Lancet Hiv最新文献

{"title":"Another step towards closing the paediatric treatment gap.","authors":"Niklaus D Labhardt","doi":"10.1016/s2352-3018(25)00035-9","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00035-9","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"43 1","pages":"e314-e315"},"PeriodicalIF":16.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903108","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":"Hospitalisation trends in people with HIV: what is our aim?","authors":"Caroline A Sabin","doi":"10.1016/S2352-3018(25)00009-8","DOIUrl":"10.1016/S2352-3018(25)00009-8","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e318-e319"},"PeriodicalIF":12.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744147","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":"Unified health surveys for integrated health systems.","authors":"Caroline A Bulstra, Felix Teufel, Pooja Joshi, Rifat Atun","doi":"10.1016/S2352-3018(25)00045-1","DOIUrl":"10.1016/S2352-3018(25)00045-1","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e319-e321"},"PeriodicalIF":12.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573993","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":"Controversial chronicler of LGBTQ rights.","authors":"Talha Burki","doi":"10.1016/S2352-3018(25)00016-5","DOIUrl":"10.1016/S2352-3018(25)00016-5","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e324"},"PeriodicalIF":12.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415907","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":"Acceptability, feasibility, and effectiveness of caregiver-assisted HIV self-testing among children using an oral mucosal test in Uganda and Zambia: a prospective interventional study.","authors":"Jessica Gross,Nazarius M Tumwesigye,Simon Mutembo,Nkumbula Moyo,Aggrey Mukose,Obvious Chilyabanyama,Japhet Matoba,KaeAnne Parris,Brianna Lee,Taralyn Churchill,Dhelia Williamson,Sherri Pals,Claire Biribawa,Joseph Kagaayi,Phillimon Ndubani,Francis Okello,Zude Zyambo,Geoffrey Taasi,Eleanor N Magongo,Gloria Munthali,Mwiya Mwiya,Esther Nazziwa,Anna C Awor,Megumi Itoh,Adetinuke Mary Boyd,David Macleod,Emilia Rivadeneira,Daniel Oliver,Rashida A Ferrand,Carl Stecker,","doi":"10.1016/s2352-3018(25)00005-0","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00005-0","url":null,"abstract":"BACKGROUNDDuring the COVID-19 pandemic, the US President's Emergency Plan for AIDS Relief supported oral caregiver-assisted HIV self-testing (CG-HIVST) to address the gap in HIV diagnosis of children. We aimed to investigate caregiver uptake, results return, acceptability, and potential social harms of CG-HIVST.METHODSThis prospective, interventional, study was done at 32 health facilities in Uganda and 15 health facilities in Zambia. Caregivers aged 18 years and older (plus emancipated minors aged 15-17 years in Uganda) living with HIV who were currently accessing HIV care and considered index cases, with no positive responses to an intimate partner violence screen, and with one or more children aged 18 months to 14 years with unknown HIV status were eligible to participate. Eligible caregivers were offered oral HIVST kits to screen their children and primary outcomes were described by caregiver and child characteristics. Following HIVST kit administration, caregivers were surveyed using a standardised questionnaire to document their perceptions, adverse events, and social harm. Primary outcomes were the uptake of HIVST and the number and proportion of returned screening test results, reactive results, reactive screens with confirmatory HIV testing, confirmatory testing with a positive result, and children who were confirmed HIV-positive who were linked to treatment. This study was registered with ClinicalTrials.gov, NCT04774666 and NCT04754386, and is completed.FINDINGSFrom Feb 1 to Oct 31, 2021, 12 998 interested caregivers were screened for eligibility, 4023 of whom were eligible. 3903 (97·0%) accepted HIVST kits to screen their child for HIV (1609 [41·2%] in Zambia and 2294 [58·8%] in Uganda). Among caregivers, 3094 (79·3%) of 3903 were female, and 809 (20·7%) were male. 7601 children were enrolled (3779 [49·7%] were female and 3822 [50·3%] were male). 4766 (97·9%) of 4866 test results were returned in Uganda and 2647 (96·8%) of 2735 in Zambia. 119 (1·6%) of 7413 children had reactive HIVST results, requiring confirmatory testing. Of 116 children with confirmatory testing, 43 were confirmed HIV-positive (HIV prevalence 0·7% [n=32] in Uganda and 0·4% [n=11] in Zambia) and 100% were linked to antiretroviral therapy. Adverse events were rare (11 [0·4%] of 2720) and minor, and there were no reports of social harm or violence. Caregivers surveyed reported the HIVST kit was easy to use (2637 [97·0%] of 2718), they would use it again (2650 [99·1%] of 2674), and they would recommend it to other parents (2615 [97·8%] of 2674).INTERPRETATIONOur findings suggest that oral CG-HIVST is acceptable, feasible, and safe, with no reports of social harm, and has the potential to expand access to HIV testing for children while reducing the service delivery burden on health facilities.FUNDINGUS President's Emergency Plan for AIDS Relief and Wellcome Trust.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"138 1","pages":"e325-e337"},"PeriodicalIF":16.