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

{"title":"Hospitalization Rates and Associated Factors Among Older Adults With HIV in the United States.","authors":"Ronnie Kasirye, Ping Yang, Jodie L White, Katherine Tassiopoulos, Janeway Granche, Lakshmi Chauhan, Clemensia Nakabiito, Mary G Fowler, Aaron A R Tobian, Philippa Musoke, Kristine M Erlandson","doi":"10.1097/QAI.0000000000003879","DOIUrl":"10.1097/QAI.0000000000003879","url":null,"abstract":"<p><strong>Introduction: </strong>Literature on hospitalization incidence and risks among people with HIV (PWH) in the current antiretroviral therapy era is limited.</p><p><strong>Methods: </strong>Using data (2017-2021) on PWH ≥ 40 years of age from the Advancing Clinical Therapeutics Globally HAILO Study, cumulative probabilities of first hospitalization were estimated using Kaplan-Meier plots. Cox proportional hazards regression was used to identify factors associated with first hospitalization.</p><p><strong>Results: </strong>Among 891 participants (median age 50 years; 80% male), 38 with prevalent hospitalization at baseline were excluded. The remaining 853 participants had a follow-up of 2721 person-years, during which 170 (20%) had at least 1 hospitalization event (incidence rate, 6.2 per 100 person-years [95% confidence interval [CI] = 5.4-7.3]). The leading causes of hospitalization included infections (14%), elective surgery (13%), cardiovascular conditions (12%), and lung problems (12%). Former and current smokers had higher hospitalization risk (adjusted hazard ratio [aHR] 1.51 [95% CI = 1.03-2.20], aHR 1.85 [95% CI = 1.24-2.76], respectively) than never smokers. Hospitalization risk was higher for participants who were frail (aHR 2.31 [95% CI = 1.38-3.86]) compared with those who were robust (not frail), and lower in the Western region compared with the Northeast region (hazard ratio = 0.55, 95% CI: 0.32-0.93). Hospitalization risk was also higher for participants with diabetes (aHR 1.69 [95% CI = 1.13-2.52]).</p><p><strong>Conclusion: </strong>We observed a lower hospitalization risk than in previous studies among PWH. Interventions to reduce smoking, prevent frailty, and improve diabetes management may further lower hospitalization risk.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"836-843"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978581","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":"Resistance Analysis of Weekly Islatravir Plus Lenacapavir in People With HIV at 48 Weeks.","authors":"Laurie A VanderVeen, Lisa Selzer, Silvia Chang, Jiani Li, Tracy L Diamond, Ernest Asante-Appiah, Cyril Llamoso, Martin S Rhee, Christian Callebaut","doi":"10.1097/QAI.0000000000003873","DOIUrl":"10.1097/QAI.0000000000003873","url":null,"abstract":"<p><strong>Background: </strong>Islatravir (ISL), a nucleoside reverse transcriptase translocation inhibitor, and lenacapavir (LEN), a capsid inhibitor, have pharmacokinetic profiles supporting once-weekly (QW) oral dosing. In a phase 2 study, QW ISL + LEN maintained a high rate (94.2%) of viral suppression (VS; HIV-1 RNA <50 copies/mL) at week 48. We report resistance analyses through week 48.</p><p><strong>Methods: </strong>Virologically suppressed participants received ISL (2 mg QW) plus LEN (600 mg days 1 + 2, then 300 mg QW; n = 52) or once-daily bictegravir/emtricitabine/tenofovir alafenamide (50/200/25 mg; n = 52). Proviral DNA sequencing of HIV-1 protease, reverse transcriptase, and integrase was performed at screening; available historical genotypes were collected. Participants with primary nucleoside reverse transcriptase inhibitor (NRTI) or non-NRTI resistance-associated mutations were excluded. Postbaseline resistance analyses were performed for participants with HIV-1 RNA ≥200 copies/mL at virologic failure (≥50 copies/mL at 2 consecutive visits or ≥50 copies/mL at study drug discontinuation/last visit).</p><p><strong>Results: </strong>Of 104 enrolled participants, 5 randomized with historical genotypes were subsequently found to have primary NRTI and/or non-NRTI resistance-associated mutations: all 5 maintained VS, including 2 participants with M184V/I (1/group). One participant receiving ISL + LEN with low-level viremia on day 1 (HIV-1 RNA 251 copies/mL) met criteria for resistance analysis; no emergent resistance was observed, and they subsequently resuppressed on ISL + LEN. Longitudinal analysis of plasma virus detected identical viruses with no evidence of viral evolution.