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

{"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}

{"title":"Kynurenine Pathway Activation is Associated with Poor Sleep Efficiency in Men With HIV.","authors":"Eran F Shorer, Raha M Dastgheyb, Helen J Burgess, Leah H Rubin, Andrea C Rogando, Sanjay R Patel, Joseph B Margolick, Naresh Punjabi, Valentina Stosor, Anjali Sharma, Deborah Gustafson, Sabina Haberlen, Matthew Mimiaga, Dierdre Hauser, Katherine H Gotlinger, Kathleen M Weber, Audrey L French","doi":"10.1097/QAI.0000000000003982","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003982","url":null,"abstract":"<p><strong>Background: </strong>Sleep disturbances are common in people with HIV, yet the underlying biological mechanisms remain poorly understood. Chronic immune activation in HIV can induce the tryptophan-kynurenine (TK) pathway, which both reduces melatonin synthesis and increases production of neurotoxic metabolites. TK pathway activation in women with HIV has been linked to fragmented sleep. Whether similar associations exist in men remains unclear, as men may exhibit different inflammatory and metabolic profiles.</p><p><strong>Method: </strong>We studied men with and without HIV (MWH/MWoH) from the Multicenter AIDS Cohort Study (MACS) who underwent actigraphy. TK pathway metabolites were directly quantified in contemporaneous plasma using liquid chromatography-tandem mass spectrometry. Partial correlation models adjusting for covariates examined relationships between TK metabolites and actigraphy-based sleep metrics by HIV status.</p><p><strong>Results: </strong>MWH (n=346) were slightly younger (mean age: 54 vs 61 yr) and more likely to be black (32% vs. 20%) than MWoH (n=304). The vast majority (96%) of MWH were virally suppressed. MWH had lower sleep efficiency, 86.6% vs 88.5% (p<0.001) than MWoH. MWH had lower tryptophan and higher kynurenine levels, indicative of TK pathway activation, and higher levels of the neurotoxic downstream kynurenine metabolites 3-hydroxykynurenine (3-HK) and quinolinic acid (QA). Higher KT ratio and 3-HK and QA levels were associated with lower sleep efficiency in MWH after multivariable adjustment.</p><p><strong>Conclusion: </strong>TK pathway activation and higher neurotoxic metabolites (3-HK, QA) were associated with poorer sleep efficiency among MWH but not MWoH. Further research exploring causal mechanisms is required to develop targeted strategies for improving sleep in this population.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169002","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":"Identification of venues for HIV prevention interventions through overlapping HIV transmission and venue elicitation networks.","authors":"Britt Skaathun, Maryam Hussain, Vanessa M Dávila, Eduardo Lopez Ortiz, Rocío Carrasco-Hernández, Claudia Garcia-Morales, Francisco Soto, Chi Fang, Margarita Matias-Florentino, Andrea González-Rodríguez, Israel Macias-Gonzalez, Raul A Cruz-Flores, Sanjay R Mehta, Santiago Ávila-Ríos","doi":"10.1097/QAI.0000000000003980","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003980","url":null,"abstract":"<p><strong>Background: </strong>Understanding the role of physical venues in HIV transmission may be advantageous for targeting HIV prevention efforts, especially among groups experiencing high HIV incidence.</p><p><strong>Setting: </strong>Large public clinic in Mexico City, Mexico.</p><p><strong>Methods: </strong>We analyzed data from 7,502 participants examining demographic, behavioral, and venue network characteristics associated with molecular HIV cluster membership (potentially indicating recent HIV transmission events). Participants nominated venues where they met partners. We constructed a co-affiliation network by linking venues that were co-nominated by the same individuals and analyzed this network for centrality and clustering within the HIV transmission network.</p><p><strong>Results: </strong>Approximately 51% of participants were part of a molecular HIV cluster. Several venues exhibited both high centrality and high proportions of nominators in HIV clusters, identifying them as priority sites for intervention. Venues with higher eigenvector centrality (influence) and with more nominations had higher odds of being named by individuals in HIV clusters (OR 2.53; 95% CI: 1.45-4.41) and (OR 1.01; 95% CI: 1.01-1.02) respectively.