HIV Medicine最新文献

{"title":"Performance of urine Xpert MTB/RIF ultra in a tuberculosis screening strategy in hospitalized patients with advanced HIV disease: Results from an implementation initiative in Brazil","authors":"Diego R. Falci,&nbsp;Alessandro C. Pasqualotto,&nbsp;Tarsila Vieceli,&nbsp;Omar Sued,&nbsp;Nicole Reis,&nbsp;Renata B. A. Soares,&nbsp;Cassia S. M. Godoy,&nbsp;Nayla A. Hatem,&nbsp;Nathalia Pereira dos Santos,&nbsp;Bruna Regis Razzolini,&nbsp;Eduardo Sprinz,&nbsp;Freddy Perez","doi":"10.1111/hiv.13746","DOIUrl":"10.1111/hiv.13746","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the performance of Xpert MTB/RIF Ultra testing in urine samples as part of a TB screening strategy in patients with advanced HIV disease (AHD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a multicentre prospective cohort study across three HIV reference hospitals in Brazil, between January and December 2023. The study included adult hospitalized patients with AHD, defined by a CD4 count of &lt;200 cells/μL in the last 3 months or clinical presentation suggestive of opportunistic infection, without effective antiretroviral treatment. Participants underwent systematic tuberculosis (TB) screening using urine Xpert MTB/RIF Ultra and TB lipoarabinomannan (TB-LAM) tests. The diagnosis performance of urine Xpert MTB/RIF Ultra was assessed including sensitivity, specificity, and positive and negative predictive values. Disease characterization was based on the Global Tuberculosis Dictionary. Survival at 30 and 90 days was also evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Urine molecular testing was performed on 133 patients. Xpert MTB/RIF Ultra showed a sensitivity of 20.7% in bacteriologically confirmed TB cases and 21.2% in cases that included both clinically diagnosed and bacteriologically confirmed TB. The addition of urine Xpert MTB/RIF Ultra to TB-LAM led to the detection of three additional cases, representing a 6.3% increase from the 48 cases detected by TB-LAM. Xpert MTB/RIF Ultra had a specificity of 96.9% and no rifampicine resistance mutations were detected. Overall mortality was 16/133 (12.0%) at 30 days and 25/127 (19.7%) at 90 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was a high overlap between urine TB-LAM and Xpert MTB/RIF Ultra results, with the addition of Xpert MTB/RIF providing limited additional benefit for TB screening in patients with AHD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 3","pages":"427-433"},"PeriodicalIF":2.8,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.13746","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806940","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}

{"title":"Rapid HIV pre-exposure prophylaxis (PrEP) initiation is safe and feasible: Experience from Wroclaw All Saints cohort in Poland 2017–2021","authors":"Bartosz Szetela MD, PhD,&nbsp;Mateusz Bozejko,&nbsp;Aleksandra Szymczak,&nbsp;Katarzyna Giniewicz,&nbsp;Jacek Gasiorowski","doi":"10.1111/hiv.13747","DOIUrl":"10.1111/hiv.13747","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>HIV pre-exposure prophylaxis (PrEP) still faces many barriers around the world. Additional barriers such as retesting or rescheduling for result analysis and prescription might lead to abandoning PrEP initiation altogether. We wanted to explore whether there would be a significant number of alert issues among people starting PrEP that would warrant more in-depth clinical analysis before commencing PrEP safely.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective medical data analysis of people who started PrEP at All Saints Clinic in Wroclaw, Poland between October 2017 and January 2021 was performed. Rapid (during the first visit) or delayed PrEP initiation was chosen at the discretion of the attending physician.