HIV Medicine最新文献

{"title":"Understanding community questions about HIV pre-exposure prophylaxis (PrEP): A thematic analysis of reddit threads to inform development of an AI chatbot for PrEP education.","authors":"Alexandar Vincent-Paulraj, William Wood, Catia Marzolini, Justin Chiong, Daryl Hodge, Sara Gibbons, Daniel Seddon, Jasmine Martin, Saye Khoo, Lauren E Waker","doi":"10.1111/hiv.70332","DOIUrl":"https://doi.org/10.1111/hiv.70332","url":null,"abstract":"<p><strong>Background: </strong>Despite growing availability of HIV pre-exposure prophylaxis (PrEP), many potential users turn to online forums for advice and information collection. These forums provide a window into real-world questions, concerns and misinformation. They serve as a tool for users to query for sensitive information without revealing their identities. These platforms could therefore be a potential source of understanding of the unmet needs of users. This study systematically analyses the social media posts referring to the four drugs mentioned in the study to identify common questions and thematic concerns among the community and uses this insight to inform the design of an AI-driven, privacy-preserving chatbot for PrEP education based on evidence.</p><p><strong>Methods: </strong>Between May 2011 to October 2025, we found 1168 relevant Reddit posts mentioning one of the four names for PrEP therapies, by either brand or generic name: Truvada (Tenofovir disoproxil fumarate + emtricitabine (TDF/FTC)), Descovy (Tenofovir alafenamide + emtricitabine (TAF/FTC)), Apretude (long-acting cabotegravir), Yeztugo (lenacapavir) using a systematic search. We used Natural Language processing (NLP) techniques to understand user needs.</p><p><strong>Results: </strong>Seven distinct discussion themes were identified within PrEP social media discourse, with side effects emerging as the most frequently discussed primary topic among 1076 posts. Across all medications, weight changes were the most frequently mentioned side effect. Truvada was the most frequently discussed PrEP medication. 96.7% of the dataset comprised questions, showing that Reddit serves as a primary information-seeking platform. Early period discussions were emphasized basic access and effectiveness questions, with more recent discussions (2022-2025) displaying increased attention to injectable and long-term safety considerations.</p><p><strong>Conclusions: </strong>Reddit users demonstrate persistent uncertainty about PrEP side effects, drug interactions and medication switching. Drug interactions represented the most frequently identified information gap (26.5% of posts). These empirically derived information needs will inform the design of a privacy-preserving PrEP chatbot trained on authoritative UK sources (hiv-druginteractions.org, BHIVA guidelines, NHS resources).</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227723","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}

{"title":"Information quality, understandability, actionability and readability of large language models for HIV health education: A cross-platform evaluation.","authors":"Mengqiu Hu, Zhiqiang Wang, Jinglan Zhang, Xiaoya Li, Mengxia Zhao","doi":"10.1111/hiv.70329","DOIUrl":"https://doi.org/10.1111/hiv.70329","url":null,"abstract":"<p><strong>Objectives: </strong>Large language models (LLMs) are increasingly used to generate health education materials, but their suitability for patient-facing human immunodeficiency virus (HIV) education remains insufficiently evaluated. We assessed the information quality, understandability, actionability, readability, text structure and source transparency of HIV patient education materials generated by six LLMs or artificial intelligence platforms.</p><p><strong>Methods: </strong>In this cross-sectional study, 100 common HIV patient education questions across 10 domains were submitted once in English to ChatGPT 5.4-Thinking, DeepSeek-V3.2, Doubao, ERNIE Bot 5.0 Preview, Ant Afu and Gemini 3.1 Pro, yielding 600 responses. Responses were evaluated using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), EQ IP-36, DISCERN, Global Quality Score (GQS), artificial intelligence response quality metric (AIRM), Journal of the American Medical Association (JAMA) benchmarks and seven readability indices. Platform comparisons used paired Friedman tests with Wilcoxon-Holm post hoc analyses; topic analyses used question-level aggregation followed by Kruskal-Wallis and Dunn-Holm comparisons.</p><p><strong>Results: </strong>Significant family-adjusted differences were observed across platforms for all prespecified text-structure, quality/understandability/actionability and readability outcomes. At the topic level, five of six text-structure outcomes, PEMAT-P Understandability, PEMAT-P Actionability, the exploratory PEMAT-P composite score and all seven readability indices differed significantly after family adjustment, whereas EQ IP-36, DISCERN, GQS, AIRM and JAMA did not. Overall actionability was limited and readability demands were high.</p><p><strong>Conclusions: </strong>LLM-generated HIV patient education materials showed substantial cross-platform and topic-level heterogeneity. These findings support the use of LLMs as expert-reviewed drafting tools rather than independent patient education sources. Direct factual accuracy, guideline concordance, hallucination and clinical safety were not assessed.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220156","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}

