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

{"title":"Use of Long-acting Injectable Antiretroviral Therapy in Kidney and Liver Transplant Recipients with HIV.","authors":"Christine Durand, Sarah Hussain, Sabrina Kopf, Shikha Mehta, Navya Eleti, Meenakashi Rana, Valentina Stosor, Sander Florman, Jonathan Hand, Nathaniel Erdmann","doi":"10.1097/QAI.0000000000003951","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003951","url":null,"abstract":"<p><strong>Background: </strong>The 2013 HIV Organ Policy Equity Act facilitated HIV-to-HIV organ transplants, enabling people with HIV to receive transplants more quickly. However, managing drug interactions between ART and immunosuppressive regimens remains a challenge.</p><p><strong>Objective: </strong>This study assesses the safety and effectiveness of cabotegravir/rilpivirine (CAB/RPV), an injectable ART, in maintaining HIV virologic suppression in kidney and liver transplant recipients.</p><p><strong>Methods: </strong>A retrospective review of three clinical studies evaluated CAB/RPV in transplant recipients with HIV. Participants had suppressed HIV RNA levels before transplant and were monitored post-transplant every six months.</p><p><strong>Results: </strong>Nine transplant recipients (7 kidney, 2 liver) received CAB/RPV. All maintained HIV suppression, with no allograft loss, although one liver recipient experienced acute rejection. One participant died from trauma unrelated to the transplant or HIV.</p><p><strong>Conclusion: </strong>CAB/RPV shows promise for HIV management after transplantation. Further research is needed using a larger cohort.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805173","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":"Sources of Active Brain White Matter Injury in Virally Suppressed HIV Infection Revealed Through Fixel-Based Analysis.","authors":"David Jakabek, Andrew Chung Bch Sci, Kurt Lancaster, Bruce J Brew, Caroline D Rae, Lucette A Cysique","doi":"10.1097/QAI.0000000000003946","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003946","url":null,"abstract":"<p><strong>Background: </strong>To better understand HIV and cardiovascular disease (CVD) effects on brain white matter during HIV infection, advanced diffusion imaging and comprehensive predictor analyses are essential.</p><p><strong>Setting: </strong>Prospective observational cohort study.</p><p><strong>Method: </strong>84 virally suppressed people with HIV infection (PWH) and 48 uninfected controls underwent T1-weighted, FLAIR, and diffusion MRI at baseline and 24 months later (75 PWH and 40 controls). White Matter Hyperintensity (WMH) volumes were derived from structural scans. Fixel-based analysis tract-based metrics included fibre density (FD), fibre cross-section (FC) and fibre density and cross-section (FDC).</p><p><strong>Results: </strong>Relative to controls, mixed models showed significant reductions (p<.05 - p<.01) of FC, and lower FDC to a lesser extent, in multiple long cortical association tracts, and within striatal- and thalamic-frontoparietal connections in PWH at both time points. Higher CVD risk was associated with reduced FC in the arcuate fasciculus and FDC in the cingulate gyrus (p<.05). In PWH, more severe cognitive impairment and longer duration of HIV disease was associated with worse FDC across multiple tracts (p<.03 - p<.001). Lower baseline CD4 counts was associated with lower FD in the frontal association tracts (p<.05 - p<.005). Higher WMH volume was associated with higher CVD risk (periventricular p<.001, deep p<.03), but not HIV status.</p><p><strong>Conclusions: </strong>Major brain white matter tracts are impacted by HIV status, HIV duration, cognitive impairment, baseline CD4, and CVD risk to a lesser extent, despite equal WMH burden between infection groups. Our study provides further evidence of active immuno-vascular underpinning of HIV neuropathogenesis on fine white matter structure despite controlled HIV.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687517","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":"HIV care interruptions during the first year of antiretroviral therapy among adolescents and young adults living with HIV aged 15-24 years in Khayelitsha, South Africa.","authors":"Patience Nyakato, Jonathan Euvrard, Chido Chinogurei, Andrew Boulle, Erin von der Heyden, Mary-Ann Davies","doi":"10.1097/QAI.0000000000003948","DOIUrl":"10.1097/QAI.0000000000003948","url":null,"abstract":"<p><strong>Background: </strong>Adolescents and young adults living with HIV (AYAHIV) aged 15-24 years experience poorer HIV outcomes than other age groups, with frequent interruptions from care. Interruptions during the first year of antiretroviral therapy (ART) are especially concerning, as they occur before sustained viral suppression. We estimated the incidence of early HIV care interruption and associated factors among AYAHIV initiating ART in the Khayelitsha cohort, Western Cape, South Africa.