Lancet Hiv最新文献

{"title":"Championing transgender rights in Peru.","authors":"Joe Parkin Daniels","doi":"10.1016/S2352-3018(25)00017-7","DOIUrl":"10.1016/S2352-3018(25)00017-7","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e251"},"PeriodicalIF":12.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434082","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 Situated Vulnerabilities and Resiliencies Framework: a call for integrated strategies to address global HIV inequities for transgender, non-binary, and gender diverse populations.","authors":"Sari L Reisner","doi":"10.1016/S2352-3018(24)00299-6","DOIUrl":"10.1016/S2352-3018(24)00299-6","url":null,"abstract":"<p><p>Transgender, non-binary, and gender diverse (trans) populations are burdened by the risk of HIV acquisition. Achieving global UNAIDS 95-95-95 targets by 2030 among trans populations requires conceptual frameworks to understand HIV epidemic drivers and optimise effective strategies to curb HIV inequities in trans populations. The Situated Vulnerabilities and Resiliencies Framework describes and explains HIV inequities in these populations. The HIV epidemic among trans populations is situated in multilevel biopsychosocial contexts, and these populations are made vulnerable to HIV through fundamental causes and conditions that render them at risk for risk. Key considerations include pathways that are linked to sex and gender, all-population and trans-specific exposures, developmental context, syndemic dynamics, and intersectionality. The framework highlights the need to deploy integrated strategies and interventions that are neutral to HIV status and grounded in health and human rights, work with trans communities, and use strengths-based approaches leveraging situated resiliencies (ie, salutogenic factors such as collective agency and trans kinships) to reduce pervasive stigma and advance HIV equity in trans populations.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e303-e312"},"PeriodicalIF":12.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755390","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":"Pharmacokinetics and safety of dolutegravir in children receiving rifampicin tuberculosis treatment in South Africa (ORCHID): a prospective cohort study.","authors":"Anushka Naidoo, Hylke Waalewijn, Kogieleum Naidoo, Marothi Letsoalo, Gabriela Cromhout, Leora Sewnarain, Nozibusiso R Mosia, Emmanuella C Osuala, Lubbe Wiesner, Roeland E Wasmann, Paolo Denti, Kelly E Dooley, Moherndran Archary","doi":"10.1016/S2352-3018(24)00312-6","DOIUrl":"10.1016/S2352-3018(24)00312-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Data on the safety and pharmacokinetics of dolutegravir in children with HIV and tuberculosis are scarce. We aimed to determine the pharmacokinetics and safety of dolutegravir 50 mg twice daily in children receiving rifampicin, and to predict exposures for once-daily dolutegravir with rifampicin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;ORCHID is an open-label, sequential, prospective cohort study in children (&lt;18 years) weighing 20-35 kg initiated on a rifampicin-based tuberculosis regimen and dolutegravir in Durban, South Africa. We collected seven plasma samples over one dosing interval from each patient while on dolutegravir 50 mg twice daily during tuberculosis treatment and while on dolutegravir 50 mg once daily after tuberculosis treatment discontinuation. Pharmacokinetic data were analysed using population modelling in NONMEM version 7.5. The final model was used to perform Monte Carlo simulations in silico of once-daily dolutegravir dosing and time below target concentration (0·064 mg/L). Participants underwent regular clinical and safety visits. HIV viral load was measured at weeks 8, 12, 24, and 48. Primary outcomes were trough concentration (C&lt;sub&gt;trough&lt;/sub&gt;), maximum concentration (C&lt;sub&gt;max&lt;/sub&gt;), and area under the concentration-time curve from dose to 24 h after dose (AUC&lt;sub&gt;0-24&lt;/sub&gt;) and population plasma pharmacokinetic parameters (ie, absorption rate constant, volume of distribution, and oral clearance) of dolutegravir film-coated tablet 50 mg twice daily in children with and without rifampicin, assessed in all participants with evaluable pharmacokinetic data (pharmacokinetic population). Secondary outcomes included pharmacokinetic parameters for the once-daily dolutegravir dosing option with rifampicin, simulated in the pharmacokinetic population. This study is registered at ClinicalTrials.gov, NCT04746547.