</p><p><strong>Conclusions: </strong>ISL + LEN maintained high rates of VS, including in 1 participant with pre-existing M184V. No participants developed drug resistance. These findings support the ongoing evaluation of QW oral ISL + LEN for HIV-1 treatment.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"926-931"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518199","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":"Harnessing Pharmacy Claims to Strengthen the HIV Care Continuum: Results from the AdhereP4 Program.","authors":"Tsung-Ying Lee, Eberechukwu Onukwugha, Abree Johnson, Hope Cassidy-Stewart, Neha Sheth Pandit","doi":"10.1097/QAI.0000000000003945","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003945","url":null,"abstract":"<p><strong>Background: </strong>Antiretroviral nonadherence hinders HIV RNA suppression and care engagement. The AdhereP4 program evaluated an interdisciplinary collaboration leveraging pharmacy claims data to identify people with HIV (PWH) nonadherent to antiretrovirals and provide clinical interventions.</p><p><strong>Setting: </strong>AdhereP4 was a collaboration of three pharmacies, two HIV clinics, and the state health department in Maryland, USA.</p><p><strong>Methods: </strong>Pharmacy claims data identified PWH with a ≥30-day antiretroviral access gap during November 2020-September 2022. Eligible individuals received pharmacy and/or clinic interventions, categorized as: full (direct communication), soft (indirect contact), and no (unreachable) intervention. Outcomes included adherence, HIV RNA, and retention and relinkage to care. Pre- and post-intervention outcomes were summarized descriptively. Logistic regression assessed associations between intervention type and outcomes, adjusting for demographic and clinical variables.</p><p><strong>Results: </strong>Among 1,702 eligible patients, 48% received full and 25% soft interventions. Mean HIV RNA changed by -0.3, -0.2, and +0.1 log10 copies/mL in the full, soft, and no intervention groups, respectively. Adherent individuals (proportion of days covered ≥80%) increased by 16% (full), 20% (soft), and 11% (no intervention). Odds ratios for retention were 1.17 (95% CI: 0.65-2.14; p=0.12) and 0.64 (95% CI: 0.33-1.23; p=0.06) for the full and soft intervention groups, respectively, versus no intervention. Odds ratios for relinkage were 0.77 (95% CI: 0.20-3.01; p=0.24) and 1.89 (95% CI: 0.48-7.44; p=0.12), respectively.</p><p><strong>Conclusion: </strong>Pharmacy claims data can identify adherence gaps to target adherence interventions to those at risk for virological failure. An interdisciplinary approach addressing barriers to care is needed to improve HIV outcomes.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633267","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":"Brief report: Aging of the HIV epidemic in a longitudinal population cohort and its implications for the understanding of long-term HIV prevalence trends.","authors":"Margot Otto, Adrian Dobra, Elphas Okango, Khai Hoan Tram, Dickman Gareta, Frank Tanser","doi":"10.1097/QAI.0000000000003944","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003944","url":null,"abstract":"<p><strong>Background: </strong>In settings with widespread antiretroviral therapy (ART), improved survival and changing HIV incidence patterns can shift the age distribution of people living with HIV. Such demographic changes may complicate interpretation of crude prevalence trends, which can reflect population aging rather than true epidemiological shifts.</p><p><strong>Setting: </strong>Population-based HIV surveillance by the Africa Health Research Institute in rural KwaZulu-Natal, South Africa, among adults aged 15-54 years (2007-2024).</p><p><strong>Methods: </strong>We assessed changes in age-specific HIV prevalence and population age structure over time. Crude prevalence trends were compared with directly age-standardized estimates using four reference populations (2007, 2017, 2024, and the overall mean age distribution). Temporal trends were analyzed using generalized estimating equation logistic models adjusted for age group and sex to account for repeated observations.