Journal of the International AIDS Society最新文献

{"title":"Towards More Accessible and More Inclusive PrEP to Break the Cycle of HIV in France.","authors":"Jade Ghosn, Marie-Laure Chaix","doi":"10.1002/jia2.70118","DOIUrl":"10.1002/jia2.70118","url":null,"abstract":"<p><strong>Introduction: </strong>Pre-exposure prophylaxis (PrEP) represents a major advance in HIV prevention, but its rollout in France remains limited, particularly among women, migrants and socially vulnerable populations. Despite full reimbursement by the national health system, oral PrEP is still rarely prescribed outside hospital settings, hindered by organizational constraints, inaccurate medical perceptions and persistent access inequalities. In this paper, we discuss the current limits of PrEP implementation in France, identify structural and individual barriers to its uptake and highlight possible strategies to make HIV prevention more accessible for all vulnerable populations across the country.</p><p><strong>Discussion: </strong>The goal of eliminating HIV transmission by 2030 in France continues to be jeopardized by insufficient PrEP coverage. The current prevention model remains overly hospital-centred and primarily focused on a group of men who have sex with men (MSM), which limits its broader impact. In addition to structural barriers, the insufficient diversity of prescribers and the lack of inclusive communication continue to reinforce inequalities in access. The arrival of long-acting injectable PrEP offers an important opportunity to ensure greater discretion and better adherence. However, its success will depend on expanding the range of authorized prescribers to include gynaecologists, general practitioners and family planning clinics, supported by specific training and outreach consultations. Equally critical is strengthening public awareness campaigns and extending them beyond MSM and urban centres such as Paris, to reach diverse populations across the country. Durable improvements in PrEP uptake and retention also depend on close collaboration with community-based organizations, building trust with marginalized populations and participatory approaches that actively listen to individuals' concerns and lived experiences.</p><p><strong>Conclusions: </strong>France, which is lagging behind its objective of ending the HIV epidemic, has the opportunity to rethink its prevention strategy to address unmet needs and move beyond a hospital- and MSM-centred model. A structural, coordinated and inclusive response is essential to expand PrEP uptake and ensure equitable protection for all populations at risk.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 5","pages":"e70118"},"PeriodicalIF":4.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147758515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining HIV Pre-Exposure Prophylaxis (PrEP) Persistence: A Scoping Review.","authors":"Sarah E Rutstein, Grace E Mulholland, Laura Limarzi-Klyn, Annabelle Gallinek, Nicole Brown, William C Miller","doi":"10.1002/jia2.70115","DOIUrl":"https://doi.org/10.1002/jia2.70115","url":null,"abstract":"<p><strong>Introduction: </strong>When assessing the effectiveness of pre-exposure prophylaxis (PrEP) programmes, interventions, or modalities, it is important to understand patterns of PrEP use. Continued use of PrEP is frequently referred to as PrEP \"persistence.\" But persistence is not defined consistently, and differences impact the interpretation of study outcomes and public health policy. We conducted a scoping review to describe and compare definitions of PrEP persistence.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Scopus and Global Health records (01/01/2012-01/26/2026) for results that discussed longitudinal anti-HIV agents for HIV prevention. We included HIV, prevention and text variations of \"persist-.\" We screened abstracts for relevance, reviewed relevant full-text articles, and then extracted key outcomes. Screening and extraction were performed independently by two investigators; conflicts were reviewed and resolved by a third.</p><p><strong>Results: </strong>Our search returned 1549 de-duplicated results. We reviewed 362 full-text articles, yielding 147 studies for extraction. Approximately one-third (42/147, 29%) provided only qualitative persistence definitions. Among studies with operational definitions (105/147; 71%), three-quarters (80/105; 76%) considered a prescription refill and/or clinic visit date, and more than half (60/105; 57%) relied exclusively on these dates. Adherence (e.g. reported or measured drug taking) was commonly considered; 28% (29/105) of studies with an operational persistence definition included adherence assessment, and 11% (12/105) used only adherence to assess persistence. Thresholds used to classify persistent versus non-persistent PrEP use varied considerably.