Journal of acquired immune deficiency syndromes (1999)最新文献

{"title":"Postural instability in individuals living with HIV infection: Relations with thalamic nuclei volumes, peripheral neuropathy, age, and falls.","authors":"Rosemary Fama, Stephanie A Sassoon, Eva M Müller-Oehring, Manojkumar Saranathan, Kilian M Pohl, Natalie M Zahr, Adolf Pfefferbaum, Edith V Sullivan","doi":"10.1097/QAI.0000000000003983","DOIUrl":"10.1097/QAI.0000000000003983","url":null,"abstract":"<p><strong>Background: </strong>Postural stability diminishes with age, is associated with falls liability, and is disrupted in people with HIV (PWH). The thalamus, which is also affected in HIV, plays a role in balance through its reciprocal connections with cortical, subcortical, and cerebellar structures. Here, we tested postural stability in PWH and sought factors, including thalamic nuclear volumes, peripheral neuropathy, falls history, HIV-related disease, and age that may contribute to instability in PWH.</p><p><strong>Methods: </strong>Participants included 58 PWH and 95 people without HIV (PWOH). Postural stability was assessed with the Fregly-Graybiel ataxia test battery. Volumes for nine thalamic nuclei were derived using THalamus Optimized Multi-Atlas Segmentation (THOMAS). Peripheral neuropathy, subjective pain, and number of falls were also quantified.</p><p><strong>Results: </strong>PWH were impaired across all postural balance tasks compared with PWOH. Poorer postural balance scores with eyes open correlated with smaller ventral posterior lateral nuclei volumes in PWH. Higher neuropathy scores in PWH correlated with poorer performance on two balance tests with eyes closed. Higher viral load was associated with greater difficulty standing on one leg with eyes closed. Even when normal aging effects were taken into account, older age in PWH related to greater difficulty standing on one leg with eyes open.</p><p><strong>Conclusions: </strong>PWH consistently demonstrated balance deficits compared to PWOH, and these deficits were greater in individuals with smaller ventral thalamic nuclei. Older age, self-reported neuropathy, and measurable viral load were also associated with greater balance instability. Thus, balance instability should be monitored and PWH should be informed about balance safety as they age, especially in those who report symptoms of neuropathy or have detectable viral load.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Birth and clinical outcomes of pregnant participants with advanced HIV disease.","authors":"Elizabeth Nalintya, Alexandra Poeschla, Ann Fieberg, Patricia Nerima, Edith Ajilong, Tessa Adzemovic, Faridah Nakiganda, Elizabeth Schwartz, Biyue Dai, David Meya, David R Boulware, Radha Rajasingham","doi":"10.1097/QAI.0000000000003995","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003995","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical trials for the evaluation of novel diagnostics and treatments for HIV-associated opportunistic infections have historically excluded pregnant persons. Little information is available regarding the clinical outcomes and pregnancy outcomes of pregnant persons with advanced HIV disease while taking opportunistic infection prophylaxis for tuberculosis (TB) and cryptococcosis. In this study, we describe characteristics at enrollment, clinical outcomes, and birth outcomes of pregnant people with advanced HIV in Uganda.</p><p><strong>Methods: </strong>We prospectively enrolled pregnant adults with advanced HIV disease within an on-going pragmatic cluster randomized clinical trial evaluating an enhanced screening and prophylaxis package for opportunistic infections (NCT05085171). The trial began enrollment in May 2022 and continues in 26 outpatient HIV clinics in the Kampala and Wakiso districts of Uganda. We present an analysis of pregnant participants enrolled through April 30, 2025, including their characteristics at study enrollment, opportunistic infections, and birth outcomes.</p><p><strong>Results: </strong>Overall, 15% (114/766) of female participants with advanced HIV disease were pregnant. Median CD4 cell count was 124 cells/µL (IQR: 82-170). Median time since HIV diagnosis was 7 days, and 45% were ART-naive at enrollment. Compared with non-pregnant female participants, pregnant participants were less likely to have a positive cryptococcal antigen (CrAg) test (2% vs 7%, p=0.023), to have a positive Alere tuberculosis (TB) lipoarabinomannan (LAM) test (11% vs 28%, p<0.001), and to be receiving active TB treatment (14% vs 39%, p<0.001). Overall, 18% (21/114) experienced at least one opportunistic infection during the study, of which 71% (n=15) were attributed to TB. Eighty-six percent (98/114) of pregnancies were carried to term. Participants on TB preventive therapy (TPT) had 94% of deliveries at term (51/54), compared with 80% (36/45) among participants who did not receive TPT (OR = 4.25, 95%CI:1.07-16.80), and 67% (8/12) among participants on active TB treatment (OR = 8.50, 95%CI: 1.60-45.25).