Pub Date : 2024-10-01Epub Date: 2024-06-20DOI: 10.1097/QAD.0000000000003965
Samuel C Russo, Mollie W Ockene, Allison K Arpante, Julia E Johnson, Hang Lee, Mabel Toribio, Takara L Stanley, Colleen M Hadigan, Steven K Grinspoon, Kristine M Erlandson, Lindsay T Fourman
Objective: Tesamorelin is the only FDA-approved therapy to treat abdominal fat accumulation in people with HIV (PWH). Phase III clinical trials were conducted prior to the introduction of integrase inhibitors (INSTIs), which are now a mainstay of HIV antiretroviral therapy.
Design: We leveraged a randomized double-blind trial of 61 PWH and metabolic dysfunction-associated steatotic liver disease to evaluate the efficacy and safety of tesamorelin 2 mg once daily vs. identical placebo among participants on INSTI-based regimens at baseline.
Methods: In the parent clinical trial, visceral fat cross-sectional area, hepatic fat fraction, and trunk-to-appendicular fat ratio were quantified using magnetic resonance imaging, proton magnetic resonance spectroscopy, and dual-energy x-ray absorptiometry, respectively, at baseline and 12 months. Metabolic and safety outcomes were compared between treatment arms.
Results: Among 38 participants on INSTI-based regimens at baseline, 15 individuals on tesamorelin and 16 individuals on placebo completed the 12-month study. Tesamorelin led to significant declines in visceral fat (median [interquartile range]: -25 [-93, -2] vs. 14 [3, 41] cm 2 , P = 0.001), hepatic fat (-4.2% [-12.3%, -2.7%] vs. -0.5% [-3.9%, 2.7%], P = 0.01), and trunk-to-appendicular fat ratio (-0.1 [-0.3, 0.0] vs. 0.0 [-0.1, 0.1], P = 0.03). Tesamorelin was well tolerated with a similar frequency of adverse events, including hyperglycemia, between groups.
Conclusions: The current analysis provides the first dedicated data on the efficacy and safety of tesamorelin among PWH on INSTI-based regimens. Despite the association of INSTI use with weight gain and adipose tissue dysfunction, tesamorelin had beneficial effects on body composition with no exacerbation of glycemic control.
{"title":"Efficacy and safety of tesamorelin in people with HIV on integrase inhibitors.","authors":"Samuel C Russo, Mollie W Ockene, Allison K Arpante, Julia E Johnson, Hang Lee, Mabel Toribio, Takara L Stanley, Colleen M Hadigan, Steven K Grinspoon, Kristine M Erlandson, Lindsay T Fourman","doi":"10.1097/QAD.0000000000003965","DOIUrl":"10.1097/QAD.0000000000003965","url":null,"abstract":"<p><strong>Objective: </strong>Tesamorelin is the only FDA-approved therapy to treat abdominal fat accumulation in people with HIV (PWH). Phase III clinical trials were conducted prior to the introduction of integrase inhibitors (INSTIs), which are now a mainstay of HIV antiretroviral therapy.</p><p><strong>Design: </strong>We leveraged a randomized double-blind trial of 61 PWH and metabolic dysfunction-associated steatotic liver disease to evaluate the efficacy and safety of tesamorelin 2 mg once daily vs. identical placebo among participants on INSTI-based regimens at baseline.</p><p><strong>Methods: </strong>In the parent clinical trial, visceral fat cross-sectional area, hepatic fat fraction, and trunk-to-appendicular fat ratio were quantified using magnetic resonance imaging, proton magnetic resonance spectroscopy, and dual-energy x-ray absorptiometry, respectively, at baseline and 12 months. Metabolic and safety outcomes were compared between treatment arms.</p><p><strong>Results: </strong>Among 38 participants on INSTI-based regimens at baseline, 15 individuals on tesamorelin and 16 individuals on placebo completed the 12-month study. Tesamorelin led to significant declines in visceral fat (median [interquartile range]: -25 [-93, -2] vs. 14 [3, 41] cm 2 , P = 0.001), hepatic fat (-4.2% [-12.3%, -2.7%] vs. -0.5% [-3.9%, 2.7%], P = 0.01), and trunk-to-appendicular fat ratio (-0.1 [-0.3, 0.0] vs. 0.0 [-0.1, 0.1], P = 0.03). Tesamorelin was well tolerated with a similar frequency of adverse events, including hyperglycemia, between groups.</p><p><strong>Conclusions: </strong>The current analysis provides the first dedicated data on the efficacy and safety of tesamorelin among PWH on INSTI-based regimens. Despite the association of INSTI use with weight gain and adipose tissue dysfunction, tesamorelin had beneficial effects on body composition with no exacerbation of glycemic control.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-07-17DOI: 10.1097/QAD.0000000000003979
Cassandra R Duffy, Julie M Herlihy, Ethan Zulu, Lawrence Mwananyanda, Leah Forman, Tim Heeren, Christopher J Gill, Megan Harper, Roma Chilengi, Roy Chavuma, Barbara Payne-Lohman, Donald M Thea
Objective: To examine the risk of preterm birth (PTB) and small for gestational age (SGA) among women with HIV compared to women without HIV. Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes.
Design: Prospective observational cohort.
Setting: Urban government-run clinic at Chawama Hospital in Lusaka, Zambia.
Participants: A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating.
Methods: From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. The independent role of IA was determined by mediation analysis.
Main outcome measures: PTB (<37 weeks) and SGA.
