AIDS最新文献

Objective: To characterize all-cause unplanned 30-day readmissions among adults with chronic kidney disease (CKD) of all-stages by HIV status in the United States.

Design: A retrospective cohort study using the Nationwide Readmissions Database-an all-payer nationally representative database.

Methods: Index (i.e., initial) admissions and readmissions were defined following the United States Centers for Medicare & Medicaid Services (CMS) guidelines. We evaluated trends in the readmission risk among adults by CKD and HIV status during 2016-2022 and compared the overall and subgroup-specific readmission risk by HIV status among adults with CKD in 2022. Crude and age and sex-adjusted risk ratios (aRRs) were calculated using average marginal estimates from mixed-effect logistic regressions. Survey weights were applied.

Results: Among people with CKD, the readmission risk declined from 33.4% in 2016 to 29.1% in 2022 for people with HIV (PWH) and declined from 23.7% in 2016 to 21.9% in 2022 for people without HIV (PWoH). In 2022, there were 43 087 index admissions from PWH and 5 170 351 from PWoH. PWH were more likely to be men, younger, have end-stage CKD, and reside in low-income areas vs. PWoH. For both PWH and PWoH, the readmission risk increased with more advanced CKD stages but decreased with older age. In 2022, PWH were more likely to be readmitted than PWoH (aRR = 1.20 [95% confidence interval, 95% CI: 1.17-1.23]). This disparity was greater among those less than 40 years of age (aRR = 1.32 [95% CI: 1.23-1.42]).

Conclusion: More efforts are needed to mitigate the excessive readmission burden of people with CKD. PWH, especially young individuals, could represent a critical group for intensified intervention in CKD readmission prevention programs.

Objectives: The bidirectional increase of visitors between Vietnam and Japan has raised concerns about the spread of CRF01_AE; however, the epidemiological characteristics of CRF01_AE in Vietnam and its relationship with Japan remain unclear. We compared the CRF01_AE gene sequences from Vietnam and Japan to understand their epidemiolocal relationships.

Design: A molecular-epidemiological observational study.

Methods: We analyzed 753 protease--reverse transcriptase sequences from CRF01_AE-infected individuals in northern Vietnam and 500 CRF01_AE sequences from the Japanese Drug Resistance HIV-1 Surveillance Network's cluster database. We inferred the chronological phylogeny of these sequences with HIV-1 subtype references and identified statistically significant Vietnam-related clusters (VRCs). Individuals' sex, infection risk, age, collection year, collection site, and nationality were analyzed in relation to clustering and bilateral epidemiological relationships.

Results: A total of 33 VRCs and 41 Vietnam-related pairs were identified. Of these, eight were linked to known Japanese domestic transmission clusters (dTCs). Two VRCs included Vietnamese individuals diagnosed in Japan. One Japanese dTC linked to Vietnam included numerous Philippine nationals who were diagnosed in Japan. Regression analysis revealed that VRCs with a higher proportion of young people had a higher number of MSM (adjR 2  = 0.422, P  < 0.001). Although VRCs involved different risk groups in northern Vietnam, a strong association was observed between bilateral epidemic links and MSM (adjOR = 8.718, P  < 0.001).

Conclusion: CRF01_AE in northern Vietnam has spread through many different at-risk populations. Some MSM groups were associated with the epidemiological relationship between northern Vietnam and Japan.

Objective: To compare antiretroviral therapy (ART) utilization and adherence before and after expansion of a drug coverage program.

Methods: A retrospective study was conducted using administrative databases in Saskatchewan, Canada. Beneficiaries with at least one diagnostic claim for HIV infection or AIDS between 1999 and 2021 were eligible. An interrupted time series analysis described trends for three indicators of ART utilization before and after drug coverage expansion in 2018: number of active users (defined by at least one ART claim), number of ART claims, and ART spending. A random-effects logistic regression model, controlling for confounders, was used to evaluate the likelihood of achieving at least 95% adherence measured by the proportion of days covered (PDC) before vs. after coverage expansion.

Results: A total of 519 individuals received at least one ART claim during the study period and met all other inclusion criteria. Time series models detected statistically significant increases in the number of active ART users and ART claims within 4 months following coverage expansion. Corresponding increases in ART spending were offset by decreases over prior years. No statistically significant changes were detected in the likelihood of achieving at least 95% PDC between the pre vs. postcoverage periods (adjusted odds ratio 1.26, 95% confidence interval: 0.71-2.25, P  = 0.423).

Conclusion: ART coverage expansion was associated with a higher number of claims, more active users, and a change in spending pattern; however, we did not detect a difference in the likelihood of achieving optimal adherence. Addressing additional gaps in HIV management remains a priority.

Comparing ActiGraph Low-Frequency Extension (LFE) vs. normal filters on accelerometer-derived physical activity and sedentary behavior in 492 people with HIV. Participants wore ActiGraph 7-10 days; metrics (sedentary bouts, light physical activity, MVPA, steps) analyzed with both filters using Wilcoxon and Quade's ANCOVA. LFE increased MVPA (213.5 vs. 162.4 min/week) and steps (11 239 vs. 4853/day; P < 0.001) with minimal effects on sedentary bouts/light physical activity; effects were consistent across subgroups, indicating caution when comparing studies with different filters.

