AIDS最新文献

Objective: In 2024, an estimated 5.3 million of 40.8 million people living with HIV (PLHIV) globally were unaware of their status, with Southern Africa bearing the highest regional burden. This review synthesises programmatic evidence on HIV testing uptake, test positivity, and linkage to care across clinician-administered testing and HIVST in Southern Africa.

Design: Systematic review with pooled programme-level outcomes analyses of HIV testing outcomes.

Methods: Searches were conducted for studies published between 2020 and 2025 from Southern African countries using Medline, Embase, and OVID Global Health. Eligible studies reported HIV positivity and optionally testing uptake or linkage to care. Pooled odds ratios were calculated to describe programme-level differences across testing modalities for testing uptake and linkage to care, while HIV positivity was analysed using a binomial generalised linear model, adjusting for country.

Results: 43 studies encompassing 290,428 participants across 8 Southern African countries were included. Programmes offering HIVST frequently reported higher testing uptake (pooled OR = 1.34, 95% CI: 1.30-1.38, p < 0.001), though estimates varied substantially by country and implementation context. Lower HIV positivity yields were reported in HIVST programmes compared with clinician-administered testing programmes (adjusted OR = 0.63, 95% CI:0.54-0.75, p < 0.001). Linkage to care following a positive result was also consistently lower in HIVST programmes (pooled OR = 0.036, 95% CI: 0.025-0.051, p < 0.001).

Conclusion: Across real-world programmes in Southern Africa, HIVST is commonly characterised by high testing uptake but lower HIV positivity yield and linkage to care, relative to clinician-administered testing. Interpretation is limited by ecological comparisons and heterogeneity in outcome measurement. Future research should prioritise robust linkage to care management.

Background: People with HIV (PWH) are more susceptible to drug reactions than the general population. This study aimed to investigate the prevalence of, and demographic characteristics associated with a history of penicillin and sulfonamide allergy and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and to assess whether HLA-B∗57:01 is associated with these drug reactions among PWH followed in a large French multicenter cohort.

Methods: All PWH followed from January 2000 to December 2023 with available results for HLA-B∗57:01 were included. Logistic regression models were used to identify associations between each drug allergy (outcome variable) and explanatory variables.

Results: Among 35,924 PWH, the prevalence of penicillin and sulfonamide allergy and SJS/TEN were 1.05% (95%CI 0.94-1.16), 1.01% (95%CI 0.91-1.11) and 0.15% (95%CI 0.11-0.19), respectively. AIDS status was significantly associated with a higher risk of penicillin and sulfonamide allergy and SJS/TEN; while female sex was associated with sulfonamide allergy and SJS/TEN. Being born in mainland France, other European countries, and North Africa was associated with a higher risk of penicillin allergy (OR 1.88 [95%CI, 1.13-3.42], p = 0.02), while being born in Sub-Saharan Africa was associated with a lower risk of penicillin allergy (OR 0.39 [95% CI, 0.19-0.81], p = 0.009) and sulfonamide allergy (OR 0.57 [95%CI, 0.34-0.95], p = 0.03). The association between HLA-B∗57:01 and penicillin allergy was positive but statistically non-significant (OR 1.34 [95%CI, 0.87-1.97], p = 0.16).

Conclusion: In the combined antiretroviral therapy era, the prevalence of both penicillin and sulfonamide allergy is low. Our study confirms ethnic differences in penicillin and sulfonamide allergy.

Objective: In Nigeria, adolescents and young adults (AYA) who engage in multiple sexual partnerships, transactional sex, and needle-sharing are eligible for preexposure prophylaxis (PrEP) and are prioritized for HIV testing. AYA with PrEP-eligible behaviors should be using facility-based HIV testing services. We examined associations between these behaviors and facility-based HIV testing among AYA aged 14-24 years.

Design: A longitudinal analysis of a stepped-wedge trial.

Methods: Using Innovative Tools to Expand Youth-friendly HIV Self-Testing (I-TEST) data, we fit generalized linear models using generalized estimating equations. We used a two-stage weighted approach to generalize I-TEST estimates to all AYA in Nigeria.