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between Aug 19, 2021, and Aug 17, 2023, we enrolled and followed up 13 children, with a median weight of 23·8 kg (IQR 21·7-24·8) and median age 10 years (range 5·9-13·0). Seven were male, six female, and 13 Black. Typical dolutegravir clearance was 0·584 L/h (95% CI 0·492-0·724), with an increase in clearance of 99·1% (73·2-120) with rifampicin. Median C&lt;sub&gt;trough&lt;/sub&gt; was 1·45 mg/L (coefficient of variation 68%) for participants on twice-daily dolutegravir with rifampicin and 1·24 mg/L (70%) for participants on once-daily dolutegravir without rifampicin. Median viral load and CD4 count at baseline were 2·48 log&lt;sub&gt;10&lt;/sub&gt; copies per mL (IQR 1·64-4·99) and 109 cells per μL (77-385), respectively. Viral load was less than 50 copies per mL in all 13 children completing week 24 and in 12 children at week 48. Four grade 3 adverse events, no grade 4 adverse events, and one serious adverse event (ie, hospitalisation) unrelated to study drug were reported, with no treatment discontinuations or switches due to adverse events. Simulated C&lt;sub&gt;trough&lt;/sub&gt; values for d","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e273-e282"},"PeriodicalIF":12.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tajikistan faces a crucial moment in HIV/AIDS response.","authors":"Ed Holt","doi":"10.1016/S2352-3018(25)00073-6","DOIUrl":"10.1016/S2352-3018(25)00073-6","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e250"},"PeriodicalIF":12.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639811","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 seropositivity and viral non-suppression in transgender, non-binary, and gender-diverse people in primary care receiving gender-affirming hormone therapy in the USA between 2013 and 2019 (LEGACY): an observational, longitudinal, cohort study.","authors":"Sari L Reisner, David R Pletta, Kenneth H Mayer, Madeline B Deutsch, Tonia Poteat, Jennifer Potter, Andrea L Wirtz, Alexander Harris, Juwan Campbell, Alex S Keuroghlian, Jaclyn M W Hughto, Alex Gonzalez, Asa E Radix","doi":"10.1016/S2352-3018(25)00004-9","DOIUrl":"10.1016/S2352-3018(25)00004-9","url":null,"abstract":"<p><strong>Background: </strong>Gender-affirming hormone therapy is medically necessary for many transgender, non-binary, and gender-diverse (trans) individuals and might improve HIV clinical outcomes for trans people. This study evaluated gender-affirming hormone therapy delivered in primary care as an intervention to improve HIV outcomes for trans adults in the USA.</p><p><strong>Methods: </strong>LEGACY is a longitudinal cohort of trans adult participants receiving primary care at two US federally qualified health centres: Fenway Health (Boston, MA, USA) and Callen-Lorde Community Health Center (New York, NY, USA). Eligibility criteria were age at least 18 years, gender identity differing from assigned sex at birth, past 12-month medical visit, and signed consent with no research exclusion documented in electronic health record data. Eligible participants contributed electronic health data from 2013 to 2019. The exposure was gender-affirming hormone therapy prescription. Clinical outcomes were HIV seropositivity (all participants) and viral non-suppression (participants with HIV; ≥200 copies per mL) in the past 12 months. Log-Poisson generalised estimating equations assessed the longitudinal association of gender-affirming hormone therapy prescription (puberty blockers, anti-androgens, oestrogens, progesterone, and testosterone) with outcomes, adjusting for individual-level confounders.</p><p><strong>Findings: </strong>Among the 8109 trans participants in 2019, median age was 29 years (IQR 24-37). 2960 (36·5%) were transgender women, 2541 (31·3%) were transgender men, 1507 (18·6%) were non-binary, and 1101 (13·6%) were another trans identity. 4446 (54·8%) were White, 1323 (16·3%) were Black or African American, 498 (6·1%) were multiracial, and 1663 (20·5%) were Hispanic or Latinx. 2736 (33·7%) of 8109 participants were publicly insured and 451 (5·6%) participants were uninsured. In 2013, 2549 (85·5%) of 2983 participants were prescribed gender-affirming hormone therapy, 272 (9·1%) of 2983 participants were HIV seropositive, and 61 (22·4%) of 272 participants were not virally suppressed. In 2019, 7252 (89·4%) of 8109 participants were prescribed gender-affirming hormone therapy, 560 (6·9%) of 8109 participants were HIV seropositive, and 88 (15·7%) of 560 participants were not virally suppressed. Gender-affirming hormone therapy prescription was associated with reduced rates of HIV seropositivity (adjusted risk ratio [RR] 0·63, 95% CI 0·56-0·70) and viral non-suppression (adjusted RR 0·56, 95% CI 0·45-0·69) across follow-up.</p><p><strong>Interpretation: </strong>Gender-affirming care is important for optimising HIV outcomes among trans people. Our results underscore the vital role of gender-affirming models of care and access to gender-affirming hormone therapy for trans people.</p><p><strong>Funding: </strong>Patient-Centered Research Outcomes Institute and the National Institutes of Health.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e283-e292"},"PeriodicalIF":12.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755388","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":"US funding cuts as a catalyst for African-led HIV solutions.","authors":"Daniel A Adeyinka, Bukola Ologunagba, Babayemi O Olakunde","doi":"10.1016/S2352-3018(25)00049-9","DOIUrl":"10.1016/S2352-3018(25)00049-9","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e248-e249"},"PeriodicalIF":12.