Objective: We assessed whether children/adolescents ages 9-11 years with in-utero HIV exposure but uninfected (CAHEU) had a lower chance of pubertal onset compared to children/adolescents who were HIV-unexposed (CAHU) during gestation. Among CAHEU, we assessed the association of in-utero combination antiretroviral therapy (ART) vs. zidovudine monotherapy exposure with pubertal onset.

Design: An observational cross-sectional study.

Methods: Pubertal onset (Tanner stage ≥2) was classified by sex and by in-utero HIV exposure status for each puberty indicator (pubic hair, breast development in girls, and male genitalia in boys) among adolescents aged 9-11 years from the Botswana-based FLOURISH study. Logistic regression models were fit to assess the association of in-utero HIV/ARV exposure with pubertal onset, adjusting for age at assessment and potential confounders. Among CAHEU, we compared the occurrence of pubertal onset for ART-exposed vs. zidovudine-exposed.

Results: We evaluated 325 children/adolescents (228 CAHEU) at median age (IQR) 10.0 years (9.5, 10.6 years). CAHEU had lower mean BMI Z -scores at Tanner assessment (-0.36 vs. 0.19) than CAHU. While female CAHEU had higher odds of pubertal onset by pubic hair compared with female CAHU (adjusted odds ratio=2.75, 95% confidence interval: 1.04-7.30), no other differences in pubertal onset were observed by in-utero HIV exposure. Among CAHEU, no differences in pubertal onset by in-utero exposure to ART vs. zidovudine were observed.

Conclusion: In this small Botswana cohort, we observed no consistent differences in pubertal onset by in-utero HIV exposure status or by in-utero antiretroviral exposure. Longitudinal studies are needed to confirm these findings.

Objective: People with HIV (PWH) with atherosclerotic cardiovascular disease (ASCVD) are at high risk of recurrent cardiovascular events. However, its drivers and impact of specific interventions are largely unknown. Therefore, we estimated the 10-year recurrence risk and the potential benefits of guideline-recommended interventions in a large cohort of PWH and controls.

Design: PWH from the ATHENA cohort with prior ASCVD were included and 1 : 1 matched for nonmodifiable risk factors (age, sex, type of ASCVD manifestation, and years since first event) to controls without HIV from the UCC-SMART cohort.

Methods: The SMART2 model was applied to estimate the 10-year risk of recurrent cardiovascular events. Subsequently, the effects of the following interventions were estimated: smoking cessation, initiation of antithrombotics, achieving systolic blood pressure <140 mmHg, and achieving low-density lipoprotein cholesterol (LDL-c) <1.4 mmol/l.

Results: A total of 1247 PWH and 1247 matched controls were included. The estimated 10-year recurrence risk in PWH was significantly higher [22% (IQR 16-31%) versus 20% (IQR 14%-29%)], primarily driven by a higher smoking prevalence. Attainment of targets potentially averts up to 113 events per 1000 PWH treated, largely attributed to smoking cessation and lipid-lowering treatment (35 and 46 averted events). In the highest-risk PWH, half of the recurrent events might be prevented with intensified treatment.

Conclusions: The estimated 10-year risk of recurrent cardiovascular events in PWH with prior ASCVD exceeds that of matched individuals without HIV. Our results indicate that stringent adherence to risk factor-targeted interventions is key and could avert many events in this at-risk population.

Objective: This study evaluated factors associated with adverse infant outcomes (preterm delivery, infant mortality) and described access of antiretroviral therapy (ART) by pregnant women living with HIV (WLWH) and their infants.

Design: The African Cohort Study (AFRICOS) enrolls individuals aged ≥ 15  years across 12 clinical sites in Kenya, Uganda, Tanzania, and Nigeria. These analyses included WLWH enrolled from 2013 to 2023. Data on sociodemographics, HIV-related factors, and pregnancy outcomes were collected by self-report and medical records.

Methods: Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for associations between maternal characteristics and infant outcomes, with clustered standard errors to account for multiple pregnancies by the same woman.

Results: Among 593 WLWH with 922 pregnancies, 753 (81.7%) resulted in singleton live births. Of these, 12.1% (91/753) were to WLWH who indicated they did not receive ART. In total, 5.2% (39/753) of live born infants were preterm; 5.6% (42/753) of infants died before 12  months of age. Odds of preterm birth were higher among WLWH under 20  years of age (aOR 3.39, 95% CI 1.12-10.31, versus 20-34 years). Increased odds of mortality were observed among infants born preterm (aOR 7.92, 95% CI 3.28-19.13, versus full term) and infants without ARV prophylaxis prescription (aOR 5.13, 95% CI 2.23-11.83, versus infants prescribed ARV prophylaxis).

Conclusion: Gaps in prevention of vertical transmission care persist. Expanding ART access to WLWH and adherence to WHO HIV treatment guidelines are critical to end vertical transmission of HIV and reduce infant mortality.