</p><p><strong>Conclusions: </strong>Venue-based network analysis revealed high-priority sites for HIV prevention, underscoring the importance of targeting interventions at highly connected venues. Incorporating venue-level strategies into HIV prevention efforts may help reduce transmission within and across sexual networks.</p><p><strong>Clinical trial number: </strong>N/A.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168617","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":"Safety and Efficacy of Doravirine/Islatravir (100 mg/0.25 mg) Once Daily after Islatravir Dose Reduction from 0.75 mg: Week 96 Results from an Open-Label Phase 3 Study in Adults with HIV-1.","authors":"Rosie Mngqibisa, Sheetal Kassim, Cheryl McDonald, Mark Bloch, Eugenie Colin-Benoit, Moti Ramgopal, Hiroyuki Gatanaga, Tracy L Diamond, Euna Kim, Uchechukwu Nwoke, Michelle C Fox, Luisa M Stamm, Mengchun Li, Wayne Greaves","doi":"10.1097/QAI.0000000000003981","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003981","url":null,"abstract":"<p><strong>Background: </strong>Once-daily doravirine/islatravir (DOR/ISL 100 mg/0.25 mg) demonstrated non-inferior efficacy and comparable safety to continuing prior antiretroviral therapy in two phase 3 studies of virologically suppressed adults with HIV-1. We assessed the safety and efficacy of DOR/ISL (100 mg/0.25 mg) in participants who received ISL (0.75 mg) in previous clinical studies.</p><p><strong>Methods: </strong>In this phase 3, open-label, single-arm study (NCT05766501), adults with HIV-1 RNA <200 copies/mL while receiving DOR/ISL (100 mg/0.75 mg) switched to DOR/ISL (100 mg/0.25 mg). Primary objectives were the safety and tolerability of DOR/ISL through week 96. Secondary objectives included antiretroviral activity (FDA snapshot approach) and changes in total lymphocyte and CD4+ T-cell counts.</p><p><strong>Results: </strong>639 participants were treated: 69.3% were male, 55.7% White, median age 44.0 (range 20-79) years, and median time on DOR/ISL before enrollment 2.7 years. By week 96, 559 participants (87.5%) reported adverse events, which were considered drug-related in 19 (3.0%). Six participants (0.9%) discontinued due to adverse events, one of which was considered drug-related. At week 96, HIV-1 RNA was <50 copies/mL in 589 participants (92.2%) and ≥50 copies/mL in 6 (0.9%). Three participants (0.5%) had confirmed HIV-1 RNA ≥200 copies/mL; resistance results were not available due to assay failure. Mean increases from day 1 (of the current study) were 16.2% for total lymphocyte count and 18.1% for CD4+ T-cell count.</p><p><strong>Conclusions: </strong>Once-daily DOR/ISL (100 mg/0.25 mg) demonstrated favorable safety and tolerability through week 96 and maintained virologic suppression in >92% of participants. DOR/ISL remained effective and well-tolerated for over 4.5 years.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172137","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":"Strengthening Panama's HIV Viral Load Testing Network through a Phased Optimization Strategy: A Retrospective Program Assessment, 2021-2025.","authors":"Sandra I Juarez, Andrés Azmitia Rugg, Cristine Gutierrez, Lissette Chang, David Cortes, Rolando Lorenzana, Carlos Vargas, B Ryan Phelps, Ravikiran Bhairavabhotla","doi":"10.1097/QAI.0000000000003977","DOIUrl":"10.1097/QAI.0000000000003977","url":null,"abstract":"<p><strong>Background: </strong>In 2021, Panama identified structural and operational gaps in its national HIV viral load (HIV VL) testing network, in the context of low testing coverage. A phased strategy was implemented to strengthen testing capacity, quality, geographic access, and referral pathways.</p><p><strong>Setting: </strong>Panama's national HIV VL testing network.</p><p><strong>Methods: </strong>We conducted a retrospective program assessment of the national HIV VL network optimization strategy implemented from 2021-2025. A 2021 baseline assessment included two HIV VL reference laboratories and 13 antiretroviral therapy (ART) clinics representing 93% of the ART cohort reported in the programmatic data used for the assessment. Findings informed phased optimization, including redistribution of testing, establishment of regional capacity, and differentiated use of GeneXpert for priority HIV VL testing. Programmatic data were used to assess HIV VL coverage, viral suppression, testing distribution, and turnaround time.