AIDS最新文献

{"title":"The HIV/AIDS pandemic: where are we now?","authors":"Chris Beyrer, Jirair Ratevosian, Huub Gelderblom, Nora E Rosenberg","doi":"10.1097/QAD.0000000000004308","DOIUrl":"10.1097/QAD.0000000000004308","url":null,"abstract":"<p><p>The global HIV/AIDS response is facing its most serious crisis in decades. Despite expanded access to antiretroviral therapy (ART) and the growing availability of prevention tools such as oral preexposure prophylaxis (PrEP), and long-acting PrEP, progress toward the UNAIDS 2025 targets has stalled. HIV incidence remains unacceptably high across key populations and geographic regions, while treatment coverage gaps and preventable deaths persist. The abrupt 2025 suspension of U.S. foreign aid programs, including the President's Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID), has further disrupted service delivery, particularly for prevention programs and marginalized groups. This editorial assesses the underlying structural, political, and programmatic failures that led to missed targets and highlights the compounded risks posed by policy reversals. Drawing on recent epidemiological data and modeling, we estimate the impact of prevention gaps, disparities in access, and policy changes on global HIV trajectories. We argue that a path forward requires reforms, renewed political will, and sustainable financing. In a moment of rising global polarization and shrinking public health budgets, the HIV response must be reimagined around equity, inclusion, and collective action. Without such recalibration, the vision of ending AIDS as a public health threat by 2030 will remain out of reach.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":"39 11","pages":"1497-1504"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The natural history of anal high-grade squamous intraepithelial lesions among MSM and transgender women in an acute HIV cohort in Thailand.","authors":"Supanat Thitipatarakorn, Nipat Teeratakulpisarn, Siriporn Nonenoy, Aphakan Klinsukontakul, Sujittra Suriwong, Sumitr Tongmuang, Piranun Hongchookiat, Napasawan Chinlaertworasiri, Pravit Mingkwanrungruang, Carlo Sacdalan, Kultida Poltavee, Nitiya Chomchey, Tippawan Pankam, Stephen J Kerr, Reshmie A Ramautarsing, Donn Colby, Nittaya Phanuphak","doi":"10.1097/QAD.0000000000004238","DOIUrl":"10.1097/QAD.0000000000004238","url":null,"abstract":"<p><strong>Objective: </strong>To describe the incidence and clearance rates of anal high-grade squamous intraepithelial lesions (HSIL) among MSM and transgender women who initiated immediate antiretroviral therapy during acute HIV acquisition.</p><p><strong>Design: </strong>A prospective cohort study of MSM and transgender women diagnosed with acute HIV acquisition in Bangkok, Thailand.</p><p><strong>Methods: </strong>Participants who were enrolled from May 2017 to June 2020 underwent anal human papillomavirus (HPV) genotyping, high-resolution anoscopy, and anal biopsies as indicated, at baseline and 6-monthly follow-up visits.</p><p><strong>Results: </strong>Among 89 MSM and 4 transgender women (median age 26 years), the anal HSIL incidence rate was 22.7 per 100 person-years over 180.9 person-years, while the clearance rate was 119.4 per 100 person-years over 32.7 person-years. After adjusting for age, smoking, and baseline CD4 + cell count, incident anal HSIL was greater in those with persistent HPV 16 [adjusted hazards ratio (aHR) 14.98, 95% confidence interval (CI) 1.73-129.48], nonpersistent HPV 16 (aHR 15.12, 95% CI 1.84-124.50), persistent non-16 cancer-associated HPV types (aHR 17.90, 95% CI 2.34-136.74), and nonpersistent non-16 cancer-associated HPV types (aHR 10.65, 95% CI 1.34-84.93) compared to participants with consistently negative cancer-associated HPV. Persistent (aHR 0.17, 95% CI 0.04-0.66) and nonpersistent HPV 16 (aHR 0.22, 95% CI 0.05-0.98) were associated with lower HSIL clearance likelihood.