HIV Medicine最新文献

{"title":"Gender equality in leadership of HIV care cascade clinical trials: A methodological study.","authors":"Fiona Rezene, Brendan Amoyaw, Myanca Rodrigues, Sandra Ofori, Lawrence Mbuagbaw","doi":"10.1111/hiv.70062","DOIUrl":"10.1111/hiv.70062","url":null,"abstract":"<p><strong>Objectives: </strong>Equitable representation in research leadership is essential across all areas of medical science. In the context of HIV-where women are disproportionately affected-examining gender distribution in the leadership of HIV trials is essential to assess progress towards equity and identify persisting barriers.</p><p><strong>Methods: </strong>We conducted a methodological study of trials from the CASCADE database, which evaluates interventions to improve the HIV care cascade. We extracted first and last authors' names and used Genderize.io to determine their gender, classifying authors as 'women' if the probability was 60% or greater. The primary outcome was the proportion of trials with women in leadership (first or last author), with secondary outcomes examining the proportions of trials with women as: first authors, last authors and in both roles. We also assessed associations with country income level, focus on women participants, study setting, pragmatism and team size.</p><p><strong>Results: </strong>Gender for both authorship roles could be determined in 332 trials, of which 233/332 (70.2%) had a woman first or last author; 169/334 (50.6%) had a woman first author; 143/337 (42.4%) had a woman last author and 74/332 (22.3%) featured women in both roles. Women's leadership increased over time but was not associated with country income level, gender focus, study setting or impact factor. Effectiveness trials and those with fewer authors were more likely to have women in leadership.</p><p><strong>Conclusions: </strong>Women's leadership in HIV trials has increased, reflecting progress in gender equity. However, smaller author teams appear to facilitate women's leadership, suggesting barriers in larger collaborations. Continued efforts are needed to ensure sustained progress and equitable representation.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333018","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":"Use of dual antiretroviral therapy in individuals with different serological patterns for hepatitis B: What are the risks? What are the clinical implications?","authors":"Arda Kaya, Dominik Benke, Tracy Swan, Sven Breitschwerdt, Jan-Christian Wasmuth, Christoph Boesecke, Jürgen Kurt Rockstroh","doi":"10.1111/hiv.70063","DOIUrl":"https://doi.org/10.1111/hiv.70063","url":null,"abstract":"","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309895","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":"Long-acting injectable cabotegravir and rilpivirine in observational cohort studies: A systematic review on virological failure, resistance and re-suppression outcomes in virally suppressed individuals living with HIV.","authors":"Kyle Ring, Alexa Elias, Megan Devonald, Melanie Smuk, Chloe Orkin","doi":"10.1111/hiv.70057","DOIUrl":"https://doi.org/10.1111/hiv.70057","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized controlled trial evidence suggests that long-acting injectable (LA-I) cabotegravir and rilpivirine (CAB+RPV) has similar virological failure (VF) rates to daily oral therapy, but clinical practice evidence is lacking. Integrase inhibitor (INI) resistance may limit future therapy. The optimal regimen is uncertain.</p><p><strong>Methods: </strong>We synthesized evidence from PubMed, EMBASE, Cochrane and conference abstract databases through 18 November 2024, to identify observational cohort studies (OCS) that reported on VF events in virally suppressed individuals who switched to LA-I CAB+RPV. We extracted data on VF, resistance-associated mutations (RAMs) at VF, post-VF regimen choice and re-suppression. We assessed the risk of bias using a modified Downs and Black tool.</p><p><strong>Results: </strong>VF definitions differed considerably among OCS, with 172 individuals experiencing VF across 79 cohorts that included 13 899 individuals. Twenty-eight cohorts (n = 7987) reported genotypic information at VF. Out of the 80 VF events with genotypic information available at the time of the VF event, NNRTI mutations were identified in 45 cases, INIs in 40 cases, and dual-class resistance in 33 cases. Notably, 28 VF events were not accompanied by resistance. Post-VF regimen choices were reported for 92 VF events. Regimens used were protease inhibitor (PI)-based, oral INI-based and some physicians continued LA-I CAB+RPV post-VF. Re-suppression occurred in 87.8% (65/74) of VF events in which it was described.</p><p><strong>Conclusions: </strong>In OCS, VF was a very uncommon occurrence and comparable with clinical trials. However, when it did occur, it was frequently accompanied by resistance. Post-VF regimens used to achieve suppression varied, including LA-I CAB+RPV maintenance and were highly successful.