Current Opinion in HIV and AIDS最新文献_第7页

Promises and challenges: cabotegravir for preexposure prophylaxis. 前景与挑战:卡波特韦用于暴露前预防。

IF 4.1 3区医学

Current Opinion in HIV and AIDS Pub Date : 2022-07-01 DOI: 10.1097/COH.0000000000000733

Matthew A Spinelli, Beatriz Grinsztejn, Raphael J Landovitz

{"title":"Promises and challenges: cabotegravir for preexposure prophylaxis.","authors":"Matthew A Spinelli, Beatriz Grinsztejn, Raphael J Landovitz","doi":"10.1097/COH.0000000000000733","DOIUrl":"https://doi.org/10.1097/COH.0000000000000733","url":null,"abstract":"Purpose of review: Tenofovir-based oral PrEP has been effective in reducing population-level HIV incidence in multiple settings, although disparities remain. Injectable cabotegravir-based PrEP is an alternative that may be attractive to individuals with adherence challenges or who do not desire to take a daily medication. We review promises and challenges of cabotegravir-based PrEP.Recent findings: Cabotegravir has demonstrated higher effectiveness than oral PrEP in two randomized trials, with a hazard ratio of 0.31 for HIV incidence among MSM and transgender women across multiple settings [95% confidence interval (CI) 0.18-0.62] and 0.11 for cisgender women in sub-Saharan Africa (95% CI 0.040.32). Cabotegravir was also highly effective among populations with disproportionate HIV incidence. Although cabotegravir breakthrough was rare, diagnosis was delayed with use of antigen/antibody-based HIV tests, and resistance occurred with breakthrough infections. Implementation will need to overcome several challenges, including HIV RNA laboratory monitoring not being widely available, requirement for additional staff time and clinic space, and need to provide oral medication during interruptions in dosing.Summary: Cabotegravir-based PrEP is a highly effective additional PrEP option that will expand HIV prevention options. For successful roll-out, strategies for streamlined and accessible delivery of cabotegravir in real-world settings will need to be developed.","PeriodicalId":10949,"journal":{"name":"Current Opinion in HIV and AIDS","volume":"17 4","pages":"186-191"},"PeriodicalIF":4.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240402/pdf/nihms-1784048.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10194700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Long-acting preexposure prophylaxis in low- and middle-income countries: key considerations for implementation. 低收入和中等收入国家的长效暴露前预防:实施的关键考虑因素。

IF 4.1 3区医学

Current Opinion in HIV and AIDS Pub Date : 2022-05-01 DOI: 10.1097/COH.0000000000000729

Quanhathai Kaewpoowat, Suwat Chariyalertsak, Nittaya Phanuphak, Reshmie A Ramautarsing

{"title":"Long-acting preexposure prophylaxis in low- and middle-income countries: key considerations for implementation.","authors":"Quanhathai Kaewpoowat, Suwat Chariyalertsak, Nittaya Phanuphak, Reshmie A Ramautarsing","doi":"10.1097/COH.0000000000000729","DOIUrl":"https://doi.org/10.1097/COH.0000000000000729","url":null,"abstract":"Purpose of review: HIV preexposure prophylaxis (PrEP) is a key tool in ending the HIV epidemic. Long-acting cabotegravir (LA- CAB) phase II/III studies revealed promising efficacy in preventing HIV acquisition. Here, we discuss key considerations for implementing LA-CAB in low- and middle-income countries (LMIC).Recent findings: PrEP roll out in LMIC is still far from ideal, and contextual factors within LMIC vary widely. Implementation science studies are urgently needed to optimize the implementation of LA-CAB in different settings, consider effective service delivery models, and ensure program sustainability. Preferences and concerns regarding LA-CAB among potential users are unknown but likely specific to local context. Demedicalized and simplified PrEP service delivery increases uptake, and ways to safely and effectively do the same for LA- CAB need to be explored. Although ideally LA-CAB should be an additional choice of HIV prevention method, its cost will be the major determinant in deciding its position as a first line choice or restricted second-line option.Summary: LA-CAB has the potential to enhance PrEP uptake. However, several implementation challenges need to be explored and addressed to ensure it can be accessed and utilized in different settings by those who need it the most.","PeriodicalId":10949,"journal":{"name":"Current Opinion in HIV and AIDS","volume":"17 3","pages":"135-144"},"PeriodicalIF":4.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Implementation of long-acting antiretroviral therapy in low-income and middle-income countries. 在低收入和中等收入国家实施长效抗逆转录病毒治疗。