Results: There were 38 fetal deaths and 1230 singleton live births. Maternal HIV infection was associated with PTB [adjusted odds ratio (AOR) 1.60, 95% confidence interval (CI) 1.11-2.32] and to a lesser extent SGA (AOR 1.29, 95% CI 0.98-1.70). Maternal cART timing impacted these associations, with highest risk in women who started cART after conception (PTB AOR 1.77, 95% CI 1.09-2.87, SGA AOR 1.52, 95% CI 1.04-2.22). Maternal IA was not associated with PTB independent of HIV infection.
Conclusions: HIV is associated with PTB. Risk of PTB and SGA was highest in women with HIV who started cART in pregnancy, a modifiable risk factor.
目的与未感染艾滋病病毒的妇女相比,研究感染艾滋病病毒的妇女早产(PTB)和胎龄小(SGA)的风险。次要目标是探讨母体免疫激活(IA)的作用以及 cART 时间对这些结果的影响:设计:前瞻性观察队列:地点:赞比亚卢萨卡 Chawama 医院由政府运营的城市诊所:1481名感染和未感染艾滋病毒的单胎妊娠妇女在妊娠26周前通过超声波测孕登记:方法:2019 年 8 月至 2022 年 11 月,按照 1:1 的 HIV 感染比例招募孕妇。收集了母体基线临床因素,以及感染 HIV 妇女的 CD4、病毒载量和 CD8 T 细胞 IA。此外,还收集了分娩结果。通过多变量逻辑回归评估了 HIV 暴露和 cART 时间与预后的关系。通过中介分析确定IA的独立作用:PTB(结果:38例胎儿死亡,1230例单胎活产。母体艾滋病病毒感染与 PTB 相关(AOR 1.60,95%CI 1.11-2.32),其次与 SGA 相关(AOR 1.29,0.98-1.70)。孕产妇开始 cART 的时间对这些相关性有影响,受孕后开始 cART 的妇女风险最高(PTB AOR 1.77,95%CI 1.09-2.87;SGA AOR 1.52,95%CI 1.04-2.22)。产妇 IA 与 PTB 无关,与 HIV 感染无关:结论:HIV 与 PTB 相关。在妊娠期开始接受 cART 治疗的女性艾滋病毒感染者中,PTB 和 SGA 的风险最高,这是一个可改变的风险因素。
{"title":"Preterm birth among women with HIV: impact of preconception cART initiation.","authors":"Cassandra R Duffy, Julie M Herlihy, Ethan Zulu, Lawrence Mwananyanda, Leah Forman, Tim Heeren, Christopher J Gill, Megan Harper, Roma Chilengi, Roy Chavuma, Barbara Payne-Lohman, Donald M Thea","doi":"10.1097/QAD.0000000000003979","DOIUrl":"10.1097/QAD.0000000000003979","url":null,"abstract":"<p><strong>Objective: </strong>To examine the risk of preterm birth (PTB) and small for gestational age (SGA) among women with HIV compared to women without HIV. Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes.</p><p><strong>Design: </strong>Prospective observational cohort.</p><p><strong>Setting: </strong>Urban government-run clinic at Chawama Hospital in Lusaka, Zambia.</p><p><strong>Participants: </strong>A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating.</p><p><strong>Methods: </strong>From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. The independent role of IA was determined by mediation analysis.</p><p><strong>Main outcome measures: </strong>PTB (<37 weeks) and SGA.</p><p><strong>Results: </strong>There were 38 fetal deaths and 1230 singleton live births. Maternal HIV infection was associated with PTB [adjusted odds ratio (AOR) 1.60, 95% confidence interval (CI) 1.11-2.32] and to a lesser extent SGA (AOR 1.29, 95% CI 0.98-1.70). Maternal cART timing impacted these associations, with highest risk in women who started cART after conception (PTB AOR 1.77, 95% CI 1.09-2.87, SGA AOR 1.52, 95% CI 1.04-2.22). Maternal IA was not associated with PTB independent of HIV infection.</p><p><strong>Conclusions: </strong>HIV is associated with PTB. Risk of PTB and SGA was highest in women with HIV who started cART in pregnancy, a modifiable risk factor.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11356690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141625710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1097/qad.0000000000004011
Maitreyi Sahu,Torin Schaafsma,Adam A Szpiro,Heidi Van Rooyen,Stephen Asiimwe,Maryam Shahmanesh,Meighan L Krows,Nsika Sithole,Alastair Van Heerden,Ruanne V Barnabas,
OBJECTIVEEvaluate the clinical utility of patient-collected dried blood spots (DBS) in measuring HIV-1 viral load (VL) for monitoring antiretroviral therapy (ART) compared to provider-collected DBS and blood plasma.DESIGNIn a randomized trial of community-based delivery of ART in South Africa, we assessed performance of: (1) DBS specimens compared to plasma, and (2) participant-collected versus staff-collected DBS specimens, to measure HIV-1 VL.METHODSThe bioMérieux NucliSENS EasyQ HIV-1 v2.0 assay was used for VL measurement. From October 2017 to November 2019, we collected 996 pairs of plasma/DBS specimens from 760 participants and 315 pairs of staff-/participant-collected DBS cards from 261 participants. We assessed DBS test sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using the WHO failure threshold of 1000 copies/mL. Log-transformed VL was compared using concordance correlation coefficients (CCC) and mean differences from linear mixed models.RESULTSIn a population with 13% detectable VL, DBS VL compared with plasma VL had 91% (95% CI: 86-95) sensitivity, 99% (98-100) specificity, 94% (90-98) PPV, and 99% (98-99) NPV. We observed high agreement between staff-collected DBS VL and plasma VL (CCC: 0.94), and between participant-collected DBS VL and plasma VL (CCC: 0.92). Correlation between participant- and staff-collected DBS was very high (CCC: 0.97; mean difference for those with a detectable result: -0.10 log10 copies/mL [-0.21-0.02]).CONCLUSIONSVL results from participant-collected DBS are clinically comparable with those collected by clinical staff and using blood plasma. Self-collected DBS has potential for use for ART monitoring outside the clinic.