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903107","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":"Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries: a modelling study.","authors":"Debra Ten Brink, Rowan Martin-Hughes, Anna L Bowring, Nisaa Wulan, Kelvin Burke, Tom Tidhar, Shona Dalal, Nick Scott","doi":"10.1016/S2352-3018(25)00074-8","DOIUrl":"10.1016/S2352-3018(25)00074-8","url":null,"abstract":"<p><strong>Background: </strong>International funding for HIV has been crucial in reducing new HIV transmissions and deaths. Five countries providing over 90% of international HIV funding have announced reductions in international aid of between 8% and 70% between 2025 and 2026, with the US Government pausing aid with immediate effect on Jan 20, 2025. We investigated the potential impact of these funding reductions on HIV incidence and mortality through mathematical modelling.</p><p><strong>Methods: </strong>We used 26 country-validated Optima HIV models (Albania, Armenia, Azerbaijan, Belarus, Bhutan, Cambodia, Colombia, Costa Rica, Côte d'Ivoire, Dominican Republic, Eswatini, Georgia, Kazakhstan, Kenya, Kyrgyzstan, Malawi, Malaysia, Moldova, Mongolia, Mozambique, South Africa, Sri Lanka, Tajikistan, Uganda, Uzbekistan, and Zimbabwe). HIV incidence and mortality were projected across 2025-30 for a status quo scenario (most recent HIV spending continued) and four additional scenarios capturing the effects of anticipated international aid reductions for HIV prevention and testing, plus additional effects on treatment and facility-based testing resulting from immediate discontinuation of President's Emergency Fund for AIDS Relief (PEPFAR) support. Country-specific effects were estimated using sources of country-reported HIV funding. We disaggregated outcomes for children, adults in the general population, and adults in key populations. We extrapolated the scenario outcomes to all low-income and middle-income countries (LMICs) based on the modelled proportion of globally reported international aid by source (the 26 countries representing 49% of overall aid and 54% of PEPFAR aid). Upper and lower bounds reflected different mitigation and absorption assumptions.</p><p><strong>Findings: </strong>Across all LMICs, an anticipated 24% weighted average of international aid reductions plus discontinued PEPFAR support could cause an additional 4·43-10·75 million new HIV infections and 0·77-2·93 million HIV-related deaths between 2025 and 2030 compared with the status quo. If PEPFAR support could be reinstated or equivalently recovered, this reduced to 0·07-1·73 million additional new HIV infections and 0·005-0·061 million HIV-related deaths. The effects were greatest in countries with a higher percentage of international funding and in those with increasing incidence of HIV among key populations.</p><p><strong>Interpretation: </strong>Unmitigated funding reductions could significantly reverse progress in the HIV response by 2030, disproportionately affecting sub-Saharan African countries and key and vulnerable populations. Sustainable financing mechanisms are crucial to ensure people have continued access to HIV prevention, testing, and treatment programmes, thereby reducing new HIV infections and deaths.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e346-e354"},"PeriodicalIF":12.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744151","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":"CD4 cell counts at HIV diagnosis in the Eastern Mediterranean Region.","authors":"Mohammad Sharifi,Seyed Aria Nejadghaderi,Maliheh Sadat Bazrafshani,Elahe Amiri,Fatemeh Tavakoli,Soheil Mehmandoost,Ahmed S Alaama,Meraj Sharifi,Mohammad Karamouzian,Hamid Sharifi","doi":"10.1016/s2352-3018(25)00101-8","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00101-8","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"46 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902907","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":"The impact of homelessness and housing insecurity on HIV.","authors":"Julia C Dombrowski,Maria A Corcorran,Tara Carney,Miłosz Parczewski,Monica Gandhi","doi":"10.1016/s2352-3018(25)00048-7","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00048-7","url":null,"abstract":"Homelessness is a global problem with wide-ranging causes and contexts. People experiencing homelessness and unstable housing (HUH) are disproportionately affected by HIV and face worse treatment outcomes than those with stable housing due to multiple complex barriers to care. Even in settings with universal health coverage, access to HIV prevention and treatment services remains insufficient for people experiencing HUH. Health system barriers-such as difficult-to-navigate, fragmented care systems and the mistreatment faced in health-care settings-hinder the engagement of this population in HIV care. Tailored service delivery models, including low-barrier care, mobile and street-based care, and long-acting antiretroviral medications for prevention and treatment, show promise in addressing these barriers and improving HIV outcomes among people experiencing HUH. Future research should prioritise high-quality studies of differentiated service delivery, implementation science to optimise prevention and care programmes for this population in varied settings, and expanded access to long-acting pre-exposure prophylaxis and antiretroviral therapy, particularly in low-income and middle-income countries.