-imposed physical distancing restrictions during the COVID-19 pandemic disrupted biobehavioral HIV prevention practices and access to healthcare services. This study aimed to use a mathematical model to evaluate the impact of COVID-19 on the HIV epidemic among MSM in Australia, using empirical data.

Design: A retrospective modeling study.

Methods: We developed a mathematical model to estimate monthly HIV incidence between January 2020 and August 2022. We obtained aggregated monthly data for sexual partners, condom use, HIV testing, preexposure prophylaxis (PrEP) use, and migration. Three scenarios were simulated: a COVID-19 scenario; a no COVID-19 scenario where input parameters remained at pre-COVID-19 values; and a no COVID-19 scenario with continued PrEP scale-up.

Results: In the absence of the COVID-19 pandemic, 1263 (95% percentile interval: 880-1706) infections would have occurred between January 2020 and August 2022 compared to 915 (95% percentile interval: 638-1282) for the COVID-19 scenario (a 27.6% reduction). Reduced sexual partners was the leading factor contributing to the change in HIV infections and diagnoses (-24.9 and -10.6%, respectively). MSM aged at least 50 years had a larger reduction (31.0%) in new HIV infections than their younger counterparts (19.9%).

Conclusion: A substantial reduction in new HIV infections and diagnoses in Australia occurred during the COVID-19 pandemic, largely due to decreased numbers of sexual partners. This reduction underscores the need for sustained public health strategies leveraging reduced transmission rates to continue progress toward eliminating HIV in Australia.

Background: Despite effective antiretroviral therapy (ART), residual low-level HIV viremia may persist. Integrase inhibitor (INSTI)-based regimens have become preferred treatments, but their impact on controlling residual viral replication remains unclear.

Objective: To evaluate the impact of integrase inhibitor-based regimens on achieving target not detected (TND) rates compared to other antiretroviral strategies.

Methods: This retrospective cohort study assessed 131 virologically suppressed people with HIV (PWH) categorized into four treatment groups: Group 1, treated with protease inhibitor or nonnucleoside reverse transcriptase inhibitor (NNRTI) based regimens ( n  = 30); Group 2, treated with INSTI-based regimens ( n  = 30); Group 3, initially treated with protease inhibitor/NNRTI regimens who switched to INSTI-based therapy ( n  = 26); and Group 4, initially treated with INSTI triple therapy who switched to dual therapy ( n  = 30). The primary endpoint was the proportion of "target not detected" (TND) HIV-1 RNA measurements.

Results: INSTI-based regimens showed significantly higher TND rates compared to PI/NNRTI-therapies (difference: 18.5%, P  < 0.001). Switching from PI/NNRTI to INSTI-based therapies increased TND rates from 52.6 to 92%. Multivariate analysis identified shorter time to viral suppression and absence of HCV co-infection as factors associated with higher TND rates. No significant differences were observed when switching from INSTI-based triple therapy to INSTI-based dual therapy.

Conclusion: INSTI-based regimens, whether triple or dual therapy, achieve better control of residual viremia compared to other treatment strategies. This improved virological control was maintained during follow-up and was independent of the number of drugs.

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.