AIDS reviews最新文献

Africa hosts the highest burden of esophageal cancer (49%) and HIV (60%) worldwide. It is imperative to investigate the synergistic impact of these two diseases on African populations. This study conducted an exhaustive computerized search of databases, including Medline/PubMed, Embase, Web of Science, Scopus, Cochrane library, and African Journals Online, to identify eligible studies up to October 2023. HIV infection was the exposure, esophageal cancer risk was the outcome, and healthy subjects with no cancer history served as comparators. Study quality was assessed using the Newcastle-Ottawa scale, and potential publication bias was evaluated through funnel plots and the Egger test. Meta-analyses were conducted using Stata 17.0 software and involved a thorough examination of 98,397 studies. Out of these, eight studies originating from Eastern and Southern Africa, recognized as esophageal cancer hotspots on the continent, met the eligibility criteria. The analysis revealed a non-significant association between HIV infection and esophageal cancer risk (odds ratio = 1.34 [95% confidence interval, 0.85-2.12]; with 0.26 as p-value of overall effects). The Egger test yielded a p-value of 0.2413, suggesting the absence of publication bias. In summary, this systematic review and meta-analysis indicate that there is no established causal link between HIV infection and esophageal cancer risk. However, further research is essential to delve into the potential mechanisms underlying this relationship.

This study was performed to reveal the risk factors associated with mortality in people living with HIV (PLHIV) who were diagnosed with COVID-19. Studies reporting deaths among PLHIV and infected with SARS-CoV-2 were investigated. After protocol setup and registration, the extracted sources were categorized and assessed for quality. This study examined ten articles with a total of 46,136 patients. Patients aged ≥ 60 years (hazard ratio [HR] = 2.22; 95% CI: 1.617, 3.050; p < 0.001), male (HR = 1.668; 95% CI: 1.179, 2.361; p = 0.004), and people with diabetes (risk ratio [RR] = 3.34; 95% CI: 1.45, 7.68; p = 0.005) were at higher risk of death. Adherence to antiretroviral therapy (ART) reduced mortality risk (RR = 0.90; 95% CI: 0.83, 0.98; p = 0.02). Patients in the survival groups showed a statistically significant lower mean of C-reactive protein (mean difference = 114.08; 95% -74.05, 154.10; p < 0.001). Deceased patients showed higher mean levels of interleukin-6 (IL-6). Chronic respiratory disorders, hypertension, oxygen requirement, admission to an intensive care unit, D-dimer levels, and HIV viral load < 50 copies RNA/mL before admission did not show statistically significant differences between the deceased and survival groups. ART therapy reduced mortality risk (RR = 0.90; 95% 0.83, 0.98; p = 0.02). Identifying PLHIV at higher mortality risk could improve the outcomes of COVID-19 by stratifying these patients to the most effective treatment in a timely fashion.

Sweden is a country with a low prevalence of human lymphotropic T-cell virus (HTLV) infection, estimated at < 0.005%, but the infection rate is notably higher in specific risk groups such as HTLV-2 among intravenous drug users (IVDU) and people originating from HTLV-1 highly endemic areas. Thus, in the most recent study from 2012, the prevalence of HTLV-2 among IVDU in Stockholm was 3.2%. However, much of the epidemiological data on HTLV in Sweden stems from studies conducted primarily between the 1990s and 2007, and the impact of migration to Sweden during the past 15 years has not been evaluated. Despite Sweden's status as a country with generally low prevalence of HTLV, it is prudent to anticipate and prepare for several potential challenges associated with HTLV infection in the future. Proactive measures to enhance awareness, alongside strategies to curtail transmission and mitigate complications, are crucial for addressing this relatively rare, but significant health issue. In this work, we review the current epidemiological knowledge about HTLV in Sweden and discuss future Swedish perspectives.

We describe and analyze resistance-associated mutations (RM) and virological failures (VF) on antiretroviral therapy using the latest approved integrase inhibitors (INIs) dolutegravir (DTG), bictegravir (BIC), and cabotegravir (CAB), together with their companion drugs in fixed-dose formulations: BIC/emtricitabine/tenofovir; CAB/rilpivirine; DTG/abacavir/lamivudine; DTG/emtricitabine/tenofovir; and DTG/lamivudine. Systematic literature searches were conducted in PubMed and other electronic databases for clinical studies published between January 2010 and May 2023, according to preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA), which analyzed VFs and RMs of INIs. Fifty clinical studies were included in the synthesis. VF in antiretroviral treatment (ART)-naïve patients occurred in 0.7-4.0%, 0.6-1.4%, and 0.6-9.0% of patients treated with DTG, BIC, and CAB, respectively. VF was reported in patients with previous ART in 0-8.1%, 0-2.0%, and 0.4-2.3% of those treated with DTG, BIC, and CAB, respectively. RMs were detected in ART-naïve patients in only one study with DTG (0.3%), none of the studies with BIC, and three of the studies with CAB (0.1-5.4%). In ART-experienced patients, RMs were detected in 0-1.9% of DTG-treated patients. No cases of RM were detected in the 11 BIC studies reviewed. In the case of CAB, RMs were detected in eight studies, ranging from 0.3% to 1.9% of patients. In conclusion, RM rates in the studies reviewed were generally low using the latest INIs. This review identified BIC as the INI with the lowest number of observed VF and lack of RM.

