Current opinion in HIV and AIDS最新文献_第2页

Human models that inform antiretroviral therapy-free remission with perinatally acquired HIV infection.

Current opinion in HIV and AIDS Pub Date : 2025-02-10 DOI: 10.1097/COH.0000000000000918

Caroline T Tiemessen

{"title":"Human models that inform antiretroviral therapy-free remission with perinatally acquired HIV infection.","authors":"Caroline T Tiemessen","doi":"10.1097/COH.0000000000000918","DOIUrl":"https://doi.org/10.1097/COH.0000000000000918","url":null,"abstract":"Purpose of review: Rare persons who achieve disease-control despite high viral loads (viraemic nonprogressors) or maintain virologic control in the absence of antiretroviral therapy (ART) (elite controllers) or following ART interruption (posttreatment controllers) possess protective factors that can be harnessed for interventions to achieve ART-free remission. This review broadly summarizes these phenotypes in adults and children, and updates on findings important in informing strategies for ART-free remission in children with HIV.Recent findings: To date, only a few individual cases of posttreatment control have been described in children. Smaller HIV reservoir size with very early ART initiation in neonates with in-utero acquired HIV associates with improved virological and immunological outcomes. Nine new cases of ART-free remission in children were recently described - 4 from the P1115 trial, and 5 males from the Ucwaningo Lwabantwana study in South Africa. A striking reduction in the decay of intact proviruses was observed over three decades on suppressive ART in two early-treated twins with HIV.Summary: The unique environment of perinatal HIV infection favours effective restriction and decay of the HIV-1 reservoir with suppressive ART initiated very early. Sex and population differences require consideration in ongoing studies to inform ART-free remission.","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416474","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}

引用次数: 0

Mucosal immunity in acute HIV: a review of recent work. 急性艾滋病病毒的粘膜免疫：最新研究综述。

Current opinion in HIV and AIDS Pub Date : 2025-01-27 DOI: 10.1097/COH.0000000000000917

Barbara L Shacklett

{"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":"Purpose of review: This review summarizes recent research literature relevant to mucosal immunity and acute/early HIV infection.Recent findings: 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.Summary: 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.","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191428","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}

引用次数: 0

Future options for long-acting HIV treatment and prevention. 长效艾滋病毒治疗和预防的未来选择。

Current opinion in HIV and AIDS Pub Date : 2025-01-01 Epub Date: 2024-11-07 DOI: 10.1097/COH.0000000000000901

Yotam Arens, Roy M Gulick

{"title":"Future options for long-acting HIV treatment and prevention.","authors":"Yotam Arens, Roy M Gulick","doi":"10.1097/COH.0000000000000901","DOIUrl":"10.1097/COH.0000000000000901","url":null,"abstract":"Purpose of review: The aim of this review was to describe future options for long-acting HIV treatment and preexposure prophylaxis (PrEP) regimens featuring both innovations with currently approved antiretrovirals and a profile of investigational agents in the pipeline.Recent findings: Newer formulations and modes of delivery for existing antiretroviral drugs and a number of investigational agents are under study for long-acting HIV treatment and PrEP. Regimens with weekly oral dosing for HIV treatment, monthly oral dosing for HIV PrEP, and injectable agents with longer dosing intervals (every 3 months or longer) for treatment and PrEP are in clinical development. Newer agents with novel mechanisms of action and newer modes of administration including vaginal rings, implants, patches, and rectal douches also are under investigation.Summary: Despite the success of current antiretroviral therapy and PrEP with one-pill, once-daily regimens, there is a continuing need for new formulations, investigational agents, and novel modes of delivery to overcome barriers to implementation and ensure real-world effectiveness. Newer long-acting antiretroviral regimens for HIV treatment and PrEP using novel preparations and strategies will offer choice, enhance adherence, decrease toxicity, and improve patient and provider satisfaction.","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":"39-47"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666740","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}

