JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

{"title":"Positive STEPS: Enhancing Medication Adherence and Achieving Viral Load Suppression in Youth Living With HIV in the United States-Results From an Efficacious Stepped Care, Randomized Controlled Trial.","authors":"Matthew J Mimiaga, Lisa M Kuhns, Katie B Biello, Jiahao Tian, Margie R Skeer, Christina Psaros, Ethan Moitra, Diane Chen, Elizabeth Yonko, Kenneth H Mayer, Steven A Safren, Robert Garofalo","doi":"10.1097/QAI.0000000000003639","DOIUrl":"10.1097/QAI.0000000000003639","url":null,"abstract":"<p><strong>Background: </strong>In the United States and worldwide, there is a significant number of young people acquiring and living with HIV. Antiretroviral therapy (ART) has led to significant reductions in HIV-related illnesses and deaths, allowing young people living with HIV to manage their condition as a chronic disease. Ensuring high levels of ART adherence is vital for treatment success. Despite this, to the best of our knowledge, there are no efficacious behavioral interventions for improving ART adherence and viral suppression among youth in the United States.</p><p><strong>Methods: </strong>We conducted a multicity, randomized, controlled trial-in Boston, MA/Providence, RI and Chicago, IL-to examine the efficacy of an stepped care, behavioral and technology-based intervention, \"Positive STrategies to Enhance Problem-Solving Skills (Positive STEPS),\" compared with a standard of care (SOC) control, for improving ART adherence and viral suppression among youth living with HIV ages 16-29 years. Positive STEPS included the following: step 1: TXTXT, an evidence-based, daily 2-way personalized text message reminder to take ART medications; step 2: only participants with <90% adherence anytime between weeks 5 and 12 postrandomization to the Positive STEPS arm would then receive five 50-minute sessions of manualized individual adherence counseling. If participants' adherence remained at ≥90% , then they did not progress to step 2. ART adherence was measured via Wisepill, an electronic medication monitoring device, and self-report. Participants were followed for 12 months and completed biospecimen collection (HIV plasma RNA viral load testing) and a quantitative assessment battery at baseline and at their 4-, 8-, and 12-month follow-up visits.</p><p><strong>Results: </strong>Between March 2018 and March 2023, 123 participants were randomized (Positive STEPS = 63; SOC control = 60). Intention-to-treat analyses showed a significant positive main effect for the Positive STEPS arm, which increased the mean log ART adherence by 18.7% relative to the SOC control at the 4-month visit (coefficient = 0.187, P = 0.021). For the time effect, a significant overall increase in ART adherence across the subsequent follow-up visits was observed, with increased mean log ART adherence by 27.8% ( P < 0.01) at 8 months and 30.1% at 12 months ( P < 0.01), relative to the SOC control. With respect to our viral suppression outcome, the analysis revealed a significant negative main effect for the Positive STEPS arm at 4-months (odds ratio = 0.264, P = 0.023), indicating that the odds of having an unsuppressed virus were 74% lower in the Positive STEPS arm compared with the SOC control; the interaction term revealed that this effect was maintained through the 12-month follow-up time period.</p><p><strong>Conclusion: </strong>These findings on the efficacy of Positive STEPS to enhance ART adherence and viral suppression among youth living with HIV represent the first b","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"64-74"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065600","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":"Brief Report: Resolution of Neuropsychiatric Adverse Events After Switching to a Doravirine-Based Regimen in the Open-Label Extensions of the DRIVE-AHEAD and DRIVE-FORWARD Trials.","authors":"Graeme Moyle, Fanxia Meng, Hong Wan, Peter Sklar, Rebeca M Plank, Rima Lahoulou","doi":"10.1097/QAI.0000000000003599","DOIUrl":"10.1097/QAI.0000000000003599","url":null,"abstract":"<p><strong>Background: </strong>Neuropsychiatric adverse events (NPAEs) are associated with several antiretrovirals. Doravirine (DOR), a non-nucleoside reverse transcriptase inhibitor indicated for HIV-1 treatment, does not interact significantly with known neurotransmitter receptors in vitro. First-line therapy with DOR-based regimens resulted in significantly fewer NPAEs than efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF) and similar rates to those of ritonavir-boosted darunavir (DRV/r) with 2 nucleos(t)ide reverse transcriptase inhibitors (NRTIs) through week 96 of the phase 3 DRIVE-AHEAD and DRIVE-FORWARD studies, respectively.