AIDS最新文献

{"title":"On the compounding manifestations of racism shaping the US HIV/AIDS epidemic: why ending the HIV epidemic must address these factors for success.","authors":"Xiao Zang, Yi Sui, Sam Bessey, Tri Minh Van, Hansel E Tookes, Brandon D L Marshall, Bohdan Nosyk","doi":"10.1097/QAD.0000000000004289","DOIUrl":"10.1097/QAD.0000000000004289","url":null,"abstract":"<p><strong>Objective: </strong>Growing racial/ethnic inequities in healthcare access and racially segregated sexual mixing contribute to persistent disparities in HIV incidence in the US. We aim to examine the extent to which eliminating racial/ethnic inequities in healthcare access could reduce disparities in HIV incidence and its interaction with assortative sexual mixing.</p><p><strong>Design: </strong>A mathematical model.</p><p><strong>Methods: </strong>We used two independently developed HIV transmission models to estimate HIV incidence among Black, Hispanic/Latino, and White/Other MSM and the corresponding incidence rate ratios (IRRs) comparing Black and Hispanic/Latino to White/Other as a measure of disparity in the four \"Ending the HIV Epidemic (EHE)\" counties in Georgia. We compared three scenarios: status quo; equal service access across racial/ethnic groups with reported assortative sexual mixing by race/ethnicity; and equal service access with random sexual mixing. We standardized both models to enhance comparability.</p><p><strong>Results: </strong>Under the status quo, both models projected a reduction in overall HIV incidence but persistent racial/ethnic disparities, with an IRR as large as 8.3 between Black and White/Other MSM. Compared to the status quo, providing equal health service access resulted in a modest reduction in IRRs with reported assortative sexual mixing in 2030, but yielded a much greater reduction when sexual mixing was at random: IRR reduced by up to 38.8% and 58.3% between Black and White/Other MSM in the two models.</p><p><strong>Conclusion: </strong>This study highlights racially segregated sexual mixing as a barrier to efforts to mitigate racial/ethnic disparities in HIV incidence. Reaching EHE targets will require not only equitable healthcare access but also strategies addressing sexual racism and other structural barriers.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1954-1962"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582824","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":"Ethical considerations for research involving pregnant women with HIV and their children.","authors":"Megan S McHenry, Eric R Masese, Daniel Kinyanjui, Edwin Were, James G Carlucci, John M Humphrey, Esther Wahome, Dennis Munyoro, Grace White, Amira Nafiseh, Kristen Cunningham, Madeline Cory, Mark Nyalumbe, Roselyne Ananda Ombitsa, Mary A Ott, Colin Halverson","doi":"10.1097/QAD.0000000000004273","DOIUrl":"10.1097/QAD.0000000000004273","url":null,"abstract":"<p><p>Pregnant and postpartum women with HIV (PPWH) and their children have historically been excluded from certain research in the name of protection. This may, however, inadvertently exacerbate health disparities. While calls for their inclusion have increased, additional practical guidance to achieve this goal is needed. Within this editorial, we provide practical recommendations for enabling PPWH and their children to participate ethically in research by identifying and addressing issues that potentially put them at risk. We ground this discussion in a framework that considers the various vulnerabilities that may exist when involving this population in research. These considerations were further informed by person-centered empirical data collected in Kenya, as well as reviews of the literature. Five key domains of consideration include: prioritizing confidentially, support for appropriate agency in decision-making, broad considerations related to respect for persons, community engagement, and appropriate oversight. We hope that the resulting guidance will inform future research practices, with implications for advancing ethical and inclusive research involving PPWH and their children.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":"39 13","pages":"1866-1877"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147460","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":"CHANGE-Rx: frailty, falls, polypharmacy, and inappropriate medication use in a Canadian cohort of people aged 65 years and older with HIV.","authors":"Julian J Hopwood-Raja, Alice L Tseng, Nancy L Sheehan, Sharon L Walmsley, Julian Falutz, Alice Zhabokritsky","doi":"10.1097/QAD.0000000000004284","DOIUrl":"10.1097/QAD.0000000000004284","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the prevalence of polypharmacy, use of potentially inappropriate medications (PIMs), anticholinergic burden (ACB), and sedative burden and their association with the risk of frailty and falls in a Canadian cohort of older people with HIV.