AIDS最新文献

{"title":"Modeling the potential impact of viral load monitoring on vertical transmission of HIV in Kenya.","authors":"Horacio A Duarte, Jeanette K Birnbaum, James G Carlucci, Yara Ghazal, Rosa C Ndiema, Eva A Enns","doi":"10.1097/QAD.0000000000004207","DOIUrl":"10.1097/QAD.0000000000004207","url":null,"abstract":"<p><strong>Introduction: </strong>Viral load monitoring among pregnant and breastfeeding women (PBFW) can reduce vertical transmission by identifying PBFW with unsuppressed viral load and promoting re-suppression. However, the impact of varying degrees of adherence to viral load monitoring guidelines on the prevention of vertical transmission (PVT) is unknown.</p><p><strong>Methods: </strong>We developed a microsimulation model of HIV progression and PVT care for PBFW living with recently acquired HIV in Kenya. We used this model to evaluate viral load monitoring in two key maternal populations: newly positive pregnant women who initiate ART during antenatal care and known positive women who are diagnosed and initiate ART prior to conception. For each population, we simulated three levels of adherence to Kenyan viral load monitoring guidelines during pregnancy and 18 months of breastfeeding: no testing; 50% adherence to indicated viral load tests (VL-50%); and 100% adherence (VL-100%). We evaluated viral load monitoring in each population by comparing live births, maternal deaths, and vertical transmission under VL-50% and VL-100% to no testing.</p><p><strong>Results: </strong>Under no testing, infants acquired HIV at a rate of 619 vs. 505 per 10 000 live births in the newly positive vs. known positive populations, respectively. Viral load monitoring reduced vertical transmission by 1.6-2.7% in newly positive women vs. 9.1-14.3% in known positive women, and it reduced maternal deaths by 1.2-1.8% vs. 1.6-2.3%.</p><p><strong>Conclusion: </strong>Maternal viral load monitoring in Kenya has considerably greater potential for achieving relative reductions in vertical transmission among known positive women than among newly positive women. In known positive women, even imperfect adherence to guidelines may achieve substantial relative reductions in vertical transmission.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1273-1282"},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957827","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":"Outcomes in people with HIV who resume or switch to bictegravir/emtricitabine/tenofovir alafenamide following a treatment interruption.","authors":"Graeme Moyle, Joshua Gruber, Megan Dunbar, Janna Radtchenko, Andrew J Frick, Andrea Marongiu, Paul E Sax, Travis Lim, Steven Santiago, Paul Benson, Charles Walworth, Richard A Elion","doi":"10.1097/QAD.0000000000004171","DOIUrl":"10.1097/QAD.0000000000004171","url":null,"abstract":"<p><strong>Objective: </strong>Treatment adherence remains critical in maintaining HIV RNA suppression on antiretroviral therapy. High genetic barrier regimens constructed with three long half-life agents may prevent resistance emergence and can be potentially started or restarted after antiretroviral treatment interruption.</p><p><strong>Methods: </strong>Data from the TRIO US HIV cohort were used to identify adult people with HIV initiating a new ART regimen from January 2021 to November 2023 and describe prevalence of treatment interruptions (defined as ≥90 days without dispensed ART). Virologic outcomes were assessed among those restarting or switching to B/F/TAF after treatment interruption.</p><p><strong>Results: </strong>Of 2710 people with HIV, 765 (28%) experienced treatment interruption. Compared to individuals without treatment interruptions, those with treatment interruptions had higher proportion of women (24 vs. 19%), Black race (50 vs. 35%), substance use (14 vs. 9%), CD4 + cell count less than 200 cells/mm 3 (15 vs. 8%) and lower proportion with commercial insurance (48 vs. 62%) or virologic suppression at initiation (76 vs. 85%). Among 379 who restarted or switched to B/F/TAF following treatment interruption, 245 (65%) were suppressed at restart; 137 (56%) had at least one viral load after treatment interruption, of whom 129 (94%) maintained suppression. Of 87 with unknown viral status at restart, 46 (53%) had at least one viral load during follow-up, of whom 44 (96%) achieved suppression. Among 47 viremic at restart, 27 (57%) had at least one viral load after treatment interruption. Of them, 70% were suppressed during follow-up. No integrase inhibitor resistance emergence was observed.