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Background objectives: To compare cognitive performance between adolescents with and without perinatally acquired HIV and to evaluate the association between oral health and cognitive performance.

Methods: A cross-sectional analysis was conducted using baseline data from a study of 118 age- and sex-matched adolescents (59 PHIV, 59 HUU) aged 9.5-16.5 years in Benin City, Nigeria. Cognitive function was assessed using two tablet-based tools: NeuroScreen and the NIH Toolbox Cognition Battery. Oral health was evaluated via clinical examination using the Decayed, Missing, and Filled Teeth (DMFT) and oral hygiene questionnaires. ANOVA and ANCOVA were used to examine associations between HIV status, oral health, and cognitive outcomes.

Results: Adolescents with PHIV demonstrated significantly lower cognitive performance compared to their HUU peers, particularly in processing speed, executive function, and language domains. NeuroScreen assessments revealed longer completion times in Trail Making tasks (TM1: 44.8 vs 37.7, adjusted p = 0.039; TM2: 51.4 vs 42.5, adjusted p = 0.018; TM3: 25.6 vs 19.8, adjusted p = 0.027) and lower scores in Visual Discrimination (VD2: 19.3 vs 21.9, adjusted p = 0.002) and Number Speed tests (NSd: 53.1 vs 46.1, adjusted p = 0.008) among adolescents with PHIV. In addition, NIH Toolbox results indicated lower scores across all cognitive domains for adolescents with PHIV. Higher DMFT scores were associated with poorer executive function, and this relationship was observed only among adolescents with PHIV in stratified analyses, across both the NeuroScreen and NIH Toolbox assessments.

Conclusion: Adolescents with PHIV exhibited notable neurocognitive deficits and a tendency toward poorer oral health compared with uninfected peers. Poor oral health correlated with diminished cognitive performance, underscoring the need for integrated care models that address both neurocognitive and oral health in youth living with HIV.

Objective: Chronic inflammation may be associated with cognitive disorders in people with HIV (PWH) on antiretroviral treatment (ART). We examine associations between cognitive function (CF) and plasma biomarkers measured in PWH and demographically-similar people without HIV in the POPPY study.

Design: Prospective longitudinal cohort study.

Methods: At baseline and 2-year follow-up, participants completed a cognitive test battery. Global T-scores were derived by averaging domain T-scores. We used linear regression to explore associations between changes in Global T-scores and log-transformed plasma biomarkers of neuronal injury, systemic inflammation and innate immune activation. We explored whether effects of biomarkers differed by HIV status.

Results: 349 participants were included (73% PWH, median [interquartile range, IQR] age 54 [50-60] years, 85% male, 95% white). Among PWH, 98% were on ART, 93% had HIV-RNA ≤ 50 copies/mL and median [IQR] CD4+ count was 627 [490,792] cells/mm 3 . Mean (standard deviation (SD)) baseline Global T-score was 47.7 (5.9) which increased to 48.9 (5.5) after a median [IQR] follow-up of 26 [24,29] months. Lower average increases in Global T-scores were seen in those with higher MIP-1α concentrations (parameter estimate: -0.27 [95%CI:-0.51,-0.03] /10% increase) and sCD14 (-0.17 [-0.30,-0.03]), though only MIP-1α (-0.46 [-0.58,-0.10]) remained significant after adjustment. There was no evidence that the associations differed by HIV status.

Conclusion: Higher MIP-1α and sCD14 showed small associations with lower average increases in Global T-scores, with no differences by HIV status or inflammatory clusters, highlighting the multifactorial influences on cognitive trajectories in people ageing with and without HIV.

Objective: To assess the prevalence and patterns of treatment-emergent resistance-associated mutations (RAMs) in people with HIV (PWH) with ≥1 prior regimen experiencing virologic failure (VF) with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), dolutegravir/lamivudine (DTG/3TC), or cabotegravir/rilpivirine (CAB + RPV) in an observational setting.

Design: A noninterventional, multicenter, retrospective, observational study was conducted between January 1, 2022, to December 31, 2024 using a national French multicenter database of genotypic resistance assays performed at confirmed VF.

Methods: VF was defined as 2 consecutive HIV-1 plasma viral loads of >50 copies/mL. Genotypic resistance assays were performed using Sanger sequencing. Treatment-emergent RAMs were characterized using the 2024 ANRS algorithm. Clinical history, virologic history, and demographic data were collected from medical records during standard clinical follow-up.

Results: A total of 6523 PWH were followed over 3 years. The prevalence of VF during follow-up was 6% with B/F/TAF, 5% with DTG/3TC, and 5% with CAB + RPV. The prevalence of treatment-emergent RAMs at VF were 3% with B/F/TAF, 15% with DTG/3TC, and 32% with CAB + RPV. Dual treatment-emergent integrase strand transfer inhibitor (InSTI) and nucleoside reverse transcriptase inhibitor (NRTI) RAMs were observed with B/F/TAF and DTG/3TC, while dual treatment-emergent nonnucleoside reverse transcriptase inhibitor (NNRTI) and InSTI RAMs were observed with CAB + RPV.