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 308 people started PrEP in the analysed period and were included in the analysis. The median age was 33 years with 96.75% being men who have sex with men (MSM) and 68.5% opting for daily dosing at PrEP initiation. Most (<i>n</i>=233) started PrEP rapidly (i.e., during the first visit), whereas for 75 individuals the initiation was delayed by a median of 7 days. Logistic regression analysis showed that lack of test laboratory results, recent exposure or age over 50 years were reasons for delaying PrEP initiation. Median creatinine values increased from 0.93 mg/mL to 0.95 mg/mL 1 month after PrEP initiation. Despite being statistically significant (<i>p</i> = 0.0282, 95% CI 0.0015–0.027), the difference was not significant clinically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rapid PrEP initiation was feasible and safe while contraindications were rare. HIV infection exclusion before PrEP initiation can be streamlined by utilizing remote consultations and patient self-interpretation of the results. Renal complications are either not clinically significant or occur rarely.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 3","pages":"434-440"},"PeriodicalIF":2.8,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784935","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":"Predictors for choosing doravirine-based versus INSTI-based regimen in ART-naïve and ART-experienced people with HIV in real-world setting: Data from the Icona cohort","authors":"Antonella d'Arminio Monforte,&nbsp;Alessandro Tavelli,&nbsp;Eugenia Quiros-Roldan,&nbsp;Massimiliano Fabbiani,&nbsp;Micol Ferrara,&nbsp;Sergio Lo Caputo,&nbsp;Nicola Squillace,&nbsp;Stefano Rusconi,&nbsp;Marta Ponzano,&nbsp;Francesca Bovis,&nbsp;Andrea Antinori,&nbsp;Annalisa Saracino,&nbsp;Alessandro Cozzi-Lepri","doi":"10.1111/hiv.13740","DOIUrl":"10.1111/hiv.13740","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Doravirine (DOR) is an attractive new option both for ART-naïve people with HIV (PWH) and those with suppressed HIV-RNA who seek treatment simplification. We used real-world data to examine the pattern of use of DOR-containing regimens in these settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All PWH enrolled in the Icona cohort after January 2020 who initiated a three-drug regimen (3-DR) with DOR or an integrase inhibitor (INSTI)-based regimen as first antiretroviral therapy (ART) or when switching ART, with HIV-RNA ≤50 copies/mL, were included. We used univariate and multivariable logistic regression models to identify demographic factors, immuno-virological and laboratory markers associated with the prescription of 3-DR DOR instead of INSTI-based regimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 5803 PWH were included; 1958 were in the first regimen (80 DOR, 1,878 INSTI) and 3854 (387 DOR, 3,458 INSTI) were ART-experienced virologically suppressed. In the first line, 3-DR DOR was more frequently started in people who inject drugs, and its use was also associated with higher body mass index, higher low-density lipoprotein levels, and less advanced HIV disease compared with PWH initiating an INSTI-based regimen. In the switch setting, older age, Italian origin, higher estimated glomerular filtration rate and aspartate aminotransferase levels were all strongly associated with 3-DR DOR use, as well as higher a CD4/CD8 ratio (only vs. 3-DR INSTI), while the association with lipid abnormalities was attenuated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our analysis shows that among PWH in care in Italy, those with less advanced HIV disease but with other fragilities and potential risk factors for comorbidities are more likely to use DOR- than INSTI-based regimens, regardless of prior treatment history.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 3","pages":"489-499"},"PeriodicalIF":2.8,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768502","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 qualitative study of perspectives, experiences and priority outcomes for people living with HIV and frailty","authors":"Howell T. Jones,&nbsp;Tristan J. Barber","doi":"10.1111/hiv.13736","DOIUrl":"10.1111/hiv.13736","url":null,"abstract":"","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 3","pages":"336-338"},"PeriodicalIF":2.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750425","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 the COVID-19 pandemic on the HIV care continuum and associated factors in middle-income countries: A mixed-methods systematic review","authors":"Emmanuela Ojukwu,&nbsp;Ava Pashaei,&nbsp;Juliana Cunha Maia,&nbsp;Oserekpamen Favour Omobhude,&nbsp;Abdulaziz Tawfik,&nbsp;Yvonne Nguyen","doi":"10.1111/hiv.13739","DOIUrl":"10.1111/hiv.13739","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The HIV care continuum during the COVID-19 era faced specific challenges. The pandemic, affecting the delivery of HIV care, exacerbated existing healthcare inequities and vulnerabilities in middle-income countries with limited financial resources. This study aims to set the stage for the systematic review, focusing on the impact of COVID-19 on HIV care in middle-income countries with a focus on barriers and facilitators.