AIDS最新文献

Objective: Using an innovative data sharing model, we assessed the impacts of the COVID-19 pandemic on the health of people who inject drugs (PWID).

Design: The PWID Data Collaborative was established in 2021 to promote data sharing across PWID studies in North America. Contributing studies submitted aggregate data on 23 standardized indicators during four time periods: pre-pandemic (Mar 2019 - Feb 2020), early-pandemic (Mar 2020 - Feb 2021), mid-pandemic (Mar 2021 - Feb 2022), and late pandemic (Mar 2022 - Feb 2023).

Methods: We present study-specific and meta-analyzed estimates for the percentage of PWID who took medications for opioid use disorder, received substance use treatment, shared syringes or injection equipment, had a mental health condition, had been incarcerated, or had experienced houselessness. To examine change over time across indicators, we fit a random effects meta-regression model to prevalence estimates using time as a moderator.

Results: Thirteen studies contributed estimates to the Data Collaborative on these indicators, representing 6,213 PWID interviews. We observed minimal change across prevalence of the six indicators between the pre-pandemic (March 2019 - February 2020) and three subsequent time periods, overall or within individual studies. Considerable heterogeneity was observed across study- and time-specific estimates.

Conclusions: Limited pandemic-related change observed in indicators of PWID health is likely a result of policy and supportive service-related changes and may also reflect resilience among service providers and PWID themselves. The Data Collaborative is an unprecedented data sharing model with potential to greatly improve the quality and timeliness of data on the health of PWID.

Objectives: Substance use disorders (SUDs) are a significant public health concern across the United States and may pose a risk to achieving sustained viral suppression (SVS) in people with HIV (PWH). This study aims to examine the association between SUDs and SVS among PWH.

Design: Using electronic health records from the South Carolina Department of Health, we conducted a retrospective study of adults diagnosed with HIV between January 2006 and December 2019.

Methods: The impact of SUDs on SVS was assessed using generalized linear mixed model. Potential confounders included age, sex, chronic diseases history, etc. Stepwise selection was performed to decide the confounders included in the final model, and the optimal correlation structure was determined by Akaike information criterion.

Results: Of the 9412 eligible participants, 7481 (79.48%) had reached SVS status during their follow-up periods. SUDs related to alcohol (adjusted odds ratio (AOR) = 1.70, 95% confidence interval (CI): 1.46-1.98), cannabis (AOR = 1.62, 95% CI: 1.35-1.95), cocaine (AOR = 1.95, 95% CI: 1.60-2.37), opioid (AOR = 1.91, 95% CI: 1.13-3.23), and tobacco (AOR = 1.80, 95% CI: 1.69-1.92) were negatively associated with SVS. Individuals with chronic conditions such as cardiovascular disease (AOR=0.31, 95% CI: 0.29-0.33), diabetes (AOR=0.49, 95% CI: 0.41-0.59), and cancer (AOR=0.47, 95% CI: 0.38-0.58) showed a higher likelihood of maintaining SVS.

Conclusion: This large cohort study of PWH with extended follow-up highlights the negative impact of SUDs on maintaining SVS. Long-term strategies for reducing substance use could support SVS in HIV patients.

Objective: To characterize the immune functionality and phenotype and the proviral composition of a cohort of young adults with perinatally-acquired HIV (p-YA) from Argentina.

Design: Cross-sectional study of 18 p-YA, 15 young adults with non-perinatally acquired HIV matched by age with p-YA and 14 adults with non-perinatally acquired HIV, matched by time from HIV diagnosis with p-YA, all from Argentina.

Methods: Immune memory/effector phenotype, exhaustion, activation, PTK-7 and Ki-67 expression were evaluated by flow cytometry on NK and T-cells. Total, intact and defective proviral (TP, IP and DP) HIV-DNA were measured in CD4 T-cells by IPDA. Soluble markers were determined by ELISA.

Results: p-YA displayed lower expression of PD-1, higher levels of CD38+ CD4 T-cells and increased levels of naïve T-cells than control groups. Also, a trend of lower levels of IP HIV-DNA normalized to CD4 T-cell counts and to the proportion of naïve T-cells was found in p-YA.

Conclusion: The higher frequency of naïve CD4 T-cells in p-YA cannot be explained by elevated thymic activity nor by a higher T-cell proliferation rate. This imbalance could have been generated early in life and persisted during adulthood. Naïve CD4 T-cells may not serve as a major viral reservoir in p-YA. Also, the lower PD-1+ CD4 T-cell count suggests that p-YA did not present higher levels of exhaustion. These findings suggest that acquiring HIV perinatally may imply different challenges for proviral eradication.

Background: We aimed to provide insights into the effects of comorbidities on sleep health in people with HIV by assessing associations between multimorbidity patterns and sleep outcomes in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) sub-study.

