AIDS最新文献

{"title":"Less frequent testing for sexually transmitted infections: do the benefits outweigh the risks for vulnerable populations?","authors":"Iulia Filip","doi":"10.1097/QAD.0000000000004106","DOIUrl":"10.1097/QAD.0000000000004106","url":null,"abstract":"","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"N7-N8"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930408","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":"Cannabis use and HIV among Black sexually minoritized men: a systematic review and narrative analysis.","authors":"Justin Knox, Christopher Magana, Dustin T Duncan, Cho-Hee Shrader, Allison Wilson, Sarah Keedy, Jade Pagkas-Bather, Yen-Tyng Chen, John A Schneider","doi":"10.1097/QAD.0000000000004149","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004149","url":null,"abstract":"<p><strong>Objective: </strong>We conducted a systematic review evaluating the extant literature examining the impacts of cannabis use on HIV-related outcomes among Black sexual minoritized men (BSMM).</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Methods: </strong>We conducted a search in November 2024 of PubMed, EMBASE, CINAHL, PsycINFO, and Web of Science using keywords related to BSMM, HIV, and cannabis. Study quality was assessed utilizing a tool developed for observational studies. 108 unique articles were screened with 55 undergoing full-text review, and 20 met inclusion criteria. Results were synthesized and presented utilizing a narrative review process.</p><p><strong>Results: </strong>We identified 20 studies published between 1999-2024. Measures of cannabis use included any use (e.g., ever, past 30 days), daily/intermittent/heavy use, use before/during sex, and problematic use. Outcomes included: HIV positivity/seroconversion, HIV Continuum of Care (CoC), PrEP CoC, and sex behavior strengths, vulnerabilities, and assets. Study findings were generally mixed, however positive associations between cannabis use and HIV seroconversion, inconsistent condom use, being HIV-positive and unaware of one's serostatus, and suboptimal ART adherence were reported.</p><p><strong>Conclusions: </strong>This systematic review identified a growing literature on cannabis use and HIV among Black SMM. Conclusions that can be drawn from the evidence are limited. There is a critical need for studies that more rigorously measure cannabis use by considering contexts of cannabis use. In addition, there is a need for research that examines the pathways and mechanisms through which cannabis use may affect prevention and treatments outcomes related to HIV among Black SMM.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363209","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":"Bone mineral density changes in breastfeeding women living with HIV on antiretroviral therapy in Eastern and Southern Africa.","authors":"Flavia Matovu Kiweewa, Lynda Stranix-Chibanda, Nonhlanhla Yende-Zuma, Sufia Dadabhai, Maxensia Owor, Sherika Hanley, Mandisa Nyati, Lameck Chinula, John M Pettifor, Sean S Brummel, Jim Aizire, Taha E Taha, Todd T Brown, Mary Glenn Fowler","doi":"10.1097/QAD.0000000000004148","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004148","url":null,"abstract":"<p><strong>Objective: </strong>To describe postpartum bone mineral density (BMD) change among breastfeeding African women living with HIV (WLHIV) on life-long antiretroviral therapy (ART).</p><p><strong>Design: </strong>In IMPAACT P1084 s, postpartum BMD declines were greater in WLHIV randomized to ART to prevent breastmilk transmission compared to infant nevirapine prophylaxis). This analysis extends the observation period through entry to a follow-on observational study, PROMOTE.</p><p><strong>Methods: </strong>Lumbar spine (LS), total hip (TH) and femoral neck (FN) BMD were assessesd using dual energy x-ray absorptiometry (DXA) at postpartum weeks 1 and 74 in P1084 s, and at PROMOTE entry. Participants were included if DXA data were available from PROMOTE entry and > 1 earlier timepoint. Country-specific Z-scores were created by internal standardization to week 1 values. Linear mixed models, adjusted for country, estimated the annualized rate of change in BMD z-scores between postpartum week 1 and PROMOTE entry. Linear regression assessed the association between maternal characteristics and BMD z-score rate of change.