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A systematic search of relevant literature, including electronic databases and manual assessment of references, was done. The review included quantitative, qualitative and mixed-methods studies conducted in middle-income countries, with no age or gender restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for reporting the results.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In the course of our systematic review, a comprehensive examination of the pertinent literature published between 2020 and 2024 yielded a total of 76 studies. This adverse impact was prominently attributed to an amalgamation of factors intrinsically associated with pandemic-induced restrictions, fear of contracting the COVID-19 and fear of disclosing HIV status. Moreover, an emergent theme observed in select studies underscored the enduring trend of HIV treatment continuity, which was facilitated by the burgeoning utilization of telemedicine within this context.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The pandemic negatively affected income and increased vulnerability to HIV across all phases of the HIV care continuum, except for viral suppression. Prevention measures, such as pre-exposure prophylaxis (PrEP), were compromised, leading to increased risky behaviours and compromised mental health among people living with HIV. HIV testing and diagnosis faced challenges, with reduced access and frequency, particularly among key populations. The pandemic also disrupted linkage and retention in care, especially in urban areas, exacerbating barriers to accessing necessary HIV treatment. Additionally, this review highlights the complex and multifaceted landscape of the pandemic's impact on HIV medical appointments, adherence and treatment engagement, with various barriers identified, including fear of COVID-19, economic constraints and disruptions in healthcare services.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 3","pages":"350-381"},"PeriodicalIF":2.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.13739","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750435","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}

{"title":"Stigma-associated attitudes and practices among Romanian clinical providers","authors":"Cabiria M. Barbosu,&nbsp;Cezar Avirvarei,&nbsp;Carmen Manciuc,&nbsp;Timothy Dye","doi":"10.1111/hiv.13742","DOIUrl":"10.1111/hiv.13742","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>People living with HIV/AIDS today expect a typical lifespan, although many continue to encounter psychological and societal challenges, including stigma and discrimination. In healthcare settings, this may manifest as refusal of care or treatment, non-consensual testing, confidentiality breaches, and unfavourable attitudes, among other issues. We sought to better understand stigma-related beliefs and practices within the Romanian clinician community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We designed an analytical cross-sectional study to measure potentially stigmatizing clinical practices and to identify training gaps that could help alleviate stigma. We conducted a 17-question survey that was distributed online to healthcare providers in Moldova, the North-Eastern Romanian region, via the WhatsApp platform, between 1 August and 30 September 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 139 healthcare providers participated in the survey: 71.9% physicians, 23.7% nurses, and 4.3% other providers (e.g., psychologists, pharmacists) working in the fields of infectious disease (36.0%), primary care (13.7%), internal medicine (22.3%), and other specialties such as obstetrics-gynaecology or paediatrics (18.0%). Most participants indicated that they were not worried about providing care to someone living with HIV/AIDS, most were hesitant to perform