引用次数: 0

Transforming HIV prevention: the promise of long-acting preexposure prophylaxis in high HIV burden settings. 艾滋病预防的变革：在艾滋病高负担环境中长效暴露前预防的前景。

Current opinion in HIV and AIDS Pub Date : 2025-01-01 Epub Date: 2024-11-04 DOI: 10.1097/COH.0000000000000895

Dvora Joseph Davey, Sumaya Dadan, Nafisa Wara

{"title":"Transforming HIV prevention: the promise of long-acting preexposure prophylaxis in high HIV burden settings.","authors":"Dvora Joseph Davey, Sumaya Dadan, Nafisa Wara","doi":"10.1097/COH.0000000000000895","DOIUrl":"10.1097/COH.0000000000000895","url":null,"abstract":"Purpose of review: Recent research on efficacy and safety of long-acting preexposure prophylaxis (PrEP) holds the promise to transform HIV prevention in high HIV burden settings. We review emerging findings regarding early end-user acceptability of long-acting PrEP modalities, feasibility of integrating long-acting PrEP into health systems, and considerations regarding drug resistance and cost.Recent findings: Long-acting PrEP, particularly injectables, was found to be highly acceptable among individuals across key populations in high HIV burden settings. Concerns around use of long-acting PrEP highlight the importance of choice and ability to switch methods. Existing provider-level barriers to oral PrEP implementation (e.g., overburdened staff, training gaps) may impact long-acting PrEP rollout - however, utilization of PrEP implementation strategies such as task-shifting, timely PrEP training for all providers, differentiated service delivery, and integration with sexual health services, may mitigate barriers. Studies modeling injectable PrEP scale-up demonstrate substantial benefits in HIV mortality reduction, outweighing risks of increased integrase inhibitor resistance, but also highlight the urgency of pricing long-acting PrEP to ensure access and affordability.Summary: Long-acting PrEP could be a game changer in HIV prevention in high burden settings. There is an urgent need for rapid scale production and price reductions to ensure access in high HIV burden settings. Implementation strategies are needed to address individual and provider-level barriers.","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":"32-38"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11620907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666741","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}

引用次数: 0

Long-acting ART and preexposure prophylaxis: profound promise but stunted access. 长效抗逆转录病毒治疗和暴露前预防：大有希望，但难以获得。

Current opinion in HIV and AIDS Pub Date : 2025-01-01 Epub Date: 2024-12-05 DOI: 10.1097/COH.0000000000000902

Monica Gandhi

引用次数: 0

Why is roll-out of long-acting PrEP agents so slow? 长效PrEP药物的推广为何如此缓慢？

Current opinion in HIV and AIDS Pub Date : 2025-01-01 Epub Date: 2024-11-14 DOI: 10.1097/COH.0000000000000899

Rupa R Patel, Kenneth H Mayer

{"title":"Why is roll-out of long-acting PrEP agents so slow?","authors":"Rupa R Patel, Kenneth H Mayer","doi":"10.1097/COH.0000000000000899","DOIUrl":"10.1097/COH.0000000000000899","url":null,"abstract":"Purpose of review: Injectable cabotegravir for HIV preexposure prophylaxis (PrEP) is effective, yet global implementation has been slow. We review factors which have contributed to the delayed roll-out of this medication.Recent findings: Fifty-three countries have approved cabotegravir for HIV prevention yet roll-out has been slow. Cabotegravir made up 2.5% of all U.S. PrEP prescriptions in 2023 and is very slowly increasing after FDA approval in 2021. Medication has not been available outside of implementation science studies in Africa and Asia. There is a lengthy process for generic medication production despite agreements signed in 2021; the first available generic dose is not anticipated until 2027. In the United States, where some of the cabotegravir medication costs can be covered under individual insurance plans, high costs and medication acquisition pathways for health centers have been complex, contributing to national implementation delays. The intensity of the staffing required for medication acquisition, insurance paperwork filing, process documentation, billing, injection administration, appointment scheduling, missed appointment monitoring and client follow up has burdened healthcare organizations.Summary: Injectable cabotegravir PrEP has not reaped its potential to be an alternative in those for whom adherence to a daily PrEP pill is challenging. Lessons learned regarding cabotegravir medication acquisition pathways and clinical delivery strategies can inform the rollout of future HIV prevention long-acting agents.","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":"20 1","pages":"48-53"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782214","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}

