Journal of the International AIDS Society最新文献

{"title":"REPRIEVE final results: What does it mean for guidelines in low- and middle-income countries?","authors":"Simiso Sokhela,&nbsp;Jennifer M. Manne-Goehler,&nbsp;Samanta Lalla-Edward,&nbsp;Mark J. Siedner,&nbsp;Mohammed K. Ali,&nbsp;Andrew Hill,&nbsp;Aaloke Mody,&nbsp;Anton Pozniak,&nbsp;Jeremy Nel,&nbsp;W. D. Francois Venter","doi":"10.1002/jia2.26525","DOIUrl":"https://doi.org/10.1002/jia2.26525","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The REPRIEVE study demonstrated significant reductions in major adverse cardiovascular events (MACE) with pitavastatin among people living with HIV (PWH) with low to moderate cardiovascular risk. Most MACE events occurred in higher-income countries, raising important considerations for similar primary prevention interventions within HIV programmes in low- and middle-income countries (LMICs) as antiretrovirals become safer and as PWH age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Limited data from Africa and within REPRIEVE suggests that MACE may not be as prevalent among PWH as within other geographies. Consequently, there remain questions about the appropriateness of extrapolating REPRIEVE data to the region and whether it should motivate programmatic implementation on the continent. Moreover, glucose and lipid screening used in REPRIEVE raise concerns about additional resources for similar screening, where there is little existing infrastructure and subsequent treatment. Similarly, questions around funding priorities, and health worker resource allocation for MACE prevention, particularly in the context of competing health priorities and limited health financing, need to be addressed. Newer cardiovascular medications, with cardiac, renal, hepatic, diabetes and weight loss benefits, may have greater promise, although cost remains a major concern. Finally, successful implementation with statins or other proven interventions will be unlikely, unless systemic change within non-communicable disease health system delivery programmes occurs first. However, HIV programmes and public health systems more generally have shown themselves to be poor at screening and treating other cardiovascular risk factors, including aspects as simple as raised blood pressure, even in high-income countries, and statins remain grossly under-prescribed for primary and secondary prevention internationally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>REPRIEVE turned a spotlight on how ill-prepared current HIV programmes are to implement the simplest and safest primary care prevention interventions for cardiometabolic disease within LMICs. As data for existing and new interventions become available, HIV delivery systems will need to raise their standard beyond simply prescribing antiretrovirals and taking viral loads.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256010","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":"Correction to PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: An analysis of the PrEP APPEAL survey","authors":"","doi":"10.1002/jia2.26520","DOIUrl":"https://doi.org/10.1002/jia2.26520","url":null,"abstract":"<p>Wirawan GBS, Schmidt HM, Chan C, Fraser D, Ong JJ, Cassell M, et al. PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey. J Int AIDS Soc. 2025;28(1):e26438. https://doi.org/10.1002/jia2.26438</p><p>In the article, the middle initial of one of the authors was incorrect and should be changed to Kimberly E. Green from Kimberly A. Green.</p><p>The online version of the article was corrected.</p><p>We apologize for this error.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256009","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":"HIV drug resistance, early treatment outcomes and impact of guidelines compliance after protease inhibitor-based second-line failure in a dedicated resistance clinic in western Kenya: a retrospective cohort study","authors":"John M. Humphrey,&nbsp;Shamim M. Ali,&nbsp;Allison DeLong,&nbsp;Vlad Novitsky,&nbsp;Edwin Sang,&nbsp;Bilal Jawed,&nbsp;Emmanuel Kemboi,&nbsp;Celia Ngetich,&nbsp;Suzanne Goodrich,&nbsp;Adrian Gardner,&nbsp;Joseph W. Hogan,&nbsp;Rami Kantor","doi":"10.1002/jia2.26523","DOIUrl":"https://doi.org/10.1002/jia2.26523","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;Data on drug resistance, viral outcomes and guidelines compliance following protease inhibitor (PI)-based second-line failure in low- and middle-income countries are limited, particularly in the era of dolutegravir-containing antiretroviral therapy (ART).