{"title":"Pilot study of a ChatGPT-based educational and counselling tool in a specialist HIV and sexual health clinic.","authors":"Matthew Chung Yi Koh, Jinghao Nicholas Ngiam, Hui Yan Joy Yong, Tiffany Puspita, Joan Quah, Lucinda Mak, Hui Wen Ho, Siok Ching Chia, Timothy Chia, Priscillia Lye, Sean Wu, Sai Meng Tham, Brenda Mae Alferez Salada, Nares Smitasin, Dariusz Piotr Olszyna, Sophia Archuleta","doi":"10.1111/hiv.70323","DOIUrl":"https://doi.org/10.1111/hiv.70323","url":null,"abstract":"<p><strong>Objectives: </strong>Real-world implementation of large language models such as ChatGPT to enhance patient education remains limited. We evaluated the feasibility, acceptability and attitudes towards a ChatGPT-based counselling tool among patients and healthcare workers (HCWs) in a specialist infectious diseases clinic.</p><p><strong>Methods: </strong>We conducted a prospective clinical implementation study in a specialist HIV and sexual health clinic in Singapore from Jan 2025 to December 2025. Patients interacted with a custom ChatGPT-based chatbot prior to routine counselling by physicians or pharmacists. Responses were reviewed with patients subsequently during consultation. Post-interaction, patients and HCWs completed structured surveys incorporating domains from a validated survey tool: perceived risk, anxiety, technology/social influence and intention for future use.</p><p><strong>Results: </strong>The chatbot was most frequently used for counselling on antiretroviral therapy initiation or switching, and sexual health advice. A total of 35 patients and 35 HCW assessments were analysed. Patients had greater perceived risk with the use of the chatbot compared to HCWs, as indicated by lower median scores (13, IQR 10-16; vs. 18, IQR 15-21), while anxiety scores were similar. Technology/social influence scores were high across both groups (overall median 20, IQR 19-22). Most participants indicated willingness for future use. Qualitative feedback highlighted improved patient understanding and more focused consultations, but concerns included lack of contextual nuance and occasional inaccuracies.</p><p><strong>Conclusions: </strong>The pilot implementation of a ChatGPT-based counselling tool in a specialist HIV and sexual health clinic was feasible and generally acceptable to patients and HCWs. Further studies are required to evaluate accuracy and clinical effectiveness before broader implementation.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220129","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}

{"title":"Changes in cardiometabolic biomarkers 1 year after direct acting antiviral therapy for hepatitis C virus co-infection among people with HIV.","authors":"Raynell Lang, Elizabeth Humes, Asya Lyass, Leila H Borowsky, Brenna Hogan, Arthur Y Kim, Michael LaValley, Jennifer O Lam, Ditipriya Bhar, Richard D Moore, Frank Palella, Heidi Crane, Michael Horberg, Sonia Napravnik, Virginia A Triant, Keri N Althoff","doi":"10.1111/hiv.70325","DOIUrl":"https://doi.org/10.1111/hiv.70325","url":null,"abstract":"<p><strong>Objectives: </strong>Among people with HIV with hepatitis C virus (HCV) co-infection, we examined differences in haemoglobin A1c (HbA1c), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and atherosclerotic cardiovascular disease (ASCVD) risk score at 12-months following direct acting antiviral (DAA) initiation, comparing people with HIV who initiated DAA with those who did not to explore the utility of DAAs beyond HCV elimination.</p><p><strong>Methods: </strong>Utilizing a nested exposure-matched study of people with HIV age <math><mrow><mo>≥</mo></mrow> </math> 18 years, on antiretroviral therapy from the NA-ACCORD and the Mass General Brigham HIV cohorts between 01/1/2014 and 12/31/2022, people with HIV with HCV co-infection were identified by detectable plasma HCV RNA. People with HIV who initiated DAA were matched 1:1 with people with HIV who did not initiate DAA. Multivariable linear regression models estimated HbA1c (N = 2374), TC (N = 3418) and ASCVD risk score (N = 488) at 12-months comparing people with HIV who initiated DAAs versus did not.</p><p><strong>Results: </strong>We identified no significant difference in the mean HbA1c at 12-months comparing DAA initiators to DAA non-initiators (β: 0.00%, 95% confidence interval [CI] -0.09% to 0.08%). The mean TC at 12-months was 13 mg/dL (95% CI 11-16 mg/dL) higher in DAA initiators and largely due to increases in LDL. There was no significant difference in the mean ASCVD risk score at 12-months when comparing DAA initiators with those who did not initiate DAAs (β: 1.10, 95% CI -0.09 to 2.20).</p><p><strong>Conclusion: </strong>People with HIV with HCV who initiated DAA demonstrated no statistically significant difference in HbA1c or ASCVD risk score at 12-months compared to HIV/HCV co-infected persons who did no initiate DAA. However, TC and LDL levels increased 12 months following DAA treatment.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220107","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}

