Lancet Hiv最新文献

{"title":"Bridging the gap in Ecuador's health system.","authors":"Joe Parkin Daniels","doi":"10.1016/S2352-3018(25)00133-X","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00133-X","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209978","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":"Magnitude and characteristics of unsuppressed HIV viral load in children and adolescents on antiretroviral therapy in sub-Saharan Africa: a systematic review and meta-analysis.","authors":"Olivier Mukuku, Kaymarlin Govender, Stanislas Okitotsho Wembonyama, Yannick Nkiambi Kiakuvue","doi":"10.1016/S2352-3018(25)00039-6","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00039-6","url":null,"abstract":"<p><strong>Background: </strong>HIV/AIDS remains a major health issue in sub-Saharan Africa, especially among children and adolescents, with a substantial proportion of people with HIV having unsuppressed viral loads despite the availability of antiretroviral therapy (ART), complicating efforts to manage and control the epidemic. We aimed to estimate the prevalence of unsuppressed viral load and identify the factors contributing to this issue among children and adolescents living with HIV on ART in sub-Saharan Africa.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, we assessed data from Web of Science, Google Scholar, Scopus, PsycINFO, Embase, PubMed (MEDLINE), EBSCOhost Research Databases, and Wiley Online Library, as well as grey literature searches. We included studies published between Jan 1, 2010, and Nov 30, 2024 that focused on children and adolescents (aged <20 years) on ART in sub-Saharan Africa and reported on factors related to viral load suppression, defined by a viral load of less than 1000 copies per mL. Eligible studies included observational and interventional designs. Data appraisal and extraction were conducted by two independent reviewers from the author group, with summary data extracted from published reports. The primary outcome assessed was the prevalence of unsuppressed viral loads, with meta-analysis performed using STATA software to calculate prevalence and associated factors. The study is registered with PROSPERO (CRD42023451212).</p><p><strong>Findings: </strong>From an initial 13 121 identified articles, 52 studies involving 169 949 children and adolescents on ART met the inclusion criteria. Prevalence of unsuppressed viral load among children and adolescents in sub-Saharan Africa was 26·47% (95% CI 23·06-29·87); specifically, 26·01% (20·51-31·52) for studies in children (<15 years), 24·76% (17·36-32·16) for studies in adolescents (10-19 years), and 28·52% (23·33-33·72) for studies in a combined group of children and adolescents. Factors associated with unsuppressed viral load included younger age (<5 years), male sex, rural residence, orphan status, attendance at a level 1 or 2 health-care facility, HIV status not disclosed, poor ART adherence, advanced WHO clinical stage of HIV, low CD4 cell counts, history of opportunistic infections, nevirapine-based treatment regimen, drug substitution history, and not receiving co-trimoxazole prophylaxis. This meta-analysis showed a significant heterogeneity across the included studies, as evidenced by I<sup>2</sup>=99·66% and p<0·0001.</p><p><strong>Interpretation: </strong>Unsuppressed viral load among children and adolescents is a key concern in sub-Saharan Africa, and is influenced by sociodemographic, clinical, immunological, and treatment-related factors. Addressing these issues through targeted interventions and improved ART adherence strategies is crucial for better health outcomes.</p><p><strong>Funding: </strong>HEARD PhD Scholarship, Swedi","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235648","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":"Activists step in to deliver PEP and PrEP in Mexico.","authors":"Roger Pebody","doi":"10.1016/S2352-3018(25)00134-1","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00134-1","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200578","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":"Safety and pharmacokinetics of N6LS, a broadly neutralising monoclonal antibody for HIV: a phase 1, open-label, dose-escalation study in healthy adults.","authors":"Richard L Wu, Katherine V Houser, Martin R Gaudinski, Alicia T Widge, Seemal F Awan, Cristina