</p><p><strong>Conclusions: </strong>Although the incidence of opportunistic infections is less commonly reported among pregnant women with advanced HIV disease, TB is the most frequent opportunistic infection. Participants on TPT had 4-fold higher odds of having a term delivery compared with those not on TPT and 8-fold higher odds compared with those with active TB.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infant exposure to antiretroviral drugs and HIV RNA in breastmilk of women living with HIV.","authors":"L van der Wekken-Pas, D Pajkrt, D Burger, F Hessing, C Rokx, L van der Knaap, F de Groof, A Toonen, J H Dekker-Boersema, T Wolfs, E van Leeuwen, E van Ewijk-Beneken Kolmer, S Jurriaans","doi":"10.1097/QAI.0000000000003991","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003991","url":null,"abstract":"<p><strong>Background: </strong>Treatment of women living with HIV with antiretroviral drugs significantly reduces the risk of HIV transmission via breastmilk. However, infant toxicity due to drug exposure through breastfeeding and breastmilk HIV RNA dynamics under sustained maternal viral suppression remains insufficiently characterized.</p><p><strong>Methods: </strong>In a pragmatic study complemented by biobank data, paired maternal and infant plasma as well as breastmilk samples were collected during monthly follow-up. Drug concentrations were measured and used to calculate breastmilk to maternal blood plasma ratios, daily infant dose, and relative infant dose. HIV RNA was also measured in both infant and maternal plasma and breastmilk.</p><p><strong>Results: </strong>21 mother-infant pairs were included, and plasma and breastmilk concentrations were determined for nine different drugs. The breastmilk to plasma ratio varied per drug, but the relative infant dose was below the safety threshold of 10% for all drugs used in this cohort. The highest relative infant dose was 6.94 % for efavirenz. Infant plasma concentrations were either very low or too low to quantify (34.8% below the limit of quantification). HIV RNA was not detected in maternal plasma, in breastmilk, or in infant plasma during breastfeeding and after breastfeeding cessation.</p><p><strong>Conclusion: </strong>Infant exposure to antiretroviral drugs is minimal, suggesting negligible toxicity risk. The absence of detectable HIV RNA in breastmilk samples supports current breastfeeding practices in comparable healthcare settings with sufficient monitoring opportunities.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Pregnancy Viral Load Monitoring but Persistent Postpartum Gaps After Guideline Changes: A Population-Based Analysis in the Western Cape, South Africa (2018-2024).","authors":"Kim Anderson, Emma Kalk, Tamsin Kate Phillips, Nisha Jacob, Florence Phelanyane, Jonathan Euvrard, Juanita Arendse, Aurelie Nelson, Muzzammil Ismail, Andrew Boulle, Mary-Ann Davies","doi":"10.1097/QAI.0000000000003994","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003994","url":null,"abstract":"<p><strong>Background: </strong>In South Africa, HIV treatment guideline changes implemented in 2020 introduced dolutegravir-based regimens and expanded viral load (VL) monitoring to include testing at delivery and 6 months postpartum for women on antiretroviral therapy (ART). We assessed temporal trends and factors associated with VL monitoring and outcomes among pregnant and postpartum women with HIV in the Western Cape.</p><p><strong>Methods: </strong>We included women with HIV with live births from 2018-2024 who initiated ART before or during pregnancy. We used routinely-collected healthcare data to assess VL monitoring at (i) delivery or third trimester (\"late pregnancy\"), and (ii) postpartum (<8 months after delivery). VL categories were defined as <50, 50-999, and ≥1,000 copies/ml. We examined predictors of VL testing coverage and viral suppression using modified Poisson GEE and multinomial logistic regression models, including policy period, maternal age, parity, and ART timing .</p><p><strong>Results: </strong>Among 88,415 deliveries to 80,095 women: 74% received ART before pregnancy and 26% started ART during pregnancy. From 2018-2024, late-pregnancy VL testing coverage increased: 69%-91% (aRR=1.28, 95%CI 1.26-1.29); whereas postpartum testing coverage declined: 51%-43% (aRR=0.96, 95%CI 0.94-0.97). The proportion of women with late-pregnancy VL<50 increased from 73-80% (2018-2024), while VL 50-999 declined from 14%-8%. ART interruptions before or during pregnancy, younger age and higher parity were predictors of lower VL testing coverage and poorer virological outcomes.