AIDS最新文献

Introduction: Estimating undiagnosed HIV prevalence facilitates planning epidemic responses, and monitoring progress towards UNAIDS and national targets. We undertook a systematic review to identify models used to estimate undiagnosed HIV prevalence in overall populations in high-income low-HIV-prevalence countries and territories to inform model selection in New Zealand.

Methods: We searched Medline, EMBASE, Web of Science, CINAHL and Cochrane Database of Systematic Reviews to 5 March 2025. Two authors independently reviewed studies with conflicts resolved by a third. We assessed study quality against five key characteristics of good modelling practice. We undertook a grey literature search to identify modelling in HIV surveillance or monitoring reports.

Results: We identified 2147 unique citations, with 119 full text studies retrieved and 48 included. Forty-six studies described modelling undiagnosed HIV prevalence in 23 countries and territories, a further two for multiple countries. The most common methods used CD4 + back-calculation, with the ECDC model most frequently used (10 studies), followed by a clinical stage-based back-calculation model, a CD4 + depletion model and the Spectrum CSAVR model (eight, four and three studies, respectively). Almost all studies noted a full mathematical model description, included parameters, validation and uncertainty estimates. Only five articles estimated undiagnosed HIV by ethnicity, but estimates by gender and exposure were common.

Conclusion: CD4 + back-calculation models, notably the online accessible ECDC model, have been most commonly used. These are well suited to surveillance systems like New Zealand's, which collect demographic and exposure details and CD4 + cell counts at HIV diagnosis, but limited exposure group size and seroprevalence information.

This study investigates cerebrospinal fluid (CSF) biomarkers associated with HIV-associated neurocognitive disorders (HAND) in people with HIV (PWH) in Brazil. Among 79 HIV-positive participants and 7 negative controls, elevated levels of inflammatory cytokines and soluble CD14 (sCD14) were found. The sCD14 showed promise as a diagnostic marker, and combined with other proinflammatory markers, may improve early detection and monitoring of HAND.

Background: Cognitive frailty (CF, the simultaneous presence of frailty and cognitive impairment) is recognized as a significant predictor of several adverse health outcomes. The objective of this study was to describe prevalence and risk factors for CF in people with HIV (PWH) >50  years.

Methods: This was a cross-sectional observational study including PWH attending Modena HIV Metabolic Clinic (MHMC). Neurocognitive function was measured with Cogstate battery that comprises six domains. Each individual CogState raw score was transformed into z-score after correction for age and sex. Neurocognitive impairment was defined by total global deficit score >0.5. Frailty was assessed by 37-Item frailty index. Scores <0.25 were considered fit or >0.26 as frail.

Results: A total of 1258 PWH were included, 916 (73%) were males, median age was 58 years, median time since HIV diagnosis was 27 years. The sample was divided into four groups (CF) based on the presence of frailty (F) and cognitive impairment (ICT): F+/ICT+, F+/ICT-, F-/ICT+, F-/ICT-. Age per 5-year increase [odds ratio (OR) = 1.27, confidence interval (CI): 1.02-1.55, P  = 0.022], nadir CD4 + cell count (OR = 0.81, CI: 0.66 - 0.99, P  = 0.042) and polypharmacy (OR = 3.47, CI: 2.00-6.00, P < 0.001) were associated with CF after adjustment for time since HIV diagnosis, multimorbidity, depression and cumulative exposure to dolutegravir.

Conclusion: CF prevalence in PWH >50 years was 6.8% and it is higher than what has been observed in the general population >65 years (1-4.4%). Nadir CD4 + cell count and polypharmacy was associated with CF, suggesting an HIV specific contribution related to the development of this condition.

Background: Healthcare needs of older people with HIV (PWH) are changing given the higher incidence and earlier onset of age-related conditions compared to people without HIV (PWoH). This emphasizes a need for novel prognostic markers that allow identification of earlier stages of functional deterioration and prevent its advancement.

Methods: With this aim, we compared muscular imaging markers (whole-body MRI) and plasma biomarkers (irisin, myostatin, and coenzyme Q10) between PWH ( n  = 50) and PWoH ( n  = 25) aged 50 or older, and their associations with clinical conditions. Spearman's rank correlation coefficient was estimated and presented in correlation matrices for the most relevant groups of study variables with intramuscular fat fraction and plasma biomarkers. The distribution of plasma biomarkers and intramuscular fat fraction values was presented graphically in boxplots as a function of the functional test category. The Wilcoxon rank sum test was performed for comparisons, and P values are presented in tables. Raw and adjusted logistic models were fitted, and the estimated odds ratios are presented in tables. Adjusted variables were age, sex, and HIV status group.