Conclusions: The overall prevalence of VF was low for all regimens. B/F/TAF was associated with a numerically lower prevalence of RAMs at VF compared with DTG/3TC and CAB + RPV. These observational findings highlight the importance of monitoring resistance patterns to optimize HIV treatment outcomes.

Objective: HIV-pre-exposure prophylaxis (PrEP) implementation can be examined by the PrEP care continuum that defines steps toward effective HIV prevention. We examined the PrEP continuum among gay, bisexual and other men who have sex with men (GBMSM) in the Netherlands and in Amsterdam.

Design: Cross-sectional study combining multiple data sources.

Methods: The following steps of the PrEP care continuum were estimated for 2023: 1) GBMSM not living with HIV, 2) accessed sexual health services, 3) PrEP-eligible, 4) PrEP-intention, 5) current PrEP use, and 6) PrEP continuation. The number of GBMSM progressing through each step were estimated and percentages were calculated using the nominator of the previous step.

Results: An estimated 746,061 (Uncertainty Interval (UI) 634,503-856,079) GBMSM were not living with HIV in the Netherlands. Of those, 44,911 (6%, UI 5-7%) accessed sexual health services, of whom 34,895 (78%, UI 71-86%) were PrEP-eligible. We estimate that 22,002 (63%, UI 49-78%) of those had intention to use PrEP. Of those with PrEP-intention, 12,341 (56%, UI 47-69%) currently used PrEP and 10,097 (82%) of those continued PrEP. Of those who accessed sexual health services, 23% continued PrEP in the Netherlands, and 30% in Amsterdam.

Conclusions: When having accessed sexual health services, retention in the PrEP care continuum was high, except for 'PrEP-intention' and 'current use' on the national level. To optimize PrEP implementation, targeted interventions to close this gap and annual monitoring of the PrEP care continuum using standardized resources are needed.

Objective: Investigate whether antiretroviral metabolites tenofovir-diphosphate (TFVdp) and lamivudine triphosphate (3TCtp) in dried blood spots (DBS) are reliable markers of ART adherence by predicting viral suppression in postpartum women living with HIV in resource-limited settings.

Design: Prospective cohort study.

Methods: Pregnant women diagnosed with HIV who started ART from 10/2018-07/2021 and participated in a video-based intervention trial were included in this substudy. Whole blood samples were collected 12 months after ART initiation to measure viral load, TFVdp, and 3TCtp. Ability of TFVdp and 3TCtp to identify HIV-suppressed women was assessed using area under the curve (AUC) in receiver operating characteristic (ROC) analysis and compared to self-reported adherence data.

Results: We included 588 women, with a mean age of 27 years. TFVdp and 3TCtp concentrations were detected in 82% (482/588) and 77% (455/588) of samples, respectively. Daily TFVdp dosing concentrations (≥1,400 fmol/punch) were observed in 389 women of whom 86% (333/389) were HIV suppressed compared with only 22% (28/128) in those taking fewer than two doses per week; similar results were observed for 3TCtp (TFVdp OR = 21.2, 95% CI: 12.8-35.2; 3TCtp OR = 7.5, 95% CI: 3.7-15.3). ROC analysis revealed identical AUCs of 0.83 (95% CI: 0.78-0.87) for both metabolites, which was significantly higher than the AUC for self-reported adherence data (0.58, 95% CI: 0.53-0.63). Approximately one-third of women had TFVdp levels >2,800 fmol/punch, which was higher than expected for daily dosing.

Conclusions: TFVdp and 3TCtp concentrations measured in DBS samples are reliable markers of ART adherence and outperform self-reported adherence data. High TFVdp levels warrant further investigations.

Objectives: We described and compared infectious-cause hospitalisation outcomes among children born without HIV in the Western Cape (WC), South Africa, during the WHO Option B+ (2013-2015) and universal ART (2016-2018) eras by exposure to maternal HIV and ART.

Design: Retrospective cohort.

Methods: Using data from the WC Provincial Health Data Centre, we described rates, causes and risk factors of infectious-cause hospitalisations, up to age 3 years, among children born at a public WC health facility. We compared rates of and risk factors for admission, in children exposed to maternal HIV and uninfected (HEU) and children HIV unexposed and uninfected (HUU), in the neonatal, post-neonatal (age >28 days to ≤12 months), and age >12-36 month periods using mixed-effects Poisson regression. Regression models were adjusted for maternal age and suburb of residence.