&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 retrospective cohort study of people living with HIV (PLWH) ≥3 years old with second-line viral failure (VF, ≥1000 copies/ml) at the Academic Model Providing Access to Healthcare from 2011 to 2021. We assessed resistance prevalence and patterns at second-line VF, stratified by PI (atazanavir/ritonavir or lopinavir/ritonavir), and examined correlations of resistance and treatment strategies with VF at 6–18 months post-genotype. Analyses employed inverse probability weighting, adjusting for calendar year, age, gender, ART duration, PI at genotyping and class-specific resistance, and considered guidelines-supported versus unsupported strategies.&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;Of 187 participants (median age 41 years, 54% female, 41% on atazanavir/ritonavir, 59% on lopinavir/ritonavir-based ART), 91% had any resistance (NRTI 79%, NNRTI 80%, major PI 37%, dual-class 36%, triple-class 37%). Predicted resistance to third-line options was 67% for etravirine or rilpivirine and 10% for darunavir/ritonavir. Despite higher resistance detected on atazanavir/ritonavir versus lopinavir/ritonavir, predicted darunavir/ritonavir resistance was similar. At median 9 months post-genotype, 95% of 173 participants with available data were on a guidelines-supported regimen (55% second-line; 45% third-line, 86% dolutegravir-based), of whom 28% had post-genotype VF. Of the 5% not on guidelines-supported regimens, 71% had post-genotype VF. Adjusted odds of VF were higher for guidelines-unsupported versus supported regimens (OR = 4.52; 95% CI 1.02−26.24), and odds of VF were 97% lower for those on third-line versus second-line (OR = 0.07; 95% CI 0.02−0.20).&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;We found high levels of drug resistance and early VF following PI-based second-line failure in Kenya. Treatment guidelines compliance and switches to third-line, even within guidelines recommendations, improved early viral outcomes. Findings highlight the vulnerability of PLWH with advanced ART experience and resistance profiles, and the importance of following guidelines and improving access to third-line and drug resistance testing, particularly in the new ART era.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244599","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":"Household economic impact of HIV-associated cryptococcal meningitis in five countries in Southern and Eastern Africa","authors":"David S. Lawrence,&nbsp;Charles Muthoga,&nbsp;Jack Adams,&nbsp;Antoinette Buhle Ndweni,&nbsp;David R. Boulware,&nbsp;Chimwemwe Chawinga,&nbsp;Kyla Comins,&nbsp;Eltas N. Dziwani,&nbsp;Admire Hlupeni,&nbsp;Mina C. Hosseinipour,&nbsp;Samuel Jjunju,&nbsp;Cecilia Kanyama,&nbsp;Tshepo B. Leeme,&nbsp;Graeme Meintjes,&nbsp;David B. Meya,&nbsp;Mosepele Mosepele,&nbsp;Melanie Moyo,&nbsp;Henry C. Mwandumba,&nbsp;Conrad Muzoora,&nbsp;Chiratidzo E. Ndhlovu,&nbsp;Edwin Nuwagira,&nbsp;Charlotte Schutz,&nbsp;Lillian Tugume,&nbsp;Darlisha Williams,&nbsp;Síle F. Molloy,&nbsp;Timothée Boyer-Chammard,&nbsp;Nabila Youssouf,&nbsp;Shabbar Jaffar,&nbsp;Louis W. Niessen,&nbsp;Thomas S. Harrison,&nbsp;Lucy Cunnama,&nbsp;Joseph N. Jarvis,&nbsp;the AMBITION Study Group","doi":"10.1002/jia2.26441","DOIUrl":"https://doi.org/10.1002/jia2.26441","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;HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related mortality. Cryptococcal meningitis is a poverty-related disease and the majority of cases occur in settings where resources are limited and access to quality care is often linked to an individual's ability to pay for services. We have previously demonstrated the efficacy, safety and cost-effectiveness of a single, high-dose liposomal amphotericin-based treatment regimen within the AMBITION-cm trial. Here, we present a five-country, within-trial analysis exploring the household economic impact of cryptococcal meningitis.&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;Eight hundred and ten participants were recruited into this sub-study in Botswana, Malawi, South Africa, Uganda and Zimbabwe between January 2018 and February 2021. We collected data on annual household expenditure, direct costs and indirect costs incurred prior to enrolment and during the 10-week trial period. Costs were inflated and converted to 2022 USD. We calculated out-of-pocket expenditure, lost income and catastrophic healthcare expenditure, defined as costs exceeding 20% of annual household expenditure.