JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

{"title":"HIV Pre-Exposure Prophylaxis (PrEP) awareness and use among Rakai Community Cohort Study youth aged 15-24.","authors":"Emily Murphy, Susie Hoffman, Victor Ssempijja, Fred Nalugoda, Larry W Chang, Robert Ssekubugu, Tom Lutalo, Godfrey Kigozi, Joseph Kagaayi, Nelson K Sewankambo, Steven J Reynolds, John Santelli, Philip Kreniske","doi":"10.1097/QAI.0000000000003640","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003640","url":null,"abstract":"<p><strong>Background: </strong>Preventing HIV infections among adolescents and young adults (AYA) is crucial for curtailing the epidemic. Oral pre-exposure prophylaxis (PrEP) is a highly effective prevention method increasingly available to this age group in sub-Saharan Africa but population-based data on awareness and use of PrEP among AYA remains limited.</p><p><strong>Methods: </strong>Analyzing survey data from two rounds of the Rakai Community Cohort Study, an open, population-based cohort, we estimated prevalence ratios associating various sociodemographic characteristics with PrEP awareness and ever-use among 15- to 24-year-olds in south-central Uganda between 2018 and 2023.</p><p><strong>Results: </strong>Most (62.4%, N=3,308/5,301) participants were aware of PrEP as an HIV prevention method but only 1.7% (N=133/7,999) of AYA had ever used it. Among the 35.5% (N=2,838/7,999) of participants meeting PrEP eligibility criteria, ever-use was similarly rare (2.6%, N=75/2,838). Compared to 20 to 24-year-olds, 15 to 19-year-olds were less likely to report awareness (fullyadjPR=0.82, 95%CI 0.78, 0.86) or ever-use (fullyadjPR=0.35, 95%CI 0.21, 0.58). Participants from fishing communities were more likely to be PrEP-aware (fullyadjPR=1.22, 95%CI 1.16, 1.29) or have ever used the prevention method (fullyadjPR=6.07, 95%CI 4.10, 8.98) than those from non-fishing communities.</p><p><strong>Conclusion: </strong>In this cross-sectional study of AYA in Uganda, awareness of PrEP was common but ever-use was rare, even among the third of respondents who were likely PrEP-eligible. This suggests that prevention policies and barriers besides unawareness of the method impede PrEP initiation. Efforts that target those barriers, particularly for adolescents, are critical for reducing HIV incidence among this priority population.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065597","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 risk perception and PrEP uptake among pregnant women offered PrEP during antenatal care in Kenya.","authors":"Mary M Marwa, Anna Larsen, Felix Abuna, Julia Dettinger, Ben Odhiambo, Salphine Watoyi, Pascal Omondi, Nancy Ngumbau, Laurén Gómez, Grace John-Stewart, John Kinuthia, Jillian Pintye","doi":"10.1097/QAI.0000000000003641","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003641","url":null,"abstract":"<p><strong>Background: </strong>Self-perceived HIV risk influences PrEP use, though few data on risk perception are available among pregnant women. We evaluated HIV risk perception and PrEP uptake among pregnant women in Kenya.</p><p><strong>Methods: </strong>We utilized data from a randomized trial evaluating universal versus risk-based PrEP delivery models at 20 antenatal clinics in Kenya (NCT03070600). Pregnant women enrolled were offered PrEP at any gestational age. A validated risk score for predicting HIV acquisition among perinatal women defined high HIV risk. HIV risk perception was assessed by asking \"What is your gut feeling about how likely you are to get infected with HIV?\" without a specified timeframe and dichotomized as low (\"extremely/very unlikely\") versus high (\"extremely/ Somewhat likely/very likely\"). All women in the universal PrEP offer arm were included in the analysis.</p><p><strong>Results: </strong>Among 2250 pregnant women the median age was 24 years (IQR 21-28), 81% were married, and 22% did not know their partner's HIV status. Overall, 27% of women had high HIV risk scores of whom 61% self-perceived high risk. Among women with high HIV risk scores (n=617), 69% declined PrEP; those who self-perceived low risk were more likely to decline than those with high risk perception (82% vs. 60%, aPR=1.35, 95% CI 1.17-1.55, p<0.001). Declining PrEP was associated with later gestational age at PrEP offer and with monogamous marriage among women with high HIV risk scores (p<0.05).</p><p><strong>Conclusion: </strong>Declining PrEP was common among pregnant women with high HIV risk, especially those who self-perceived low HIV risk. Refining risk perception may encourage PrEP uptake.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065599","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":"Positive STEPS: Enhancing Medication Adherence and Achieving Viral Load Suppression in Youth Living with HIV in the United States - Results from a Stepped-Care Randomized Controlled Efficacy 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":"https://doi.org/10.1097/QAI.0000000000003639","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In the U.S. 