</p><p><strong>Conclusion: </strong>High levels of suppression following treatment interruption may suggest B/F/TAF regimen forgiveness making it an appropriate choice for treatment switch or restart.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1125-1132"},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575643","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":"Dolutegravir plus lamivudine downregulates cellular stress responses vs. three-drug HIV regimens.","authors":"Victoria Rios-Vazquez, Wilhelm A J W Vos, Marc J T Blaauw, Louise E Van Eekeren, Albert L Groenendijk, Adriana Navas, Nadira Vadaq, Leo A B Joosten, Mihai G Netea, Willem L Blok, Janneke E Stalenhoef, Lambert Van Den Heuvel, Andre J A M Van Der Ven, Jan Van Lunzen","doi":"10.1097/QAD.0000000000004198","DOIUrl":"10.1097/QAD.0000000000004198","url":null,"abstract":"<p><strong>Objective: </strong>To compare the systemic and immune effects of two-drug regimens (2DR) and three-drug regimens (3DR) in people with HIV (PWH).</p><p><strong>Design: </strong>In a cross-sectional study, multiomics data were analyzed in dolutegravir (DTG) plus lamivudine (3TC) 2DR and 3DR comprising DTG with two nucleoside reverse transcriptase inhibitors (NRTIs).</p><p><strong>Methods: </strong>Data from the 2000HIV cohort of virally suppressed PWH on combination antiretroviral treatment (cART) regimens were analyzed. Groups included DTG + 3TC ( n  = 191), DTG + 3TC + abacavir (ABC) ( n  = 188), and DTG + tenofovir disoproxil fumarate or tenofovir alafenamide (TDF/TAF) + emtricitabine (FTC) ( n  = 115). Systemic functions were assessed via plasma protein profiling (Olink Explore, 2367 proteins), while peripheral blood mononuclear cells (PBMCs) were used to evaluate immune effects by analyzing Bulk RNA-Seq and ex-vivo cytokine production capacity.</p><p><strong>Results: </strong>Plasma protein analysis revealed that 2DR associated to lower protein expression and pathways related to metabolism, stress responses, chemokine signaling, and immune responses compared to 3DR. Four proteins - CXCL8, DDC, PMM2, and EPS8L2 - were consistently downregulated in 2DR. Differential gene expression analysis identified 17 overlapping downregulated genes across all 3DR vs. 2DR comparisons, linked to chromatin structure, cellular senescence, stress response, and cytokine activity. Cytokine production was similar across 2DR and 3DR groups, except for enhanced interleukin (IL)-17 production in DTG + TDF + FTC users.</p><p><strong>Conclusions: </strong>Reducing NRTIs in DTG-based 2DR, particularly by omitting ABC or TAF/TDF, suggests decreased activation of stress response and immune-related pathways. Importantly, the functional capacity of circulating immune cells remains largely unchanged between 2DR and 3DR.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1106-1119"},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762791","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":"Routine testing for chlamydia and gonorrhea in an HIV preexposure prophylaxis program in Hanoi, Vietnam: implications for low- and middle-income countries.","authors":"Paul C Adamson, Hao T M Bui, Loc Q Pham, Phuong T Truong, Ngan T Le, Giang M Le, Jeffrey D Klausner","doi":"10.1097/QAD.0000000000004203","DOIUrl":"10.1097/QAD.0000000000004203","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the prevalence, anatomical distribution, and correlates of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections within an HIV preexposure prophylaxis (PrEP) program in Hanoi, Vietnam.</p><p><strong>Design: </strong>Cross-sectional, observational study.</p><p><strong>Methods: </strong>Between January and December 2022, HIV PrEP program clients who were male at birth, ≥16 years old, reported ≥1 male sex partner in the prior 12 months, were enrolled. A questionnaire collected sociodemographics, sexual behaviors, and clinical data. CT/NG testing was performed on self-collected urine, rectal, and pharyngeal specimens. Multivariate logistic regression was used to identify factors associated with infections.</p><p><strong>Results: </strong>Among 529 participants, the prevalence of CT or NG was 28.9% (153/529). The prevalence of NG was 14.4% (76/529) and highest for pharyngeal infections (11.7%; 62/528), while for CT, the prevalence was 20.4% (108/529) and highest for rectal infections (15.0%; 74/493). Symptoms in the prior week were reported by 45.8% (70/153) of those with CT or NG infections. Among asymptomatic participants, there was a low prevalence of urethral CT (3.1%; 14/457) and NG (0.9%; 4/457). Condomless anal sex [adjusted odds ratio (aOR) = 1.98; 95% confidence interval (CI): 1.27, 3.09] and sexualized drug use in the prior 6 months (aOR = 1.71; 95% CI: 1.09, 2.69) were associated with CT/NG infections.