HIV Medicine最新文献

{"title":"Trend of HIV/AIDS disease burden in China from 1990 to 2021: An age-period-cohort model analysis.","authors":"Xiaxia He, Wenjie Zheng, Xin Wang, Yongpo Jiang, Weimin Zhu","doi":"10.1111/hiv.70009","DOIUrl":"https://doi.org/10.1111/hiv.70009","url":null,"abstract":"<p><strong>Background: </strong>Understanding the burden of HIV/AIDS in China over the last few decades is vital for creating effective control strategies.</p><p><strong>Methods: </strong>This study systematically retrieved data from the Global Burden of Disease (GBD) study 2021, including information related to HIV/AIDS in China. It assessed the burden of HIV/AIDS using specific indicators and methods, such as incidence, mortality and disability-adjusted life-years (DALYs). Joinpoint regression models were used to analyse the trends in disease burden, and age-period-cohort models were used to evaluate the effects of age, period and cohort.</p><p><strong>Results: </strong>From 1990 to 2021, the incidence, mortality and DALYs of HIV/AIDS in China increased for the total population, as well as for males and females. The age-standardized incidence, mortality and DALY rates rose at average annual rates of 0.051, 0.056 and 2.629, respectively. Age-period-cohort model analysis showed that net drift values for incidence, mortality and DALY rates across all age groups were greater than 0 (p < 0.05), with local drifts peaking between the ages of 20 and 24. The risk of HIV/AIDS increased with age. Compared with the 2005-2009 reference period, overall, male and female incidence risks first increased and then decreased, while mortality and DALY risks continued to rise. Additionally, the risks for the 1945-1949 birth cohort also showed an increasing trend.</p><p><strong>Conclusion: </strong>In conclusion, the overall HIV/AIDS burden in China grew from 1990 to 2021. To combat this, future efforts should focus on educating and preventing transmission among adolescents and the elderly.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541788","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":"Lipid nanoparticles in antiretroviral therapy: A nanotechnology breakthrough for HIV/AIDS treatment.","authors":"D Dulana C Suriyarachchi, Nuwanthi P Katuwavila","doi":"10.1111/hiv.13770","DOIUrl":"https://doi.org/10.1111/hiv.13770","url":null,"abstract":"<p><strong>Background: </strong>The development of an effective drug delivery system for the treatment of HIV/AIDS is a global challenge. The conventional drug delivery approach, namely highly active antiretroviral therapy (HAART), has increased the lifespan of HIV/AIDS patients. While antiretroviral drugs are critical for managing HIV/AIDS, they are not considered curative treatments and require additional supportive treatments depending on the clinical condition. Theoretically, all steps in the life cycle of HIV are potential targets for antiretroviral therapy. However, the eradication of HIV is still not possible with these approaches on account of some limitations. Lipid nanoparticles are effective in the delivery of antiretrovirals (ARVs) as they primarily lower the toxicity of ARVs and ease of scaling up and manufacturing, and also offer functionalization capabilities, targeted drug delivery, controlled release profiles and increased load capacity.</p><p><strong>Methods: </strong>Data were retrieved from various online electronic resources, including PubMed, Google Scholar and Scopus among others. Keywords such as 'lipid nanoparticles', 'antiretroviral therapy', 'HIV/AIDS' and 'nanomedicine' were used to formulate search strategies across approximately 106 research and review articles.</p><p><strong>Results: </strong>Lipid-based nanoparticles, including liposomes, solid lipid nanoparticles, nanostructured lipid carriers and hybrid lipid nanoparticles, have been reported as being an effective strategy for the delivery of anti-HIV drugs.</p><p><strong>Conclusions: </strong>This review discusses how lipidic nanoparticles can be used to deliver drugs to their target sites in an effective manner and considers the fate of lipid nanoparticles within the animal body.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541787","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":"Predicting PrEP acceptability and self-efficacy among men who have sex with men in the UK: The roles of identity resilience, science mistrust, and stigma.","authors":"Anthony J Gifford, Rusi Jaspal, Bethany A Jones, Daragh T McDermott","doi":"10.1111/hiv.13768","DOIUrl":"https://doi.org/10.1111/hiv.13768","url":null,"abstract":"<p><strong>Introduction: </strong>Pre-exposure prophylaxis (PrEP) is medication used to prevent the spread of HIV. Populations with increased need of HIV prevention (e.g., men who have sex with men [MSM]) are eligible for free PrEP in the UK. However, HIV surveillance reports indicate stagnated uptake of the drug, alongside increasing rates of HIV acquisition. As such, psychosocial research is needed to explore the social barriers to PrEP uptake. This study aimed to explore the role of identity resilience (i.e., ability to maintain a positive and stable sense of self) as a predictor for PrEP usage. We hypothesized that PrEP self-efficacy (i.e., belief in one's ability to take PrEP) would be positively predicted by PrEP acceptability. We also hypothesized that identity worth and identity continuity (components of identity resilience) would be associated with PrEP acceptability and PrEP self-efficacy. These would be mediated by mistrust in science, PrEP stigma, and perceived risk of HIV.