</p><p><strong>Results: </strong>HIV VL testing increased from 6,967 tests in 2021 to 15,897 in 2025, while the ART cohort increased 25%, from 14,560 to 18,200. HIV VL coverage increased from 47% to 89%, and viral suppression from 78% to 94%. Testing was redistributed across the laboratory network. Post-optimization routine turnaround time was approximately 1 week at the regional Veraguas laboratory and 10 days at ICGES; priority GeneXpert testing provided results in approximately 24 hours.</p><p><strong>Conclusion: </strong>Panama's phased optimization was associated with expanded HIV VL testing access, increased coverage, redistributed testing capacity, and more timely testing pathways. These findings represent programmatic trends and should not be interpreted as causal effects of the strategy.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169910","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":"Comparing Structural Determinants, Psychosocial Factors, and Individual-Level Risk Indicators for Women's HIV Prevention in the Urban South.","authors":"Abigail LeCates, Megan Schwinne, Mingya Yang, Mariam Assi, Chad Robichaux, Emma Hollenberg, Anandi N Sheth, Sarah Gruber, Meredith Lora","doi":"10.1097/QAI.0000000000003984","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003984","url":null,"abstract":"<p><strong>Background: </strong>Cisgender women, particularly Black women in the Southeastern U.S., experience substantial HIV risk. While current prevention strategies emphasize individual-level risk indicators, understanding the relative contributions of structural determinants and psychosocial factors is essential. This study aimed to evaluate the effects of structural determinants, psychosocial factors, and individual indicators on HIV risk among women in a high-incidence U.S. region.</p><p><strong>Methods: </strong>Retrospective cohort of adults assigned female at birth, with ≥1 encounter at Grady Health, a safety-net system serving two of Atlanta's Ending the HIV Epidemic counties (2012-2022). New HIV diagnoses were identified using state surveillance. Logistic regression estimated associations between structural, psychosocial and individual-level indicators and HIV. Population attributable fractions (PAFs) were derived from multivariable models.</p><p><strong>Results: </strong>Of 333,263 women, 617 (0.19%) acquired HIV; 88% were Black, mean age was 41. Structural determinants were common and strongly associated with HIV, specifically above-median SVI (aOR=1.7 [1.5-2.0]) and housing insecurity (5.2 [3.9-6.7]). Psychosocial factors such as substance use disorder (3.8 [3.1-4.6]) and individual-level indicators like STIs [3.1 [2.2-4.4]) were also associated. PAF analyses indicated that structural determinants, specifically residence in high-prevalence HIV zip codes (PAF=63% [57%-70%]) and above-median SVI (21% [14%-27%]), accounted for a larger share of population-level HIV risk than individual-level indicators like STIs (5% [3%-7%]).</p><p><strong>Conclusion: </strong>Structural determinants were more strongly associated with HIV and explained a greater share of population-level risk than individual-level indicators. Integrating community context into risk tools may better identify PrEP candidates and support prevention in high-incidence settings.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130147","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":"Exploring provider preferences for HIV treatment support packages integrating long-acting injectable antiretroviral therapy in New York Ryan White Part A medical case management programs.","authors":"Rebecca Zimba, Elizabeth A Kelvin, Sarah Kulkarni, Jennifer Carmona, Tigran Avoundjian, Connor Emmert, Meghan Peterson, Mary Irvine, Denis Nash","doi":"10.1097/QAI.0000000000003978","DOIUrl":"10.1097/QAI.0000000000003978","url":null,"abstract":"<p><strong>Background: </strong>Understanding the preferences of core HIV medical case management (MCM) program staff for long-acting injectable antiretroviral therapy (LAI ART)-related support services could help integrate those services into MCM programs, thus facilitating uptake of LAI ART and increasing opportunities for viral suppression among clients who have struggled with daily oral ART adherence.</p><p><strong>Setting: </strong>New York City (NYC)-area Ryan White Part A MCM programs.