IF 4.1 3区医学

Current Opinion in HIV and AIDS Pub Date : 2022-05-01 DOI: 10.1097/COH.0000000000000732

Fiona V Cresswell, Mohammed Lamorde

{"title":"Implementation of long-acting antiretroviral therapy in low-income and middle-income countries.","authors":"Fiona V Cresswell, Mohammed Lamorde","doi":"10.1097/COH.0000000000000732","DOIUrl":"https://doi.org/10.1097/COH.0000000000000732","url":null,"abstract":"Purpose of review: With oral antiretroviral therapy, HIV has become a manageable chronic illness. However, UNAIDS targets for virologic suppression have not yet been attained in many low-income and middle-income countries (LMICs). Long-acting drug formulations hold promise to improve treatment outcomes. In this rapidly evolving area of research, we aim to review recent literature on the treatment of HIV with long-acting agents and identify implementation considerations for LMICs.Recent findings: Randomized controlled trials have shown that monthly long-acting injectable cabotegravir (CAB) and rilpivirine (RPV) is noninferior to oral ART, and 2-monthly CAB/RPV is noninferior to monthly injections. However, few people from LMICs were included. A modelling study predicts that in sub-Saharan Africa, injectable CAB/RPV is best targeted to those with poor adherence (HIV viral load >1000 copies/ml) in whom cost-effectiveness is greatest and risk of contributing to further resistance is no greater than continuation of oral ART. Other promising agents, such as lenacapavir are under investigation and may prove particularly useful in heavily treatment-experienced adults.Summary: Long-acting regimens are a promising advance in HIV treatment. By extending the dosing interval, increasing convenience and being discreet these regimens may reduce HIV treatment challenges. However, there are multiple implementation considerations in LMICs including the need for exclusion of hepatitis B, cold chain, oral bridging in case of missed dosing and switching during tuberculosis therapy. Efficacy and safety data are also awaited for settings without routine access to baseline resistance testing or regular viral load monitoring and for special populations, such as pregnancy, children and the elderly.","PeriodicalId":10949,"journal":{"name":"Current Opinion in HIV and AIDS","volume":"17 3","pages":"127-134"},"PeriodicalIF":4.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Key population perceptions and opinions about long-acting antiretrovirals for prevention and treatment: a scoping review. 主要人群对长效抗逆转录病毒药物预防和治疗的看法和意见:范围审查。

IF 4.1 3区医学

Current Opinion in HIV and AIDS Pub Date : 2022-05-01 DOI: 10.1097/COH.0000000000000734

Omar Sued, Norma Nardi, Luciana Spadaccini

{"title":"Key population perceptions and opinions about long-acting antiretrovirals for prevention and treatment: a scoping review.","authors":"Omar Sued, Norma Nardi, Luciana Spadaccini","doi":"10.1097/COH.0000000000000734","DOIUrl":"https://doi.org/10.1097/COH.0000000000000734","url":null,"abstract":"Purpose of review: Key populations are disproportionately affected by human immunodeficiency virus (HIV). Access, retention, and adherence are important barriers for the efficacy of preexposure prophylaxis (PrEP) and HIV treatment among these populations. Long-acting (LA) antiretrovirals hold the promise to solve some of these backdrops. The objective of the current review is to update the perceptions of key populations and PLWH about LA, based on their opinion, acceptability, and willingness to use it.Recent findings: According to the review preferences for LA vary with the population studied. Regarding people living with HIV (PLWH), male having sex with men are interested in having different options, adolescents are interested in LA (strong preference for implants), yet also perceive substantial obstacles to using biomedical prevention; transgender women aimed to nonvisible small implants, with long-lasting effects or LA injections that can be applied in other areas than buttocks, and women who experienced history of medical injections might increase preference for LA (except for history of people who inject drugs [IDU]). Female sex workers and IDU both showed interest in LA-PrEP. Regarding antiretroviral therapy, LA increased treatment satisfaction and acceptance, mainly among those receiving injections every 2 months. LA helped overcome pill fatigue, stigma, and adherence issues.Summary: Knowing preferences for biomedical interventions will contribute to better understanding and developing effective strategies for these populations.","PeriodicalId":10949,"journal":{"name":"Current Opinion in HIV and AIDS","volume":"17 3","pages":"145-161"},"PeriodicalIF":4.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9577756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

An exploration of how broadly neutralizing antibodies might induce HIV remission: the 'vaccinal' effect. 如何广泛中和抗体可能诱导HIV缓解的探索:“疫苗”效应。

