Lancet Hiv最新文献

{"title":"The global HIV response at a crossroads: protecting gains and advancing sustainability amid funding disruptions.","authors":"Beatrice Matanje,Ruth Laibon Masha,Gallican Rwibasira,Kenneth Ngure,Hidayat B Yahaya,Florence R Anam,Mumbi Chola,Hasina Subedar,Lilian Chunda,Charles B Holmes","doi":"10.1016/s2352-3018(25)00106-7","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00106-7","url":null,"abstract":"The global HIV response faces a crisis as abrupt funding cuts, particularly from the USA, threaten decades of progress. Governments across Africa report widespread disruptions in essential services, including HIV testing, treatment, and prevention. Reliance on previously stable partnerships and external funding has left many programmes vulnerable to sudden financial shock. Achieving self-reliance will require national health system integration, streamlined service delivery, digital health solutions to extend health system functions, and diversified funding sources, including greater mobilisation of domestic resources, innovative financing, and impact investment. Although some countries have made major strides towards self-reliance, urgent actions are needed to protect against harms to individuals and communities due to service delivery interruptions. Governments should lead efforts to integrate the continuum of HIV services into broader health systems, and donors should pivot towards strategic support, including technical assistance and catalytic funding for commodities and services that mitigate harms. Without decisive action, funding disruptions could result in catastrophic increases in infections and mortality, undermining the global HIV response for the next generation.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"3 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945197","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":"Simultaneous initiation of dolutegravir-based antiretroviral therapy and once-weekly rifapentine and isoniazid for tuberculosis prevention in antiretroviral-naive people with HIV: an open-label, non-randomised, phase 1/2 trial.","authors":"Ethel D Weld,Trevor Beattie,Jayajothi Moodley,Manasa Mapendere,Isadora Salles,Belén P Solans,Bareng A S Nonyane,Lubbe Wiesner,Tanya Nielson,Vinodh A Edward,Violet Chihota,Radojka M Savic,Kelly E Dooley,Richard E Chaisson,Gavin J Churchyard,,","doi":"10.1016/s2352-3018(25)00002-5","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00002-5","url":null,"abstract":"BACKGROUNDTuberculosis preventive treatment with 3 months of once-weekly isoniazid (900 mg) and rifapentine (900 mg; 3HP) is a recommended option for people with HIV; among adults with virological suppression, the 3HP regimen given with dolutegravir-based antiretroviral therapy (ART) is safe and maintained virological suppression. The DOLPHIN-TOO study assessed safety, dolutegravir pharmacokinetics, and virological efficacy of concurrent initiation of dolutegravir-based ART and 3HP among antiretroviral-naive adults with HIV.METHODSDOLPHIN-TOO was a non-randomised, open-label, pragmatic phase 1/2 trial done at The Aurum Institute Tembisa Clinical Research Site (Tembisa, South Africa). Antiretroviral-naive adults (aged ≥18 years) with HIV and no symptoms of tuberculosis disease or microbiologically confirmed absence of tuberculosis disease were sequentially enrolled and assigned to 6 months of once-daily isoniazid 300 mg (6H; n=25) or to 3HP (n=50). Once-daily dolutegravir 50 mg with tenofovir disoproxil fumarate 300 mg and lamivudine 300 mg was initiated on day 0 and tuberculosis preventive treatments were initiated on day 1; sparse pharmacokinetic sampling for dolutegravir was done on day 1 (before starting 3HP or 6H), and in week 3 (day 17) and week 8 (day 52) of treatment. HIV-1 RNA viral loads were measured serially by PCR. The primary endpoints were adverse events (grade 3 or worse per the Division of AIDS Adverse Event Grading Table version 2.1) and population pharmacokinetics of dolutegravir with and without 3HP, using 6H as a pharmacokinetic control. Non-linear mixed-effects modelling was used for pharmacokinetic analysis. The analysis population for both safety and pharmacokinetics was the intention-to-treat population. The trial is registered with the South African National Clinical Trials Register, DOH-27-1217-5770, and ClinicalTrials.gov, NCT03435146, and is completed.FINDINGS75 participants were sequentially enrolled from Aug 31, 2021, to June 28, 2022, and assigned to 6H (n=25) or 3HP (n=50). Overall median age of participants was 35 years (IQR 27-41), all participants were Black African, and 37 (49%) were female and 38 (51%) were male. At baseline, overall median HIV viral load was 27 056 copies per mL (IQR 7088-111 620), and 20 (27%) participants had HIV viral loads higher than 100 000 copies per mL; median baseline CD4 count was 283 cells per μL. One grade 3 or worse adverse event was reported: a grade 3 cutaneous abscess requiring hospitalisation (unrelated to treatment) in a participant in the 6H group. No treatment-related grade 3 adverse events occurred. Coadministered 3HP increased dolutegravir clearance by 72% (relative standard error 12%), from 0·95 L/h before 3HP treatment to 1·64 L/h during 3HP treatment. Median dolutegravir trough concentrations were significantly lower in the 3HP group than in the 6H group at week 3 (720 ng/mL [range 92-4250] vs 1310 ng/mL [431-2980]; Wilcoxon rank-sum p=0·0006) and week 8 (669 ng/mL [1","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"26 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932976","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":"Combined dolutegravir and tuberculosis preventive therapy.","authors":"Grace Muzanyi,Harriet Mayanja-Kizza","doi":"10.1016/s2352-3018(25)00069-4","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00069-4","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"230 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932933","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; 12: e130-42.","authors":"","doi":"10.1016/s2352-3018(25)00129-8","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00129-8","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"51 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932934","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":"Lifestyle first: tackling MASLD in people living with HIV.","authors":"Felice Cinque,Giada Sebastiani","doi":"10.1016/s2352-3018(25)00044-x","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00044-x","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"31 