Lancet Hiv最新文献

{"title":"Efficacy and safety of short-cycle, dolutegravir-based antiretroviral therapy in adolescents living with HIV (BREATHER Plus): a multicentre, open-label, randomised, parallel, two-arm, non-inferiority trial","authors":"Adeodata R Kekitiinwa MMed, Angus Jennings MSc, Mutsa Bwakura-Dangarembizi PhD, Cissy Kityo PhD, Prof Abraham Siika MMed, Prof Moherndran Archary PhD, Alexandra Green MSc, Lungile Jafta BComH, George Patrick Akabwai MMED, Prof Hilda Angela Mujuru MMed, Henry Mugerwa MSc, Cecilia Kiilu MMed, Rosie Mngqibisa MPH, Prof Janet Seeley PhD, Rashidah Nazzinda MBchB, Naomi Apoto MPH, Prof Simon Walker MSc, Prof David Burger PhD, Carlo Giaquinto MD, Resty Babirye Okello MSc, Godfrey Musoro MSc, Charity Wambui DrPH, Tiyara Arumugam MBChB, Magda Conway BAHons, Nadine Van Looy MSc, Annabelle South PhD, Alasdair Bamford PhD, Margaret J Thomason PhD, Deborah Ford PhD, Prof Sarah L Pett PhD, BREATHER Plus trial team, Sarah Pett, Deborah Ford, Margaret Thomason, Alasdair Bamford, Ellen White, Jessica Kirk, Angus Jennings, Helen Ainscough, Rebecca Dodds, Molly Bush, Simona Salomone, Hanh Nguyen, Anas Omar, Ben Spittle, Paul Crawley, Alexandra Green, George Pettitt, Jemima Shickle, Stephen Townsend, Hannah Sweeney, Margaret Hook, Sara Peres, Nadine Van Looy, Andy Sum, Diana Gibb, Annabelle South, Berta Terre-Torras, Elizabeth Chappell, Aoife Nolan, Adeodata Kekitiinwa, George Patrick Akabwai, Fredrick Katongole, Naomi Apoto, Resty Babirye Okello, Ronald Nabimba, Muzamil Nsibuka Kisekka, Collins Mujyanama, Gerald Agaba Muzorah, Gideon Ahimbisibwe, Florence Namuli, Rose Namaganda, Lameck Kiyimba, Angella Baita, Rachael Namuddu Kikabi, Henry Balwa, Susan Tukamuhebwa, Maria Benita Aino, Judith Tikabibamu, Anthony Kirabira, Lekku Lawrence, Barbra Nantume, Muhammad Lutalo, Diana Louis Anena, Rose Jacqueline Kadhuba, Patricia Nahirya Ntege, Teddy Kembabazi, Cissy Kityo, Victor Musiime, Shamim Nakabuye, Miriam Namasinga, Peace Hellen Masiga, Roselyn Kabasingo, Claire Nasaazi, Centurio Wandera, Josephine Kobusingye, Disan Mulima, Alex V Musiime, Faith Mbasani, Ezra Lutalo, Brenda Namukwaya Efrance, Odoch Denis, Baliruno David, Ampaire Phionah, Edgar Ayesiga Wandigali, Patrick Ssebunya, Barbara Mukanza, Rashidah Nazzinda, Ritah Mbabazi, Abigail Atwine, Juliet Ankunda, Priscilla Kyobutungi, Elizabeth Kaudha, Sharif Musumba, Jesca Nantale, Mariam Naabalamba, Mangadalen Nansaigi, Diana Antonia Rutebarika, Mary Nannungi, Benson Ouma, Edward Bagirigomwa, Eddie Rubanga, Josephine Namusanje, Henry Mugerwa, Crispus Katemba, Deborah Kahinju, Eram David Williams, Juliet Ategeka, Ocitti Sunday Paul Labeja, Joan Nantege, Shirat Nakabiri, Jeremy Kirunda, Charles Draleku, Jamilah Namwanga, Joan Nangiya, Baker Rubinga, Rodney Kazooba, Cate Naluyima, Christopher Lwanga, Faith Balmoi Labote, Dridah Nakiboneka, Bibian Nakigozi Nakato, Christine Nambi, Milly Ndigendawani, Jovia Kavuma, Timothy Lubwama, Frank Mbamanya, Nabuuma Haawa Muweesi, Carol Otike, Mwanje John Bosco, Anna Ritah Namuganga, Mutsawashe Bwakura-Dangarembizi, Kusum Nathoo, Hilda Mujuru, Misheck Phiri, Stuart Chitongo, Wendy Mapfumo, Sandra Musarurwa, Taona Mudzviti, Columbus Moyo, Shepherd Mudzingwa, Shirley Mutsai, Vivian Mumbiro, Joy Chimanzi, Makhosonke Ndlovu, Maureen Tshuma, Ruth Nhema, Ennie Chidziva, Cleopatra Langa, Godfrey Musoro, Dorinda Mukura, Edson Marimo, Tinashe Chidemo, Bernadette Malunda, Musunga Tomu, Lynnet Nyakudya, Nicholas Dhibi, Alfed Kateta, Sidney Sithole, Lynette Chibanda, Deka Vincent, Elaine Mwandiwata, Secrecy Gondo, Moses Chitsamatanga, Farai Selina Matimba, Tsitsi Gwenzi, Nathalie Mudzimirema, Allen Matubu, Prosper Sibonile Dube, Pia Ngwaru, Joyline Bhiri, Trust Mukanganiki, Vinie Kouamou, Rufaro Chivaura, Xeshelihle Mhlanga, Hazel Patricia Munyama, Sibusisiwe Weza, Vongai Margaret Chanaiwa, Shamiso Barbara Gwande, Constantine Mutata, Dorothy Murungu, Abraham Siika, Winstone Nyandiko, Cecilia Kiilu, Charity Wambui, Ronald Tonui, Viola Kirui, Caroline Watiri Maina, Florence Kiwunja Njulu, Cornelius Chege, Natalie Sang, Beatrice K. Jakait, Damaris Lagat, Salinah