Results: PWH exhibited greater deterioration, including lower autonomy, higher rates of prefrailty/frailty and malnutrition, and reduced bone mineral density. Mild to moderate dependency (Barthel) was observed only in PWH (18.4%), with 50% of PWH at risk of dependency (Barber) compared to 25% in PWoH. Prefrailty (Fried) was more prevalent in PWH (46%) than PWoH (28%), and frailty was exclusive to PWH (14%). PWH also had higher plasma myostatin and lower irisin levels. Lower intramuscular fat content was associated with malnutrition and dependency, while total intramuscular fat was positively correlated with time living with HIV and negatively with CD4 + T-cell count. Higher coenzyme Q10 levels were seen in states of poorer health, particularly frailty [Fried, Short Physical Performance Battery (SPPB)], while higher irisin levels were observed together with frailty (Fried) and dependency (Barthel, Barber). For all adjusted models, HIV status strongly influenced Fried, Barthel, and SPPB functional scores.

Conclusion: These findings underscore the need for further assessment of these biomarkers for their diagnostic and predictive potential in aging-related conditions such as frailty in PWH.

Objective: To estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk among US adults with diagnosed HIV (PWH) and number of first major adverse cardiovascular events (MACE) that are potentially preventable over a 5-year period, if US Department of Health and Human Services recommendations for statin therapy for PWH were fully implemented.

Design: Cross-sectional study of nationally representative, individual-level data on behavioral and clinical characteristics of US PWH.

Methods: Using data from standardized questionnaires and medical records abstraction collected from June 2022 to May 2023, we calculated weighted estimates of the following among PWH aged 40-75 years without documented cardiovascular disease ( N  = 2155): 10-year ASCVD risk; statin prescription by risk level; number potentially avoidable first MACE over 5 years with moderate-intensity statin treatment. We used the 2013 Pooled Cohort Equation to calculate ASCVD risk. MACE averted was estimated by applying the 5-year number needed to treat, from the REPRIEVE trial North American cohort, to the weighted number of PWH eligible for statin therapy.

Results: Among PWH eligible for therapy, 72.5% were male individuals, 42.5% were aged 50-59 years and 35.9% were Black, non-Hispanic persons. The overall median risk score was 7.1% [95% confidence interval (CI): 6.8-7.4%]. Among those with low (<5%) and moderate risk (5 to <20%), 19.8% (16.7-22.9%) and 36.9% (33.4-40.4%) were on statin therapy, respectively. An estimated 7418 (95% CI: 1116 -13 909) additional first MACE could be prevented over 5 years if eligible PWH received moderate-intensity statin therapy.

Conclusion: Fully implementing statin therapy recommendations for PWH in the United States could substantially reduce MACE among this population.

Objective: This study analyses liver stiffness (LS) dynamics in people with HIV (PWH) and advanced liver fibrosis who achieved sustained virological response (SVR) and assess factors associated with LS normalization or progression, after long-term follow-up.

Design: Prospective multicenter cohort study.

Methods: This study included individuals with HIV/HCV co-infection from the Spanish GEHEP-011 cohort, fulfilling: pretreatment LS ≥9.5 kPa; sustained virological response (SVR) with direct-acting antiviral regimen; available measurement of LS at SVR. Factors associated with LS normalization (achieving ≤7.2 kPa in two consecutive measurement) and progression (increase of >20% LS at the last measurement available) were analyzed.

Results: A total of 678 patients were included. The median follow-up was 40 (17-71) months. The repeated measures ANOVA revealed a significant main effect of time on LS. Overall, 221 (32.6%) achieved normalization. Lower probability of normalization was associated with advanced liver disease [baseline LS: sHR = 0.26 (95% CI, 0.19-0.37), P  < 0.001; liver decompensation before SVR: sHR = 0.22 (0.05-0.97), P  < 0.001; baseline MELD score: sHR = 0.81 (0.69-0.94), P  = 0.006]. LS progression occurred in 50 (7.4%). Progression was associated with higher baseline LS [sHR = 1.04 (1.01-1.07), P  = 0.007], controlled attenuation parameter (CAP) [CAP ≥ 280 dB/m: sHR = 2.94 (1.16-7.44)] and older age [sHR 1.06 (1.00-1.13), per year, P  = 0.04].

Conclusions: In PWH, LS significantly decreases after HCV cure in the long-term, achieving values of ≤7.2 kPa. In a substantial proportion of patients, LS remain stable or even increases. Older age and concomitant steatotic liver disease are associated with LS progression.

Background: Cerebral toxoplasmosis is a common opportunistic infection in people with HIV (PWH), associated with high morbidity and mortality. It is unclear how clinical characteristics, treatment response and long-term clinical outcomes in PWH with cerebral toxoplasmosis have changed due to improved treatment of HIV.

Methods: This single-centre retrospective observational cohort study of PWH with cerebral toxoplasmosis included patients over almost 25 years.

Results: Sixty-three eligible patients were identified. Most patients were late presenters presenting with headache and neurological symptoms. Overall survival was 79% over a mean follow up of 15 years. Seventy-three percent of deaths occurred within the first year after diagnosis. Almost 10% of patients experienced residual impairments.

Conclusion: An earlier diagnosis of HIV reduces the incidence of cerebral toxoplasmosis due to timely initiation of combination antiretroviral therapy (cART) and anti- Toxoplasma prophylaxis. High index of suspicion by clinicians is vital to timely start anti- Toxoplasma therapy. If treated correctly and timely, overall survival is high.