Results: Of 1429 trial participants, the median age was 20 years (IQR: 18-22), 50.3% were female, and 69.4% reported secondary education as highest level of education completed. Recent facility-based HIV testing uptake was higher among AYA with one [unadjusted risk difference: 11.7%, 95% confidence interval (95% CI): 8.1-15.2], two [11% (5.3, 16.8)], and three or more sexual partners in the past 3 months [17.3% (10.5, 24)], compared to AYA with no recent sexual partners. AYA who engaged in transactional sex had higher facility-based testing uptake [14.7% (9.8, 19.5)] than AYA who never engaged in transactional sex. AYA who shared needles had lower facility-based testing uptake [-3.3% (-6.7, 0.2)] than AYA with no needle-sharing history. The trial and generalized estimates were in the same direction.

Conclusion: While facility-based testing may reach AYA who engaged in multiple sexual partnerships or transactional sex, AYA who shared needles may require more tailored HIV testing approaches.

Objective: This study evaluated the efficacy (day 8) and safety (week 49) of doravirine/islatravir (DOR/ISL; 100 mg/0.75 mg) plus baseline antiretroviral therapy (ART) and optimized background therapy (OBT) in heavily treatment-experienced (HTE) adults living with detectable HIV-1 RNA.

Design and methods: HTE adults with confirmed plasma viral load more than 500 copies/ml receiving a stable ART regimen for at least 3 months were randomly assigned 1 : 2 : 1 : 1 to receive once-daily ISL alone, DOR alone, DOR/ISL, or matching placebo for 7 days; at day 8, baseline ART was optimized and all participants received DOR/ISL and OBT through week 49. The primary efficacy endpoint was percentage of participants receiving DOR/ISL achieving at least 0.5 log 10 decline in viral load from baseline (day 1) to day 8. Secondary efficacy endpoints included HIV-1 RNA levels and CD4 + T-cell counts through week 49.

Results: Thirty-five of the planned 100 participants were enrolled; most were White (57.1%) and men (77.1%) with median age of 50 years. From days 1 to 8, an at least 1.0 log 10 decrease in HIV-1 RNA was achieved in 85.7% of the DOR/ISL group compared with 0 in the placebo group. At week 49, HIV-1 RNA less than 50 copies/ml was achieved in 22 participants (71%) and the mean increase in CD4 + T-cell count was 87 cells/μl. Adverse events were reported in 29 participants (82.9%) through week 49; 9 (25.7%) were considered related to DOR/ISL.

Conclusion: DOR/ISL plus OBT improved HIV-1 suppression in HTE adults living with HIV-1 and was generally well tolerated.

Clinicaltrialsgov: NCT04233216.

Background: Increased risk of infectious morbidity and hospitalization has been reported during infancy among children HIV-exposed uninfected (CHEU) compared to children HIV-unexposed uninfected (CHUU). However, data on risks beyond infancy are limited.

Methods: We enrolled pregnant women with and without HIV from a primary healthcare facility in a lower income area in Cape Town, South Africa (2017-2018). We tracked their children's HIV test results and hospitalizations using routine electronic healthcare data. We previously reported increased rates of infectious-cause hospitalization among CHEU in the first year of life, and now extend the analysis to cover the period from age 1 to less than 5 years. Using random-effects Poisson regression, we calculated adjusted incidence rate ratios (aIRR) for infectious-cause hospitalization among CHEU vs. CHUU, clustered by infant and adjusted for child sex and vaccination status, maternal age and education, and housing type.

Results: Among 446 CHEU and 455 CHUU, 147 admissions occurred from age 1 to less than 5  years; with 59% ( n  = 87) due to infections. All-cause hospitalization occurred in 9.2% of CHEU and 10.5% of CHUU; infectious-cause hospitalization occurred in 6.5% of CHEU and 7.3% of CHUU with crude incidence rates of 2.4 per 100 child-years for both groups [IRR = 1.0; 95% confidence interval (CI) 0.6-1.6]. Adjusted analyses showed no evidence of increased hospitalization among CHEU (aIRR = 0.71; 95% CI 0.36-1.41).

