Lancet Hiv最新文献

{"title":"Guidance on the clinical management of HIV-1 persistent low-level viraemia on antiretroviral treatment: a scoping review and an international Delphi consensus.","authors":"Tommaso Clemente, Arjen J Stam, Olof Elvstam, Anna Maria Geretti, Richard Harrigan, Milosz Parczewski, Nicola E Mackie, Vincenzo Spagnuolo, Marije Hofstra, Francois Venter, Daniel R Kuritzkes, Josep M Llibre, Robert W Shafer, Jonathan Schapiro, Esteban Martinez, Cissy Kityo-Mutuluuza, Monique Nijhuis, Per Björkman, Charlotte Charpentier, Simon Collins, Huldrych F Günthard, Diego Cecchini, Antonella Castagna, Nele Brusselaers, Annemarie Mj Wensing","doi":"10.1016/S2352-3018(26)00107-4","DOIUrl":"10.1016/S2352-3018(26)00107-4","url":null,"abstract":"<p><p>Despite the success of antiretroviral therapy, a subset of people with HIV experience low-level viraemia (LLV), a challenging condition with inconsistent definitions and management across settings. We conducted a scoping review of the literature and developed international consensus recommendations through a modified Delphi process involving a multidisciplinary panel of experts. Available evidence shows wide variability in definitions of persistent LLV, most commonly encompassing repeated viral loads between 50 and 1000 copies per mL. Outcomes associated with LLV are heterogeneous. Despite associations between LLV at 50-200 copies per mL and virological failure of more than 1000 copies per mL, resistance emergence or adverse clinical outcomes are inconsistent; stronger evidence links LLV of 200-1000 copies per mL to these endpoints. Based on these findings, we propose a pragmatic management framework that includes prompt confirmation of LLV, assessment of adherence and drug interactions, consideration of resistance testing (especially at viral loads of 200-1000 copies per mL), a broader clinical evaluation, individualised treatment optimisation (according to viral load strata, the genetic barrier to resistance of current and potential antiretroviral regimens, and the HIV resistance profile), and individual prevention strategies for viral loads of 200-1000 copies per mL. This international guidance aims to support clinicians in identifying when LLV requires action, reduce variability in clinical practice, and inform management strategies across diverse health-care settings.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e502-e514"},"PeriodicalIF":14.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228929","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-1 subtype diversity in Europe.","authors":"Miłosz Parczewski, Karol Serwin, Dimitros Paraskevis, Thomas Klimkait, Charlotte Charpentier, Annemarie Wensing","doi":"10.1016/S2352-3018(26)00108-6","DOIUrl":"10.1016/S2352-3018(26)00108-6","url":null,"abstract":"<p><p>Although subtype B historically dominated HIV-1 epidemics in western and parts of central Europe, the WHO European region is now characterised by a heterogeneous mixture of HIV-1 variants including non-B subtypes, circulating recombinant forms (CRFs), and unique recombinant forms. This diversification reflects repeated introductions through migration, local onward transmission, and ongoing recombination. Subtype A, particularly sub-subtype A6, continues to dominate much of eastern Europe, where the largest regional burden of HIV-1 is concentrated. Across Europe, marked regional differences persist, with subtype B remaining common in western Europe, diverse non-B variants and CRFs contributing to western and central European epidemics, and recombinant forms increasingly recognised across all regions. Emerging clinical and laboratory data suggest that sub-subtype A6 might have an increased propensity to develop resistance under cabotegravir pressure, with potential implications for long-acting cabotegravir-rilpivirine treatment and cabotegravir-based pre-exposure prophylaxis in regions where A6 circulates widely. Subtype diversity might also affect virulence, reservoir dynamics, and susceptibility to broadly neutralising antibodies and other novel therapeutic approaches. In this Review, we summarise the changing epidemiology of HIV-1 variants in Europe and outline how growing viral diversity should inform prevention, treatment, and surveillance strategies.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e490-e501"},"PeriodicalIF":14.