IF 4.1 3区医学

Current Opinion in HIV and AIDS Pub Date : 2022-05-01 Epub Date: 2022-04-18 DOI: 10.1097/COH.0000000000000731

Timothy Tipoe, Sarah Fidler, John Frater

{"title":"An exploration of how broadly neutralizing antibodies might induce HIV remission: the 'vaccinal' effect.","authors":"Timothy Tipoe, Sarah Fidler, John Frater","doi":"10.1097/COH.0000000000000731","DOIUrl":"10.1097/COH.0000000000000731","url":null,"abstract":"Purpose of review: Broadly neutralizing antibodies (bNAbs) are a potential new therapeutic strategy to treat HIV infection. This review explores possible mechanisms of action of bNAbs and summarizes the current evidence supporting their immunomodulatory properties, which might lead to sustained virological remission - the 'vaccinal effect'.Recent findings: Antiretroviral therapy (ART) is required to confer lasting HIV suppression; stopping ART almost invariably leads to HIV recrudescence from a persistent pool of virally infected cells - the HIV reservoir. HIV-specific broadly neutralizing antibodies (bNAbs) may confer viral control after ART cessation predominantly through blockade of viral entry into uninfected target cells. In some human and animal studies, HIV bNAbs also conferred lasting viral suppression after therapeutic bNAb plasma levels had declined. Immune-modulatory mechanisms have been postulated to underlie this observation - the 'vaccinal effect'. Hypothesized mechanisms include the formation of immune complexes between bNAbs and HIV envelope protein, thereby enhancing antigen presentation and uptake by immune cells, with boosted adaptive immune responses subsequently controlling the HIV reservoir.Summary: There is emerging evidence for potent antiviral efficacy of bNAb therapy. Whether bNAbs can induce sustained viral suppression after dropping below therapeutic levels remains controversial. Mechanistic data from on-going and future clinical trials will help answer these questions.","PeriodicalId":10949,"journal":{"name":"Current Opinion in HIV and AIDS","volume":"17 3","pages":"162-170"},"PeriodicalIF":4.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Editorial: Is it time to implement injectable antiretroviral treatments globally? 社论:现在是在全球实施可注射抗逆转录病毒治疗的时候了吗?

IF 4.1 3区医学

Current Opinion in HIV and AIDS Pub Date : 2022-05-01 DOI: 10.1097/COH.0000000000000736

M. Boffito, Kimberley K. Scarsi, C. Orkin

引用次数: 0

Clinical implementation of long-acting antiretroviral treatment in high-income countries: challenges and advantages 高收入国家长效抗逆转录病毒治疗的临床实施:挑战与优势

IF 4.1 3区医学

Current Opinion in HIV and AIDS Pub Date : 2022-04-18 DOI: 10.1097/COH.0000000000000730

L. Waters, Alex Sparrowhawk

{"title":"Clinical implementation of long-acting antiretroviral treatment in high-income countries: challenges and advantages","authors":"L. Waters, Alex Sparrowhawk","doi":"10.1097/COH.0000000000000730","DOIUrl":"https://doi.org/10.1097/COH.0000000000000730","url":null,"abstract":"Purpose of review Long-acting antiretroviral therapy (LA-ART) brings a paradigm shift to HIV care with injectable cabotegravir/rilpivirine (IM-CAB/RPV) in current or imminent use in several countries. This brings the usual opportunities and challenges of a new therapy, plus requirements to adapt services to reliably deliver injections and ensure patients understand advantages and limitations. We summarise key considerations for implementation in high-income countries. Recent findings Monthly IM-CAB/RPV is noninferior to oral ART and monthly IM-CAB/RPV to 1-monthly in carefully selected virally suppressed people. The numerically higher virological failure rate on two-monthly IM-CAB/RPV warrants close attention and careful monitoring. Implementation projects report positive experiences for patients and staff, but also barriers. Data is needed in younger people, pregnancy/breastfeeding, and in those with detectable viraemia secondary to suboptimal adherence. Summary We highlight a paucity of real-world data and key unanswered questions. Existing data on injection techniques may have implications for training; monitoring of outcomes is crucial to ensure clinical trial results are replicated in real-life. Better understanding of treatment failure, and individualised therapy, is crucial, and it is important to repeat patient preference surveys as new data emerges to ensure decisions are based on the most recent evidence of benefit vs risk.","PeriodicalId":10949,"journal":{"name":"Current Opinion in HIV and AIDS","volume":"17 1","pages":"121 - 126"},"PeriodicalIF":4.1,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61654524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Editorial introductions. 编辑介绍。