Results: We included 398,334 mother-child pairs, 17.2% children HEU and 82.8% HUU. Infectious-cause hospitalisation, between birth and age 3 years, occurred in 11.5% vs. 10.9% of children HEU and HUU respectively. Children HEU experienced higher rates of hospitalisation than children HUU, irrespective of maternal ART history, during the neonatal period (adjusted incidence rate ratios, aIRRs: 1.34-1.66) and post-neonatal period (aIRRs: 1.13-1.42), but not during the >12-36 month period. Among children HEU, maternal VL ≥1000/mL vs. <1000/mL during pregnancy was associated with higher admission rates during the post-neonatal period (aIRR = 1.15; 95% CI:1.06-1.25).

Conclusions: Irrespective of timing of maternal ART start, children HEU vs. HUU had higher rates of infectious-cause hospitalisation during the first year of life, but not thereafter.

Objectives: People with HIV (PWH) are unable to get private disability insurance on a regular basis in contrast with individuals with other chronic diseases. We aimed to estimate the risk of public disability pension and work absence due to sickness for PWH compared with the background population in Denmark.

Design: Nationwide, population-based, matched cohort study of employed PWH with favorable disease characteristics. A comparison cohort of employed individuals was matched 10:1 to PWH by date of birth and sex from the general population.

Methods: We computed time to first date of 4 weeks of uninterrupted sick leave, 26 weeks of uninterrupted sick leave, and disability pension being granted. We used Cox regression to obtain hazard ratios (HRs) as a measure of relative risk and competing risk analysis to assess absolute risk.

Results: After 6 months of observation, PWH had an increased risk of 4-week sick leave, 26-week sick leave and disability pension compared with the comparison cohort (HR of 1.1 (95% CI: 1.0-1.2), 1.4 (95% CI: 1.1-1.6) and 2.0 (95% CI: 1.5-2.6), respectively). These risks were increased in most patient subgroups.

Conclusion: PWH have an increased risk of prolonged sick leave and disability pension, and a slightly increased risk of 4-week sick leave. These risks were within the range of what is described for other chronic diseases. PWH with contemporary cART and favorable disease characteristics should not be generally excluded from access to private disability insurance.

We assessed integrase resistance in 837 treatment-experienced people with HIV (PWH) with virological failure (2022-2024) in Portugal. Major resistance mutations were found in 5.5%, with N155H and R263K being the most common. Resistance was more frequent in non-B subtypes and often co-occurred with resistance to other antiretroviral classes. Though prevalence remains low, the findings highlight the need for continued surveillance to inform treatment decisions, especially as integrase inhibitors like dolutegravir, bictegravir and cabotegravir become more widely used.

Antiretroviral therapy (ART) effectively controls HIV replication but adherence in infants and children remains a challenge. This study analyzed broadly neutralizing antibody (bNAb) resistance in viral isolates from perinatally infected infants from Mozambique. We found high intra-individual bNAb resistance heterogeneity, unrelated to viral burden, and evidence for early or preexisting resistance. These findings underscore the importance of individualized resistance screening and reinforce the need for accessible, adherence-supportive ART strategies in pediatric HIV.

Background: Social determinants of health (SDoH) impact health outcomes and rarely exert their influence in isolation. We examined associations between SDoH patterns, multimorbidity and quality of life (QoL) in people of Black ethnicities with HIV in England.

Methods: This mixed-methods study comprised questionnaires, focus group discussions and semi-structured interviews with staff members from a community-based organization. We used principal component analysis to identify patterns of SDoH and z scores to describe the burden of each pattern. Associations between SDoH burden scores, multimorbidity and QoL (EQ-5D) were assessed using logistic regression, adjusting for sex and age.

Results: Amongst 340 participants [median (interquartile range, IQR) age 52 (45-57) years, 54% women, 95% HIV RNA <200 copies/ml], we identified three SDoH patterns: livelihood (food, employment and financial insecurity, loneliness and isolation), shelter/displacement (housing, migration and food insecurity) and social exclusion (discrimination, loneliness and isolation). An increase in SDoH z scores was associated with higher odds of multimorbidity [livelihood: adjusted odds ratio (aOR) 2.09 (1.63-2.69), shelter/displacement: 1.41 (1.12-1.78), social exclusion: 1.78 (1.40-2.26)]. Higher livelihood and social exclusion z scores correlated with all QoL domains ( P  < 0.001), and shelter/displacement was associated with problems with usual activity [aOR 1.29 (1.04-1.61), P  = 0.02] and pain/discomfort [1.29 (1.05-1.58), P  = 0.02]. Qualitative findings supported the quantitative findings whilst providing further context on how SDoH intersect and shape health.

Conclusion: This study highlights how SDoH intersect and are associated with multimorbidity and lower QoL in people of Black ethnicities living with HIV. These findings emphasize the need for comprehensive, biopsychosocial interventions to address health inequities in this population.