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Adverse perinatal outcomes associated with different classes of antiretroviral drugs in pregnant women living with HIV: a systematic review and meta-analysis. 与感染艾滋病病毒的孕妇服用不同类别的抗逆转录病毒药物有关的围产期不良后果:系统综述和荟萃分析。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-08 DOI: 10.1097/QAD.0000000000004032
Molly Hey, Lucy Thompson, Clara Portwood, Harriet Sexton, Mary Kumarendran, Zoe Brandon, Shona Kirtley, Joris Hemelaar

Objective: Women living with HIV (WLHIV) are at increased risk of adverse perinatal outcomes compared to HIV-negative women, despite antiretroviral therapy (ART). There is evidence that the risk of adverse perinatal outcomes may differ according to ART regimen. We aimed to assess the risk of adverse perinatal outcomes among WLHIV receiving different classes of ART, compared to HIV-negative women.

Design: Systematic review and meta-analysis.

Methods: We searched Medline, CINAHL, Global Health and EMBASE for studies published between 1 January 1980 and 14 July 2023. We included studies which assessed the risk of 11 predefined adverse perinatal outcomes among WLHIV receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART, protease inhibitor (PI)-based ART or integrase strand transfer inhibitor (INSTI)-based ART, compared to HIV-negative women. The perinatal outcomes assessed were preterm birth (PTB), very PTB (VPTB), spontaneous PTB (sPTB), low birthweight (LBW), very LBW (VLBW), term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth and neonatal death (NND). Random effects meta-analyses examined the risk of each adverse outcome in WLHIV receiving either NNRTI-based, PI-based or INSTI-based ART, compared with HIV-negative women. Subgroup and sensitivity analyses were conducted based on country income status, study quality, and timing of ART initiation. The protocol is registered with PROSPERO, CRD42021248987.

Results: Of 108,720 identified citations, 22 cohort studies including 191,857 women were eligible for analysis. We found that WLHIV receiving NNRTI-based ART (mainly efavirenz or nevirapine) are at increased risk of PTB (risk ratio (RR) 1.40, 95% confidence interval 1.27-1.56), VPTB (1.94, 1.25-3.01), LBW (1.63, 1.30-2.04), SGA (1.53, 1.17-1.99) and VSGA (1.48, 1.16-1.87), compared with HIV-negative women. WLHIV receiving PI-based ART (mainly lopinavir/ritonavir or unspecified) are at increased risk of PTB (1.88, 1.55-2.28), VPTB (2.06, 1.01-4.18), sPTB (16.96, 1.01-284.08), LBW (2.90, 2.41-3.50), VLBW (4.35, 2.67-7.09) and VSGA (2.37, 1.84-3.05), compared with HIV-negative women. WLHIV receiving INSTI-based ART (mainly dolutegravir) are at increased risk of PTB (1.17, 1.06-1.30) and SGA (1.20, 1.08-1.33), compared with HIV-negative women.

Conclusions: The risks of adverse perinatal outcomes are higher among WLHIV receiving ART compared with HIV-negative women, irrespective of the class of ART drugs. This underlines the need to further optimise ART in pregnancy and improve perinatal outcomes of WLHIV.