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544025","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; published online March 26. https://doi.org/10.1016/S2352-3018(25)00074-8.","authors":"","doi":"10.1016/S2352-3018(25)00095-5","DOIUrl":"10.1016/S2352-3018(25)00095-5","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789102","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 not so pleiotropic in people with HIV?","authors":"Peter Reiss, Peter Hunt","doi":"10.1016/S2352-3018(25)00006-2","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00006-2","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 4","pages":"e241-e242"},"PeriodicalIF":12.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781708","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":"Long-acting PrEP for adolescent girls and young women.","authors":"Wipaporn Natalie Songtaweesin, Thanyawee Puthanakit","doi":"10.1016/S2352-3018(25)00042-6","DOIUrl":"10.1016/S2352-3018(25)00042-6","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e240-e241"},"PeriodicalIF":12.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634880","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":"Statin effects on the incidence of major non-cardiovascular disease events among a global cohort of people with HIV: a randomised controlled trial.","authors":"Marissa R Diggs, Triin Umbleja, Sara McCallum, Markella V Zanni, Sarah M Chu, Kathleen V Fitch, Gerald S Bloomfield, Judith S Currier, Esteban Martinez, Philip E Castle, Aya Awwad, Mamta K Jain, Roger Bedimo, Bronwyn Hendricks, Jose Narrea, Vincente Estrada, Jorge Pinto, Judith A Aberg, Carlos D Malvestutto, Carl J Fichtenbaum, Michael T Lu, Heather J Ribaudo, Pamela S Douglas, Steven K Grinspoon","doi":"10.1016/S2352-3018(24)00345-X","DOIUrl":"10.1016/S2352-3018(24)00345-X","url":null,"abstract":"<p><strong>Background: </strong>Given the pleiotropic effects of statins beyond lipid-lowering, statins might positively impact other, non-cardiovascular diseases (non-CVDs). In this study, we prospectively assessed statin effects on non-CVD events and their incidence among people with HIV globally.</p><p><strong>Methods: </strong>The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE; ClinicalTrials.gov, NCT02344290) was a randomised, placebo-controlled trial of pitavastatin for CVD prevention took place from 2015 to 2023 at 145 research sites in 12 countries and is completed. In this analysis of prespecified secondary outcomes of REPRIEVE, we assessed effects of pitavastatin 4 mg daily (vs placebo) on major non-CVD events (including AIDS-defining events, non-AIDS-defining cancers, renal disease, and liver disease) and the Strategic Timing of Antiretroviral Treatment (START) trial outcome (a collective measure of morbidity including CVD among people with HIV) using Cox proportional hazards regression, stratified by sex and CD4 cell count.</p><p><strong>Findings: </strong>Among the 7769 people with HIV enrolled (3888 in the pitavastatin group and 3881 in the placebo group), 6402 participants completed the study (3201 in each group). Over a median 5·6 years (IQR 4·7-6·3) of follow-up, the incidence of major non-CVD events was 9·17 per 1000 person-years in the pitavastatin group and 9·90 per 1000 person-years in the placebo group (hazard ratio [HR], cause-specific: 0·92, 95% CI 0·76-1·13; p=0·44). The incidence of the START outcome was 15·2 per 1000 person-years in the pitavastatin and 18·3 per 1000 person-years in the placebo group (HR 0·83, 95% CI 0·71-0·97; p=0·016), driven by the effect on CVD. In the placebo group, incidences of the non-AIDS-defining cancer and CVD components of the START Trial outcome were highest (5·83 per 1000 person-years and 5·48 per 1000 person-years) whereas AIDS-defining events were less frequent (3·60 per 1000 person-years), and varied across global regions. With pitavastatin, the incidence of CVD was lower compared with placebo (3·36 per 1000 person-years), however non-AIDS-defining cancers remained high (5·40 per 1000 person-years). Non-AIDS-defining cancers were the leading cause of mortality for both groups.</p><p><strong>Interpretation: </strong>Among a global cohort of people with HIV, treatment with pitavastatin showed no major reduction in non-CVD events, including non-AIDS-defining cancers. These findings outline the limitations of statin therapy for the prevention of non-CVD, highlighting the need for other strategies for such events.</p><p><strong>Funding: </strong>National Institutes of Health, Kowa Pharmaceuticals America, Gilead Sciences, and ViiV Healthcare.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 4","pages":"e261-e272"},"PeriodicalIF":12.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781709","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}