</p><p><strong>Results: </strong>We included BMD data from 519 participants between postpartum week 1 through PROMOTE entry (median (IQR) 4.6 (3.5-5.1) years postpartum). For every 5 years passed, LS BMD Z-scores increased by + 0.250 units, while TH and FN BMD z-scores decreased by -0.173 and -0.141 units, respectively. LS, TH and FN BMD increased between postpartum week 74 and PROMOTE entry, but only LS BMD fully recovered to week 1 values.</p><p><strong>Conclusion: </strong>Given dampened TH and FN BMD recovery post-breastfeeding, longer term monitoring is needed to assess peri-/post-menopausal fracture risk, and interventions to optimize bone health among WLHIV on life-long ART.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363208","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":"Cerebrospinal fluid biomarkers of inflammation and immune activation associated with neurocognitive impairment among U.S. Latinos living with HIV.","authors":"Monica M Diaz, Lily Kamalyan, Tala Al-Rousan, Jordana Breton, Donald R Franklin, Anya Umlauf, Ronald J Ellis, Mariana Cherner, Jennifer Iudicello, Robert K Heaton, Scott L Letendre, María J Marquine","doi":"10.1097/QAD.0000000000004143","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004143","url":null,"abstract":"<p><strong>Objective: </strong>Examine the association between markers of inflammation in the cerebrospinal fluid (CSF) and neurocognitive impairment (NCI) among diverse persons with HIV (PWH).</p><p><strong>Background: </strong>Latino PWH are at higher risk for NCI than non-Latino White PWH (NLW). Evidence of inflammation in cerebrospinal fluid (CSF) can be higher among racial and ethnic minority PWH and has been linked to NCI.</p><p><strong>Methods: </strong>We performed a retrospective cross-sectional analysis of 363 PWH who identified as Latinos or NLW. Neurocognitive performance was measured by a comprehensive battery. A focused panel of biomarkers [interleukin-6 (IL-6), soluble CD14 (sCD14), interferon-γ-inducible protein-10 (IP-10), neurofilament light chain (NFL)] was measured in CSF by immunoassay. Covariates included demographic, HIV disease, medical, psychiatric, and substance use characteristics.</p><p><strong>Results: </strong>The cohort consisted of 126 Latinos and 237 NLW (age: M = 42.5, SD = 11.0, 88% male, 51.5% AIDS history; 64% on antiretroviral therapy). Latinos had significantly higher NFL levels than NLW (P < 0.0001, adjusted Cohen's d 1.15), but not among virally-suppressed PWH. In the entire cohort, higher sCD14 was associated with NCI (adjusted odds ratio (aOR) = 2.6, confidence interval (CI) = 1.1-6.5] after adjusting for statistically significant covariates.</p><p><strong>Conclusions: </strong>We did not identify a relationship between ethnicity, inflammation and NCI in this cohort. Future studies might examine sociocultural factors leading to increased inflammation in the CSF in diverse PWH.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254044","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":"Impact of increased uptake of long-acting injectable antiretroviral therapy on HIV incidence and viral suppression in the United States under 2021 FDA guidelines.","authors":"Alex Viguerie, Jesse O'Shea, Marie Johnston, Daniel Schreiber, Joella Adams, Laurel Bates, Justin Carrico, Katherine A Hicks, Cynthia M Lyles, Paul G Farnham","doi":"10.1097/QAD.0000000000004144","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004144","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the impact of increased long-acting injectable antiretroviral therapy (Cabotegravir-rilpivirine [CAB/RPV]) use among persons with diagnosed HIV (PWDH) with viral suppression (VLS), per 2021 US Food and Drug Administration (FDA) guidelines, on HIV incidence and levels of VLS in the US.</p><p><strong>Methods: </strong>We used the HOPE compartmental model to simulate CAB/RPV use during 2023-2035. We first simulated a baseline scenario (no CAB/RPV), in which 69% of PWDH had VLS. We then introduced CAB/RPV in 2023 under two scenarios: (1) where CAB/RPV improved the duration of VLS post-cessation of ART use compared to oral ART; (2) where CAB/RPV additionally improved adherence. We compared cumulative 2023-35 incidence and percentage of PWDH with VLS at year-end 2035 to baseline.