</p><p><strong>Discussion: </strong>Definitions of PrEP persistence are heterogeneous. Most considered engagement in PrEP services (e.g. a clinic visit or medication refill), but nearly one-third included or relied exclusively on adherence measures. The differences in definitions have important implications for cross-study comparisons.</p><p><strong>Conclusions: </strong>The heterogeneity observed among persistence definitions complicates comparisons of PrEP interventions and related public health decision-making. A single consensus definition of persistence is unlikely to suit all study settings, objectives, and designs; however, interpretability and comparability of results could be improved by increasing transparency and consistency in reporting. Our findings emphasize the importance of capturing clinically relevant, prevention-effective use when possible and of rigorously considering the implications of a chosen persistence definition on estimates and associated conclusions.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 5","pages":"e70115"},"PeriodicalIF":4.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability and Preferences of Long-Acting Injectable Pre-Exposure Prophylaxis and Antiretroviral Therapy Among Men Who Have Sex With Men and People Who Inject Drugs in India: Insights for Future Implementation.","authors":"Allison M McFall, Talia A Loeb, Jiban J Baishya, Ashwini Kedar, Archit Sinha, A K Srikrishnan, Sunil S Solomon, Gregory M Lucas, Shruti H Mehta","doi":"10.1002/jia2.70114","DOIUrl":"10.1002/jia2.70114","url":null,"abstract":"<p><strong>Introduction: </strong>Long-acting injectable (LAI) antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) have significant potential to impact the HIV epidemic, but there is little data on the acceptability of these newer technologies among people who inject drugs (PWID) and men who have sex with men (MSM) in low-resource settings. We examined acceptability and preferences of LAI ART and PrEP among community-based samples of PWID and MSM in India.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of PWID and MSM in eight Indian cities (November 2022-May 2024) using respondent-driven sampling. Participants completed a survey including socio-demographics, substance use, risk behaviours, HIV testing/care history, acceptability of LAI ART and knowledge, acceptability, and preferences of different PrEP modalities (i.e. daily oral, monthly oral, LAI and implant). We assessed correlates of acceptability using Poisson regression models. To understand PrEP preferences, we used a modified Borda count method-a rank voting procedure.</p><p><strong>Results: </strong>Overall, 2249 MSM and 4499 PWID (98% male) were recruited. Among those previously diagnosed with HIV, 89% (MSM) and 75% (PWID) reported a very good chance they would use LAI ART. MSM experiencing unstable housing and PWID virally suppressed were more willing to use LAI ART. Twenty percent and five percent of MSM and PWID, respectively, had ever heard of PrEP. Among those without an HIV diagnosis, 77% (MSM) and 62% (PWID) reported a very good chance they would use LAI PrEP. MSM with more sexual partners and sexually transmitted infection symptoms and PWID who had heard of PrEP were more willing to use LAI PrEP. Among MSM interested in PrEP, monthly oral pills were most preferred, followed by LAI, daily oral pills and then implant. Among PWID, monthly oral pills were most preferred, followed by daily oral pills, LAI and then implant.</p><p><strong>Conclusions: </strong>MSM and PWID in India were open and interested in LAI ART and PrEP. Once these become available, programmes with thoughtful community outreach and education, alongside flexible delivery models, will be critical to success. For PrEP, continued investment in the development of extended-duration oral formulations is warranted and valuable in order to provide a variety of HIV prevention choices.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 5","pages":"e70114"},"PeriodicalIF":4.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147758531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scaling Up HIV Self-Testing in Africa: Insights From National Programmatic Data in Eight Countries.","authors":"Adrien Allorant, Anne Bekelynck, Aliza Monroe-Wise, Carlota Baptista da Silva, Thato Chidarikire, Olanrewaju Edun, Leonid Joaquim, Christine Kisia, Joseph Larmarange, Johnson John Lyimo, Juma McOllogi James, Christine Musanhu, Getrude Ncube, Isabel Sathane, Arlette Simo-Fotso, Geoffrey Taasi, Cheryl Case Johnson","doi":"10.1002/jia2.70120","DOIUrl":"10.1002/jia2.70120","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence from routine, national programme data on HIV self-testing (HIVST) scale-up is limited. This study examines HIVST scale-up in eight African countries, describing how HIVST has been integrated into testing strategies and how testing coverage, test positivity, and linkage to antiretroviral therapy (ART) have evolved.