Lancet Hiv最新文献

{"title":"Trauma-informed HIV prevention for forcibly displaced adolescents and young adults.","authors":"Catherine L Chantre, Trace Kershaw, Sarah R Lowe, J L Davis, Antonio Suleman, Sten H Vermund, Jennifer J Mootz","doi":"10.1016/S2352-3018(24)00313-8","DOIUrl":"https://doi.org/10.1016/S2352-3018(24)00313-8","url":null,"abstract":"<p><p>The number of people forcibly displaced due to conflict is rising rapidly each year. Previous studies have documented associations between mental ill health, HIV risk, and poor engagement with HIV care in conflict-affected populations. Most people forced to migrate are adolescents and young adults, who might already be affected by a high burden of mental ill health due to factors such as high trauma exposure during the developmental period. Adolescent girls (aged 15-19 years) and young men (aged 20-24 years) are highly vulnerable populations for HIV acquisition. Trauma and migration stress can further exacerbate the burden of mental ill health on forcibly displaced adolescents and young adults. Given the high level of vulnerability this population faces, delivery of trauma-informed HIV prevention to this group is crucial, through combined mental health and HIV interventions that are tailored to their unique developmental and socioenvironmental contexts. Trauma-informed HIV prevention is key to controlling and ending the HIV epidemic among adolescents and young adults affected by crises.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068885","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":"Risk estimation in HIV reveals our usual blind spots.","authors":"Madeleine Durand","doi":"10.1016/s2352-3018(24)00351-5","DOIUrl":"https://doi.org/10.1016/s2352-3018(24)00351-5","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"10 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991816","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":"Performance of the pooled cohort equations and D:A:D risk scores among individuals with HIV in a global cardiovascular disease prevention trial: a cohort study leveraging data from REPRIEVE.","authors":"Steven K Grinspoon,Markella V Zanni,Virginia A Triant,Amy Kantor,Triin Umbleja,Marissa R Diggs,Sarah M Chu,Kathleen V Fitch,Judith S Currier,Gerald S Bloomfield,José L Casado,Mireia de la Peña,Lori E Fantry,Edward Gardner,Judith A Aberg,Carlos D Malvestutto,Carl J Fichtenbaum,Michael T Lu,Heather J Ribaudo,Pamela S Douglas","doi":"10.1016/s2352-3018(24)00276-5","DOIUrl":"https://doi.org/10.1016/s2352-3018(24)00276-5","url":null,"abstract":"BACKGROUNDRisk estimation is an essential component of cardiovascular disease prevention among people with HIV. We aimed to characterise how well atherosclerotic cardiovascular disease (ASCVD) risk scores used in clinical guidelines perform among people with HIV globally.METHODSIn this prospective cohort study leveraging REPRIEVE data, we included participants aged 40-75 years, with low-to-moderate traditional cardiovascular risk, not taking statin therapy. REPRIEVE participants were enrolled from sites in 12 countries across Global Burden of Disease Study (GBD) regions. We assessed the performance of the pooled cohort equations (PCE) risk score for ASCVD and the data-collection on adverse effects of anti-HIV drugs (D:A:D) risk score. We calculated C statistics, observed-to-expected (OE) event ratios, and Greenwood-Nam-D'Agostino goodness-of-fit (GND) statistics, overall and in subgroups by race, sex, and GBD regions (clustering low-income and middle-income countries and high-income countries). We did a recalibration for PCE risk score among people with HIV in high-income countries. REPRIEVE was registered with ClinicalTrials.gov, NCT02344290.FINDINGSWe included 3893 participants, recruited between March 26, 2015, and July 31, 2019. The median age was 50 years (IQR 45-55), with 2684 (69%) male and 1209 (31%) female participants. 1643 (42%) were Black or African American, 1346 (35%) participants were White, 566 (15%) were Asian, and 338 (9%) were recorded as other race. Overall, discrimination of the PCE risk score was moderate (C statistic 0·72 [95% CI 0·68-0·76]) and calibration was good (OE event ratio 1·11; GND p=0·87). However, calibration suggested overprediction of risk in low-income and middle-income countries and corresponding underprediction in high-income countries. When restricted to high-income countries, we found underprediction (OE event ratio &gt;1·0) among women (2·39) and Black or African American participants (1·64). Findings were similar for the D:A:D risk score (C statistic 0·71 [0·65-0·77]; OE event ratio 0·89; p=0·68). Improved calibration of the PCE risk score in high-income countries was achieved by multiplying the original score by 2·8 in Black or African American women, 2·6 in women who were not Black or African American, and 1·25 in Black or African American men.INTERPRETATIONAmong the global cohort of people with HIV in REPRIEVE, the PCE risk score underpredicted cardiovascular events in women and Black or African American men in high-income countries and overpredicted cardiovascular events in low-income and middle-income countries. Underprediction in subgroups should be considered when using the PCE risk score to guide statin prescribing for cardiovascular prevention among people with HIV in high-income countries. Additional research is needed to