{"title":"Performance of patient-collected dried blood spot specimens for HIV-1 viral load testing: evidence from the DO ART Study in South Africa.","authors":"Maitreyi Sahu,Torin Schaafsma,Adam A Szpiro,Heidi Van Rooyen,Stephen Asiimwe,Maryam Shahmanesh,Meighan L Krows,Nsika Sithole,Alastair Van Heerden,Ruanne V Barnabas,","doi":"10.1097/qad.0000000000004011","DOIUrl":"https://doi.org/10.1097/qad.0000000000004011","url":null,"abstract":"OBJECTIVEEvaluate the clinical utility of patient-collected dried blood spots (DBS) in measuring HIV-1 viral load (VL) for monitoring antiretroviral therapy (ART) compared to provider-collected DBS and blood plasma.DESIGNIn a randomized trial of community-based delivery of ART in South Africa, we assessed performance of: (1) DBS specimens compared to plasma, and (2) participant-collected versus staff-collected DBS specimens, to measure HIV-1 VL.METHODSThe bioMérieux NucliSENS EasyQ HIV-1 v2.0 assay was used for VL measurement. From October 2017 to November 2019, we collected 996 pairs of plasma/DBS specimens from 760 participants and 315 pairs of staff-/participant-collected DBS cards from 261 participants. We assessed DBS test sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using the WHO failure threshold of 1000 copies/mL. Log-transformed VL was compared using concordance correlation coefficients (CCC) and mean differences from linear mixed models.RESULTSIn a population with 13% detectable VL, DBS VL compared with plasma VL had 91% (95% CI: 86-95) sensitivity, 99% (98-100) specificity, 94% (90-98) PPV, and 99% (98-99) NPV. We observed high agreement between staff-collected DBS VL and plasma VL (CCC: 0.94), and between participant-collected DBS VL and plasma VL (CCC: 0.92). Correlation between participant- and staff-collected DBS was very high (CCC: 0.97; mean difference for those with a detectable result: -0.10 log10 copies/mL [-0.21-0.02]).CONCLUSIONSVL results from participant-collected DBS are clinically comparable with those collected by clinical staff and using blood plasma. Self-collected DBS has potential for use for ART monitoring outside the clinic.","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1097/qad.0000000000004012
Mark H Kuniholm,Gad Murenzi,Fabienne Shumbusho,Ellen Brazier,Marie K Plaisy,Ephrem Mensah,Gilles Wandeler,Carlotta Riebensahm,Belinda V Chihota,Niharika Samala,Lameck Diero,Aggrey S Semeere,Thida Chanyachukul,Rohidas Borse,Dung T H Nguyen,Hugo Perazzo,Alvaro Lopez-Iniguez,Jessica L Castilho,Fernanda Maruri,Antoine Jaquet
OBJECTIVETo understand the relationship between cardiovascular disease (CVD) risk and liver steatosis and fibrosis among people living with HIV (PLWH) ≥40 years on antiretroviral therapy (ART) in low- and middle-income countries (LMIC).DESIGNWe used cross-sectional behavioral and clinical data collected during study enrollment visits in 2020-2022 for the Sentinel Research Network of International epidemiology Databases to Evaluate AIDS (SRN of IeDEA).METHODSTen-year CVD risk was calculated using 2019 World Health Organization non-laboratory and laboratory models. Transient elastography (TE) was used to assess liver disease. Presence of steatosis and significant fibrosis were defined by Controlled Attenuation Parameter (CAP) ≥248 dB/m and liver stiffness measurement (LSM) ≥7.1 kPa, respectively. Participants with viral hepatitis, hazardous alcohol consumption and unsuppressed HIV viral load were excluded from the analysis. Logistic regression was used to estimate odds ratios, adjusting for study site, CD4 T cell count, stavudine and didanosine exposure, and in models stratified by sex and geographic region.RESULTSThere were 1,750 participants from nine LMIC. Median CVD risk was 3% for both non-laboratory and laboratory-based models. Adjusted odds ratios (ORs) for steatosis and significant fibrosis associated with laboratory CVD risk (≥10% vs. <5%) were OR = 1.83 (95% confidence interval:(CI) = 1.21-2.76; P = 0.004) and OR = 1.62 (95% CI = 0.85-3.07; P = 0.14), respectively. Associations of CVD risk with steatosis were stronger in males and among participants at study sites outside Africa.CONCLUSIONSHigher CVD risk was associated with steatosis but not with significant fibrosis in PLWH in our LMIC cohort.