</p><p><strong>Methods: </strong>We conducted a survey among MCM program administrators, clinicians, and non-clinical direct-service providers (hereafter, \"providers\") concerning LAI ART adherence supports. The survey included a discrete choice experiment (DCE) and implementation-readiness and choice-motivation questions. We defined four DCE attributes with 2-4 levels each: Type of ART Medication (monthly/bimonthly LAI ART), Service Location and Mode, Support for Clients, and Rewards for Clients. We ran latent class analysis (LCA) to explore hypothesis-free preference heterogeneity.</p><p><strong>Results: </strong>From July 2022-January 2023, 177 providers completed surveys. About half (52%) were aged 40-59, 72% were women, and the plurality (41%) were Latino/a. In the two-group LCA solution, both groups preferred Bimonthly over Monthly LAI ART. Group 1 (n=45) preferred conventional approaches (e.g., clinic-based injections) whereas Group 2 (n=132) preferred more client-centered approaches (e.g., home-based injections). Reported motivations focused on client convenience. Implementation measures indicated endorsement of LAI ART supports.</p><p><strong>Conclusions: </strong>Our implementation science study suggests that NYC-area MCM providers are motivated to facilitate LAI ART access and adherence. More work is needed to understand what LAI ART-related services programs have integrated, track uptake, and ascertain impacts on viral suppression.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130155","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":"Correlates of confidence to utilize non-occupational Post-Exposure Prophylaxis (PEP) if needed among sexual minority men in relationships.","authors":"Demetria Cain, Christel Adhemar, Kaitlyn Howe, Lila Amin, Tyrel J Starks","doi":"10.1097/QAI.0000000000003979","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003979","url":null,"abstract":"<p><strong>Background: </strong>Non-occupational post-exposure prophylaxis (PEP) is an underutilized biomedical prevention strategy and may be beneficial for sexual minority men (SMM) who are in relationships and not currently taking pre-exposure prophylaxis (PrEP). The goal of this study was to examine relationship characteristics as well as behavioral and structural correlates of confidence to utilize PEP if needed.</p><p><strong>Methods: </strong>A sample of 5,370 partnered SMM not taking PrEP completed an online survey. Bivariate comparisons evaluated differences in confidence to utilize PEP. An ordinal regression determined whether the association between relationship quality and confidence to utilize PEP was moderated by sexual agreements.</p><p><strong>Results: </strong>Fifty-seven percent of the sample endorsed feeling highly confident they would utilize PEP if needed. Relationship quality had a significant and positive relationship with confidence to utilize PEP among SMM in relationships with non-monogamous agreements (OR = 1.01; p < .001), but not among those with monogamous agreements (OR = 0.99; p = .462). At high levels of relationship quality, SMM in relationships with non-monogamous agreements were significantly more confident in their ability to utilize PEP if needed (OR = 1.27; p = .005), but not at low levels of relationship quality (OR = 0.89; p = .185). Feeling confident in accessing and affording PEP was associated with confidence in utilizing PEP over and above HIV testing frequency and previously taking PrEP.</p><p><strong>Conclusions: </strong>HIV prevention services for partnered SMM, like couples HIV testing and counseling or PrEP navigation, should stress PEP as an alternative option during a potential exposure event.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122829","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":"Clinical Characteristics of Adolescents and Youth Living With HIV Transitioning From Pediatric to Adult Clinics Before and After 18 Years in Asia.","authors":"Nichkamol Lertamornkitti, Chatkamol Pheerapanyawaranun, Oanh N Le, Revathy A Nallusamy, Tavitiya Sudjaritruk, Thahira J Mohamed, Thanyawee Puthanakit, Pradthana Ounchanum, Pope Kosalaraksa, Vohith Khol, Nagalingeswaran Kumarasamy, Nguyen D Qui, Lam Van Nguyen, Nik K N Yusoff, Aarti Kinikar, Quy T Du, Siew M Fong, Dina Muktiarti, Annette H Sohn, Kulkanya Chokephaibulkit","doi":"10.1097/QAI.0000000000003914","DOIUrl":"10.1097/QAI.0000000000003914","url":null,"abstract":"<p><strong>Background: </strong>Transitioning from pediatric to adult HIV care is critical for adolescents and young adults living with HIV (AYLH). This study assessed the timing and factors associated with this transition in Asia.