</p><p><strong>Methods: </strong>We conducted a retrospective descriptive analysis of national programme data from January 2019 to December 2023 across Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Uganda and Zimbabwe. Data were disaggregated by quarter and subnational district. Indicators included HIVST kits distributed, conventional testing volumes, new HIV diagnoses and new ART initiations. We derived testing rates, testing positivity, ART linkage, and stability of HIVST distribution by district and over time.</p><p><strong>Results: </strong>HIVST scale-up varied across countries. By the most recent quarter, HIVST accounted for 63% of total testing in Lesotho, 19%-25% in Malawi and Zimbabwe, but <15% in Kenya, Tanzania, Uganda and South Africa. In Malawi, Lesotho and Zimbabwe, large volumes of HIVST partially offset declines in conventional testing during the COVID-19 pandemic. HIVST remained modest (<15% of total tests) in Kenya and Tanzania. In Mozambique, both conventional testing and HIVST expanded. In South Africa, conventional testing remained high after COVID-19, while HIVST expanded slowly. Despite divergent trajectories, new HIV diagnoses and ART initiations remained stable in most settings, indicating programmes adapted to maintain case-finding even as testing volumes shifted.</p><p><strong>Conclusions: </strong>This descriptive analysis shows HIVST has been scaled to different degrees, with its contribution to overall testing shaped by national contexts, and distribution models. Interpretation is constrained by incomplete reporting, the inability to identify kits used out of kits distributed and distinguishing first-time from repeat testers. These findings can guide optimizing HIV testing services, an essential step towards meeting global HIV targets and ending AIDS by 2030.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 5","pages":"e70120"},"PeriodicalIF":4.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147758509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of the I'm Ready HIV Self-Testing Programme Among High-Risk Populations in Canada","authors":"Lisa Masucci,&nbsp;Hawre Jalal,&nbsp;Sean B. Rourke,&nbsp;Kristin McBain,&nbsp;Min Xi,&nbsp;Wei Zhang,&nbsp;Hai V. Nguyen,&nbsp;William W. L. Wong,&nbsp;M. John Gill,&nbsp;Alice Zwerling,&nbsp;Kednapa Thavorn","doi":"10.1002/jia2.70097","DOIUrl":"10.1002/jia2.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While HIV self-testing (HIVST) presents a promising solution for early HIV detection, access to such testing remains limited in Canada. Achieving the United Nations 95% target for HIV status awareness requires scalable and cost-effective implementation approaches. The I'm Ready programme is a national, mail-based HIVST initiative targeting key high-risk populations supplemented by peer navigation supports to enhance engagement. This study aimed to explore the cost-effectiveness of the I'm Ready programme from the perspective of Canada's publicly funded healthcare system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed a Markov model to predict the lifetime costs and quality-adjusted life-years (QALYs) for high-risk individuals receiving HIVST through the I'm Ready programme compared to point-of-care testing in a physician's office (standard care). Probability and health utility values were obtained from published literature, while costs were obtained from the pilot I'm Ready programme or secondary Canadian data sources. Costs and outcomes were discounted 1.5% annually, with costs reported in 2024 Canadian dollars.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At a 53% uptake, 100% HIVST sensitivity and 99.5% specificity, the I'm Ready programme was associated with an incremental cost of C$270 and a QALY gain of 0.01 per person, with an incremental cost-effectiveness ratio of $23,331/QALY compared to standard care. Key drivers of cost-effectiveness included cost and utility associated with antiretroviral therapy initiation, utility of the AIDS health state and testing uptake under standard care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>At the current test uptake and diagnostic accuracy levels, the I'm Ready programme is cost-effective at the willingness-to-pay threshold of $50,000 per QALY. While findings reflect the Canadian health system context, this study offers broader insight into the value of HIVST as a public health tool to accelerate progress towards global HIV awareness