{"title":"Antiretroviral therapy intensification in people living with HIV on virological and clinical outcomes: A systematic review.","authors":"Renatus B Magati, Belinda J Njiro, Hafidhi H Ntissi, Martine Aron Manguzu, Tusaligwe Mbilinyi, Goodluck G Nyondo, George Msema Bwire","doi":"10.1111/hiv.70333","DOIUrl":"https://doi.org/10.1111/hiv.70333","url":null,"abstract":"<p><strong>Background: </strong>Antiretroviral therapy (ART) intensification involves increasing the dose or frequency of existing regimens or adding agents to standard therapy. This systematic review evaluated the impact of ART intensification on selected virological and clinical outcomes among people living with HIV.</p><p><strong>Methods: </strong>We searched PubMed/MEDLINE, Embase, and Scopus for English-language studies published from database inception to 5 July 2024. Risk of bias was assessed using Cochrane tools. This review was registered by PROSPERO registration: CRD42024565822.</p><p><strong>Results: </strong>Of 1652 identified records, 22 studies met the inclusion criteria. Virological outcomes were heterogeneous, with most strategies showing no significant improvement in viral suppression or HIV reservoir reduction. Neurocognitive outcomes were inconsistent, while immune recovery was observed in some studies. ART intensification was generally safe and well tolerated, although evidence on long-term outcomes remains limited.</p><p><strong>Conclusions: </strong>There was no consistent evidence supporting a clear benefit of ART intensification on virological or clinical outcomes. ART intensification outcomes vary according to drug selection, patient characteristics, and treatment goals. These findings highlight the uncertainty surrounding the clinical utility of ART intensification. Further research is needed to optimize intensification strategies for specific patient populations and to better define its role in long-term HIV management.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220112","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}

{"title":"Breastfeeding and HIV in high-income settings: Exploring women living with HIV and health care providers' perspectives in Belgium.","authors":"H'ava Masquelier, Julie Nagel, Christine Gilles, Marc Delforge, Deborah Konopnicki","doi":"10.1111/hiv.70321","DOIUrl":"https://doi.org/10.1111/hiv.70321","url":null,"abstract":"<p><strong>Objectives: </strong>In high-income countries, breastfeeding among women living with HIV remains controversial, despite evidence of a residual transmission risk below 1% on effective antiretroviral therapy (ART) with sustained viral suppression. Following the recent adoption of Belgian national guidance allowing breastfeeding in selected cases, we explored breastfeeding intentions among women living with HIV and assessed the knowledge, attitudes, practices and ethical perceptions of healthcare providers (HCPs).</p><p><strong>Methods: </strong>A single-centre cross-sectional study and a national cross-sectional survey were conducted between November 2024 and April 2025. Twenty pregnant women living with HIV receiving care at an HIV referral centre in Brussels were interviewed using a semistructured questionnaire. In parallel, an online survey was distributed to HCPs involved in the care of pregnant women living with HIV.</p><p><strong>Results: </strong>Nearly half of the women (9/20) wished to breastfeed, motivated by perceived benefits for the child, mother-infant bonding, cultural norms and concerns about HIV disclosure; the risk of transmission was the most frequently endorsed factor, and 15/17 reported that their provider's opinion had influenced their decision. Among 97 HCPs, 78/97 (80.4%) would inform and support a woman choosing to breastfeed, yet 61/93 (65.6%) read the national guidance as advising against it. Although 88/97 (90.7%) knew the current recommendations, only 36/96 (37.5%) had received specific training on breastfeeding and HIV, and 79/97 (81.4%) requested more.</p><p><strong>Conclusions: </strong>Our findings reveal a gap between women living with HIV's growing openness to breastfeeding and a healthcare workforce not yet fully equipped to support it. Closing this gap will require harmonized protocols, targeted training and culturally sensitive, patient-centred counselling.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206731","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}