目的:与 HIV 阴性女性相比,尽管接受了抗逆转录病毒疗法(ART),但感染 HIV 的女性(WLHIV)围产期不良预后的风险更高。有证据表明,抗逆转录病毒疗法不同,围产期不良结局的风险也可能不同。我们旨在评估与 HIV 阴性女性相比,接受不同类别抗逆转录病毒疗法的 WLHIV 患者围产期不良结局的风险:系统回顾和荟萃分析:我们检索了 Medline、CINAHL、Global Health 和 EMBASE 中 1980 年 1 月 1 日至 2023 年 7 月 14 日期间发表的研究。我们纳入的研究评估了接受非核苷类逆转录酶抑制剂 (NNRTI) 抗逆转录病毒疗法、蛋白酶抑制剂 (PI) 抗逆转录病毒疗法或整合酶链转移抑制剂 (INSTI) 抗逆转录病毒疗法的 WLHIV 妇女与 HIV 阴性妇女相比发生 11 种预定义不良围产期结局的风险。所评估的围产期结局包括早产 (PTB)、极早产 (VPTB)、自发性早产 (sPTB)、低出生体重 (LBW)、极低出生体重 (VLBW)、足月低出生体重、早产低出生体重、小于胎龄 (SGA)、极小于胎龄 (VSGA)、死产和新生儿死亡 (NND)。随机效应荟萃分析研究了与 HIV 阴性女性相比,接受 NNRTI、PI 或 INSTI 抗逆转录病毒疗法的 WLHIV 感染各种不良结局的风险。根据国家收入状况、研究质量和开始接受抗逆转录病毒疗法的时间进行了分组分析和敏感性分析。该研究方案已在 PROSPERO 注册,注册号为 CRD42021248987:结果:在 108,720 篇已识别的引文中,有 22 项队列研究(包括 191,857 名女性)符合分析条件。我们发现,与 HIV 阴性女性相比,接受以 NNRTI 为基础的抗逆转录病毒疗法(主要是依非韦伦或奈韦拉平)的 WLHIV 患 PTB(风险比 (RR) 1.40,95% 置信区间 1.27-1.56)、VPTB(1.94,1.25-3.01)、LBW(1.63,1.30-2.04)、SGA(1.53,1.17-1.99)和 VSGA(1.48,1.16-1.87)的风险更高。接受以 PI 为基础的抗逆转录病毒疗法(主要是洛匹那韦/利托那韦或未指定)的 WLHIV 感染 PTB(1.88,1.55-2.28)、VPTB(2.06,1.01-4.18)、sPTB(16.96,1.01-284.08)、LBW(2.90,2.41-3.50)、VLBW(4.35,2.67-7.09)和 VSGA(2.37,1.84-3.05)。与 HIV 阴性妇女相比,接受 INSTI 抗逆转录病毒疗法(主要是多罗替韦)的 WLHIV 患 PTB(1.17,1.06-1.30)和 SGA(1.20,1.08-1.33)的风险更高:结论:与 HIV 阴性妇女相比,接受抗逆转录病毒疗法的 WLHIV 妇女围产期不良结局的风险更高,无论抗逆转录病毒疗法药物的类别如何。这强调了进一步优化妊娠期抗逆转录病毒疗法并改善 WLHIV 围产期结局的必要性。
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引用次数: 0
Person-centered pre-exposure prophylaxis: the next wave of innovation in HIV prevention. 以人为本的暴露前预防:艾滋病预防的下一波创新。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-07 DOI: 10.1097/QAD.0000000000004030
Iulia Filip
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引用次数: 0
Accuracy of nine-item Patient Health Questionnaire against psychiatric diagnosis for depression among people with HIV. PHQ-9 对艾滋病病毒感染者抑郁症精神诊断的准确性:一项多县横断面研究。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-26 DOI: 10.1097/QAD.0000000000003963
Marcel Yotebieng, Natalia Zotova, Charlotte Bernard, Suzanne Goodrich, Ajeh Rogers Awoh, Dana Watnick, Dominique Mahambu Nsonde, Elodie Flore Tchiengang Moungang, Julie Laure Nguemo Noumedem, Guy Calvin Nko'o Mbongo'o, Albert Minga, Moussa Seydi, Paul Gandou, Edith Kamaru Kwobah, Lukoye Atwoli, Antoine Jaquet, Kara Wools-Kaloustian, Kathryn Anastos

Objective: The aim of this study was to assess the performance of the nine-item Patient Health Questionnaire (PHQ-9) against psychiatrist diagnosis in people with HIV (PWH).

Design: Cross-sectional analysis of data collected between January 2018 and July 2022 across five sites in Cameroon, Cote d'Ivoire, Kenya, Senegal, and the Republic of Congo. Participants were ≥18 years and receiving HIV care at the participating site. PHQ-9 was administered by study staff followed by a psychiatrist's evaluation within 3 days.