</p><p><strong>Conclusion: </strong>Among predominantly young participants initiating antiretroviral therapy during acute HIV acquisition, anal HSIL showed high incidence yet markedly high clearance rates. Anal HPV 16 infection increased risk of incident anal HSIL and decreased lesion clearance. HPV vaccination and HSIL screening/treatment should be implemented despite rapid antiretroviral therapy initiation.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1641-1649"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered mitochondrial mass and fatty acid uptake by natural killer cells in HIV-exposed uninfected children at 6 years of age.","authors":"Hope Mataramvura, Ana Jordan-Paiz, Kewreshini Naidoo, Julia Jaeger, Lucia Testa, Felicity Z Gumbo, Ronald L Mazengera, Madeleine J Bunders, Kerina Duri","doi":"10.1097/QAD.0000000000004228","DOIUrl":"10.1097/QAD.0000000000004228","url":null,"abstract":"<p><strong>Background: </strong>Cell metabolism is critical for adequate responses by immune cells. Although changes in immune cell populations in uninfected children born to women living with HIV (HEU children) are well described, little is known regarding the metabolic characteristics of their immune cells.</p><p><strong>Methods: </strong>Peripheral blood mononuclear cells of 110 children at approximately 6 years of age were analysed with flow cytometry to characterize natural killer (NK) cells and measure fatty acid uptake (BODIPY FL C 16 ) and mitochondrial mass [MitoTracker Green (MTG)]. HEU children born to women initiating antiretroviral therapy (ART) during pregnancy [medium-term ART exposure (HEUMT)] ( N  = 30), before conception [long-term ART exposure (HEULT)] ( N  = 39), and 41 HIV-unexposed uninfected (HUU) children were included.</p><p><strong>Results: </strong>Overall, NK cell frequencies were similar between HEU and HUU children. However, NKG2A +/- CD56 dim NK cells in HEUMT children had a lower fatty acid (FA) uptake compared to HEULT and HUU children. NKG2A + CD57 - CD56 dim NK cells in HEULT children had a significantly higher mitochondrial mass compared to HEUMT and HUU children. Granzyme B and perforin negatively correlated with mean fluorescence intensity (MFI) MTG in NKG2A +/- CD56 dim NK cells in HEU and HUU children, but positively correlated with MFI BODIPY FL C 16 , in HEULT children, indicating that increased mitochondrial mass and lower FA acid uptake is associated with a lower cytotoxic potential.</p><p><strong>Conclusion: </strong>Taken together, mitochondrial mass and FA uptake differ between HEU and HUU children at 6 years of age suggesting long-term metabolic changes in HEU children. Further studies are needed to assess whether these have implications for immune competence in HEU children.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1505-1517"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse childhood experiences, sexual orientation-related victimization, and cardiovascular disease risk among men with and without HIV.","authors":"Allison A Appleton, Serim Lee, Mark H Kuniholm, Elizabeth Vásquez, Mardge H Cohen, Jessica Donohue, Michelle Floris-Moore, M Reuel Friedman, Deborah Gustafson, David B Hanna, Deborah L Jones, Matthew J Mimiaga, Caitlin A Moran, Michael W Plankey, Sanyog G Shitole, Linda A Teplin, Deanna Ware, Jenni M Wise","doi":"10.1097/QAD.0000000000004235","DOIUrl":"10.1097/QAD.0000000000004235","url":null,"abstract":"<p><strong>Objective: </strong>Adverse childhood experiences (ACEs) are traumatic events occurring before age 18 and can increase cardiovascular disease (CVD) risk. Many sexual minority men (SMM) and men with HIV (MWH) have trauma histories and elevated CVD risk. We investigated the association between ACEs and CVD risk among SMM with and without HIV (MWH and MWOH).