develop risk scores accurate in predicting ASCVD among people with HIV in low-income and middle-income countries.FUNDINGUS National Institutes of Health, Kowa Pharmaceuticals Am","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"10 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991815","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":"Dolutegravir plus lamivudine treatment without HIV drug-resistance tests.","authors":"Josep M Llibre","doi":"10.1016/s2352-3018(24)00301-1","DOIUrl":"https://doi.org/10.1016/s2352-3018(24)00301-1","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"31 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991702","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":"Efficacy of dolutegravir plus lamivudine in treatment-naive people living with HIV without baseline drug-resistance testing available (D2ARLING): 48-week results of a phase 4, randomised, open-label, non-inferiority trial.","authors":"Ezequiel Cordova,Jeniffer Hernandez Rendon,Veronica Mingrone,Patricio Martin,Gisela Arevalo Calderon,Soledad Seleme,Jamile Ballivian,Norma Porteiro","doi":"10.1016/s2352-3018(24)00294-7","DOIUrl":"https://doi.org/10.1016/s2352-3018(24)00294-7","url":null,"abstract":"BACKGROUNDDolutegravir plus lamivudine has emerged as a preferred treatment for HIV; however, initiating this regimen without baseline resistance testing raises concerns about the potential presence of pretreatment lamivudine resistance. We aimed to evaluate the efficacy of dolutegravir plus lamivudine in the absence of information on baseline resistance testing in treatment-naive people with HIV.METHODSWe did an open-label, non-inferiority, single-centre, phase 4, randomised controlled study (D2ARLING), designed to assess the efficacy and safety of dolutegravir plus lamivudine in treatment-naive people with HIV with no available baseline resistance testing. We included participants aged 18 years or older with HIV-1 diagnosis who were naive to antiretroviral therapy and had no baseline genotypic resistance testing result available. We randomly assigned (1:1) participants to receive dolutegravir 50 mg plus lamivudine 300 mg or a three-drug regimen including dolutegravir 50 mg plus tenofovir disoproxil fumarate 300 mg and either emtricitabine 200 mg or lamivudine 300 mg. Randomisation was stratified by baseline HIV-1 RNA (≤100 000 vs &gt;100 000 copies per mL) and CD4 cell count (&lt;200 vs ≥200 cells per μL). Per protocol, we performed genotypic drug-resistance testing on day 1 and it remained double-masked throughout the study, simulating a scenario of inaccessibility of baseline resistance testing. The primary endpoint was the proportion of participants with plasma HIV-1 RNA less than 50 copies per mL at week 48 (intention-to-treat exposed analysis via the Snapshot algorithm) with prespecified non-inferiority margin of 10%. This trial is registered with ClinicalTrials.gov (NCT04549467).FINDINGSBetween Nov 17, 2020, and Aug 31, 2022, 214 participants were randomly assigned to and treated with dolutegravir plus lamivudine (n=106) or dolutegravir plus tenofovir disoproxil fumarate and either emtricitabine or lamivudine (n=108). Median age of participants was 31 years (IQR 26-39) and 49 (23%) were female. At baseline, 66 (31%) of participants had an HIV-1 RNA viral load of more than 100 000 copies per mL, and 44 (21%) had a CD4 T-cell count of less than 200 cells per μL. At week 48, 97 (92%) of 106 participants in the dolutegravir plus lamivudine group and 96 (89%) of 108 participants in the dolutegravir plus tenofovir disoproxil fumarate with either emtricitabine or lamivudine group had HIV-1 RNA of less than 50 copies per mL (difference 2·62%; 95% CI -5·3 to 10·6), showing non-inferiority of dolutegravir plus lamivudine to the three-drug regimen. None of the participants in the dolutegravir plus lamivudine group and two in the control group had protocol-defined virological failure, and none developed treatment-emergent resistance mutations to any of the study drugs. Overall adverse event rates were similar between arms. Less than 1% of participants in both groups were discontinued due to adverse events.INTERPRETATIONThis study provides evidence supporti","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"10 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991739","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":"Event-driven PrEP beyond cisgender men who have sex with men.","authors":"Whitney C Irie, Melanie R Nicol, Meredith Clement, Elizabeth Anne Bukusi, Linda-Gail Bekker, Jean-Michel Molina, Jenell Stewart","doi":"10.1016/S2352-3018(24)00300-X","DOIUrl":"https://doi.org/10.1016/S2352-3018(24)00300-X","url":null,"abstract":"<p><p>Despite advancements in existing antiretroviral-based prevention strategies, including daily oral, locally acting, and injectable options, there is a pressing need for more inclusive and flexible event-driven pre-exposure prophylaxis (PrEP) strategies for all. Event-driven or intermittent dosing of PrEP in populations beyond cisgender men who have sex with men would offer a promising alternative by fitting prevention into the diverse lifestyles of affected populations and thereby advancing health equity. Evidence from PrEP clinical trials, pharmacokinetic studies, modelling studies, and real-world observational research suggests that event-driven PrEP could be a flexible and inclusive option, yet optimal dosing has not been established across sex and gender spectrums. To advance PrEP equity through inclusivity, studies on event-driven PrEP should include people across the gender spectrum. Real-world demonstration studies and simulation studies of optimal dosing strategies are needed. While awaiting further evidence, clinical providers can offer shared decision making and counselling on available data to include event-driven dosing as an option, especially when daily oral, locally acting, or injectable PrEP are not acceptable or preferred methods. Wider access to diverse PrEP options for all populations fosters a more inclusive and effective global HIV prevention strategy.