Cherutich, Benedister Kangogo Cheruiyot, Brian Odul, Hilda Kaziga, Teri Tarus, Getruth Jerop Kiptoo, Vincent Kipchirchir, Clinton Otieno Achida, Tom Oyoo Osoro, Jairus Kipyego, Violah Samoei, Martha Mokeira Mokaya, Wilson Lokitala Ekiru, Ruth Bosire, Rispher Chepkoech, Festus Kirwa Rugut, Matthew Justus Mutuku, Hellen Jerotich Kiplagat, Millicent Orido, Eslyne Jepkemboi, Vincent Otieno Onyango, Alice Mudogo, Mary Chebet, Joan Chepkurui Kotut, Philemon Kipchirchir Mutai, Eunice Jepkemboi, Julie Chepchumba Choge, Evans Ochieng Ouno, Cecilia Chebet Mengich, Amina Msuo Shali, Solomon Kimurgor Ngetich, Dorcas Akinyi Opot, Shauri Kahindi Gona, Richard Kipsang Kirui, Damaris Jepchumba Kiprutto, Mowlem Pierre, Dorcus Adhiambo, Nicholas Kigen, Sophia Simatwa, Michael Njenga, Cornelius Magut, Kennedy Oyamo, Edna Jepngetich, Gideon Obila, Lydiah Maru, Victor Kibet Langat, Iris Jaluha Sande, Scholastica Njeri Wanjiru, Martha Kaimuri Mwongela, Moherndran Archary, Sundrapragasen Pillay, Rosie Mngqibisa, Raziya Bobat, Nozibusiso Rejoice Mosia, Precious Sphiwe Cebekhulu, Nombuso Nkosi, Rashina Nundlal, Saajida Rizvi, Jabu Mkhulise, Innocentia Thandokuhle Mncube, Nathaniel Malatjie, Shingirai Chimene, Zethu Mnyandu, Sheleika Singh, Clement Pillay, Tiyara Arumugam, Shauna Francis, Michelle Moodley, Sylvia Nylobo, Fathima Mather, Ida Mundhree, Popi Shabalala, Ntombizonta Ignatia Phewa, Khombisile Muthwa, Simangele Abigail Bengu, Tshamand Fulufhelo Netshitangani, Rayania Premoutt, Kelly Shermon Clark, Mthokozisi Khuzwayo, Janet Seeley, Sarah Bernays, Nothando Ngwenya, Tawanda Makusha, Zinhle Ngubo, Phindile Guga, Londiwe Shandu, Tamlyn Seunanden, Stella Namukwaya, Allen Asiimwe, Alice Nassanga, Paul Revill, Simon Walker, Yingying Zhang, David Burger, Angela Colbers, Tom Jacobs, Lisanne Bevers, Magda Conway, Lungile Jafta, Mercy Shibemba, Carlo Giaquinto, Karina Butler, Sam Phiri, Avy Violari, Nathan Ford, Imelda Mahaka, Addy Kekitiinwa, Hebron Kalikwani, Priscilla Nakiwala, Anton Pozniak, Rodolphe Thiebaut, Jane Crawley, Justus Ashaba","doi":"10.1016/s2352-3018(25)00326-1","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00326-1","url":null,"abstract":"Short-cycle antiretroviral therapy (ART), comprising 5 days on and 2 days off treatment, offers the potential for ART-free weekends, reduced toxicity, and improved quality of life for adolescents living with HIV, who typically have worse treatment outcomes than other age groups. We aimed to compare the efficacy and safety of short-cycle ART containing tenofovir disoproxil fumarate–lamivudine–dolutegravir with continuous ART in adolescents living with HIV in Africa.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"51 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147642187","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":"Pitavastatin effects on lipids in relation to major adverse cardiovascular events: a REPRIEVE secondary analysis","authors":"Triin Umbleja, Mohammad U Zafar, Sara McCallum, Arijeet K Gattu, Markella V Zanni, Gerald S Bloomfield, Carlos D Malvestutto, Carl J Fichtenbaum, Judith S Currier, Craig A Sponseller, Marissa R Diggs, Sarah M Chu, Alex B Lu, Marshall J Glesby, Jack T Stapleton, Michael Frank, Kim-Lien Nguyen, Rachel A Bender Ignacio, Win Min Han, Pamela S Douglas, Judith A Aberg, Heather J Ribaudo, Steven K Grinspoon","doi":"10.1016/s2352-3018(26)00031-7","DOIUrl":"https://doi.org/10.1016/s2352-3018(26)00031-7","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"25 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597995","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: e712–21","authors":"","doi":"10.1016/s2352-3018(26)00056-1","DOIUrl":"https://doi.org/10.1016/s2352-3018(26)00056-1","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"17 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147598001","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 cost of punitive drug legislation","authors":"","doi":"10.1016/s2352-3018(26)00057-3","DOIUrl":"https://doi.org/10.1016/s2352-3018(26)00057-3","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"403 