Results: Overall, 778 participants with complete data were included: 297 (38.2%) in Cameroon, 132 (17.0%) in Congo, 148 (19.0%) in Cote d'Ivoire, 98 (12.6%) in Kenya, and 103 (13.2%) in Senegal. The area under the curve for PHQ-9 score was generally high ranging from 0.935 [95% confidence interval (CI): 0.893, 0.977] in Cote d'Ivoire to 0.768 (95% CI: 0.589, 0.947) in Congo. However, for the common cut-off score ≥10, sensitivity was low: 50% or lower in Cameroon, Congo and Senegal, 66.7% in Kenya and 70.6% in Cote d'Ivoire. But negative predictive values (NPV) were high: 98.9% (95% CI: 96.9%, 99.8%) in Cameroon, 96.1 (95% CI: 91.1, 98.7) in Cote d'Ivoire, 96.3% (95% CI: 89.7%, 99.2%) in Kenya, 95.7% (95% CI: 90.2%, 98.6%) in Congo, and 89.0% (95% CI: 81.2%, 94.4%) in Senegal.

Interpretation: Across all countries, PHQ-9 score ≥10 performed very poorly (low sensitivity) as a tool to identify psychiatrist diagnosed depression. However, the observed high NPV suggests it can be used to rule out depression.

研究目的本研究旨在评估 9 项患者健康问卷(PHQ-9)与精神病医生对 PLWH 诊断的对比情况:对2018年1月至2022年7月期间在喀麦隆、科特迪瓦、肯尼亚、塞内加尔和刚果共和国五个地点收集的数据进行横断面分析。参与者年龄≥18 岁,并在参与地点接受艾滋病护理。研究人员对参与者进行PHQ-9测试,然后在3天内由精神科医生进行评估:共有 778 名参与者提供了完整的数据:喀麦隆有 297 人(38.2%),刚果有 132 人(17.0%),科特迪瓦有 148 人(19.0%),肯尼亚有 98 人(12.6%),塞内加尔有 103 人(13.2%)。PHQ-9 评分的曲线下面积普遍较高,科特迪瓦为 0.935(95% CI:0.893,0.977),刚果为 0.768(95% CI:0.589,0.947)。然而,对于常用的截断分数≥10,灵敏度较低:喀麦隆、刚果和塞内加尔为 50%或更低,肯尼亚为 66.7%,科特迪瓦为 70.6%。但阴性预测值(NPV)很高:喀麦隆为 98.9%(95% CI:96.9%,99.8%),科特迪瓦为 96.1(95% CI:91.1,98.7),肯尼亚为 96.3%(95% CI:89.7%,99.2%),刚果为 95.7%(95% CI:90.2%,98.6%),塞内加尔为 89.0%(95% CI:81.2%,94.4%):在所有国家中,PHQ-9 评分≥10 分的人作为精神科医生诊断抑郁症的识别工具表现很差(灵敏度低)。然而,观察到的高 NPV 表明它可用于排除抑郁症。
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引用次数: 0
The impact of past HIV interventions and diagnosis gaps on new HIV acquisitions, transmissions, and HIV-related deaths in Côte d'Ivoire, Mali, and Senegal. 在科特迪瓦、马里和塞内加尔,过去的艾滋病毒干预措施和诊断差距对新感染艾滋病毒、艾滋病毒传播和艾滋病毒相关死亡的影响。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-01 DOI: 10.1097/QAD.0000000000003974
Romain Silhol, Mathieu Maheu-Giroux, Nirali Soni, Arlette Simo Fotso, Nicolas Rouveau, Anthony Vautier, Clémence Doumenc-Aïdara, Olivier Geoffroy, Kouassi Noël N'Guessan, Younoussa Sidibé, Odé Kanku Kabemba, Papa Alioune Gueye, Pauline Dama Ndeye, Christinah Mukandavire, Peter Vickerman, Abdelaye Keita, Cheikh Tidiane Ndour, Eboi Ehui, Joseph Larmarange, Marie-Claude Boily

Objectives: To estimate the epidemiological impact of past HIV interventions and the magnitude and contribution of undiagnosed HIV among different risk groups on new HIV acquisitions in Côte d'Ivoire, Mali and Senegal.