</p><p><strong>Methods: </strong>In the DRIVE-AHEAD (NCT02403674) and DRIVE-FORWARD studies (NCT02275780), treatment-naive adults randomly received DOR/lamivudine/TDF or EFV/FTC/TDF and DOR + 2 NRTIs or DRV/r + 2 NRTIs, respectively, for a 96-week double-blind phase; afterward, participants could continue or switch to a DOR-based regimen for a 96-week open-label extension.</p><p><strong>Results: </strong>Overall, 269 and 233 participants in the DRIVE-AHEAD and DRIVE-FORWARD studies, respectively, switched to a DOR-based regimen. At week 96, 26 and 15 participants randomized to EFV/FTC/TDF and DRV/r + 2 NRTIs, respectively, had ongoing NPAEs, resolving by week 192 in 73% (19/26) and 40% (6/15) of participants switching to a DOR-based regimen. New-onset NPAEs were reported by 9% (25/269) and 8% (18/233) of participants; by week 192, new-onset NPAEs were resolved and/or resolving in 60% (15/25) and 61% (11/18) of participants.</p><p><strong>Conclusions: </strong>In both trial extensions, NPAEs persisted in 3%-4% of participants 96 weeks after switching to a DOR-based regimen, possibly representing the background rate for these events. This suggests that DOR-based therapy may be a good option for adults with baseline neuropsychiatric symptoms or those experiencing NPAEs with other antiretrovirals.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"81-86"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921698","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":"Brief Report: What Matters Most for Long-Acting Antiretroviral Therapy? A Best-Worst Scaling Discrete Choice Experiment.","authors":"Rebecca J Fisk-Hoffman, Yiyang Liu, Charurut Somboonwit, Maya Widmeyer, Lori A Bilello, Colby Cohen, Robert F Leeman, Mattia Prosperi, Ramzi G Salloum, Robert L Cook","doi":"10.1097/QAI.0000000000003609","DOIUrl":"10.1097/QAI.0000000000003609","url":null,"abstract":"<p><strong>Introduction: </strong>Florida remains a high-incidence, high-prevalence setting for HIV. Long-acting (LA) antiretroviral therapies (ART) could improve HIV-related outcomes and reduce transmission. This study identifies preferred LA ART characteristics and classes of preference among persons with HIV (PWH) in Florida.</p><p><strong>Methods: </strong>The Florida Cohort enrolls adult PWH from 6 counties. In February 2023, a best-worst scaling discrete choice experiment was added that included 12 tasks with 3 alternatives and an opt-out (i.e., their current regimen). Six attributes were included: treatment type (e.g., shot), long-term effects, side effects, location (e.g., at home), effectiveness, and frequency. A Hierarchical Bayes model was used to estimate level utilities, attribute importance was calculated, and a latent class model was run in Sawtooth Software.</p><p><strong>Results: </strong>Overall, 208 PWH participated (60% aged 50+, 49% non-Hispanic Black, 54% male). Treatment type had the greatest impact on preference [27.2% (95% CI: 25.1 to 29.3)], followed by frequency [23.4% (95% CI: 21.6 to 25.2)], and long-term effects [19.0% (95% CI: 17.8 to 20.3)]. Within treatment type, LA pills were preferred over other options, including their current regimen. Less frequent administration was preferred, but only yearly administration was preferred over their current regimen. Within long-term effects, participants preferred no increase in risk. Two classes were identified where one class (27% of participants) preferred their current regimen and the other (73% of participants) preferred an alternative, placing greater importance on frequency.</p><p><strong>Conclusions: </strong>PWH preferred LA pills and less frequent administration, so future ART development could focus on options with these traits. Further exploration of user preference classes is needed.