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147598759","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":"Same-day versus rapid ART initiation in people with HIV and symptoms of tuberculosis (SaDAPT): a randomised, non-inferiority trial in Lesotho and Malawi.","authors":"Felix Gerber, Robina Semphere, Blaise Lukau, Palesa Mahlatsi, Hannah Mbale, Giuliana Sanchez-Samaniego, Nikita Sass, Alain Amstutz, Mamello Molatelle, Nthuseng Bridgett Marake, Tapiwa Tarumbiswa, Marriot Nliwasa, Irene Ayakaka, Tracy R Glass, Peter MacPherson, Rachael M Burke, Niklaus D Labhardt","doi":"10.1016/S2352-3018(25)00276-0","DOIUrl":"10.1016/S2352-3018(25)00276-0","url":null,"abstract":"<p><strong>Background: </strong>Whether same-day antiretroviral therapy (ART) should be offered to people with HIV with tuberculosis symptoms or whether ART should be initiated only after tuberculosis diagnostic results are available is unknown. This randomised trial aimed to determine whether same-day ART initiation for people with tuberculosis symptoms is non-inferior to deferral until tuberculosis diagnostic results are available in achieving viral suppression at 6 months.</p><p><strong>Methods: </strong>We did an open-label, individually randomised, non-inferiority trial among people with HIV who were outpatients at 11 primary or secondary level health facilities in Lesotho and Malawi, were aged at least 12 years, were initiating or reinitiating ART with at least one tuberculosis symptom, and had no symptoms or signs of meningitis. Participants were randomly assigned (1:1) to be offered same-day ART or offered ART after tuberculosis was confirmed or refuted. Primary analysis was a non-inferiority comparison of viral suppression (<400 copies per mL) 26 weeks (measurement window 22-40 weeks) after enrolment, with a non-inferiority margin of 10%. The modified intention-to-treat analysis included all randomly assigned participants excluding those found ineligible after randomisation. The per-protocol analysis excluded participants who did not adhere to the randomly assigned intervention. The study is completed. The study is registered with ClinicalTrials.gov (NCT05452616).</p><p><strong>Findings: </strong>Between Oct 19, 2022, and Feb 21, 2024, 610 participants were enrolled. 590 participants were included in the modified intention-to-treat analysis of whom 356 (60%) were male, median age 37 years (IQR 31-45), median CD4 count was 202 cells per μL (IQR 92-374); 573 in the per-protocol analysis. 212 (71%) of 297 in the ART-first group and 199 (72%) of 276 in the tuberculosis-results-first group had viral suppression at 26 weeks in the per-protocol population (absolute risk difference -1·6%, 95% CI -9·1 to 6·0) with similar results in the modified intention-to-treat population. Nine and six deaths, 11 and ten non-fatal serious adverse events, and six and five tuberculosis-associated immune reconstitution inflammatory syndrome (IRIS) events occurred in ART-first and in tuberculosis-results-first groups, respectively.</p><p><strong>Interpretation: </strong>Same-day initiation was non-inferior to ART initiation after tuberculosis investigations regarding viral suppression and there were no indications of safety concerns or increase in IRIS. Programmatic implementation considerations and individual patient preference should guide the decision for same-day ART initiation versus initiation after receipt of tuberculosis test results for people with HIV with tuberculosis symptoms.</p><p><strong>Funding: </strong>Swiss National Science Foundation.