{"title":"Metabolic dysfunction-associated steatotic liver disease in people with HIV.","authors":"Arijeet K Gattu, Lindsay T Fourman","doi":"10.1097/COH.0000000000000952","DOIUrl":"https://doi.org/10.1097/COH.0000000000000952","url":null,"abstract":"<p><strong>Purpose of review: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among people with HIV (PWH) and increasingly recognized as a major contributor to morbidity and mortality. The field of MASLD is rapidly evolving with adoption of a new nomenclature and approval of the first FDA-approved therapy within the past year. These developments underscore the need to consider the current state of the science specifically in the context of HIV.</p><p><strong>Recent findings: </strong>MASLD in PWH (MASLD-HIV) follows a more aggressive clinical course compared to HIV-negative individuals. While MASLD-HIV shares common pathogenic mechanisms with MASLD in the general population, HIV-specific factors - including altered body composition, chronic immune activation, enhanced gut permeability, and antiretroviral therapy - exacerbate disease progression. Despite an expanding pipeline of MASLD therapies, a critical gap remains in evaluating these interventions specifically among PWH. Nonetheless, dedicated studies of glucagon-like peptide-1 receptor agonists and the growth hormone-releasing hormone analog tesamorelin have shown promise in MASLD-HIV.</p><p><strong>Summary: </strong>MASLD is a key contributor to liver-related and cardiovascular-morbidity in PWH. While there have been exciting advances to improve diagnosis and management of MASLD in the general population, differences in MASLD pathophysiology demonstrate the need to tailor our approach specifically for PWH.</p>","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Update on neurological complications of HIV.","authors":"Monica M Diaz","doi":"10.1097/COH.0000000000000951","DOIUrl":"https://doi.org/10.1097/COH.0000000000000951","url":null,"abstract":"<p><strong>Purpose of review: </strong>The prevalence of neurological complications among people with HIV (PWH) is expected to increase as PWH live longer due to increased access to antiretroviral treatment (ART). This review provides updates to the understanding of the neurological sequelae, including neurocognitive impairment, neuropathy, neurological opportunistic infections, and others, which are crucial for improving care and outcomes of PWH.</p><p><strong>Recent findings: </strong>Recent literature highlights several key themes: the pathophysiology of HIV-related neuronal damage involving HIV proteins (gp120, Nef) and neuroinflammation; the role of aging in exacerbating neurological complications; the high prevalence of HIV-associated neurocognitive disorders (HAND) and Alzheimer's disease-related dementias (AD/ADRD) among PWH; the importance of neurocognitive screening tools like IHDS and MoCA; and the identification of biomarkers and neuroimaging techniques for early detection and monitoring of HAND.</p><p><strong>Summary: </strong>The findings highlight the need for comprehensive healthcare strategies to manage neurological complications in PWH, including targeted interventions for high-risk groups, improved diagnostic tools, and tailored treatments. It is important for clinicians and researchers to develop effective approaches to mitigate the impact of HIV on brain health and improve quality of life for PWH.</p>","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laventa M Obare, Victoria R Stephens, Celestine N Wanjalla
{"title":"Understanding residual risk of cardiovascular disease in people with HIV.","authors":"Laventa M Obare, Victoria R Stephens, Celestine N Wanjalla","doi":"10.1097/COH.0000000000000953","DOIUrl":"https://doi.org/10.1097/COH.0000000000000953","url":null,"abstract":"<p><strong>Purpose of review: </strong>Traditional cardiovascular risk factors, combined with persistent systemic inflammation, contribute to the increased prevalence of atherosclerotic cardiovascular disease (ASCVD) in people with HIV (PWH). This review highlights key findings from the REPRIEVE trial on statin-based primary prevention of major adverse cardiovascular events in PWH. It explores HIV-specific immune mechanisms contributing to residual cardiovascular risk.</p><p><strong>Recent findings: </strong>In REPRIEVE, statin therapy used for primary prevention of major adverse cardiovascular events in PWH decreased the plasma lipoprotein-associated phospholipase A2, oxidized low-density lipoprotein, and high-sensitivity C-reactive protein (hs-CRP). However, several inflammatory markers including soluble CD14 (sCD14), sCD163, interleukin (IL)-1β, interleukin (IL)-6, IL-10, and caspase 1 did not change. The HIV reservoir, dysfunctional CD4+ T cells, immunoglobulin G N-glycans, antiapolipoprotein A1 autoantibodies, trained immunity, and clonal hematopoiesis of indeterminate potential may contribute to residual inflammation.