targets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147626731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory Biomarkers Predicting Major Adverse Cardiovascular Events in People Living With HIV: A Systematic Review and Meta-Analysis.","authors":"Ashley Murray, Niamh Louwman, Augustine Luk, Andrew Parker, Nomalanga Madyiwa, Harold Parker, Kathryn Woodward, Carola Fajardo Gallegos, Jienchi Dorward, Richard J Stevens, Thomas R Fanshawe","doi":"10.1002/jia2.70101","DOIUrl":"https://doi.org/10.1002/jia2.70101","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic inflammation is a unique contributor to cardiovascular disease (CVD) risk among people living with HIV, yet there is a lack of consensus on the predictive utility of inflammatory biomarkers in this population. We conducted a systematic review assessing the predictive value of inflammatory biomarkers for major adverse cardiovascular events in people living with HIV to inform their potential integration into CVD risk assessment.</p><p><strong>Methods: </strong>MEDLINE, Embase and Google Scholar were searched for articles published up to 01 May 2024. We included prospective cohort and nested case-control studies of adults living with HIV with inflammatory biomarker measurements in blood and at least one year of follow-up to major adverse cardiovascular events. Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Where at least two studies reported the same type of effect measure for a biomarker, results were pooled using an inverse variance heterogeneity model.</p><p><strong>Results: </strong>Among 5156 screened citations, 21 studies reporting 31 inflammatory biomarkers met inclusion criteria. Meta-analysis showed high-sensitivity C-reactive protein (hsCRP) positively associated with future cardiovascular events (hazard ratio =  1.86 per log₁₀ unit; 95% CI 1.39-2.50, n = 5,254). Three biomarkers, interleukin 6 (IL-6), D-dimer, and N-terminal pro-brain natriuretic peptide (NT-proBNP), demonstrated positive, statistically significant associations with adverse cardiovascular outcomes in at least two non-overlapping studies, though heterogeneous effect measures precluded meta-analysis. Most research (14/21 studies) was conducted exclusively in high-income settings, and female representation was low (median proportion = 15.5%; IQR 8.4-20.9%). All but three studies had a moderate or high risk of bias in at least one domain.</p><p><strong>Discussion: </strong>We identified several inflammatory biomarkers with potential prognostic value, but most associations were derived from single or heterogeneous studies. The certainty of evidence is reduced by methodological heterogeneity, few high-quality studies and the underrepresentation of low- and middle-income countries (LMICs).</p><p><strong>Conclusions: </strong>Consistent positive associations between inflammatory biomarkers and future CVD in people living with HIV support a central role of inflammation in HIV-related CVD. Representative, large-scale studies that include women and LMICs are needed to guide the integration of candidate biomarkers into CVD risk prediction models.</p><p><strong>Prospero number: </strong>CRD42024542944.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 4","pages":"e70101"},"PeriodicalIF":4.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13113420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147758480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Persistence of Long-Acting Injectable Cabotegravir and Rilpivirine in Migrant Individuals Living With HIV in Spain: Substudy of the RELATIVITY Cohort.","authors":"Jara Llenas-García, María Del Mar Arcos Rueda, Ruth Calderón Hernaiz, Roberto Pedrero Tomé, Otilia Bisbal Pardo, Mariano Matarranz, Miguel Torralba, María José Galindo Puerto, Adrián Rodríguez, María Peñaranda Vera, Isabel Sanjoaquín Conde, Sara de la Fuente Moral, Alfonso Cabello-Úbeda, Carolina Navarro San Francisco, Karenina Antelo Cuéllar, Marc Pedrosa Aragón, María Aguilera García, Juan Tiraboschi, Rosa María Martínez Álvarez, María Jesús Vivancos, Carmen Montero Hernández, Enrique Bernal Morell, Noemí Cabello-Clotet, Luis Enrique Morano Amado, Laura Gisbert Pérez, María Antonia Sepúlveda, María Remedios Alemán Valls, Antonio Jesús Sánchez Guirao, Chiara Fanciulli, Cristina Escrig, Eva María Ferreira Pasos, Ana Lucas-Dato, Sara García Torras, Carmen Hidalgo Tenorio, Miriam Estébanez, Magdalena Muelas-Fernandez, Juan Emilio Losa García, Ana Cerezales Calviño, María Elisa Pino Díaz, Clara Martínez Montes, Víctor Arenas García, Francisco Arnaiz de Las Revillas, Hadrián Pernas Pardavila, Sergio Padilla, María Ángeles Garcinuño Jiménez, Lucía Alonso Alonso, Noemí Ramos Vicente, Patricia Noemí Barragán Gallo, Rebeca Cabo Magadan, Míkel Del Álamo, Miguel Vicente Egido Murciano, Alberto Juárez Toquero, Alberto Romero Palacios, Marta Clavero Olmos, María Del Mar García Navarro, José Sanz, Juan Carlos Gainzarain, Marta Milian Sanz, Beatriz de la Calle, Oscar Luis Ferrero Benéitez, Jesús Troya, Luis Buzón-Martín","doi":"10.1002/jia2.70106","DOIUrl":"10.1002/jia2.70106","url":null,"abstract":"<p><strong>Introduction: </strong>Migrants living with HIV often face high mobility, vulnerability and limited baseline information on HIV-1 genotype or treatment history. We aimed to assess the effectiveness and persistence of long-acting injectable cabotegravir and rilpivirine (LAI CAB+RPV) among migrants in Spain.