AIDS最新文献

Objective: To compare HIV incidence among female sex workers (FSW) and single mothers, and to determine the factors associated with seroconversion among both populations.

Design: Prospective cohort conducted in Lusaka and Ndola, Zambia between 2012 and 2022.

Methods: Study staff recruited FSW from common sex work locales and recruited single mothers from postnatal infant vaccination clinics. Enrolled participants were HIV-negative, aged 18-45, and identified as either a FSW or single mother. We measured HIV incidence and assessed associated factors using Poisson regression with adjusted rate ratios (aRRs) and 95% confidence intervals (CIs).

Results: The study enrolled 2539 women (1533 FSW and 1006 single mothers). HIV incidence was not statistically different for FSW (3.24 per 100 person-years; 95% CI: 2.63-3.95) and single mothers (2.64 per 100 person-years; 95% CI: 2.00-3.43). Factors associated with HIV seroconversion were positive syphilis (aRR: 2.03; 95% CI: 1.46-2.83) and trichomonas (aRR: 1.48; 95% CI: 1.06-2.06) diagnoses, inconsistent condom use (aRR: 1.60; 95% CI: 1.06-2.40), and greater than 6months follow-up time in the study (aRR: 2.45; 95% CI: 1.52-3.94).

Conclusions: Single mothers share similar HIV risk to FSW, and both populations require targeted interventions. For single mothers, government postnatal clinics should combine comprehensive sexual education with screening and treatment for syphilis and trichomoniasis. For FSW, we recommend integrated and accessible interventions to prevent HIV and sexually transmitted infections. Future studies should investigate the social determinants of condom use among both FSW and single mothers.

Objective: People with HIV on ART are highly vulnerable to non-AIDS-related comorbidities, including HIV-associated neurocognitive disorders, which are linked to persistently activated monocytes/macrophages. Smoking is a major contributor to HIV-related comorbidities. However, nicotine alone has anti-inflammatory effects, mainly through α7-nicotinic receptor (nAChR) activation. Galantamine (GAL) is an FDA-approved pro-cognitive medication that increases endogenous acetylcholine and also directly potentiates the α7-nAChR. We hypothesized that GAL would improve neurocognition in PWH, both by direct pro-cognitive effects and by reducing inflammation. We also explored whether effects differed by smoking status.

Design/methods: Smoking and nonsmoking PWH/ART participated in a double-blind, randomized, placebo-controlled crossover study of 12 weeks of GAL treatment. Primary outcomes were composite neurocognitive test score; monocyte CD16, CD163 and CCR2, and CD8 T-cell CD38/HLA-DR; and plasma sCD16, sCD163 and CCL2. Plasma hsCRP and neurofilament light chain (NFL) were also measured. Exploratory analyses included plasma mediators by Luminex and monocyte transcriptome by RNAseq.

Results: Neurocognition did not differ between GAL and placebo treatment (adjusted standardized difference (95% CI) -0.02 (-0.2, 0.2); P  = 0.82), with no difference by smoking status ( P  = 0.51). Monocyte CCR2 expression was 15.2% (5, 25.1) greater with GAL than placebo ( P  = 0.006). No differences were seen in monocyte CD16 ( P  = 0.76) or CD163 ( P  = 0.8), CD8 + T-cell CD38/HLA-DR ( P  = 0.54), or plasma sCD163 ( P  = 0.36), sCD14 ( P  = 0.46), or CCL2 ( P  = 0.34). NFL and hsCRP were not different, but several pro-inflammatory cytokines increased with GAL. Only modest effects were seen on monocyte gene expression.

Conclusions: Galantamine for 12 weeks did not improve cognition or reduce inflammation in PWH/ART regardless of smoking status.

Despite viral suppression, many people with HIV (PWH) experience persistent cognitive difficulties. We previously demonstrated that cerebrospinal fluid (CSF) N-acetyl-aspartyl-glutamate (NAAG) was associated with spatial attention and working memory. Here, we report that CSF NAAG also correlates with an inflammatory signature (M-CSF, IL-15, MCP-1, sCD40L, IL-18, MMP-9) that relates to spatial attention and working memory. These results suggest that CSF NAAG may serve as an immunomodulatory biomarker relevant to cognition in PWH.

