AIDS最新文献

Objectives: Migrant women (MW) often experience difficulties in accessing sexual healthcare services. We assess the knowledge and acceptability of (Pre-Exposure Prophylaxis) PrEP in MW.

Methods: We carried out a survey exploring HIV and PrEP knowledge in a cohort of adult MW residing in Padua (Italy). Subsequently, women were counselled about PrEP, screened for sexually transmitted infections (STIs) and asked about PrEP acceptability. We assessed factors correlating with PrEP acceptability using logistic regression.

Results: 221 MW were included, mostly Nigerian (122, 55.2%), asylum seekers (78, 35.3%), with a low level of education (179, 81%), with a median age of 31 (IQR:26-37) years and a median time in Italy of 59 months (IQR:16-82). Of these 86% disclosed a regular sexual activity, 17.4% reported to have experienced non-consensual sexual intercourse, and 9.5% to have been paid for sex. Only 14.5% disclosed to regularly use condoms during sexual intercourse. Since their arrival in Italy, 35.7% had undergone a gynaecological examination, and 50.2% had received a STI screening. 85.5% women did not know how to access contraception, and 28.5% knew about PrEP. After counselling, 16.7% women said they would accept PrEP. PrEP acceptability was associated with living in an asylum seeker centre (AdjOR: 0.08, p = 0.03), international protection status (AdjOR:4.98, p = 0.041) and natural contraception use (AdjOR:5.27, p = 0.024).

Conclusions: Sexual health awareness/care and PrEP uptake in MW were low and highlighted the urgency of tackling the HIV/STI risk in this vulnerable population, by adopting specific outreach programmes and ensuring they receive information, support and empowerment about options to make their sexual health safer.

Objective: Low muscle mass and chronic lung disease are common among people with HIV (PWH), but whether low muscle mass is associated with a faster decline in lung function in this population remains unknown. We aimed to determine the prevalence and associated factors of low muscle mass, and the association between low muscle mass and lung function decline in PWH.

Design: Prospective study on PWH from the Copenhagen Comorbidity in HIV Infection (COCOMO) study.

Methods: Skeletal muscle index (SMI) was assessed with computed tomography and low muscle mass was defined as SMI below the lowest 5% of a healthy population. Lung function was measured as forced expiratory volume in 1 second (FEV1) at baseline and two-year follow-up. We used logistic regression to investigate potential risk factors for low muscle mass. Using linear mixed models, we investigated if low muscle mass was associated with a faster FEV1 decline.

Results: We included 509 PWH, and 16% had low muscle mass. Older age, male sex, lower body mass index, and high concentrations of interleukin 6 and tumor necrosis factor alpha were associated with low muscle mass. Low muscle mass was not associated with a faster FEV1 decline (35.9 mL/year versus 34.0 mL/year in PWH with and without low muscle mass, respectively; P = 0.69).

Conclusions: Almost one in six PWH had low muscle mass, mirroring the general population. Traditional risk factors and inflammatory markers were associated with low muscle mass. We found no association between low muscle mass and a faster FEV1 decline among PWH.

Objective: To examine the relationship between body mass index (BMI), abdominal adiposity, handgrip strength and physical function in people with HIV (PWH), and to explore the potential influence of physical activity (PA) and diet on this relationship.

Design: Cross-sectional analyses.

Methods: The PROSPER-HIV Study was conducted at four clinical sites across the United States. Eligible participants were on antiretroviral therapy and had a viral load <200 copies/mL. Measures included: a) handgrip strength; b) physical function, assessed with the Short Physical Performance Battery (SPPB); c) BMI; d) abdominal adiposity, estimated using waist circumference (WC); e) PA levels, measured using accelerometers; and f) diet quality, measured using triple-pass 24-hour recalls. Data were analyzed using quantile regression between covariates and median of the outcomes.

Results: Among PWH (n = 409, 59.0 years old [51.0-65.0], 76.5% male), 71.4% were overweight or obese, 72.4% had high WC, 12.7% had low handgrip strength, and 11.5% had low SPPB. After controlling for age and sex, there was a negative association between SPPB and WC (β=-0.011, p = 0.02). When PA and diet variables were considered in the model, moderate-to-vigorous PA (MVPA) and step count were significant (p < 0.05) and influenced the relationship between WC and SPPB. Although there was a moderate negative correlation between WC and SPPB for the lowest quartiles of MVPA and steps, this correlation weakens as the activity levels increase.