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"87-92"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005317","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":"Updates to HIV Transmission Rate Estimates Along the HIV Care Continuum in the United States, 2019.","authors":"Arden Baxter, Chaitra Gopalappa, Md Hafizul Islam, Alex Viguerie, Cynthia Lyles, Anna Satcher Johnson, Nidhi Khurana, Paul G Farnham","doi":"10.1097/QAI.0000000000003623","DOIUrl":"10.1097/QAI.0000000000003623","url":null,"abstract":"<p><strong>Background: </strong>In 2019, there were an estimated 1.2 million persons with HIV (PWH) and 35,100 new infections in the United States. The HIV care continuum has a large influence on transmission dynamics.</p><p><strong>Methods: </strong>We updated Progression and Transmission of HIV 3.0, an agent-based simulation model, to estimate 2019 HIV transmission rates and distribution of transmissions by the HIV care continuum, race/ethnicity, transmission group, and age group.</p><p><strong>Results: </strong>In 2019, the estimated transmission rate in the United States was 2.94 new infections per 100 person-years ( inf/100p-y) . Transmission rates decreased along the HIV care continuum; the highest transmission rate was associated with persons with acute HIV infection and unaware of their HIV status at 16.35 inf/100p-y , followed by PWH (nonacute) and unaware of their HIV status (9.52), persons aware of their HIV status and not in care (5.96), persons receiving HIV care (on antiretroviral therapy) but not virally suppressed (4.53), and persons virally suppressed (0). The highest transmission rate by transmission group was among men who have sex with men at 3.68 inf/100p-y . Transmission rates decreased as age increased and are similar by race/ethnicity, after accounting for the HIV care continuum.</p><p><strong>Conclusions: </strong>Our results support a continued emphasis on helping PWH move along the care continuum through early diagnosis, linkage to care, and adherence to ART, resulting in viral suppression to reduce HIV transmissions. Furthermore, efforts should focus on reducing disparities in the provision of HIV prevention and care services, particularly for populations disproportionally affected by HIV.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"47-54"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023265","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":"Identifying Metabolomic Biomarkers of Lung Function Decline in People with HIV.","authors":"Tyler C Lovelace, Stacy L Gelhaus, Barbara Methé, Steven J Mullett, Biying Zhang, Kelvin Li, Stephen Y Chan, Cathy Murray, Heather Gentry, Shulin Qin, Charles R Rinaldo, Panayiotis V Benos, Alison Morris","doi":"10.1097/QAI.0000000000003689","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003689","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary complications in people living with HIV (PWH) have shifted away from infectious disease and towards chronic disease. HIV is an independent risk factor for chronic obstructive pulmonary disease (COPD), with PWH developing COPD younger and declining faster in pulmonary function. As an accelerated decline is associated with greater mortality, there is a need to identify individuals at high risk of longitudinal decline.</p><p><strong>Setting: </strong>59 adults with HIV enrolled from the Pittsburgh Lung HIV study cohort.</p><p><strong>Methods: </strong>Targeted metabolite profiling was performed on baseline bronchoalveolar lavage fluid (BALF, n=35) and serum samples (n=54) using liquid chromatography-high resolution mass spectrometry. Longitudinal pulmonary function tests (median 3 measurements over 2.95 years with a follow-up interval of 1.34 years) were used to determine rates of decline. Predictive modeling and feature selection algorithms identified baseline clinical and metabolomic factors associated with longitudinal decline across forced expiratory volume, forced vital capacity, and diffusing capacity of the lung.