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of AYAHIV initiating ART between 2017 and 2021. Early HIV care interruption was defined as ≥90 days late for a scheduled refill without documented death or transfer. Participants were followed for 12-15 months. Cox proportional hazards models assessed associated factors, adjusting for age, sex, calendar year, dispensing interval (single-month vs multi-month), and regimen among 2020-2021 initiators. A sensitivity analysis was restricted to those with ≥4 refills.</p><p><strong>Results: </strong>Among 5,149 AYAHIV (85% female; median age 23 years), 44% experienced early interruption, most within six months. Initiation in 2020 (adjusted Hazard ratio (aHR): 1.10, 95% confidence interval (95% CI): 1.03, 1.17) and 2021 (aHR: 1.28 95% CI: 1.18, 1.39) was associated with increased interruption risk versus 2017-2019. Dolutegravir was associated with a reduced risk compared to efavirenz (aHR: 0.87 95% CI: 0.78, 0.97). In sensitivity analyses (n=3,013), 32% interrupted, with similar associations.</p><p><strong>Conclusions: </strong>Early HIV care interruption was common, particularly during COVID-19. Dolutegravir was associated with improved retention, yet substantial early interruptions persisted, highlighting the need for intensified youth-focused support following ART initiation.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687457","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":"\"Delivering high-quality care in this setting requires a lot of resources\": HPTN 094 Implementation Lessons from Delivering Integrated HIV and MOUD Care Through Mobile Units In Local Neighborhoods.","authors":"Kiyomi Tsuyuki, Renee El-Krab, Steven Shoptaw, Nabila El-Bassel, Jordan E Lake, Manya Magnus, Irene Kuo, David Goodman-Meza, Cecile Denis, Omar Nieto, Julie Franks, Yolanda R Villareal, Peter Smith, Sydney Bornstein, Philip Andrew, Jayla Harris-Wisecarver, Rahul Paul Choudhury, Amaya Perez-Brumer, Peter Davidson, Laramie R Smith","doi":"10.1097/QAI.0000000000003947","DOIUrl":"10.1097/QAI.0000000000003947","url":null,"abstract":"<p><strong>Background: </strong>The HIV Prevention Trials Network 094 INTEGRA study sought to fill the gap in implementation science literature by exploring the delivery of integrated prevention and care for HIV and opioid use dependence (OUD) through mobile units to people who inject drugs (PWID).</p><p><strong>Setting: </strong>Five U.S. INTEGRA sites with diverse implementation landscapes disproportionately affected by the HIV and opioid epidemics (New York, Philadelphia, Washington, DC, Houston, Los Angeles) .</p><p><strong>Methods: </strong>In-depth qualitative interviews from an embedded implementation science evaluation were conducted with 37 clinical and research INTEGRA staff delivering integrated care through mobile units. Pragmatic qualitative analysis was guided by the PRISM framework to identify key implementation needs, challenges, and solutions for delivering the INTEGRA intervention via mobile units in local neighborhoods.</p><p><strong>Results: </strong>Staff described how mobile delivery of INTEGRA reduced key barriers that limit PWID access to HIV and OUD services. Yet, they also detailed complex implementation needs, including the proactive coordination among staff to ensure sustained access to INTEGRA services, navigating internal and external spaces to deliver services, maintenance-related demands to keep the mobile unit's infrastructure operational, and interdependent efforts that bridged the mobile unit's service delivery within the extant health systems and community landscapes.</p><p><strong>Conclusion: </strong>Findings demonstrated that mobile integrated care models can reduce access barriers for PWID but require tailored implementation strategies to address operational, spatial, infrastructural, and community-level demands. Results may help inform an implementation blueprint for similar communities working to respond to the intersecting HIV and opioid epidemics affecting PWID across U.S. settings.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148682053","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":"Epidemiologic Impact of Prioritizing Long-Acting Injectable Cabotegravir to Men Who Have Sex With Men With Low Pre-Exposure Prophylaxis Use Adherence in the Netherlands: A Mathematical Modeling Study.","authors":"Haoyi Wang, Kai J Jonas, David van de Vijver","doi":"10.1097/QAI.0000000000003882","DOIUrl":"10.1097/QAI.0000000000003882","url":null,"abstract":"<p><strong>Background: </strong>Long-acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP), given once every 8 weeks, has been found to have superior efficacy over oral PrEP among men who have sex with men (MSM). We compared the epidemiologic impact of expanding CAB-LA to current oral PrEP users with different levels of adherence, and non-PrEP users among MSM in the Netherlands.