HIV testing because they feared the patient's response, and most indicated that co-workers were hesitant to work alongside a colleague with HIV. In total, 31.7% of participants reported no stigmatizing attitudes or practices, 18.7% reported one stigmatizing attitude or practice, 32.4% reported two, and 17.3% reported three or more. After controlling for confounders, not having an HIV discrimination policy in place and not having been trained on HIV-related confidentiality were significantly predictive of holding one or more stigmatizing attitudes or practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The policy context—particularly anti-discrimination workplace policies and provider training on HIV-related confidentiality—is an important determinant of HIV-related stigmatizing practices and attitudes in Romania.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 3","pages":"390-398"},"PeriodicalIF":2.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.13742","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716156","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}

{"title":"Trends and disparities in antiretroviral therapy prescription rates among US Medicare beneficiaries with HIV","authors":"Xiaoying Yu,&nbsp;Yong-Fang Kuo,&nbsp;Ashley A. Dike,&nbsp;Tsola Efejuku,&nbsp;Mukaila A. Raji,&nbsp;Abbey B. Berenson,&nbsp;Thomas P. Giordano","doi":"10.1111/hiv.13745","DOIUrl":"10.1111/hiv.13745","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our objective was to evaluate antiretroviral therapy (ART) prescription rates over time among US Medicare enrolees with HIV and to describe disparities in ART prescription and associated factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We constructed successive cross-sectional cohorts including adult enrollees with HIV and fee-for-service coverage and Part D enrolment in US Medicare between 2007 and 2019. We calculated the percentage of receipt of any ART prescription (ART%) in a calendar year by sex, age, and original Medicare entitlement and calculated age–sex standardized ART% over time. We used multivariable logistic regression to assess the association between ART prescription and sociodemographic factors and chronic conditions by age strata (&lt;65, ≥65 years) in 2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ART% increased over time and was highest among people with HIV aged 50–64 years in 2019: 95% in males and 92% in females. Multivariable analysis showed that female sex was associated with less ART%, with odds ratios (ORs) of 0.65 (95% confidence interval [CI] 0.60–0.70) and 0.34 (95% CI 0.30–0.39), than male sex in those aged &lt;65 and ≥65 years, respectively. The youngest and oldest enrollees had lower ART use (e.g., OR 0.43 [95% CI 0.34–0.54] for 18–29 vs. 50–64 years; OR 0.34 [95% CI 0.30–0.39] for ≥80 vs. 65–69 years). The top conditions associated with less ART included dementia and alcohol use disorder. Other factors included no Part D low-income subsidy, non-Hispanic white race, and Midwest residence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ART use increased over time in US Medicare enrollees. Non-Hispanic white, female, and the youngest and oldest enrollees received less ART. Multimorbidity, substance use, and dementia were associated with less ART use. Research to overcome these disparities is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 3","pages":"415-426"},"PeriodicalIF":2.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716178","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":"Loneliness and social isolation in people with HIV aged ≥50 years. The No One Alone (NOA)-GeSIDA study conducted by the GeSIDA 12021 study group","authors":"José-Ramón Blanco,&nbsp;Alicia Gonzalez-Baeza,&nbsp;Ana Martinez-Vicente,&nbsp;Helena Albendin-Iglesias,&nbsp;Javier De La Torre,&nbsp;Inma Jarrin,&nbsp;Inmaculada González-Cuello,&nbsp;Noemí Cabello-Clotet,&nbsp;Ana-María Barrios-Blandino,&nbsp;Isabel Sanjoaquin-Conde,&nbsp;Mª-Luisa Montes-Ramirez,&nbsp;Estrella Melus,&nbsp;Verónica Pérez-Esquerdo,&nbsp;Cristina Tomas-Jimenez,&nbsp;María Saumoy-Linares,&nbsp;Ana-Mª Lopez-Lirola,&nbsp;Carmen Hidalgo-Tenorio,&nbsp;Magdalena Muelas-Fernandez,&nbsp;Mª-José Galindo-Puerto,&nbsp;Jessica Abadía,&nbsp;Eduardo Manzanares,&nbsp;Cristina Segundo-Martin,&nbsp;Mª-Angeles Fernandez-Lopez,&nbsp;María Barrios-Vega,&nbsp;Marta De Miguel,&nbsp;Julian Olalla,&nbsp;Grupo_Estudio_Gesida_12021","doi":"10.1111/hiv.13743","DOIUrl":"10.1111/hiv.13743","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;There is a growing number of people with HIV who are aged 50 years or older, and the prevalence of loneliness and social isolation remains unknown.