&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;The average total out-of-pocket expenditure plus lost income prior to enrolment was $132 and 17.9% (145/810, 95% CI 15.3–20.5) of participant households had already experienced catastrophic healthcare expenditure. Among the 592 surviving participants, when combining out-of-pocket expenditure and lost income, the average cost was $516 and 29.1% of annual household expenditure across all countries, ranging from $230 (7.6%) in South Africa to $592 (64.2%) in Zimbabwe. More than half (296/581, 51.0%, 95% CI 46.9–55.0) of households experienced catastrophic healthcare expenditure by the end of the trial, ranging from 16.0% (13/81, 95% CI 7.9–24.2) in South Africa to 68.1% (156/229, 95% CI 62.0–74.2) in Uganda.&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;This is the first study exploring the household economic impact experienced by those diagnosed with cryptococcal meningitis. The household economic impact of cryptococcal meningitis is high and more than half of households of individuals who survive experience catastrophic healthcare expenditure. It is likely these figures are higher outside of the research setting. This highlights the profound financial impact of this devastating infection and provides a rationale to offer financial and social protection to those affected.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26441","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220123","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":"Correction to Evaluation of point-of-care diagnostics for sexually transmitted infection on oral PrEP initiation and persistence among young people in South Africa: a randomized controlled study","authors":"","doi":"10.1002/jia2.26519","DOIUrl":"https://doi.org/10.1002/jia2.26519","url":null,"abstract":"<p>Joseph Davey, D., Fynn, L., Rousseau, E., Macdonald, P., Leonard, B., Lebelo, K., Kolisa, A., Little, F. and Bekker, L.-G. (2025), Evaluation of point-of-care diagnostics for sexually transmitted infection on oral PrEP initiation and persistence among young people in South Africa: a randomized controlled study. J Int AIDS Soc., 28: e26488. https://doi.org/10.1002/jia2.26488</p><p>In the article, one of the author names was incorrect and should be changed to <i>Keitumetse Lebelo</i> from Keitumese Lebelo.</p><p>The online version of the article was corrected.</p><p>We apologize for this error.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26519","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220183","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":"Measuring mobility in HIV research in sub-Saharan Africa: a scoping review","authors":"Aleya Khalifa,&nbsp;Sara Wallach,&nbsp;M. Kate Grabowski,&nbsp;Dustin T. Duncan,&nbsp;Fred Nalugoda,&nbsp;Quarraisha Abdool Karim,&nbsp;Barun Mathema","doi":"10.1002/jia2.26508","DOIUrl":"https://doi.org/10.1002/jia2.26508","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;Mobility—from overnight travel to permanent migration—can reduce service access and increase HIV risk, driving the epidemic in sub-Saharan Africa (SSA). This scoping review described mobility measures used in HIV research to identify gaps and guide research on mobility to strengthen HIV responses in SSA.&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;Literature from three databases (PubMed, Embase, Web of Science) were systematically screened to identify research articles examining relationships between mobility and individual-level HIV-related outcomes in SSA from 2014 through 2023. Key terms for mobility included “mobility,” “movement,” “migration” and “travel.” Measures were first extracted according to International Organization of Migration definitions of migration (a change in the place of usual residence) and travel (movement between geographies). Then, metrics used to categorize or quantify mobility were organized by the stage (origin, transit, destination, return) and dimension (spatial, temporal, socio-structural) of the movement captured. Measures were analysed within three research contexts: the HIV outcome(s) of interest, study population and local geographies. Outcomes included HIV acquisition, AIDS-related death, and indicators along the prevention, care and treatment cascade.