Lancet Hiv最新文献

{"title":"Making America unhealthy again.","authors":"The Lancet Hiv","doi":"10.1016/S2352-3018(25)00107-9","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00107-9","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 5","pages":"e313"},"PeriodicalIF":12.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021574","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":"Tuberculosis disease among people with HIV: therapeutic advances.","authors":"Vidya Mave, Mandar Paradkar, Francesca Conradie, Amita Gupta, Anchalee Avihingsanon, Graeme Meintjes, Anna Turkova, Kelly E Dooley, Richard E Chaisson","doi":"10.1016/S2352-3018(25)00040-2","DOIUrl":"10.1016/S2352-3018(25)00040-2","url":null,"abstract":"<p><p>Over the past 80 years, tuberculosis treatment has evolved with the development of all-oral treatments, which are now given for 4-6 months for drug-sensitive tuberculosis and 6-9 months for drug-resistant tuberculosis. Treatment success is often reduced among people with HIV due to an interplay of factors, including immune dysregulation, lower drug concentrations, complexities of cotreatment (eg, high pill burden and overlapping toxicities), and social factors. Recent clinical trials have shown that among adults and adolescents, treatment duration can be decreased to 4 months with repurposed therapeutics for drug-sensitive tuberculosis, and a four-drug regimen of isoniazid, rifapentine, moxifloxacin, and pyrazinamide has become part of WHO recommendations. Among children with drug-sensitive, non-severe tuberculosis disease, a 4-month regimen of standard tuberculosis drugs (eg, isoniazid, rifampicin, pyrazinamide, and ethambutol) is non-inferior to a 6-month regimen. Following recent research advances for drug-resistant tuberculosis, a 6-month regimen containing a potent combination of bedaquiline, pretomanid, linezolid, and moxifloxacin is a new standard for people with and without HIV. The tuberculosis drug development pipeline contains promising new therapeutics in various stages of development. To accelerate tuberculosis elimination, future research should focus on shortened treatment duration, and safer and effective therapeutics for tuberculosis-affected populations globally, including people with HIV, children, and pregnant people, and should assess newer modalities of treatment delivery.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e367-e381"},"PeriodicalIF":12.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731569","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":"Causes of hospitalisation among people living with HIV worldwide, 2014-23: a systematic review and meta-analysis.","authors":"Rachael M Burke, Nadia Sabet, Jayne Ellis, Ajay Rangaraj, David S Lawrence, Joseph N Jarvis, Jane Falconer, Lillian Tugume, Gabriella Bidwell, Rebecca H Berhanu, Peter MacPherson, Nathan Ford","doi":"10.1016/S2352-3018(24)00347-3","DOIUrl":"10.1016/S2352-3018(24)00347-3","url":null,"abstract":"<p><strong>Background: </strong>Despite improved access to antiretroviral therapy (ART), HIV-related morbidity and mortality remain high. A previous review (2007-14) found that AIDS-related illnesses were the leading causes of hospitalisations. We aimed to summarise the causes of hospitalisations among people living with HIV from 2014 to 2023.</p><p><strong>Methods: </strong>For this meta-analysis we searched eight databases (Ovid Medline ALL, Ovid Embase Classic and Ovid Embase, Ovid Global Health, EBSCOhost CINAHL Complete, EBSCOhost Africa-Wide Information, Clarivate Analytics Web of Science Core Content, Clarivate Analytics Web of Science SciELO, and Global Index Medicus) on April 26, 2023. We included studies of any design that reported on the cause of admission to hospital for at least 20 people after Jan 1, 2014. We extracted summary-level data about CD4 cell counts, ART use, cause of admission, and incidence of death, and assessed risk of bias with the use of a modified Newcastle-Ottowa Scale. We constructed random effects models to estimate prevalence of various diseases as a cause of hospital admission.</p><p><strong>Findings: </strong>From the 19 629 records identified, we obtained data from 110 studies representing 100 628 hospital admissions. The weighted median CD4 count was 111 cells per μL (range of medians 25-713); 60% of admissions (95% Cl 54-66) were people receiving ART. The most common cause of admission was AIDS-related illnesses (42% of admissions, 95% CI 35-49), including tuberculosis (19%, 15-23). The second most common cause was bacterial infection (26%, 20-33). AIDS-related illnesses were more common in WHO regions of South and Central America (62%, 53-71), Africa (49%, 39-60), Western Pacific (68%, 57-77), and South-East Asia (40%, 31-50) than in Europe (30%, 23-37) and North America (13%, 6-25). Wasting and parasitic infections were more common in children (malnutrition 31%, 11-63; parasitic infection 13%, 4-37) than in adults. In-hospital mortality was 17% (13-20), with substantial regional variation.</p><p><strong>Interpretation: </strong>Our results indicate providing high-quality care to hospitalised people with HIV-related conditions (AIDS-related illness and severe bacterial infections) should be prioritised.</p><p><strong>Funding: </strong>The Bill & Melinda Gates Foundation.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e355-e366"},"PeriodicalIF":12.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744144","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":"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":"Lateral flow assay-based CD4 cell count testing for advanced HIV disease.","authors":"Zibusiso Ndlovu, Ana Moore, Esther C Casas, Geoffrey Fatti","doi":"10.1016/S2352-3018(25)00094-3","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00094-3","url":null,"abstract":"<p><p>The global policy shift to treating all people living with HIV, regardless of CD4 cell count, has inadvertently led donors and national programmes to reduce their investments in CD4 testing. The subsequent decline in testing volumes has caused manufacturers to discontinue major point-of-care CD4 testing instruments, despite these tests being crucial for the diagnosis of advanced HIV disease (AHD). Mortality from AHD remains high, with an estimated 630 000 deaths among people living with HIV in 2023. CD4 lateral flow assay (LFA) testing could provide pragmatic screening for AHD. Published studies show moderate-to-high diagnostic performance of Visitect CD4 LFA tests in venous blood samples, with a sensitivity of 93·4-95·0% and specificity of 81·9-87·7%, but the specificity from fingerprick samples is substantially lower (61·4-78·3%). Therefore, the interplay between diagnostic test performance, other attributes (eg, result turnaround time, accessibility, feasibility of decentralisation, cost-effectiveness, and diagnostic yield), and AHD prevalence needs to be considered. Given its potential to cost-effectively support and increase AHD screening, and to subsequently assist in long-term reductions in HIV mortality beyond 2030 UNAIDS targets, a greater appreciation of the diagnostic yield of LFA-based CD4 testing is crucial. Implementation science and policy development should consider public health impacts in addition to test clinical accuracy.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992494","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}