AIDS reviews最新文献

The epidemiological profile of people living with HIV (PLWH) has expressively changed since the introduction of antiretroviral therapy (ART), from a high mortality rate to a profile similar to those living with chronic diseases. Despite the advances and effectiveness of ART, there are still various challenges to overcome, and we highlight the increased risk of sarcopenia in PLWH. This review study aims to (i) explore the pathophysiological background of sarcopenia in PLWH under the different existing ART and (ii) develop a mini-systematic review searching epidemiological studies investigating sarcopenia prevalence in PLWH. As our main findings: we established the risk of sarcopenia development, under a sequential path involving HIV, ART, immune activation, low-grade systemic inflammation, metabolic disorders, and changes in protein synthesis and breakdown in skeletal muscle tissue; some ART drugs, mainly reverse transcriptase inhibitors and protease inhibitors, contribute to critical metabolic changes, lowering the autophagy, increasing mitochondrial dysfunction and insulin resistance, which favor the development of inflammation and muscle protein breakdown. There is still insufficient data to discuss the effects of the new generation drugs, namely integrase inhibitors and fusion inhibitors, on skeletal muscle. More studies are needed to better clarify these relationships.

Liver-related diseases are associated with the high levels of morbidity and mortality in people living with HIV. Between 13% and 18% of all-cause mortality in HIV-infected patients involves a liver-related damage, this being one of the main causes of death not related to acquired immunodeficiency syndrome (AIDS). People living with HIV, even when the disease is under control, are more likely to develop pathologies and complications of a liver-related origin than the general population, both due to common causes such as alcoholism, non-alcoholic fatty liver disease, hepatic viral infections and ageing, in addition to specific HIV-related processes such as antiretroviral treatment toxicity and liver damage inherent to HIV infection. On the other hand, some antiretroviral drugs may have a beneficial effect in reversing liver fibrosis in patients with HIV and chronic liver disease. This paper reviews the main risk factors associated with liver disease in people living with HIV and the role of antiretroviral therapy (ART) in this disease.

Tobacco smoking undermines the effectiveness of antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA) and potentially associates with other health problems. This study aimed to analyze the growth and content of research on smoking among PLWHA on Web of Science Database. Co-occurrence analysis and Jaccard's' similarity index calculation were performed to identify and visualize networks of countries collaboration, keywords co-occurrence, and research topics. Exploratory factor analysis was applied to the abstracts' contents to uncover research domains and landscapes. The number of publications increased by 14.55% annually in the period of 1991-2017, with 74% of total papers published within 2007-2017. A wide range of topics have been covered, notably co-morbidities, interventions on smoking abstinence and cessation, and the enforcing relationship of smoking cessation with antiretroviral treatment adherence. A shortage of studies on smoking among PLWHA in low- and middle-income countries, limited collaborations between countries outside of close geographical proximity and a lack of discussion on local contexts and psychosocial factors were found. Smoking among PLWHA has been being studied more extensively in recent years, enhancing our knowledge and awareness of the significant and specific effects smoking have on PLWHA, which, in turn, assisting the proposals and implementations of suitable solutions. However, more efforts should be made to examine and understand contextualized aspects, including culture and beliefs specific to each nation or smaller sub-population within a country, especially those currently under-researched, as well as psycho-behavioral factors to implement more effective interventions to reduce smoking among PLWHA.

Anal cancer is a common disease in men who have sex with men (MSM) with HIV infection and is associated with human papilloma virus (HPV) infection, which is very prevalent in this population. Advanced anal cancer has an aggressive treatment, with a high risk of producing an impaired quality of life. In cases of late diagnosis, mortality remains elevated. Based on these findings, it is a priority to carry out a systematic screening to detect earlier and prevent the disease. In this review and based in our experience at the Infectious Diseases outclinic at Hospital de la Santa Creu and Sant Pau in Barcelona, Spain, we propose a series of actions carried out by trained nurses. We recommend a coordinated set of multidisciplinary activities on HIV + MSM focused on HPV immunization and periodic anal cytology screening. A good implementation of the program will provide significant benefits, since at this time, the best care for anal cancer relies in HPV prevention and early diagnosis of HPV oncogenic lesions.