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"10 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889335","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":"HIV prevention and undiagnosed infections in children in sub-Saharan Africa.","authors":"Souleymane Tassembedo,Nicolas Meda,Chipepo Kankasa,Roger Shapiro,Theodore Ruel,Ameena Goga,Mwiya Mwiya,Isidore Tiandiogo Traore,Thorkild Tylleskär,Anais Mennecier,Jean Pierre Moles,Philippe Van de Perre,Nicolas Nagot","doi":"10.1016/s2352-3018(25)00070-0","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00070-0","url":null,"abstract":"Despite the efforts to prevent vertical transmission of HIV, about 130 000 children worldwide acquire HIV each year, and 40% of those remain undiagnosed. Many factors contribute to this poor outcome including, but not limited to, failure to identify mothers seroconverting during pregnancy or postpartum, suboptimal early infant diagnosis, misinterpretation of negative test results in children before the end of breastfeeding, and child testing not being a key indicator for national programmes. To close the paediatric HIV diagnosis gap and improve child mortality rates, several changes are necessary. These changes include intensifying HIV retesting efforts to identify women who seroconvert during pregnancy or breastfeeding, counselling caregivers and health-care providers on the necessity of doing a final HIV test in children after breastfeeding ends, setting a formal indicator for child testing between age 18 months and 24 months, and extending child HIV diagnosis as a concern for all health-care workers when the children leave the programme to prevent vertical transmission of HIV after 2 years.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"9 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885475","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":"Impact of quasi-elimination of Wuchereria bancrofti on HIV incidence in southwest Tanzania: a 12-year prospective cohort study.","authors":"Inge Kroidl,Thomas F Marandu,Lucas Maganga,Sacha Horn,Agatha Urio,Antelmo Haule,Jacklina Mhidze,Jonathan Mnkai,Maureen Mosoba,Elizabeth Ntapara,Nhamo Chiwarengo,Petra Clowes,Bettina Pitter,Friedrich Riess,Basel Habboub,Elmar Saathoff,Manuel Ritter,Achim Hoerauf,Leonard Maboko,Christof Geldmacher,Nyanda E Ntinginya,Michael Hoelscher,Mkunde Chachage","doi":"10.1016/s2352-3018(25)00001-3","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00001-3","url":null,"abstract":"BACKGROUNDBefore introduction of anthelmintic treatment programmes in southwest Tanzania, our group described a 2·3-fold increase in HIV incidence among adults infected with the helminth Wuchereria bancrofti. Between 2007 and 2011, HIV incidence was 1·91 cases per 100 person-years in people with a W bancrofti infection and 0·80 cases per 100 person-years in those without the infection. We aimed to examine the impact of a reduction in W bancrofti infection as a result of mass drug administration on HIV incidence in southwest Tanzania.METHODSThe Risk of HIV Infections through Nematode Organism (RHINO) study is a prospective cohort study that used data from participants in one village collected during the Evaluation and Monitoring of the Impact of New Interventions (EMINI) study in 2007-11 and new data from EMINI participants collected in 2019. Study participants were tested for HIV and circulating filarial antigen (an indicator of W bancrofti infection), once a year from 2007 to 2011 and once in 2019. From 2009 to 2015, anthelmintics were annually distributed to all villagers through government programmes, followed by transmission assessment surveys. We analysed data from individuals aged 14-65 years with negative HIV test results at enrolment in EMINI in 2007. We did multilevel mixed-effects Poisson regression to describe and compare age-adjusted and sex-adjusted incidence rates.FINDINGSOf the 1299 previous study participants rescreened in 2019, 1139 had been HIV-negative at the end of the last surveillance period in 2011 and were included in this analysis. 552 (48·5%) participants were female and 587 (51·5%) were male, and the median age was 26.4 years (IQR 19·8-37·8). Of the 1139 participants included, 848 (74·5%) never tested positive for W bancrofti infection, 272 (23·9%) previously tested positive but did not have a W bancrofti infection in 2019 (cured individuals), 15 (1·3%) tested positive for W bancrofti infection both in 2007-11 and 2019, and four (0·4%) had a new W bancrofti infection in 2019. Between 2011 and 2019, HIV incidence rate was 0·68 cases (95% CI 0·50-0·93) per 100 person-years in the 848 participants with no W bancrofti infection (39 new HIV infections during 5724 person-years) and 0·73 cases (0·45-1·17) per 100 person-years in the 272 cured individuals (17 new HIV cases during 2344 person-years; incidence rate ratio (IRR) after adjusting for age and sex 1·14, 95% CI 0·64-2·04; p=0·65). HIV incidence rate was 1·5 cases (0·39-6·04) per 100 person-years in the 15 individuals who tested positive for W bancrofti infection both in 2007-11 and in 2019 (two new HIV infection in 131 person-years; adjusted IRR 3·43, 95% CI 0·8-15; p=0·10).INTERPRETATIONIn the group of participants cured of W bancrofti infection, the HIV incidence significantly decreased in 2011-19 compared with 2007-11, the period when they tested positive for W bancrofti infection. This effect was not observed in the group of individuals who never had a positive W ba","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"26 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827101","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}