Design: HIV transmission dynamic models among the overall population and key populations [female sex workers (FSW), their clients, and MSM].

Methods: Models were independently parameterized and calibrated for each set of country-specific demographic, behavioural, and epidemiological data. We estimated the fraction of new HIV infections over 2012-2021 averted by condom use and antiretroviral therapy (ART) uptake among key populations and non-key populations, the direct and indirect contribution of specific groups to new infections [transmission population-attributable fraction (tPAF)] over 2012-2021 due to prevention gaps, and the distribution of undiagnosed people with HIV (PWH) by risk group in January 2022 and their tPAF over 2022-2031.

Results: Condom use and ART may have averted 81-88% of new HIV infections over 2012-2021 across countries, mostly due to condom use by key population. The tPAF of all key populations combined over 2012-2021 varied between 27% (Côte d'Ivoire) and 79% (Senegal). Male key populations (clients of FSW and MSM) contributed most to new infections (>60% in Mali and Senegal) owing to their higher HIV prevalence and larger prevention gaps. In 2022, men represented 56% of all PWH with an undiagnosed infection in Côte d'Ivoire (male key populations = 15%), 46% in Mali (male key populations = 23%), and 69% in Senegal (male key populations = 55%). If HIV testing and ART initiation rates remain at current levels, 20% of new HIV infections could be due to undiagnosed key populations living with HIV in Côte d'Ivoire over 2022-2031, 53% in Mali, and 65% in Senegal.

Conclusion: Substantial HIV diagnosis gaps remain in Western Africa, especially among male key populations. Addressing these gaps is key to impacting the HIV epidemics in the region and achieving the goal of ending AIDS by 2030.