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 U.S.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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 STEPS,\" compared to a standard of care (SOC) control, for improving ART adherence and viral suppression among youth living with HIV ages 16 to 29 years. Positive STEPS included: Step-1: TXTXT, an evidence-based, daily two-way personalized text message reminder to take ART medications; and Step-2: only participants with &lt;90% adherence anytime between weeks 5 and 12 post-randomization to the Positive STEPS arm, would then receive five 50-minute sessions of manualized individual adherence counseling. If their adherence remained at 90% or higher, then they did not progress to Step-2. 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between March 2018 to 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&lt;0.01) at 8 months and 30.1% at 12 months (p&lt;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 the 4-month visits (odds ratio [OR]=0.264, p=0.023), indicating that the odds of having an unsuppressed virus were 74% lower in the Positive STEPS arm compared to the SOC control; the interaction term revealed that this effect was maintained through the12-month visit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;These findings on the efficacy of Positive STEPS to enhance ART adherence and viral suppression among youth living with HIV represents the first behavioral intervention for youth to show significant and sustained effects on both behavioral (Wisepi","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The disparities of PrEP adherence among men who have sex with men between the Global South and the Global North: An updated determinantal global meta-analysis.","authors":"Haoyi Wang, Marit Delnoij, Hanne M L Zimmermann, Kai J Jonas","doi":"10.1097/QAI.0000000000003635","DOIUrl":"10.1097/QAI.0000000000003635","url":null,"abstract":"<p><strong>Background: </strong>Suboptimal adherence to PrEP limits its global impact, with current evidence mostly from the Global North and lacking Global South perspectives. This meta-analysis synthesises the rates and determinants of suboptimal adherence to oral PrEP among MSM in both regions.</p><p><strong>Methods: </strong>We searched for literature describing PrEP adherence and its determinants among MSM globally up until October 2024 to conduct a meta-analysis on the rate and determinants of suboptimal adherence in both regions. The definition of (sub-)optimal adherence were study-based.</p><p><strong>Results: </strong>We included 82 studies in the meta-analysis, with 24, 53, and 5 stemmed from the Global South, North, and global multicentre studies, respectively. Oral PrEP suboptimal adherence is prevalent among MSM PrEP-users globally (rate=0.33, 95%CI:0.28-0.38) with a significantly higher rate (p=0.021) in the Global South (rate=0.41, 95%CI:0.33-0.50) compared to the Global North (rate=0.29, 95%CI:0.23-0.35). In the Global South, older age (OR=0.57, 95%CI:0.37-0.87), alcohol use (OR=1.28, 95%CI:1.02-1.60) and presenting depressive symptoms (OR=1.47, 95%CI:1.01-2.16) were associated with suboptimal adherence. In the Global North, MSM self-identified as Black (OR=2.27, 95%CI:1.31-3.95) or Other (OR=1.36, 95%CI:1.02-1.81), having a university degree (OR=0.50, 95%CI:0.34-0.73), and presenting depressive symptoms (OR=2.26, 95%CI:1.35-3.78) were associated with suboptimal adherence. On-demand PrEP-users globally demonstrated a higher likelihood of suboptimal adherence (OR=1.59, 95%CI:1.18-2.14).</p><p><strong>Conclusions: </strong>Suboptimal adherence to oral PrEP is prevalent among MSM globally, particularly higher in the Global South. Regional differences in determinants highlight the need for tailored interventions. Tailored interventions are required to address mental health with tailored efforts to younger MSM in the Global South, while interventions in the Global North should be tailored to specific sub-groups.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058798","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":"Schizophrenia and retention in HIV care among adults insured through Medicaid in the United States: a population-based retrospective cohort study.","authors":"Alexander R Bazazi, Marilyn Thomas, Eric Vittinghoff, James Walkup, Richard Hermida, Emily A Arnold, Francine Cournos, Stephen Crystal, Lindsey Dawson, Priya Dahiya, Paola Alonso-Fraire, James Dilley, Mark Olfson, Christina Mangurian","doi":"10.1097/QAI.0000000000003606","DOIUrl":"10.1097/QAI.0000000000003606","url":null,"abstract":"<p><strong>Background: </strong>People with schizophrenia spectrum disorders are at elevated risk of HIV, and people with both HIV and schizophrenia are at elevated risk of death compared to individuals with either diagnosis alone. Limited research has assessed the HIV care cascade, and in particular retention in care, among people with HIV (PWH) and schizophrenia in the U.S.