Conclusions: Increased abdominal adiposity is associated with poorer physical function among PWH. Participants with higher MVPA and steps presented higher physical function even in the presence of high WC.

Objective: Develop and validate a strategy to improve HIV testing rates using HIV teams.

Design: A prospective clinical trial was conducted from January 2020 to July 2023 in two Dutch university hospitals.

Methods: The intervention involved implementing HIV teams to provide peer awareness, education, and feedback to physicians treating patients ≥18 years newly diagnosed with HIV indicator conditions. The primary outcome was the HIV testing rate. Secondary outcomes included testing rates by specialty, HIV prevalence, and reasons for withholding testing.

Results: Of the 313,666 newly registered diagnoses, 2,395 involved indicator conditions. The overall HIV testing rate of newly diagnosed HIV indicator conditions increased from 50.1% (222/443) pre-implementation to 80.7% (1,575/1,952) post-implementation of HIV teams (p < 0.001) with sustained improvement during the observation period (range 72.4-90.4%). The intervention was effective across physicians from all medical specialties. HIV prevalence among those tested was 0.6% (95%CI 0.3-1.1%). Peer feedback for 411 untested indicator conditions, resulted in 69 (16.3%) additional HIV tests. Failure to test frequently remained without reason (50.6%) or due to patient loss of follow-up (18.4%). Multivariate analysis indicated that women with indicator conditions were tested less often (aOR 0.59, 95%CI 0.45-0.79, p < 0.01), and indicator conditions without HIV testing recommendations in national guidelines were also less likely to be tested for HIV (aOR 0.36, 95%CI 0.27-0.48, p < 0.01). For external validation, we implemented this intervention in a second hospital, where it also significantly increased the testing rate post-implementation of HIV teams.

Conclusion: Implementing HIV teams in hospitals is feasible, effective and leads to a sustained increase in HIV indicator condition-guided testing, supporting its broader adoption.

Objective: Treatment adherence remains critical in maintaining HIV RNA suppression on antiretroviral therapy. High genetic barrier regimens constructed with three long half-life agents may prevent resistance emergence and can be potentially started or restarted after antiretroviral treatment interruption (TI).

Methods: Data from the TRIO US HIV cohort were used to identify adult people with HIV initiating a new ART regimen from January 2021 - November 2023 and describe prevalence of TIs (defined as ≥90 days without dispensed ART). Virologic outcomes were assessed among those restarting or switching to B/F/TAF after TI.

Results: Of 2710 people with HIV, 765 (28%) experienced TI. Compared to individuals without TIs, those with TIs had higher proportion of females (24% vs 19%), black race (50% vs 35%), substance use (14% vs 9%), CD4 <200 cells/mm3 (15% vs 8%) and lower proportion with commercial insurance (48% vs 62%) or virologic suppression at initiation (76% vs 85%). Among 379 who restarted or switched to B/F/TAF following TI, 245 (65%) were suppressed at restart; 137 (56%) had ≥1 viral load (VL) after TI, of whom 129 (94%) maintained suppression. Of 87 with unknown viral status at restart, 46 (53%) had ≥1 VL during follow-up, of whom 44 (96%) achieved suppression. Among 47 viremic at restart, 27 (57%) had ≥1 VL after TI. Of them, 70% were suppressed during follow-up. No integrase inhibitor resistance emergence was observed.

Conclusion: High levels of suppression following TI may suggest B/F/TAF regimen forgiveness making it an appropriate choice for treatment switch or restart.

Objective: Cognitive impairment and frailty are critical aging-related phenotypes prevalent among people living with HIV (PLWH). Yet, limited data exist isolating the determinants of cognitive function among persons with a history of injection drug use (PWID) with and at risk for HIV, or on the intersecting relationship of cognitive function and frailty with mortality in this population.

Design/methods: Standard cognitive assessments were performed among PWID with and without HIV in the AIDS Linked to the IntraVenous Experience (ALIVE) cohort. Frailty was assessed using the 5 Fried physical frailty phenotype criteria. An inflammatory index score was constructed from IL-6 and soluble TNF-α receptor-1 data. Cox proportional hazards models were utilized to estimate mortality risk.