目标:在科特迪瓦、马里和塞内加尔,估计过去的 HIV 干预措施对流行病学的影响,以及不同风险群体中未诊断出的 HIV 对新感染 HIV 的影响程度和贡献:设计:在总体人群和关键人群[女性性工作者 (FSW)、其客户和男男性行为者]中建立 HIV 传播动态模型:方法:针对每个国家特定的人口、行为和流行病学数据集,对模型进行独立参数化和校准。我们估算了重点人群和非重点人群使用安全套和接受抗逆转录病毒疗法(ART)所避免的 2012-2021 年艾滋病毒新感染病例的比例、特定人群因预防差距而对 2012-2021 年新感染病例的直接和间接贡献[传播人口可归因比例(tPAF)],以及 2022 年 1 月按风险人群分列的未确诊感染者分布情况及其 2022-2031 年的传播人口可归因比例:结果:使用安全套和抗逆转录病毒疗法可能避免了各国 2012-2021 年间 81-88% 的艾滋病毒新感染病例,这主要是因为关键人群使用了安全套。在 2012-2021 年期间,所有关键人群的总 tPAF 在 27%(科特迪瓦)和 79%(塞内加尔)之间。男性关键人群(性工作者和男男性行为者的客户)对新感染的贡献最大(在马里和塞内加尔>60%),因为他们的艾滋病毒感染率更高,预防差距更大。2022 年,在科特迪瓦(男性关键人群 = 15%)、马里(男性关键人群 = 23%)和塞内加尔(男性关键人群 = 55%),男性占所有未确诊感染的艾滋病毒感染者的 56%。如果艾滋病毒检测和抗逆转录病毒疗法的启动率保持在目前的水平,那么在 2022-2031 年期间,科特迪瓦 20% 的艾滋病毒新感染病例可能来自未确诊的重点人群艾滋病毒感染者,马里为 53%,塞内加尔为 65%:结论:在西非,艾滋病毒诊断仍存在巨大差距,尤其是在男性重点人群中。解决这些差距是影响该地区艾滋病疫情和实现到 2030 年根除艾滋病目标的关键。
{"title":"The impact of past HIV interventions and diagnosis gaps on new HIV acquisitions, transmissions, and HIV-related deaths in Côte d'Ivoire, Mali, and Senegal.","authors":"Romain Silhol, Mathieu Maheu-Giroux, Nirali Soni, Arlette Simo Fotso, Nicolas Rouveau, Anthony Vautier, Clémence Doumenc-Aïdara, Olivier Geoffroy, Kouassi Noël N'Guessan, Younoussa Sidibé, Odé Kanku Kabemba, Papa Alioune Gueye, Pauline Dama Ndeye, Christinah Mukandavire, Peter Vickerman, Abdelaye Keita, Cheikh Tidiane Ndour, Eboi Ehui, Joseph Larmarange, Marie-Claude Boily","doi":"10.1097/QAD.0000000000003974","DOIUrl":"10.1097/QAD.0000000000003974","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the epidemiological impact of past HIV interventions and the magnitude and contribution of undiagnosed HIV among different risk groups on new HIV acquisitions in Côte d'Ivoire, Mali and Senegal.</p><p><strong>Design: </strong>HIV transmission dynamic models among the overall population and key populations [female sex workers (FSW), their clients, and MSM].</p><p><strong>Methods: </strong>Models were independently parameterized and calibrated for each set of country-specific demographic, behavioural, and epidemiological data. We estimated the fraction of new HIV infections over 2012-2021 averted by condom use and antiretroviral therapy (ART) uptake among key populations and non-key populations, the direct and indirect contribution of specific groups to new infections [transmission population-attributable fraction (tPAF)] over 2012-2021 due to prevention gaps, and the distribution of undiagnosed people with HIV (PWH) by risk group in January 2022 and their tPAF over 2022-2031.</p><p><strong>Results: </strong>Condom use and ART may have averted 81-88% of new HIV infections over 2012-2021 across countries, mostly due to condom use by key population. The tPAF of all key populations combined over 2012-2021 varied between 27% (Côte d'Ivoire) and 79% (Senegal). Male key populations (clients of FSW and MSM) contributed most to new infections (>60% in Mali and Senegal) owing to their higher HIV prevalence and larger prevention gaps. In 2022, men represented 56% of all PWH with an undiagnosed infection in Côte d'Ivoire (male key populations = 15%), 46% in Mali (male key populations = 23%), and 69% in Senegal (male key populations = 55%). If HIV testing and ART initiation rates remain at current levels, 20% of new HIV infections could be due to undiagnosed key populations living with HIV in Côte d'Ivoire over 2022-2031, 53% in Mali, and 65% in Senegal.</p><p><strong>Conclusion: </strong>Substantial HIV diagnosis gaps remain in Western Africa, especially among male key populations. Addressing these gaps is key to impacting the HIV epidemics in the region and achieving the goal of ending AIDS by 2030.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1783-1793"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11356671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141490465","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}
引用次数: 0
Impact of COVID-19 vaccination on HIV parameters in people with HIV on antiretroviral therapy. 接种 COVID-19 疫苗对接受抗逆转录病毒疗法的艾滋病病毒感染者体内艾滋病病毒参数的影响。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-29 DOI: 10.1097/QAD.0000000000003969
Tiurlina Siregar, Rebeka Konstantina Weriditi, Yansen Alberth Reba, M Zaenul Muttaqin, Yovian Yustiko Prasetya
{"title":"Impact of COVID-19 vaccination on HIV parameters in people with HIV on antiretroviral therapy.","authors":"Tiurlina Siregar, Rebeka Konstantina Weriditi, Yansen Alberth Reba, M Zaenul Muttaqin, Yovian Yustiko Prasetya","doi":"10.1097/QAD.0000000000003969","DOIUrl":"https://doi.org/10.1097/QAD.0000000000003969","url":null,"abstract":"","PeriodicalId":7502,"journal":{"name":"AIDS","volume":"38 12","pages":"1807-1808"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103438","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}
引用次数: 0
Cancer in people with multidrug-resistant HIV. 耐多药艾滋病病毒感染者中的癌症。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-29 DOI: 10.1097/QAD.0000000000003952
Tommaso Clemente, Domenico Pontillo, Vincenzo Malagnino, Leonardo Calza, Antonio Di Biagio, Giovanni Cenderello, Riccardo Lolatto, Elio Manzillo, Maria Cristina Moioli, Giuseppe Vittorio De Socio, Antonella Castagna, Vincenzo Spagnuolo

