AIDS Research and Therapy最新文献

Sub-Saharan Africa (SSA) remains at the epicentre of the global HIV epidemic and faces a decisive moment in its journey toward achieving the UNAIDS 95-95-95 targets. This review aims to provide a comprehensive overview of the progress toward these targets in SSA, identifying key challenges, barriers to viral load suppression, and potential strategies to improve treatment adherence and health outcomes. These goals-ensuring that 95% of people living with HIV know their status, 95% of those diagnosed are receiving treatment, and 95% of those receiving treatment achieve VLS-represent a bold vision to end HIV as a public health threat by 2030. However, across the region, progress is threatened by persistent structural barriers, entrenched stigma, health system weaknesses, and recent global funding disruptions, including the 2025 freeze on U.S. foreign aid. This review explores the multifaceted obstacles that continue to hinder the HIV response in SSA, from testing gaps to challenges in care retention and VLS, particularly among vulnerable populations. It further examines the potential consequences of funding cuts for health system resilience and epidemic control. Emphasising the need for equity-driven, locally adapted, and innovative strategies-such as community-based service delivery, digital health tools, long-acting therapies, and integrated care models-this article argues for renewed political commitment, sustainable financing, and stronger local and global partnerships. When setbacks loom large, this piece calls for urgent, coordinated action to protect progress, address persistent inequities, and secure a future where epidemic control is truly within reach.

Background: This retrospective observational study evaluated the clinical use and treatment outcomes in virologically suppressed people with HIV (PWH) switching to either bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or dolutegravir (DTG)-based regimens (single- and multi-tablet formulations (STR and MTR)).

Methods: We analyzed electronic medical and dispensing records from Trio Health HIV Research Network for treatment-experienced PWH ≥ 18 years suppressed (viral load [VL] < 200 copies/mL) at switch to B/F/TAF, DTG STR (DTG/3TC, DTG/RPV, DTG/3TC/ABC) or most common DTG MTRs with VL at 12 months (+/-3) since switch between April 2019 and December 2024. Univariate comparisons: chi-square or t-test; characteristics associated with virologic suppression at 12 months: multivariable logistic regression [LR], controlling for age, gender, race, baseline CD4 count, regimen, and adherence (proportion days covered [PDC] ≥ 80%).

Results: Of 3141 PWH, 66% switched to B/F/TAF, 27% to DTG STR, and 7% to DTG MTRs. Baseline characteristics differed significantly between groups: B/F/TAF group had a higher proportion of males (81% vs. 67% DTG MTR) and Black individuals (40% vs. 31% DTG STR), while the DTG STR and MTR groups had higher proportions of PWH with cardiovascular disease (35% and 39% respectively vs. 32% on B/F/TAF) and eGFR < 60 mL/min/1.73 m² (18% and 22% respectively vs. 8% on B/F/TAF). At 12 months post switch, proportion of individuals with PDC ≥ 80% was higher in the DTG STR group (76%) compared to DTG MTR (67%) and B/F/TAF (69%) with similar virologic suppression across groups (98%, 98%, and 97% respectively). In multivariable LR, there was an association of White race, PDC ≥ 80%, and CD4 ≥ 200 cells/mm³ with greater probability of suppression at 12 months.

Conclusions: Despite differences in baseline characteristics and regimen adherence between individuals switched to B/F/TAF, DTG STRs, and MTRs, both B/F/TAF and DTG-based regimens were associated with high rates of virologic suppression. This data strongly supports the inclusion of these simple and safe regimens as switch options in virologically suppressed PWH. Baseline differences in patient demographics and characteristics may have impacted the adherence on B/F/TAF compared to DTG STR, however virologic outcomes were preserved, demonstrating the forgiveness of B/F/TAF in populations potentially facing adherence challenges.

Background: Progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome (PML-IRIS) is a high-mortality disease among patients with AIDS. It is caused by infection with the John Cunningham virus (JCV). Currently, there are no specific antiviral treatments targeting JCV. Thus, immune reconstitution remains the primary therapeutic approach.

Case presentation: A 29-year-old male patient diagnosed with AIDS presented for medical evaluation after two months of antiretroviral therapy (ART), reporting symptoms of dizziness and headache. The detection of JC virus was confirmed in cerebrospinal fluid (CSF) through metagenomic next-generation sequencing (mNGS) analysis. Plain and enhanced cranial MRI scans revealed diffusely distributed nodular and patchy enhancement shadows within the brain parenchyma, consistent with a diagnosis of PML-IRIS. Given that glucocorticoids and PD-1 inhibitors may possess higher toxicity profiles and side effects compared to intravenous immunoglobulin (IVIG), which has been shown to restore immune function while causing fewer adverse reactions rapidly, a five-day regimen of intravenous IVIG infusion was administered in conjunction with continuous ART. Following this intervention, the patient showed significant clinical improvement, including reduced dizziness and headache, and improved neurological function.