</p><p><strong>Design: </strong>CHANGE-Rx is a cross-sectional analysis of baseline data from CHANGE-HIV, a prospective Canadian cohort of people with HIV aged 65 years and older.</p><p><strong>Methods: </strong>Information on prescription, over-the-counter/natural-health product use, comorbidities, HIV-specific factors, frailty, and fall history were assessed at the baseline visit at cohort entry. Proportion of people with polypharmacy (≥5 non-antiretroviral drugs), severe polypharmacy (≥10 non-antiretroviral drugs), PIMs, ACB, and sedative burden were determined. Chi-square tests and multivariate regression analysis were used to assess the association between medication factors and the risk of frailty and falls.</p><p><strong>Results: </strong>Four hundred forty participants were included: median age 69 years (range: 65-89), 16.4% were classified as frail, 20.7% experienced a fall (last 6 months), 53.8% had polypharmacy, 14.6% had severe polypharmacy, 49.3% had at least one 1 PIM. For prescribed comedications, 16.5 and 55.7% of participants had high ACB and sedative burden, respectively. The odds ratios (ORs) for frailty were 3.3, 2.6, and 2.9 among patients with high ACB, high sedative burden, and severe polypharmacy, respectively. The OR for falls were 1.9 and 1.8 for patients with high sedative burden and at least one PIM, respectively.</p><p><strong>Conclusion: </strong>Polypharmacy, PIMs, and high ACB and sedative burden are common among older adults with HIV in Canada. It remains to be determined if interventions addressing polypharmacy/PIMs would reduce falls and frailty.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1898-1906"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526000","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":"Neurocognitive functioning in women with HIV: a comparative study in a low/middle-income country.","authors":"Janice Buckley, Haseena Cassim, Kennedy Otwombe, Khuthadzo Hlongwane, Nonhlanhla Yende-Zuma, Celeste Joyce, Given Leshabane, Lisa Galvin, Candice W Ramsammy, Sean S Brummel, Jim Aizire, Taha E Taha, Mary Glenn Fowler, Avy Violari","doi":"10.1097/QAD.0000000000004277","DOIUrl":"10.1097/QAD.0000000000004277","url":null,"abstract":"<p><strong>Objective: </strong>In untreated HIV infection, the prevalence of HIV-associated neurocognitive disorders was high. Studies from the ART era with appropriate controls from a resource-limited setting are lacking. Neurocognitive functioning of young women with HIV (WWH) was compared to women without HIV (WWOH) in South Africa between 2018 and 2019.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Methods: </strong>WWH from the Pro mise O ngoing T reatment E valuation (PROMOTE) study and WWOH completed a neuropsychological battery targeted at domains affected by HIV. Factors known to be associated with neurocognitive impairment (NCI) were assessed by generalized linear model adjusting for covariates. Clinical symptoms were evaluated using WHODAS.</p><p><strong>Results: </strong>Of 451 women, with a median age of 35 (IQR: 31-39) years, 224 (49.7%) were WWH. More WWH had NCI (46 vs. 36%, P  = 0.06) and mild to severe deficits in verbal learning and memory (51 vs. 30%, P  < 0.001), motor speed (32 vs. 19%, P  = 0.002), language (55 vs. 44%, P  = 0.021), and information processing (40 vs. 25%, P  = 0.001). The risk of NCI was higher in women aged at least 35 years [relative risk (RR): 1.46, 95% confidence interval (95% CI): 1.16-1.84, P  = 0.001], incomplete secondary education (RR: 1.26, 95% CI: 1.01-1.58, P  = 0.04), HIV infection (RR: 1.26, 95% CI: 1.02-1.56, P  = 0.03), and high alcohol use (RR: 1.42, 95% CI: 1.13-1.78, P  = 0.003).</p><p><strong>Conclusion: </strong>WWH on long-term ART had a high prevalence of NCI. High alcohol use and incomplete secondary education were significant risk factors in all women. This study highlights the higher risk of NCI in this population despite a younger age and successful ART.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1887-1897"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473679","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":"Suboptimal ART adherence, undetectable urine tenofovir, and higher C-reactive protein values.","authors":"Delaram Ghanooni, Megan J Heise, Kevin Sassaman, David V Glidden, Tyler Martinson, Shivani Mahuvakar, Dustin T Duncan, Keith J Horvath, Sabina Hirshfield, Renessa Williams, Mallory O Johnson, Christian Grov, Monica Gandhi, Adam W Carrico, Matthew Spinelli","doi":"10.1097/QAD.0000000000004288","DOIUrl":"10.1097/QAD.0000000000004288","url":null,"abstract":"<p><p>Even with antiretroviral therapy, people with HIV often face residual immune activation and chronic systemic inflammation, heightening their risk for early-onset comorbidities such as cardiovascular disease. In a study of 492 men who have sex with men, suboptimal ART adherence, measured by undetectable urine tenofovir, was directly associated with elevated C-reactive protein, even after adjusting for viral suppression and stimulant use. These findings highlight the importance of adherence monitoring to reduce inflammation-related chronic health outcomes.