Retrospective, cohort analysis including people with HIV and 4-class drug resistance (4DR). The 8-year probability of malignancy after first evidence of 4DR was 12%, with an incidence of 1.6/100 person years of follow-up. Cancer risk tended to increase with higher precancer viremia copy-years adjusted for time [per 1 - log10 copies/ml higher: adjusted hazard ratio (aHR) = 1.35; 95% confidence interval (95% CI) = 0.98-1.85] and male sex-assigned-at-birth (aHR = 2.50; 95% CI = 0.86-7.27). Efforts to achieve long-term undetectability, risk factor control, prevention, and more aggressive cancer screening are needed in this fragile population.

回顾性队列分析,包括艾滋病病毒感染者和4类耐药性(4DR)患者。首次发现 4DR 后 8 年的恶性肿瘤概率为 12%,随访期间的发病率为 1.6/100 人年。经时间调整后,癌症风险往往随着癌前病毒拷贝数-年数的增加而增加[每增加1-log10拷贝数/毫升:调整后危险比(aHR)=1.35;95%置信区间(95% CI)=0.98-1.85]以及出生时性别为男性(aHR=2.50;95% CI=0.86-7.27)。在这一脆弱人群中,需要努力实现长期检测不到、风险因素控制、预防和更积极的癌症筛查。
{"title":"Cancer in people with multidrug-resistant HIV.","authors":"Tommaso Clemente, Domenico Pontillo, Vincenzo Malagnino, Leonardo Calza, Antonio Di Biagio, Giovanni Cenderello, Riccardo Lolatto, Elio Manzillo, Maria Cristina Moioli, Giuseppe Vittorio De Socio, Antonella Castagna, Vincenzo Spagnuolo","doi":"10.1097/QAD.0000000000003952","DOIUrl":"https://doi.org/10.1097/QAD.0000000000003952","url":null,"abstract":"<p><p>Retrospective, cohort analysis including people with HIV and 4-class drug resistance (4DR). The 8-year probability of malignancy after first evidence of 4DR was 12%, with an incidence of 1.6/100 person years of follow-up. Cancer risk tended to increase with higher precancer viremia copy-years adjusted for time [per 1 - log10 copies/ml higher: adjusted hazard ratio (aHR) = 1.35; 95% confidence interval (95% CI) = 0.98-1.85] and male sex-assigned-at-birth (aHR = 2.50; 95% CI = 0.86-7.27). Efforts to achieve long-term undetectability, risk factor control, prevention, and more aggressive cancer screening are needed in this fragile population.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":"38 12","pages":"1801-1806"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103435","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}
引用次数: 0
Increasing HIV prevalence rate among men who have sex with men: results of a comparison of two national surveys. 男男性行为者中艾滋病毒感染率的上升:两项全国性调查的比较结果。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-29 DOI: 10.1097/QAD.0000000000003934
Marto Leal, Ligia Kerr, Rosa M S Mota, Ana R C Motta-Castro, Luana N C Lima, Lisangela C Oliveira, Edgar Merchan-Hamann, Ximena Pamela Díaz Bermudez, Alexandre K Pontes, Regina C Moreira, Mark Guimarães, Ana Maria Brito, Inês Dourado, Maria Amelia Veras, Andréa F Leal, Daniela Knauth, Raimunda H M Macena, Luís Brigido, Laio Magno, Carl Kendall

Our objective was to compare HIV prevalence between two national surveys among men who have sex with men in Brazil in 2009 and 2016. HIV prevalence was estimated stratifying by age and socioeconomic status. HIV prevalence increased from 11.9% [95% confidence interval (CI): 9.9-14.3], in 2009, to 19.1% (95% CI: 16.5 - 22.0), in 2016 [odds ratio (OR) = 1.8; 95% CI: 1.3-2.3] increasing 320% among Young MSM of low SES. Political leadership is needed to develop a scientifically sound and inclusive solution.