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957281","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":"Closing the gap to UNAIDS 95-95-95: Lesotho's success story.","authors":"Karin Hatzold, Yasmin Dunkley","doi":"10.1016/S2352-3018(24)00314-X","DOIUrl":"10.1016/S2352-3018(24)00314-X","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e6-e8"},"PeriodicalIF":12.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822735","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":"Effectiveness of bi-monthly long-acting injectable cabotegravir and rilpivirine as maintenance treatment for HIV-1 in the Netherlands: results from the Dutch ATHENA national observational cohort.","authors":"Vita W Jongen, Ferdinand W N M Wit, Anders Boyd, Arne van Eeden, Annemarie E Brouwer, Robert Soetekouw, Rachida El Moussaoui, Janneke Stalenhoef, Kim C E Sigaloff, Tatiana Mudrikova, Jet Gisolf, David Burger, Annemarie M J Wensing, Marc van der Valk","doi":"10.1016/S2352-3018(24)00269-8","DOIUrl":"https://doi.org/10.1016/S2352-3018(24)00269-8","url":null,"abstract":"<p><strong>Background: </strong>Real-world data showing the long-term effectiveness of long-acting injectable cabotegravir and rilpivirine are scarce. We assessed the effectiveness of cabotegravir and rilpivirine in all individuals who switched to cabotegravir and rilpivirine in the Netherlands.</p><p><strong>Methods: </strong>We used data from the ATHENA cohort, an ongoing observational nationwide HIV cohort in the Netherlands. In the primary analysis, we matched individuals who commenced cabotegravir and rilpivirine and had no history of virological failure (ie, one or more measurements of a plasma HIV RNA ≥1000 copies per mL; hereafter referred to as exposed) 1:2 with individuals using oral antiretroviral therapy (ART; hereafter referred to as unexposed). We assessed the effectiveness of cabotegravir and rilpivirine using restricted mean survival time (RMST) until loss of virological control (one or more measurements of plasma HIV RNA ≥200 copies per mL). In the secondary analysis, we assessed loss of virological control in individuals who commenced cabotegravir and rilpivirine with previous virological failure or unsuppressed HIV-1 RNA at cabotegravir and rilpivirine initiation, or both.</p><p><strong>Findings: </strong>In primary analysis, 585 exposed and 1170 unexposed individuals were included between Feb 27, 2018, and Aug 17, 2023. Median follow-up was 1·3 years (IQR 0·9 to 1·7). 14 exposed (2%) and 29 unexposed (2%) individuals had a loss of virological control, with no difference in RMST (difference=0·026, 95% CI -0·029 to -0·080). Seven (50%) exposed individuals re-suppressed without a regimen change. Seven (50%) switched ART, and six (43%) of 14 had documented integrase strand transfer inhibitor (INSTI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance. No unexposed individuals switched ART after loss of virological control. In the secondary analysis, 105 individuals were included between July 1, 2016, and Aug 17, 2023. During a median follow up of 1·4 years (IQR 0·8 to 1·8), nine (9%) had a loss of virological control, of which five (56%) had INSTI or NNRTI resistance.</p><p><strong>Interpretation: </strong>Switching to cabotegravir and rilpivirine was not associated with a higher risk of loss of virological control among individuals without previous virological failure compared with oral ART. The high risk of loss of virological control among individuals with previous virological failure or an unsuppressed HIV-1 RNA at cabotegravir and rilpivirine initiation warrants more careful monitoring.</p><p><strong>Funding: </strong>Dutch Ministry of Health, Welfare, and Sport.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 1","pages":"e40-e50"},"PeriodicalIF":12.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056131","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":"Improving quality of interpersonal care in HIV programmes.","authors":"Kwena Tlhaku, Jienchi Dorward","doi":"10.1016/S2352-3018(24)00311-4","DOIUrl":"10.1016/S2352-3018(24)00311-4","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e3-e5"},"PeriodicalIF":12.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796572","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":"Coffee with IAS President Beatriz Grinsztejn.","authors":"Tony Kirby","doi":"10.1016/S2352-3018(24)00349-7","DOIUrl":"https://doi.org/10.1016/S2352-3018(24)00349-7","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 1","pages":"e10-e11"},"PeriodicalIF":12.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957285","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}