</p><p><strong>Methods: </strong>An MSM HIV transmission model was calibrated to the Dutch MSM HIV epidemic. The real-world effectiveness of daily oral-PrEP was assumed to decrease by users' adherence levels: High (defined as >75% of the days covered, 93% effectiveness), medium (50%-74% covered, 69%), and low (<50% covered, 18%), respectively. CAB-LA effectiveness was assumed as 91%. CAB-LA was targeted to current oral-PrEP users by their use adherence and non-PrEP-using MSM in 2025. The epidemiologic impact of CAB-LA targeting strategies was evaluated for 5, 15, and 25 years.</p><p><strong>Results: </strong>Assuming 100% coverage, providing CAB-LA to MSM with low oral PrEP adherence would avert 862 (19.7%) new HIV infections among all MSM for 25 years. Expanding CAB-LA to MSM with medium/high oral PrEP adherence and non-PrEP users did not show a substantial epidemiologic impact. Moreover, our model suggested that the epidemiologic impact would decrease with a lower real-world CAB-LA effectiveness.</p><p><strong>Conclusions: </strong>Our model showed that CAB-LA can be an important addition to ending the HIV epidemic by 2030. To optimize the full potential of CAB-LA at the beginning stage of CAB-LA introduction, we suggest prioritizing the transition of current oral PrEP users with low adherence to CAB-LA to reduce HIV transmissions more efficiently.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"871-880"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148020475","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":"Optimizing Antihypertensive Care for Tanzanians Living With HIV: Effectiveness Outcomes From the COACH Pilot Trial.","authors":"Julian T Hertz, Faraan Rahim, Claire Wang, Arthi Vaidyanathan, Lisa Wanda, Francis M Sakita, Blandina T Mmbaga, Godfrey L Kweka, Jerome J Mlangi, Rennyda Zebedayo, Francis Gwasma, Tarun Prakash, Tazeen H Jafar, Hayden B Bosworth, Nathan M Thielman, Preeti Manavalan","doi":"10.1097/QAI.0000000000003874","DOIUrl":"10.1097/QAI.0000000000003874","url":null,"abstract":"<p><strong>Background: </strong>In Tanzania, many people living with HIV have uncontrolled hypertension, yet integration of hypertension management into HIV care remains limited. The Community Health Worker Optimization of Antihypertensive Care in HIV (COACH) intervention was developed to integrate standardized hypertension management into HIV clinic workflows.</p><p><strong>Setting: </strong>A single-arm pilot trial was conducted from December 2024 to September 2025 at 2 public HIV clinics in Moshi, Tanzania.</p><p><strong>Methods: </strong>COACH included 6 monthly community health worker-delivered hypertension education sessions within HIV clinic visits, monthly blood pressure (BP) checks, care coordination, subsidized antihypertensive medications, a standardized treatment algorithm, and provider training. The primary effectiveness outcome was BP control at 6 months (<140/<90 mm Hg). Secondary effectiveness outcomes included systolic and diastolic BP, Hypertension Knowledge Level Scale score, medication adherence, body mass index, and 5-year cardiovascular risk. Paired t tests and McNemar tests compared baseline and follow-up values.</p><p><strong>Results: </strong>Of 100 participants, 96 completed follow-up. Six-month BP control was achieved in 73 participants (76%). Mean systolic BP decreased from 159.6 mm Hg at baseline to 130.8 mm Hg at follow-up (-28.9 mm Hg, P < 0.001); diastolic BP decreased from 100.8 to 85.5 mm Hg (-15.4 mm Hg, P < 0.001). Hypertension Knowledge Level Scale scores increased from 15.0 to 20.4 (P < 0.001), and self-reported adherence improved from 14.0% to 95.0% (P < 0.001). Mean body mass index decreased from 27.0 to 26.6 kg/m2 (P = 0.019), and the proportion with ≥20% 5-year cardiovascular risk declined from 33% to 7% (P < 0.001).</p><p><strong>Conclusions: </strong>COACH resulted in substantial improvements in BP control, hypertension knowledge, medication adherence, and cardiovascular risk among people living with HIV in Tanzania.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":"101 8","pages":"896-906"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431874","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":"Effect of COVID-19 on Late HIV Diagnosis Rates by Race/Ethnicity in Ending the HIV Epidemic Priority Jurisdictions in the United States.","authors":"Qiyou Wu, Sayyeda Karim, Minh-Tri Van, Benjamin Enns, Brenda C Guerra-Alejos, Brandon D L Marshall, Bruce R Schackman, Carlos Del Rio, Czarina N Behrends, Eva Enns, Hansel E Tookes, Lisa Rosen-Metsch, Matthew Golden, Steffanie A Strathdee, Shruti H Mehta, Wendy S Armstrong, Bohdan Nosyk, Xiao Zang","doi":"10.1097/QAI.0000000000003888","DOIUrl":"10.1097/QAI.0000000000003888","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to determine the effect of the COVID-19 pandemic on changes in late HIV diagnoses by race/ethnicity across Ending the HIV Epidemic (EHE) priority jurisdictions in the US.