我们的目的是比较 2009 年和 2016 年两次全国性调查在巴西男男性行为者中的 HIV 感染率。根据年龄和社会经济状况对艾滋病毒感染率进行了分层估算。HIV 感染率从 2009 年的 11.9% [95% 置信区间 (CI):9.9-14.3]上升到 2016 年的 19.1% (95% CI:16.5-22.0)[几率比 (OR) = 1.8; 95% CI:1.3-2.3],在社会经济地位较低的年轻 MSM 中增加了 320%。需要政治领导力来制定科学合理且具有包容性的解决方案。
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引用次数: 0
Deconvoluting the contribution of antiretroviral choice in weight gain. 分解抗逆转录病毒疗法对体重增加的影响。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-29 DOI: 10.1097/QAD.0000000000003980
Melanie R Nicol, Halima Dawood, Jennifer F Hoy
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引用次数: 0
Trends in HIV testing and HIV stage at diagnosis among people newly diagnosed with HIV. 新诊断出的艾滋病毒感染者中艾滋病毒检测和艾滋病毒诊断阶段的趋势。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.1097/QAD.0000000000003961
Jonathan M King, Timothy Dobbins, Phillip Keen, Vincent J Cornelisse, Mark Stoové, Steven J Nigro, Jason Asselin, Nasra Higgins, Limin Mao, Htein Linn Aung, Kathy Petoumenos, Skye McGregor

Objective: To identify groups more likely to be referred for HIV testing because of symptomatic presentation rather than as part of asymptomatic screening.

Design: A retrospective analysis of Australian National HIV Registry (NHR) surveillance data including sociodemographic and clinical data, as well as reasons for HIV test.

Methods: Using notification records from 2017 to 2022, we summarised reasons for testing leading to an HIV diagnosis. Reasons for testing were combined with clinical status at diagnosis to derive HIV testing categories: testing while symptomatic; asymptomatic HIV screening; seroconversion; and other test reason. We stratified these categories by stage of HIV at diagnosis with late-stage HIV defined as a CD4 + cell count <350 cells/μl at time of diagnosis.

Results: Among 4134 HIV notifications with at least one reason for testing recorded, STI screening was the predominant reason for test referral (38%), followed by HIV indicative symptoms (31%), and risk behaviour (13%). By testing category, people aged 50 years or older (24%), people with HIV attributed to heterosexual sex (21%), people born in sub-Saharan Africa (19%), and women (17%) had lower levels of asymptomatic screening. More late-stage HIV diagnoses resulted from testing while symptomatic (58%) compared with asymptomatic screening (25%).

Conclusions: Older people and heterosexuals may not access HIV focused healthcare where HIV screening is routinely offered. Instead, HIV testing opportunities may arise in other settings. By normalising HIV testing and offering low-cost HIV screening in a range of settings, it may be possible to facilitate earlier HIV diagnoses, better health outcomes, and reduced onward transmission.

目的确定哪些人群更有可能因出现症状而被转介进行 HIV 检测,而不是作为无症状筛查的一部分:对澳大利亚国家艾滋病登记处(NHR)监测数据进行回顾性分析,包括社会人口学和临床数据,以及进行艾滋病检测的原因:利用 2017 年至 2022 年的通知记录,我们总结了导致 HIV 诊断的检测原因。将检测原因与诊断时的临床状态相结合,得出了艾滋病毒检测类别:有症状时检测;无症状艾滋病毒筛查;血清转换;其他检测原因。我们按照诊断时的 HIV 感染阶段对这些类别进行了分层,晚期 HIV 感染被定义为 CD4 细胞计数结果:在 4,134 份至少有一个检测原因记录的艾滋病毒通报中,性传播感染筛查是转介检测的主要原因(38%),其次是艾滋病毒提示症状(31%)和危险行为(13%)。按检测类别划分,50 岁或以上人群(24%)、异性性行为感染艾滋病毒者(21%)、撒哈拉以南非洲出生的人(19%)和女性(17%)的无症状筛查率较低。与无症状筛查(25%)相比,有症状时进行的检测(58%)导致了更多的后期艾滋病毒诊断:结论:老年人和异性恋者可能无法获得常规提供 HIV 筛查的以 HIV 为重点的医疗保健服务。相反,HIV 检测机会可能会出现在其他场合。通过将艾滋病毒检测常态化,并在各种环境中提供低成本的艾滋病毒筛查,有可能促进更早地诊断出艾滋病毒,改善健康状况,并减少继续传播。
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引用次数: 0
Risk factors for progression from prediabetes to diabetes among older people with HIV. 感染艾滋病毒的老年人从糖尿病前期发展为糖尿病的风险因素。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.1097/QAD.0000000000003970
Mary Clare Masters, Katherine Tassiopoulos, Yajing Bao, Kunling Wu, Susan L Koletar, Leah H Rubin, Jingyan Yang, Edgar T Overton, Scott Letendre, Todd T Brown, Kristine M Erlandson, Frank J Palella