{"title":"A retrospective cohort study of Ukrainian beneficiaries of temporary protection living with HIV attending an Irish tertiary care service.","authors":"S P Connolly, C Carey, C Lenihan, K McFaul","doi":"10.1111/hiv.70328","DOIUrl":"https://doi.org/10.1111/hiv.70328","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the demographic, clinical and healthcare utilization characteristics of Ukrainian beneficiaries of temporary protection living with HIV (UBOTPLWH) attending an Irish tertiary HIV service and to assess the impact of individual barriers to care on virological outcomes and retention in care.</p><p><strong>Methods: </strong>We performed a retrospective observational cohort study of adult UBOTPLWH enrolled in an outpatient HIV service in Cork University Hospital, Ireland, between February 2022 and April 2025. Data were extracted from clinical and laboratory records. Descriptive statistics summarized demographics, HIV parameters, antiretroviral therapy (ART), co-infections and healthcare utilization. Exploratory analyses assessed associations between individual barriers to care and clinical outcomes.</p><p><strong>Results: </strong>Fifty-nine patients were included; 59.3% were female and median age was 44 years (interquartile range [IQR] 39-51 years). Most (84.7%) had a known HIV diagnosis prior to arrival, with a median duration of diagnosis of 10 years. At enrolment, 66.7% were virologically suppressed (<50 copies/mL) and median CD4 count was 561 cells/μL. Prior opportunistic infection was reported in 25.0% of the 48 patients for whom such data were available. ART regimens were frequently modified following enrolment, particularly among those receiving tenofovir disoproxil fumarate/lamivudine/dolutegravir prior to migration. At the most recent follow-up, viral load data were available for 49 participants, of whom 87.8% were suppressed. Barriers to care were common, including interpreter requirement (64.4%), geographic dispersion (median distance 54 km) and residential instability. In exploratory analyses, detectable viral load at enrolment was associated with missed clinic attendance (p = 0.019), while viral non-suppression at follow-up was associated with hospital admission (p = 0.007) and missed clinic attendance (p = 0.047).</p><p><strong>Conclusions: </strong>Despite timely linkage to care and preserved immune status at enrolment, UBOTPLWH in Ireland experience substantial structural barriers that may adversely affect engagement and virological outcomes. Tailored, accessible service models are required to support displaced populations living with HIV.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206765","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}

{"title":"Hepatitis D virus infection in persons with HIV and hepatitis B virus across Europe: A cross-sectional analysis of the HDV-Europe cohort.","authors":"Anders Boyd, Thomas Lutz, Kathrin van Bremen, Alessandro Tavelli, Antonella d'Arminio Monforte, Marc van der Valk, Miłosz Parczewski, Magdalena Tchorz, Iwona Cielniak, Luz Martín-Carbonero, María Del Mar Arcos-Rueda, Charles Béguelin, Gilles Wandeler, Sanjay Bhagani, Charlotte Lim, Fauzi Elamouri, Juan Berenguer, Jürgen K Rockstroh, Pablo Ryan","doi":"10.1111/hiv.70320","DOIUrl":"https://doi.org/10.1111/hiv.70320","url":null,"abstract":"<p><strong>Introduction: </strong>Infection with hepatitis D virus (HDV) is known to accelerate the progression of liver disease and is associated with mortality in individuals with HIV and hepatitis B virus (HBV). However, little is known about current HDV epidemiology, including HDV-testing practices and prevalence, in this population in Europe.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of clinical cohorts across Europe (Germany, Italy, the Netherlands, Poland, Spain, Switzerland and United Kingdom). Included individuals were those living with HIV, ever hepatitis B surface antigen positive, aged ≥18 years and actively in care on December 31, 2023. We calculated the percentage of individuals tested for HDV, prevalence of individuals who ever had anti-HDV positive serology (i.e., past/current infection) and the prevalence of individuals whose last HDV RNA result was positive (i.e., active infection).</p><p><strong>Results: </strong>A total of 2970 individuals were included. Anti-HDV antibody results were available in 2189 (73.7%). Of them, 261 (12.0%) had past/current HDV infection, ranging between 3.8% in the United Kingdom and 27.3% in Poland. Among the 261 individuals with an anti-HDV-positive result, 162 (62.1%) had been tested for HDV RNA. Of them, 92 (56.8%) had active HDV infection. Of the overall population with available data, active HDV infection was observed in 4.4% (n = 92/2077), ranging between 0.9% in the Netherlands and 11.0% in Italy.</p><p><strong>Conclusions: </strong>In Europe, about one-eighth of individuals with HIV/HBV in care have evidence of past/current HDV infection, in whom half have active HDV infection. Nevertheless, these results come from a setting where one-quarter have yet to be tested for anti-HDV antibodies.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193220","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}