&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;We identified 69 studies after screening 5343 titles/abstracts and 200 full texts for eligibility. Studies included research from 16 countries, mostly representing general adult populations in eastern and southern Africa. Most studies measured migration (51) versus travel (21) and examined relationships with HIV prevalent infection (29) or care and treatment indicators (44) compared to other epidemiological and programmatic outcomes. Studies employed a range of metrics, mostly of the duration of stay at the destination (28), the number of mobility events (12) or the geographic boundaries across which individuals moved (14). Socio-structural dimensions like the motivation for movement were measured less often. Only 15 studies examined more than one dimension.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Mobility measures varied widely and were inconsistently studied across research contexts. Future studies should fill evidence gaps, standardize reporting and develop multidimensional mobility measures tailored to local settings and HIV outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26508","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220181","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":"Risk of suicide in people living with HIV: A nationwide, retrospective population-based cohort study in South Korea","authors":"Tak Kyu Oh,&nbsp;Kyoung-Ho Song,&nbsp;Eunjeong Heo,&nbsp;Hye Yoon Park,&nbsp;In-Ae Song","doi":"10.1002/jia2.26521","DOIUrl":"https://doi.org/10.1002/jia2.26521","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is a paucity of studies that compare suicide- and non-suicide-related deaths, with strict adjustments for people living with human immunodeficiency virus (HIV; PLWH) and those without HIV. We, therefore, aimed to determine whether the risk of suicide differs between these groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included all PLWH diagnosed with HIV in South Korea between 1 January 2017 and 31 December 2017. Individuals who had never been diagnosed with HIV were selected as controls using 1:10 stratified random sampling, considering age and sex. The heterogeneity of covariates between PLWH and controls was decreased by 1:5 propensity score matching. The endpoint of the study was death by suicide, with follow-up from 1 January 2018 to 31 December 2022. Death that was not ruled as a suicide was categorized as being due to other causes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After propensity score matching, 22,415 PLWH (mean age 45.9 years; 91% male) and 96,790 controls (mean age 45.8 years; 90.5% male) were included in the final analysis. Within 5 years, 104 (0.5%) of PLWH and 246 (0.3%) of controls died by suicide. Cox regression analysis revealed a 1.84-fold higher risk of suicide among PLWH compared with controls (hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.46–2.31; <i>p</i> &lt; 0.001). Moreover, 836 (3.7%) of 22,415 PLWH and 2882 (3.0%) of 96,790 controls died of other causes within 5 years. Cox regression analysis also revealed a 1.26-fold increase in the risk of mortality due to other causes among PLWH (HR: 1.26; 95% CI, 1.17–1.36; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This analysis of a South Korean cohort found higher rates of death due to suicide and other causes among people living with and without HIV. The risk of death by suicide was higher than that of other causes among PLWH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26521","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220182","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":"Analytical treatment interruption among women with HIV in southern Africa who received VRC01 or placebo in the Antibody Mediated Prevention Study: ATI stakeholder engagement, implementation and early clinical data","authors":"Shelly Karuna,&nbsp;Fatima Laher,&nbsp;Sufia Dadabhai,&nbsp;Pei-Chun Yu,&nbsp;Doug Grove,&nbsp;Catherine Orrell,&nbsp;Joseph Makhema,&nbsp;Mina C. Hosseinipour,&nbsp;Carrie-Anne Mathew,&nbsp;William Brumskine,&nbsp;Nyaradzo Mgodi,&nbsp;Philip Andrew,&nbsp;Lucio Gama,&nbsp;Carissa Karg,&nbsp;Gail Broder,&nbsp;Kagisho Baepanye,&nbsp;Jonathan Lucas,&nbsp;Michele Andrasik,&nbsp;Simbarashe Takuva,&nbsp;Manuel Villaran,&nbsp;Azwidihwi Takalani,&nbsp;Randall Tressler,&nbsp;Lydia Soto-Torres,&nbsp;Amanda S. Woodward Davis,&nbsp;Ames Dhai,&nbsp;Ian M. Sanne,&nbsp;Myron S. Cohen,&nbsp;Lawrence