Objective: Risk factors for progression from prediabetes mellitus (pre-DM) to diabetes mellitus (DM) among people with HIV (PWH) receiving modern antiretroviral therapy (ART) require better characterization.

Design: AIDS Clinical Trials Group (ACTG) A5322 (HAILO) was an observational cohort study of PWH ≥40 years old. Participants initiated ART through ACTG randomized clinical trials.

Methods: We used Cox proportional hazards regression models to identify risk factors for development of DM among HAILO participants with pre-DM.

Results: Among 1035 HAILO participants, 74 (7%) had pre-DM at entry and another 679 (66%) developed pre-DM during follow-up. Of 753 PWH with pre-DM, 167 (22%) developed DM. In multivariable models, the risk of developing DM was greater with higher BMI, lower CD4 count (≤200 cells/mm 3 ), hypertriglyceridemia, or higher waist circumference at pre-DM diagnosis ( P  < 0.01).

Conclusion: Rates of pre-DM and progression to DM remain high among virally suppressed PWH receiving modern ART regimens. Traditional risks for DM, such as higher BMI or waist circumference, are associated with increased risk of incident DM among PWH with pre-DM. The association between lower CD4 + and progression to DM suggests a role for advanced immunodeficiency and inflammation. Further investigation of interventions aimed at preventing DM among PWH with pre-DM is needed. Optimizing prevention and treatment for DM may be an intervenable opportunity to improve long-term outcomes for PWH.

目的接受现代抗逆转录病毒疗法(ART)的艾滋病病毒感染者(PWH)从糖尿病前期(pre-DM)发展为糖尿病(DM)的风险因素需要更好的描述:艾滋病临床试验组(ACTG)A5322(HAILO)是一项针对年龄≥40 岁的艾滋病病毒感染者的观察性队列研究。参与者通过 ACTG 随机临床试验开始接受抗逆转录病毒疗法:我们使用 Cox 比例危险度回归模型来确定 HAILO 参与者中发生 DM 的风险因素:在1035名HAILO参与者中,74人(7%)在入组时患有糖尿病前期,另有679人(66%)在随访期间发展为糖尿病前期。在753名有DM前期症状的PWH中,167人(22%)发展为DM。在多变量模型中,体重指数(BMI)越高、CD4 细胞数越低(≤200 cells/ mm3)、高甘油三酯血症或腰围越大的人患糖尿病前期的风险就越高(p 结论:糖尿病前期和病情恶化的发生率与体重指数(BMI)、CD4 细胞数(≤200 cells/ mm3)、高甘油三酯血症和腰围有关:在接受现代抗逆转录病毒疗法的病毒抑制型艾滋病患者中,糖尿病前期和糖尿病进展率仍然很高。传统的糖尿病风险,如较高的体重指数(BMI)或腰围,与糖尿病前期感染者中糖尿病发病风险的增加有关。CD4 较低与糖尿病进展之间的关联表明,晚期免疫缺陷和炎症也起着一定的作用。需要进一步调查旨在预防糖尿病前期的残疾人中发生糖尿病的干预措施。优化DM的预防和治疗可能是改善PWH长期预后的一个可干预机会。
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