</p><p><strong>Results: </strong>HIV prevalence increasingly shifted toward older adults, alongside gradual aging of the surveillance population. Crude prevalence rose from 22.3% (95% CI 21.4-23.2) in 2007 to 35.0% (34.1-36.0) in 2016, remaining broadly stable through 2024 (33.3%; 32.3-34.2). After age standardization, prevalence declined by approximately 4-6 percentage points after 2016 across all reference populations. Adjusted models showed similar patterns: odds of HIV infection peaked in 2016 (OR 1.55; 1.48-1.62 vs 2007) and decreased to 1.35 (1.28-1.42) by 2024.</p><p><strong>Conclusions: </strong>HIV prevalence is increasingly concentrated at older ages in this cohort, reflecting demographic aging in the ART era. Age standardization clarifies longitudinal prevalence trends by distinguishing demographic shifts from underlying epidemiological change.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633204","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":"The Epidemiology of HIV and Injection Practices Among People Who Inject Drugs in Nigeria: Results from the 2020 Integrated Biological and Behavioural Surveillance Survey.","authors":"Souradet Y Shaw, Kalada Green, Chukwuebuka Ejeckam, Adediran Adesina, Gambo Aliyu, Gregory Ashefor, Rose Aguolu, Shajy Isac, Faran Emmanuel, Lisa Lazarus, Leigh M McClarty, Marissa L Becker, James F Blanchard","doi":"10.1097/QAI.0000000000003939","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003939","url":null,"abstract":"<p><strong>Introduction: </strong>People who inject drugs (PWID) are an important driver of the HIV epidemic in Nigeria. This study describes the HIV, demographic, and injection characteristics of PWID.</p><p><strong>Methods: </strong>Cross-sectional integrated biological and behavioural survey conducted in 2020 across 12 states in Nigeria. HIV seroprevalence based on screening and confirmatory tests, and self-reported data on socio-demographic and injection/sharing practices. Multivariable logistic regression models estimated crude and adjusted odds ratios (A/ORs) and 95% confidence intervals (95% CIs) of factors associated with HIV prevalence, and injection and sharing practices.</p><p><strong>Results: </strong>Among 4,358 participants, weighted HIV prevalence was 10.9%. Median age was 30 years (IQR: 25-35) with two-thirds reporting less than 75 months of injection drug use. 80% of participants reported injecting in the last month. Of those injecting in the last month, 21% reported injecting at least once a day, 15% reported \"almost/every time\" to sharing or lending syringes/needles, while 9% reported back/front-loading, sharing paraphernalia, or drawing up from a common container \"almost/every time\". In multivariable models, female sex (AOR: 1.6, 95% CI: 1.2-2.1) and less than secondary education (AOR: 1.4, 95% CI: 1.1-2.0) was associated with HIV. Riskier injection practices were associated with pentazocine (AOR: 1.7, 95% CI: 1.2-2.4) and crack cocaine (AOR: 2.0, 95% CI: 1.4-2.8) injection.</p><p><strong>Conclusions: </strong>HIV prevalence was high amongst study participants, as were riskier injection and sharing practices, with structural determinants like education being associated with both.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586595","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":"Longitudinal Determinants Associated with Latino Sexual Minority Men's Recent HIV Testing.","authors":"Alyssa Lozano, Nequiel Reyes, Manuel A Ocasio, Daniel J Feaster, Steven A Safren, Audrey Harkness","doi":"10.1097/QAI.0000000000003940","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003940","url":null,"abstract":"<p><strong>Background: </strong>Miami-Dade County leads in US HIV incidence, with Latino sexual minority men (LSMM) diagnosed with HIV more frequently than any other subgroup. HIV testing is a first step toward linkage to appropriate biomedical prevention or treatment services, therefore maximizing the reach of HIV testing to LSMM is paramount. The purpose of this study was to identify longitudinal determinants associated with recent HIV testing among LSMM in the greater Miami, FL area.</p><p><strong>Methods: </strong>Participants included 234 LSMM who completed a self-report assessment of HIV-prevention service engagement and related measures at baseline, 4- and 8-months. We utilized stochastic search variable selection (SSVS) and hierarchal linear modeling to identify predictors of recent HIV testing.