</p><p><strong>Summary: </strong>Despite antiretroviral and statin therapy, residual ASCVD risk in PWH underscores the need for targeted interventions. Anti-inflammatory therapies, including IL-6 and IL-1β inhibitors, CCR5 antagonists (e.g., maraviroc, cenicriviroc mesylate), and immunomodulatory agents like methotrexate and colchicine, are being explored. Understanding HIV-driven immune dysregulation may lead to novel strategies to mitigate cardiovascular risk in this population.</p>","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Balancing polypharmacy and comorbidity management: cardiovascular health.","authors":"Alex E Rock, Matthew L Russell, Virginia A Triant","doi":"10.1097/COH.0000000000000948","DOIUrl":"https://doi.org/10.1097/COH.0000000000000948","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review will discuss statin therapy for prevention of cardiovascular disease (CVD) among people with HIV (PWH) in the context of balancing prevention and treatment of chronic diseases with challenges related to polypharmacy.</p><p><strong>Recent findings: </strong>Aging PWH confront an increased risk of chronic diseases, resulting in the need for prevention and treatment of comorbidities in addition to antiretroviral therapy (ART). Paradigm-shifting data from the REPRIEVE trial demonstrated a reduction in CVD events with statin therapy among PWH at low to moderate CVD risk, prompting the Department of Health and Human Services (HHS) to recommend statin therapy for primary prevention of CVD in people with HIV aged 40-75 years. Statins should be initiated according to guideline recommendations for CVD prevention, and discussion of statin initiation should include consideration of concurrent medications and the potential effects of polypharmacy.</p><p><strong>Summary: </strong>Statins should be initiated for primary prevention of CVD in people with HIV age 40-75 years. The effects of polypharmacy should be considered in all aging PWH. Prevention and treatment of chronic diseases among PWH is important to reduce morbidity and mortality and promote healthy aging.</p>","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Indira Mallik, Merle Henderson, Sarah Fidler, Caroline Foster
{"title":"Aging of adult lifetime survivors with perinatal HIV.","authors":"Indira Mallik, Merle Henderson, Sarah Fidler, Caroline Foster","doi":"10.1097/COH.0000000000000938","DOIUrl":"https://doi.org/10.1097/COH.0000000000000938","url":null,"abstract":"<p><strong>Purpose of review: </strong>We describe the emerging clinical outcomes for adults born with perinatally acquired HIV (PHIV), who have been living with HIV throughout their life. Whilst many comorbidities appear similar to adults with horizontally acquired HIV, they manifest at a younger chronological age. The additional impact of HIV throughout postnatal, childhood and adolescent growth and development requires further consideration.</p><p><strong>Recent findings: </strong>There is growing evidence of an increased incidence of metabolic, cardiovascular, respiratory, bone and renal impairment as well as structural brain changes associated with impaired cognitive function, and mental health disorders; early case series data suggests a six-fold increased prevalence of psychosis for those with lifelong HIV compared with age-matched peers. Older age, prior CDC-C diagnoses and lower nadir CD4 count confer the greatest risk of PHIV complications in adulthood, but biological factors are compounded by socioeconomic deprivation, bereavement, HIV-associated stigma, discrimination and immigration. The aetiology of these increased comorbidities is yet to be fully elucidated but includes lifelong systemic inflammation and immune dysfunction despite suppressive antiretroviral therapy (ART).</p><p><strong>Summary: </strong>Adults living with lifelong HIV experience increased risk of comorbidities at a younger chronological age despite viral suppression on ART. Exploring the aetiology and characterizing the clinical manifestations of lifelong HIV can best inform screening tools and interventions that can enhance quality of life and longevity.</p>","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The utility of nonhuman primate models for understanding acute HIV-1 infection.","authors":"Matthew S Parsons, Diane L Bolton","doi":"10.1097/COH.0000000000000920","DOIUrl":"10.1097/COH.0000000000000920","url":null,"abstract":"<p><strong>Purpose of review: </strong>Nonhuman primate (NHP) models of HIV-1 infection provide complementary experimental pathways for assessing aspects of acute HIV-1 infection (AHI) that cannot be addressed in humans. This article reviews acute infection studies in SIV-infected or SHIV-infected macaque species over the previous 18 months.