</p><p><strong>Design and methods: </strong>Data were from the Multicenter AIDS Cohort Study ( n  = 1245; n  = 650 MWOH, n  = 595 MWH). Participants self-reported 20 ACEs reflecting household dysfunction and victimization. CVD risk was measured with Framingham (FRS-H) and American College of Cardiology/American Heart Association-Pooled Cohort Equation (ACC/AHA-PCE) scores. Longitudinal generalized estimating equations (GEE) using 10 years of repeated CVD measures were examined with each ACE type, total number of ACEs, and ACE latent classes.</p><p><strong>Results: </strong>The prevalence of each ACE was high, ranging from 50.3 to 83.8%. Childhood sexual orientation-related victimization was positively associated with CVD risk for MWOH ( βFRS-H  = 2.95, SE = 1.48, P  = 0.005; βACC/AHA-PCE  = 3.31, SE = 1.48, P  = 0.002) and MWH ( βFRS-H  = 2.69, SE = 1.58, P  = 0.03; βACC/AHA-PCE  = 2.82, SE = 1.62, P  = 0.03). Among MWH, ACE Class 2 (characterized by high sexual orientation-related victimization, moderate levels of parental abuse, and household dysfunction) was associated with higher CVD risk ( βFRS-H  = 3.63, SE = 1.78, P  = 0.03; βACC/AHA-PCE  = 3.09, SE = 1.78, P  = 0.05). Dose-response associations were observed for the full sample when considering the total number of ACEs, though attenuated in models stratified by HIV status.</p><p><strong>Conclusion: </strong>ACEs were associated with CVD risk among MWH and MWOH. Assessing ACE history in clinical encounters may yield important insights for the prevention and management of CVD. This study underscores the importance of trauma-informed care for this population.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1621-1631"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum triglyceride and high-density lipoprotein at admission are associated with 30-day overall mortality of patients with HIV and Talaromycosis.","authors":"Handan Zhao, Shasha Ye, Guanjing Lang, Danting Tang, Jiaying Qin, Xingguo Miao, Mengyan Wang, Minghan Zhou, Lingyun Wang, Feifei Su, Xu Lijun","doi":"10.1097/QAD.0000000000004327","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004327","url":null,"abstract":"<p><strong>Objective: </strong>Dyslipidemia is common in severe infections, but its role in people with HIV and Talaromycosis (PWHT) remains unclear.</p><p><strong>Design and method: </strong>Three hundred and eighty-seven PWHT were enrolled in present study. Furthermore, 267 of 387 PWHT, 267 people with HIV but without talaromycosis (PWH) and 267 healthy controls were selected to compare the lipid profiles by propensity score matching method on sex, age, body mass index, comorbidities and HBV infection.</p><p><strong>Results: </strong>PWHT showed significantly lower total cholesterol [2.9(2.2-3.5) vs. 3.5(2.9-4.0) vs. 4.6(4.0-5.2) mmol/L, P < 0.001], LDL [1.5(0.9-2.0) vs. 1.9(1.5-2.4) vs. 2.5(2.1-3.1) mmol/L, P < 0.001] and HDL [0.5(0.3-0.7) vs. 0.7(0.6-0.9) vs. 1.2(1.0-1.4) mmol/L, P < 0.001], but higher triglycerides [1.6(1.2-2.0) vs. 1.3(1.0-1.7) vs.1.2(0.9-1.7)mmol/L, P < 0.001] than PWH and healthy controls at admission. Multivariate Cox analysis identified triglycerides ≥2.0 mmol/L [adjusted odds ratio (AOR)(95% confidential interval, CI):2.5(1.3-4.7), P = 0.005], HDL < 0.3 mmol/L [AOR:2.7(1.4-5.3), P = 0.004], age ≥35.0 years [AOR:3.2(1.6-6.4), P = 0.001], BMI < 18.0 kg/m2 [AOR:2.0(1.0-3.8), P = 0.036), WBC ≥5.0 × 109/L (AOR:2.4(1.3-4.6), P = 0.006), albumin <27 g/L (AOR:2.7(1.2-6.3), P = 0.018), and non-amphotericin B therapy (AOR:2.2(1.1-4.5), P = 0.028) as independent mortality risk factors. The 30-day overall mortality was higher in patients with triglycerides ≥2.0 mmol/L (24.0% vs. 7.6%, Log-rank P < 0.001) or HDL <0.3 mmol/L (27.1% vs. 6.5%, Log-rank P < 0.001) among PWHT.