</p><p><strong>Results: </strong>When CAB/RPV increased the duration of VLS only, cumulative incidence was reduced up to 9%, and VLS increased up to 4%. When CAB/RPV also improved ART adherence, incidence was reduced up to 19.5%, and VLS increased up to 9%.</p><p><strong>Conclusions: </strong>CAB/RPV, even if only used among PWDH with VLS, may reduce HIV incidence and increase VLS, due to longer-lasting VLS post-cessation of usage. If CAB/RPV also improves ART adherence, incidence is further reduced. Improved clinical efficacy of CAB/RPV may translate to improved population-level outcomes, even in limited use cases.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254014","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":"Long-term non-progression in children living with HIV: estimates from international cohort data.","authors":"Charlotte Jackson, Siobhan Crichton, Ali Judd, Alasdair Bamford, Philip Goulder, Nigel Klein, Laura Marques, Paolo Paioni, Andrew Riordan, Vana Spoulou, Vinicius Adriano Vieira, Santa Ansone, Elena Chiappini, Sophie Le Coeur, Luminita Ene, Luisa Galli, Carlo Giaquinto, Tessa Goetghebuer, Claudia Fortuny, Suparat Kanjanavanit, Magda Marczynska, Marisa Navarro, Lars Naver, Nicole Ngo-Giang-Huong, Yulia K Plotnikova, Aleksey A Plynskey, Jose Tomas Ramos, Irina Raus, Vladimir Y Rozenberg, Anna V Samarina, Elisabeth H Schölvinck, Natalia Vasylenko, Alla Volokha, Intira Jeannie Collins, Ruth Goodall","doi":"10.1097/QAD.0000000000004136","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004136","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the probability of long-term nonprogression (LTNP) in the absence of antiretroviral treatment (ART) in children with perinatally acquired HIV, and the impact of LTNP definitions on these estimates.</p><p><strong>Design: </strong>Analysis of longitudinal routine care data (follow-up to 2016) collected through a collaboration of cohorts of children in routine HIV care across Europe and Thailand.</p><p><strong>Methods: </strong>LTNP was defined as reaching age 8 years without disease progression (defined as an AIDS diagnosis or immunosuppression based on WHO immunosuppression-for-age thresholds, age-adjusted CD4+z-scores or CD4+ counts). ART initiation was treated as a competing risk (children initiating ART before age 8 were not considered to have LTNP). We included children born domestically in six national HIV cohorts (n = 2481). Additional analyses included domestic-born children enrolled in national cohorts in infancy (aged <12 months, n = 1144, six cohorts), or all domestic-born children in national and nonnational cohorts (n = 4542, 18 cohorts). Results were stratified by birth year.</p><p><strong>Results: </strong>Among children born domestically in national cohorts in 2004-2007, the probability [95% confidence interval (CI)] of LTNP at age 8 years was 10% (6-15%) based on WHO immunosuppression-for-age criteria. This was lower for children born earlier when ART use was less frequent. Results were similar using other immunosuppression thresholds. Estimates were lower when restricted to domestic-born children in national cohorts enrolled in infancy, and higher when including all domestic-born children.</p><p><strong>Conclusion: </strong>Up to 10% of children born during 2004-2007 had LTNP at age 8. Our findings may help identify participants with LTNP for research into posttreatment control and HIV cure.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254017","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":"Cost-effectiveness of long-acting injectable cabotegravir-rilpivirine as HIV treatment per virally-suppressed persons in a San Francisco clinic: an intermediary outcome analysis.","authors":"Elliot Marseille, Ryan S Walker, Matthew D Hickey, Janet Grochowski, Francis Mayorga-Munoz, Jon Oskarsson, Elizabeth Imbert, Mary Shiels, John D Szumowski, Tor B Neilands, Mallory O Johnson, Monica Gandhi, Katerina A Christopoulos","doi":"10.1097/QAD.0000000000004145","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004145","url":null,"abstract":"<p><strong>Background: </strong>Long-acting injectable cabotegravir-rilpivirine (CAB/RPV-LA) is a promising treatment alternative for people with HIV (PWH) who face adherence challenges with oral antiretroviral therapy (ART). While its clinical efficacy is well-documented, cost-effectiveness data from real-world settings remain limited.