Lancet Hiv最新文献

{"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":"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":"e596-e602"},"PeriodicalIF":13.0,"publicationDate":"2025-08-01","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":"Ending paediatric AIDS: time to close implementation gaps.","authors":"Marcel Yotebieng","doi":"10.1016/s2352-3018(25)00155-9","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00155-9","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"21 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769788","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":"Probability of vertical HIV transmission: a systematic review and meta-regression.","authors":"Magdalene K Walters,Michelle A Bulterys,Michael Barry,Sarah Hicks,Ann Richey,Margalit Sabin,Diana Louden,Mary Mahy,John Stover,Robert Glaubius,Hmwe H Kyu,Marie-Claude Boily,Lynne Mofenson,Kathleen Powis,Jeffrey W Imai-Eaton","doi":"10.1016/s2352-3018(25)00132-8","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00132-8","url":null,"abstract":"BACKGROUNDEliminating HIV vertical transmission is a global priority and monitored by estimating paediatric HIV infections with the UNAIDS-supported Spectrum AIDS Impact Module (Spectrum-AIM). Recent innovations in antiretroviral therapy (ART) service-delivery models and first-line regimens aimed to reduce vertical transmission probabilities. We did a systematic review and meta-analysis to estimate vertical transmission probabilities by maternal immunological and treatment status.METHODSIn this systematic review and meta-regression, we combined an updated systematic review with previous data in meta-regression models to estimate vertical transmission probabilities and determinants. We searched PubMed, Embase, the Global Health Database, WHO Global Index Medicus, CINAHL Complete, and Cochrane CENTRAL for peer-reviewed English-language studies from all regions published between Jan 1, 2018 and Feb 8, 2024, with search term domains mentioning \"HIV\", \"transmission\", \"perinatal\", and \"breastfeeding periods\", and \"infants born to women living with HIV\" or related terms from randomised trials, cohort studies, or observational studies. Four meta-regression models estimated vertical transmission probabilities. We assessed model sensitivity and compared estimates to Spectrum-AIM's previous results. Finally, we fit a meta-regression model to assess the association of ART class and initiation timing on viral load suppression (VLS) at delivery.FINDINGSOf 12 588 potential studies, we identified 24 new studies, which along with the 86 from previous reviews yielded 110 total studies included in meta-regression analysis. For women not receiving ART, higher CD4 count was associated with lower odds of perinatal vertical transmission (odds ratio [OR] 0·80, 95% CI 0·75-0·84, per 100 cells per μL increase). For pregnant women on ART, each additional week on ART before delivery reduced odds of vertical transmission by 5·6% (95% CI 4·2-7·0). The OR of perinatal vertical transmission among pregnant women initiating integrase inhibitor-based ART 20 weeks before delivery was 0·36 (0·14-0·94) compared with those initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART. This association was confounded by study region. Odds of VLS were lower when ART was initiated late in pregnancy (OR 0·37, 0·21-0·68) for the reference regimen [NNRTI]), without significant difference by ART regimen.INTERPRETATIONVertical transmission probability varies by maternal immunological stage, treatment regimen, and timing of treatment initiation. These estimates have been incorporated into Spectrum-AIM for UNAIDS 2025 HIV estimates. Earlier ART initiation is associated with higher odds of VLS at delivery. Further evidence is needed on the effects of recent ART innovations on vertical transmission outcomes.FUNDINGNational Institutes of Health, UNAIDS, and UK Research and Innovation.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"5 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769790","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":"Iconic AIDS memorial on show.","authors":"Talha Burki","doi":"10.1016/S2352-3018(25)00220-6","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00220-6","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":13.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769206","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 support for Global Majority communities in London.","authors":"Udani Samarasekera","doi":"10.1016/s2352-3018(25)00196-1","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00196-1","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"3 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766010","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 2023; 10: e528-42.","authors":"","doi":"10.1016/s2352-3018(25)00228-0","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00228-0","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"2 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766015","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 imperative for increased investment for an HIV cure.","authors":"Remko van Leeuwen, Françoise Barré-Sinoussi, Michaela Müller-Trutwin, Asier Sáez-Cirión, Monique Nijhuis, Sharon R Lewin, Thumbi Ndung'u, Florence Riako-Anam, Mitchell Warren, Izukanji Sikazwe, Birgit Poniatowski, Beatriz Grinsztejn, Cissy Kityo, Masen Davis, Ole S Søgaard, Marcus Altfeld, Javier Martinez-Picado, Linos Vandekerckhove, Andrea Gramatica, Devin Sok, Simon Collins, Yazdan Yazdanpanah","doi":"10.1016/S2352-3018(25)00193-6","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00193-6","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718935","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":"Lessons