</p><p><strong>Results: </strong>Predictive models found the BALF metabolome to successfully predict outcomes more consistently than serum. Key BALF metabolites such as elevated carnitine and reduced pyruvate predicted greater risk of longitudinal decline. Low serum citrate levels were a robust predictor of decline across multiple tests. Probabilistic graphical models supported direct relationships between these metabolites and lung function decline.</p><p><strong>Conclusion: </strong>Baseline metabolomic profiling, especially using BALF, can help identify PWH at risk for accelerated lung function decline. Key metabolic pathways related to glucose oxidation, fatty acid metabolism, and amino acid metabolism underlie observed lung function changes.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002794","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":"Exploratory Substudy of a Phase 2 Trial to Evaluate the Pharmacokinetic Effect of Once-Monthly Islatravir on Long-Acting Reversible Contraceptives.","authors":"Michelle Pham, Prachi Wickremasingha, Ryan Vargo, Munjal Patel, Katherine Nedrow, Brenda Homony, Michael N Robertson, Rebeca M Plank","doi":"10.1097/QAI.0000000000003678","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003678","url":null,"abstract":"<p><strong>Background: </strong>People living with, or at risk of acquiring, HIV-1 may use hormonal long-acting reversible contraceptives (LARCs). Islatravir is a nucleoside reverse transcriptase translocation inhibitor in development for the treatment of HIV-1. We aimed to evaluate the effects of once-monthly oral islatravir on the pharmacokinetics of LARCs.</p><p><strong>Setting: </strong>This was an exploratory substudy of a double-blind, randomized, placebo-controlled, Phase 2a trial of once-monthly oral islatravir in adults at low risk of HIV-1 infection (MK-8591-016; NCT04003103).</p><p><strong>Methods: </strong>Participants were randomized 2:2:1 to receive 6 once-monthly doses of oral islatravir 60 mg, oral islatravir 120 mg, or placebo. At randomization, participants using an etonogestrel-releasing implant, injectable medroxyprogesterone acetate, or injectable norethindrone enanthate could enroll in the LARC substudy. LARC use was not a stratification factor. Plasma samples for hormone concentrations were collected at normally scheduled study visits and assayed using high-performance liquid chromatographic-tandem mass spectrometric methods.</p><p><strong>Results: </strong>The analyses included 36 participants (etonogestrel, n = 8; medroxyprogesterone acetate, n = 20; norethindrone enanthate, n = 9; one participant was in 2 groups due to contraceptive change mid-study). No differences in hormone concentrations were observed between islatravir groups and placebo. Although sampling was insufficient to characterize full pharmacokinetics parameters, hormone concentrations were above the thresholds for contraceptive effectiveness for 94.4% (34/36) of participants.</p><p><strong>Conclusion: </strong>Coadministration with once-monthly islatravir does not appear to affect exposure to LARCs in people at low risk of HIV-1 infection. Due to the exploratory nature of this substudy, prospective studies are needed to verify these findings.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969958","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":"Amyloid-β PET Positivity Among Cognitively Impaired People with HIV Over Age 60.","authors":"Samuel Wilson, Andjelika Milicic, Shireen Javandel, Claire Yballa, Benedetta Milanini, Kilian Pohl, Robert Paul, Victor Valcour","doi":"10.1097/QAI.0000000000003686","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003686","url":null,"abstract":"<p><strong>Objective: </strong>We sought to characterize the frequency of amyloid-PET positivity among older cognitively impaired people with HIV (PWH) compared to cognitively unimpaired people without HIV (PWoH). We also examined the neuropsychological profiles of the PWH group by amyloid-PET status, cross-sectionally and longitudinally.</p><p><strong>Methods: </strong>Virally suppressed PWH were sought for a study of HAND where amyloid-PET positivity was used to exclude the possibility of AD. Participants underwent a standardized neuropsychological battery to diagnose HAND. Age and sex-matched cognitively unimpaired PWoH were identified from a separate cohort at our site. No participant from either group showed clinical signs and symptoms in a pattern concerning for AD. All participants completed amyloid-PET ([18F]Florbetapir). A certified neurologist visually read these as amyloid positive (PET+) or negative (PET-).