</p><p><strong>Methods: </strong>This multicentre cohort study across 58 Spanish hospitals included virologically suppressed adults switching to CAB+RPV LAI before January 2025. Data collection started in June 2023. Baseline characteristics and outcomes were compared by migrant status, and multivariate Cox proportional hazards regression models were fitted to assess factors associated with virological failure (VF) and discontinuation. Propensity score matching (PSM) by gender, age, known genotype and prior VF was employed to control for confounding.</p><p><strong>Results: </strong>Of 3135 participants, 951 (30.3%) were migrants, predominantly from Latin America. Median follow-up was 13.8 months (interquartile range 8.91-19.1). VF occurred in 0.9% of migrants versus 0.5% of Spanish-born individuals (odds ratio 1.89, 95% confidence interval [CI] 0.69-5.03; p = 0.22). In adjusted models, migrant status showed a non-significant trend towards higher VF (adjusted hazard ratio [aHR] 2.16, 95% CI 0.89-5.22; p = 0.079). At 12 months, 95.8% of migrants (461/481) persisted on LAI CAB+RPV treatment versus 98.3% of Spanish-born individuals (1348/1372) (p = 0.005). Discontinuation due to any adverse event was more frequent in migrants (3.3% vs. 1.8%). Migrant status was significantly associated with discontinuation due to both local (aHR 2.63, 95% CI 1.33-5.26; p = 0.005) and systemic adverse events (aHR 3.33, 95% CI 1.45-7.69, p = 0.005). In the PSM cohort (n = 932 per group), migrant status was independently associated with increased risk of VF (aHR 3.51, 95% CI 0.95-12.98, p = 0.045) and discontinuation due to systemic adverse events (aHR 2.88, 95% CI 1.01-8.17, p = 0.047).</p><p><strong>Conclusions: </strong>Nearly one-third of participants switching to LAI CAB+RPV were migrants. While VF was rare overall, migrants had a significantly higher risk of treatment discontinuation, partly driven by adverse events. These findings highlight the need for closer monitoring and tailored strategies to optimize persistence with LAI regimens in migrant populations.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 4","pages":"e70106"},"PeriodicalIF":4.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13097113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147727944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty Transition Among Older Adults Living With HIV in Thailand: A 5-Year Longitudinal Study","authors":"Tanakorn Apornpong,&nbsp;Win Min Han,&nbsp;Akarin Hiransuthikul,&nbsp;Hay Mar Su Lwin,&nbsp;Napon Hiranburana,&nbsp;Sasiwimol Ubolyam,&nbsp;Stephen J. Kerr,&nbsp;Thira Woratanarat,&nbsp;Anchalee Avihingsanon,&nbsp;HIV-NAT 006 and 207 study team","doi":"10.1002/jia2.70099","DOIUrl":"10.1002/jia2.70099","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;Frailty is highly prevalent among older people with HIV (PWH), driven by multimorbidity and HIV-associated accelerated ageing. We investigated frailty transitions and associated factors over a 5-year follow-up period in an ageing cohort of PWH in Thailand.&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;We conducted a prospective cohort study among PWH aged ≥50 years in Bangkok, Thailand, between May 2015 and June 2024. Frailty phenotypes were assessed at baseline and at 5 years of follow-up using the Fried frailty phenotype, including unintentional weight loss, low physical activity, exhaustion, weak grip strength and slow walking speed. Multinomial logistic regression was performed to identify factors associated with frailty progression and reversibility over follow-up.