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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。
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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。
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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
Challenges in clinical monitoring of people with HIV: evolution from prediabetes mellitus to diabetes mellitus. 艾滋病病毒感染者临床监测的挑战:从糖尿病前期到糖尿病的演变。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-29 DOI: 10.1097/QAD.0000000000003982
Luiz Fernando Gouvêa-E-Silva
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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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引用次数: 0
Efficacy and safety of tesamorelin in people with HIV on integrase inhibitors. 使用整合酶抑制剂的艾滋病毒感染者服用替沙莫林的有效性和安全性。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-20 DOI: 10.1097/QAD.0000000000003965
Samuel C Russo, Mollie W Ockene, Allison K Arpante, Julia E Johnson, Hang Lee, Mabel Toribio, Takara L Stanley, Colleen M Hadigan, Steven K Grinspoon, Kristine M Erlandson, Lindsay T Fourman

Objective: Tesamorelin is the only FDA-approved therapy to treat abdominal fat accumulation in people with HIV (PWH). Phase III clinical trials were conducted prior to the introduction of integrase inhibitors (INSTIs), which are now a mainstay of HIV antiretroviral therapy.

Design: We leveraged a randomized double-blind trial of 61 PWH and metabolic dysfunction-associated steatotic liver disease to evaluate the efficacy and safety of tesamorelin 2 mg once daily vs. identical placebo among participants on INSTI-based regimens at baseline.

Methods: In the parent clinical trial, visceral fat cross-sectional area, hepatic fat fraction, and trunk-to-appendicular fat ratio were quantified using magnetic resonance imaging, proton magnetic resonance spectroscopy, and dual-energy x-ray absorptiometry, respectively, at baseline and 12 months. Metabolic and safety outcomes were compared between treatment arms.

Results: Among 38 participants on INSTI-based regimens at baseline, 15 individuals on tesamorelin and 16 individuals on placebo completed the 12-month study. Tesamorelin led to significant declines in visceral fat (median [interquartile range]: -25 [-93, -2] vs. 14 [3, 41] cm 2 , P  = 0.001), hepatic fat (-4.2% [-12.3%, -2.7%] vs. -0.5% [-3.9%, 2.7%], P  = 0.01), and trunk-to-appendicular fat ratio (-0.1 [-0.3, 0.0] vs. 0.0 [-0.1, 0.1], P  = 0.03). Tesamorelin was well tolerated with a similar frequency of adverse events, including hyperglycemia, between groups.

Conclusions: The current analysis provides the first dedicated data on the efficacy and safety of tesamorelin among PWH on INSTI-based regimens. Despite the association of INSTI use with weight gain and adipose tissue dysfunction, tesamorelin had beneficial effects on body composition with no exacerbation of glycemic control.

目的特萨莫林是美国食品及药物管理局批准的唯一一种治疗艾滋病病毒感染者(PWH)腹部脂肪堆积的疗法。III期临床试验是在整合酶抑制剂(INSTIs)问世之前进行的,现在整合酶抑制剂已成为艾滋病抗逆转录病毒疗法的主流:设计:我们利用一项针对61名PWH和代谢功能障碍相关性脂肪肝患者的随机双盲试验,在基线接受INSTI治疗的参与者中评估特萨莫林2毫克每日一次与相同安慰剂的疗效和安全性:在母体临床试验中,分别在基线和12个月时使用磁共振成像、质子磁共振波谱和双能X射线吸收测量法对内脏脂肪横截面积、肝脏脂肪分数和躯干与肛门脂肪比率进行量化。比较了不同治疗方案的代谢和安全性结果:在基线接受基于 INSTI 方案治疗的 38 名参与者中,15 名服用替沙莫瑞林的患者和 16 名服用安慰剂的患者完成了为期 12 个月的研究。替沙莫瑞林可显著减少内脏脂肪(中位数[四分位距]:-25 [-93, -2] vs. 14 [3, 41] cm2,P = 0.001)、肝脏脂肪(-4.2%[-12.3%,-2.7%] vs. -0.5% [-3.9%,2.7%],P = 0.01)和躯干与肛门脂肪比(-0.1 [-0.3,0.0] vs. 0.0 [-0.1,0.1],P = 0.03)。两组患者对替沙莫林的耐受性良好,包括高血糖在内的不良反应发生频率相似:目前的分析首次提供了有关使用 INSTI 方案的 PWH 使用特萨莫林的疗效和安全性的专门数据。尽管使用 INSTI 会导致体重增加和脂肪组织功能障碍,但特萨莫林对身体组成有益处,而且不会加剧血糖控制。
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引用次数: 0
Choice of antiretroviral therapy has low impact on weight gain. 抗逆转录病毒疗法的选择对体重增加的影响较小。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-05-31 DOI: 10.1097/QAD.0000000000003950
Henning Drechsler, Colby Ayers, Ikwo Oboho, Ngozi Enwerem, John Hanna, Christopher Clark, Ellen Kitchell, Mamta Jain, Amneris Luque, Roger Bedimo