</p><p><strong>Conclusions: </strong>The study found a high prevalence of CT/NG infections, particularly pharyngeal and rectal infections, within an HIV PrEP program in Hanoi, Vietnam. The findings suggest testing for urethral infections among asymptomatic individuals is of limited value. Further research is needed for STI prevention strategies and updated guidelines for CT/NG screening in HIV PrEP programs in low- and middle-income countries.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1152-1160"},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956098","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":"Microbial translocation and liver fibrosis in women with HIV - unraveling the gut-liver axis.","authors":"Sepiso K Masenga, Donald D Anthony, Enass A Abdel-Hameed","doi":"10.1097/QAD.0000000000004218","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004218","url":null,"abstract":"","PeriodicalId":7502,"journal":{"name":"AIDS","volume":"39 9","pages":"1297-1299"},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493403","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":"Multicenter study of heart failure phenotypes and physician-adjudicated causes in people with HIV.","authors":"Nour Beydoun, Robin M Nance, Matthew S Durstenfeld, Alexander P Hoffmann, Bridget M Whitney, Greer A Burkholder, Sonya Health, Priscilla Y Hsue, Michael Saag, Joseph Ac Delaney, Chris T Longenecker, Heidi M Crane, Matthew J Feinstein","doi":"10.1097/QAD.0000000000004182","DOIUrl":"10.1097/QAD.0000000000004182","url":null,"abstract":"<p><strong>Background: </strong>Limited systematic data exist on heart failure phenotypes in contemporary HIV care, and no prior multicenter studies have investigated physician-adjudicated phenotypes and causes of heart failure in people with HIV (PWH).</p><p><strong>Methods: </strong>We adjudicated heart failure events and sub-phenotypes occurring between January 1, 2010, and December 31, 2021, at two large urban clinical centers within the CFAR Network of Integrated Clinical Systems (CNICS) cohort. Using Cox proportional hazard regression, hazard ratios were calculated to examine associations of HIV-specific and cardiometabolic risk factors with incident heart failure among PWH. Exploratory analyses investigated presence of physician-adjudicated ischemic and nonischemic causes of HF.</p><p><strong>Results: </strong>Of 402 individuals with events screened as possible heart failure, 289 were adjudicated as heart failure. Of these 289, 77 were prevalent at baseline and 212 were incident. Higher viral load and lower CD4 +  T cell count were associated with incident heart failure. In addition, older age, smoking, hypertension, diabetes mellitus, history of myocardial infarction (MI), and renal insufficiency were associated with higher heart failure risk. Nonischemic heart failure causes were more common than ischemic, and heart failure with reduced ejection fraction (HFrEF) was more common than preserved ejection fraction (HFpEF). Despite distinct demographic and risk factor compositions between the two sites, heart failure phenotypes were similar.</p><p><strong>Conclusion: </strong>HIV viremia, low CD4 +  T cell count, traditional CVD risk factors, and renal insufficiency were associated with higher risk for heart failure. The predominant heart failure subtype was nonischemic heart failure. While further studies are needed, our findings suggest heart failure prevention and management in PWH will require addressing complex interactions between HIV-related and traditional CVD risk factors.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1246-1253"},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655871","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":"Cognitive function and mortality among persons aging with HIV and injection drug use.","authors":"Damani A Piggott, Shruti H Mehta, Leah H Rubin, Jing Sun, Sean X Leng, Gregory D Kirk","doi":"10.1097/QAD.0000000000004169","DOIUrl":"10.1097/QAD.0000000000004169","url":null,"abstract":"<p><strong>Objective: </strong>Cognitive impairment and frailty are critical, aging-related phenotypes prevalent among people with HIV (PWH). Yet, limited data exist isolating the determinants of cognitive function among persons with a history of injection drug use (PWID) with and at risk for HIV, or on the intersecting relationship of cognitive function and frailty with mortality in this population.