</p><p><strong>Results: </strong>SSVS identified four variables that were then entered into a hierarchal linear model. Over time, participants were significantly more likely to have had a recent HIV test. Three of the four variables identified were significantly associated with recent HIV testing: knowing people who had a recent HIV test, knowledge about HIV, and sexual behavior indicating CDC PrEP eligibility.</p><p><strong>Conclusions: </strong>This study identified multilevel determinants associated with LSMM's recent HIV testing. At the individual level, HIV testing was influenced by behavioral risk factors related to sexual activity and HIV knowledge. Pertaining to the interpersonal level, knowing people who recently tested for HIV was associated with HIV testing. Multilevel adjunctive interventions and implementation strategies that increase HIV knowledge and leverage peer influence may improve testing uptake among LSMM in the Miami, FL area.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586632","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":"Artificial Intelligence and JAIDS.","authors":"William A Blattner, Paul A Volberding","doi":"10.1097/QAI.0000000000003943","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003943","url":null,"abstract":"<p><p>AI is a massively important tool for advancing the health of persons impacted by HIV. JAIDS is prioritizing rapid publication of research in this arena. AI also presents challenges to the quality of scientific publication and the bedrock peer review process that underpins scientific quality. JAIDS is committed to promoting the highest standard and rigor or science publication in the HIV space.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586636","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":"Associations between pain, mobility, quality of life and mental health in people of Black ethnicities with HIV in London.","authors":"Tamzin Hull, Lourdes Dominguez-Dominguez, Lucy Campbell, Julie Fox, Lisa Hamzah, Michael Evangeli, Shema Tariq, Whitney Scott, Frank A Post","doi":"10.1097/QAI.0000000000003938","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003938","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain, and its relationship with physical function and mental health, remains under-explored in people of Black ethnicities with HIV who experience intersecting inequities which may affect the experience and impact of pain. We investigated associations between severity of pain, physical function and mental health in these populations.</p><p><strong>Setting: </strong>Three HIV clinics in South London, UK.</p><p><strong>Methods: </strong>We conducted a cross-sectional study in adults of Black ethnicities with HIV. Multivariable logistic regression analysis was used to examine associations between mild and moderate-severe pain, physical function and mental health.</p><p><strong>Results: </strong>We enrolled 398 participants (median age 52 years, 55% female); 16% reported mild pain and 25% moderate-severe pain. In multivariable analysis, moderate-severe pain (vs. no pain) was associated with moderate-severely impaired mobility (adjusted odds ratio [aOR] 72.6 [25.7, 250]), moderate-severely impaired ability to self-care (aOR 16.4 [4.1, 111]), moderate-severely impaired ability to perform usual activities (aOR 14.9 [6.3, 37.4]), and poor mental health (aOR 9.2 [5.1, 17.1]), and mild pain with mild and moderate-severe impairment of mobility (aOR 6.5 [2.5, 17.8] and 5.2 [1.5, 18.8] respectively), mild impairment in the ability to perform usual activities (aOR 4.8 [1.9, 11.9), and poor mental health (aOR 2.4 [1.2, 4.8]).</p><p><strong>Conclusion: </strong>In this sample of people of Black ethnicities with HIV, two-fifths reported pain. Pain, regardless of severity, was associated with mobility impairment, difficulties performing activities of daily living, and poor mental health. We recommend evaluation of pain in HIV clinical services and establishing robust pain management pathways to maximise quality of life.