</p><p><strong>Conclusion: </strong>PWHT exhibit distinct dyslipidemia patterns from PWH and healthy control. Elevated triglycerides and reduced HDL independently predicted poor outcomes of PWHT.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetics of lopinavir/ritonavir in second-line treatment of children living with HIV in the CHAPAS-4 trial.","authors":"Anne E M Kamphuis, Timo Kiezebrink, Hylke Waalewijn, Alasdair Bamford, Alexander J Szubert, Chishala Chabala, Mutsa Bwakura-Dangarembizi, Shafic Makumbi, Joan Nangiya, Vivian Mumbiro, Veronica Mulenga, Victor Musiime, Saskia N de Wildt, Angela P H Colbers, Diana M Gibb, David M Burger","doi":"10.1097/QAD.0000000000004328","DOIUrl":"10.1097/QAD.0000000000004328","url":null,"abstract":"<p><strong>Objective: </strong>Lopinavir/ritonavir (LPV/r) remains a much-used drug combination for treatment of children with HIV, but pharmacokinetic data when the adult formulation (LPV/r 200/50 mg) is used for children weighing 25-34.9 kg, or when combined with tenofovir alafenamide/emtricitabine (TAF/FTC), is currently lacking.</p><p><strong>Design: </strong>We aim to provide this data by an intensive LPV/r pharmacokinetic sub-study nested within the CHAPAS-4 trial (#ISRCTN22964075).</p><p><strong>Methods: </strong>Children (3-15 years), weighing 14-24.9 kg received 200/50 mg LPV/r orally twice daily; those weighing 25-34.9 kg received 400/100 mg LPV/r in the morning and 200/50 mg in the evening; and those weighing ≥35 kg received 400/100 mg LPV/r twice daily. LPV/r was used in combination with either TAF/FTC or standard-of-care backbone (abacavir/lamivudine or zidovudine/lamivudine). Pharmacokinetic parameters were compared to those reported in children receiving WHO-recommended dosages.</p><p><strong>Results: </strong>We enrolled 40 children from Uganda, Zambia and Zimbabwe. The geometric mean (GM) area under the concentration-time curve (AUC 0-12h ) for LPV was 116.2 h∗mg/L (coefficient of variation [CV%], 37%), comparable to children receiving WHO-recommended dosages. The GM trough concentration was 7.7 mg/L (52%), 57% higher than the reference value of 4.9 mg/L (95% confidence interval, 4.14-5.80), mainly caused by higher exposure in children 25-34.9 kg. There were no differences in LPV AUC 0-12h or C trough between backbones.</p><p><strong>Conclusions: </strong>Children (3-15 years), weighing ≥14 kg and taking LPV/r in second-line treatment achieve adequate exposure of LPV within limits reported to be safe and well tolerated. These data support the use of a LPV/r based regimen and the adult formulation of 200/50 mg in children 25-34.9 kg.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embracing uncertainty in early safety signals: A lesson from the Tsepamo study results describing neural tube defect risk and the use of Dolutegravir (DTG) in pregnancy.","authors":"Sean S Brummel, Sonja Swanson, Ellen Caniglia, Shahin Lockman, Rebecca Zash, Roger Shapiro","doi":"10.1097/QAD.0000000000004326","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004326","url":null,"abstract":"<p><strong>Objective: </strong>We investigated how randomness may have contributed to the apparent decline in observed risk of neural tube defects (NTDs) following in utero dolutegravir (DTG) exposure. We aimed to describe statistical approaches to uncertainty using accessible language for non-statistical audiences.</p><p><strong>Methods: </strong>We reanalyzed Tsepamo Study data using frequentist confidence intervals, repeated intervals accounting for group sequential monitoring, and Bayesian posterior and posterior predictive distributions. We estimated the probability of decision reversal using simulation.