Results: Among 519 ALIVE participants, the median age was 52 years and 41% were PLWH. Hazardous alcohol use and older age were significantly associated with reductions in processing speed, motor function, and global cognitive function. In multivariable models, reduced processing speed, motor function, and global cognitive function were significantly associated with increased mortality. Reduced global cognitive function and frailty were independently associated with mortality. Reduced processing speed, motor function, executive function, and global cognitive function were significantly associated with heightened inflammation.

Conclusion: Reduced cognitive function is a significant predictor of death among people living with HIV and PWID, independent of frailty, HIV disease stage, and comorbidity. Interventions that target both cognitive function and frailty, including those targeting inflammation pathways, among PLWH and PWID may improve aging outcomes for these populations.

The breadth of the overdose crisis is underestimated because of a lack of quantifying nonfatal overdoses. We estimate the proportion of nonfatal overdoses among all people with HIV (PWH) in British Columbia, Canada, and the prevalence of fatal overdoses among people who had a nonfatal overdose, stratified by sex. A small proportion of PWH who experienced a nonfatal overdose subsequently died of a fatal overdose, signaling opportunities for crucial interventions and treatment to prevent overdose death.

Objective: The ability of HIV-1 Nef to counteract the host restriction factor SERINC5 and enhance virion infectivity has been well established. However, the impact of long-term within-host Nef evolution on this antagonistic capability remains unclear.

Design: Analysis of longitudinal activity of Nef in antagonizing SERINC5.

Methods: We investigated the downregulation activity of Nef against SERINC5 at different stages of infection by analyzing the cognate transmitted/founder, set point, and/or chronic Nef isolates from a cohort of 19 people with either subtype B or C HIV-1.

Results: The Nef isolates from different stages exhibited varying abilities to antagonize SERINC5. Long-term evolution resulted in mutations accumulated in Nef and a decline of Nef-mediated SERINC5 downregulation function in subtype B, but not in subtype C viruses, leading to a rapid reduction in viral load from peak viremia. Furthermore, we identified four polymorphisms of both subtype B and C Nef that are associated with variations in the SERINC5 antagonistic function and viral infectivity. HIV-1 NL4-3 variants encoding Nef E63G, A83G, R105K, or D108E mutants exhibited reduced replication capacity through a SERINC5-dependent mechanism. However, among different subjects, only a small part of naturally occurring mutations at these sites were selected by host T-cell responses, suggesting a limited impact of host T-cell responses on influencing Nef's ability to antagonize SERINC5.

Conclusion: These results highlight the potential contribution of functional variation in Nef to differences in HIV-1 pathogenesis and provide significant implications for understanding the evolutionary interaction between Nef and SERINC5 in vivo .

Objective: Falls are a significant public health concern, particularly among older adults and people with HIV (PWH). This study examines the association between alcohol consumption and falls in PWH.

Methods: The PROSPER-HIV study recruited PWH from four US sites. Participants were categorized based on Alcohol Use Disorders Identification Test Consumption (AUDIT-C) scores: none, nonhazardous, and hazardous drinking. Data collection included demographics, medical history [i.e. comorbidities, treated hypertension, estimated glomerular filtration rate (eGFR)], alcohol consumption using AUDIT-C, daily alcohol recall in grams, and self-reported falls over the previous year. Physical performance was measured using the Short Performance Physical Battery (SPPB). Statistical analyses included Pearson's correlation and Poisson regression models to estimate fall prevalence ratios, adjusting for confounders (SPPB, comorbidities, treated hypertension, and eGFR).

Results: The study included 315 PWH, aged 52 ± 12 years, with 78% male participants. Thirty-three percentage were classified as nondrinking, 50% nonhazardous, and 17% hazardous drinking. Poisson regression showed a significantly higher risk of falls [prevalence ratio: 2.12, 95% confidence interval (CI) 1.11-4.03] and recurrent falls (prevalence ratio 3.54, 95% CI 1.21-10.3) among hazardous drinking compared with nonhazardous drinking, even after adjusting for confounders. The prevalence ratios for falls per daily intake in grams was not statistically significant.

Conclusion: There is a significant association between hazardous alcohol consumption and increased fall risk in PWH using AUDIT-C but not when accessing recall of alcohol consumption in grams.