</p><p><strong>Conclusion: </strong>Updated ART guidelines improved late-pregnancy but not postpartum VL testing coverage. Dolutegravir introduction was associated with improved viral suppression <50 copies/ml. Persistently low postpartum coverage suggests substantial gaps in retention and/or VL testing.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin Prescribing and Guideline Concordance Among Adults With HIV Aged 40-75 Years in a Single Urban Outpatient HIV Clinic, 2024.","authors":"Ana Khazan, Andrea M Pallotta, Deepali Boothankad Sharath, Bethany Lehman","doi":"10.1097/QAI.0000000000003993","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003993","url":null,"abstract":"<p><strong>Background: </strong>People with HIV (PWH) have elevated atherosclerotic cardiovascular disease (ASCVD) risk. Following the REPRIEVE trial, 2024 HHS Adult and Adolescent Antiretroviral Guidelines recommend at least moderate-intensity statins for adults with HIV aged 40-75 years with 10-year ASCVD risk 5% to <20%. The 2026 ACC/AHA Dyslipidemia Guideline expands eligibility, supporting statins for all adults aged 40-75 years with HIV for primary prevention, regardless of LDL-C. We evaluated statin prescribing and HHS guideline concordance for primary prevention in this population.</p><p><strong>Setting: </strong>Single urban outpatient HIV clinic in the United States.</p><p><strong>Methods: </strong>Retrospective electronic health record review of adults with HIV aged 40-75 years with an outpatient HIV visit on or after February 27, 2024. Statin prescribing was an active prescription at the index visit. ASCVD risk was abstracted from clinical documentation; virologic suppression was HIV RNA <50 copies/mL. Primary-prevention eligibility followed the February 27, 2024 HHS framework: LDL-C ≥70 mg/dL plus ASCVD risk ≥5% or diabetes mellitus.</p><p><strong>Results: </strong>Of 753 patients reviewed, 414 met inclusion criteria. Statins were prescribed for 212 (51.2%). Statin-prescribed patients were older (median 62 vs. 54 years) with higher median ASCVD risk (13% vs. 7%). ASCVD risk was unavailable for 100 (24.2%). Among 242 patients eligible for primary-prevention statin therapy, 128 (52.9%) had an active statin prescription at the index visit. In multivariable modeling (n=314), higher ASCVD risk, higher CD4 count, and virologic suppression were independently associated with prescribing.</p><p><strong>Conclusions: </strong>Only half of statin-eligible adults with HIV were prescribed statins, with the largest gap among those eligible by ASCVD risk 5% to <20% without diabetes. The 2026 ACC/AHA guideline expands eligibility to all adults aged 40-75 years with HIV. These findings highlight opportunities to improve implementation of guideline-directed cardiovascular prevention through improved cardiovascular risk assessment, clinician education, and electronic clinical decision support.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging non-AIDS comorbidities among adults with and without perinatally-acquired HIV.","authors":"Patrick Ryscavage, Jeffrey Fenn, Devang Patel, Hegang Chen","doi":"10.1097/QAI.0000000000003989","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003989","url":null,"abstract":"<p><strong>Background: </strong>Individuals with perinatally acquired HIV (PHIV) who age into adulthood may be at risk for the early development of specific non-AIDS associated comorbidities (NAC). It is unclear whether the early initiation of ART among PHIV may decrease risk for the development of specific NAC.</p><p><strong>Methods: </strong>This retrospective study examined NAC outcomes among a cohort of PHIV and an age range-matched cohort of people with non-perinatally acquired HIV (NPHIV). Multivariate logistic regression models examined the association between clinical/demographic predictors and NAC and the association between early vs. late ART initiation and development of NAC among PHIV. Log rank test was used to compare Kaplan-Meier curves for NAC outcomes.</p><p><strong>Results: </strong>Compared to NPHIV (N=173), PHIV (N=171) significantly differed by age (30.1 vs 31.8 yrs), tobacco use, lower CD4 nadir, and with less HIV viral suppression. Both groups had high rates of HTN (PHIV 38.5%, NPHIV 29.5%), ≥stage 3 CKD (PHIV 5.9%, NPHIV 1.73%), hypercholesterolemia, and asthma. PHIV demonstrated higher likelihood of hypertension (OR 1.87, 95%CI 1.1-3.2), chronic kidney disease (OR 6.95, 95%CI 1.7-29.7), and a non-significant trend towards higher likelihood of death. PHIV had significantly earlier acquisition of HTN, and CKD. Rates of NAC among patients within the PHIV cohort did not differ based on early vs. late ART initiation.</p><p><strong>Conclusions: </strong>Compared to NPHIV of similar age, PHIV adults had higher rates of HTN and CKD and were more likely to acquire these diseases at a younger age than NPHIV. These findings may have long term implications for cardiovascular risk among aging PHIV.