</p><p><strong>Objective: </strong>To evaluate the incremental first-year cost and cost-effectiveness of CAB/RPV-LA versus standard of care (SoC) oral ART among PWH with adherence challenges, from the perspective of a healthcare payer.</p><p><strong>Methods: </strong>A cohort of 59 PWH initiating CAB/RPV-LA at Ward 86, a San Francisco-based clinic, was analyzed. Viral suppression (VS) rates and treatment costs were compared between CAB/RPV-LA and SoC ART. Cost-effectiveness was assessed using incremental cost per newly virally-suppressed PWH and net monetary benefit (NMB). Sensitivity analyses were performed to evaluate parameter uncertainty.</p><p><strong>Results: </strong>CAB/RPV-LA achieved a VS rate of 92%, compared to an estimated 15% with SoC ART. The estimated first-year cost of CAB/RPV-LA delivery was $67,041 per patient versus $50,668 for SoC. The incremental cost per newly virally-suppressed PWH was $21,264. CAB/RPV-LA is the most cost-effective option at any willingness-to-pay above this level. The NMB was $243,721 suggesting favorable cost-effectiveness. Sensitivity analyses confirmed the robustness of these results.</p><p><strong>Conclusions: </strong>Initiating CAB/RPV-LA for PWH with viremia suggests highly favorable cost-effectiveness. Results are sensitive to the costs of antiretroviral drugs, but not to variations in personnel costs or rates of viral suppression within plausible input ranges.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254048","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":"Reduced peri-pubertal bone density accrual among Zimbabwean males living with HIV: a longitudinal study.","authors":"Lisha Jeena, Rashida A Ferrand, Victoria Simms, Cynthia Kahari, Tsitsi Bandason, Ruramayi Rukuni, Andrea M Rehman, Sarah Rowland-Jones, Anthony Y Y Hsieh, Celia L Gregson","doi":"10.1097/QAD.0000000000004134","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004134","url":null,"abstract":"<p><strong>Objective: </strong>To investigate bone density accrual over 1 year among peripubertal children living with HIV (CWH) compared to children without infection (CWOH); and risk factors associated with bone density accrual among CWH.</p><p><strong>Design: </strong>A prospective cohort study in urban Zimbabwe.</p><p><strong>Methods: </strong>CWH on antiretroviral therapy aged 8-16 years, and CWOH, frequency-matched by age were recruited in Zimbabwe. Z-scores for height-adjusted total-body less-head bone mineral content for lean mass (TBLH-BMCLBM) and size-adjusted lumbar spine bone mineral apparent density (LS-BMAD) were calculated from dual X-ray absorptiometry (DXA) scan measurements. Linear regression compared bone density accrual by HIV status.</p><p><strong>Results: </strong>Of 609 participants, 492 (80.7%) completed a follow-up visit (50.2% male, 49.6% CWH). Mean baseline age was 12.5 years. More female CWH than CWOH were in Tanner stages I/II at baseline. Bone density accrual (Δ) adjusted for age, Tanner stage and baseline DXA Z-score was less in male CWH than male CWOH {adjusted mean (95% confidence interval (CI)] ΔLS-BMAD Z-score -0.14 (-0.25 to -0.02) vs. 0.01 (-0.09 to 0.12), P = 0.020, and ΔTBLH-BMCLBMZ-score -0.19 (-0.33 to -0.04) vs. 0.07 (-0.07 to 0.20), P = 0.015}, but similar in females with and without HIV [ΔLS-BMAD Z-score 0.05 (-0.07 to 0.17) vs. -0.01 (-0.09 to 0.07), P = 0.416, and ΔTBLH-BMCLBMZ-score 0.08 (-0.07 to 0.22) vs. -0.03 (-0.12 to 0.07), P = 0.295]. Viral load greater than 1000 copies/ml and tenofovir disoproxil fumarate use were associated with less gain in LS-BMAD Z-score among males, whereas Tanner stage IV and V were associated with greater gains in LS-BMAD and TBLH-BMCLBMZ-scores among CWH.</p><p><strong>Conclusion: </strong>Among males only, CWH had impaired bone accrual, associated with high viral load and tenofovir use. Bone density gains were greater in later puberty among CWH suggesting potential to correct deficits.