Objectives: Long-acting injectable cabotegravir and rilpivirine (LAI CAB+RPV) provides an alternative to daily therapy for people with HIV (PWH) with virologic suppression. Although genotypic testing is recommended before switching, its real-world clinical value is unclear. We assessed outcomes after switching to LAI CAB+RPV with or without available genotypes in the Spanish RELATIVITY cohort.

Design: RELATIVITY is a multicenter, ambispective cohort study assessing the effectiveness and safety of LAI CAB+RPV in adults with HIV across 58 centers in Spain.

Methods: Posthoc analysis of 3146 participants, focusing on the availability of genotypic resistance data before switching.

Results: Of the 3146 participants, 53.5% ( n = 1682) did not have genotypes available. The median follow-up was 13.3 months [interquartile range (IQR) 8.6, 18.9] in the no-genotype group and 14.9 months (IQR 9.0, 19.2) in the genotype group ( P  = 0.003). Both groups maintained high virological suppression rates (>93%) up to the 23rd month of follow-up, with no significant differences observed in virological or immunological outcomes. Virologic failure rates (0.5% vs. 1.0%; P  = 0.476) and permanent discontinuation rates (6.1% vs. 6.6%; P  = 0.804) were similar. Of the 20 participants with virologic failure, 12 had genotype data. After resuming oral antiretroviral therapy, 8 of those with and 4 of those without the genotype achieved undetectable viral loads. Adherence to injection schedules and changes in body mass index were comparable.

Conclusions: In this large real-world cohort, the absence of genotypic data did not affect LAI CAB+RPV effectiveness in virologically suppressed PWH. Limitations, including ambispective design, short follow-up, and low non-B subtype prevalence, may limit generalizability.

Using an HIV transmission model in 30 states and Washington DC, we simulated ending Ryan White services from Parts C and D and the Ending the HIV Epidemic and Minority AIDS initiatives in February 2026. We projected 23 883 additional infections by 2030 (95% credible interval 2812-53 813) - a 17.6% (2-39.5%) excess. A 'conservative' estimate of suppression losses projected 8.1% (4.4-12.3%) more infections. Ryan White services are critical to preventing US HIV transmission.

Objectives: To compare cognitive function and identify correlates of lower cognitive functioning among children and youth exposed to HIV (CHEU) aged 7-18 years and peers unexposed to HIV (CHU).

Design: Cross sectional survey.

Methods: Using the NIH Toolbox African Languages cognitive battery, we assessed working memory, attention and inhibitory control, episodic memory, cognitive flexibility, and processing speed. We compared domain scores between HIV exposure groups and determined correlates using multivariable linear regression adjusted for age and potential confounders.

Results: Among 185 CHEU and 187 CHU assessed, median age was 12 years (interquartile range [IQR]: 10, 14) for CHEU and 13 (IQR: 10, 15) for CHU. CHEU were more likely to be orphaned and had older, less educated mothers. Among CHEU, 54.1% mothers started antiretroviral treatment prepregnancy. Compared to CHU, CHEU had significantly lower scores in working memory (adjusted β -1.2, 95% CI -2.0, -0.5, P  = 0.002) and processing speed (adjusted β -4.9, 95% CI -7.3, -2.5, P  < 0.001).Among CHEU, maternal combination ART in pregnancy was associated with better working memory; food insecurity was associated with poorer processing speed. In both groups, maternal education and child male sex were associated with better cognitive outcomes.

Conclusions: CHEU experienced deficits in working memory and processing speed compared to CHU. Discerning mechanisms for CHEU could inform interventions. Ensuring maternal ART and addressing food insecurity among CHEU may enhance cognitive outcomes.

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

Design: A retrospective cohort, 2000-2023.

Methods: Adults with HIV aged at least 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 to 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.

Conclusion: 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.