</p><p><strong>Methods: </strong>In total, 500 MSM who were assigned male at birth, were aged ≥18 years, and did not have HIV participated in an online cross-sectional, psychometric study between June and September 2023. Participants had to be based in the UK but could either be PrEP users or non-users. Structural equation modelling was used to explore a model of best fit to test the hypotheses.</p><p><strong>Results: </strong>Participants were aged 18-73 years (mean 35.61, standard deviation [SD] 9.95), mostly (91.2%) white, educated to an undergraduate level or above (70.9%), and non-users of PrEP (58.2%). Model fit was satisfactory: χ² = 4.51, degrees of freedom = 3, p-value = 0.209, comparative fit index 0.997, Tucker Lewis Index 0.972, root mean square of approximation 0.032, and standardized root mean square residual 0.011. Identity worth was positively associated with PrEP self-efficacy. Identity worth was indirectly associated with PrEP acceptability and PrEP self-efficacy. The positive association of identity worth and PrEP acceptability was mediated through lower mistrust of science and lower PrEP stigma but not perceived risk of HIV.</p><p><strong>Conclusions: </strong>Results indicate that the decision to take PrEP is associated with the constructs of identity worth (i.e., self-esteem, self-efficacy, and distinctiveness) rather than risk-based appraisals alone. The reasons for accessing and using PrEP may no longer be motivated by an inherent perceived risk of HIV acquisition. When trying to increase PrEP uptake, addressing specific parts of identity resilience may be beneficial. For example, therapeutic interventions (e.g., counselling) could include interventions to improve positive sexual identities and self-esteem.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523347","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":"Frequent hepatitis B surface antigen (HBsAg) clearance during tenofovir therapy in persons with HIV/hepatitis B virus coinfection.","authors":"Charles Béguelin, Bernard Surial, Eveline Hofmann, Lorin Begré, Aline Munting, Huldrych F Günthard, Marcel Stöckle, Enos Bernasconi, Patrick Schmid, Alexandra Calmy, Franziska Suter-Riniker, Andri Rauch, Gilles Wandeler","doi":"10.1111/hiv.13766","DOIUrl":"https://doi.org/10.1111/hiv.13766","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatitis B surface antigen (HBsAg) loss is a rare event among persons with hepatitis B virus (HBV) monoinfection but seems to happen more frequently in people with HIV (PWH). We assessed the proportion of PWH/HBV coinfection who experienced HBsAg loss during long-term tenofovir-therapy and evaluated its association with quantitative HBsAg (qHBsAg) levels at tenofovir start.</p><p><strong>Methods: </strong>All Swiss HIV Cohort Study participants with two or more positive HBsAg measurements more than 6 months apart, and at least 4 years of tenofovir-containing antiretroviral therapy (ART), were considered. Our main outcomes were the loss of HBsAg during the first 2 years of tenofovir therapy and until the last available follow-up. We explored the association between qHBsAg levels at tenofovir start and HBsAg loss using multivariable logistic regression adjusted for potential confounders.</p><p><strong>Results: </strong>A total of 272 PWH and HBV coinfection were included. Median age was 41 years (IQR 36-46) and 81% (221) were men. At tenofovir start, 62% (169/272) received prior HBV active therapy, 49% (110/224) were hepatitis B e antigen (HBeAg)-positive, 82% (222/272) had detectable HBV DNA (median 4.0 log10 IU/mL, IQR 2.1-7.5) and 19% (46/242) had low qHBsAg, defined as <1000 IU/mL. HBsAg loss was observed in 7% (19/272) of participants during the first 2 years of tenofovir-containing ART and in 16% (43/272) after a median follow-up time of 8.4 years (IQR 2.6-15.8). At the last follow-up, 59% (16/27) of those with HBsAg loss had seroconverted for detectable anti-HBs antibodies. In multivariable analyses, low qHBsAg at tenofovir start (OR 5.3, 95% CI 1.6-17.8) was a significant predictor of HBsAg loss.</p><p><strong>Conclusion: </strong>We found high rates of HBsAg loss in PWH and HBV coinfection on long-term tenofovir-containing ART, most of whom had low qHBsAg at tenofovir start.