{"title":"BHIVA Audit 2023: Prior engagement in HIV care among people living with HIV admitted to hospital.","authors":"Thomas Juniper, Lucie Stuart, Ranjababu Kulasegaram, Fiona Windebank, Caroline Sabin, Fiona Burns","doi":"10.1111/hiv.70330","DOIUrl":"https://doi.org/10.1111/hiv.70330","url":null,"abstract":"<p><strong>Objectives: </strong>To describe prior engagement in HIV care among people with HIV admitted to hospital in the United Kingdom and to examine clinical characteristics and causes of admission by engagement status.</p><p><strong>Methods: </strong>A national audit of adult HIV services was conducted across the United Kingdom in 2023. Participating centres undertook case-note review of up to 20 recent hospital admissions involving people with HIV. Individuals were categorized into groups based on engagement in care: new diagnosis, regularly attending, irregularly attending (missed ≥1 HIV clinic appointment in past 12 months) and not attending (not seen in HIV care for >12 months). Demographic, clinical and psychosocial data were collected. Analyses were descriptive.</p><p><strong>Results: </strong>Data were available for 975 admissions from 85 centres. Overall, 22% of people were a new diagnosis, 21% irregular attenders and 17% not in HIV care. People with sub-optimal engagement more frequently had viraemia and immunosuppression; 86% of those not attending and 92% of newly diagnosed individuals had viral load >200 copies/mL, and 73% in both groups had CD4 ≤ 200 cells/mm³. AIDS-defining illnesses accounted for 29% of admissions and were more commonly observed among those newly diagnosed (53%) and not attending care (40%). Psychosocial factors were frequently reported, particularly among irregular attenders (mental health issues 51%, substance use 42%, housing instability 34%). Missed opportunities for earlier diagnosis or re-engagement were identified in 17% of cases.</p><p><strong>Conclusions: </strong>Hospital admissions in people with HIV commonly occur in the context of late diagnosis and sub-optimal engagement in care. Interventions to improve testing, retention and re-engagement, particularly those addressing psychosocial barriers, may help reduce preventable morbidity and support progress towards HIV elimination.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193256","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}

{"title":"Chronic alanine aminotransferase elevation in people with HIV: Time trends over 22 years and genetic predisposition.","authors":"Noemi R Simon, Carlotta Mondoka, Christian W Thorball, Isabella C Schoepf, Lene Ryom, Irene Abela, Charles Béguelin, Urs Führer, Helen Kovari, Catia Marzolini, Annalisa Marinosci, Christian Kahlert, Luigia Elzi, David Haerry, Matthias Cavassini, Bruno Ledergerber, Jacques Fellay, Gilles Wandeler, Philip E Tarr","doi":"10.1111/hiv.70322","DOIUrl":"https://doi.org/10.1111/hiv.70322","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic elevation of alanine aminotransferase (cALT) is common in people with HIV. Published reports on cALT prevalence time trends have not been uniform. It is unknown whether genetic background is associated with cALT in people with HIV.</p><p><strong>Methods: </strong>cALT was defined as ALT levels (male, >50 U/L, female, >35 U/L) at ≥2 consecutive, 6-monthly per protocol Swiss HIV Cohort Study (SHCS) visits. We calculated cALT prevalence plus trends in time-updated clinical and HIV-related cALT risk factors per calendar year in SHCS participants without viral hepatitis co-infection. In cALT cases and matched controls, we obtained uni- and multivariable odds ratios (ORs) for cALT, adjusting additionally for a polygenic risk score (PGS) associated with transaminase levels in the general population.</p><p><strong>Results: </strong>Between 2002 and 2023, 8'909 SHCS participants contributed 203'832 ALT values obtained per protocol, and 8'414 cALT events occurred. The yearly cALT prevalence increased significantly (p < 0.001) from 7.5% (95% confidence interval, 6.3%-8.9%) in 2002 to the highest level of 10.1% (9.1%-11.1%) in 2005, followed by a significant (p < 0.001) decline to 5.3% (4.8%-5.9%) in 2018, with stable rates thereafter (p = 0.280). An increased multivariable cALT-OR was noted for obesity (OR = 2.84; 1.99-4.07), for 6-12-month exposure to non-nucleoside reverse transcriptase inhibitors (OR = 2.09; 1.09-4.03) and tenofovir disoproxil fumarate (OR = 1.99; 1.15-3.46). Participants with unfavourable genetic background (top vs. bottom quintile of PGS) had a multivariable-adjusted cALT-OR of 4.44 (3.09-6.39).</p><p><strong>Conclusion: </strong>cALT prevalence has decreased by almost half in people with HIV in Switzerland since 2005. Unfavourable genetic background is a strong independent risk factor for cALT.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168712","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}