Conclusions: The administration of IVIG alone may be considered an effective immunologic reconstitution strategy in treating early stages of PML-IRIS associated with AIDS, despite the complexity of the disease. This approach could be attributed to direct anti-JCV effects, neutralization of toxins, inhibition of inflammatory cytokine release, and its relatively tolerable safety profile. This case report aims to serve as a reference for clinical practitioners regarding the use of standalone IVIG therapy for HIV-related early PML-IRIS management; however, further investigation is warranted to determine its efficacy in cases where PML-IRIS has been detected at later stages.

Introduction: Hypoalbuminemia is linked to an earlier onset of acquired immune deficiency syndrome and increased mortality in patients living with HIV infection. Serum albumin is therefore an independent factor for the prediction of disease progression and mortality in People Living With HIV.

Methods: This was a cross-sectional study conducted at Lira Regional Referral Hospital in northern Uganda that targeted HIV-positive outpatients attending the ART clinic with a sample size of 373 patients. Data were collected through structured interviews and laboratory tests in which the serum albumin concentration, viral load, and CD4 count were measured.

Results: The prevalence of hypoalbuminemia was 19.6% (73/373). A moderate positive correlation was observed between the serum albumin concentration and the CD4 count (rs = 0.43, p < 0.001). Patients with no formal education [AOR = 2.03, 95%CI = 1.69-2.07, P = 0.03] were 2.03 times more likely to have hypoalbuminemia than those who had a tertiary/university education level. The odds of having hypoalbuminemia [AOR = 2.17, CI = 1.80-3.06, P = 0.02] were 2.17 higher among HIV-infected patients who were naïve ART than among those who were on ART. Additionally, the odds of having hypoalbuminemia [AOR = 2.91, CI = 2.13-3.66, P = 0.01] were 2.91 higher among HIV-infected patients who were in stage four than among those who were in stage 1.

Conclusion: Hypoalbuminemia prevalence was high in PLWHIV, and a moderate positive correlation was found between the serum albumin level and the CD4 cell count. Lower education level, not being ART, and advanced HIV disease were independently associated with hypoalbuminemia.

Background: Many people with HIV experience considerable barriers to accessing HIV clinic services. Options that would permit blood sampling that preclude the need for in-clinic visits and increase privacy would aid in overcoming many of the obstacles that hinder receiving adequate HIV care.

Methods: In Project Home-MaDE, 57 participants were evaluated for their ability to collect fingerstick blood (minimum 250 µL) in Microtainer tubes (MCT), then package and overnight mail specimens following kit instructions without assistance. Specimens were required to arrive at the laboratory within four days of collection. Plasma viral loads obtained from mailed blood were compared to matched venipuncture samples collected on the same day. For fingerstick-derived plasma, the limit of quantitation was 210 copies/mL, a benchmark relevant for Undetectable = Untransmissible prevention. A non-reactive or below-quantifiable result reflected viral suppression. Self-collected dried blood spots which have historically been used for remote blood sampling were likewise evaluated.

Results: Forty-seven (82%) participants had acceptable MCT samples for testing. Ten specimens were rejected either for excessive time and temperature (n = 1) or insufficient sample volume (n = 9). Of the 34 participants who initially experienced difficulty in obtaining sufficient sample 29 elected to retry and 24 were successful. All 46 acceptable MCT plasmas tested provided accurate results as compared to the suppression levels in their matched conventional venipuncture viral loads.

Conclusion: Under a rigorous protocol, plasma from mailed, self-collected fingersticks by untrained individuals were suitable for remote viral suppression monitoring. This evaluation, however, was limited to temperatures and courier service in the U.S. Approved testing options for self-collected samples may support HIV telemedicine and empower persons to overcome barriers to care services.

Objectives: The diversity of HIV-1 genotypes among Men who have sex with men (MSM) globally has changed considerably. The purpose of this study to assess the global prevalence of HIV-1 genotypes among MSM.

Methods: PubMed, Embase, Scopus, and Web of Science were systematically searched to identify the articles. Pooled prevalence of HIV-1 genotypes was calculated and subgroup analyses were performed to examine the prevalence estimates across time and locations.