</p><p><strong>Results: </strong>The initial Tsepamo analysis reported a large difference in NTD risk between DTG and non-DTG exposures, with point estimates of 0.94% and 0.12%, respectively. This difference diminished with subsequent data, with updated estimates of 0.10% for DTG and 0.11% for non-DTG exposures. Our analyses showed the early finding was statistically compatible with a wide range of effect sizes, including no difference. Due to the large uncertainty in the first analysis, the probability of decision reversal was high under repeated testing frameworks.</p><p><strong>Conclusion: </strong>Early safety signals may reflect statistical noise. Evaluating the range of confidence intervals and estimating decision reversal probabilities provide meaningful insight into early results. Formal frameworks for uncertainty should guide decisions about interim data reporting, especially when findings may influence clinical or regulatory action.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening benefits for breast and colorectal cancer-specific survival among medicare enrollees with HIV.","authors":"Xiaoying Yu, Meagan Carter, Daoqi Gao, Nhu Nguyen, Yanxun Xu, Michael J Silverberg, Elizabeth Chiao, Yong-Fang Kuo","doi":"10.1097/QAD.0000000000004325","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004325","url":null,"abstract":"<p><strong>Objective: </strong>Cancer screening improves survival in the general population, but its effectiveness in people with HIV (PWH) remains underexplored, particularly for breast and colorectal cancer. This study examines the impact of cancer screening on cancer-specific survival among U.S. Medicare enrollees with HIV.</p><p><strong>Design: </strong>Retrospective cohort design.</p><p><strong>Methods: </strong>Using Medicare data (2009-2019) with follow-up through 2021, we identified PWH aged 50+ without baseline breast or colorectal cancer and with at least two years of fee-for-service coverage. Cox regression models were used to assess the association between cancer screening and cancer-specific survival, adjusting for sociodemographic factors and baseline comorbidities by age (50-64, 65+ years).</p><p><strong>Results: </strong>In total, 40,768 and 133,665 PWH were included for breast and colorectal cancer screening, with median follow-up of 7.4 and 7.6 years, respectively. Among females with HIV, breast cancer mortality was 0.28% (50-64 years) and 0.40% (65+ years), with significant screening benefits observed in both age groups. The hazard ratio (HR) was 0.53 (95% Confidence Interval [CI]: 0.32-0.87) and 0.47 (95% CI: 0.29-0.76) for those aged 50-64 and 65+, respectively. Colorectal cancer mortality was 0.31% (50-64 years) and 0.48% (65+ years), with screening colonoscopy providing significant survival benefit only in younger PWH (50-64: 0.41, 0.20-0.88; 65+: 0.42, 0.16-1.14).</p><p><strong>Conclusion: </strong>Breast cancer screening improved survival in all females with HIV aged 50+, while colonoscopy screening provided significant benefit only in PWH aged 50-64. This finding underscores the importance of cancer screening in PWH. Studies should assess the effect across modalities of colorectal cancer screening.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammation in frailty, cognitive impairment, clinical events and mortality among older adults with HIV in the ACTG HAILO cohort.","authors":"Win Min Han, Kunling Wu, Katherine Tassiopoulos, Kevin Knowles, Kate Ailstock, Morgan Cummings, Stephen Kerr, Ponego Ponatshego, Mosepele Mosepele, Netanya S Utay, Anchalee Avihingsanon, Nicholas T Funderburg, Kristine M Erlandson","doi":"10.1097/QAD.0000000000004324","DOIUrl":"10.1097/QAD.0000000000004324","url":null,"abstract":"<p><strong>Objectives: </strong>Associations between inflammatory markers and prevalent or incident frailty, cognitive impairment, clinical events and mortality in older people with HIV are poorly understood.</p><p><strong>Design: </strong>An observational cohort study.