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283746","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":"Factors mediating and associated with immunological response in women living with HIV in Sweden: A nationwide register-based study.","authors":"Josefin Nilsson, Olof Elvstam, Erik Sörstedt, Philippe Wagner, Piotr Nowak, Johanna Brännström, Christina Carlander","doi":"10.1111/hiv.70059","DOIUrl":"https://doi.org/10.1111/hiv.70059","url":null,"abstract":"<p><strong>Introduction: </strong>Women remain underrepresented in studies on immunological response (IR) among virally suppressed people living with HIV. Despite receiving antiretroviral therapy (ART) some individuals do not attain an IR, increasing their risk of non-AIDS morbidity and mortality. This nationwide study investigated biomedical and social factors associated with IR among women with HIV in Sweden.</p><p><strong>Methods: </strong>We conducted a register-based cohort study using the Swedish National HIV Registry (InfCareHIV). Virally suppressed women diagnosed with HIV between 2000 and 2020, ≥18 years old were included. Included women were observed for 2 years after ART initiation. The associations between IR and clinical and social determinants were investigated using logistic regression.</p><p><strong>Results: </strong>There were 841 women included in the final model, of whom 90% (n = 739, 95% CI: 0.88-0.92) had an IR after a 2-year follow-up. Mean age was 37 years at inclusion, and 52% (n = 439) were born in a sub-Saharan African country. A significant interaction between baseline HIV viral load and HIV acquisition mode was observed. Higher baseline HIV viral load (≥100 000 copies/mL) increased the odds of IR (adjOR 1.81, 95% CI: 0.96-3.41), except among women acquiring HIV via intravenous drug use (IDU), where this association was strongly attenuated (adjOR: 0.03; 95% CI: 0.01-0.35). Baseline CD4, ART experience and age showed no significant associations.</p><p><strong>Conclusions: </strong>The relationship between higher baseline HIV viral load and improved IR differed by HIV acquisition mode, suggesting the importance of tailored interventions addressing social determinants and immune activation. This potential interaction needs to be validated in future studies, also including sex-specific variables.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274668","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":"Circulating fibroblast growth factor 21 and growth differentiation factor 15 are associated with severity of hepatic steatosis in people with HIV.","authors":"Paula Debroy, F Pike, S Gawrieh, K E Corey, S Hartig, A Balasubramanyam, K Ailstock, N Funderburg, J E Lake","doi":"10.1111/hiv.70060","DOIUrl":"https://doi.org/10.1111/hiv.70060","url":null,"abstract":"<p><strong>Background: </strong>Hepatic steatosis poses a significant health burden in people with HIV. Fibroblast growth factor 21 (FGF21) production from the liver regulates glucose metabolism. Higher serum levels of FGF21 are associated with hepatic steatosis and liver fibrosis in the general population. Growth differentiation factor 15 (GDF15) secretion from the liver is also upregulated in chronic inflammatory diseases and is associated with cardiovascular dysfunction in people with HIV. Here, we measured serum FGF21 and GDF15 concentrations in people with HIV and hepatic steatosis.</p><p><strong>Methods: </strong>A total of 177 people with HIV with no other known cause of liver disease underwent vibration-controlled transient elastography for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) quantification. Hepatic steatosis was defined as CAP ≥ 263 dB/m and advanced fibrosis as LSM > 12 kPa. Fasting serum total FGF21 and GDF15 concentrations were measured by ELISA. Relationships between biomarkers and hepatic parameters were analysed using a Censored Tobit Model.</p><p><strong>Results: </strong>Participants with hepatic steatosis exhibited significantly higher mean (SD) levels of serum FGF21 (p = 0.002) and GDF15 (p = 0.02) than participants without steatosis. FGF21 levels increased with BMI (p = 0.04). Higher FGF21 and GDF15 levels correlated modestly with higher CAP (FGF21 r = 0.30, p < 0.001; GDF15 r = 0.21, p = 0.01) and LSM scores (FGF21 r = 0.25, p < 0.001; GDF15 r = 0.27, p = 0.01). FGF21 concentrations were 40% higher and GDF15 17% higher in persons with steatosis. Participants with the highest FGF21 levels (quartile 4) showed significantly higher mean CAP and LSM values, and longer mean duration of HIV compared with persons in quartile 1. Similar trends were also seen with GDF15 level quartiles.</p><p><strong>Conclusions: </strong>People with HIV and hepatic steatosis had higher levels of serum FGF21 and GDF15 than those without steatosis, and levels correlated with disease severity. FGF21 and GDF15 may aid in identifying people with HIV at risk of steatotic liver disease.