Corey,&nbsp;Glenda Gray,&nbsp;Allan C. deCamp,&nbsp;Katharine J. Bar","doi":"10.1002/jia2.26495","DOIUrl":"https://doi.org/10.1002/jia2.26495","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;Antiretroviral therapy (ART) prevents and treats, but does not eradicate, HIV. Early ART initiation is associated with post-ART virologic control, particularly among African women, and anti-HIV-1 broadly neutralizing antibodies (bnAbs) may modulate immune responses to HIV. We evaluate whether early ART with or without anti-HIV-1 bnAb VRC01, present at HIV acquisition, is associated with later ART-free control in African women and we assess potential associations with observed control.&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;Stakeholder engagement informed analytical treatment interruption (ATI) study design and implementation. Participants who received placebo or VRC01 and acquired HIV in the Antibody Mediated Prevention efficacy trial were assessed for ATI eligibility, including HIV acquisition within 8 weeks of receiving VRC01 or placebo, followed by early ART initiation and ≥1 year of viral suppression. Participation facilitators and barriers were assessed. From May 2021 to February 2024, participants enrolled, stopped ART and received frequent viral load and CD4+ T-cell count monitoring for safety and assessment of meeting ART reinitiation criteria.&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;Thirteen women enrolled from southern Africa. No ATI-related serious adverse events (AEs), HIV transmissions, pregnancies or ≥Grade 2 AEs were observed. Eight sexually transmitted infections were diagnosed in seven women during ATI. Two participants had tenofovir levels consistent with use during ATI; 2/11 (18%) who completed ATI without antiretroviral use exhibited ART-free control for ≥32 weeks. The median time to confirmed VL≥200 was 5.4 weeks (range 2.7−112). The most common ART reinitiation criterion met was virologic (&lt;i&gt;n&lt;/i&gt; = 7). VRC01 receipt proximate to HIV acquisition was not associated with control. Controllers versus non-controllers did not differ by early post-acquisition viral load kinetics, acquired virus characteristics, or time from estimated acquisition to closest infusion or to ART initiation.&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;In a safe, well-tolerated ATI, 18% of 11 African women exhibited post-intervention control. Design and implementation lessons inform future ATIs in Africa. Analyses of peri-acquisition and post-ATI host and viral characteristics can inform the development of interventions for HIV cure, prevention and treatment.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Clinical Trial Registration&lt;/h3&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26495","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206736","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":"Postnatal prophylaxis and the use of presumptive HIV therapy for the prevention of vertical transmission of HIV in Canada 1997–2020","authors":"Jeanne Brochon,&nbsp;Terry Lee,&nbsp;Jason Brophy,&nbsp;Joel Singer,&nbsp;Marie-Elaine Metras,&nbsp;Jeannette Comeau,&nbsp;Alena Tse-Chang,&nbsp;Athena McConnell,&nbsp;Deborah Money,&nbsp;Isabelle Boucoiran,&nbsp;Laura J. Sauve,&nbsp;Ari Bitnun,&nbsp;Fatima Kakkar","doi":"10.1002/jia2.26510","DOIUrl":"https://doi.org/10.1002/jia2.26510","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Presumptive HIV therapy (PHT) is recommended for post-natal HIV prophylaxis (PNP) in situations at high risk of HIV vertical transmission (VT), for both prevention of transmission and as early treatment in cases of in utero transmission. The objective of this study was to describe the risk of VT and use PHT among newborns in Canada, and specifically, factors associated with the use of PHT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were analysed for all mother-infant pairs (MIPs) in the Canadian Perinatal HIV Surveillance Program (1997−2020), collected annually from 22 perinatal HIV centres in Canada. Infants were categorized as high risk (delivery viral load [dVL] ≥1000 copies/ml or maternal combined antiretroviral [cART] &lt;4 weeks prior to delivery), moderate risk (dVL detectable and &lt;1000 copies/ml, and maternal cART ≥4 weeks prior to delivery) and low risk (dVL undetectable and maternal cART ≥4 weeks prior to delivery). Neonatal prophylaxis and HIV transmission risk were compared