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586590","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 Trajectories of Change in PrEP Readiness Across an Intervention Pilot Trial to Increase Uptake Among Young South African Women: A Markov Modeling Approach.","authors":"Elise S Mara, Theresa M Exner, Nonhlonipho Bhengu, Abigail D Harrison, Curtis Dolezal, Jill Hanass-Hancock, Susie Hoffman","doi":"10.1097/QAI.0000000000003941","DOIUrl":"10.1097/QAI.0000000000003941","url":null,"abstract":"<p><strong>Background: </strong>In South Africa, uptake of HIV oral pre-exposure prophylaxis (PrEP) has been slow among women, who account for 60% of new HIV diagnoses. A gender-enhanced (GE) online group workshop, Masibambane (\"Let Us Work Together\") (N = 50), demonstrated greater increases in PrEP stage of change versus providing participants with individual access (IA) to online PrEP educational and motivational materials (N = 50). However, participants began the study at different stages, and it was unclear which women may have benefited most from the intervention. We explored how an underused analytic method could offer greater insight into women's change trajectories.</p><p><strong>Methods: </strong>Participants completed questionnaires at baseline (\"pre-intervention\"), post-intervention, and three months after baseline (\"follow-up\") and documented readiness through a 5-point stage-of-change (SOC) score based on the transtheoretical model. We used Markov transition matrices to calculate probabilities of different trajectories.</p><p><strong>Results: </strong>Participants who reported 3 (\"would like to speak to a counselor\") were most likely to transition to 5 (\"ready to take PrEP\") at post-intervention in the GE arm (Ppost, pre(5|3) = 0.60) but not the IA arm (Ppost, pre(5|3) = 0.17). Those who scored 2 (\"uncertain\") at pre-intervention also exhibited greater probabilities of upward movement in the GE arm.</p><p><strong>Discussion: </strong>Compared to IA, GE women who expressed uncertainty or a desire for counseling at baseline were more likely to shift into a state of readiness, driving the observed difference across study arms. This analysis demonstrates how Markov modeling can provide greater understanding of population change dynamics than mean values alone.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586567","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":"Health economic impact and cost threshold for switching from bivalent to nonavalent HPV vaccination for preadolescent girls in KwaZulu Natal, South Africa: A mathematical modeling analysis accounting for the HIV epidemic.","authors":"Christine L Hathaway, Jacinda Tran, Cari van Schalkwyk, Louise Kuhn, Darcy W Rao, Ruanne V Barnabas, Monisha Sharma","doi":"10.1097/QAI.0000000000003936","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003936","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus bivalent (2vHPV) and nonavalent (9vHPV) vaccines protect against HPV types causing 70% and 90% of cervical cancers, respectively. South African guidelines recommend vaccinating girls ages 9-14 with one dose of 2vHPV. Switching recommendations to 9vHPV could avert more cervical cancer burden, but the cost-effectiveness and cost-threshold of 9vHPV in South Africa is unknown.</p><p><strong>Methods: </strong>Using a validated compartmental HPV and HIV transmission model parameterized to KwaZulu-Natal, South Africa, we simulated scenarios of 2vHPV and 9vHPV implementation over 100 years with two doses (72% coverage) and one dose (80% and 90% coverage) with lifelong or waning single-dose vaccine efficacy. We evaluated cervical cancer cases and deaths averted. We also estimated the maximum cost/dose for 9vHPV to be cost-effective using willingness-to-pay thresholds from $500/DALY averted to $3,015/DALY averted (2023 USD). We also assessed the incremental cost-effectiveness ratios (ICERs) of 9vHPV at current costs ($110/dose) compared to 2vHPV ($9.23/dose).</p><p><strong>Results: </strong>Single-dose 9vHPV at 80% coverage could avert 7.9% more cervical cancer cases and 6.4% more deaths than 2vHPV (lifelong efficacy). The maximum 9vHPV price to be cost-effective (lifelong efficacy, 80% coverage) ranged from $15 ($500/DALY averted threshold) to $45/dose ($3,015/DALY averted threshold). At current market costs, single-dose 9vHPV at 90% coverage exceeds commonly used cost-effective thresholds with ICERs of $10,480/DALY averted (lifelong efficacy) and $8,806/DALY averted (waning efficacy).</p><p><strong>Conclusion: </strong>Implementing 9vHPV can result in a greater reduction in cervical cancer burden than 2vHPV, but vaccine costs need to be reduced for 9vHPV to be cost-effective in KwaZulu-Natal.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551850","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}