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Objective: People with HIV (PWH) experience excess comorbidities, including neurocognitive disorders, which are linked to inflammation, particularly monocyte-macrophage activation. Smoking contributes to morbidity and mortality in well treated PWH. We investigated associations between smoking, neurocognitive function, and inflammation in PWH on antiretroviral therapy (ART).

Design: We used baseline data on cognition and inflammation from a longitudinal study of virologically suppressed PWH who do and do not smoke.

Methods: Participants completed four neurocognitive tests (seven measures), with a composite score as the primary measure. Inflammatory markers were plasma sCD14, sCD163, and CCL2/MCP-1; %CD14 + monocytes expressing CD16, CD163, and CCR2; and %CD8 + T cells co-expressing CD38/HLA-DR. Exploratory analyses included a plasma cytokine/chemokine panel, neurofilament light chain (NFL), hsCRP, and monocyte transcriptomes by RNAseq.

Results: We recruited 58 PWH [26 current smoking (PWH/S), 32 no current smoking (PWH/NS)]. Mean composite and individual neurocognitive scores did not differ significantly by smoking status except for the color shape task; PWH/S exhibited worse cognitive flexibility, with adjusted mean times 317.2 [95% confidence interval (CI) 1.4-632.9] ms longer than PWH/NS. PWH/S had higher plasma sCD14 than PWH/NS [median (IQR) 1820 (1678-2105) vs. 1551 (1284-1760) ng/ml, P  = 0.009]. Other inflammatory markers were not significantly different between PWH/S and PWH/NS. Monocyte transcriptomes showed several functions, regulators, and gene-sets that differed by smoking status.

Conclusion: sCD14, a marker of monocyte activation, is elevated in PWH who smoke. Although neurocognitive measures and other inflammatory markers did not generally differ, these data implicate smoking-related myeloid activation and monocyte gene dysregulation in the HIV/smoking synergy driving HIV-associated comorbidities.

Objective: To determine the prevalence and the risk factors for anal high-grade intraepithelial neoplasia and anal cancer (HSIL+) in women with HIV (WWH), and to compare them to women without HIV with other risk factors.

Design: Prospective cohort study.

Methods: WWH and women without HIV with other risk factors were included. Screening for anal HSIL+ using anal cytology and HPV testing was performed. A high-resolution anoscopy with directed biopsy was also performed in patients with an abnormal cytology result or a positive HPV testing for high-risk (HR) genotypes, and in those with anal symptoms.

Results: The period prevalence of anal HR-HPV infection and histological HSIL was 57.9% and 10.9% among WWH, and 60.8% and 9.2% among women without HIV. The prevalence of anal HPV 18 infection was higher in WWH. The risk factors for anal HSIL+ in WWH included anal HPV 16, other HR genotypes and low-risk genotypes infection, as well as a history of vulvar HSIL+. In women without HIV, the risk factors included anal HPV 16 infection, history of anogenital warts and of vulvar HSIL+, and immunosuppressive treatment.

Conclusions: A high prevalence of anal HPV infection and HSIL was observed in WWH and women without HIV with other risk factors. Both groups share anal HPV 16 infection and history of vulvar HSIL+ as risk factors for the development of anal HSIL+. Genotyping for anal HPV 16 may help identify women at higher risk of anal cancer.

Objective: Sleep disorders (SD) are prevalent in people with HIV (PWH), but poorly addressed in HIV care. We evaluated the effectiveness of a multidimensional program for SD in an outpatient HIV clinic.

Methods: Interventional study in 175 PWH on ART suffering from insomnia. Insomnia severity index (ISI), sleep quality, mood disorders, and well being were assessed at baseline and at month 6 after counseling for sleep hygiene and referral to tailored pharmacological and/or neuropsychological interventions. Participants were classified as fully, partial, and nonadherent (FA-PA-NA) to the interventions. Mixed-effects models and longitudinal paired tests evaluated the impact of adherence to interventions on SD overtime.

Results: Participants (male 65.7%, median age 51 years, 95.4% with viral suppression) were referred to psychologist (94.8%), psychiatrist (9.1%), and neurologist (2.8%), and 30.3% and 20.5% had indication to hypo-inducing drugs and psychotherapy/cognitive-behavioral therapy. Seventy-seven participants (44.0%) were NA, 9.1% PA, and 46.8% FA. ISI improved in all, but the strongest effect size was seen in FA (D = 0.89, P < 0.001). Perceived wellness improved only in FA, and hours slept per night increased in all but more relevantly in FA and PA (both P < 0.001). In adjusted models, adherence to the interventions ISI decreased (improve) overtime only in FA (aβ = -1.24, P = 0.005 vs. NA; aβ = -0.71, P = 0.349 for PA vs. NA).