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220299","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":"Effectiveness of interventions to promote couples-based HIV testing and family health during pregnancy and postpartum in Kenya: a multicentre, couples-based, randomised controlled trial.","authors":"Janet M Turan,Zachary A Kwena,Kevin Owuor,Anna Helova,Abigail M Hatcher,Thomas M Braun,Evelyne Owengah,Moses Okombo,Van T Nghiem,Harsha Thirumurthy,Elizabeth A Bukusi,Lynae A Darbes","doi":"10.1016/s2352-3018(26)00104-9","DOIUrl":"https://doi.org/10.1016/s2352-3018(26)00104-9","url":null,"abstract":"BACKGROUNDEngaging couples during pregnancy can improve HIV prevention and family health. We examined the effectiveness of two couples-focused interventions on uptake of couples HIV testing and counselling (CHTC) and maternal and child health outcomes.METHODSIn this multicentre, couples-based, randomised controlled trial, HIV status-concordant and HIV status-discordant pregnant couples (aged ≥15 years) from 24 antenatal clinics across Migori and Kisumu counties in Kenya were randomly assigned (1:1:1) to one of three study groups: lay counsellors delivered five couple home visits on health and relationship skills and offered CHTC at home (home visit group); HIV self-test kits were given to women to use with their partners (HIV self-test group); standard care access with routine perinatal health services offered at their health facility, including offers of individual and couples HIV testing (standard care group). Couples were followed up to 18 months postpartum. The primary outcome was both couple members reporting CHTC uptake by 12 months postpartum. For analyses, we used generalised linear and generalised estimating equation models. This trial is registered at ClinicalTrials.gov, NCT03547739, and is complete.FINDINGSBetween March 20, 2019, and July 26, 2022, we recruited and randomly assigned 800 couples to the home visit group (n=267), HIV self-test group (n=266), or standard care group (n=267). Two-thirds (n=533 [66·7%]) of couples included a woman living with HIV. CHTC uptake was higher in the home visit group and HIV self-test group, with 114 (56·2%; adjusted risk ratio 4·22 [95% CI 2·88-6·18]) and 106 (50·0%; 3·69 [2·50-5·45]) couples reporting CHTC by 12 months, compared with 26 (13·6%) in the standard care group. We reported 54 severe adverse events (adverse pregnancy outcomes, none related to study procedures) and 37 adverse events (two possibly related to study procedures).INTERPRETATIONBoth home visits and HIV self-test kits offer a gateway for positive health outcomes for perinatal women and families. Home visits, which directly engage both members of the couple, can provide additional advantages for HIV-related health.FUNDINGNational Institute of Mental Health.TRANSLATIONFor the Kiswahili translation of the abstract see Supplementary Materials section.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"112 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148349291","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":"Achieving 95-95-95 outcomes: it takes a couple.","authors":"Nora E Rosenberg,Olivia R Gonzalez,Cheryl C Johnson","doi":"10.1016/s2352-3018(26)00122-0","DOIUrl":"https://doi.org/10.1016/s2352-3018(26)00122-0","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"74 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148349292","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":"Cost-effectiveness of emergency department opt-out testing for HIV in England: a modelling study.","authors":"Josephine G Walker,Rebecca F Baggaley,Gareth Myring,Michael A Irvine,Asra Asgharzadeh,Yoko V Laurence,Eleanor Bell,Victoria Schoemig,Eloise Cross,Siobhan Allison,Bidisha Kundu,Anna L McNaughton,Jason Brown,Duncan Cresswell,Clare van Halsema,Mohammed Osman Hassan-Ibrahim,Jonathan Roberts,Shazaad Ahmad,Rachel Todd,Robyn Heath,Zoe Ward,Ruth Simmons,Tom May,Rachel Hill-Tout,Jeremy Horwood,Monica Desai,Peter Vickerman,Tamara Djuretic,Matthew Hickman,Sema Mandal","doi":"10.1016/s2352-3018(26)00109-8","DOIUrl":"https://doi.org/10.1016/s2352-3018(26)00109-8","url":null,"abstract":"BACKGROUNDIn England, up to 5% of people living with HIV are undiagnosed and the proportion of late diagnoses remains high. Opt-out testing could help to identify people living with undiagnosed HIV who might not access testing in other settings. We aimed to evaluate the cost-effectiveness of the first phase of UK National Health Service (NHS)-funded opt-out testing for HIV in emergency departments, which scaled up from 2022.METHODSWe adapted a previously developed deterministic model of HIV diagnosis, progression, and transmission to simulate the impact of the first 33 months of the opt-out testing intervention in improving HIV diagnosis, incorporating programme data on CD4 cell count at diagnosis. We conducted a bottom-up costing of the intervention in two sites, from an NHS perspective, and gathered costs of HIV care from the literature. In the base case we assumed 93% of new diagnoses would not have been diagnosed elsewhere during the programme as these individuals had never previously been tested for HIV. Cost-effectiveness is presented as incremental costs per quality-adjusted life-year (QALY) gained over 20 years compared with a £25 000-35 000 per QALY threshold. We explored scenario analyses