Methods: Principal component analysis identified six multimorbidity patterns among participants with HIV (n = 1073) at baseline: Cardiovascular diseases (CVDs), Sexually transmitted diseases, Metabolic, Mental/Joint, Neurological and Cancer/Other. Burden z-scores were calculated for each individual/pattern. A subset of 478 participants completed sleep assessments at follow-up, including questionnaires (Insomnia Severity Index [ISI], Patient-Reported Outcomes Measurement Information System [PROMIS] Sleep Disturbance [SD] and Sleep Related Impairment [SRI]) and overnight oximetry (4% oxygen desaturation index [ODI] and percentage of time with oxygen saturation [SpO2] <90%). Multivariable regression assessed associations between burden z-scores and sleep measures.

Results: Amongst 309 participants (median [interquartile range] age 53 [47-59] years), 21% had insomnia (ISI≥15). Higher Mental/Joint z-scores were associated with increased odds of insomnia (aOR 1.06 [95%CI 1.03, 1.09]) and worse PROMIS-SRI (1.34 [1.22, 1.48]) and PROMIS-SD (1.27 [1.16, 1.39]) scores. Higher Metabolic and Neurological z-scores were associated with worse PROMIS-SRI scores (p < 0.01). Higher CVDs z-scores were associated with worse ISI and PROMIS-SRI scores, and a higher percentage of time with Sp02 below 90% (all p's < 0.01).

Conclusion: This study is among the first to describe specific multimorbidity patterns linked to poorer sleep outcomes in people with HIV. Findings suggest the need for targeted sleep interventions based on multimorbidity profiles, which may mitigate broader health risks associated with poor sleep.

Objective: To estimate the effect of antidepressant initiation on viral non-suppression among people with HIV (PWH) with clinically recognized, untreated depression.

Design: Retrospective, observational cohort study.

Methods: We included clinical diagnoses of depression from January 2012-June 2022 among PWH in the Johns Hopkins HIV Clinical Cohort without another serious psychiatric illness who had initiated antiretroviral therapy. We excluded diagnoses less than 90 days from a prior diagnosis, antidepressant prescription, or >1 mental health visits. We estimated the association between initiating an antidepressant within 1 month of the index depression diagnosis and viral load non-suppression (>200 copies/mL) on the first viral load 3-12 months subsequent. We adjusted for a comprehensive set of demographic and clinical confounders.

Results: We included 2,346 depression diagnoses among 946 patients; patients initiated an antidepressant following 16%. The risk of viral non-suppression in the absence of antidepressant treatment was 15.6% (95% confidence interval [CI]: 13.1, 18.4). Antidepressant initiation was not associated with viral non-suppression (risk difference: 0.5%; 95% CI: -3.7, 4.8) or secondary outcomes: improvement or resolution of depressive symptoms or adherence to scheduled clinic visits.

Conclusions: In this sample of patients with as-yet-untreated depression, in a setting with co-located, low-barrier psychiatric services, antidepressant treatment was not associated with improved viral suppression. Pharmacologic management of depression has documented benefits in other studies. However, there may be a subset of PWH with depression who have been previously unsuccessfully treated with antidepressants who are less likely to respond to approved pharmacologic options and who require different interventions to improve their viral suppression.

Objective: To investigate the use of non-barrier contraceptives among women with HIV (WWH) compared to women from the general population (WGP) in Denmark.

Design: Nationwide population-based matched cohort study.

Methods: We included WWH aged 16-50, treated at an HIV specialized clinic, and included in The Danish HIV Cohort Study between 1995-2021 and an age-matched comparison cohort of WGP. We examined use of hormonal contraception (HC), intrauterine devices (IUD), and sterilization from 10 years before to 20 years after study inclusion. Additionally, we calculated age-standardized proportions and incidences over calendar time.

Results: We included 1,720 WWH and 17,720 WGP. Median age was 33 years and almost half of WWH had African origin (41%). Non-barrier contraceptive use was lower among WWH (8.5%) compared to WGP (32.1%) at study inclusion. Before and after inclusion, WWH had nearly half the non-barrier contraceptive use of WGP, with notably lower HC and IUD use. Initially, fewer WWH were sterilized, but five years after inclusion, sterilization became the preferred method among WWH. HC use increased among WWH after 2010 but decreased among WGP after 2005. IUD use increased among both groups during 1995-2021 but remained lower among WWH. Incidence of sterilizations remained stable in both groups.

Conclusion: Use of non-barrier contraceptives was lower among WWH compared to WGP. For WWH, sterilization became the preferred non-barrier method few years after study inclusion. HC and IUD use increased among WWH after 2010 but remained lower than for WGP. Improved contraceptive counseling is recommended to support reproductive health among WWH.