Conclusion: Elevated risk of infectious-cause hospitalization among CHEU did not persist beyond the first year of life. These findings highlight infancy as a key window for targeted interventions, while providing reassurance regarding longer term infectious morbidity risk.

Introduction: Estimating undiagnosed HIV prevalence facilitates planning epidemic responses, and monitoring progress towards UNAIDS and national targets. We undertook a systematic review to identify models used to estimate undiagnosed HIV prevalence in overall populations in high-income low-HIV-prevalence countries and territories to inform model selection in New Zealand.

Methods: We searched Medline, EMBASE, Web of Science, CINAHL and Cochrane Database of Systematic Reviews to 5 March 2025. Two authors independently reviewed studies with conflicts resolved by a third. We assessed study quality against five key characteristics of good modelling practice. We undertook a grey literature search to identify modelling in HIV surveillance or monitoring reports.

Results: We identified 2147 unique citations, with 119 full text studies retrieved and 48 included. Forty-six studies described modelling undiagnosed HIV prevalence in 23 countries and territories, a further two for multiple countries. The most common methods used CD4 + back-calculation, with the ECDC model most frequently used (10 studies), followed by a clinical stage-based back-calculation model, a CD4 + depletion model and the Spectrum CSAVR model (eight, four and three studies, respectively). Almost all studies noted a full mathematical model description, included parameters, validation and uncertainty estimates. Only five articles estimated undiagnosed HIV by ethnicity, but estimates by gender and exposure were common.

Conclusion: CD4 + back-calculation models, notably the online accessible ECDC model, have been most commonly used. These are well suited to surveillance systems like New Zealand's, which collect demographic and exposure details and CD4 + cell counts at HIV diagnosis, but limited exposure group size and seroprevalence information.

Background: In people with HIV (PWH), urine tubular biomarkers have been linked to kidney function decline, but urine concentration variability limits their clinical utility. Plasma biomarkers may offer more stable indicators of kidney tubular health.

Methods: We conducted a case-cohort study of 440 PWH from the Multicenter AIDS Cohort Study (MACS)/Women's Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS). Cases developed rapid kidney function decline [RKFD: ≥30% estimated glomerular filtration rate (eGFR) reduction]. We measured plasma biomarkers of tubular injury [kidney injury molecule-1 (KIM-1)], inflammation [tumor necrosis factor receptor-1 (TNFr1) and tumor necrosis factor receptor-2 (TNFr2)], and synthetic function [uromodulin (UMOD) and epidermal growth factor (EGF)] at baseline and year 2. Associations with RKFD were assessed using multivariable risk regression, adjusting for chronic kidney disease (CKD) and HIV-related risk factors, eGFR, and albuminuria. In a random sub-cohort, linear mixed models evaluated associations with annualized eGFR change.

Results: At baseline, median age was 49 years; 33% were women; 69% were virally suppressed; eGFR was similar in cases vs. noncases (93 vs. 94 ml/min/1.73 m 2 ). Over a median of 4.5 years, 172 RKFD events occurred. Each 1-standard deviation higher baseline KIM-1, TNFr1, TNFr2, UMOD, and EGF level was associated with adjusted relative risks (RR) for RKFD of 1.26 [95% confidence interval (CI): 1.15-1.39], 1.39 (1.24-1.55), 1.40 (1.24-1.57), 0.84 (0.77-0.93), and 0.85 (0.78-0.92), respectively. Findings were similar at year 2 and for 2-year biomarker changes. In joint models, baseline KIM-1, TNFr2, and UMOD remained independently associated with RKFD [RR: 1.19 (1.08-1.31), 1.27 (1.12-1.43), and 0.86 (0.78-0.95)], respectively. No biomarker was associated with annualized eGFR change in the sub-cohort.

Conclusion: In PWH, plasma biomarkers reflecting impaired kidney tubular health were independently associated with RKFD and may be useful prognosticators of adverse kidney outcomes.