Lancet Hiv最新文献

{"title":"Association of state-level PrEP coverage and new HIV diagnoses in the USA from 2012 to 2022: an ecological analysis of the population impact of PrEP.","authors":"Patrick S Sullivan, Marta Juhasz, Stephanie N DuBose, Gordon Le, Kamaria Brisco, Duygu Islek, James Curran, Eli Rosenberg","doi":"10.1016/S2352-3018(25)00036-0","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00036-0","url":null,"abstract":"<p><strong>Background: </strong>Pre-exposure prophylaxis (PrEP) medications are highly efficacious for preventing new HIV infections, but the population impact of PrEP depends on whether prescribed PrEP reaches the people at greatest risk in a population, and adherence and persistence on PrEP over time. We sought to use ecological analysis methods to characterise the impact of PrEP on HIV infections at the population level, complementing data from efficacy trials and programmatic monitoring.</p><p><strong>Methods: </strong>We conducted an ecological analysis of US state-level data on PrEP use, HIV viral suppression, and trends in HIV diagnoses in all US states and the District of Columbia by using a nationwide commercial pharmacy database (IQVIA) to calculate PrEP coverage (PrEP users per 100 people with a PrEP indication) and public health surveillance data to document HIV diagnoses from Jan 1, 2012, to Dec 31, 2022, by state and year. States were assigned to quintiles of mean PrEP coverage over the 10-year period, and we calculated quintile-specific changes in HIV diagnoses from 2012 to 2022. We used generalised linear mixed modelling to assess the state-level and national-level associations of PrEP coverage with HIV diagnosis rates, controlling for state-specific viral suppression.</p><p><strong>Findings: </strong>From 2012 to 2022, mean PrEP coverage across the USA increased dramatically from 0·6% to 26·3%, and HIV diagnosis rates decreased modestly from 13·0 to 10·6 per 100 000 population. Proportionate decreases in HIV diagnoses were higher in states with higher PrEP coverage; a significant inverse dose-response relationship existed between PrEP coverage and HIV diagnoses, in that areas with higher PrEP coverage had progressively larger declines in HIV diagnoses.</p><p><strong>Interpretation: </strong>Ecological evidence supports the population-level impact of PrEP in the USA and suggests that higher levels of PrEP coverage are associated with larger reductions in HIV diagnoses, even accounting for effects of viral suppression on HIV transmission. To the extent that these relationships are causal, programmes and policies to lower barriers to PrEP use among people with indications are likely to be associated with subsequent population-level declines in new HIV diagnoses.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 6","pages":"e440-e448"},"PeriodicalIF":12.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183253","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":"Mortality risk in people with HIV and anal cancer.","authors":"Kirsten Rozemeijer, Sarah van Veelen, Catharina J Alberts, Maarten Schim van der Loeff","doi":"10.1016/S2352-3018(25)00103-1","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00103-1","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 6","pages":"e399"},"PeriodicalIF":12.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182040","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":"PrEP and its challenges for HIV elimination.","authors":"Eliã Pinheiro Botelho","doi":"10.1016/S2352-3018(25)00125-0","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00125-0","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 6","pages":"e397-e398"},"PeriodicalIF":12.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183716","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":"Supporting Poland's LGBT+ community through thick and thin.","authors":"Ed Holt","doi":"10.1016/S2352-3018(24)00261-3","DOIUrl":"10.1016/S2352-3018(24)00261-3","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e404"},"PeriodicalIF":12.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356514","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":"UK boosts HIV testing efforts.","authors":"Tony Kirby","doi":"10.1016/S2352-3018(25)00098-0","DOIUrl":"10.1016/S2352-3018(25)00098-0","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e402-e403"},"PeriodicalIF":12.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991215","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":"Adapting the UK's HIV response to a changing epidemic.","authors":"","doi":"10.1016/S2352-3018(25)00136-5","DOIUrl":"https://doi.org/10.1016/S2352-3018(25)00136-5","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 6","pages":"e393"},"PeriodicalIF":12.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180994","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":"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":"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}