</p><p><strong>Design/methods: </strong>Standard cognitive assessments were performed among PWID with and without HIV in the AIDS Linked to the IntraVenous Experience (ALIVE) cohort. Frailty was assessed using the five Fried physical frailty phenotype criteria. An inflammatory index score was constructed from IL-6 and soluble TNF-α receptor-1 data. Cox proportional hazards models were utilized to estimate mortality risk.</p><p><strong>Results: </strong>Among 516 ALIVE participants, the median age was 52 years, and 41% were PWH. Hazardous alcohol use and older age were significantly associated with reductions in processing speed, motor function, and global cognitive function. In multivariable models, reduced processing speed, motor function, and global cognitive function were significantly associated with increased mortality. Reduced global cognitive function and frailty were independently associated with mortality. Reduced processing speed, motor function, executive function, and global cognitive function were significantly associated with heightened inflammation.</p><p><strong>Conclusion: </strong>Reduced cognitive function is a significant predictor of death among PWH and PWID, independent of frailty, HIV disease stage, and comorbidity. Interventions that target both cognitive function and frailty, including those targeting inflammation pathways, among PWH and PWID may improve aging outcomes for these populations.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1214-1223"},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575629","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":"Interest and disparities in awareness and uptake of doxycycline postexposure prophylaxis among US MSM with HIV.","authors":"Tyler Martinson, Megan J Heise, Kevin Sassaman, Hannah R Schmidt, Alexa B D'Angelo, Shivani Mahuvakar, Dustin T Duncan, Keith J Horvath, Sabina Hirshfield, Renessa Williams, Mallory O Johnson, Christian Grov, Adam Carrico, Monica Gandhi, Matthew A Spinelli","doi":"10.1097/QAD.0000000000004192","DOIUrl":"10.1097/QAD.0000000000004192","url":null,"abstract":"<p><strong>Objective: </strong>The CDC recommends doxycycline postexposure prophylaxis (doxyPEP) for MSM with a bacterial sexually transmitted infection (bSTI) in the past year. This study explored determinants of doxyPEP awareness and uptake, and associations with HIV care outcomes, among US MSM with HIV.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>From October 2023 to October 2024, we enrolled 827 MSM with HIV from 46 states, Washington, DC, and Puerto Rico via a popular geospatial networking app. Adjusted multivariable logistic regression examined determinants of doxyPEP awareness/use and associations with HIV treatment adherence, viral suppression, and care engagement.</p><p><strong>Results: </strong>Among 827 participants, 13% were currently taking doxyPEP, 46% were aware of doxyPEP but not prescribed it, and 41% had not heard of it. Of 360 participants Centers for Disease Control and Prevention (CDC)-eligible for doxyPEP, 20% were prescribed it, 49% had heard of it but were not on it, and 31% were unaware, 95% of whom expressed interest. Neither awareness nor use of doxyPEP was associated with HIV care outcomes. Both awareness and uptake of doxyPEP were higher among participants with a recent bSTI [adjusted odds ratio (aOR) = 1.15, 95% confidence interval (CI): 1.06-1.25; aOR = 1.11, 95% CI: 1.05-1.17, respectively) and lower in the United States. Midwest, Mountain, and South regions [inverse-variance weighted average (IVW-Avg) aOR = 0.81, 95% CI: 0.76-0.86; IVW-Avg aOR = 0.86, 95% CI: 0.82-0.90, respectively] relative to Pacific states.</p><p><strong>Conclusion: </strong>High doxyPEP interest underscores unmet demand in integrated HIV/sexual healthcare. Sociodemographic and geographic disparities in doxyPEP implementation necessitate targeted interventions for MSM with HIV to optimize impact on the bSTI epidemic.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1191-1196"},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750603","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":"Predictors of unsuppressed viral load among MSM with HIV in South Africa.","authors":"Jessica S van der Mannen, Stanford Furamera, Jacqueline Pienaar, Pontsho Komane, Luxolo Shokota, Boitumelo Ramashala, Lindiwe Tsope, Elise M van der Elst, Danielle Giovenco, Don Operario, Eduard J Sanders","doi":"10.1097/QAD.0000000000004205","DOIUrl":"10.1097/QAD.0000000000004205","url":null,"abstract":"<p><strong>Introduction: </strong>South Africa has the largest HIV epidemic of the world, but predictors of unsuppressed viral load among MSM are scarce.