&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;Among 324 participants enrolled (63% male; median age of 54 [IQR, 52−59] years), 158 (49%) were robust, 153 (47%) were pre-frailty and 13 (4%) were frailty at baseline. Over 5 years, 111 participants (34%) experienced frailty worsening, 158 (49%) remained stable and 55 (17%) demonstrated frailty reversal. Among 158 PWH who were robust at baseline, 75 (47%) remained robust, 57 (36%) transitioned to pre-frailty and 26 (16%) progressed to frailty. Notably, among those frail at baseline (&lt;i&gt;N&lt;/i&gt; = 13), 65% improved to pre-frailty or robustness. Low physical activity was the most common frailty component at baseline, while weak grip strength was the most predominant frailty phenotype at year 5. In multivariable analysis, multimorbidity (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI]: 1.42−6.72, &lt;i&gt;p&lt;/i&gt; = 0.004), antiretroviral therapy (ART) duration&gt;20 years (aOR 1.82, 95% CI: 1.08−3.06, &lt;i&gt;p&lt;/i&gt; = 0.025) and baseline vitamin D deficiency (aOR 1.85, 95% CI: 1.10−3.10, &lt;i&gt;p&lt;/i&gt; = 0.019) were independently associated with increased frailty over the 5-year follow-up. Conversely, multimorbidity (aOR 0.44, 95% CI: 0.44 [0.23−0.84], &lt;i&gt;p&lt;/i&gt; = 0.013) and CD4 counts&lt; 500 cells/mm&lt;sup&gt;3&lt;/sup&gt; (aOR 0.25, 95% CI: 0.10−0.62, &lt;i&gt;p&lt;/i&gt; = 0.003) were associated with a lower likelihood of frailty reversal.&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;Frailty among PWH aged ≥50 years in Thailand was common and highly dynamic, with over half of frail participants improving over 5 years. Multimorbidity, prolonged ART exposure and vitamin D deficiency were key predictors of frailty progression, whereas CD4&lt; 500 cells/mm&lt;sup&gt;3&lt;/sup&gt; and multimorbidity reduced the likelihood of frailty revers","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Acting Technologies to Prevent HIV: Why Is the Asia-Pacific Being Left Behind?","authors":"Giten Khwairakpam, Caroline Thomas, Anushiya Karunanithy, Rena Janamnuaysook, Rajkumar Nalinikanta","doi":"10.1002/jia2.70112","DOIUrl":"10.1002/jia2.70112","url":null,"abstract":"","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 4","pages":"e70112"},"PeriodicalIF":4.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Four-Item Risk Score to Target Acute HIV Infection Testing Among Men Who Have Sex With Men in Indonesia: Development and Validation in the INTERACT Prospective Cohort.","authors":"Gilbert Lazarus, Nurhayati H Kawi, Hendry Luis, Dwi P Rahmawati, Erik P Sihotang, Margareta Oktaviani, Pande Putu Januraga, Suwarti, Evi Sukmaningrum, Evy Yunihastuti, Maartje Dijkstra, Eduard J Sanders, Frank Stephen Wignall, Keerti Gedela, Irwanto, Raph L Hamers","doi":"10.1002/jia2.70111","DOIUrl":"10.1002/jia2.70111","url":null,"abstract":"<p><strong>Introduction: </strong>Indonesia has an escalated HIV epidemic among key populations, especially men who have sex with men (MSM). Diagnosis and immediate treatment of acute HIV infection (AHI), the earliest phase with the highest transmission risk, is beneficial for individual health and can reduce onward transmission. To inform whom to test for possible AHI using targeted, risk-stratified HIV-PCR testing, this study evaluated the performance of the validated, seven-item Amsterdam AHI risk score among Indonesian MSM, and developed a locally optimized score.</p><p><strong>Methods: </strong>We used the INTERACT prospective cohort of MSM (≥16 years) attending sexual health clinics in Jakarta and Bali (May 2023-February 2025) who were tested with add-on Xpert HIV-PCR (Cepheid) if their HIV antibody rapid testing was negative or inconclusive. We used generalized estimating equation models to generate risk scores, combining symptoms, risk factors and socio-demographics. The optimized risk score was internally validated using bootstrap resampling. We calculated area under the curve (AUC), sensitivity and specificity (ISRCTN41396071).</p><p><strong>Results: </strong>Among 1887 individuals, 20 were diagnosed with AHI, and 1867 tested AHI negative across 3446 test visits. The Amsterdam score yielded an AUC of 0.82 (95% CI 0.75-0.90) with a sensitivity of 85.0% (64.0%-94.8%) and a specificity of 59.2% (57.5-60.8). The optimized risk score included one symptom (fever <2 weeks), one risk factor (condomless receptive anal intercourse <6 months) and two socio-demographic characteristics (age 16-30 years, not having received higher education), and achieved an AUC of 0.91 (0.87-0.96) with a sensitivity of 100% (83.9-100) and a specificity of 65.3% (63.6%-66.8%). Internal validation yielded an AUC of 0.86 (0.67-0.97). Applying this risk score would classify 35.1% of MSM as eligible for add-on HIV-PCR testing, identifying 83.9%-100% of individuals who have AHI.</p><p><strong>Conclusions: </strong>This four-item risk score of easily collected variables can facilitate efficient AHI detection in high-yield clinic settings, enhancing opportunities for HIV prevention. In the Indonesian context, younger MSM with lower educational attainment were particularly vulnerable to AHI.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 4","pages":"e70111"},"PeriodicalIF":4.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}