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491796","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":"High-risk human papillomavirus prevalence and serostatus in a cohort of cisgender women and people with a cervix living with perinatally acquired HIV.","authors":"Merle Henderson, Dierdre Lyons, Simon Beddows, Miranda Cowen, Kavita Panwar, Corrina Wright, Jacquie Ujetz, Ellie Crook, Hasit Patel, David Smith, Caroline Foster, Sarah Fidler, Tamara Elliott","doi":"10.1111/hiv.70001","DOIUrl":"https://doi.org/10.1111/hiv.70001","url":null,"abstract":"<p><strong>Objectives: </strong>Human papillomavirus (HPV)-associated cervical cancer risk is greater in people with HIV, although this has been at least partially attenuated by antiretroviral medication, enhanced cervical screening and HPV vaccination. People with perinatally acquired HIV may remain at higher risk due to lifelong immunosuppression and potentially reduced vaccine effectiveness. In this study in people with a cervix with perinatally acquired HIV, we explored cervical high-risk HPV (hrHPV) prevalence and HPV serostatus.</p><p><strong>Methods: </strong>Participants were recruited from a London HIV service between 2020 and 2022. Cervical samples from those sexually active were analysed for hrHPV (Cepheid GeneXpert) and cytology, and, if abnormal, a referral was made to colposcopy. Serum samples were tested for antibodies against HPV6/11/16/18/31/33/45/52/58. A self-reported questionnaire including HPV vaccination history was completed.</p><p><strong>Results: </strong>Fifty-seven people were recruited with a median age of 25 years (range 18-34). Of those providing a cervical sample, 15/47 (32%) were hrHPV-positive and 12/40 (30%) had abnormal cytology; 1/17 referred for colposcopy had CIN2 (6%); 7/15 (47%) with hrHPV were below the national screening age of 24.5 years (range 19-23), and 9/15 (60%) reported previous HPV vaccination. No vaccinated participants had hrHPV16/18. Of those vaccinated, 37/39 (95%) were seropositive for HPV16 and 30/39 (77%) for HPV18. Two vaccinated participants were seronegative for HPV16/18; both had detectable HIV viral loads and CD4 counts <200 cells/μL at recruitment.</p><p><strong>Conclusion: </strong>In this small observational study we identified a 32% prevalence of cervical hrHPV. Cervical screening and HPV vaccination remain vital in this group, with further data required to inform screening guidelines for this population.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500522","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":"HIV in Latin American migrants in the UK: A neglected population in the 95-95-95 targets.","authors":"Natalie Elkheir, Catherine Dominic, Amy Price, Jessica Carter, Nadia Ahmed, David A J Moore","doi":"10.1111/hiv.70007","DOIUrl":"https://doi.org/10.1111/hiv.70007","url":null,"abstract":"<p><strong>Background: </strong>The UK has reached the UNAIDS 2025 targets (of 95% of those living with HIV to be diagnosed, 95% to be on treatment and 95% of those on treatment to be virally suppressed). However, it is not known whether this target is met in subgroups such as migrant populations. Latin Americans are a fast-growing migrant group in the UK and have low engagement with healthcare services, yet little is known about the HIV profile in this population. This study aimed to explore the profile of Latin American migrants under HIV care in the UK, and to identify any gaps in the 95-95-95 target in this population.</p><p><strong>Methods: </strong>Country of birth- and gender- stratified prevalence of HIV in Latin American migrants in the UK (as of December 2022) was estimated using data from the HIV and AIDS Reporting System and the Office for National Statistics. UNAIDS (2024) estimates from Latin American countries were used as proxies for expected prevalences and applied to Latin American demography in England to calculate expected cases. The ratio of the observed (or diagnosed) cases to the expected cases was calculated to estimate potential underdiagnosis.</p><p><strong>Results: </strong>A total of 2482 migrants born in Latin American countries were diagnosed with (and under care for) HIV in the UK (observed prevalence 841 per 100 000 population) by the end of 2022. The highest observed prevalence was in men born in Brazil (2431 per 100 000 population) and the lowest in women born in Mexico (30 per 100 000 population). Some 89% (n = 2219) of Latin American migrants under care for HIV were men, with 263 women under care with HIV in the whole of the UK. For women born in Mexico, Argentina, Chile, Venezuela and Uruguay it was estimated that only 14%, 17%, 25%, 26% and 33% of women living with HIV were under care, respectively.</p><p><strong>Conclusions: </strong>There may be a significant burden of underdiagnosis of HIV among Latin American women in the UK. Although based on some assumptions (notably the application of national HIV estimates to migrant populations which have a different risk profile), the gender disparity is striking. Community engagement and culturally appropriate targeted awareness raising and testing campaigns are recommended.