目的了解中低收入国家(LMIC)中接受抗逆转录病毒疗法(ART)的≥40岁艾滋病病毒感染者(PLWH)的心血管疾病(CVD)风险与肝脏脂肪变性和纤维化之间的关系。设计我们使用了2020-2022年国际流行病学数据库评估艾滋病哨点研究网络(SRN of IeDEA)研究注册访问期间收集的横断面行为和临床数据。方法使用2019年世界卫生组织非实验室和实验室模型计算十年心血管疾病风险。瞬态弹性成像(TE)用于评估肝脏疾病。脂肪变性和明显纤维化的定义分别为可控衰减参数(CAP)≥248 dB/m和肝脏硬度测量值(LSM)≥7.1 kPa。分析中排除了患有病毒性肝炎、危险饮酒和艾滋病毒病毒载量未得到抑制的参与者。在按性别和地理区域分层的模型中,使用逻辑回归估算几率,并对研究地点、CD4 T细胞计数、司他夫定和地达诺辛暴露进行调整。非实验室模型和实验室模型的心血管疾病风险中位数均为 3%。脂肪变性和明显纤维化与实验室心血管疾病风险(≥10% vs. <5%)的调整后几率比(ORs)分别为 OR = 1.83(95% 置信区间:(CI) = 1.21-2.76;P = 0.004)和 OR = 1.62(95% 置信区间:(CI) = 0.85-3.07;P = 0.14)。结论在我们的低收入国家队列中,较高的心血管疾病风险与脂肪变性相关,但与明显的纤维化无关。
{"title":"Association of cardiovascular disease risk with liver steatosis and fibrosis in people living with hiv in low- and middle-income countries.","authors":"Mark H Kuniholm,Gad Murenzi,Fabienne Shumbusho,Ellen Brazier,Marie K Plaisy,Ephrem Mensah,Gilles Wandeler,Carlotta Riebensahm,Belinda V Chihota,Niharika Samala,Lameck Diero,Aggrey S Semeere,Thida Chanyachukul,Rohidas Borse,Dung T H Nguyen,Hugo Perazzo,Alvaro Lopez-Iniguez,Jessica L Castilho,Fernanda Maruri,Antoine Jaquet","doi":"10.1097/qad.0000000000004012","DOIUrl":"https://doi.org/10.1097/qad.0000000000004012","url":null,"abstract":"OBJECTIVETo understand the relationship between cardiovascular disease (CVD) risk and liver steatosis and fibrosis among people living with HIV (PLWH) ≥40 years on antiretroviral therapy (ART) in low- and middle-income countries (LMIC).DESIGNWe used cross-sectional behavioral and clinical data collected during study enrollment visits in 2020-2022 for the Sentinel Research Network of International epidemiology Databases to Evaluate AIDS (SRN of IeDEA).METHODSTen-year CVD risk was calculated using 2019 World Health Organization non-laboratory and laboratory models. Transient elastography (TE) was used to assess liver disease. Presence of steatosis and significant fibrosis were defined by Controlled Attenuation Parameter (CAP) ≥248 dB/m and liver stiffness measurement (LSM) ≥7.1 kPa, respectively. Participants with viral hepatitis, hazardous alcohol consumption and unsuppressed HIV viral load were excluded from the analysis. Logistic regression was used to estimate odds ratios, adjusting for study site, CD4 T cell count, stavudine and didanosine exposure, and in models stratified by sex and geographic region.RESULTSThere were 1,750 participants from nine LMIC. Median CVD risk was 3% for both non-laboratory and laboratory-based models. Adjusted odds ratios (ORs) for steatosis and significant fibrosis associated with laboratory CVD risk (≥10% vs. <5%) were OR = 1.83 (95% confidence interval:(CI) = 1.21-2.76; P = 0.004) and OR = 1.62 (95% CI = 0.85-3.07; P = 0.14), respectively. Associations of CVD risk with steatosis were stronger in males and among participants at study sites outside Africa.CONCLUSIONSHigher CVD risk was associated with steatosis but not with significant fibrosis in PLWH in our LMIC cohort.","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/qad.0000000000004009
Tammy H Cummings,Joseph Magagnoli,Sasha Sikirzhytskaya,Ilya Tyagin,Ilya Safro,Michael D Wyatt,Michael Shtutman,S Scott Sutton
BACKGROUNDThe decreased mortality of people living with HIV (PLWH) has revealed non-HIV-associated comorbidities such as neurocognitive disorders (e.g., dementia). There is an urgency to discover therapeutics to prevent or delay neurocognitive decline among PLWH.METHODSThe artificial intelligence platform Automatic Graph-mining And Transformer based Hypothesis Generation Approach (AGATHA) was utilized to seek potential drugs to be repurposed for the management of non-HIV-associated dementia. AGATHA revealed angiotensin-converting enzyme inhibitors that cross the blood-brain barrier (BBB ACEi) as a target for decreasing dementia. Subsequently, we conducted a retrospective study evaluating incident dementia using the VA Informatics and Computing Infrastructure (VINCI) evaluating ACE inhibitors. Cox proportional hazards models were fit and hazard ratios (HR) with corresponding 95% confidence intervals (CIs) are presented.FINDINGSA total 9,419 PLWH exposed to an BBB ACE inhibitor (ACEi) and 8,831 PLWH unexposed demonstrated that PLWH exposed to BBB ACEi had a 21.4% (univariate) and 15.2% (multivariate) lower hazard of dementia. The propensity score matched analysis demonstrated a 14.3% lower hazard of incident dementia compared to BBB ACEi unexposed (HR 0.857, 95% CI 0.747-0.984).INTERPRETATIONAn artificial intelligence-based literature mining system (AGATHA) was utilized to uncover a medication with potential to be repurposed. AGATHA demonstrated that BBB ACEi as a target for decreasing dementia among PLWH. Additionally, we conducted a retrospective study demonstrating a decrease in incident dementia among PLWH exposed to BBB ACEi. Future research is needed to explore further and understand the relationship of dementia among PLWH exposed to ACEi.