Objective: Antiretroviral therapy (ART) containing integrase inhibitors (INSTIs) and/or tenofovir alafenamide (TAF) has been associated with greater weight gain. Yet few studies have delineated between exposure to 'anchor' drugs [protease inhibitors (PI), nonnucleoside reverse transcriptase inhibitors (NNRTI) or INSTIs] and exposure to nucleoside reverse transcriptase inhibitors (NRTIs).

Design: In this cohort of antiretroviral drug-naive patients who initiated ART from 2008-2022, we analyzed BMI gain for eight contemporary 'anchor' drugs and three contemporary NRTIs during the first 3 years of ART. We censored patients if they stopped, switched, or added another antiretroviral drug to their regimen.

Methods: We used generalized estimating equations (GEE) to assess the association between BMI gain and choice of ART and a nonlinear mixed model for the marginal coefficients of determination. We adjusted for time, baseline demographic and HIV-characteristics, and time-updated HIV and substance use-related variables.

Results: The median BMI gain in 4 194 patients over 3 years was + 1.9 kg/m 2 [interquartile range (IQR) 0.1-4.1]. Most patients were black (55%) and men (77%). Multivariable modeling from 20 528 BMI measurements revealed that the type of ART accounted for just 9% of the predicted BMI change. Only efavirenz (EFV) and tenofovir disoproxil fumarate (TDF) were independently associated with (lower) weight gain but no differences were observed between INSTIs, PIs, and rilpivirine, or between TAF and abacavir.

Conclusion: The choice of initial ART had little impact on weight gain. INSTIs or TAF were not independently associated with weight change after ART initiation, but EFV and TDF were.

目的:含有整合酶抑制剂(INSTIs)和/或替诺福韦-阿拉非酰胺(TAF)的抗逆转录病毒疗法(ART)与体重增加有关。然而,很少有研究对 "锚 "药物(蛋白酶抑制剂[PI]、非核苷类逆转录酶抑制剂[NNRTI]或INSTIs)的暴露与核苷类逆转录酶抑制剂(NRTIs)的暴露进行区分:在 2008-2022 年间开始接受抗逆转录病毒疗法的抗逆转录病毒(ARV)新患者队列中,我们分析了抗逆转录病毒疗法头 3 年中 8 种当代 "锚定 "药物和 3 种当代 NRTIs 的体重指数(BMI)增长情况。如果患者停药、换药或在治疗方案中添加另一种抗逆转录病毒药物,我们将对其进行删减:我们使用广义估计方程(GEE)来评估 BMI 增长与抗逆转录病毒疗法选择之间的关系,并使用非线性混合模型来计算边际决定系数。我们对时间、基线人口统计学和 HIV 特征以及时间更新的 HIV 和药物使用相关变量进行了调整:4,194名患者提供了20,528个BMI测量值,这些测量值被用于建立多变量模型。大多数患者为黑人(55%)和男性(77%)。3 年中体重指数的中位增长为 +1.9 kg/m2(IQR 0.1-4.1)。使用抗逆转录病毒药物仅占预测体重指数变化的 9%。只有依非韦伦(EFV)和富马酸替诺福韦二吡呋酯(TDF)与(较低的)体重增加独立相关,而INSTIs、PIs或利匹韦林之间以及TAF和阿巴卡韦之间均未观察到差异:结论:初始抗逆转录病毒疗法的选择对体重增加影响不大。INSTIs或TAF与开始接受抗逆转录病毒疗法后的体重变化无关,但EFV和TDF与体重变化有关。
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引用次数: 0
Preterm birth among women with HIV: impact of preconception cART initiation. 感染艾滋病毒妇女的早产情况:孕前开始 cART 的影响。
IF 3.4 2区 医学 Q3 IMMUNOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-17 DOI: 10.1097/QAD.0000000000003979
Cassandra R Duffy, Julie M Herlihy, Ethan Zulu, Lawrence Mwananyanda, Leah Forman, Tim Heeren, Christopher J Gill, Megan Harper, Roma Chilengi, Roy Chavuma, Barbara Payne-Lohman, Donald M Thea

Objective: To examine the risk of preterm birth (PTB) and small for gestational age (SGA) among women with HIV compared to women without HIV. Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes.