There is no correlation between HIV per se and other risk factors for severe COVID-19 disease. Pivotal studies have shown that vaccination is one of the effective ways to prevent severe COVID-19 illness in the general population. Studies on people living with HIV (PLWH) are scarce. The majority of these studies with mRNA (BNT126b2 and mRNA-1273) and adenovirus vector (Ad26.COV2.2 and ChAdOx1) vaccines with a low number of patients included shows that PLWH on antiretroviral treatment and with CD4 count > 200/mm³ has a robust immune response. These vaccines are thus effective in preventing severe infection caused by severe acute respiratory syndrome coronavirus 2 in PLWH. However, PLWH with a CD4 count of < 200/mm³ and uncontrolled viral load (VL) seems to have a lower immune response. COVID-19 vaccines are safe in PLWH; adverse effects are mild or moderate, and their incidence is similar to non-HIV people (NHP). The CD4 count decreased significantly and transiently, and the VL rebounded insignificantly in a few patients. A complete vaccination including a third dose is, therefore, recommended. A booster dose with an mRNA vaccine is recommended in PLWH with an advanced stage of their disease.

Aging, a time-dependent loss of physiological function, and its drivers are turning into a significant topic of researchas the population's mean age increases. Epigenetic alterations, telomere shortening or dysfunction, mitogenic stress,oxidative stress, or accumulation of DNA damage can drive the cell to senescence a permanent cell cycle arrest sometimes associated with a secretory phenotype and inflammatory consequences in the surrounding tissue. The amount of senescent cellsgrows over time in older organisms and may induce tissue inflammation and threaten overall tissue homeostasis, favoring aging. Senolytic and senomorphic therapeuticsare an emerging approach to eliminate senescent cells or to block their secretoryphenotypes respectively. Given that people living with HIV suffer non-AIDS comorbidities in a higher prevalence than the general population, aging is accentuated among them. Inflammation biomarkers may be helpful to assess prognosis or act as surrogate endpoints for studies of strategies focused on reversal of HIV-associated accelerated aging. This review summarizes the latest findings in aging and its major drivers, under the light of HIV infection. Since the number of older PLWH is currently rising, it will be of great importance to address and treat their age-related conditions, as well as to better decipher their biological mechanisms.

The prevalence of obesity has increased dramatically in recent decades worldwide. An increase in the prevalence of obesity has also been observed among people living with HIV (PLHIV) in high and low incomes countries. Antiretroviral therapy (ART), by controlling the viral load (VL) and restoring cellular immunity, has improved the health status and life expectancy in PLHIV. However, the risk of developing non-AIDS events (NAEs) remains higher than the general population. Therefore, specific attention is given to managing risk factors associated with NAEs during the follow-up of PLHIV, including obesity. Factors related to weight gain in PLHIV include demographic factors, HIV disease-related factors, and ART-associated factors. In naive PLHIV, weight gain after the initiation of ART is expected. The weight gains observed are generally not severe even if there appear to be risk factors such as the advanced stage of disease (low CD4 cells count and high VL), female sex, black race, and taking integrase strand transfer inhibitors (INSTI) associated or not with tenofovir alafenamide fumarate (TAF). The role of each antiretroviral drug per-se remains to clarify. As INSTI ± TAF has been associated with significant weight gain, further research is needed to identify the individual-level factors predictive of weight gain, the mechanisms of ART-associated weight gain and the clinical relevance of this weight gain. As PLHIV survive longer on effective ART, the prevention and management of NAEs will remain a challenge for healthcare providers.

An extension of the UNAIDS 90-90-90 target proposes >90% of people living with HIV (PLHIV) should have good health-related quality of life (HrQoL); however, limited guidance exists. The "Health Goals for Me" framework, an individualized approach to HIV care, provides a framework to assess HrQoL. We analyzed several patient-reported outcome measures (PROMs) to develop a practical toolkit to facilitate shared physician-patient decision-making. HrQoL subdomains, actionable in the clinical setting and measurable as PROMs, were selected. PROMs were collated through systematic literature searches, scored by the authors on usability, validation, and availability, after which practical recommendations were made. Nine subdomains were selected across physical, psychological, social, and environmental domains; 46 validated PROMs were identified. After pre-screening, from 39 evaluated PROMs, we recommended PROMs in the following subdomains: fatigue/energy loss, frailty/resilience, sleep disturbance, substance use, anxiety/depression, cognition, sexual function and desire, and stigma. Using this toolkit, healthcare professionals and PLHIV can collaborate and mutually agree on individual care objectives. Following the "Health Goals for Me" framework, appropriate care interventions can be implemented and reviewed in a continuous cycle. We discussed how eHealth interventions, which will have increasing importance in the post-COVID era, can facilitate improved HrQoL for PLHIV by utilizing toolkits such as the one described here. Implementation of this practical framework and the PROMs toolkit could provide a useful approach to assessing HrQoL in PLHIV and could enhance the physician's ability to gain valuable insights into the patient's daily life across a broad range of HrQoL issues.