Current opinion in HIV and AIDS最新文献

Purpose of review: Understanding the immunology and pathogenesis of Mpox, an illness caused by the re-emerging monkeypox virus (MPXV), which has recently been responsible for human outbreaks globally. In particular, summarizing the knowledge on host immune responses to Mpox, the mechanisms underlying viral pathogenesis, viral evolution, and recent human outbreak data on vaccines and emerging immunotherapeutics.

Recent findings: Recurrent global outbreaks of Mpox led the WHO to declare it a public health emergency of international concern twice, in May 2022 and August 2024, with the emergence of a new clade Ib. Although vaccines are available for Mpox access is challenging in certain communities and sustained transmission may promote emergence of novel virus variants. Mpox is more severe and can be lethal in immunocompromised people, notably those with human immunodeficiency virus (HIV), children, and pregnant persons.

Summary: Insights into the immunology and pathogenesis including data from contemporary outbreaks, highlight emerging priorities for research and preparedness for fighting the disease. This also emphasizes the importance of understanding the unique features of Mpox in HIV co-infected individuals who have disproportionate burden of severe infections and the need vaccine and therapeutic optimization especially for immunocompromised patients.

Purpose of review: For individuals with hepatitis B virus (HBV), hepatitis B surface antigen (HBsAg) loss is associated with substantially decreased risk of liver-related morbidity and mortality. In recent years, many determinants of HBsAg loss have been investigated in several studies involving persons with chronic HBV infection living with and without HIV. The purpose of this review is to summarize factors that could help predict HBsAg loss in persons with HIV (PWH).

Recent findings: Rates of HBsAg loss can be higher in PWH with HBV compared to those without HIV, which has been partially attributed to immune reconstitution after starting antiretroviral therapy. In recent years, quantitative HBsAg (qHBsAg) levels were identified as the most important single serum marker predicting HBsAg loss. Other viral markers, such as hepatitis B core-related antigen, circulating HBV RNA, and immunological markers (i.e., quantitative hepatitis B core antibody, assessment of HBV-specific immune responses, peripheral blood mononuclear cells phenotypes), might also help predict HBsAg loss in PWH with HBV, particularly for certain sub-populations.

Summary: Low qHBsAg before or fast qHBsAg declines after initiating potent anti-HBV therapy has been identified as the most reliable predicting serum marker. Other markers might be useful in certain sub-populations and clinical situations.

Purpose of review: The 2022 global mpox outbreak showed that surveillance systems were not ready to quickly detect or adapt to the new dynamic of human-to-human spread. While many lessons were learned, ongoing mpox outbreaks underscore the need for focused attention on enhancing mpox surveillance systems. This review presents ongoing challenges, successes, recent advances, and future considerations for seven areas related to surveillance for mpox.

Recent findings: The development of real-time polymerase chain reaction assays has greatly improved MPXV detection, though there remain diagnostic gaps and critical needs for expanding genomic surveillance. Challenges to complete case ascertainment, data sharing, and reporting also persist. At the same time, key advances have been made regarding the integration of mpox into existing surveillance and healthcare service delivery for HIV and sexually transmitted infections; use of the One Health approach to understand the interconnectedness of human, animal, and environmental health; and application of newer innovations in surveillance efforts such as wastewater monitoring and artificial intelligence.

Summary: This review highlights recent work that informs how to maintain nimble, sustainable, and coordinated surveillance systems that will not only strengthen the response to the evolving mpox outbreaks but also contribute to future pandemic preparedness initiatives.

Purpose of review: To highlight current knowledge on antibody targets in MPXV and evaluate how these insights can inform the development of effective therapeutics or next-generation orthopoxvirus vaccines.

Recent findings: Since 2022, mpox infection has emerged as a global public health concern. While the spread of clade IIb of the monkeypox virus (MPXV) has declined, the new clade Ib is now demonstrating sustained human-to-human transmission outside Central Africa. Despite the rising number of mpox cases, no effective antiviral is currently available for treating mpox or any infection caused by other Orthopoxvirus. Moreover, the only licensed vaccine for mpox prevention was developed based on an attenuated strain of Vaccinia virus and elicits only moderate antibody responses. These challenges demonstrate the urgent need to identify specific viral epitopes among the more than 200 proteins encoded by MPXV that serve as targets for antibody recognition and represent sites of viral vulnerability. Defining such epitopes will be essential for the rational design of next-generation therapeutics and vaccines aimed at achieving durable and broad protection against mpox and other orthopoxvirus infections.

Summary: This review summarizes the major antibody targets identified in MPXV, recent advances in understanding antibody-mediated neutralization and protection, and how the therapeutic potential of antibodies can be leveraged to treat mpox and other orthopoxvirus infections as well as to guide the design of effective antiorthopoxvirus vaccines.