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254021","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, safety, and pharmacokinetics of lenacapavir oral bridging when subcutaneous lenacapavir cannot be administered.","authors":"Onyema E Ogbuagu, Anchalee Avihingsanon, Sorana Segal-Maurer, Hui Wang, Vamshi K Jogiraju, Renu Singh, Martin S Rhee, Hadas Dvory-Sobol, Peter A Sklar, Jean-Michel Molina","doi":"10.1097/QAD.0000000000004142","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004142","url":null,"abstract":"<p><strong>Objective: </strong>To assess efficacy, safety and pharmacokinetics (PK) of oral lenacapavir (LEN) when used as oral bridging (OB) between delayed subcutaneous (SC) LEN injections.</p><p><strong>Design: </strong>Posthoc analysis of participants in two clinical trials of SC LEN for HIV-1 treatment who required OB when LEN SC dosing was interrupted.</p><p><strong>Methods: </strong>Oral LEN [300 mg once weekly (QW)] was initiated within 2 weeks of the next scheduled injection (dosing interval: 26 weeks). Efficacy, safety, and PK were assessed every 10-12 weeks.</p><p><strong>Results: </strong>Overall, 139 participants received ≥1 dose of oral 300 mg QW LEN plus other antiretrovirals. Median duration of OB was 19 weeks in both clinical trials. By missing = excluded analysis, over 95% of participants maintained virologic suppression (HIV-1 RNA <50 copies/ml) at Weeks 10, 20, and 30. Treatment-emergent AEs (TEAEs) were similar to those with SC LEN (excluding injection site reactions). No Grade ≥3 or serious TEAEs were considered related to oral LEN. Throughout OB, mean LEN plasma concentrations and lower bound 90% confidence intervals (CIs) were consistently above inhibitory quotient 4 (4-fold in-vitro protein binding-adjusted 95% effective concentration). OB adherence (by pill count) was ≥95% in the majority of participants in both clinical trials.</p><p><strong>Conclusions: </strong>High rates of virological suppression were maintained during OB. Oral 300 mg QW LEN was well tolerated and provided adequate plasma concentrations to bridge SC LEN dosing. This analysis supports using 300 mg QW LEN for OB when SC LEN treatment is interrupted.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254012","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":"Sociobehavioral determinants of non-retention among adolescents and young adults living with HIV.","authors":"Sarah Hicks, Wenwen Jiang, James Kibugi, Jacinta Badia, Barbra A Richardson, Kristin Beima-Sofie, Kawango Agot, Pamela Kohler, Grace John-Stewart","doi":"10.1097/QAD.0000000000004141","DOIUrl":"https://doi.org/10.1097/QAD.0000000000004141","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify age-specific cofactors of nonretention among adolescents and young adults living with HIV (AYLHIV) ages 10-24.</p><p><strong>Design: </strong>This analysis used data from the Data-Informed Stepped Care study (DiSC; NCT05007717), a cluster randomized clinical trial in 24 health facilities in Western Kenya.</p><p><strong>Methods: </strong>During 12-month follow-up, youth-reported cofactors of missed visits and loss-to-follow-up (LTFU; did not return to clinic within study period) were assessed using generalized linear and mixed effect models and stratified by gender and age.</p><p><strong>Results: </strong>Among 1904 AYLHIV, median age was 17 years (interquartile range 14-19), and 57.9% were female. A higher proportion of missed visits was observed in older ages (10-14: 6.0%; 15-19: 7.9%; 20-24: 12.5%). Overall, higher resilience (PR = 0.93) and satisfaction with clinic (PR = 0.81) were associated with lower risk of missed visits. Among males, satisfaction with clinic was associated with lower risk (PR = 0.61) while higher stigma was associated with increased risk (PR = 1.31). Among females, resilience was associated with lower risk (PR = 0.93). Having no living parents was associated with higher LTFU risk (PR = 2.24). Among males, horizontal transmission was associated with higher risk (PR = 2.98) and resilience with lower risk (PR = 0.76). Females who came to clinic alone had lower risk of LTFU (PR = 0.27). Age-stratified analyses did not identify additional cofactors.</p><p><strong>Conclusions: </strong>In this large multisite cohort, older AYLHIV had the most retention challenges. Resilience, satisfaction with clinical care, and stigma exerted an influential role, but cofactors differed between age and gender strata, underscoring the heterogeneity of AYLHIV and suggesting need for tailored approaches.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254036","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}