to address the limitations of the model assumptions.FINDINGSThe mean cost per HIV test was £6·31 (US$7·91). Under base case assumptions, emergency department opt-out testing is projected to avert 187 HIV-related deaths (95% credible interval 182-196) and 28 secondary acquisitions (26-52) over 20 years, costing £18 630 (17 413-23 119) per QALY gained. This result is robust (below £35 000 per QALY) to different assumptions about HIV-related quality of life and HIV care costs, HIV-related mortality, and the rate of diagnosis outside the programme. Under a lower test yield scenario of 0·20 new diagnoses per 1000 tests (compared with 0·29 in the base case), the intervention remains cost-effective at £25 000 per QALY.INTERPRETATIONEmergency department opt-out testing for HIV in England was cost-effective due to averted HIV-related morbidity and mortality resulting from improving diagnosis and linkage to care for people who would otherwise not be tested, many of whom have already reached an advanced stage of HIV progression. Our findings provide evidence to support continuation of the opt-out testing programme as part of the HIV Action Plan for England.FUNDINGNational Institute for Health and Care Research and NHS England.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"7 1","pages":""},"PeriodicalIF":16.1,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148322507","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 prevention in Chile has a mountain to climb.","authors":"Sophie Cousins","doi":"10.1016/S2352-3018(26)00146-3","DOIUrl":"https://doi.org/10.1016/S2352-3018(26)00146-3","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":""},"PeriodicalIF":13.0,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240316","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":"Human impact of cuts to global aid in South Africa.","authors":"The Lancet Hiv","doi":"10.1016/S2352-3018(26)00120-7","DOIUrl":"https://doi.org/10.1016/S2352-3018(26)00120-7","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"13 6","pages":"e357"},"PeriodicalIF":13.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158787","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":"Global mental health disparities among transgender women and transfeminine people living with HIV: a systematic review and meta-analysis of 63 studies.","authors":"David R A Coelho, Maria L R Defante, Rômulo da Silva Sanglard, Beatriz Ximenes Mendes, Willians Fernando Vieira, Carrie G Wade, Arjee Javellana Restar, Lilia Maria Lima de Oliveira, Joshua D Salvi, Alex S Keuroghlian","doi":"10.1016/S2352-3018(26)00004-4","DOIUrl":"10.1016/S2352-3018(26)00004-4","url":null,"abstract":"<p><strong>Background: </strong>Transgender women and transfeminine people face a disproportionate burden of mental health conditions driven by stigma, discrimination, and structural inequities, with additional psychosocial challenges related to HIV diagnosis and barriers to care among those living with HIV. We conducted a systematic review and meta-analysis to assess the global prevalence of mental health and substance use outcomes among transgender women and transfeminine people living with HIV.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, and Cochrane CENTRAL from database inception to Jan 22, 2025 for studies reporting mental health outcomes among transgender women and transfeminine people living with HIV. Outcomes included depression, suicidality, anxiety, post-traumatic stress disorder (PTSD), gender discrimination, and substance use. We assessed risk of bias using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Checklist, and we pooled prevalence estimates for each outcome. We registered the protocol in PROSPERO (CRD42023465717).</p><p><strong>Findings: </strong>Of 6293 records screened, 63 studies (n=8030) met inclusion criteria, with 49 classified as having low risk of bias. Most studies (89%) were conducted in North, Central, and South America, with a substantial proportion originating from the USA (57%). Pooled prevalence estimates were 40% (95% CI 33-48) for depressive symptoms, 29% (11-47) for suicidal ideation, 26% (12-40) for suicide attempt, 39% (32-46) for anxiety symptoms, 33% (20-46) for PTSD symptoms, and 50% (36-64) for gender discrimination. For substance use, results were 40% (33-47) for any substance use excluding tobacco and alcohol, 61% (52-69) for tobacco use, 40% (30-50) for any alcohol use, 31% (20-42) for hazardous alcohol use, 25% (15-34) for binge drinking, 35% (25-45) for marijuana use, 36% (25-47) for cocaine use, 29% (19-38) for crack cocaine use, 18% (7-29) for amphetamine use, 38% (32-44) for methamphetamine use, 13% (7-19) for opioid use, 25% (17-34) for injection drug use, and 32% (19-44) for chemsex.