</p><p><strong>Recent findings: </strong>Reviewed studies examined the dynamics of replication-competent viral reservoir establishment during early infection, reservoir maintenance throughout therapy, and factors influencing viral rebound after treatment cessation. Also discussed are acute infection events in the central nervous system and liver and potential links between these events and manifestations of comorbidities during chronic infection. Additional studies addressed how occurrences during acute infection impact the development of natural viral control or posttreatment control. Another report evaluated treatment during acute infection with broadly neutralizing antibodies with enhanced ability to engage innate immune cells, highlighting the ability of this early intervention to shape innate and adaptive antiviral responses.</p><p><strong>Summary: </strong>NHP models of HIV-1 infection are a fundamental research tool for investigating AHI events. These models enable detailed pathogenesis characterization and the testing of hypothesis-driven strategies for altering disease courses through interventions during AHI, including targeting viral persistence and comorbidities that persist throughout chronic infection.</p>","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":"218-227"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"HIV diagnosis during acute infection: implications of long-acting preexposure prophylaxis and other evolving challenges.","authors":"Tamara Elliott, Daniel Bradshaw, Sarah Fidler","doi":"10.1097/COH.0000000000000919","DOIUrl":"10.1097/COH.0000000000000919","url":null,"abstract":"<p><strong>Purpose of review: </strong>Tests for HIV may perform differently in some circumstances such as with preexposure prophylaxis (PrEP) or other HIV prevention agents. Testing algorithms may not account for this, with a risk of false negative or positive HIV results. In this review we have explored the challenges of HIV testing in these special circumstances.</p><p><strong>Recent findings: </strong>Long-acting injectable PrEP using cabotegravir or lenacapavir has been studied in large randomized controlled trials (HPTN083/084 and PURPOSE1/2 respectively). Injectable PrEP was significantly more efficacious than oral PrEP, but infections still occurred risking the emergence of HIV drug-resistance. HIV diagnostic test results were atypical in those receiving injectable PrEP, with low or undetectable HIV viral loads, delayed or diminished antibody, and HIV detection assays reverting from reactive to unreactive; so-called long acting early viral inhibition (LEVI) syndrome. In these cases, missed or delayed HIV diagnoses could be reduced with the use of HIV nucleic acid amplification tests in addition to routine testing, but this remains unfeasible in many settings.</p><p><strong>Summary: </strong>Finding HIV testing strategies that are affordable and practical in low- and middle-income countries that can accurately diagnose HIV in the context of HIV prevention is of high importance, but more research is needed in this area.</p>","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":"228-235"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mucosal immunity in acute HIV: a review of recent work.","authors":"Barbara L Shacklett","doi":"10.1097/COH.0000000000000917","DOIUrl":"10.1097/COH.0000000000000917","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes recent research literature relevant to mucosal immunity and acute/early HIV infection.</p><p><strong>Recent findings: </strong>Recent findings include new insights on the HIV transmission \"bottleneck\" at mucosal surfaces, the impact of acute HIV on germinal centers and mucosal B-cell function, the expression of cytotoxic effector molecules by mucosal CD8 + T-cells, and an enhanced understanding of the impact of acute HIV on innate cell-mediated defenses including mucosa-associated invariant T-cells invarant natural killer T-cells and natural killer cells.</p><p><strong>Summary: </strong>Now more than 40 years since the beginning of the HIV/AIDS pandemic, extensive research has elucidated the dynamics of HIV replication and the corresponding host response. However, the vast majority of HIV-related immunopathogenesis studies have focused on innate and adaptive immune responses in peripheral blood. Mucosal tissues serve as the primary portals of entry for HIV and house the majority of the body's lymphocytes. Innate and adaptive immune responses in mucosal tissues are of particular relevance during the acute phase of HIV disease, as successful defenses can both limit viral dissemination within the host and prevent transmission to a new host, yet until recently these responses were poorly understood.</p>","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":"193-198"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah E Rutstein, Laura Limarzi-Klyn, William C Miller, Kimberly A Powers