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266056","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 characteristics and HIV-clinical outcomes of pregnant people living with HIV in the UK.","authors":"H Okhai, A Baskaran, L Bukasa, H Peters, C Thorne, C Sabin","doi":"10.1111/hiv.70056","DOIUrl":"https://doi.org/10.1111/hiv.70056","url":null,"abstract":"<p><strong>Objective: </strong>In this study, we explore changes in the demographic and clinical characteristics of pregnant people living with HIV, and their post-partum HIV outcomes between 2000 and 2018.</p><p><strong>Methods: </strong>We described pregnancies resulting in a live birth from the linked UK CHIC/ISOSS dataset in three calendar periods (2000-2006; 2007-2012; 2013-2018). Thereafter, we explored median CD4 count change and viral rebound from delivery to 12 months post-partum.</p><p><strong>Results: </strong>In total, 4341 pregnancies were included. Maternal age increased from 31 (IQR: 28-35) years in 2000-2006 to 34 (IQR: 30-37) years in 2013-2018. Those conceiving in the most recent period had been diagnosed with HIV for longer (2000-2006: 3.0 years to 2013-2018: 7.5 years), had a higher median CD4 count (431-583 cells/mm³), and median nadir CD4 count (219-260 cells/mm³); they were also more likely to have initiated ART prior to estimated conception (70.1%-92.3%), and have a suppressed conception viral loads (VL) (56.6%-82.0%). There was no difference in median CD4 count change over the three calendar periods (2000-2006: +60 [IQR: -44, +179]; 2007-2012: +51 [-45, +172]; 2013-2018: +28 [-100, +175] cells/mm³; p = 0.12). The cumulative proportion of people with viral rebound at 12 months post-delivery was reduced in 2013-2018 (8.2%) when compared with previous periods (2000-2006: 28.1%; 2007-2012: 19.5%).</p><p><strong>Conclusion: </strong>Clinical management of pregnant people has changed over time, resulting in positive trends in this study both within pregnancy and post-partum. Further work needs to understand what barriers remain for those who do not achieve optimal management of HIV in the post-partum period.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257981","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":"Willingness to participate in clinical trials and expectations towards antiretroviral therapy among heavily treatment-experienced people living with HIV: A feasibility survey.","authors":"Marie Ballif, Manuela Correia da Silva Saúde, David Haerry, Marcel Stoeckle, Patrick Schmid, Dominique Braun, Alexandra Calmy, Gilles Wandeler, Bernard Surial","doi":"10.1111/hiv.70053","DOIUrl":"https://doi.org/10.1111/hiv.70053","url":null,"abstract":"<p><strong>Introduction: </strong>As life expectancy among persons with HIV on antiretroviral therapy (ART) is increasing, comorbidities and polypharmacy increase. Drug-drug interactions (DDIs) are common among persons with HIV with a history of virological failure, since many are receiving boosted ART. We assessed the willingness of individuals with a history of virological failure on a boosted ART to participate in simplification trials and evaluated their expectations towards ART.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey among persons with HIV at five hospitals in Switzerland between October 2021 and July 2022. We collected data using quantitative paper-based questionnaires and analysed the data using descriptive statistics. Community representatives were involved in the study planning and conduct, and in the interpretation of findings.</p><p><strong>Results: </strong>Overall, 143 (64%) of 223 eligible persons with HIV participated. Median age was 59 years (interquartile range [IQR] 52.5-63.5), 32 (22%) were female, median time on ART was 26 years (IQR: 20-27). Among participants, 104 (72%) would agree to participate in clinical trials aiming at evaluating simplified ART regimens with reduced DDI risks, or were still undecided. Of them, 92 (88%) were satisfied with their current treatment. Their main expectations about simplified ART were treatment efficacy (91%), fewer DDIs (83%), low pill number (78%) and forgiveness in case of missed doses (75%).</p><p><strong>Conclusions: </strong>Persons with HIV and a history of virological failure were motivated to participate in clinical research. This underlines the importance of including them in future trials. Furthermore, conducting feasibility surveys and including persons with HIV in the study design prior to trials ensures their relevance and alignment with people's needs and expectations.