</p><p><strong>Interpretation: </strong>This review highlights the disproportionate burden of mental health and substance use challenges among transgender women and transfeminine people living with HIV. Our findings emphasise the crucial need for integrated HIV care models that incorporate routine mental health screening with culturally affirming and trauma-informed interventions. Policies to address structural inequities and to scale up evidence-based strategies to improve mental health and HIV outcomes for this population are also needed.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e402-e413"},"PeriodicalIF":13.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870105","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":"Consideration of brain health in ART interruption studies - Authors' reply.","authors":"Donn J Colby, Krista L Dong, Mark F Cotton, Lydie Trautmann, Thumbi Ndung'u","doi":"10.1016/S2352-3018(26)00101-3","DOIUrl":"https://doi.org/10.1016/S2352-3018(26)00101-3","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"13 6","pages":"e362-e363"},"PeriodicalIF":13.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158789","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":"Short-cycle 4-days-per-week maintenance two-drug therapy in people living with HIV (ANRS-177 DUETTO): a randomised, open-label, multicentre, non-inferiority trial.","authors":"Roland Landman, Lambert Assoumou, Sidonie Lambert-Niclot, Karine Amat, Christine Katlama, Clotilde Allavena, Karine Lacombe, Olivier Bouchaud, Geoffroy Liegeon, Jade Ghosn, Severine Gibowski, Jean-Claude Alvarez, Emuri Abe, Jacqueline Capeau, Soraya Fellahi, Salima Barkat, Jean-Jacques Parienti, Laurence Morand-Joubert, Pierre De Truchis","doi":"10.1016/S2352-3018(26)00012-3","DOIUrl":"10.1016/S2352-3018(26)00012-3","url":null,"abstract":"<p><strong>Background: </strong>Previous trials have validated the strategy of short-cycle three-drug (triple) antiretroviral therapy for HIV treatment. The main objective of ANRS-177 DUETTO was to assess whether a two-drug (dual) regimen taken on 4 consecutive days per week (4/7-days) was virologically non-inferior to standard dual therapy regimen taken 7 days per week (7/7-days) in participants with HIV and sustained viral suppression.</p><p><strong>Methods: </strong>This open-label, randomised, parallel, multicentre, non-inferiority trial enrolled adults (aged ≥18 years) living with HIV-1 at 36 ANRS clinical research hospital sites in France. Participants were on dual therapy, for 6 months or more, with plasma viral loads less than 50 copies per mL for more than 12 months, and no resistance to their current therapy. Individuals with CD4 counts of 250 cells per μL or less or with chronic hepatitis B were excluded. Participants were randomly assigned (1:1) to continue their current dual therapy on a 4/7-days or 7/7-days regimen. The primary endpoint was virological failure at week 48 in the modified intention-to-treat (mITT) population, using the US Food and Drug Administration snapshot algorithm with a 5% non-inferiority margin. The Cochran-Mantel-Haenszel test, adjusted for baseline regimen, was used to compare virological failure proportions between groups. Non-inferiority was confirmed if the 95% CI for the adjusted difference in virological failure (4/7-days minus 7/7-days) was less than 5% in both the mITT and per-protocol populations. The trial is completed and was registered with ClinicalTrials.gov (NCT04867083) and EudraCT (2020-003951-13).</p><p><strong>Findings: </strong>Between June 21, 2021, and Jan 24, 2022, 487 individuals were screened. After exclusions, 441 participants were randomly assigned to treatment groups and 433 went on to participate in the study (219 to 4/7-days, 214 to 7/7-days) and were included in the mITT analysis. Median age was 53 years, and 350 (81%) were male. Virological failure occurred in eight (4%) of 219 participants in the 4/7-days group and none of 214 in the 7/7-days group (adjusted difference of 3·7%, 95% CI 1·2-6·2). The per-protocol analysis yielded a similar result (3·7%, 95% CI 1·2-6·3), meaning that non-inferiority was not demonstrated. Grade 3-4 adverse events occurred in ten (5%) of 219 participants in the 4/7-days group and 11 (5%) of 214 in the 7/7-days including one study treatment discontinuation and one death.</p><p><strong>Interpretation: </strong>The 4/7-days short-cycle dual therapy strategy did not demonstrate non-inferiority for virological failure and is not recommended for routine use.</p><p><strong>Funding: </strong>Agence Nationale de Recherche sur le Sida et les Hépatites Virales, Maladies Infectieuses Emergentes (Inserm ANRS-MIE).</p><p><strong>Translation: </strong>For the French translation of the abstract see Supplementary Materials section.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e380-e391"},"PeriodicalIF":13.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949892","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}