between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4743 MIPs were included in the analysis. Overall, 13.3% of newborns received PHT; the most prescribed PHT regimens included combinations using zidovudine, lamivudine and nelfinavir (48.5%) or nevirapine (41.9%). While the most significant risk factor for transmission on univariate analysis was a detectable dVL ≥1000 copies/ml versus undetectable (odds ratio [OR] 27.91 [11.20−69.54]), the risk remained significantly increased at dVL between 400 and 999 copies/ml (OR 31.71 [8.31−120.98], but not at dVL between 50 and 399 copies/ml (OR 3.03 [0.72−12.81]). At dVL 50–399 copies/ml, 29.8% of infants received PHT, increasing to 46.7% at dVL 400–999 copies/ml, and 64.4% of infants at dVL≥1000 copies/ml. The overall risk of transmission was 6% in the high-risk group, 0.5% in the moderate-risk group and 0.2% in the low-risk group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PHT has been widely used in Canada in situations at high risk of VT, with 25% of newborns in this risk group receiving PHT as PNP. While PHT may reduce the risk of VT in high-risk situations and may be of benefit in cases of VT, these data also highlight ongoing gaps in perinatal HIV prevention in Canada.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26510","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206737","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":"Epidemiological impact and cost-effectiveness analysis of PrEP provision expansion among MSM in the Netherlands","authors":"Haoyi Wang,&nbsp;Stephanie Popping,&nbsp;David van de Vijver,&nbsp;Kai J. Jonas","doi":"10.1002/jia2.26516","DOIUrl":"https://doi.org/10.1002/jia2.26516","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;Several European countries show potential for pre-exposure prophylaxis (PrEP) provision expansion, with many men who have sex with men (MSM) on waiting lists. In the Netherlands, approximately 15,000 PrEP-eligible/intending MSM are awaiting PrEP access. We modelled the epidemiological and economic impact of extending PrEP provision considering several PrEP provision routes (National PrEP Programme and alternative PrEP providers).&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 calibrated our HIV transmission model among the Dutch MSM epidemic. PrEP was expanded from 2022 onwards, covering an additional 3000 MSM on the waiting list and in addition one-third (5000), two-thirds (10,000), and all (15,000) PrEP-eligible/intending MSM by 2024, compared to a non-expansion scenario. The epidemiological impact was projected by 2030. Costs were calculated from a third-party payer's perspective over 40 years with Dutch-specific quality-adjusted life years (QALY). Additionally, a budget impact analysis was performed over 5 years.&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;Covering the 3000 waiting-list MSM, one-third, two-thirds and all PrEP eligible/intending MSM by 2024 will avert 17 (5.7%), 46 (15.2%), 88 (29.1%) and 115 (37.9%) cumulative new HIV acquisitions compared to the base-case scenario. Consequently, 4, 2, 0 and 0 new HIV acquisitions will result by 2030, respectively. The epidemiological impact of PrEP expansion is sensitive to the users’ PrEP adherence, but overall minimal by PrEP targeting strategies, given the strongly declining epidemic. Increasing the National PrEP Programme's capacity incurred more costs to the payer (short-term budget impact ranging from €2.25 to €45.29 million). PrEP expansion can be cost-saving when all PrEP-eligible/intending MSM are covered and fully provided by alternative PrEP providers, with an incremental cost-effectiveness ratio of −€2160/QALY over 40 years. This scenario dominated over all other scenarios. Our cost-effectiveness analysis is most sensitive to the individual co-payment for PrEP-related testing when accessing PrEP via alternative PrEP providers and on-demand PrEP use.&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;Expanding PrEP coverage is crucial to reduce HIV acquisitions further and reach zero new acquisitions by 2030. As the Dutch National PrEP Programme reached capacity limits, PrEP expansion through alternative routes should be encouraged. Nevertheless, balancing out-of-pocket expenses and reimbursed care is key for healthcare equity.&lt;/p&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26516","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206738","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}