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unhealthy alcohol use's impact on clinical pharmacist-delivered tobacco treatment among persons with HIV: An exploratory analysis of a randomized clinical trial.","authors":"E Jennifer Edelman, Yanhong Deng, James Dziura, June Weiss, Krysten Bold, Sherry Aiudi, Lydia Aoun-Barakat, Dini Harsono, Colleen Mistler, Erika Payne, Manisha Gupta, Keith Sigel, Jessica E Yager, Inbal Nahum-Shani, David M Ledgerwood, Steven L Bernstein","doi":"10.1097/QAI.0000000000003992","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003992","url":null,"abstract":"<p><strong>Aims: </strong>Unhealthy alcohol use (UAU) and cigarette smoking drive morbidity and mortality among persons with HIV (PWH). Few studies have focused on UAU among PWH receiving tobacco treatment.</p><p><strong>Methods: </strong>Exploratory analysis of A SMART Approach to Treating Tobacco Use Disorder (SMARTTT) trial Stage 1 data, during which participants were randomized to clinical pharmacist-delivered nicotine replacement therapy (NRT) alone or NRT with contingency management (NRT+CM) in HIV clinics from 7/2020-3/2024. Analyses were restricted to participants with baseline AUDIT-C; UAU was defined by AUDIT-C (women=3+/men=4+). Outcomes included visit completion rates, adjusted differences in cigarettes per day (CPD) and abstinence at week 12.</p><p><strong>Results: </strong>Participants (n=314) smoked a mean of 13 CPD and 27% reported UAU at baseline. Participants with UAU were more likely to be younger, Black, healthier, report using cannabis and stimulants and greater reliance on the bus or walking for transportation. Participants with UAU generally had lower visit completion rates. Treatment differences in CPD between NRT+CM and NRT alone at week 12 did not vary by UAU (least squares means UAU: 6.0 vs. 6.7 and no UAU: 6.1 vs. 5.3, respectively; difference in adjusted treatment difference [95% CI]=1.6 [-2.1, 5.3]). Treatment differences in abstinence were also not moderated by UAU (UAU: 18.9% vs. 5.5% and no UAU: 21.7% vs. 10.0%; difference in adjusted difference [95% CI]=1.7% [-14.3%, 17.8%]).</p><p><strong>Conclusions: </strong>Among SMARTTT participants, UAU was common and associated with lower visit completion, without observed effects on smoking outcomes. Future studies should focus on targeting UAU and TUD together to optimize outcomes.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying disparities at the intersection of race and HIV in patients with sepsis and pneumonia.","authors":"Gwenyth L Day, Anuj B Mehta, Kristine M Erlandson, Thomas S Valley, Joshua A Barocas","doi":"10.1097/QAI.0000000000003987","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003987","url":null,"abstract":"<p><strong>Background: </strong>Pneumonia and sepsis remain leading causes of hospitalization and death among people with HIV (PWH) despite widespread antiretroviral therapy. Although disparities in critical illness have been described, it remains unclear whether the association between HIV status and mortality differs across racial groups.</p><p><strong>Setting: </strong>Retrospective cohort study of adults hospitalized with pneumonia and/or sepsis using the Healthcare Cost and Utilization Project State Inpatient Databases from seven U.S. states (2018-2021).</p><p><strong>Methods: </strong>We compared crude in-hospital mortality by HIV status and race. Multilevel logistic regression models adjusted for demographics, comorbidities, acute organ failures present on admission, do-not-resuscitate status, surgical status, and hospital-level clustering. We evaluated race as an effect modifier using an HIV × race interaction model to estimate race-specific adjusted odds ratios. Complementary analyses evaluated racial disparities separately among patients with and without HIV.</p><p><strong>Results: </strong>Among 3,949,906 hospitalizations, PWH had lower crude mortality than patients without HIV (8.4% vs. 10.2%; absolute risk difference, 1.8%, 95% CI, 1.6-2.0). A significant HIV × race interaction was observed (P=0.0033). HIV infection was associated with increased mortality among patients identified as White (aOR, 1.09; 95% CI, 1.03-1.16) and Asian (aOR, 1.53; 95% CI, 1.13-2.08), but not among patients identified as Black or Other race. Racial disparities also differed according to HIV status.</p><p><strong>Conclusions: </strong>The association between HIV infection and pneumonia- and sepsis-related mortality differs across racial groups, indicating important heterogeneity masked by average population estimates. An intersectionality framework may provide insight into structural mechanisms underlying disparities in critical illness among PWH.