Lancet Hiv最新文献

{"title":"Predictors of treatment-emergent resistance to dolutegravir","authors":"Suzanne M McCluskey MD, Prof Monica Gandhi MD","doi":"10.1016/s2352-3018(25)00127-4","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00127-4","url":null,"abstract":"Integrase strand transfer inhibitor (INSTI)-based regimens became a first-line treatment for HIV worldwide in 2018, with 93% of people with HIV who are on antiretroviral therapy (ART) estimated to be taking dolutegravir-based regimens as of 2023. Since the genetic barrier to resistance of dolutegravir is not impenetrable, rising rates of dolutegravir resistance among those with virological failure on this drug regimen have been reported. Risk factors for dolutegravir resistance include treatment experience, having background resistance to the nucleoside reverse transcriptase inhibitors in the regimen, switching to tenofovir, lamivudine, and dolutegravir when viraemic on a former regimen, previous experience with first-generation INSTIs, and being on dolutegravir monotherapy or dual therapy, with rates higher in children than in adults. HIV drug resistance does not emerge if selective drug pressure is not present, so some exposure to the ART regimen with virological failure is associated with higher rates of resistance than complete non-adherence. Detectable objective metrics of adherence (eg, ART drug concentrations in urine, plasma, dried blood spots, and hair) have been associated with high levels of viral resistance and can be used to triage who needs resistance testing the most.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"70 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144341085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"UNAIDS cuts leave enormous gap in global HIV response.","authors":"Talha Burki","doi":"10.1016/s2352-3018(25)00183-3","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00183-3","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"32 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lenacapavir-associated drug resistance: implications for scaling up long-acting HIV pre-exposure prophylaxis.","authors":"Gert van Zyl,Mateo Prochazka,Heather-Marie Ann Schmidt,Catherine Orrell,Jonathan M Schapiro,Suzanne M McCluskey,Marco Vitoria,Rami Kantor,Urvi M Parikh,Michelle Rodolph,Michael R Jordan,Robert W Shafer","doi":"10.1016/s2352-3018(25)00128-6","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00128-6","url":null,"abstract":"Although drug resistance could emerge if lenacapavir is initiated during undiagnosed acute infection or if infection occurs during the drug's pharmacokinetic tail, these cases will not compromise the effectiveness of WHO-recommended therapies, as there is no cross-resistance between lenacapavir and other licensed antiretroviral drugs. Lenacapavir pre-exposure prophylaxis (PrEP) is also unlikely to drive population-level lenacapavir resistance given the rarity of breakthrough infections and the reduced replication capacity of most lenacapavir-resistant variants, which most likely reduces their transmission potential. Conversely, the risk of acquiring lenacapavir-resistant HIV-1 while receiving lenacapavir PrEP is likely to remain extremely low, as lenacapavir-associated drug-resistance mutations are rare among individuals without previous lenacapavir exposure, and widespread use of lenacapavir-based regimens remains years away. Nonetheless, as the number of lenacapavir PrEP programmes increase, surveillance for emerging lenacapavir resistance should also be implemented.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"628 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet HIV 2025; published online April 3. https://doi.org/10.1016/S2352-3018(25)00097-9.","authors":"","doi":"10.1016/s2352-3018(25)00170-5","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00170-5","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"38 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do we need routine integrase resistance testing before starting antiretroviral therapy?","authors":"Rami Kantor,Alice K Pau,Michael J Kozal,Emily P Hyle","doi":"10.1016/s2352-3018(25)00108-0","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00108-0","url":null,"abstract":"Oral second-generation integrase strand transfer inhibitors are now anchor drugs of antiretroviral therapy (ART) globally due to their high resistance barriers. In high-income settings, guidelines recommend routine protease and reverse transcriptase resistance testing before ART initiation but suggest routine integrase resistance testing only for individuals at elevated risk of integrase resistance. Improved characterisation of transmitted integrase resistance, its detection, and its clinical impact will guide future recommendations for clinical decision making. Balancing the need to protect this important drug class against concerns about resource allocation and care complexity presents a substantial challenge. Shifting the responsibility to providers to decide whether and when to test for integrase resistance before ART initiation can be problematic, particularly given the uncertainty around the need to reassess related available recommendations. As our understanding of integrase resistance evolves, prioritising this discussion is essential, and providers, researchers, and policy makers should engage in addressing this important issue.