</p><p><strong>Methods: </strong>Participants ≥50 years from the ACTG HAILO cohort study were included. Participants completed annual evaluations for cognitive impairment and frailty. Clinical events included non-AIDS-defining cancers, diabetes and cardiovascular, liver and kidney diseases. Associations between inflammatory markers (hsCRP, IL-6, TNFR1, CXCL-9 and inflammatory index score [IIS]) at baseline and prevalence and incidence of frailty, cognitive impairment, any clinical event and non-accidental mortality were examined. We used 10-fold cross validation to examine whether the combination of inflammatory markers and frailty improved the ability to predict incident outcomes.</p><p><strong>Results: </strong>Among 484 participants (17% assigned female at birth, 25% Black and 20% Hispanic), median age was 56 years. Median BMI was 27 kg/m 2 , median CD4 count was 627 cells/mm 3 , and 95% had HIV-1 RNA <200 copies/mL. HsCRP, IL-6, TNFR1, CXCL-9 and IIS were associated with increased risk of prevalent frailty and clinical events, but not cognitive impairment. CXCL-9 (Q4 vs. Q1) and TNFR1 were associated with an increased incidence of both frailty and clinical events; Q4 vs Q1 of the IIS was associated with clinical events; increased inflammatory markers (except CXCL-9) were associated with an increased risk of mortality. TNFR1 combined with frailty modestly improved the predictability of incident clinical events and mortality over frailty alone.</p><p><strong>Conclusions: </strong>Several inflammatory markers were associated with increased risk of frailty, clinical events, and mortality, but not cognitive impairment.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analyses of COVID-19 in-hospital mortality in people living with HIV during SARS-CoV-2 pre-delta, delta, and omicron waves: data from the who global clinical platform.","authors":"Seth Inzaule, Ronaldo Silva, Nathan Ford, Soe Soe Thwin, Jassat Waasila, Alimuddin Zumla, Meg Doherty, Janet Diaz, Silvia Bertagnolio","doi":"10.1097/QAD.0000000000004323","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004323","url":null,"abstract":"<p><strong>Background: </strong>We investigated in-hospital mortality trends across waves of different SARS-CoV-2 variants and assessed the effect of COVID-19 immunization among PLHIV.</p><p><strong>Method: </strong>We analyzed individual-level data from the WHO Global Clinic Platform comprising 823,845 hospitalized children and adults from 61 countries. Survival analyses was used to assess the association of HIV co-infection with in-hospital mortality across SARS-CoV-2 pre-Delta, Delta and Omicron variant waves.</p><p><strong>Findings: </strong>PLHIV experienced significantly higher in-hospital mortality compared to HIV-negative individuals across all variant waves. Adjusted hazard ratios (aHRs) for PLHIV mortality were 1.85 (95%CI 1.76-1.93) during the pre-Delta wave, 1.58 (95%CI 1.42-1.74) during the Delta wave, and 3.07 (95%CI 2.75-3.42) during the Omicron wave. In-hospital mortality risk was notably higher in PLHIV with CD4 ≤200 cells/mm3. While mortality declined modestly between pre-Delta and Delta waves in both HIV-negative (10% reduction) and HIV-positive populations (9% reduction), the decline was more substantial for HIV-negative individuals during the Omicron wave (from 18.9% to 8.0%) than for PLHIV (from 24.2% to 19.3%) relative to the Delta wave.</p><p><strong>Interpretation: </strong>Although in-hospital mortality among HIV-negative individuals declined markedly during the Omicron wave, reduction in PLHIV was less pronounced, leading to a relatively higher mortality risk for this group. These findings highlight the need for adherence to WHO recommendations on booster vaccinations and therapeutics for populations at elevated risk of severe COVID-19 outcomes, including PLHIV.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}