{"title":"Public health implications of diagnosing and treating acute HIV.","authors":"Sarah E Rutstein, Laura Limarzi-Klyn, William C Miller, Kimberly A Powers","doi":"10.1097/COH.0000000000000921","DOIUrl":"10.1097/COH.0000000000000921","url":null,"abstract":"<p><strong>Purpose of review: </strong>The earliest months of HIV infection are characterized by high viral loads and elevated transmissibility, particularly during the acute (preseroconversion) phase. Transmission prevention during early HIV requires diagnostic tools that narrow the window between viral acquisition and reactive test, followed by rapid linkage to effective antiretroviral therapy (ART). Here, we review recent advances related to diagnosing and treating persons during early HIV, with a particular focus on acute HIV infection (AHI).</p><p><strong>Recent findings: </strong>Point-of-care (POC) fourth-generation antigen/antibody tests have mixed performance, often dependent on the pretest probability of early infection within the screened population. Risk score algorithms demonstrate the potential for prioritizing resource-intensive tests, such as POC HIV RNA, to those most likely to have AHI, but their predictive performance varies across populations, complicating implementation. Emerging and re-emerging infections, including SARS-CoV-2 and mpox, present opportunities for and challenges to symptom-driven AHI screening. Daily oral ART with standard first-line regimens quickly suppresses viremia during AHI, but long-acting injectable drugs are yet to be explored for this indication.</p><p><strong>Summary: </strong>Few practice-changing results related to diagnosing or treating persons with early HIV have been released in the last 18 months. Accurate POC HIV RNA tests could leapfrog fourth-generation POC assays, but they remain unavailable for routine use. Implementation science approaches are needed to guide use of evidence-based strategies for early HIV screening, and additional research on same-day ART linkage, including injectable ART, could produce dramatic impacts on forward transmission during this period.</p>","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":"236-246"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Harriet R Parker, Julia E Edgar, Philip J R Goulder
{"title":"Autovaccination revisited: potential to boost antiviral immunity and facilitate HIV-1 cure/remission in children.","authors":"Harriet R Parker, Julia E Edgar, Philip J R Goulder","doi":"10.1097/COH.0000000000000924","DOIUrl":"10.1097/COH.0000000000000924","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review the concept of autovaccination as a strategy to boost anti-HIV-1 immunity and improve immune control, especially as a means to facilitate cure/remission in paediatric HIV-1 infection, where effective interventions in clinical testing remain limited compared to adults.</p><p><strong>Recent findings: </strong>Early autovaccination studies, conducted 15-25 years ago, suggested potential immunological benefits from exposure to autologous virus in both children and adults, specifically when antiretroviral therapy (ART) was initiated during acute infection. More recent work in nonhuman primates (NHPs) has shown that early ART initiation can significantly reduce the viral setpoint following treatment interruption, primarily through CD8 + T-cell responses, and prevent early immune escape - a phenomenon commonly observed in ART-naive acute infections. Additionally, NHP studies indicate that multiple, short analytical treatment interruptions (ATIs) can delay viral rebound and further lower the viral setpoint via enhanced CD8 + T-cell responses.</p><p><strong>Summary: </strong>Recent studies in NHP support the potential for autovaccination via short ATIs to enhance antiviral immunity and improve immune control of HIV-1. With well tolerated, well monitored ATI protocols, autovaccination could be a valuable approach to facilitating cure/remission in children living with HIV (LWH), in whom very early-ART initiation and early-life immunity are associated with low viral reservoirs and high cure/remission potential.</p>","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":"271-278"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}