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: To assess whether the coronavirus disease 2019 (COVID-19) pandemic altered the clinical composition of HIV/AIDS-related deaths in Peru, distinguishing HIV/AIDS-only deaths from HIV/AIDS-COVID deaths and examining indicators of advanced HIV disease and opportunistic infections (OIs).

Design: Nationwide retrospective observational study using the onset of COVID-19 as an exogenous shock within a natural-experiment framework. Triangulation was performed across interrupted time series, ecological, and individual-level analyses.

Methods: Individual-level mortality records from Peru's National Death Registry (January 2017-December 2024) were analyzed. HIV/AIDS-related deaths were identified using ICD-10 codes and text terms and classified as HIV/AIDS-only or HIV/AIDS-COVID. Segmented interrupted time series models estimated changes in monthly proportions of clinical indicators among HIV/AIDS-only deaths. Ecological models examined relationships between the monthly share of HIV/AIDS-COVID deaths and patterns in HIV/AIDS-only deaths. Multivariable regressions compared individual-level clinical characteristics during 2020-2024.

Results: The onset of COVID-19 coincided with abrupt declines in documentation of severe immunosuppression and OI among HIV/AIDS-only deaths. Months with a higher share of HIV/AIDS-COVID deaths were associated with lower prevalence of advanced HIV indicators among HIV/AIDS-only deaths. Individually, HIV/AIDS-COVID deaths showed slightly higher prevalence of advanced HIV disease but lower prevalence of OIs, whereas HIV/AIDS-only deaths more often reflected complex HIV-related pathology.

Conclusions: The COVID-19 pandemic reconfigured the clinical composition of HIV/AIDS-related mortality in Peru, concentrating HIV/AIDS-only deaths among individuals with more advanced disease while generating a distinct profile of HIV/AIDS-COVID co-infection. Strengthening diagnostic capacity, continuity of HIV care, and integrated surveillance is essential to protect people living with HIV during future health-system shocks.

Objective: Guangxi faces a persistent HIV epidemic driven by heterosexual transmission and aging populations. This study uses molecular network to examine network topology and dynamics over time, providing insights for HIV control strategies.

Methods: A total of 9,751 samples were collected from HIV-infected individuals across Guangxi between 2005 and 2024. HIV pol gene was extracted, and molecular networks were constructed based on the TN93 genetic distance. Network indicators, including clustering rate, network density, degree distribution, transmission rate, and proportional detection rate, were calculated across four time periods (≤2009, 2010-2014, 2015-2020, 2021-2024). Stratified analyses were further conducted.

Results: Population characteristics revealed pronounced epidemic aging (individuals aged ≥50 years increased from 10.6% to 62.3%) and a predominance of heterosexual transmission (rising from 50.4% to 90.6%). The network structure evolved from centralized to fragmented: clustering rate declined from 70.64% to 49.92%, network density decreased from 0.084 to 0.037, and the proportion of nodes with degree ≥4 fell from 37.50% to 13.34%. Degree distribution narrowed, suggesting a reduction in superspreading. Transmission rate and proportional detection rate also shifted downward, indicating suppressed network expansion in later periods. Stratified analyses showed higher clustering rates among heterosexual transmission, older adults, individuals with low education, and farmers, although overall declines were consistent across subgroups.

Conclusions: This study highlights evolving HIV molecular network characteristics in Guangxi after three rounds of AIDS Conquering Project, offering evidence of reduced complexity and intensity over time. These findings inform planned HIV control efforts, underscoring the need for targeted interventions and enhanced monitoring, particularly for older, less-educated farmers.

Objectives: To characterize lactation consultants' (LCs) HIV-related knowledge, attitudes, stigma, and tele-lactation experience relevant to supporting pregnant and postpartum people with HIV (PP-PWH).

Design: Cross-sectional mixed-methods study of lactation consultants.

Methods: We conducted a mixed-methods survey of certified LCs in the United States and Canada. Quantitative measures assessed general HIV knowledge, HIV breastfeeding-specific knowledge, attitudes toward breastfeeding among PP-PWH, HIV-related stigma, and tele-lactation experience using validated instruments. Multivariable regression models examined associations between provider characteristics, knowledge, stigma, and attitudes. Qualitative free-text responses were analyzed thematically using the Health Stigma and Discrimination Framework, with findings integrated to contextualize quantitative results.

Results: The sample included 207 internationally certified LCs, most of whom reported no or limited clinical experience supporting PP-PWH. General HIV knowledge was high, while HIV-specific breastfeeding knowledge was moderate. Higher HIV-specific knowledge was independently associated with prior experience supporting PP-PWH and awareness of updated infant-feeding recommendations, whereas years in practice and general HIV knowledge were not. HIV-related stigma levels were generally low; lower stigma was associated with greater support for patient autonomy but more cautious endorsement of breastfeeding in high-resource settings. Tele-lactation experience was common. Qualitative findings emphasized strong support for patient autonomy and nonjudgmental, informed counseling, alongside high willingness to learn and engage in additional training to better support PP-PWH.

Conclusions: LCs are motivated to support PP-PWH but face HIV-specific knowledge gaps and structural challenges shaping preparedness and counseling practices. Targeted education, clear guidance, and integration of tele-lactation within HIV care systems may strengthen equitable, person-centered lactation support.