Results: A total of 95 studies were included in the final analysis, including 84,622 successfully genotyped samples. The predominant strains were CRF01_AE (34.46%), subtype B (31.16%), and CRF07_BC (24.72%). In subgroup analyses, Subtype B and C showed a declining trend over the years. However, CRF07_BC exhibited a consistent year-on-year increase, while CRF01_AE experienced a slight reduction after 2018. Notably, both subtypes currently account for more than 35% of the total. In addition, the distribution of HIV-1 subtypes in this population shown a clear regional distribution. Regionally, subtype B predominated in Latin America and Europe, CRF01_AE and CRF07_BC in Asia and China, while subtype C and CRF02_AG were dominant in Africa and the Middle East.

Conclusions: Global and regions MSM HIV-1 subtypes are becoming more complex over time and the prevalence of recombinant viruses is increasing. Ongoing and effective surveillance of the global and regional molecular epidemiology of HIV-1 in MSM is critical for developing targeted preventive control measures against HIV.

Background: Human Immunodeficiency Virus and malaria are significant public health challenges in sub-Saharan Africa, contributing substantially to morbidity and mortality in the region. The trajectory of HIV and malaria mono- and coinfections may be different with presentations of drug-drug and disease-disease interactions. Current medications of artemether-lumefantrine and dolutegravir (DTG) -based anti-retroviral therapy which are the preferred drugs are metabolised by CYP2B6, CYP3A4/5 and UGTs which are polymorphic and may contribute to drug disposition and clinical outcomes. This study investigated the pharmacogenetic effects of co-administration of arthemeter-lumfantrine and DTG in HIV-malaria mono and coinfection.

Methods: Malaria and HIV mono- and coinfected participants were recruited from health facilities in the Central region of Ghana. Blood samples were taken at pre-defined time points during malaria and HIV mono- and coinfection. Plasma drug concentrations of artemether-lumefantrine and dolutegravir and their metabolites of dihydroartemisinin and desbutyl-lumefantrine were determined by liquid chromatography-mass spectrometry (LC-MS/ MS). Genotyping for CYP2B6, UGT1A, CYP3A4 and CYP3A5 was undertaken using PCR-RFLP, TaqMan assays and Iplex GOLD SNP genotyping protocol.

Results: Two hundred and sixty-one participants were involved in this study, with a male to female ratio of 1:2. Median parasitaemia for malaria monoinfection and HIV-malaria coinfection was 947.34 parasites/µL of whole blood and 5287.36 parasites/µL of whole blood respectively on day 1. By days 3 and 7, the parasitaemia had decreased to 0 for both malaria monoinfection and HIV-malaria coinfections. Plasma median C_{day 7} for lumefantrine was 741.5 (496.0, 1276.0) ng/mL for malaria monoinfection and 426.0 (254.5, 803) ng/mL for malaria and HIV coinfection (MHC) showing a decreased plasma concentration during coadministration with DTG. There was a decrease in the plasma concentration of DTG in MHC cases compared to HIV monoinfection. This trend is observed in CYP3A5 rs776746, CYP3A rs10264272, CYP3A4 rs2740574, UGT1A1 rs4148323 and CYP2B6 rs28399499 genetic variations.

Conclusions: There is an observed decrease in plasma drug concentrations during the co-administration of artemether-lumefantrine and dolutegravir. Possible long-term effects from non-adherence may include sub-optimal levels that could result in clinical differences and outcomes.

Introduction: Abortion is a critical reproductive health issue among young women living with HIV (YWLHIV). Despite the widespread use of the antiretroviral therapy (ART) for women of reproductive age, its impact on abortion prevalence remains unclear. We set out to determine the prevalence of abortion among the YWLHIV receiving TLD-based ART regimen in northern Uganda and its association with the ART regimen and duration alongside other key socio-demographic, reproductive health, lifestyle and facility access- related factors.

Methods: A cross-sectional study of YWLHIV who reported at least one pregnancy in northern Uganda. Using an interviewer-administered questionnaire, participants were asked about their abortion history, ART regimen and duration, contraceptive use, parity, male partner's HIV status, and access to community-based family planning resources. Descriptive statistics for abortion prevalence, Chi-square test, Fisher's Exact test, bivariate and multivariate Poisson regression analyses for the associations between these variables and the occurrence of abortion were used. The 5% significance level and 95% confidence intervals were considered.

Results: We analyzed data of 268 YWLHIV who reported conceiving at least one pregnancy. The abortion prevalence was 20.9% (95% Confidence Interval (CI) of 16.2% - 26.1%). No significant association was found between the abortion experience and ART regimens nor duration. The significant predictors for abortion included awareness of public health facilities that provide family planning services, parity, sero-concordant HIV-positive partnerships, and modern contraceptive use.