Objective: Data on the impact of COVID-19 in people living with HIV (PWH) are lacking in resource-constrained settings. We utilised existingrandomised clinical trials (RCTs) on antiretroviral therapies (ART) in HIV-1 infection to conduct a SARS-CoV-2 serosurvey, between January and March 2021, while characterising participants' features.

Design: Cross-sectional serosurvey.

Methods: Demographic characteristics, medical history and a serum sample were collected from consenting PWH. Samples were analysed centrally for immunoglobulin G antibodies to recombinant nucleocapsid and spike proteins derived from SARS-CoV-2 using a Luminex based assay.

Results: The 549participants recruited in 9 sites across Africa had a median age of 40 years (IQR [34-45]); 63.0% (346) were female. All were on ART; 81.8% (449) had an HIV-1 viral load <50 copies/mL, with CD4 count median at 478/mm 3 (IQR [320-677]). None had received vaccination against SARS-CoV-2. Forty participants (7.3%) had a prior SARS-CoV-2 PCR testing, of whom 10 were positive (1.8%). Crude SARS-CoV-2 seroprevalence was 36.2% (; 95%CI [32.2-40.4]). In the explorative multivariable analysis, comparison of the characteristics of PWH with a positive SARS-CoV-2 serology with those with a negative or indeterminate serology: PWH with a body mass index (BMI)≥30 kg/m 2 were more likely to have a positive serology than those with a BMI≤25 (aOR = 2.39 [1.48-3.86], p < 0.001); and PWH living in Cameroon were less likely to have a positive serology.

Conclusion: This study demonstrates a substantial seroprevalence level of SARS-CoV-2 in PWH in the first quarter of 2021, with a marked disparity with the number of COVID-19 PCR tests reported positive.

Objective: Binge eating is a mental health disorder related to weight gain, whose prevalence/correlation with weight excess in people with HIV (PWH) have been scarcely investigated.Design: A cross-sectional study of PWH who underwent the validated Binge Eating Scale (BES) questionnaire.

Methods: We included adult PWH during routine visits from October 2022 to February 2023. The BES questionnaire was administered with the support of a psychiatrist (score <17 binge eating very unlikely, binge eating ≥17 possible/very likely). We performed a logistic regression for the binary outcome BES at least 17 and being overweighted/obese as effect measure of risk association, and then adjusted for possible confounders (as integrase inhibitor exposure) and performed a sensitivity analysis fitting the regression model including and excluding depression (which may drive binge eating).

Results: We included 1204 PWH, 75.2% men, median age 53 years [interquartile range (IQR): 44-60], 95.6% with undetectable HIV-RNA. As for BMI, we had overweight and obesity in 35.1 and 19.4% cases. Considering BES, 1089 (90.4%) PWH had a score less than 17, 115 (9.6%) at least 17. Multivariable analysis showed that obesity [odds ratio (OR) = 6.21, P  < 0.0001), overweight (OR = 2.21, P  = 0.006) and depression (OR = 1.98, P  = 0.028) were significantly associated with high BES score. By excluding depression, our results were confirmed, and obesity/overweight remained significantly associated with binge eating (obesity OR = 6.58, P  < 0.0001, overweight OR = 2.17, P  = 0.023).

Conclusion: Binge eating should be considered among possible causes of weight gain in PWH. Our results push towards an in-depth study of this topic for a better understanding of the phenomenon in PWH, possibly identifying subgroups of this population who could benefit from a psychoeducational/psychological intervention to preventing WG.

Objective: It is unclear how often anxiety is diagnosed and treated and whether anxiety treatment is associated with improved viral suppression in persons with HIV. In this study, we characterized the anxiety care continuum and its association with viral suppression in a large urban HIV clinic in the United States.

Design: Observational cohort study.

Methods: We described the anxiety care continuum by combining data on self-reported anxiety symptoms, engagement in mental health care, clinical diagnoses and prescriptions from 1967 persons receiving HIV care and treatment in Baltimore, Maryland, from 2014 to 2023. We examined cross-sectional associations with viral suppression. All analyses were stratified by sex and race/ethnicity; a secondary analysis adjusted for age, years in care, and depressive symptoms.

Results: Nearly one in five patients reported mild-severe symptoms of anxiety but were not currently receiving mental health care or pharmacologic treatment for anxiety; 6% of patients reported anxiety symptoms but were receiving treatment, and 7% had been treated for anxiety that was currently in remission. The prevalence of viral suppression ranged from 87% to 89% across the anxiety care continuum except among patients with untreated moderate-severe anxiety, only 81% of whom were virally suppressed [95% confidence interval (CI): 80, 83]. In adjusted models, untreated moderate-severe anxiety remained associated with viral nonsuppression across demographic groups.

Conclusion: We observed a robust association between untreated anxiety and viral nonsuppression in a large urban cohort of persons with HIV. Screening for anxiety may identify patients with unmet mental health care needs who face barriers to maintaining viral suppression.