Purpose of review: Despite longstanding recommendations for HBV vaccination in people with HIV, coverage has remained low, and vaccine effectiveness has historically been limited due to poor immune responses and rapid waning of protection. This review summarizes recent advances in HBV vaccination strategies, updated guidelines, and emerging risks related to the increasing use of long-acting antiretroviral therapy and worsening vaccine mistrust.

Recent findings: People with HIV experience reduced vaccine immunogenicity and faster waning of protective antibodies. The adjuvanted HepB-CpG vaccine, which includes a TLR-9 agonist, has demonstrated superior seroprotection and durability in both vaccine-naive and previously vaccinated individuals with HIV. Updated guidelines now recommend HepB-CpG as the preferred vaccine. The use of long-acting antiretroviral therapy and oral ART combinations without HBV activity has renewed attention to gaps in HBV immunity and the potential for new HBV infection or HBV reactivation.

Summary: HBV vaccination remains fundamental to HBV prevention in PWH, especially as antiretroviral strategies evolve. Broader use of HepB-CpG vaccine, attention to serologic monitoring, and proactive vaccination before antiretroviral switches are essential to reduce HBV-related morbidity and support HBV elimination efforts.

Purpose of review: This article reviews the evidence behind mpox antiviral therapies which are clinically available and/or or under clinical investigation. For much of the mpox epidemic, tecovirimat has been used compassionately but there is no evidence of its clinical efficacy.

Recent findings: Multiple phase 3 placebo-controlled trials have failed to demonstrate clinical efficacy of tecovirimat in the treatment of mpox.

Summary: This article summarizes the evidence behind current treatment recommendations including tecovirimat, brincidofovir, cidofovir, trifluridine, and VIGIV, as well as other investigational treatments.

Purpose of review: This review aims at exploring how stigma played a role in the naming of mpox, its classification, and how anti-LGBT+ bias and systemic racism all played roles in facilitating the outbreak.

Recent findings: The naming of mpox is in flux with recent efforts to change back to monkeypox in the United States, which could exacerbate stigma and discrimination. Anti-LGBT+ bias affected access to mpox testing, treatment, and prevention, but mpox also served as a facilitator of homophobic rhetoric. Systemic racism and colonialism both affect the global response to mpox and could further promote endemic fatalism and a lack of equitable global health mpox prevention.

Summary: Stigma served as a facilitator of the 2022 mpox outbreak, which was unique from previous outbreaks due to it affecting multiple historically neglected and marginalized populations. Anti-LGBT+ stigma, systemic racism, endemic fatalism, and colonialism all played roles within this outbreak and must be addressed to prevent future outbreaks of mpox.

Purpose of review: Early treatment of recently acquired HCV infections (RAHCV) in people with HIV (PWH) can be of particular importance for both individual and public health. Since the introduction of direct acting antivirals (DAA), guideline recommendations have shifted from waiting/ re-testing approaches towards immediate treatment. Until recently, however, the fact that no DAA regimen had regulatory approval for the treatment of acute HCV infection represented an obstacle to early treatment. This review aims to summarize lessons learned on RAHCV in PWH.

Recent findings: A phase 3b trial has recently supported safety and efficacy of glecaprevir/ pibrentasvir (G/P) for the treatment of RAHCV in PWH, which led to the approval of that regimen for acute hepatitis C by the U.S. Food and Drug administration. Studies evaluating shorter durations of common pangenotypic regimens for RAHCV showed mixed results. Despite some positive developments, like a steep decline of HCV infections in men who have sex with men (MSM) living with HIV in Europe or Australia, current efforts are not sufficient to meet WHO targets.

Summary: Treatment of RAHCV, especially among key populations living with HIV, is a cornerstone of HCV elimination attempts. Recent studies might help reinvigorate these efforts.

Purpose of review: Direct-acting antivirals (DAAs) have transformed hepatitis C virus (HCV) management. People with HIV (PWH) are prioritized in elimination strategies due to higher HCV prevalence, faster progression, and linkage to HIV care. This review summarizes evidence on HCV elimination in PWH, highlighting progress, gaps, and future directions toward WHO elimination targets.

Recent findings: DAAs achieve cure rates above 95% in PWH across stages and contexts, with pangenotypic regimens enabling integration into HIV services. Studies in high-income countries report steep declines in HCV viremia among PWH, some nearing microelimination. Yet gaps persist as subsets remain untreated, with lower uptake among women, heterosexual men, migrants, and people who inject drugs (PWID). Reinfections cluster among MSM and PWID, though overall incidence has declined with treatment-as-prevention. In contrast, low-income and middle-income countries face restricted access, high costs, limited harm reduction, stigma, and criminalization, leaving interim 2025 goals unmet. Integrated HIV-HCV-substance use care, point-of-care diagnostics, telehealth, and community outreach improve linkage and treatment completion.

Summary: HCV elimination among PWH is feasible in well resourced settings, but global progress remains uneven. Universal screening, unrestricted DAA access, harm reduction, and sustained political commitment are essential to consolidate gains and prevent setbacks.