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932936","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":"Lifestyle modification programme for people living with HIV with metabolic dysfunction-associated steatotic liver disease: a randomised controlled trial.","authors":"Guanlin Li,Vincent Wai-Sun Wong,Ruth Suk-Mei Chan,Daisy Man-Ching Sin,Winnie Chu,Vivian Wong,Catherine Cheung,Shirley Lam,Huapeng Lin,Suey Yeung,Timothy Chun-Man Li,Tracy Hang-Yee Ho,Grace Lai-Hung Wong,Terry Cheuk-Fung Yip,Grace Chung-Yan Lui","doi":"10.1016/s2352-3018(25)00032-3","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00032-3","url":null,"abstract":"BACKGROUNDMetabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease among people living with HIV, and preliminary evidence shows that lifestyle modification can reduce liver fat in people living with HIV with MASLD. We aimed to assess a dietitian-led lifestyle modification programme in inducing resolution of MASLD in this population.METHODSIn this single-blind, randomised controlled trial at the Prince of Wales Hospital, Hong Kong, people living with HIV with fatty liver defined by intrahepatic triglyceride content ≥5% on proton magnetic resonance spectroscopy (1H-MRS) were enrolled if they were aged 18 years or older, were on antiretroviral therapy, and had HIV RNA of ≤50 copies per mL for 6 months or longer. Participants were randomly assigned (1:1) to either receive a dietitian-led lifestyle modification programme or standard care for 12 months. Randomisation was performed using computer-generated random numbers in blocks of 4 stratified by presence or absence of diabetes. The primary outcome, assessed in the intention-to-treat population, was resolution of MASLD, defined as intrahepatic triglyceride content less than 5% at month 12, measured by 1H-MRS. This trial was registered with ClinicalTrials.gov, NCT03913351, and is completed.FINDINGSFrom May 21, 2019, to March 22, 2022, 203 people were screened for eligibility, of whom 84 were randomly assigned to either the lifestyle modification programme (n=43) or standard care (n=41). 74 (88%) participants were male and ten (12%) were female. 78 participants completed all assessments during the 12-month intervention. In the intention-to-treat analysis, 12 (28%) participants in the intervention group and four (10%) in the control group had resolution of MASLD (p=0·040 adjusted for baseline diabetes status). No deaths were reported during the follow-up period. One serious adverse event (hospitalisation due to cellulitis) was reported in the control group. The occurrence of adverse events was similar in the intervention and control groups. The majority of adverse events were of mild severity, and none were considered to be related to study intervention.INTERPRETATIONOur findings suggest that a lifestyle modification programme could be a routine behavioural strategy to improve a range of health outcomes in people living with HIV with MASLD.FUNDINGHealth and Medical Research Fund from the Health Bureau, Hong Kong Special Administrative Region.TRANSLATIONFor the Chinese translation of the abstract see Supplementary Materials section.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"10 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932978","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":"Transgender erasure is a crisis for HIV science.","authors":"Kristi E Gamarel,Arjee J Restar,Sari L Reisner,Don Operario","doi":"10.1016/s2352-3018(25)00126-2","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00126-2","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"96 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926443","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":"Modelling study shows staggering impact of HIV funding cuts.","authors":"Euphemia Lindelwe Sibanda, Andrew N Phillips","doi":"10.1016/S2352-3018(25)00076-1","DOIUrl":"10.1016/S2352-3018(25)00076-1","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e316-e318"},"PeriodicalIF":12.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744167","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":"Statin use in HIV: European AIDS Clinical Society guidance for the primary prevention of cardiovascular disease.","authors":"Jasmini Alagaratnam,Kathrin van Bremen,Georg M N Behrens,Franck Boccara,Paola Cinque,Magnus Gisslén,Giovanni Guaraldi,Deborah Konopnicki,Justyna D Kowalska,Patrick W G Mallon,Catia Marzolini,Luis Mendão,José M Miró,Eugenia Negredo,Peter Reiss,Lene Ryom,Marc van der Valk,Alan Winston,Susanne D Nielsen,Esteban Martínez","doi":"10.1016/s2352-3018(25)00047-5","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00047-5","url":null,"abstract":"Atherosclerotic cardiovascular disease (ASCVD) is an important comorbidity in people ageing with HIV. Over-representation of classic risk factors such as smoking, and other factors such as HIV infection and its therapy, which are exclusive to people with HIV, are responsible for the increased risk of developing ASCVD. The tools to estimate risk, including Systematic Coronary Risk Evaluation 2 (SCORE2), generally underestimate risk in people with HIV. The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study showed that pitavastatin among people with HIV with low-to-moderate ASCVD risk significantly reduced the incidence of major adverse cardiovascular events. Following these results, the European AIDS Clinical Society recommends the use of moderate-intensity statins for people with HIV with a SCORE2 value between 5% and less than 10%, or ≥2·5% if older than 50 years with no additional listed risk factors. Moderate-intensity statins can be considered in people with HIV aged 40 years and over with a SCORE2 <5%. Although the REPRIEVE study findings are expected to have a major effect on clinical care, implementation could be hampered by the absence of adequate guidance or access to statins, concerns about tolerability and potential drug interactions, and difficulties in maintaining adherence. These key recommendations from the European AIDS Clinical Society aim to provide support in this remit.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"28 1","pages":"e382-e392"},"PeriodicalIF":16.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903116","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":"Highlights from CROI 2025.","authors":"Adrian Gonzalez Lopez","doi":"10.1016/S2352-3018(25)00099-2","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00099-2","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 5","pages":"e322-e323"},"PeriodicalIF":12.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993028","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}