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e225-e234"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203435","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":"ART timing in people being investigated for tuberculosis.","authors":"Graeme Meintjes, Gary Maartens","doi":"10.1016/S2352-3018(25)00324-8","DOIUrl":"10.1016/S2352-3018(25)00324-8","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e214-e215"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203405","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 vaginal microbiome and HIV acquisition risk","authors":"Lindi Masson PhD, Nina Radzey PhD, Andrea G Abrahams MSc, Sinaye Ngcapu PhD, Lyle McKinnon PhD, Heather B Jaspan MD","doi":"10.1016/s2352-3018(26)00032-9","DOIUrl":"https://doi.org/10.1016/s2352-3018(26)00032-9","url":null,"abstract":"Non-optimal vaginal bacteriomes, vulvovaginal candidiasis, and sexually transmitted infections have been associated with increased risk of HIV acquisition in multiple clinical studies. However, there are still major gaps in our understanding of the role of the vaginal microbiome in HIV acquisition risk and non-bacterial components of the vaginal microbiome are not well characterised. Additionally, the functional interactions between the vaginal microbiome and its host that can result in increased risk of HIV acquisition are not fully understood. Better vaginal microbiome diagnostics and therapeutics feasible for implementation in settings with insufficient financial, human, and infrastructural resources are needed, and the effects of vaginal microbiome interventions on HIV risk need to be clinically evaluated. Progress is being made towards effective interventions through advanced omics technologies and improved in-vitro models that more accurately represent the complexity of the female genital tract. However, continued research and investments are needed to address this important women's health issue.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"22 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147587182","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 of obesity, diabetes, hypertension, and major adverse cardiovascular events after a switch to an integrase inhibitor: a target trial emulation in REPRIEVE.","authors":"Emma M Kileel,Carlos D Malvestutto,Markella V Zanni,Emma Davies-Smith,Carl J Fichtenbaum,Jordan E Lake,Janet Lo,Judith A Aberg,Esteban Martinez,Kunjal Patel,Gerald S Bloomfield,Sarah M Chu,Aya Awwad,Marissa R Diggs,Alex B Lu,Sara H Bares,Daniel Berrner,Marek Smieja,Nwora Lance Okeke,Princy Kumar,Esau João,Judith S Currier,Michael T Lu,Matthew P Fox,Alana T Brennan,Pamela S Douglas,Steven K Grinspoon,Heather J Ribaudo","doi":"10.1016/s2352-3018(25)00354-6","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00354-6","url":null,"abstract":"BACKGROUNDIntegrase strand-transfer inhibitors (INSTIs) are linked to weight gain, but data on their cardiometabolic effects, particularly major adverse cardiovascular events (MACE), are scarce. We aimed to estimate the risk of obesity, diabetes, hypertension, and MACE after switching to an INSTI in people with HIV at low-to-moderate cardiovascular risk.METHODSIn this retrospective cohort study, we used data from the global Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) to emulate a series of trials comparing switching to an INSTI versus remaining on a non-INSTI regimen on risk of incident obesity, diabetes, hypertension, and MACE. The REPRIEVE trial collected data across 12 countries from participants aged 40-75 years, on a stable antiretroviral therapy regimen for at least 6 months, with a CD4 count of >100 cells per μL, and with low-to-moderate risk for atherosclerotic cardiovascular disease. From this cohort, we included participants without a previous diagnosis of the outcomes or previous INSTI use and used data for a follow-up period of 5 years, until the outcome event, loss to follow-up, death, or study end. Data from emulated trials were pooled and hazard ratios (HRs) were estimated with weighted Cox proportional hazard models, accounting for competing events.FINDINGS5114 participants met eligibility criteria for at least one emulated trial, representing 99 357 person-trials (median age 49 years [45-54]; 62 826 [63·2%] of 99 357 were male; 36 531 [36·8%] were female). 