AIDS Research and Therapy最新文献

Background: Vaccine acceptance among People Living with HIV (PLWH) is crucial for managing and mitigating the spread of infectious diseases, including Mpox. This systematic review and meta-analysis assess the rate of vaccine acceptance for Mpox among PLWH and identify factors influencing these rates.

Methods: We searched major databases including PubMed, Embase, and Web of Science up to 30 August 2024 for observational studies involving PLWH that reported on mpox vaccine acceptance rates. A random-effects model was employed for the meta-analysis, utilizing R software version 4.4. Heterogeneity among the studies was quantified using the I² statistic, and the methodological quality of each study was assessed using a modified version of the Newcastle-Ottawa Scale.

Results: Out of 1,123 articles identified, 17 studies met the inclusion criteria and included 7,248 participants. The pooled estimate of the Mpox vaccine acceptance rate was 61.1% (95% CI: 44.2-75.7%), with high heterogeneity (I² = 99%). Additionally, a pooled vaccine hesitancy prevalence was 13.2%, (95% CI: 2.4-48.6%), reflecting substantial variability and had high heterogeneity (I² = 98%).

Conclusion: This systematic review and meta-analysis reveal moderate Mpox vaccine acceptance and considerable hesitancy among PLWH. To further increase vaccine uptake and address any remaining hesitancy in this at-risk population, targeted public health strategies and ongoing research are necessary. Strengthening vaccine acceptance is critical to safeguarding PLWH against emerging infectious diseases such as Mpox.

Clinical trial number: Not applicable.

Introduction: HPTN 071 (PopART) implemented a comprehensive HIV prevention package which aimed to reduce HIV incidence within 21 communities of Zambia and South Africa: Arm A, PopART intervention of universal HIV testing and treatment; Arm B, PopART intervention of universal HIV testing with ART provided according to local guidelines; and Arm C, standard of care. Analyses so far have not accounted for the sampling design of the enrolled cohort. We performed a sample-weighted re-analysis of the primary outcome of the PopART trial to derive a population-based estimate of the intervention effect.

Methods: Enrollment used a two-stage sampling design: household and adult participant within each household. We constructed post-stratification weights to match the age and sex distribution of the target population in these communities. Weighted Poisson regression was used to estimate community-level HIV incidence. The PopART intervention effect was estimated using log-transformed community-level incidence estimates in an ANCOVA model.

Results: The analysis based on community-level incidence shows a 25% reduction in incidence for Arm B communities compared to standard of care (RR: 0.75, 95% CI: 0.56-1.02, p = 0.06) while Arm A communities show no difference in HIV incidence compared to standard of care (RR: 1.08, 95% CI: 0.81-1.46, p = 0.56).

Conclusions: Our re-analysis shows 25% reduction in HIV incidence comparing Arm B to Arm C communities. No effect was observed comparing Arm A communities to Arm C communities. These results align with the primary results of the PopART trial.

Clinicaltrials: gov number, NCT01900977, HPTN 071 [PopArt].

Introduction: Data on the impact of World Health Organization (WHO)'s guideline changes and COVID-19 on ART initiation in the Asia-Pacific remain scarce. This study described temporal trends from HIV diagnosis to ART initiation from 2013 to 2023 and its associated factors.

Methods: Adults (≥ 18 years) diagnosed with HIV after 2013 in a regional observational cohort were included. Fine and Gray competing risk regression examined predictors of ART initiation (≥ 3 antiretroviral medications), accounting for those lost to follow-up or deceased before treatment considered as competing risks.