{"title":"Exposure to angiotensin-converting enzyme inhibitors that cross the blood-brain barrier and the risk of dementia among People Living with HIV.","authors":"Tammy H Cummings,Joseph Magagnoli,Sasha Sikirzhytskaya,Ilya Tyagin,Ilya Safro,Michael D Wyatt,Michael Shtutman,S Scott Sutton","doi":"10.1097/qad.0000000000004009","DOIUrl":"https://doi.org/10.1097/qad.0000000000004009","url":null,"abstract":"BACKGROUNDThe decreased mortality of people living with HIV (PLWH) has revealed non-HIV-associated comorbidities such as neurocognitive disorders (e.g., dementia). There is an urgency to discover therapeutics to prevent or delay neurocognitive decline among PLWH.METHODSThe artificial intelligence platform Automatic Graph-mining And Transformer based Hypothesis Generation Approach (AGATHA) was utilized to seek potential drugs to be repurposed for the management of non-HIV-associated dementia. AGATHA revealed angiotensin-converting enzyme inhibitors that cross the blood-brain barrier (BBB ACEi) as a target for decreasing dementia. Subsequently, we conducted a retrospective study evaluating incident dementia using the VA Informatics and Computing Infrastructure (VINCI) evaluating ACE inhibitors. Cox proportional hazards models were fit and hazard ratios (HR) with corresponding 95% confidence intervals (CIs) are presented.FINDINGSA total 9,419 PLWH exposed to an BBB ACE inhibitor (ACEi) and 8,831 PLWH unexposed demonstrated that PLWH exposed to BBB ACEi had a 21.4% (univariate) and 15.2% (multivariate) lower hazard of dementia. The propensity score matched analysis demonstrated a 14.3% lower hazard of incident dementia compared to BBB ACEi unexposed (HR 0.857, 95% CI 0.747-0.984).INTERPRETATIONAn artificial intelligence-based literature mining system (AGATHA) was utilized to uncover a medication with potential to be repurposed. AGATHA demonstrated that BBB ACEi as a target for decreasing dementia among PLWH. Additionally, we conducted a retrospective study demonstrating a decrease in incident dementia among PLWH exposed to BBB ACEi. Future research is needed to explore further and understand the relationship of dementia among PLWH exposed to ACEi.","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1097/QAD.0000000000004007
Elizabeth Zaniewski, Veronika Whitesell Skrivankova, Ellen Brazier, Anchalee Avihingsanon, Sandra Wagner Cardoso, Carina Cesar, Henri Chenal, Brenda E Crabtree-Ramírez, Rossana A Ditangco, Peter Vanes Ebasone, Brian Eley, Jonathan George Euvrard, Geoffrey Fatti, Jacqueline Madalitso Huwa, Patricia Lelo, Daisy Maria Machado, Eugene Kouassi Messou, Albert Kla Minga, Joseph Muleebwa, Sanjay Mundhe, Gad Murenzi, Winnie R Muyindike, Dominique Mahambou Nsonde, Sarah M Obatsa, Joseph Odhiambo, Hans Walter Prozesky, Supattra Rungmaitree, Aggrey Semwendero Semeere, Moussa Seydi, Nosisa Sipambo, Tavitiya Sudjaritruk, Karl-Günter Technau, Thierry Tiendrebeogo, Christelle Twizere, Marie Ballif
Objective: We studied the transition to dolutegravir-containing antiretroviral therapy (ART) at HIV treatment clinics within the International epidemiology Databases to Evaluate AIDS (IeDEA).
Design: Site-level survey conducted in 2020-2021 among HIV clinics in low- and middle-income countries (LMICs).
Methods: We assessed the status of dolutegravir rollout and viral load and drug resistance testing practices for patients on ART switching to dolutegravir-based regimens. We used generalized estimating equations to assess associations between clinic rollout of both first- and second-line dolutegravir-based ART regimens (dual rollout) and site-level factors.
Results: Of 179 surveyed clinics, 175 (98%) participated; 137 (78%) from Africa, 30 (17%) from the Asia-Pacific, and 8 (5%) from Latin America. Most clinics (80%) were in low- or lower-middle-income countries, and there were a mix of primary-, secondary- and tertiary-level clinics. Ninety percent reported rollout of first-line dolutegravir, 59% of second-line, 94% of first- or second-line and 55% of dual rollout. The adjusted odds of dual rollout were higher among tertiary-level (aOR 4.00; 95% CI 1.39 to 11.47) and secondary-level clinics (aOR 3.66; 95% CI 2.19 to 6.11) than in primary-level clinics. Over half (59%) of clinics that introduced first- or second-line dolutegravir-based ART required recent viral load testing before switching to dolutegravir, and 15% performed genotypic resistance testing at switch.
Conclusions: Dolutegravir-based ART was rolled out at nearly all IeDEA clinics in LMICs, yet many switched patients to dolutegravir without recent viral load testing and drug resistance testing was rarely performed. Without such testing, drug resistance among patient switching to dolutegravir may go undetected.