A Carter, LaSonji A Holman, Jamie Saunders, Cynthia S Hendel, Aba Eshun, William R Whalen, Xiaolin Wang, Anita Arthur, Jennifer E Cunningham, Allison Beck, Joseph P Casazza, Galina V Yamshchikov, Ro Shauna Rothwell, Larisa Strom, Tejaswi Dittakavi, Myra Happe, Somia P Hickman, Michelle Conan-Cibotti, Kevin Carlton, Lily Zhang, Yunda Huang, Edmund V Capparelli, Mike Castro, Bob C Lin, Sarah O'Connell, Britta S Flach, Robert T Bailer, Sandeep R Narpala, Leonid Serebryannyy, Adrian B McDermott, Frank J Arnold, Jason G Gall, Sandra Vazquez, Nina M Berkowitz, Ingelise J Gordon, Grace L Chen, Peter D Kwong, Jinghe Huang, Theodore C Pierson, Mark Connors, John R Mascola, Tongqing Zhou, Nicole A Doria-Rose, Richard A Koup, Lesia K Dropulic","doi":"10.1016/S2352-3018(25)00041-4","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00041-4","url":null,"abstract":"<p><strong>Background: </strong>Broadly neutralising antibodies (bNAbs) have shown promise as both prevention and treatment strategies against HIV-1. The clinical effectiveness of bNAbs depends on enhancing their neutralisation breadth and extending their serum half-lives. In this study, we aimed to assess the safety, tolerability, pharmacokinetic profile, and neutralisation activity in serum of N6LS, a HIV-1 bNAb.</p><p><strong>Methods: </strong>In this first-in-human, dose-escalation, open-label, phase 1 trial, healthy adult participants (aged 18-50 years) who were HIV-1 negative were recruited to the National Institutes of Health Clinical Center (Bethesda, MD, USA). Three groups received one intravenous administration of N6LS at 5 mg/kg (n=3), 20 mg/kg (n=3), or 40 mg/kg (n=3); one group received one subcutaneous administration of 5 mg/kg N6LS (n=3); two groups received three administrations of either 5 mg/kg subcutaneous (n=5) or 20 mg/kg intravenous (n=5) N6LS every 12 weeks; and two groups received one subcutaneous administration of either 5 mg/kg (n=5) or 20 mg/kg (n=5) N6LS with ENHANZE drug product (EDP), recombinant human hyaluronidase PH20. The primary objectives were the safety and tolerability of N6LS with and without EDP. All participants who received N6LS were included in the primary safety analyses. This trial is registered at ClinicalTrials.gov, NCT03538626, and is complete.</p><p><strong>Findings: </strong>Between June 18, 2018, and April 11, 2022, we enrolled 33 healthy adults (19 female individuals and 14 male individuals). One participant did not receive N6LS and one participant was lost to follow-up after 8 weeks. N6LS had an encouraging safety profile similar to other HIV-1 bNAbs, with no serious adverse events. Local reactogenicity was observed after administration of N6LS, with the most common symptom being mild to moderate injection site pain or tenderness in subcutaneous groups, reported in six of eight participants. All ten participants who received N6LS with EDP had mild to severe injection site erythema, which, despite being graded as severe in size, was generally not noticed by participants or deemed bothersome, and resolved without intervention. Systemic reactogenicity was mild in all groups. N6LS had an overall mean serum half-life of 48·6 days and retained its broad and potent neutralisation characteristics in serum. EDP administration increased N6LS bioavailability. No functional anti-drug antibodies to N6LS were detected following administration.</p><p><strong>Interpretation: </strong>N6LS showed a promising safety and pharmacokinetics profile while retaining its potent neutralisation characteristics in serum, making it a promising candidate for inclusion in HIV-1 prevention and therapeutic combination strategies. The addition of EDP can enable safe subcutaneous administration of higher doses and larger volumes of N6LS, supporting additional methods for prophylactic and therapeutic bNAb administration.</p><p><s","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209979","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":"Expanding PrEP treatment options with a potent anti-HIV antibody.","authors":"Giacomo Schmidt Frattari, Ole Schmelz Søgaard","doi":"10.1016/S2352-3018(25)00072-4","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00072-4","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133323","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 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}