for long-acting lenacapavir: catalysing equitable PrEP access in low-income and middle-income countries","authors":"Sharonann Lynch, Rachel M Cohen MPP, Matthew Kavanagh PhD, Agrata Sharma MBBS LLM, Yvette Raphael, Yogan Pillay PhD, Prof Linda-Gail Bekker PhD","doi":"10.1016/s2352-3018(25)00161-4","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00161-4","url":null,"abstract":"Despite substantial advances in biomedical HIV prevention, including long-acting injectable pre-exposure prophylaxis (PrEP) options such as cabotegravir, barriers to widespread adoption and scale-up persist in low-income and middle-income countries. Long-acting injectable lenacapavir is a potentially transformative HIV prevention tool, providing an unprecedented opportunity to accelerate progress. However, the global HIV response is under threat like never before, with drastic funding cuts undermining the gains of the past 25 years. The challenges of introducing and scaling up long-acting lenacapavir and other PrEP innovations are numerous. Without deliberate policy, programmatic, and financing interventions, new prevention technologies risk following slow adoption patterns of previous innovations, weakening a needed transformation of the HIV response. Drawing on lessons from the scale-up of antiretroviral therapy, and experience with previous biomedical prevention tools, a new ten-point framework should be adopted to accelerate individual and epidemiological impact—even at this time of extraordinary uncertainty.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"38 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622453","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":"Daring to dream of long-acting HIV prevention","authors":"The Lancet HIV","doi":"10.1016/s2352-3018(25)00194-8","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00194-8","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"124 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622452","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":"Progress in the HIV response in Uganda: findings from two sequential population-based HIV impact assessment surveys, 2017-21.","authors":"Mansoor Farahani,Wilford L Kirungi,Shannon M Farley,Veronicah Mugisha,David Hoos,Theodore F Smart,Giles A Reid,Samuel Biraro,Wafaa M El-Sadr","doi":"10.1016/s2352-3018(25)00100-6","DOIUrl":"https://doi.org/10.1016/s2352-3018(25)00100-6","url":null,"abstract":"BACKGROUNDUganda has experienced a severe HIV epidemic and has endeavoured to implement HIV programmes to confront it. We assessed progress in the Ugandan response by comparing data from two sequential Uganda Population-based HIV Impact Assessments (UPHIAs) conducted in 2017 and 2021.METHODSThe UPHIA was a nationally representative, cross-sectional survey using two-stage, stratified cluster sampling among adults aged 15-64 years (UPHIA 2017) or aged 15 years and older (UPHIA 2021) from all 11 regions of Uganda. Participants from randomly selected households provided demographic information and underwent HIV testing according to national guidelines, with laboratory confirmation of reactive results. We determined HIV-positive status awareness and antiretroviral therapy (ART) use through self-reporting or detection of antiretroviral drugs in blood samples. Viral suppression was defined as HIV-1 RNA of less than 1000 copies per mL. HIV incidence was estimated using a recent infection testing algorithm, and the incidence-to-prevalence ratio was calculated to assess epidemic dynamics, with lower values indicating progress towards epidemic control. We compared key indicators between surveys to evaluate progress towards the 95-95-95 targets and epidemic control. We applied Poisson regression models using survey weights and estimated variances using the Taylor series linearisation approach.FINDINGS29 594 participants were enrolled in UPHIA 2017 and 23 898 participants were enrolled in UPHIA 2021. Overall HIV incidence decreased from 0·40% (95% CI 0·25-0·56) in 2017 to 0·30% (0·18-0·43) in 2021, although this change was not statistically significant (p=0·28). Among adults who tested positive for HIV, awareness of HIV status significantly improved from 72·5% (70·0-74·9) in 2017 to 80·8% (78·0-83·3) in 2021 (p<0·0001). Additionally, the proportion of participants on ART among those aware of their HIV status increased significantly from 90·4% (88·1-92·3) to 96·0% (94·3-97·2, p<0·0001), and the prevalence of viral suppression among those on ART also increased significantly from 83·7% (81·2-85·8) to 92·0% (90·1-93·5, p<0·0001). After adjusting for demographic covariates, adults living with HIV in 2021 were significantly more likely than those in 2017 to know their HIV status (adjusted prevalence ratio 1·09 [95% CI 1·05-1·14], p<0·0001), to be on ART if aware of their status (1·06 [1·03-1·09], p<0·0001), and to be virally suppressed if on ART (1·09 [1·05-1·14], p<0·0001).INTERPRETATIONUganda made substantial progress in its HIV response, with substantial improvements in HIV-positive awareness, ART coverage, and viral suppression. However, the absence of a statistically significant decrease in annual incidence or incidence-to-prevalence ratio and the fact that one-quarter of all people with HIV had unsuppressed viral load underscore the need for intensified testing, prevention, and treatment efforts to achieve a definitive epidemic transition.FUNDINGThe US Presid","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"36 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565775","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}