2981 (58·3%) of 5114 participants were captured as an INSTI switcher in at least one trial. Most switchers (2412 [80·9%] of 2981) initiated a dolutegravir-based regimen and most (47 263 [67·1%] of 70 458) non-switchers were on an efavirenz-based regimen. The HR of obesity (HR 1·41, 95% CI 1·22-1·59), diabetes (1·50, 1·24-1·81), and hypertension (1·45, 1·26-1·67) was higher in switchers than non-switchers. We did not observe an effect on MACE (1·17, 0·87-1·57).INTERPRETATIONThe increase in cardiometabolic risk profile suggests long-term observation of people with HIV switching to INSTIs will be crucial to ensure appropriate management of comorbidities and to assess for future development of MACE.FUNDINGNational Institutes of Health, Kowa Pharmaceuticals America, Gilead Sciences, and ViiV Healthcare.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"62 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578209","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":"Incident diabetes after switching to integrase strand transfer inhibitors in people with HIV in the USA and Canada: a cohort study.","authors":"Y Joseph Hwang,Catherine R Lesko,Todd T Brown,G Caleb Alexander,Keri N Althoff,Lauren C Zalla,Jarratt D Pytell,Oluwaseun Falade-Nwulia,Eva Tseng,Richard D Moore,Vincent C Marconi,John R Koethe,Michael J Silverberg,Michael A Horberg,Raynell Lang,Timothy R Sterling,Anthony Todd Fojo, ","doi":"10.1016/s2352-3018(25)00335-2","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00335-2","url":null,"abstract":"BACKGROUNDIntegrase strand transfer inhibitor (INSTI) initiation has been associated with diabetes in antiretroviral therapy (ART)-naive people with HIV. We aimed to examine the effect of switching to INSTIs on incident diabetes in ART-experienced people with HIV.METHODSIn this target trial emulation, we retrospectively used individual-level data from 27 longitudinal cohorts of people with HIV in the USA and Canada. We included participants aged at least 18 years without diabetes who had used non-nucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors for at least 180 days (in 2016-22) but had never used an INSTI. We used data from any clinical encounters in which participants continued an NNRTI or protease inhibitor versus switched to an INSTI, with a follow-up period of up to 5 years. The effect of switching to INSTIs on incident diabetes was estimated with weighted Cox regression with robust variance. We further assessed whether the effect varied by time since the switch and was explained by weight gain in the first year.FINDINGS13 071 participants were followed up from 2702 encounters in which they switched to an INSTI from an NNRTI, 54 766 encounters in which they continued an NNRTI, 1714 encounters in which they switched to an INSTI from a protease inhibitor, and 26 599 encounters in which they continued a protease inhibitor. Switching from protease inhibitors to INSTIs conferred an adjusted hazard ratio (HR) of 1·38 (95% CI 1·06-1·80) for incident diabetes, whereas switching from NNRTIs to INSTIs conferred an adjusted HR of 1·10 (0·87-1·39). The diabetes risk was higher during the first 2 years after switching from protease inhibitors to INSTIs (HR 1·67, 95% CI 1·21-2·30), but not thereafter (1·08, 0·75-1·57; pinteraction=0·064). The effect of switching from protease inhibitors to INSTIs on diabetes did not appear to be explained by weight gain. In the sensitivity analysis in which weight gain did not exceed 5% in the first year after, the switch from NNRTIs to INSTIs had a HR of 1·03 (95% CI 0·79-1·36) and the switch from protease inhibitors to INSTIs had a HR of 1·37 (1·02-1·84).INTERPRETATIONThe increased diabetes risk after switching from protease inhibitors to INSTIs highlights a metabolic implication of regimen change and could warrant close monitoring early after switch, regardless of weight gain.FUNDINGUS National Institutes of Health.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"36 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578210","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":"Metabolic syndrome and cardiovascular risk on INSTIs.","authors":"Jean-Jacques Parienti,Franck Boccara","doi":"10.1016/s2352-3018(25)00371-6","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00371-6","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"104 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578211","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}