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A multicentre study was conducted across 22 GeSIDA centres. A survey was carried out to assess loneliness [UCLA 3-item Loneliness Scale-3 (UCLA-3)] and social isolation [Lubben Social Network Scale-Revised (LSNS-R)], along with sociodemographic aspects, HIV-related factors, comorbidities, tobacco, alcohol and drug consumption, quality of life, anxiety and depression, and stigma. The prevalence of loneliness (UCLA-3 ≥ 6) and evident social isolation (LSNS-R ≤ 20) was calculated, and multivariable multinominal logistic regression models were used to identify associated factors.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 399 people with HIV were included; 77.4% were men, of average age 59.9 years (SD 6.5); 45.1% were aged ≥60 years; 86% were born in Spain; 86.7% in urban areas; 56.4% with secondary or higher education; 4.5% living alone against their wishes. A total of 66.9% were infected through sexual transmission, with a median of 22.9 years since diagnosis [interquartile range (IQR): 12.6–29.5] and a median nadir CD4 count of 245 cells/μL (IQR: 89–440). Overall, 90.7% had viral load &lt;50 copies/mL, 93.5% had adherence &gt;95%, and 26.3% had a prior AIDS diagnosis. In all, 29.1% and 21% reported significant symptoms of anxiety and depression, respectively, 24.3% had mobility issues, and 40.8% reported pain. Overall, 77.7% of participants reported neither loneliness nor social isolation, 10.0% loneliness only, 5.8% social isolation only and 6.5% both. Multivariable analyses identified that being aged 50–59, unemployed or retired, living alone unwillingly, single, poor quality of life, anxiety, and HIV-related stigma were associated with loneliness. Meanwhile, lower education, living alone unwillingly, and depressive symptoms were associated with social isolation. Individuals living alone unwillingly, with depressive symptoms and experiencing HIV-related stigma were at higher risk for both loneliness and social isolation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;There is a relatively high prevalence of loneliness and social isolation in our population. Living alone against one's wishes, being unmarried, and experiencing mobility issues could predispose individuals to feel lonely and socially isolated. Those with anxiety and stigma are more prone to loneliness, while individuals with depression are more predisposed to social isolation. It is necessary to develop strategies for ","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 3","pages":"399-414"},"PeriodicalIF":2.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692874","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 prevalence of osteoporosis among virally suppressed older people (≥60 years) living with HIV","authors":"Jeremy Penner,&nbsp;Loice A. Ombajo,&nbsp;Joseph Nkuranga,&nbsp;Edwin Otieno,&nbsp;Diana Nyakoe,&nbsp;Ruth Wanjohi,&nbsp;Victor Mbewa,&nbsp;Florentius Ndinya,&nbsp;Sheila Eshiwani,&nbsp;Simon Wahome,&nbsp;Sanjay Bhagani,&nbsp;Anton Pozniak,&nbsp;Celia L. Gregson","doi":"10.1111/hiv.13741","DOIUrl":"10.1111/hiv.13741","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Our objective was to evaluate bone mineral density (BMD) among older people living with HIV at the time of enrolment into a clinical trial in Kenya.