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482823","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":"Impact of training healthcare professionals in the detection and management of neuropsychiatric comorbidities in people with HIV: The CONECTAR project in Spain.","authors":"Jordi Blanch, Esteban Martinez, Álvaro Mena, Carlos Dueñas, Enrique Bernal, Alfonso Cabello, Marcelino Hayek, Rafael Mican, Ramón Morillo-Verdugo, María Sainz, Cristina González Conde, Ignacio Perez-Valero","doi":"10.1111/hiv.70002","DOIUrl":"https://doi.org/10.1111/hiv.70002","url":null,"abstract":"<p><strong>Introduction: </strong>Although anxiety, depression and insomnia in people with HIV (PWH) are prevalent and have a major impact on clinical outcomes and quality of life, physicians fail to evaluate them routinely. The CONECTAR Project [Neuropsychiatric Comorbidity (NPC): Key to Antiretroviral Treatment] aimed to improve NPC clinical care in PWH in Spain by upskilling healthcare professionals (HCPs).</p><p><strong>Methods: </strong>A group of HCPs developed a training programme, supported by national and international guidelines, to improve expertise on detecting and managing NPCs in PWH. The programme was conducted through workshops for physicians and nurses in various Spanish regions from April to November 2023; survey questionnaires were administered to physicians before the commencement of training and 15 days after. Later, a workshop was held for nurses who manage NPCs in PWH.</p><p><strong>Results: </strong>The programme was completed by 64 physicians (22 had completed both questionnaires) and 11 nurses (no feedback obtained). Feedback from physicians reflected that the programme boosted awareness and self-perception of being more qualified, knowledgeable and able to use management tools and resources. Physicians also reported improved perception of time available for visits and more frequent enquiries about patients' NPC symptoms. Despite their satisfaction with the workshops, half of the physicians recognized the need for more training.</p><p><strong>Conclusion: </strong>The CONECTAR Project was a successful training programme that was well received and valued by HCPs who routinely manage NPCs in PWH. Institutions involved in HCP training to manage anxiety, depression and insomnia more effectively in PWH should consider similar proposals to reinforce clinical practices.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491807","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":"Associations between country of birth, migration status and engagement in HIV care among gay and bisexual men living with HIV in Australia, 2019-2022.","authors":"Simin Yu, James MacGibbon, Benjamin Bavinton, Anthony K J Smith, John Rule, Limin Mao, Timothy R Broady, Martin Holt","doi":"10.1111/hiv.13769","DOIUrl":"https://doi.org/10.1111/hiv.13769","url":null,"abstract":"<p><strong>Background: </strong>In the last decade, while HIV diagnoses have declined among Australian-born gay and bisexual men (GBM), they have declined much less among migrant GBM, with recently arrived GBM facing particular challenges, such as access to HIV treatment. This study assessed HIV care cascade (treatment) outcomes among GBM living with HIV in Australia by migration status.</p><p><strong>Methods: </strong>Data were collected in national cross-sectional behavioural surveillance surveys during 2019-2022. HIV cascade outcomes were stratified by country of birth and length of residency in Australia, examining HIV clinical appointments in the previous year, being on antiretroviral treatment (ART) and achieving an undetectable viral load. Percentages were calculated with the previous cascade step as the corresponding denominator.</p><p><strong>Results: </strong>Between 2019 and 2022, 32 236 GBM completed surveys, including 2533 (7.9%) people living with HIV (PLWH). Among 2188 PLWH reporting migration/residency status, 72.2% were Australian-born, 13.3% were from high-income English-speaking countries, 13.0% were non-recently arrived migrant GBM from other countries and 1.5% were recently arrived in Australia (<2 years). Median ages for the four groups were 50, 51, 41 and 34 years, respectively. Recently arrived PLWH were the most likely to be recently diagnosed (<2 years, 15.2% vs. <5% in the other groups). The HIV cascade of care, treatment, and viral suppression differed by migration status (p < 0.001): Australian-born, 92.5%, 96.9% and 94.6%, respectively; born in high-income-English-speaking countries, 91.8%, 97.4%,9 8.9%; non-recently arrived, 93.7%, 95.1%, 96.8%; and recently-arrived, 90.9%, 90.0%, 100%. Recently-arrived PLWH were less likely to be on treatment, but all those on treatment achieved viral suppression.</p><p><strong>Conclusions: </strong>Engaging and supporting recently arrived PLWH in Australia to access ART and relinking PLWH disengaged from care remains crucial.