</p><p><strong>Setting: </strong>Retrospective study of AYLH enrolled in Therapeutics Research, Education, and AIDS Training Asia Pediatric HIV Observational Database clinics between May 1991 and December 2020.</p><p><strong>Methods: </strong>Eligible AYLH were categorized into <18-year-old transitions, and ≥18-year-old transitions or continued pediatric care.</p><p><strong>Results: </strong>The analysis included 1803 AYLH from 6 countries. Of these, 92.7% (n = 1672) had perinatally acquired HIV, and 69.9% (n = 1260) were ≥18-year-old transitions or continued pediatric care. Excluding AYLH who remained in pediatric care, median age at transition was 16.1 years (interquartile range [IQR]: 14.9-17.0) for <18-year-old transitions and 20.0 years (IQR: 19.1-21.2) for ≥18-year-old transitions. At age 18, among 1368 AYLH with available viral load data, 72.9% (n = 998) had viral loads <50 copies/mL (78.9% in <18-year-old transitions [n = 310/393] vs 70.6% in ≥18-year-old transitions [n = 688/975]; P = 0.002). The median CD4 count was 635 cells/μL (IQR: 450-842). Factors independently associated with transitions at ≥18-year-old or continued pediatric care included residence in an upper-middle-income country (adjusted odds ratio [aOR] 10.68 [95% confidence interval (CI): 7.76 to 14.68], P < 0.001), living with family (aOR 2.81 [95% CI: 1.99 to 3.97], P < 0.001), and previous antiretroviral therapy class switching (aOR 1.91 [95% CI: 1.34 to 2.72], P < 0.001).</p><p><strong>Conclusion: </strong>Most AYLH in this cohort transitioned at ≥18 years of age. About one-fourth had unsuppressed viral loads at age 18, irrespective of transition status, underscoring the need for personalized treatment approaches that support antiretroviral therapy adherence from pediatric care, preparing AYLH for transition to adult clinics.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"1165-1173"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Housing Instability and HIV Care Outcomes Among People With HIV in the United States.","authors":"Carolyn A Fahey, Bridget M Whitney, Lydia N Drumright, Shruti H Mehta, Sonia Napravnik, Deana Agil, George Yendewa, Greer Burkholder, Rob J Fredericksen, Julia Fleming, Maile Karris, Gregory D Kirk, Stephanie A Ruderman, L Sarah Mixson, Marianna K Baum, Joseph A C Delaney, Catherine R Lesko, Richard D Moore, Mari M Kitahata, Heidi M Crane, Raul N Mandler, Geetanjali Chander","doi":"10.1097/QAI.0000000000003906","DOIUrl":"10.1097/QAI.0000000000003906","url":null,"abstract":"<p><strong>Background: </strong>People with HIV (PWH) disproportionately experience homelessness and other forms of housing instability. Understanding how housing status influences HIV clinical outcomes remains limited, especially among individuals engaged in care.</p><p><strong>Methods: </strong>We evaluated associations between housing status and HIV care markers using clinical data and patient-reported measures from the Centers for AIDS Research Network of Integrated Clinical Systems cohort of adults receiving HIV care across the United States (US), between 2019 and 2025. We used relative risk regression and linear regression to estimate associations between self-perceived housing instability and outcomes including HIV viral suppression (<200 copies/mL), self-reported antiretroviral therapy (ART) use and adherence (visual analog scale), and CD4 cell count, adjusted for demographic characteristics, year, and site.</p><p><strong>Results: </strong>Among 6873 individuals in clinical care, nearly 10% reported some form of housing instability at their most recent visit: 4.6% \"Unstable,\" 3.3% \"Homeless,\" and 1.7% \"Do not know.\" Compared with stably housed individuals, the prevalence of viral suppression was lower among those experiencing homelessness [prevalence ratios (PR) = 0.82, 95% CI: 0.77 to 0.89] and unstable housing (PR = 0.94, 95% CI: 0.90 to 0.98), as was the prevalence of ART use, mean ART adherence, and mean CD4 count. Results were similar when stratified by substance use and depression and when compared with a community-based cohort of PWH.</p><p><strong>Conclusion: </strong>Housing instability is associated with a lower prevalence of HIV viral suppression even among individuals engaged in clinical care. These results highlight lack of access to stable housing as a structural barrier to successful management of HIV and to ending the HIV epidemic in the US.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"1074-1081"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}