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"9 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining HIV prevention with artificial intelligence.","authors":"Jirair Ratevosian, Michael Reid, Zhao Ni, Rouella Mendonca, Robyn Eakle, Cheryl Johnson, Izukanji Sikazwe, Meshack Ndirangu, Solange Baptiste, Linda-Gail Bekker","doi":"10.1016/S2352-3018(25)00158-4","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00158-4","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maintenance therapy with dolutegravir and lamivudine versus bictegravir, emtricitabine, and tenofovir alafenamide in people with HIV (PASO-DOBLE): 48-week results from a randomised, multicentre, open-label, non-inferiority trial.","authors":"Pablo Ryan, José L Blanco, Mar Masia, Lucio Garcia-Fraile, Maria J Crusells, Pere Domingo, Adrian Curran, Roberto Guerri-Fernandez, Enrique Bernal, Joaquin Bravo, Boris Revollo, Juan Macias, Juan M Tiraboschi, Rocio Montejano, Concepción Amador, Miguel Torralba, Dolores Merino, Vicens Diaz-Brito, M J Galindo, Sergio Ferra, Aroa Villoslada, Juan Emilio Losa, Francisco J Fanjul, Xavier Perez-Stachowski, Joaquim Peraire, Joaquin Portilla, Sara de la Fuente, Carlos Dueñas, Maria J Vazquez, Silvana Di Gregorio, Herminia Esteban, Pedro Gil, Marta de Miguel, Belen Alejos, Esteban Martínez","doi":"10.1016/S2352-3018(25)00105-5","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00105-5","url":null,"abstract":"<p><strong>Background: </strong>Although single-tablet, oral bictegravir, emtricitabine, and tenofovir alafenamide or dolutegravir and lamivudine are preferred regimens in several major guidelines and are widely used in many countries, they have not been compared in a fully powered trial. This study aimed to prospectively compare the 48-week results of dolutegravir and lamivudine versus bictegravir, emtricitabine, and tenofovir alafenamide as maintenance therapies for people with HIV.</p><p><strong>Methods: </strong>PASO-DOBLE is a randomised, multicentre, open-label, non-inferiority trial done over 48 weeks at 30 sites in Spain. Adults (aged ≥18 years) with HIV-1, without previous viral failure, who had reached virological suppression on oral regimens containing at least one pill a day, cobicistat, efavirenz, or tenofovir disoproxil fumarate and no previous use of dolutegravir or bictegravir, and plasma HIV-1 RNA <50 copies per mL for at least 24 weeks were eligible. Participants were randomly assigned (1:1) to switch regimens to dolutegravir 50 mg and lamivudine 300 mg or bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafenamide 25 mg once daily, using random block permutation, stratified by tenofovir alafenamide presence at baseline and sex assigned at birth. The primary endpoint was the proportion of participants with HIV RNA ≥50 copies per mL at week 48 in the intention-to-treat exposed population (ie, all participants who received at least one dose of study medication). The primary and safety analysis was done in the intention-to-treat exposed population. The non-inferiority margin was 4%. This trial is registered with ClinicalTrials.govNCT04884139 and is incomplete.</p><p><strong>Findings: </strong>Between July 14, 2021, and March 24, 2023, 553 participants initiated dolutegravir and lamivudine (n=277) or bictegravir, emtricitabine, and tenofovir alafenamide (n=276). The difference in the proportion of participants with HIV RNA ≥50 copies per mL between the dolutegravir and lamivudine group (six [2%] of 277) and bictegravir, emtricitabine, and tenofovir alafenamide group (two [1%] of 276) was 1·4% (95% CI -0·5 to 3·4; p=0·16), showing non-inferiority. The most common adverse events occurring in at least 10% of participants in either group were infections, musculoskeletal, gastrointestinal, metabolic, and psychiatric events. Adverse events were usually mild or moderate and considered unrelated to the study drugs. More grade 3-4 adverse events occurred in the bictegravir group (ten [3%]) than in the dolutegravir group (three [1%]; p=0·049). Very few participants discontinued dolutegravir and lamivudine (n=1) or bictegravir, emtricitabine, and tenofovir alafenamide (n=2) due to adverse events. There were no deaths in either group.</p><p><strong>Interpretation: </strong>These results provide further evidence that might be useful in shared decision-making between physicians and people living with HIV regarding switching oral antiretrov","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiretroviral therapy and obesity risk: a weighty question.","authors":"Jennifer Manne-Goehler, Nomathemba Chandiwana","doi":"10.1016/S2352-3018(25)00157-2","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00157-2","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uzbekistan's progress in HIV care blighted by stigma.","authors":"Ed Holt","doi":"10.1016/S2352-3018(25)00160-2","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00160-2","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retiring the language of first-line and second-line ART.","authors":"Marco Vitoria, Graeme Meintjes, Nathan Ford, Lisa Frigati, Nandita Sugandhi, Alexandra Calmy","doi":"10.1016/S2352-3018(25)00137-7","DOIUrl":"10.1016/S2352-3018(25)00137-7","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250469","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}