Conclusion: This study found a substantial abortion prevalence of 20.9% among the YWLHIV in northern Uganda. There was no significant association between the occurrence of abortion and ART regimens nor duration. Key predictors of abortion included awareness of public health facilities that provide family planning services, parity, use of contraceptive methods and the male partner's HIV positive status. To reduce abortion, creation of awareness of public health facilities that provide family planning services, contraceptive use, and couple-focused HIV testing and status disclosure are recommended.

Introduction: Antiretroviral therapy (ART) reduces morbidity and mortality due to human immunodeficiency virus (HIV) infection. In 2019, Tanzania adopted Dolutegravir (DTG) as a first-, second-line, and third-line treatment for children and adolescents living with HIV (CALHIV). Viral load suppression (VLS) is desirable in the prevention of HIV transmission thus achieving the third '95' target. DTG treatment has highly potent antiviral activity, a high genetic barrier to resistance, and a high safety profile. We aimed to determine VLS and associated factors among CALHIV on DTG-based ART in Tanzania.

Methods: We conducted a retrospective cohort analysis among CALHIV who were on a DTG-based regimen in Tanzania between 2019 and 2021. We extracted demographic and clinical characteristics from the care and treatment clinic database. A multilevel mixed effects Poisson regression model was used to determine factors associated with VLS at < 1000 copies/ml among CALHIV on a DTG-based regimen.

Results: A total of 63,453 CALHIV on a DTG-based regimen were analysed. The proportion of viral suppression was 91.64%. Overall, 66.19% of previously unsuppressed individuals became suppressed, and 88.45% of previously suppressed remained suppressed. Factors leading to higher chances of viral suppression were aged 15-19 years (aRR: 1.02; 95%CI: 1.017-1.03), those in WHO stage I (aRR: 1.03; 95%CI: 1.01-1.04), those in WHO stage II (aRR: 1.02; 95%CI: 1.00-1.04), and those who ever received a multi-month prescription on ART (aRR: 1.25; 95% CI: 1.23-1.28), while those aged 10-14 years (aRR: 0.98; 95%CI: 0.97-0.99), previously unsuppressed prior to starting DTG (aRR: 0.92; 95%CI: 0.91-0.93), duration on ART more than 24 months (aRR: 0.96; 95%CI: 0.94-0.97), not retained in care (aRR: 0.83; 95% CI: 0.77-0.89), severe malnutrition (aRR:0.77; 95%CI: 0.69-0.94) and coastal zone (aRR: 0.98; 95% CI: 0.96-0.99) were less likely to achieve VLS.

Conclusions: This study showed DTG-based regimens have a good response for both naïve, previously unsuppressed, and suppressed Children and Adolescents Living with HIV (CALHIV) with significant improvement in viral suppression. Improving retention in care and malnutrition might improve VLS and achieve the third '95'.

Background: To inform strategies aimed at reducing Metabolic Syndrome (MetS) among People Living with HIV (PLWH), it is important to understand the contribution of pre-Antiretroviral Therapy (ART) health. We estimated the prevalence and factors associated with MetS among ART naïve PLWH.

Methods: A multi-centre cross-sectional study was conducted among adult ART naïve PLWH. MetS was defined as presence of any three sub-components; central obesity, raised blood pressure, impaired fasting glucose, reduced high-density lipoprotein cholesterol and raised triglycerides. Modified World Health Organization (WHO) Steps questionnaire was used to collect information on demographics, behavioral, and physical measurements. Fasting blood samples were taken for blood sugar, high density lipoprotein cholesterol (HDLc) and triglyceride measurements. MetS prevalence was estimated and logistic regression used to determine associated factors. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were reported.

Results: Of 347 ART naïve PLWH with median age 38 years (IQR:19-67), MetS prevalence was at 15.3% (95% CI: 11.7-19.5). Abnormal HDLc was the most prevalent MetS sub-component 64.8% (95% CI: 59.6-69.9). Each year increase in age of participants increased odds of Mets by 4% (aOR = 1.04, 95% CI: 1.01-1.07). Being overweight/obese increased the odds of having MetS by 3.2 times compared to being of healthy weight (aOR = 3.2, 95% CI: 1.6-6.3).

Conclusion: We found that about one in seven ART Naïve PLWH in Accra, Ghana, met the diagnostic criteria for MetS. The contributory factors were consistent with known risk factors for cardiometabolic illnesses. We recommend routine screening of PLWH for MetS sub-components.