</p><p><strong>Results: </strong>Compared to cognitively unimpaired PWoH (n=65, mean age=67), the cognitively impaired PWH group (n=74, mean age=69) was predominantly male (94.6% vs. 72.3%, p<0.001), of non-hispanic white ethnicity (74.3% vs. 83.1%, p=0.211) and reported lower educational attainment (16.2 vs. 17.4 years, p<0.001). Among them, 6 (8.1%) had PET+ scans compared to 14 PWoH (21.5 %, p=0.024). Within the PWH group, we did not identify differences in the neuropsychological testing pattern by amyloid-PET status (all p-values >0.05).</p><p><strong>Conclusion: </strong>Cognitively impaired PWH did not show increased frequency of amyloid positivity relative to cognitively unimpaired PWoH. Among PWH, cognitive performance did not differ by amyloid-PET status in analyses of cross-sectional baseline and longitudinal performance.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005660","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":"Association between Maternal HIV and Adverse Birth Outcomes in the Era of Universal Antiretroviral Therapy in Malawi.","authors":"Nginache Nampota-Nkomba, Andrea Buchwald, Osward M Nyirenda, Felix A Mkandawire, Rhoda Masonga, Samuel Meja, Dominic Moyo, Cristiana Cairo, Miriam K Laufer","doi":"10.1097/QAI.0000000000003685","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003685","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the relationship between maternal HIV and birth outcomes in pregnant women.</p><p><strong>Setting: </strong>Primary health care facilities in Malawi.</p><p><strong>Methods: </strong>In this prospective cohort study, pregnant women attending their first antenatal care (ANC) visit between 20-36 weeks gestation were categorized by HIV status. Women living with HIV were grouped by HIV viral load at ANC and delivery (detectable >400 copies/mL), CD4+ count at delivery (low <250 cells/mm3), and ART regimen (tenofovir- and efavirenz-based ART). We evaluated low birth weight (LBW, <2500g), preterm birth (PTB, <37 weeks gestation), small for gestational age (SGA, <10th percentile for gestational age), fetal death (pregnancy loss >28 weeks gestation), and perinatal death (<7 days) at delivery using multivariate log-binomial regression.</p><p><strong>Results: </strong>We enrolled 1208 pregnant women (633 and 575 living with and without HIV, respectively) from 2018-2022. HIV was significantly associated with increased risk of fetal or perinatal death (adjusted risk ratio (aRR) 2.09, 95% CI 1.21, 3.70), LBW (aRR 1.88, 95% CI 1.30, 2.76), and PTB (aRR 1.49, 95% CI ( 1.07, 2.09). The strength of the association with LBW increased with increasing exposure to viral load, with an aRR of 2.35 (1.01, 3.99) for LBW among women with detectable viral loads throughout pregnancy. Low CD4+ count at delivery was associated with LBW. HIV was not significantly associated with SGA. Adverse birth outcomes did not differ by ART regimen.</p><p><strong>Conclusion: </strong>Maternal HIV infection is a risk factor for adverse birth outcomes and the effect is partially mitigated by viral suppression.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966818","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":"Approaches to optimally target frailty screening among people with HIV in clinical care: findings from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS).","authors":"Heidi M Crane, Stephanie A Ruderman, Robin M Nance, Lydia N Drumright, Bridget M Whitney, L Sarah Mixson, Kenneth H Mayer, Joseph J Eron, Sonia Napravnik, Katerina Christopoulos, Edward R Cachay, Laura Bamford, Geetanjali Chander, Allison Webel, Michael S Saag, Amanda L Willig, Greer Burkholder, Chintan Pandya, Francisco Cartujano-Barrera, Charles Kamen, Andrew W Hahn, Jimmy Ma, Mari M Kitahata, William B Lober, Joseph Ac Delaney","doi":"10.1097/QAI.0000000000003688","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003688","url":null,"abstract":"<p><strong>Background: </strong>Frailty screening in HIV care has been recommended, however, screening adds burden to busy clinics. We compared criteria that predict concurrent frailty to identify approaches to optimally target frailty screening.