目的我们研究了国际艾滋病流行病学评估数据库(IeDEA)中的艾滋病治疗诊所向含多罗替韦的抗逆转录病毒疗法(ART)过渡的情况:设计:2020-2021 年在中低收入国家(LMICs)的 HIV 诊所进行的现场调查:我们评估了多罗替拉韦的推广情况以及接受抗逆转录病毒疗法的患者转用多罗替拉韦治疗方案后的病毒载量和耐药性检测情况。我们使用了广义估计方程来评估诊所同时推广基于多鲁特韦的一线和二线抗逆转录病毒疗法(双线推广)与地点水平因素之间的关联:在 179 家接受调查的诊所中,175 家(98%)参与了调查;其中 137 家(78%)来自非洲,30 家(17%)来自亚太地区,8 家(5%)来自拉丁美洲。大多数诊所(80%)位于低收入或中低收入国家,其中包括初级、二级和三级诊所。90%的诊所报告推出了一线多鲁曲韦,59%的诊所推出了二线多鲁曲韦,94%的诊所推出了一线或二线多鲁曲韦,55%的诊所推出了双线多鲁曲韦。三级诊所(aOR 4.00;95% CI 1.39 至 11.47)和二级诊所(aOR 3.66;95% CI 2.19 至 6.11)的调整后双线推广几率高于一级诊所。在引入基于多鲁曲韦的一线或二线抗逆转录病毒疗法的诊所中,超过一半(59%)的诊所要求在转用多鲁曲韦之前进行近期病毒载量检测,15%的诊所在转用时进行了基因型耐药性检测:结论:在低收入发展中国家,几乎所有的 IeDEA 诊所都推出了基于多鲁曲韦的抗逆转录病毒疗法,但许多诊所在未进行近期病毒载量检测的情况下就将患者转为使用多鲁曲韦,而且很少进行耐药性检测。如果不进行此类检测,转用多鲁特韦的患者的耐药性可能不会被发现。
{"title":"Transition to dolutegravir-based ART in 35 low- and middle-income countries: a global survey of HIV care clinics.","authors":"Elizabeth Zaniewski, Veronika Whitesell Skrivankova, Ellen Brazier, Anchalee Avihingsanon, Sandra Wagner Cardoso, Carina Cesar, Henri Chenal, Brenda E Crabtree-Ramírez, Rossana A Ditangco, Peter Vanes Ebasone, Brian Eley, Jonathan George Euvrard, Geoffrey Fatti, Jacqueline Madalitso Huwa, Patricia Lelo, Daisy Maria Machado, Eugene Kouassi Messou, Albert Kla Minga, Joseph Muleebwa, Sanjay Mundhe, Gad Murenzi, Winnie R Muyindike, Dominique Mahambou Nsonde, Sarah M Obatsa, Joseph Odhiambo, Hans Walter Prozesky, Supattra Rungmaitree, Aggrey Semwendero Semeere, Moussa Seydi, Nosisa Sipambo, Tavitiya Sudjaritruk, Karl-Günter Technau, Thierry Tiendrebeogo, Christelle Twizere, Marie Ballif","doi":"10.1097/QAD.0000000000004007","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004007","url":null,"abstract":"<p><strong>Objective: </strong>We studied the transition to dolutegravir-containing antiretroviral therapy (ART) at HIV treatment clinics within the International epidemiology Databases to Evaluate AIDS (IeDEA).</p><p><strong>Design: </strong>Site-level survey conducted in 2020-2021 among HIV clinics in low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>We assessed the status of dolutegravir rollout and viral load and drug resistance testing practices for patients on ART switching to dolutegravir-based regimens. We used generalized estimating equations to assess associations between clinic rollout of both first- and second-line dolutegravir-based ART regimens (dual rollout) and site-level factors.</p><p><strong>Results: </strong>Of 179 surveyed clinics, 175 (98%) participated; 137 (78%) from Africa, 30 (17%) from the Asia-Pacific, and 8 (5%) from Latin America. Most clinics (80%) were in low- or lower-middle-income countries, and there were a mix of primary-, secondary- and tertiary-level clinics. Ninety percent reported rollout of first-line dolutegravir, 59% of second-line, 94% of first- or second-line and 55% of dual rollout. The adjusted odds of dual rollout were higher among tertiary-level (aOR 4.00; 95% CI 1.39 to 11.47) and secondary-level clinics (aOR 3.66; 95% CI 2.19 to 6.11) than in primary-level clinics. Over half (59%) of clinics that introduced first- or second-line dolutegravir-based ART required recent viral load testing before switching to dolutegravir, and 15% performed genotypic resistance testing at switch.</p><p><strong>Conclusions: </strong>Dolutegravir-based ART was rolled out at nearly all IeDEA clinics in LMICs, yet many switched patients to dolutegravir without recent viral load testing and drug resistance testing was rarely performed. Without such testing, drug resistance among patient switching to dolutegravir may go undetected.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1097/QAD.0000000000004006
Stephanie A Ruderman, Amanda L Willig, John D Cleveland, Greer Burkholder, Christine Horvat Davey, Julia Fleming, Barbara Gripshover, Mari Katundu, Thomas W Buford, Raymond Jones, Michael S Saag, Joseph A C Delaney, Heidi M Crane, Allison R Webel
Background: Low food security is common among people with HIV (PWH) and is associated with poorer health outcomes. Frailty, an aging-related outcome that is increasingly prevalent among PWH, may be stimulated by low food security. We assessed associations between food security and frailty among PWH.
Methods: The Impact of Physical Activity Routines and Dietary Intake on the Longitudinal Symptom Experience of People Living with HIV (PROSPER-HIV) study follows PWH to evaluate how diet and physical activity impact symptoms. We utilized food security and frailty data from PROSPER-HIV Year 1 visits (January 2019 to July 2022) to estimate associations. Food security was measured via the validated two-item Food Security Questionnaire and categorized as Food Secure, Low Food Security, or Very Low Food Security. Frailty was measured with the Fried frailty phenotype, and categorized as robust, prefrail, and frail. We used relative risk regression to estimate associations between food security and frailty status, adjusted for demographic characteristics.