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247672","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":"Causes of death in people living with HIV from a North London cohort between 2006 and 2023: A descriptive analysis.","authors":"Linda Cheyenne Vaccari, Damien K Ming, Jane Hazell, Alan Hunter, Fiona M Burns, Robert F Miller","doi":"10.1111/hiv.70054","DOIUrl":"https://doi.org/10.1111/hiv.70054","url":null,"abstract":"<p><strong>Background: </strong>The provision of highly active anti-retroviral therapy has improved outcomes for people with HIV, worldwide. There are few data on trends and changes in the cause of death among people with HIV in the United Kingdom since its advent.</p><p><strong>Methods: </strong>We retrospectively reviewed deaths in people attending HIV services at Royal Free Hospital London between 2006 and 2023. Cause of death was categorized using the CoDe protocol. Analysis included description of demographics over time, HIV-specific metrics (late diagnoses, AIDS-defining illnesses) and aspects related to HIV treatment and trends in non-AIDS-related causes of death.</p><p><strong>Results: </strong>Of 529 deaths, 79.8% were male. Cause of death was non-AIDS-defining malignancy 21.4%, non-AIDS-defining infection 12.1%, AIDS-defining infection 11.2%, AIDS-defining malignancy 7.8%, self-harm 9.3%, cardiovascular 8.3%, liver 2.8%, respiratory 2.6%, other 7.2% and unknown 17.4%. Comparing 2006-2011 and 2018-2023, the proportion of those dying from AIDS-defining infection and malignancy fell from 13.8% to 7.1%, and from 13.8% to 3.1%, respectively; median age at death increased from 44.9 years (interquartile range [IQR] 39.7-52.4) to 58.0 (IQR 52.0-67.7): p < 0.001 and median interval between HIV diagnosis and death increased from 8.5 years (IQR 2.9-14.0) to 19.1 (IQR 11.8-26.1): p < 0.001.</p><p><strong>Conclusions: </strong>Between 2006 and 2023, there was a significant increase in median age at death and in the interval between HIV diagnosis and death. The proportion of deaths associated with AIDS-defining infection and malignancy fell, while non-AIDS-defining infection, malignancy and deaths from self-harm increased. These data suggest that focusing on earlier diagnosis, holistic clinical management and support for mitigating modifiable lifestyle risk factors including cancer screening and mental health services could result in improved outcomes and reduce preventable deaths.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225337","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":"Enhancing sexually transmitted and blood-borne infection prevention in opioid-agonist therapy programmes: Lessons from a canadian pragmatic trial and implications for Taiwan.","authors":"Shu-Chuan Chiu, Lien-Chung Wei","doi":"10.1111/hiv.70055","DOIUrl":"https://doi.org/10.1111/hiv.70055","url":null,"abstract":"","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198906","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":"Free antiretrovirals as a key tool against the HIV pandemic: A systematic review.","authors":"Melissa Doutre, Marie-Pier Godin, Iliya Dmitriev, Ana Paula Pena-Gralle, Amy Bergeron, Lucie Blais, Benoît Lemire","doi":"10.1111/hiv.70051","DOIUrl":"https://doi.org/10.1111/hiv.70051","url":null,"abstract":"<p><strong>Background/objectives: </strong>Access to antiretroviral (ARV) drugs remains a critical challenge in achieving the WHO/UNAIDS 95-95-95 targets, with medication costs representing a substantial barrier. This systematic review evaluates the effect of free ARVs, without out-of-pocket cost to the patient, on the HIV cascade of care: the use of ARV therapy, viral suppression and the use of prophylaxis (PrEP).</p><p><strong>Methods: </strong>The following databases were searched for publications between 1 January 1996 and 10 July 2024: MEDLINE, Embase, CINAHL, CNKI, Global Index Medicus, the Web of Science, the SciELO Citation Index and grey literature. Publications were eligible if they included people living with or at risk of HIV and compared free access to ARVs with out-of-pocket fees. Reviewers screened publications that focused on the outcomes: being on therapy, being virally suppressed and being on PrEP. The National Heart, Lung and Blood Institute (NHLBI) and Joanna Briggs Institute (JBI) Quality Assessment Tools were used to assess publication quality.</p><p><strong>Results: </strong>A total of 34164 documents were identified, and 407 full-text manuscripts were reviewed. A total of 22 publications met the inclusion criteria. In six of the seven publications reporting on being on therapy, providing free ARVs increased the number of people who received treatment. All four publications reporting on viral suppression showed improvement with free access. Additionally, both publications reporting on PrEP use showed increased utilization with free access.</p><p><strong>Conclusions: </strong>The review offers valuable insights for countries considering implementing free ARV programmes. It suggests that expanding access to free ARVs helps achieve the global HIV targets and improve health outcomes.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158130","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}