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":"39 13","pages":"1975-1978"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147483","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":"Off target effects of HIV integrase strand transfer inhibitors in cell and animal models: a scoping review.","authors":"Marie-Soleil R Smith, Renying Cai, Hélène C F Côté","doi":"10.1097/QAD.0000000000004261","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004261","url":null,"abstract":"<p><p>In the past decade, integrase strand transfer inhibitor (INSTI)-containing regimens have become the most widely used HIV treatment worldwide. Despite their high efficacy and tolerability, numerous adverse effects have been reported, including weight gain, neuropsychiatric effects, and reproductive health concerns. These reports were the impetus for an array of postapproval in vitro and in vivo studies. This scoping review consolidates and discusses all research conducted post-INSTI approval, from 2007 to 2024, that focused on the effects of INSTI exposure in cell and animal models. It provides insights into potential effects and mechanistic details that may not be revealed through clinical trials.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":"39 13","pages":"1849-1865"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147514","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":"No evidence of a detrimental effect of pitavastatin on neurocognitive function among people with HIV.","authors":"Kristine M Erlandson, Ashley McKhann, Douglas W Kitch, Frank J Palella, Ronald J Ellis, Beau M Ances, Markella V Zanni, Marissa R Diggs, Sarah M Chu, Judith S Currier, Gerald S Bloomfield, Carlos D Malvestutto, Carl J Fichtenbaum, Judith A Aberg, Susan L Koletar, Rachel M Presti, Timothy J Hatlen, Daniel J Skiest, Pamela S Douglas, Heather J Ribaudo, Steven K Grinspoon","doi":"10.1097/QAD.0000000000004267","DOIUrl":"10.1097/QAD.0000000000004267","url":null,"abstract":"<p><strong>Objective: </strong>Effects of statins on neurocognitive function remain poorly understood, with some studies suggesting harm and others suggesting benefit. Limited observational data among people with HIV (PWH) is biased by indication for statin prescription. We sought to assess statin effects on neurocognitive function among PWH.</p><p><strong>Design: </strong>We leveraged data from participants co-enrolled in REPRIEVE (randomized trial of pitavastatin vs. placebo among PWH with low-to-moderate cardiovascular risk) and HAILO (observational study involving repeated neurocognitive measures).</p><p><strong>Methods: </strong>Participants with at least one measure of neurocognitive function before and after REPRIEVE randomization were included. Neurocognitive function was determined by NPZ-4, the average of the Z scores from Hopkins Verbal Learning Test Revised, Trailmaking A and B, and Digit Symbol Test every 48 weeks. Trajectories before and after randomization were analyzed with generalized estimating equation models.</p><p><strong>Results: </strong>Of 181 co-enrolled participants (pitavastatin 88, placebo 93), changes over median 2.3 years on overall and individual neurocognitive scores were small, not meeting a clinically relevant threshold of more than 0.5/year, and similar between arms. Although subgroup analyses were limited by a small sample size, we observed trends toward improved Trailmaking A in participants with baseline impairment who were randomized to pitavastatin vs. placebo and towards worsened NPZ-4 in women randomized to pitavastatin vs. placebo that similarly did not reach threshold for clinical relevance. Other subgroup effects were minimal and not statistically or clinically significant.</p><p><strong>Conclusion: </strong>We found no evidence of a detrimental effect of pitavastatin use on a limited battery of neurocognitive assessments among PWH, even among PWH with baseline neurocognitive impairment.