Design: Prospective observational cohort.

Setting: Urban government-run clinic at Chawama Hospital in Lusaka, Zambia.

Participants: A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating.

Methods: From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. The independent role of IA was determined by mediation analysis.

Main outcome measures: PTB (<37 weeks) and SGA.

Results: There were 38 fetal deaths and 1230 singleton live births. Maternal HIV infection was associated with PTB [adjusted odds ratio (AOR) 1.60, 95% confidence interval (CI) 1.11-2.32] and to a lesser extent SGA (AOR 1.29, 95% CI 0.98-1.70). Maternal cART timing impacted these associations, with highest risk in women who started cART after conception (PTB AOR 1.77, 95% CI 1.09-2.87, SGA AOR 1.52, 95% CI 1.04-2.22). Maternal IA was not associated with PTB independent of HIV infection.

Conclusions: HIV is associated with PTB. Risk of PTB and SGA was highest in women with HIV who started cART in pregnancy, a modifiable risk factor.

目的与未感染艾滋病病毒的妇女相比,研究感染艾滋病病毒的妇女早产(PTB)和胎龄小(SGA)的风险。次要目标是探讨母体免疫激活(IA)的作用以及 cART 时间对这些结果的影响:设计:前瞻性观察队列:地点:赞比亚卢萨卡 Chawama 医院由政府运营的城市诊所:1481名感染和未感染艾滋病毒的单胎妊娠妇女在妊娠26周前通过超声波测孕登记:方法:2019 年 8 月至 2022 年 11 月,按照 1:1 的 HIV 感染比例招募孕妇。收集了母体基线临床因素,以及感染 HIV 妇女的 CD4、病毒载量和 CD8 T 细胞 IA。此外,还收集了分娩结果。通过多变量逻辑回归评估了 HIV 暴露和 cART 时间与预后的关系。通过中介分析确定IA的独立作用:PTB(结果:38例胎儿死亡,1230例单胎活产。母体艾滋病病毒感染与 PTB 相关(AOR 1.60,95%CI 1.11-2.32),其次与 SGA 相关(AOR 1.29,0.98-1.70)。孕产妇开始 cART 的时间对这些相关性有影响,受孕后开始 cART 的妇女风险最高(PTB AOR 1.77,95%CI 1.09-2.87;SGA AOR 1.52,95%CI 1.04-2.22)。产妇 IA 与 PTB 无关,与 HIV 感染无关:结论:HIV 与 PTB 相关。在妊娠期开始接受 cART 治疗的女性艾滋病毒感染者中,PTB 和 SGA 的风险最高,这是一个可改变的风险因素。
{"title":"Preterm birth among women with HIV: impact of preconception cART initiation.","authors":"Cassandra R Duffy, Julie M Herlihy, Ethan Zulu, Lawrence Mwananyanda, Leah Forman, Tim Heeren, Christopher J Gill, Megan Harper, Roma Chilengi, Roy Chavuma, Barbara Payne-Lohman, Donald M Thea","doi":"10.1097/QAD.0000000000003979","DOIUrl":"10.1097/QAD.0000000000003979","url":null,"abstract":"<p><strong>Objective: </strong>To examine the risk of preterm birth (PTB) and small for gestational age (SGA) among women with HIV compared to women without HIV. Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes.</p><p><strong>Design: </strong>Prospective observational cohort.</p><p><strong>Setting: </strong>Urban government-run clinic at Chawama Hospital in Lusaka, Zambia.</p><p><strong>Participants: </strong>A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating.</p><p><strong>Methods: </strong>From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. The independent role of IA was determined by mediation analysis.</p><p><strong>Main outcome measures: </strong>PTB (<37 weeks) and SGA.</p><p><strong>Results: </strong>There were 38 fetal deaths and 1230 singleton live births. Maternal HIV infection was associated with PTB [adjusted odds ratio (AOR) 1.60, 95% confidence interval (CI) 1.11-2.32] and to a lesser extent SGA (AOR 1.29, 95% CI 0.98-1.70). Maternal cART timing impacted these associations, with highest risk in women who started cART after conception (PTB AOR 1.77, 95% CI 1.09-2.87, SGA AOR 1.52, 95% CI 1.04-2.22). Maternal IA was not associated with PTB independent of HIV infection.</p><p><strong>Conclusions: </strong>HIV is associated with PTB. Risk of PTB and SGA was highest in women with HIV who started cART in pregnancy, a modifiable risk factor.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11356690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141625710","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}
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