Objective: In 2024, an estimated 5.3 million of 40.8 million people living with HIV (PLHIV) globally were unaware of their status, with Southern Africa bearing the highest regional burden. This review synthesises programmatic evidence on HIV testing uptake, test positivity, and linkage to care across clinician-administered testing and HIVST in Southern Africa.

Design: Systematic review with pooled programme-level outcomes analyses of HIV testing outcomes.

Methods: Searches were conducted for studies published between 2020 and 2025 from Southern African countries using Medline, Embase, and OVID Global Health. Eligible studies reported HIV positivity and optionally testing uptake or linkage to care. Pooled odds ratios were calculated to describe programme-level differences across testing modalities for testing uptake and linkage to care, while HIV positivity was analysed using a binomial generalised linear model, adjusting for country.

Results: 43 studies encompassing 290,428 participants across 8 Southern African countries were included. Programmes offering HIVST frequently reported higher testing uptake (pooled OR = 1.34, 95% CI: 1.30-1.38, p < 0.001), though estimates varied substantially by country and implementation context. Lower HIV positivity yields were reported in HIVST programmes compared with clinician-administered testing programmes (adjusted OR = 0.63, 95% CI:0.54-0.75, p < 0.001). Linkage to care following a positive result was also consistently lower in HIVST programmes (pooled OR = 0.036, 95% CI: 0.025-0.051, p < 0.001).

Conclusion: Across real-world programmes in Southern Africa, HIVST is commonly characterised by high testing uptake but lower HIV positivity yield and linkage to care, relative to clinician-administered testing. Interpretation is limited by ecological comparisons and heterogeneity in outcome measurement. Future research should prioritise robust linkage to care management.

Background: Children and adolescents with HIV previously taking ritonavir-boosted lopinavir (LPV/r)-based antiretroviral therapy (ART) were recently programmatically transitioned to dolutegravir (DTG)-based ART in Lesotho, southern Africa. We investigated associated changes in treatment satisfaction and potential side effects.

Methods: This single-center prospective cohort study enrolled participants <18 years transitioned from LPV/r- to DTG-based ART during the national programmatic DTG rollout in 2022-2023. Virally suppressed participants ≥6 years able to handle a sleep diary and actigraphy were eligible for additional sleep monitoring. Enrollment occurred 2 weeks before (with actigraphy) or at (without actigraphy) transition with follow-up until 4 weeks post-transition. Co-primary endpoints were i) change in treatment satisfaction, using the HIV Treatment Satisfaction Questionnaire change version (HIVTSQc; Teen and Parent versions) at 4 weeks, and ii) difference in mean sleep period length over a two-week period before and after transition (only actigraphy participants). Secondary endpoints assessed treatment satisfaction status, gastrointestinal symptoms, depressive symptoms, and additional sleep measures.

Results: Among 245 participants with transition and 4-week data, 115 (47%) were female and median age was 11.1 (interquartile range 8.9-13.6) years. HIVTSQc outcomes favored DTG, with 88/92 (96%) HIVTSQc-Teen and 149/151 (99%) HIVTSQc-Parent responses indicating being "much more satisfied now" post-transition. Among 69 (28%) actigraphy participants, mean sleep period length was 9.0 hours (standard deviation [SD] 1.0) before and 9.2 hours (SD 1.0) 2-4 weeks post-transition (mean difference 0.2, 95% CI 0.0-0.4). Secondary outcomes did not change meaningfully.

Conclusions: Observed treatment satisfaction and tolerability support the rollout of DTG in pediatric HIV care.

Objective: In Nigeria, adolescents and young adults (AYA) who engage in multiple sexual partnerships, transactional sex, and needle-sharing are eligible for preexposure prophylaxis (PrEP) and are prioritized for HIV testing. AYA with PrEP-eligible behaviors should be using facility-based HIV testing services. We examined associations between these behaviors and facility-based HIV testing among AYA aged 14-24 years.

Design: A longitudinal analysis of a stepped-wedge trial.

Methods: Using Innovative Tools to Expand Youth-friendly HIV Self-Testing (I-TEST) data, we fit generalized linear models using generalized estimating equations. We used a two-stage weighted approach to generalize I-TEST estimates to all AYA in Nigeria.

Results: Of 1429 trial participants, the median age was 20 years (IQR: 18-22), 50.3% were female, and 69.4% reported secondary education as highest level of education completed. Recent facility-based HIV testing uptake was higher among AYA with one [unadjusted risk difference: 11.7%, 95% confidence interval (95% CI): 8.1-15.2], two [11% (5.3, 16.8)], and three or more sexual partners in the past 3 months [17.3% (10.5, 24)], compared to AYA with no recent sexual partners. AYA who engaged in transactional sex had higher facility-based testing uptake [14.7% (9.8, 19.5)] than AYA who never engaged in transactional sex. AYA who shared needles had lower facility-based testing uptake [-3.3% (-6.7, 0.2)] than AYA with no needle-sharing history. The trial and generalized estimates were in the same direction.

Conclusion: While facility-based testing may reach AYA who engaged in multiple sexual partnerships or transactional sex, AYA who shared needles may require more tailored HIV testing approaches.