Viruses cause a large burden of human infectious diseases. During the past 50 years, antivirals have been developed to treat many pathogenic viruses, including herpesviruses, retroviruses, hepatitis viruses, and influenza. Besides being used as treatment, antivirals have shown efficacy for preventing certain viral infections. Following the success in the HIV field, a renewed interest has emerged on the use of antivirals as prophylaxis for other viruses. The development of formulations with extended half-life has pushed further this consideration in persons at risk for a wide range of viral infections. In this way, long-acting antivirals might behave as "chemovaccines" when classical vaccines do not exist, cannot be recommended, immune responses are suboptimal, escape mutants emerge, and/or immunity wanes. Five main caveats would temper its use, namely, selection of drug resistance, drug interactions, short- and long-term side effects, potential teratogenicity in women of child-bearing age, and high cost. Herein, we discuss the prospects for long-acting antivirals as prophylaxis of human viral infections other than HIV.

People living with HIV (PLWH) constitute a vulnerable population for acquiring additional sexually transmitted infections (STIs). This study was conducted to provide a summary of the evidence on the global prevalence of STIs in PLWH with an emphasis on infectious agents, diagnostic methods, and related risk factors. PubMed, Scopus, and Web of Science were systematically searched to include records published from January 01, 1990, to January 31, 2022, and the Google Scholar search engine was used to check the search strategy. In total, 132 eligible studies reporting STIs in PLWH were included, enrolling subjects from 35 countries across five continents. The pooled proportion of STIs was estimated to be 30.23% (95% CI, 26.1-34.45%) in PLWH and 20.01% (95% CI, 17.17-23.01%) in HIV-negative patients. Our meta-analysis indicated that in PLWH, the pooled OR of STIs compared to HIV-negatives was 1.77 (95% CI: 1.58-1.98) (p < 0.0001). The pooled OR of STIs by viral infectious agents was highest in PLWH (52.19% [95% CI: 43.88-60.43]) compared with fungal (22.19% [95% CI: 15.64-29.53]), bacterial (19.07% [95% CI: 13.59-26.63]), and parasitic (14.05% [95% CI: 11.88-16.38]) infections. Our findings show that there is a rather significant frequency of STIs among PLWH. This study highlights the need for new programs for the detection, treatment, and prevention of STIs in this at-risk population.

Since its emergence, HIV has been linked to metabolic alterations with an impact on the distribution of fat and the weight of people living with HIV. While extreme weight loss and processes such as lipodystrophy were of concern at first, in recent years, and with the appearance of increasingly effective and better tolerated drugs, an abnormal weight gain is paradoxically taking place among people living with HIV. Although this weight gain is a multifactorial process in which lifestyle habits, physical exercise or diet have a great impact, antiretroviral treatment has been recently considered as one of the key causes of this increase according to different clinical trials and real-life cohorts. The use of integrase inhibitors, specifically dolutegravir or bictegravir, and being female and/or from African/American origin appear to contribute to weight gain. In contrast, drugs such as tenofovir disoproxil fumarate would be protective factors. Even though different mechanisms of action have been proposed by which these agents would cause weight gain, the exact processes remain unclarified. Efforts are currently focused on knowing not only these mechanisms, but, more importantly, on finding the clinical relevance that this abnormal weight gain could have in other pathologies such as diabetes or cardiovascular events.

Sexually transmitted infections (STIs) have become the second in the global rating of infectious diseases after respiratory infections. Globally, over 1 million, new STI is diagnosed every day. Although four conditions are the most representative and of obligatory declaration (gonorrhea, syphilis, chlamydia, and human immunodeficiency virus [HIV]), there are many other prevalent STI, including trichomona, herpes simplex, papillomavirus, and viral hepatitis. Herein, we perform a narrative and retrospective review, analyzing information from public databases from distinct Spanish government institutions. STI significantly declined in Spain during 2020 as a result of lockdown and social isolation measures dictated in response to the COVID-19 pandemic. After releasing restrictions, a major STI rebound occurred in 2021. Increases were 49% for gonorrhea, 45% for HIV, 39% for chlamydia, and 32% for syphilis. Based on nationwide statistics, we build a narrative review of the recent STI surge after COVID-19. In summary, we propose a holistic approach to confront the current re-emergence of STI. On one hand, new innovative medical advances must be implemented, including new rapid tests, novel vaccines, pre-exposure prophylaxis beyond HIV, and long-acting antivirals. On the other hand, information to citizens needs to be reformulated with interventions aimed to build a healthier society, alike it has been undertaken with tobacco, alcohol, diet, and lifestyle. STI determines important sexual, reproductive, and maternal-child health consequences. To promote human well-being or flourishing, the education of adolescents and young adults should be aligned with human ecology. Therefore, it is urgent to address new approaches in sexual health that represent a clear benefit for individual persons and society. In this way, favoring a cultural evolution aimed to delay the age of first sexual intercourse and the avoidance of multiple sex partners should be prioritized.