</p><p><strong>Methods: </strong>We analyzed annual county-level and state-level (when county-level data were unavailable) late HIV diagnosis data in EHE priority jurisdictions from local epidemiological profiles and the AIDSVu between 2017 and 2022. Descriptive analyses were conducted to examine the percentages of late diagnoses across racial/ethnic groups before and after the onset of the pandemic. We then used interrupted time-series analysis to assess changes in both the level and trend of late diagnosis percentages across non-Hispanic White, non-Hispanic Black, and Hispanic populations.</p><p><strong>Results: </strong>We included a total of 31 jurisdictions. The highest percentages of late HIV diagnoses were more often reported among Black or Hispanic populations. There were statistically significant ( P < 0.05) downward trends in late diagnosis percentages before the pandemic among the Black population in Kings County, NY (-3.8%), Georgia (-0.8%), and Los Angeles County, CA (-4.5%), and among the Hispanic population in Georgia (-4.9%). Subsequently, there were significant immediate increases in 2020 in the Black population in Kings County, NY (11.5%), Georgia (2.5%), and Los Angeles County, CA (10.8%), and among the Hispanic population in Georgia (11.5%). In addition, there was a significant annual increase in the trend after the onset of the pandemic in both the Black (1.0%) and Hispanic populations (4.8%) in Georgia. By contrast, no statistically significant changes were found in the White population.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic seems to have exacerbated existing race/ethnic disparities in late HIV diagnoses among several EHE jurisdictions.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"803-811"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13377573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694748","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":"Long-Acting Injectable Cabotegravir HIV PrEP Uptake, Adherence, and Persistence in Two Large US Integrated Healthcare Systems.","authors":"Michael W Traeger, Wendy A Leyden, Lindsay G Eberhart, Jonathan E Volk, Michael J Silverberg, Michael A Horberg, Teaniese L Davis, Kenneth H Mayer, Douglas S Krakower, Jessica G Young, Samuel M Jenness, Julia L Marcus","doi":"10.1097/QAI.0000000000003889","DOIUrl":"10.1097/QAI.0000000000003889","url":null,"abstract":"<p><strong>Background: </strong>Long-acting cabotegravir (CAB-LA) was approved as HIV preexposure prophylaxis (PrEP) in the United States in December 2021, but data are limited on uptake, adherence, and persistence in clinical practice.</p><p><strong>Methods: </strong>We extracted electronic health records of adults receiving oral or injectable PrEP during December 2021 to June 2024 at Kaiser Permanente (KP) Northern California and Mid-Atlantic States, 2 large integrated healthcare systems. We used χ 2 tests to compare characteristics of CAB-LA users and oral-PrEP-only users. Among CAB-LA users, we assessed adherence to bimonthly injections after lead-in doses (weeks 0 and 4) and used Kaplan-Meier methods to estimate persistence.</p><p><strong>Results: </strong>Among 23,311 individuals accessing oral or injectable PrEP, 180 (0.8%) received CAB-LA, with 23.9% having no documentation of previous PrEP use at KP. Compared with oral-PrEP-only users, a lower proportion of CAB-LA users were commercially insured (82.2% vs 89.2%; P = 0.014) and a higher proportion were Black (18.9% vs 10.2%) or Hispanic (34.4% vs 23.6%; P < 0.001 across race/ethnicity categories). Of 688 non-lead-in CAB-LA injections, 90.4% were administered within 8 weeks +7 days after the previous injection. Persistence on CAB-LA was 87.9% and 74.9% at 6 and 12 months, respectively. There were no incident HIV infections during CAB-LA use.</p><p><strong>Conclusions: </strong>CAB-LA is engaging new users, including populations traditionally underrepresented in PrEP uptake, and adherence and persistence are high in clinical practice. However, uptake of CAB-LA is extremely low, suggesting population affect will be limited without efforts to expand implementation and use.