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The bictegravir/emtricitabine/tenofovir alafenamide (BFTAF) Elderly Study is a clinical trial among virally suppressed people living with HIV aged ≥60 years randomized to switch to BFTAF or continue their pre-enrolment regimen. At enrolment, dual-energy x-ray absorptiometry (DXA) of the lumbar spine, total hip, and femoral neck was performed and T-scores calculated for BMD. Osteoporosis was defined as T-score −2.5 or lower and osteopenia as T-score between −1 and −2.5. Fracture risk was calculated based on clinical risk factors (not including BMD), considering HIV as a secondary cause of osteoporosis, and the correlation between FRAX®-HIV and BMD assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between February and May 2022, a total of 296 participants were enrolled. All were Black African, 147 (49.7%) were female, the median age was 64 years (range 60–77), and 280 (94.6%) were on tenofovir disoproxil fumarate. The median BMD of lumbar spine, total hip, and femoral neck was 0.87 g/cm² (interquartile range [IQR] 0.78–0.99), 0.89 g/cm² (IQR 0.79–1.01), and 0.75 g/cm² (IQR 0.67–0.84), respectively, with median T-scores of −1.9 (IQR −2.8 to −0.7), −1.0 (IQR −1.9 to −0.3), and −1.5 (IQR −2.2 to −0.9), respectively. Osteoporosis and osteopenia were found in 37.5% and 47.3% of participants, respectively. Major osteoporotic fracture and hip fracture 10-year median probabilities using FRAX®-HIV were 3.4% (IQR 2.8–4.6) and 1.0% (IQR 0.7–1.3). Correlation coefficients between these FRAX®-HIV probabilities and femoral neck BMD were −0.204 for major osteoporotic fracture and −0.338 for hip fracture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The prevalence of osteoporosis is high among older people living with HIV in Kenya, where DXA is not readily available and risk calculation without BMD had low correlation with measured BMD values. Additional data are required on the impact of investment in fracture risk assessment and treatment, including population-specific risk calculators.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 3","pages":"382-389"},"PeriodicalIF":2.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.13741","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681764","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}

{"title":"Comparing short-term mortality between people with and without HIV admitted to the intensive care unit: A single-centre matched cohort study (2000–2019)","authors":"N. Bakewell,&nbsp;T. Kanitkar,&nbsp;O. Dissanayake,&nbsp;M. Symonds,&nbsp;S. Rimmer,&nbsp;A. Adlakha,&nbsp;M. C. Lipman,&nbsp;S. Bhagani,&nbsp;B. Agarwal,&nbsp;R. F. Miller,&nbsp;C. A. Sabin","doi":"10.1111/hiv.13737","DOIUrl":"10.1111/hiv.13737","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The survival rate of people with HIV admitted to intensive care units (ICUs) is approaching that of people without HIV. We conducted a matched-cohort study of people with and without HIV admitted to ICU at a large hospital to compare short-term mortality, during 2000–2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>People with HIV were matched to people without HIV (1:2) on age, sex, admission year and Acute Physiology and Chronic Health Evaluation (APACHE)-II score. Applying logistic regression models fitted using independence estimating equations, we describe population-averaged associations of HIV with short-term (in-ICU, in-hospital) mortality during a patient's first admission to ICU, and explore whether these varied by year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 177 people with HIV were matched to 354 people without HIV (71.2% vs. 71.2% male; median age: 47 vs. 48 years, median APACHE-II: 18 vs. 17, median admission year: 2013 vs. 2013). Among people with HIV, 73.4% were on antiretroviral therapy, 51.2% had HIV-RNA ≤50 copies/mL and median CD4 T-cell count was 132 cells/<span></span><math>\u0000 <mrow>\u0000 <mi>μ</mi>\u0000 </mrow></math>L. People with HIV had higher in-ICU (24.3% vs. 15.3%) and in-hospital (31.6% vs. 20.1%) mortality. People with HIV had 1.69-fold higher odds (95% confidence interval: 1.03–2.76) of in-ICU mortality and 1.86 (1.19–2.91) higher odds of in-hospital mortality than people without HIV, adjusted for age, sex, year and APACHE-II. There was no evidence that these associations varied by year (<i>p</i>-interaction-in-ICU = 0.90; <i>p</i>-interaction-in-hospital = 0.46).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that although outcomes have improved over time, people with HIV continue to have higher short-term in-ICU and in-hospital mortality following ICU admission compared with people without HIV with similar characteristics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"26 2","pages":"275-284"},"PeriodicalIF":2.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681762","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}