Conclusions: The introduction of multidimensional programs for SD can reduce the prevalence and severity of insomnia and improve sleep quality and wellness in PWH. Such approach should be integrated into daily multidisciplinary clinical practice for HIV care.

Use of cannabis and alcohol were common during pregnancy and the first year postpartum among people with HIV in the United States (2007-2019), but there were no major differences in substance use during pregnancy based on mode of HIV acquisition. The relatively high prevalence of substance use in this population, particularly postpartum alcohol and cannabis use, warrants further attention.

Background: Men who inject drugs who have sex with men (MWIDSM) may acquire HIV through injecting drugs or sex. Interventions to increase awareness of HIV preexposure prophylaxis (PrEP) have focused on gay/bisexual MSM and may not be reaching heterosexual-identifying men or people who inject drugs (PWID). We explored changes in PrEP awareness and use among MWIDSM from 2018 to 2022 by sexual identity.

Methods: We used data from the 2018 and 2022 National HIV Behavioral Surveillance among PWID recruited via respondent-driven sampling in 19 urban areas in the US. We examined changes in PrEP awareness and use over time by sexual identity among HIV-negative men who inject drugs and who had sex with another man in the past 12 months using log-linked Poisson regression models with robust standard errors with an interaction term between year and sexual identity.

Results: Among 758 HIV-negative MWIDSM (463 in 2018; 295 in 2022), nearly all sample participants were likely indicated for PrEP (94.2 and 92.9%, respectively). PrEP awareness increased from 2018 to 2022 among gay/bisexual-identifying MWIDSM [45.5 to 65.5%; aPR = 1.49, 95% confidence interval (95% CI) = 1.30-1.70] but remained stable for heterosexual-identifying MWIDSM (39.4 to 40.8%; aPR = 1.01, 95% CI 0.75-1.36). PrEP use remained low among all MWIDSM (2.5 to 7.7%, among heterosexually identifying; 15.3 to 10.2% among gay/bisexual-identifying).

Conclusion: PrEP awareness increased among gay/bisexual-identifying MWIDSM but not among heterosexual-identifying. PrEP use was low for all MWIDSM. Public health initiatives catered to MWIDSM should focus on improved campaigns and expanding PrEP accessibility in existing healthcare, harm reduction, and social services.

Background: Neurocognitive impairment (NCI) may occur during and persist even after recovery from HIV-related central nervous system (CNS) co-infections such as toxoplasmic encephalitis (TE). The long-term cognitive effects of TE and latent toxoplomasmic infections (LTI) among persons with HIV (PWH) are unknown. We measured longitudinal effects on neurocognitive functioning in PWH with TE compared to LTI or no toxoplasmal infection.

Methods: PWH (n = 345) followed in two longitudinal cohort studies underwent comprehensive neurocognitive assessments and an anti- toxoplamic immunoglobulin G (IgG) assay. Participants were classified into one of three groups: TE+ ( n  = 39), LTI+ ( n  = 34), LTI- ( n  = 272). The primary outcome was change in neurocognitive function between baseline and 7-year visit.

Results: The mean age was 48 ± 11 years, mean educational level 13 ± 3 years, and 13% were female. TE+ patients were less likely to have undetectable viral loads (≤50 copies/ml) and had lower absolute CD4 + cell count. The TE+ group had the highest prevalence of NCI globally and in domains of verbal, executive function, learning, recall, working memory, processing speed and motor at baseline and at 7-year follow-up. Changes in longitudinal NC function over 7 years were small and did not differ significantly among all groups, except that speed of information processing improved more in TE+ compared with LTI- participants.

Conclusions: PWH with a history of TE had cognitive impairment over a broad range of severity at both baseline and last follow-up. Changes in cognition from baseline to last examination in all groups were minimal and did not differ significantly among the groups with the exception of speed of information processing.

People with HIV (PWH) and people with diabetes mellitus have increased risk of severe COVID-19, but little is known about humoral response to COVID-19 vaccines in PWH with DM. We investigated SARS-CoV-2 antireceptor-binding domain (anti-RBD) immunoglobulin G (IgG) geometrical concentrations and neutralizing antibody capacity (nAB) in PWH with and without diabetes mellitus. Anti-RBD IgG and nAB in COVID-19-vaccinated PWH were not associated with diabetes mellitus-status or HbA1c 24 months after the initial COVID-19 vaccination.