</p><p><strong>Methods: </strong>This population-based retrospective cohort used Medicaid claims data to compare retention in HIV care between PWH with schizophrenia (n=38,217) and matched controls without schizophrenia (n=29,455) from 2001-2012. The primary outcome of annual retention in HIV care was at least 2 tests for CD4+ T-cell count or HIV viral load at least 90 days apart per year. Unadjusted and covariate-adjusted differences in period prevalence of retention among cases and controls were estimated.</p><p><strong>Findings: </strong>Annual retention in HIV care was 29·9% (95% CI: 29·4-30·4%) among people with schizophrenia and 38·5% (95% CI: 37·9-39·1%) among controls, representing 8·5% (95% CI 9·3-7·7) lower retention in unadjusted and 9·0% (95% CI 9·9-8·2) lower retention in adjusted estimates for people with HIV and schizophrenia. This disparity varied across states. Over time, retention increased and the disparity between people with and without schizophrenia diminished.</p><p><strong>Interpretation: </strong>PWH in the U.S. insured through Medicaid and diagnosed with schizophrenia experience lower retention in HIV care than controls. Suboptimal retention likely drives disparities in HIV-related morbidity and mortality for PWH with schizophrenia, and targeted individual and structural interventions are merited to improve the health of this population.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023263","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":"Rectal Douche as HIV Pre-Exposure Prophylaxis for Receptive Anal Intercourse: An End User Tenofovir Powder Sachet Preparation Feasibility Study (DREAM-04).","authors":"Clarissa P Diniz, Sandra Abdul-Massih, Christina Bagia, Rebecca Giguere, Lisa C Rohan, Lin Wang, Curtis Dolezal, Michelle Yu, Vy Bui, Sasha Beselman, Rahul Bakshi, Santiago Alvarez-Arango, Mark Marzinke, Edward J Fuchs, Craig W Hendrix","doi":"10.1097/QAI.0000000000003608","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003608","url":null,"abstract":"<p><strong>Background: </strong>Unprotected receptive anal intercourse (RAI) carries the highest sexual HIV transmission risk. The need for diverse pre-exposure prophylaxis (PrEP) options has encouraged the development of on-demand, topical PrEP products for those preferring non-systemic or occasional PrEP. We assessed end-users' proficiency in preparing tenofovir douches from sachets containing two different powder types, lyophilized and spray-dried, and evaluated their experience.</p><p><strong>Methods: </strong>Cisgender adult men with a history of RAI-related douching were consented, screened, and randomized 1:1 to the order of the powder type prepared. All participants prepared at least three enema bottles of each powder type. Aliquots from each prepared douche bottle were analyzed for TFV concentration, osmolality, and pH. User experience and likelihood of future product use were assessed by questionnaire.</p><p><strong>Results: </strong>Twenty-one eligible participants were enrolled. Most participants reported both products as easy or very easy to prepare and likely or very likely to be used. Participants preferred the lyophilized product. The lyophilized and spray-dried douche bottles prepared met the osmolality specifications 89% and 61% of the time and TFV content specifications 81% and 29% of the time, respectively. Questionnaires indicated the most common challenges were tearing open the sachets and transferring the spray-dried product.</p><p><strong>Conclusions: </strong>The majority of participants reported the douches were easy to prepare and indicated likely future use. While the lyophilized sachets were prepared sufficiently to establish preparation feasibility, the spray-dried sachets often fell outside specifications. Failure analysis provided insights to guide product modifications to improve the proficiency of douche preparation and future product use.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023348","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":"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 persons with HIV (non-acute) 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>Conclusion: </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. Further, 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":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of fertility desire-based service on HIV seroconversion among serodiscordant partners: A 12-year retrospective cohort study.","authors":"Bin Yu, Chunnong Jike, Xiaomei Lan, Ju Wang, Gang Yu, Shujuan Yang","doi":"10.1097/QAI.0000000000003607","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003607","url":null,"abstract":"<p><strong>Background: </strong>Fertility desire-based service guided by behavioral theory is a potential strategy to mitigate the HIV transmission risk, while related evidence remains scarce. We examined the long-term effect of theory-guided fertility desire-based services on HIV seroconversion between seropositive/seronegative partners in areas with high HIV prevalence and a cultural emphasis on fertility in China.