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1913-1919"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12250025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315719","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":"Emergence of in-vitro resistance to lenacapavir is similar across HIV-1 subtypes.","authors":"Vidula Naik, Anurag Nekkalapudi, Archana V Boopathy, Brie Falkard, Christian Callebaut, Nicolas A Margot","doi":"10.1097/QAD.0000000000004334","DOIUrl":"10.1097/QAD.0000000000004334","url":null,"abstract":"<p><strong>Objective: </strong>To assess the potential in-vitro emergence of resistance mutations to the capsid inhibitor lenacapavir (LEN) in clinical samples from subtype B versus non-B HIV-1 subtype.</p><p><strong>Design: </strong>Twenty-four clinical isolates with non-B or B HIV-1 subtype were assessed for their in vitro susceptibility to LEN and their potential to develop resistance to LEN in viral breakthrough experiments.</p><p><strong>Methods: </strong>The HIV-1 gag -protease DNA fragment from various HIV-1 isolates was cloned (pXXLAI vector), and viruses were generated by transfection. Viruses were tested for antiretroviral drug susceptibility, and subjected to selection with LEN in tissue culture for up to 46 days. The capsid and reverse transcriptase sequence from the selected viruses were analyzed to determine the presence of resistance mutations.</p><p><strong>Results: </strong>Samples with HIV-1 subtype A1, AE, AG, B, C, D, F1, G, and H were evaluated. Wild-type susceptibility to LEN (EC 50 21-115 pM) was observed across all subtypes tested. Resistance selections in non-B subtypes led to the emergence of the same mutations with similar timeframe as in subtype B. The most prevalent capsid mutations selected across all subtypes were N74D (9 of 25 cultures), Q67H (4/25), and T107N (4/25), while M66I, K70R/S, and N74H were also observed.</p><p><strong>Conclusion: </strong>In-vitro susceptibility to LEN was not affected by the subtype of the samples tested, and selected resistance mutations were not significantly different across HIV-1 subtypes. These data indicate that LEN is a pan-genotypic inhibitor of HIV-1 that can be effective in all geographical settings, regardless of HIV-1 subtypes.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1878-1886"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079274","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":"Reassuring evidence on statins and cognition in people with HIV.","authors":"Jaime H Vera, Esteban Martinez","doi":"10.1097/QAD.0000000000004286","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004286","url":null,"abstract":"","PeriodicalId":7502,"journal":{"name":"AIDS","volume":"39 13","pages":"1970-1971"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147476","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":"Efficacy and safety of doravirine/islatravir in heavily treatment-experienced participants living with HIV-1 from a randomized trial.","authors":"Andrew Carr, Rosie Mngqibisa, Ilsiyar Khaertynova, Princy N Kumar, Shariq Haider, Ying Zhang, Todd Correll, Ernest Asante-Appiah, Wayne Greaves","doi":"10.1097/QAD.0000000000004367","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004367","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the efficacy (Day 8) and safety (Week 49) of doravirine/islatravir (DOR/ISL 100 mg/0.75 mg) plus baseline antiretroviral therapy (ART) and optimized background therapy (OBT) in heavily treatment-experienced (HTE) adults living with detectable HIV-1 RNA.</p><p><strong>Design and methods: </strong>HTE adults with confirmed plasma viral load >500 copies/mL receiving a stable ART regimen for ≥3 months were randomly assigned 1:2:1:1 to receive once-daily ISL alone, DOR alone, DOR/ISL, or matching placebo for 7 days; at Day 8, baseline ART was optimized and all participants received DOR/ISL and OBT through Week 49. The primary efficacy endpoint was percentage of participants receiving DOR/ISL achieving ≥0.5 log10 decline in viral load from baseline (Day 1) to Day 8. Secondary efficacy endpoints included HIV-1 RNA levels and CD4+ T-cell counts through Week 49.</p><p><strong>Results: </strong>Thirty-five of the planned 100 participants were enrolled; most were White (57.1%) and male (77.1%) with median age of 50 years. From Day 1 to 8, a ≥1.0 log10 decrease in HIV-1 RNA was achieved in 85.7% of the DOR/ISL group compared with 0% of the placebo group. At Week 49, HIV-1 RNA <50 copies/mL was achieved in 22 participants (71.0%) and the mean increase in CD4+ T-cell count was 87 cells/mm3. Adverse events were reported in 29 participants (82.9%) through Week 49; 9 (25.7%) were considered related to DOR/ISL.</p><p><strong>Conclusions: </strong>DOR/ISL plus OBT improved HIV-1 suppression in HTE adults living with HIV-1 and was generally well tolerated.</p><p><strong>Clinicaltrialsgov: </strong>NCT04233216.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205370","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}