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a drug-level feedback adherence counseling intervention for young MSM in the U.S.","authors":"Shivani Mahuvakar, Juan Argueta-Rodriguez, Rikki Montoya, Delaram Ghanooni, Leah Davis Ewart, Emily Ross, Carlos Moreira, Renata Buccheri, Kevin Sassaman, Tyler Martinson, Margaret Handley, K Rivet Amico, M J Heise, Karen Kuncze, Hideaki Okochi, Susan Buchbinder, Hyman Scott, Emily Arnold, Monica Gandhi, Matthew Spinelli","doi":"10.1097/QAI.0000000000003986","DOIUrl":"10.1097/QAI.0000000000003986","url":null,"abstract":"<p><strong>Background: </strong>Young men who have sex with men (MSM) in the U.S. have suboptimal adherence to oral tenofovir-based pre-exposure prophylaxis (PrEP), undermining HIV prevention goals. Drug-level feedback using urine point-of-care tenofovir assays has improved adherence in Eastern and Southern African settings but has not been assessed among U.S. MSM.</p><p><strong>Setting: </strong>Community-based PrEP clinic in San Francisco and home-based remote counseling sessions among young MSM across the U.S.</p><p><strong>Methods: </strong>A two-phase study was conducted. Phase 1 involved qualitative interviews with 20 young MSM (mean age 25.7 years) from a San Francisco PrEP clinic, guided by the COM-B model and Behavior Change Wheel framework to identify barriers to adherence, informing the development of the PrEP2-BAY intervention. Phase 2 pilot-tested the PrEP2-BAY intervention remotely among 20 MSM (mean age 27.7 years), using at-home urine tenofovir tests and counselor-led feedback and action planning via Zoom. Acceptability was assessed qualitatively through the Theoretical Framework of Acceptability. Urine tenofovir levels were compared pre- and post-intervention.</p><p><strong>Results: </strong>Key barriers to PrEP adherence identified included mental health, substance use, relationship dynamics, and stigma. Participants preferred at-home testing with counselor guidance, leading to adaptation of PrEP2-BAY into an mHealth approach. In the pilot phase, participants reported high acceptability and perceived effectiveness. There was a trend toward improved urine tenofovir levels with all participants exhibiting positive urine test results post-intervention.</p><p><strong>Conclusions: </strong>PrEP2-BAY demonstrated high acceptability with a trend toward improved adherence among young MSM. Further evaluation through a randomized controlled trial is recommended to assess efficacy and support broader implementation.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-sectional Comparison of the PREVENT and Pooled Cohort Equations for 10-Year Atherosclerotic Cardiovascular Risk Estimates in a U.S. Cohort of Black and Latina Transgender Women with HIV.","authors":"Megan Zheng, Molly Ehrig, Hayley E Cunningham, L Zachary DuBois, Robert-Paul Juster, Sari L Reisner, Andrea L Wirtz, Asa E Radix, Jowanna Malone, Kenneth Mayer, Carl Streed, Mabel Toribio, Ashleigh J Rich, Bridget Dobson, Tonia Poteat","doi":"10.1097/QAI.0000000000003985","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003985","url":null,"abstract":"<p><strong>Background: </strong>Transgender women with HIV face higher rates of atherosclerotic cardiovascular disease (ASCVD) than the general population. However, ASCVD risk estimators use binary sex variables that may misclassify their risk. We examined the effects of sex variable inputs in the Predicting Risk of Cardiovascular Disease Events (PREVENT) and Pooled Cohort Equation (PCE) risk calculations and tested for associations of ASCVD risk scores with HIV and hormone use.</p><p><strong>Setting: </strong>Participants were recruited from health centers in Boston, New York, and Washington, DC.</p><p><strong>Methods: </strong>We performed a cross-sectional comparison of PCE and PREVENT scores by sex variable inputs using data from 108 Black and Latina transgender women with HIV. Logistic regression models tested whether hormone duration and time since HIV diagnosis were associated with hyperlipidemia, diabetes, hypertension, or cardiac events.</p><p><strong>Results: </strong>Using an illustrative ≥ 5% risk score as the threshold for statin initiation, 40.6% with PCE versus 9.5% with PREVENT met or exceeded 5% risk when male was entered for all, compared with 17.7% with PCE versus 9.5% with PREVENT when female was entered for all, and 24.0% with PCE versus 8.4% with PREVENT when female was entered for participants taking hormones. Neither years since HIV diagnosis nor hormone duration were associated with ASCVD risk factors or events.</p><p><strong>Conclusion: </strong>Use of the PREVENT calculator generates lower ASCVD risk estimates than PCE in transgender women with HIV. Research is needed to determine how best to incorporate gender diversity and intersecting factors into ASCVD risk calculations.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}