Results: Among 14,968 participants, most were male (70.1%), with a median age of 36 years (interquartile range [IQR]: 28-44). At HIV diagnosis, median CD4 count was 208 cells/µL (IQR: 69-395), and median viral load was 86,296 copies/mL (IQR: 13,186-392,000). Over 85% of participants had initiated ART during the study period. Median time from HIV diagnosis to ART initiation differed across years of HIV diagnosis: 51 days (2013-2015), 28 days (2016-2019), and 26 days (≥ 2020). Factors associated with shorter time to ART initiation were higher country income-level (upper-middle: sub-distribution hazard ratio [SHR] = 1.34, 95% CI: 1.28, 1.40; high: SHR = 1.35, 95% CI: 1.28, 1.43; vs. lower-middle); HIV transmission via male-to-male contact (SHR = 1.06, 95% CI: 1.02, 1.11) or injection drug use (SHR = 1.23, 95% CI: 1.09, 1.38; vs. heterosexual contact); and later years of HIV diagnosis (2016-2019: SHR = 1.33, 95% CI: 1.28, 1.38; ≥ 2020: SHR = 1.40, 95% CI: 1.33, 1.48; vs. 2013-2015). Those with higher CD4 counts had longer time to ART start (350-499 cells/µL: SHR = 0.76, 95% CI: 0.67, 0.86; > 500 cells/µL: SHR = 0.55, 95% CI: 0.49, 0.61; vs. CD4 < 200 cells/µL).

Conclusion: Time to ART initiation from HIV diagnosis decreased after 2016, aligning with evolving WHO guidelines, and did not appear to be impacted by COVID-19. Optimizing treatment initiation during the treat-all era is crucial, especially among those with higher CD4 counts.

This study aimed to explore willingness to use and preference for long-acting injectable PrEP (LAI-PrEP) among Thai youth at risk of HIV. A cross-sectional study was conducted in 100 Thai youth aged 18 to 24 years attending a sexual health clinic in Bangkok, Thailand. Participants received information about oral and LAI-PrEP before completing a questionnaire. Of the 98 participants willing to use pre-exposure prophylaxis, 47 preferred the injectable form. Preference for the injectable form was higher among individuals not currently using oral pre-exposure prophylaxis, affordability and longer injection intervals were key for acceptance of long-acting injectable pre-exposure prophylaxis.

Introduction: Simplified HIV treatment guidelines favor integrase strand transfer inhibitors (INSTIs). However, non-infectious comorbidities and co-occurring conditions (i.e. pregnancy) often necessitate individualized antiretroviral therapy (ART) regimens. This study aimed to characterize United States HIV provider strategies for ART selection when faced with concomitant health conditions.

Methods: A survey of US HIV providers was conducted using hypothetical patient cases. Standardized clinical case-vignettes were developed and providers were asked to select their preferred regimen. Eleven cases focused on cardiometabolic syndrome, renal dysfunction, weight gain, and pregnancy.

Results: 119 providers responded across all cases (with a median 57 responses [interquartile range 55.5-72] per case), and were primarily Infectious Diseases physicians in academic settings from across the continental United States. Bictegravir/tenofovir alafenamide/emtricitabine was most commonly prescribed for three case-scenarios of cardiometabolic disease (62.3%). Diverse regimens were recommended for a case involving weight gain, with 98.5% switching from dolutegravir plus tenofovir alafenamide/emtricitabine, most commonly to doravirine/tenofovir disoproxil fumarate/lamivudine. Dolutegravir-based regimens were selected in case-scenarios of pregnancy (77.3%), with some use of bictegravir/tenofovir alafenamide/emtricitabine (13.6%). For two case-scenarios renal disease with worsening creatinine clearance to < 30 mL/minute, many providers used lamivudine or emtricitabine in fixed-dose combination (43.3%).

Conclusion: This study reveals varied ART approaches for people living with HIV and non-infectious conditions, often diverging from standard regimens. While guidelines provide a framework, providers adapt treatment based on patient needs. Further research is crucial to optimize ART management in these complex situations.

This Matters Arising explores the article titled "Willingness to Trade-Off Years of Life for an HIV Cure- An Experimental Exploration of Affective Forecasting," published in AIDS Research and Therapy in August 2024. We highlight the importance of considering ethical concerns and the inclusion of people with HIV (PWH) in the design of socio-behavioral research focused on HIV cure. While the authors suggest that PWH with lower quality of life may be more willing to trade years of life for a cure, we encourage further reflection on the potential emotional and psychological impacts of such hypothetical scenarios. The term "cure" could be clarified, as it traditionally implies an improvement in quality of life. We also note that future studies would benefit from clearer objectives and terminology that respects the dignity of PWH. We suggest that future research in this area prioritize the lived experiences of PWH and aim for both quality and quantity of life improvements, ensuring that research outcomes are aligned with the real-world needs and perspectives of PWH.