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"812-818"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978639","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":"Validating HIV Viral Suppression Threshold Adjustments for Comparable Estimates Using Data From Nationally Representative Household Surveys in Sub-Saharan Africa.","authors":"Olanrewaju Edun, Lucy Okell, Timothy M Wolock, Eline L Korenromp, Leigh F Johnson, Jeffrey W Imai-Eaton","doi":"10.1097/QAI.0000000000003878","DOIUrl":"10.1097/QAI.0000000000003878","url":null,"abstract":"<p><strong>Introduction: </strong>To enable comparable global assessments of viral load suppression (VLS) among people living with HIV on antiretroviral therapy, the Joint United Nations Programme on HIV/AIDS applies a model to adjust VLS estimates reported at different thresholds to a common viral load ≤1000 copies/mL definition. We assessed performance of the current reverse Weibull model and alternatives using survey data from sub-Saharan Africa.</p><p><strong>Methods: </strong>Using data from 21 Population-based HIV Impact Assessment surveys in 16 sub-Saharan African countries (2015-2022), we assessed 6 models (Weibull, reverse Weibull, Pareto, Fréchet, gamma, and lognormal) in adjusting VLS reported at viral load <50, <200, <400 copies/mL to ≤1000. We compared predictions using parameters from Johnson et al and recalibrated using Population-based HIV Impact Assessment surveys, assessing whether new shape parameters improved adjustments and varied by sex and age.</p><p><strong>Results: </strong>In adjustments from all thresholds, the Weibull model had the lowest prediction errors (root-mean-squared error for <200 to ≤1000: Weibull: 1.9%; reverse Weibull: 3.1%; Pareto: 2.5%). Prediction errors for reverse Weibull and Pareto models were higher in subgroups with low VLS compared with Weibull. Across 21 surveys, in adjustments from <200 to ≤1000, reverse Weibull overestimated VLS by 2.3%, compared with 1.5% by Weibull and Pareto. The Fréchet, gamma, and lognormal models performed similarly to Weibull. Shape parameter estimates for the Weibull and reverse Weibull were slightly higher after recalibration and varied by sex and age.</p><p><strong>Conclusions: </strong>The Weibull, Fréchet, gamma, and lognormal models provided more reliable VLS adjustments across thresholds than the previously recommended reverse Weibull model, avoiding inflated VLS estimates that could obscure gaps in HIV treatment programs and underestimate HIV transmission risks.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"827-835"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694843","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":"Brief Report: Association Between Pharmacologic Tenofovir Adherence Measures and Subsequent 24-Week Viral Load Outcomes for People With HIV in South Africa.","authors":"Nicola Bodley, Katya Govender, Pravikrishnen Moodley, Natasha Samsunder, Yukteshwar Sookrajh, Philip J Turner, Christopher C Butler, Gail N Hayward, Monica Gandhi, Paul K Drain, Nigel Garrett, Jienchi Dorward","doi":"10.1097/QAI.0000000000003866","DOIUrl":"10.1097/QAI.0000000000003866","url":null,"abstract":"<p><strong>Background: </strong>Objective measures of antiretroviral therapy adherence, such as tenofovir (TFV) concentrations, may allow for targeted interventions to prevent future HIV viremia. We evaluated 3 TFV adherence measures and their association with current and 24-week viral load outcomes.</p><p><strong>Methods: </strong>In a South Africa-based trial, we measured urine TFV using a point-of-care (POC) antibody-based assay and 2 metrics assessed through liquid-chromatography-mass-spectrometry: quantitative urine TFV and TFV-diphosphate (TFV-DP) concentrations in dried blood spots (DBS). Logistic regression assessed the association between current and subsequent 24-week viral load outcomes and these 3 measures. We also compared the baseline characteristics of individuals with detectable vs. undetectable POC urine TFV results at enrollment.</p><p><strong>Results: </strong>Of 124 participants, 54.8% female, median age 39 years, 100 (81.5%) had detectable POC urine TFV and 23 (18.5%) did not. Higher TFV-DP concentrations in DBS were negatively associated with viremia at 24 weeks [odds ratio (OR) 0.83, 95% confidence interval (CI): 0.725-0.928, P = 0.003], while a detectable POC urine TFV (OR 0.62, 95% CI: 0.22-1.82, P = 0.380) and quantitative urine TFV (OR 0.98, 95% CI: 0.95-1.00, P = 0.153) showed no significant association. Compared with those with detectable POC urine TFV, those with undetectable POC urine TFV were more likely to be viremic at enrollment (78.3% vs. 25.7%, P < 0.001) and have a CD4 count <200 cells/uL (34.8% vs. 12.9%, P = 0.001).</p><p><strong>Conclusions: </strong>DBS TFV-DP was associated with viremia at 24 weeks and could help predict future viremia. Undetectable POC urine TFV was associated with recent antiretroviral therapy initiation, current viremia, and lower CD4 count.</p><p><strong>Trial registration: </strong>Pan African Clinical Trials Registry (PACTR202001785886049) and the South African Clinical Trials Registry (DOH-27-072020-6890).</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"890-895"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518201","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}