</p><p><strong>Methods: </strong>We did a cross-sectional study to assess socio-demographic characteristics, year of antiretroviral therapy (ART) initiation, and viral load data from 1385 MSM registered in five key population clinics in five districts in South Africa in 2023 and 2024. We used logistic regression to assess predictors of unsuppressed viral load (≥200 copies/ml). We then conducted a case--control study involving 57 cases (viral load≥200 copies/ml) and 57 matched controls (viral load<200 copies/ml; matched on age, ART start date, clinic, and outreach vs. facility attendance) drawn from the cross-sectional study to explore additional differences between groups.</p><p><strong>Results: </strong>In the cross-sectional study, predictors for unsuppressed viral load included on ART for 1-2 years [odds ratio (OR) 3.53; 1.77-7.69] or 3-5 years (OR 2.33; 1.18-5.04) vs. more than 5 years, being an outreach vs. facility-based client (OR: 2.64; 1.79-3.94), and enrolled at Johannesburg (OR: 3.53; 2.25-5.64), or Durban (OR: 0.36; 0.84-0.70), vs. Pretoria. The case-control study identified predictors for unsuppressed viral load, which included missing more than four ART dosages per month (OR: 5.55; 1.19-41,03), having moderate to severe anxiety (OR: 3.90; 1.34-12,52), hazardous alcohol use (OR: 2.70; 1.14-6.81), and Christian vs. no religion (OR: 3.89; 1.34-12.29).</p><p><strong>Conclusion: </strong>We identified regional differences and key predictors of unsuppressed viral load among MSM living with HIV in South Africa. Screening for risk factors for unsuppressed viral load at ART continuation may inform where adherence support and other health services are needed.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1290-1296"},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961605","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":"Effectiveness of levonorgestrel implant and depot medroxyprogesterone acetate injectable for women with HIV on efavirenz.","authors":"Katie R Mollan, Brian W Pence, Daniel Westreich, Agatha Bula, Clara Lemani, John Chapola, Jill M Hagey, Karen Diepstra, Jennifer Winston, Sam Phiri, Jane Chiwoko, Lameck Chinula, Mina C Hosseinipour, Michael G Hudgens, Mackenzie L Cottrell, Audrey Pettifor, Michele Jonsson-Funk, Jennifer H Tang","doi":"10.1097/QAD.0000000000004201","DOIUrl":"10.1097/QAD.0000000000004201","url":null,"abstract":"<p><strong>Objective: </strong>We compared the contraceptive effectiveness of typical-use LNG implant and depot medroxyprogesterone acetate (DMPA) injectable during efavirenz use.</p><p><strong>Design: </strong>We conducted a prospective cohort study of women with HIV (WHIV) on efavirenz-containing antiretroviral treatment in Lilongwe, Malawi. Eligible participants were 18-40 years of age and initiating LNG implant or DMPA injectable with a desire to prevent pregnancy for 4+ years. Study visits and urine pregnancy testing occurred at enrollment, week 4, and every 24 weeks up to week 192. Malawi's efavirenz-to-dolutegravir transition shortened our duration of efavirenz follow-up.</p><p><strong>Methods: </strong>Pregnancy incidence rates/100 person-years and an incidence rate difference (IRD) were estimated using an inverse-probability-weighted Poisson model.</p><p><strong>Results: </strong>We enrolled 1179 WHIV on efavirenz: 592 and 587 chose to initiate the LNG implant and DMPA, respectively. Median follow-up during efavirenz use was 1.1 years [interquartile range (IQR): 0.5-1.7]. Estimated pregnancy incidence rates were 6.6/100 person-years [95% confidence interval (95% CI): 5.0-8.7] in the LNG implant enrollment group (50 pregnancies) and 7.3/100 person-years (95% CI: 5.5-9.7) in the DMPA enrollment group (54 pregnancies), IRD -0.7/100 person-years (95% CI: -3.5 to 2.0). Results were similar in an analysis of first incident pregnancy during continued typical use of LNG implant (5.7/100 person-years) versus continued typical use of DMPA (5.7/100 person-years), IRD 0.0/100 person-years (95% CI: -2.6 to 2.7).</p><p><strong>Conclusion: </strong>In many settings, LNG implant has better contraceptive effectiveness than DMPA injectable. However, for WHIV on efavirenz, we observed similar typical-use effectiveness for LNG implant versus provider-administrated DMPA injectable during the initial 1-2 years of use.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1197-1203"},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771048","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}