</p><p><strong>Methods: </strong>We established a retrospective cohort by recruiting 8,653 seropositive partners with seronegative partners between January 1, 2009, and December 31, 2020, in Liangshan, China. The differences in HIV seroconversion between partners who received fertility desire-based services guided by the extended Information-Motivation-Behavioral Skills (IMB) model and those who did not were estimated, based on multivariable and inverse probability weighting (IPW) adjusted multivariable Cox regression models. Subgroup analysis was conducted based on participants' demographic and HIV-related characteristics.</p><p><strong>Results: </strong>Among the 8,653 HIV-seropositive partners, 7,958 (92.0%) and their seronegative partners received fertility desire-based services. At the end of the 12-year follow up, 18 seronegative partners who did not receive fertility desire-based services experienced HIV seroconversion (incidence density: 7.4/1,000 person-years), while 98 seronegative partners receiving such services exhibited HIV seroconversion (3.4/1,000 person-years). Fertility desire-based services significantly reduced the risk of HIV seroconversion according to multivariable (HR=0.32, 95%CI: 0.19-0.53) and IPW-adjusted multivariable Cox regression models (HR=0.48, 95%CI: 0.27-0.84). The effect of fertility desire-based services was more pronounced in males and those above 40 years old.</p><p><strong>Conclusions: </strong>Fertility desire-based services based on the extended IMB model may help reduce the HIV transmission risk between seropositive/seronegative partners in areas with high HIV prevalence.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005311","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":"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 people with HIV (PWH) in Florida.</p><p><strong>Methods: </strong>The Florida Cohort enrolls adult PWH from six counties. In February 2023, a best-worst scaling discrete choice experiment (BWDCE) was added which included 12 tasks with three 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 25.1-29.3)], followed by frequency [23.4% (95%CI 21.6-25.2)], and long-term effects [19.0% (95%CI 17.8-20.3)]. 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>Conclusion: </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":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EFFICACY AND SAFETY OF DOLUTEGRAVIR/LAMIVUDINE IN ANTIRETROVIRAL THERAPY-NAIVE PEOPLE LIVING WITH HIV-1 AND WITH HIGH-LEVEL VIREMIA.","authors":"Leonardo Calza, Vincenzo Colangeli, Maddalena Giglia, Claudio Rigamonti, Isabella Bon, Silvia Cretella, Pierluigi Viale","doi":"10.1097/QAI.0000000000003600","DOIUrl":"10.1097/QAI.0000000000003600","url":null,"abstract":"<p><strong>Background: </strong>Dual regimen dolutegravir/lamivudine (DOL/3TC) showed potent efficacy and favourable safety in both antiretroviral therapy-naïve and -experienced patients, but data from real life about naive people with high-level viremia are still lacking.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of people living with HIV (PLWH) who were naive to antiretroviral therapy, had baseline HIV-1 RNA ranging from 100000 to 500000 copies/mL, and initated DOL/3TC. Virological efficacy and changes in immunological parameters after 12 months of treatment were evaluated and compared with highly viremic PLWH who started a triple antiretroviral combination.</p><p><strong>Results: </strong>Inclusion criteria were met by 58 patients with median age of 43.4 years. At baseline, mean HIV RNA was 5.4 log10 and mean CD4 T lymphocyte count was 488 cells/mm3. HIV RNA <50 copies/mL was obtained in 45 patients (77.6% in the intention-to-treat analysis) after 6 months and in 53 (91.4%) after 12 months. Reasons for treatment failure were virological failure in two cases and adverse events in three. No significant changes in median value of lipids were reported, while there was a not significant increase in body weight (+1.18 Kg). Virological and immunological response at month 12 in patients on DOL/3TC was comparable to that observed in 50 naive patients with high-level viremia and starting a triple antiretroviral therapy.</p><p><strong>Conclusion: </strong>In this real-life cohort of naive patients with high-level viremia, DOL/3TC was associated with high virological efficacy and good tolerability after 12 months, supporting use of this dual regimen also in persons with high initial viremia.</p>","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978434","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}