Results: Among 574 PWH, nearly one-quarter were women (22%), mean age was 52 years old, 8% were frail, and 46% prefrail. Low food security was reported among nearly one-third of PWH: 13% Low Food Security and 18% Very Low Food Security. Compared with being Food Secure, we found Low Food Security was associated with frailty [prevalence ratio: 4.06 (95% confidence interval (CI) 2.16-7.62] and Very Low Food Security was associated with both prefrailty [1.48 (1.23-1.78)] and frailty [5.61 (3.14-10.0)], as compared with robust status.
Conclusion: Low food security was associated with increased frailty among PWH in this study, suggesting a potential intervention point to promote healthy aging.
{"title":"Low food security is associated with frailty status and frailty components among people with HIV.","authors":"Stephanie A Ruderman, Amanda L Willig, John D Cleveland, Greer Burkholder, Christine Horvat Davey, Julia Fleming, Barbara Gripshover, Mari Katundu, Thomas W Buford, Raymond Jones, Michael S Saag, Joseph A C Delaney, Heidi M Crane, Allison R Webel","doi":"10.1097/QAD.0000000000004006","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004006","url":null,"abstract":"<p><strong>Background: </strong>Low food security is common among people with HIV (PWH) and is associated with poorer health outcomes. Frailty, an aging-related outcome that is increasingly prevalent among PWH, may be stimulated by low food security. We assessed associations between food security and frailty among PWH.</p><p><strong>Methods: </strong>The Impact of Physical Activity Routines and Dietary Intake on the Longitudinal Symptom Experience of People Living with HIV (PROSPER-HIV) study follows PWH to evaluate how diet and physical activity impact symptoms. We utilized food security and frailty data from PROSPER-HIV Year 1 visits (January 2019 to July 2022) to estimate associations. Food security was measured via the validated two-item Food Security Questionnaire and categorized as Food Secure, Low Food Security, or Very Low Food Security. Frailty was measured with the Fried frailty phenotype, and categorized as robust, prefrail, and frail. We used relative risk regression to estimate associations between food security and frailty status, adjusted for demographic characteristics.</p><p><strong>Results: </strong>Among 574 PWH, nearly one-quarter were women (22%), mean age was 52 years old, 8% were frail, and 46% prefrail. Low food security was reported among nearly one-third of PWH: 13% Low Food Security and 18% Very Low Food Security. Compared with being Food Secure, we found Low Food Security was associated with frailty [prevalence ratio: 4.06 (95% confidence interval (CI) 2.16-7.62] and Very Low Food Security was associated with both prefrailty [1.48 (1.23-1.78)] and frailty [5.61 (3.14-10.0)], as compared with robust status.</p><p><strong>Conclusion: </strong>Low food security was associated with increased frailty among PWH in this study, suggesting a potential intervention point to promote healthy aging.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.1097/QAD.0000000000004005
Patrick C Eustaquio, Janet Burnett, Joseph Prejean, Johanna Chapin-Bardales, Susan Cha
Background: Men who inject drugs who have sex with men (MWIDSM) may acquire HIV through injecting drugs or sex. Interventions to increase awareness of HIV preexposure prophylaxis (PrEP) have focused on gay/bisexual MSM and may not be reaching heterosexual-identifying men or people who inject drugs (PWID). We explored changes in PrEP awareness and use among MWIDSM from 2018 to 2022 by sexual identity.
Methods: We used data from the 2018 and 2022 National HIV Behavioral Surveillance among PWID recruited via respondent-driven sampling in 19 urban areas in the US. We examined changes in PrEP awareness and use over time by sexual identity among HIV-negative men who inject drugs and who had sex with another man in the past 12 months using log-linked Poisson regression models with robust standard errors with an interaction term between year and sexual identity.
Results: Among 758 HIV-negative MWIDSM (463 in 2018; 295 in 2022), nearly all sample participants were likely indicated for PrEP (94.2 and 92.9%, respectively). PrEP awareness increased from 2018 to 2022 among gay/bisexual-identifying MWIDSM [45.5-65.5%; aPR = 1.49, 95% confidence interval (95% CI) = 1.30-1.70] but remained stable for heterosexual-identifying MWIDSM (39.4-40.8%; aPR = 1.01, 95% CI 0.75-1.36). PrEP use remained low among all MWIDSM (2.5-7.7%, among heterosexually identifying; 15.3 to 10.2% among gay/bisexual-identifying).
Conclusion: PrEP awareness increased among gay/bisexual-identifying MWIDSM but not among heterosexual-identifying. PrEP use was low for all MWIDSM. Public health initiatives catered to MWIDSM should focus on improved campaigns and expanding PrEP accessibility in existing healthcare, harm reduction, and social services.