引用次数: 0

Post-intervention control in HIV immunotherapy trials. 艾滋病免疫疗法试验中的干预后控制。

Current opinion in HIV and AIDS Pub Date : 2025-01-01 Epub Date: 2024-11-04 DOI: 10.1097/COH.0000000000000890

Demi A Sandel, Rachel L Rutishauser, Michael J Peluso

{"title":"Post-intervention control in HIV immunotherapy trials.","authors":"Demi A Sandel, Rachel L Rutishauser, Michael J Peluso","doi":"10.1097/COH.0000000000000890","DOIUrl":"10.1097/COH.0000000000000890","url":null,"abstract":"Purpose of review: While post-treatment control following interruption of standard-of-care antiretroviral therapy (ART) is well described, post-intervention control following immunotherapy in HIV cure-related clinical trials is less well understood. We provide an overview of recent studies that have identified post-intervention controllers and review the mechanisms that may drive this biologically important phenotype.Recent findings: Post-intervention controllers have been identified in recent immunotherapy trials testing broadly neutralizing antibodies, immune modulators, modified T cells, checkpoint inhibitors, and gene therapy administered individually or in combination. Currently, there is substantial variability in how each trial defines post-intervention control, as well as in how the mechanisms underlying such control are evaluated. Such mechanisms include ongoing activity of both exogenous and autologous antibodies, as well as changes in HIV-specific T cell function.Summary: While no therapeutic strategy to date has succeeded in definitively inducing HIV control, many studies have identified at least a small number of post-intervention controllers. The field would benefit from a standardized approach to defining and reporting this phenotype, as well as standardization in the approach to assessment of how it is achieved. Such efforts would allow for comparisons across clinical trials and could help accelerate efforts toward an HIV cure.","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":"70-79"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11620322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570696","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}

引用次数: 0

Long-acting antiretroviral therapy in low-income and middle-income countries: considerations for roll-out. 低收入和中等收入国家的长效抗逆转录病毒疗法：推广考虑因素。

Current opinion in HIV and AIDS Pub Date : 2025-01-01 Epub Date: 2024-11-11 DOI: 10.1097/COH.0000000000000900

Angela Tembo, Willem Daniel Francois Venter, Simiso Sokhela

{"title":"Long-acting antiretroviral therapy in low-income and middle-income countries: considerations for roll-out.","authors":"Angela Tembo, Willem Daniel Francois Venter, Simiso Sokhela","doi":"10.1097/COH.0000000000000900","DOIUrl":"10.1097/COH.0000000000000900","url":null,"abstract":"Purpose of review: Long-acting ART (LA-ART) in low-income and middle-income countries (LMICs) may address specific issues that affect people living with HIV (PWH) and people at substantial risk of HIV infection. We reviewed products in use and under consideration in LMICS, current and anticipated challenges for implementation, and offer strategies for effective rollout.Recent findings: Factors to consider for effective implementation of LA-ART in LMICs are: managing co-conditions (pregnancy) and comorbidities (TB and hepatitis B); medication access, both cost and supply-related; and health systems delivery mechanisms for products.Summary: LA-ART present promising new alternatives in LMICs. Although they may tackle certain adherence concerns and systemic issues, which impact delivery of services, significant obstacles remain before their widespread implementation in people that require them most, particularly in countries most affected by HIV. We offer best practices from prior experiences and implementation studies for effective coordination of multiple stakeholders, critical for effective rollout.","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":"19-24"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678087","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}