</p><p><strong>Methods: </strong>The development cohort included people with HIV (PWH) at six U.S. sites. Frailty was assessed based on four components of a modified Fried phenotype: fatigue, unintentional weight loss, low mobility, and poor physical activity. We evaluated demographic and clinical characteristics, comorbidities, and substance use as predictors of who should be screened using selection approaches for simple and complex frailty screening tools, including machine learning approaches. We compared discrimination and calibration including area under the receiver operator characteristic (ROC) curve (AUC), sensitivity, and specificity in a validation cohort (7th site).</p><p><strong>Results: </strong>Among the 9,592 PWH in the development cohort, 11% were frail. AUC ranged from 0.52 for simple screening approaches such as age-based to 0.84 for complex approaches in the development and validation cohorts. Using an age cutoff >50 years reduced the percentage of PWH needing screening by over half but also reduced the sensitivity to 58% in the validation cohort. Complex approaches required 47% to be screened and had a sensitivity of 89%.</p><p><strong>Conclusions: </strong>Age-based frailty screening approaches (e.g., >50 years) miss many frail PWH. Complex tools had marginally better testing characteristics but would be more difficult to implement in clinical care. Simple targeted screening based on three characteristics (age, gender, and depressive symptoms) identified 89% of frail PWH and reduced the number who needed screened by 52%.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011810","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":"IMMUNOLOGICAL AND VIROLOGIC OUTCOMES WITHIN TEN YEARS OF COMBINED ANTIRETROVIRAL THERAPY INITIATED BEFORE ONE YEAR OF AGE IN CAMEROONIAN CHILDREN WITH PERINATAL HIV.","authors":"Francis Ateba Ndongo, Mathurin Cyrille Tejiokem, Calixte Ida Penda, Suzie Tetang Ndiang, Georgette Guemkam, Paul Alain Tagnouokam-Ngoupo, Jules Tchatchueng, Jean-Audrey Ndongo, Hubert Mbassi Awa, Paul Olivier Koki Ndombo, Philippe Msellati, Josiane Warszawski, Albert Faye","doi":"10.1097/QAI.0000000000003687","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003687","url":null,"abstract":"<p><strong>Background: </strong>We reported immunological and virologic outcomes within 10 years of combined Antiretroviral Therapy (cART) initiated no later than age one year and associated factors in children with perinatal HIV in Cameroon.</p><p><strong>Setting: </strong>This study was conducted in 3 referral hospitals in Cameroon.</p><p><strong>Methods: </strong>We conducted a prospective cohort study, using time-to-event analysis. Probabilities of the following outcomes were assessed within the first 10 years of cART initiation: first Viral Suppression to <400 copies/mL (VS), maintaining first VS, Immunocompetence (IC) - stage 1, CDC Immunological Classification - and mortality.</p><p><strong>Results: </strong>190 children started cART before one year of age, at an average age of 4.3 months (Standard deviation: ±2.5 months), of whom 45.3% were immunocompetent; 66.8% on nevirapine (NVP)-based versus ritonavir-boosted lopinavir (LPV/r)-based regimens; 37.9% with running water at home. At 10 years of cART initiation, outcomes probabilities estimates were: 22.0% of death mostly in the first 2 years and mainly due to advanced HIV disease, 72.0% of first VS achieved; 70.0% and 50.4% of first VS maintained considering children with first VS achieved and all the study participants, respectively; immunocompetent children increased to 88.6%. Being immunocompetent at cART initiation and receiving LPV/r-based regimens (versus NVP-based ones) over time were significantly associated with maintaining VS.</p><p><strong>Conclusion: </strong>Long term efficacy of early cART in children with perinatal HIV was mainly impaired by high mortality during initial phase. Screening strategies, even community-based, for early detecting HIV in exposed infants before advanced HIV disease had set up, should be implemented.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024157","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}