{"title":"Changes in HIV Pre-exposure Prophylaxis Awareness and Use Among Males Who Inject Drugs Who Have Sex with Men by Sexual Identity, 19 US Urban Areas, 2018 & 2022.","authors":"Patrick C Eustaquio, Janet Burnett, Joseph Prejean, Johanna Chapin-Bardales, Susan Cha","doi":"10.1097/QAD.0000000000004005","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004005","url":null,"abstract":"<p><strong>Background: </strong>Men who inject drugs who have sex with men (MWIDSM) may acquire HIV through injecting drugs or sex. Interventions to increase awareness of HIV preexposure prophylaxis (PrEP) have focused on gay/bisexual MSM and may not be reaching heterosexual-identifying men or people who inject drugs (PWID). We explored changes in PrEP awareness and use among MWIDSM from 2018 to 2022 by sexual identity.</p><p><strong>Methods: </strong>We used data from the 2018 and 2022 National HIV Behavioral Surveillance among PWID recruited via respondent-driven sampling in 19 urban areas in the US. We examined changes in PrEP awareness and use over time by sexual identity among HIV-negative men who inject drugs and who had sex with another man in the past 12 months using log-linked Poisson regression models with robust standard errors with an interaction term between year and sexual identity.</p><p><strong>Results: </strong>Among 758 HIV-negative MWIDSM (463 in 2018; 295 in 2022), nearly all sample participants were likely indicated for PrEP (94.2 and 92.9%, respectively). PrEP awareness increased from 2018 to 2022 among gay/bisexual-identifying MWIDSM [45.5-65.5%; aPR = 1.49, 95% confidence interval (95% CI) = 1.30-1.70] but remained stable for heterosexual-identifying MWIDSM (39.4-40.8%; aPR = 1.01, 95% CI 0.75-1.36). PrEP use remained low among all MWIDSM (2.5-7.7%, among heterosexually identifying; 15.3 to 10.2% among gay/bisexual-identifying).</p><p><strong>Conclusion: </strong>PrEP awareness increased among gay/bisexual-identifying MWIDSM but not among heterosexual-identifying. PrEP use was low for all MWIDSM. Public health initiatives catered to MWIDSM should focus on improved campaigns and expanding PrEP accessibility in existing healthcare, harm reduction, and social services.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1097/QAD.0000000000004002
Ran Zhao, Erinn Sanstead, Fernando Alarid-Escudero, Megan Huchko, Michael Silverberg, Karen Smith-Mccune, Steven E Gregorich, Wendy Leyden, Miriam Kuppermann, George F Sawaya, Shalini Kulasingam
Objective: To compare the model-predicted benefits, harms, and cost-effectiveness of cytology, cotesting, and primary HPV screening in U.S. women living with HIV (WLWH).
Design: We adapted a previously published Markov decision model to simulate a cohort of U.S. WLWH.
Setting: United States.
Subjects, participants: A hypothetical inception cohort of WLWH.
Intervention: We simulated five screening strategies all assumed the same strategy of cytology with HPV triage for ASCUS for women aged 21 to 29 years. The different strategies noted are for women aged 30 and older as the following: continue cytology with HPV triage, cotesting with repeat cotesting triage, cotesting with HPV16/18 genotyping triage, primary hrHPV testing with cytology triage, and primary hrHPV testing with HPV16/18 genotyping triage.
Main outcome measures: The outcomes include colposcopies, false-positive results, treatments, cancers, cancer deaths, life-years and costs, and lifetime quality-adjusted life-years.
Results: Compared with no screening, screening was cost-saving, and > 96% of cervical cancers and deaths could be prevented. Cytology with HPV triage dominated primary HPV screening and cotesting. At willingness-to-pay thresholds under $250,000, probabilistic sensitivity analyses indicated that primary HPV testing was more cost-effective than cotesting in over 98% of the iterations.
Conclusions: Our study suggests the current cytology-based screening recommendation is cost-effective, but that primary HPV screening could be a cost-effective alternative to cotesting. To improve the cost-effectiveness of HPV-based screening, increased acceptance of the HPV test among targeted women is needed, as are alternative follow-up recommendations to limit the harms of high false-positive testing.
{"title":"Primary HPV screening compared with other cervical cancer screening strategies in women with HIV: a cost-effectiveness study.","authors":"Ran Zhao, Erinn Sanstead, Fernando Alarid-Escudero, Megan Huchko, Michael Silverberg, Karen Smith-Mccune, Steven E Gregorich, Wendy Leyden, Miriam Kuppermann, George F Sawaya, Shalini Kulasingam","doi":"10.1097/QAD.0000000000004002","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004002","url":null,"abstract":"<p><strong>Objective: </strong>To compare the model-predicted benefits, harms, and cost-effectiveness of cytology, cotesting, and primary HPV screening in U.S. women living with HIV (WLWH).</p><p><strong>Design: </strong>We adapted a previously published Markov decision model to simulate a cohort of U.S. WLWH.</p><p><strong>Setting: </strong>United States.</p><p><strong>Subjects, participants: </strong>A hypothetical inception cohort of WLWH.</p><p><strong>Intervention: </strong>We simulated five screening strategies all assumed the same strategy of cytology with HPV triage for ASCUS for women aged 21 to 29 years. The different strategies noted are for women aged 30 and older as the following: continue cytology with HPV triage, cotesting with repeat cotesting triage, cotesting with HPV16/18 genotyping triage, primary hrHPV testing with cytology triage, and primary hrHPV testing with HPV16/18 genotyping triage.</p><p><strong>Main outcome measures: </strong>The outcomes include colposcopies, false-positive results, treatments, cancers, cancer deaths, life-years and costs, and lifetime quality-adjusted life-years.</p><p><strong>Results: </strong>Compared with no screening, screening was cost-saving, and > 96% of cervical cancers and deaths could be prevented. Cytology with HPV triage dominated primary HPV screening and cotesting. At willingness-to-pay thresholds under $250,000, probabilistic sensitivity analyses indicated that primary HPV testing was more cost-effective than cotesting in over 98% of the iterations.</p><p><strong>Conclusions: </strong>Our study suggests the current cytology-based screening recommendation is cost-effective, but that primary HPV screening could be a cost-effective alternative to cotesting. To improve the cost-effectiveness of HPV-based screening, increased acceptance of the HPV test among targeted women is needed, as are alternative follow-up recommendations to limit the harms of high false-positive testing.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1097/QAD.0000000000004004
Iulia Filip
{"title":"Perinatal exposure to HIV leaves a lasting neurocognitive mark - even when vertical transmission is prevented.","authors":"Iulia Filip","doi":"10.1097/QAD.0000000000004004","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004004","url":null,"abstract":"","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}