Background: The growing number of older adults living with HIV, facilitated by wider access to antiretroviral therapy (ART), presents unique challenges. This study aims to identify predictors of survival among older persons living with HIV receiving ART in Uganda's AIDS Support Organization Centers of Excellence (1987-2023). Understanding these predictors can inform effective clinical interventions to improve outcomes for this population.

Methods: This study conducted a retrospective analysis of medical records from 11 TASO centers of excellence in Uganda (1987-2023). Using Cox proportional hazards regression, we identified factors associated with survival among older adults living with HIV. TASO centers of excellence in Entebbe, Gulu, Jinja, Masaka, Masindi, Mbale, Mbarara, Mulago, Rukungiri, Soroti, and Tororo. Cox proportional hazards regression analysis identified factors influencing survival among older persons living with HIV (OPLHIV).

Results: Of the 30,758 OPLHIV medical records analyzed (1987-2023), 72.5% were active on ART, 5.9% had died, 15.2% were lost to follow-up, and 5.6% transferred to other facilities. Survival was significantly associated with: gender (female, HR = 1.19, p < 0.001), marital status (married, HR = 0.99, p < 0.001; separated/divorced, HR = 0.85, p < 0.001), WHO clinical stage (II, HR = 1.66, p < 0.001), viral load (> 200 copies/ml, HR = 1.49, p < 0.001), and ART adherence (fair, HR = 0.94, p = 0.157).

Conclusion: Key predictors of survival among Older Adults Living with HIV (OPLHIV) include: female gender, age 50-59, weight 51-70 kg, married status, viral load > 200 copies/ml, WHO HIV clinical stage II, paid employment, and ART adherence. To improve survival outcomes, consistent clinical screenings of WHO clinical stages, viral load, and ART adherence are essential. These measures can guide healthcare providers in making informed treatment decisions to enhance survival and quality of life for OPLHIV in Uganda.

Recommendations: Strengthen routine monitoring of viral load, ART adherence, and WHO clinical staging. Provide targeted support to married and separated/divorced adults to improve their survival chances. Address gender disparities in care to enhance outcomes for females. Focus on maintaining ART adherence and viral suppression to reduce mortality risks.

Background: Despite progress towards HIV epidemic control, people living with HIV (PLHIV) in Zambia continue to face high mortality during and especially after hospitalization, with suboptimal post-discharge care leading to poor outcomes. We conducted a qualitative study to better understand factors influencing post-discharge engagement in care for HIV and associated comorbidities.

Methods: We conducted in-depth interviews with 16 recently discharged PLHIV, seven caregivers, and two doctors; and three focus group discussions with inpatient doctors (n = 8) and lay counsellors (n = 16) at two tertiary hospitals in Lusaka, guided by the social-ecological model. Data were audio-recorded, transcribed verbatim, managed with Atlas.ti 9, and thematically analyzed.

Results: Individual and household-level barriers to post-discharge care for PLHIV included HIV status denial and stigma, limited disclosure, and limited social and emotional support. Health-related barriers included concomitant treatments for TB, HIV comorbidities, and behavioral health issues like depression and alcohol abuse. Health system barriers included limited confidentiality during admission and poor communication between healthcare providers and between facilities aftercare transitions following discharge. Social-economic factors included economic shocks of hospitalization and post-discharge recovery, which compounded pre-existing poverty and high transportation and food costs. Conversely, disclosure of HIV status, better social support, a financially stable household, and hospital follow-up appointment reminders facilitated better post-discharge care.

Conclusion: After hospital discharge with HIV, system and individual challenges exacerbate pre-existing interpersonal, health, environmental, and system-related factors to cause poor outcomes. Holistic community-based interventions to facilitate these patients' re-engagement in care after discharge could help HIV programs reach the last mile in epidemic control.