IF 4.1 3区医学

Current Opinion in HIV and AIDS Pub Date : 2022-03-01 DOI: 10.1097/COH.0000000000000719

引用次数: 0

Adapting digital health interventions for the evolving HIV landscape: examples to support prevention and treatment research. 适应不断变化的艾滋病毒形势的数字卫生干预措施:支持预防和治疗研究的实例。

IF 4.1 3区医学

Current Opinion in HIV and AIDS Pub Date : 2022-03-01 DOI: 10.1097/COH.0000000000000721

Henna Budhwani, B Matthew Kiszla, Lisa B Hightow-Weidman

{"title":"Adapting digital health interventions for the evolving HIV landscape: examples to support prevention and treatment research.","authors":"Henna Budhwani, B Matthew Kiszla, Lisa B Hightow-Weidman","doi":"10.1097/COH.0000000000000721","DOIUrl":"https://doi.org/10.1097/COH.0000000000000721","url":null,"abstract":"Purpose of review Although many HIV prevention and/or treatment digital health interventions (DHIs) have shown feasibility and acceptability, fewer have indicated efficacy, and only a subset have been adapted for new contexts. Adaptation is a key element of pragmatic implementation science research. Adaptation is cost effective and time efficient compared with new development. Leveraging adaptation can lead to accelerated scale-up and enhanced public health impact. Considering the value of adaptation, the purpose of this piece is to present examples of DHI to DHI adaptation sequences to inform future HIV prevention and/or treatment research. Recent findings From an examination of recent academic articles (01 November 2016 to 31 October 2021), we identified adaptation sequences that included an original DHI with at least two adaptations. Four models are presented herein; examples consist of adapted DHIs for new population, health outcome, geography, or a combination thereof. Summary Adaptation is a promising scientific approach to expeditiously respond to the evolving HIV landscape. We present examples of DHI adaptations alongside considerations for each type of adaptation; we also present adaptation challenges with responsive strategies. We suggest when conducted with attention to rigor (leveraging adaptation frameworks, community engagement, and tailoring content), adaptation is a powerful tool to pragmatically address the HIV epidemic.","PeriodicalId":10949,"journal":{"name":"Current Opinion in HIV and AIDS","volume":"17 2","pages":"112-118"},"PeriodicalIF":4.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9833493/pdf/nihms-1859688.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10141324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Context, COVID-19 and comorbidities: exploring emergent directions in syndemics and HIV research. 背景、COVID-19 和合并症：探索综合症和艾滋病研究的新方向。

IF 4.1 3区医学

Current Opinion in HIV and AIDS Pub Date : 2022-03-01 DOI: 10.1097/COH.0000000000000722

Carmen H Logie, Madelaine Coelho, Brandon Kohrt, Alexander C Tsai, Emily Mendenhall

{"title":"Context, COVID-19 and comorbidities: exploring emergent directions in syndemics and HIV research.","authors":"Carmen H Logie, Madelaine Coelho, Brandon Kohrt, Alexander C Tsai, Emily Mendenhall","doi":"10.1097/COH.0000000000000722","DOIUrl":"10.1097/COH.0000000000000722","url":null,"abstract":"Purpose of review: The purpose of this review is to identify themes across articles that aimed to explore HIV-related syndemics in 2020 and 2021 and to discuss their implications for research on syndemics.Recent findings: We identified 189 articles on syndemics between 2020 and 2021. Key themes across studies included COVID-19; mental health and psychosocial challenges; substance use; socio-structural factors; protective factors; and methodological approaches. COVID-19's implications for HIV syndemic research were discussed. Mental health and substance use research largely examined linkages with sexual practices or reduced HIV care retention. Researchers examined associations between socio-structural variables (e.g. poverty) and elevated HIV exposure, reduced HIV testing and poorer health. Concepts of water insecurity and 'ecosyndemics' were also raised, as was the importance of attending to noncommunicable diseases and comorbidities. Most studies did not assess interactions between health conditions, signalling the need for methodological grounding in the foundational concepts of syndemic theory.Summary: Most studies recommended that HIV prevention and care research attend to the interplay between poor mental health, substance use and multidimensional violence. Increased attention to structural factors, particularly exacerbated poverty in the COVID-19 pandemic, is required. Research can identify protective factors to harness to advance HIV prevention and care.","PeriodicalId":10949,"journal":{"name":"Current Opinion in HIV and AIDS","volume":"17 2","pages":"46-54"},"PeriodicalIF":4.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11045292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10194693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0