引用次数: 0

Viral and immune predictors of HIV posttreatment control. HIV治疗后控制的病毒和免疫预测因子。

Current opinion in HIV and AIDS Pub Date : 2025-01-01 Epub Date: 2024-11-07 DOI: 10.1097/COH.0000000000000898

Flavio S Mesquita, Yijia Li, Jonathan Z Li

{"title":"Viral and immune predictors of HIV posttreatment control.","authors":"Flavio S Mesquita, Yijia Li, Jonathan Z Li","doi":"10.1097/COH.0000000000000898","DOIUrl":"10.1097/COH.0000000000000898","url":null,"abstract":"Purpose of review: This review focuses on the viral and immune factors influencing HIV posttreatment control (PTC), a rare condition where individuals maintain viral suppression after discontinuing antiretroviral therapy (ART).Recent findings: Studies demonstrate that early ART initiation leads to smaller HIV reservoirs and delayed viral rebound in PTCs. Virologically, PTCs harbor smaller HIV reservoirs and show lower levels of reservoir transcriptional activity compared with posttreatment noncontrollers. Immunologically, PTCs exhibit distinct T-cell dynamics, with reduced CD4+ and CD8+ T-cell activation and exhaustion, enhanced natural killer (NK) cell activity, and enhanced proliferative responses of HIV-specific CD8+ T cells post-ART interruption. Additionally, humoral immunity, particularly the development of autologous neutralizing antibodies (aNAbs), plays a role in viral control, though broadly neutralizing antibodies (bnAbs) are rare.Summary: The mechanisms behind posttreatment control are multifactorial, involving virological and immunological factors. Early ART initiation, a smaller and less transcriptionally active HIV reservoir, and immune responses including proliferative T-cell activity and NK cell function are key contributors to achieving ART-free HIV remission.","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":"20 1","pages":"54-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782213","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}

引用次数: 0

HIV-1 reservoir landscape of post-treatment control. 治疗后控制的 HIV-1 病毒库状况。

Current opinion in HIV and AIDS Pub Date : 2025-01-01 Epub Date: 2024-10-21 DOI: 10.1097/COH.0000000000000891

Caroline Charre, Yanis Merad, Véronique Avettand-Fenoel

{"title":"HIV-1 reservoir landscape of post-treatment control.","authors":"Caroline Charre, Yanis Merad, Véronique Avettand-Fenoel","doi":"10.1097/COH.0000000000000891","DOIUrl":"10.1097/COH.0000000000000891","url":null,"abstract":"Purpose of review: This review explores the viral reservoir landscape in individuals who control viral replication after treatment interruption (TI), designated as post-treatment controllers (PTCs). Identifying their virologic features is crucial to inform drug-free HIV remission strategies.Recent findings: Traditionally characterized as small, likely due to early treatment, the viral reservoir of PTCs, after TI, exhibits limited transcriptional activity, residual viral replication and subsequent proviral diversity. Intact proviruses are found to be restricted. In nonhuman primate PTCs, this depletion of intact proviruses is already observed in lymph nodes before TI, suggesting that control mechanisms begin during antiretroviral therapy. Furthermore, recent studies suggest immune-driven proviral deep latency associated with repressive epigenetic features and integration sites in PTCs. While molecular mapping of virological features of PTCs is increasingly precise and coupled with in-depth immunologic assays, robust predictive biomarkers of PTCs are still lacking.Summary: Despite limited sample sizes and heterogeneous definitions, common virologic features of PTCs include restricted reservoir size and transcriptional activity, fewer intact proviruses and deep proviral latency. Ongoing research using innovative technologies will further elucidate the mechanisms underlying post-treatment control, paving the way for successful HIV cure interventions.","PeriodicalId":93966,"journal":{"name":"Current opinion in HIV and AIDS","volume":" ","pages":"99-108"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559839","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}

引用次数: 0