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457850","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":"Spatial and temporal trends in HIV/AIDS burden among South Asian countries from 1990 to 2021: A systematic examination of the Global Burden of Disease study 2021.","authors":"Akashanand, Mahalaqua Nazli Khatib, Hashem Abu Serhan, Diptismita Jena, G PadmaPriya, Pawan Sharma, Pradeep Soothwal, Amit Barwal, M Ravi Kumar, Pranchal Rajput, Lara Jain, Abhay M Gaidhane, Ganesh Bushi, Muhammed Shabil, Rachana Mehta, Kiran Bhopte, Manika Gupta, Sanjit Sah","doi":"10.1111/hiv.70003","DOIUrl":"https://doi.org/10.1111/hiv.70003","url":null,"abstract":"<p><strong>Background: </strong>HIV/AIDS remains a significant public health concern in South Asia, and trends in disease burden vary across the region. This study analyzed spatial and temporal trends in HIV/AIDS from 1990 to 2021 using data from the Global Burden of Disease (GBD) study 2021, focusing on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs).</p><p><strong>Methods: </strong>We conducted a secondary analysis of GBD 2021 data, applying Joinpoint regression and auto-regressive integrated moving average models to assess trends in HIV/AIDS burden across South Asian countries. We calculated metrics such as average annual percentage change (AAPC), and estimated APC (EAPC) to evaluate temporal trends.</p><p><strong>Results: </strong>We found significant variations in HIV/AIDS trends across South Asia. India had the highest burden, with a sharp increase in DALYs between 1990 and 2000 with a percentage change (PC) of 184.09, followed by a decline (-0.73 in 2010-2021). Pakistan experienced the highest growth in DALYs and mortality (average PC 36.46; estimated PC 38.65), indicating severe ongoing public health challenges. In contrast, Nepal and Maldives showed notable reductions in both DALYs and mortality rates, reflecting successful intervention efforts. Afghanistan and Bangladesh exhibited fluctuating trends, with slight increases in the initial years followed by stabilization or modest declines. Auto-regressive integrated moving average projections suggested a slight increase in HIV/AIDS incidence by 2031, with mortality rates expected to decline more significantly.</p><p><strong>Conclusion: </strong>The burden of HIV/AIDS in South Asia varies significantly, with some countries achieving reductions and others, particularly Pakistan, facing rising challenges. Continued and targeted public health interventions are crucial for managing and reducing the burden of HIV/AIDS across South Asia.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457854","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":"Patients re-engaging with HIV care in Guatemala: Prioritizing CD4 counting and screening for histoplasmosis and tuberculosis.","authors":"Narda Medina, Ana Alastruey-Izquierdo, Oscar Bonilla, Danicela Mercado, Eduardo Arathoon, Juan Luis Rodriguez-Tudela","doi":"10.1111/hiv.70000","DOIUrl":"https://doi.org/10.1111/hiv.70000","url":null,"abstract":"<p><strong>Background: </strong>Discontinuation of antiretroviral therapy (ART) significantly contributes to the development of advanced HIV disease (AHD) and opportunistic infections. This study analyzed data from patients who re-engaged in care after ART interruption and compared the cohort with patients with newly diagnosed HIV, focusing on the burden of tuberculosis and histoplasmosis.</p><p><strong>Methods: </strong>A diagnostic package for opportunistic infections was implemented in Guatemala in 2017, encompassing tuberculosis and histoplasmosis. From 2017 to 2019, we enrolled 1379 adults re-engaging in care and 3412 patients with newly diagnosed HIV across 13 healthcare facilities. Data collection included demographic information, laboratory test results, and patient outcomes.</p><p><strong>Results: </strong>Among patients re-engaging in care, 54% (491 of 903) had AHD, which was comparable to the 50.1% (1349 of 2692) in newly diagnosed patients. Among the re-engaging cohort, 34.5% had not undergone CD4 testing, compared with 21.1% in the newly diagnosed group. This highlights a significant gap in assessing advanced HIV status through an objective, unbiased test. Among patients re-engaging in care, the incidence rates of tuberculosis and histoplasmosis were 9.7% and 8.3%, respectively, regardless of immune status. This indicated a high burden of opportunistic infections in this group, with newly diagnosed patients showing similar incidence rates of 8.5% for tuberculosis and 8.3% for histoplasmosis.</p><p><strong>Conclusion: </strong>Patients re-engaging in care should follow a similar process to newly diagnosed patients. There is an urgent need for routine and immediate CD4 testing to identify AHD and implement the recommended comprehensive diagnostic and care package. Early detection and targeted interventions are crucial for reducing AIDS-related mortality.</p>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440763","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}