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RCT | Bictegravir regimen noninferior to dolutegravir regimen in HIV-1, HBV co-infection treatment

31 Jul, 2023 | 14:00h | UTC

Bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir, emtricitabine, and tenofovir disoproxil fumarate for initial treatment of HIV-1 and hepatitis B coinfection (ALLIANCE): a double-blind, multicentre, randomised controlled, phase 3 non-inferiority trial – The Lancet HIV (free registration required)


RCT | Pitavastatin effective in the primary prevention of cardiovascular disease in HIV-infected individuals

26 Jul, 2023 | 13:35h | UTC

Pitavastatin to Prevent Cardiovascular Disease in HIV Infection – New England Journal of Medicine (link to abstract – $ for full-text)


Pitavastatin lowers risk of cardiovascular events in people living with HIV – Aidsmap

Statins reduce cardiovascular risk in people living with HIV, new global study finds – STAT

Pitavastatin Cuts MACE in HIV-Infected Patients: REPRIEVE – TCTMD


Commentary on Twitter


New WHO guidance on the role of HIV viral suppression in improving individual health and reducing transmission

24 Jul, 2023 | 13:17h | UTC

News Release: New WHO guidance on HIV viral suppression and scientific updates released at IAS 2023 – World Health Organization

WHO Guidance: The role of HIV viral suppression in improving individual health and reducing transmission – Word Health Organization

Related WHO Guidelines:

WHO recommends optimizing HIV testing services – World Health Organization

Primary health care and HIV: convergent actions – World Health Organization


Systematic Review | Low-level HIV viremia (below 1000 copies/mL) linked to minimal sexual transmission risk

24 Jul, 2023 | 13:15h | UTC

The risk of sexual transmission of HIV in individuals with low-level HIV viraemia – The Lancet

Editorial: HIV is sexually untransmittable when viral load is undetectable – The Lancet

Related: Study: Growing Acceptability of “Undetectable = Untransmittable” but Widespread Misunderstanding of HIV Transmission Risk Persists (several texts on the subject)


Commentary on Twitter


Cohort Study | Increased risk of depression and suicide among people with HIV, especially in the first two years post-diagnosis

24 Jul, 2023 | 13:01h | UTC

Risk of Depression in People With HIV: A nationwide population-based matched cohort study – Clinical Infectious Diseases


Commentary on Twitter


Cohort Study | Long-acting antiretroviral therapy may achieve virologic suppression in HIV patients with adherence challenges

17 Jul, 2023 | 13:26h | UTC

Demonstration Project of Long-Acting Antiretroviral Therapy in a Diverse Population of People With HIV – Annals of Internal Medicine (link to abstract – $ for full-text)

Commentary: Long-Acting ART Achieves Virologic Suppression for People With HIV – HealthDay


RCT | Dolutegravir is noninferior as a replacement for ritonavir-boosted protease inhibitor in HIV therapy

27 Jun, 2023 | 13:52h | UTC

Summary: This randomized clinical trial (RCT) assessed the switch from ritonavir-boosted protease inhibitor (PI) to dolutegravir in HIV patients without genotype information but with viral suppression. The multicenter, open-label trial, involving 795 participants across four sites in Kenya, compared those who switched to dolutegravir (398) with those continuing with their current ritonavir-boosted PI regimen (397). The primary end point was an HIV type 1 RNA level of at least 50 copies per milliliter at week 48.

At the end of the trial period, the number of patients in both groups who met the primary end point was nearly the same (5.0% in the dolutegravir group and 5.1% in the ritonavir-boosted PI group). This indicates the noninferiority of dolutegravir, within a 4% margin. Additionally, no mutations conferring resistance to either drug were detected. The incidence of treatment-related adverse events of grade 3 or 4 was similar in both groups (5.7% for dolutegravir and 6.9% for ritonavir-boosted PI).

The study concludes that dolutegravir is a noninferior alternative to ritonavir-boosted PI for previously treated, virally suppressed HIV patients lacking drug-resistance mutation data. The similar safety profiles also support the switch. However, further research may provide valuable insights on the long-term implications of the switch.

Article: Second-Line Switch to Dolutegravir for Treatment of HIV Infection – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Second-Line Switch to Dolutegravir Noninferior in HIV – HealthDay


Commentary on Twitter


RCT | Evaluating the viability of dolutegravir monotherapy in primary HIV infection

27 Jun, 2023 | 13:50h | UTC

Summary: The study in focus is a randomized, controlled, non-inferiority trial spanning over 192 weeks, titled “EARLY-SIMPLIFIED”. It evaluated the effect of simplifying combination antiretroviral therapy (cART) to dolutegravir (DTG) monotherapy in patients with early-stage HIV-1 infection. The trial recruited 101 people who had begun cART within 180 days of a documented primary HIV-1 infection with suppressed viral load.

The patients were randomly divided into two groups: DTG monotherapy (n=68) and continued cART (n=33). The primary endpoints were viral failure rates at 48, 96, 144, and 192 weeks. Results revealed no difference in viral response between the two groups at 96 weeks, suggesting non-inferiority of DTG monotherapy. At the end of the trial (192 weeks), no virological failures were recorded in either group.

The study indicates that early initiation of cART during primary HIV infection might permit sustained virological suppression after switching to DTG monotherapy. However, the study was limited by its highly selected patient population and the transition to an observational design after 96 weeks. It provides insight into the potential for minimizing ART toxicity by stratifying patients according to the latent reservoir size or duration of active infection before starting therapy.

Article: Sustained viral suppression with dolutegravir monotherapy over 192 weeks in patients starting combination antiretroviral therapy during primary HIV infection (EARLY-SIMPLIFIED): a randomized, controlled, multi-site, non-inferiority trial – Clinical Infectious Diseases


Review | Update on the management of patients with HIV infection in anesthesia and critical care

26 Jun, 2023 | 00:36h | UTC

Update on the management of patients with HIV infection in anaesthesia and critical care – BJA Education


M-A | CRP at 5 mg/L cut-off efficient for tuberculosis screening in HIV outpatients

21 Jun, 2023 | 13:30h | UTC

Clinical utility of WHO-recommended screening tools and development and validation of novel clinical prediction models for pulmonary tuberculosis screening among outpatients living with HIV: an individual participant data meta-analysis – European Respiratory Review


Commentary on Twitter


Cryptococcosis: 90% cases in HIV-negative patients, Australasian study identifies risk factors

5 Jun, 2023 | 12:52h | UTC

Current epidemiology and clinical features of Cryptococcus infection in patients without HIV infection: a multicentre study in 46 hospitals from Australia and New Zealand – Clinical Infectious Diseases


Cohort Study | Association of HIV infection and incident abdominal aortic aneurysm

31 May, 2023 | 13:55h | UTC

Association of HIV Infection and Incident Abdominal Aortic Aneurysm Among 143 001 Veterans – Journal of the American Heart Association


Phase 2 RCT | Single high-dose L-AmB shows comparable efficacy to standard treatment in HIV/AIDS-related histoplasmosis

29 May, 2023 | 10:41h | UTC

Single High-dose of Liposomal Amphotericin B in HIV/AIDS-related Disseminated Histoplasmosis: a Randomized Trial – Clinical Infectious Diseases

See also: Visual Abstract


A humorous peek into HIV research papers: a quick guide

18 May, 2023 | 13:46h | UTC

Types of HIV Papers — A Quick Guide – HIV and Observations


Commentary on Twitter


RCT | ART intensification shows no benefit in treating HIV-associated neurocognitive impairment

18 May, 2023 | 13:31h | UTC

Antiretroviral Therapy Intensification for Neurocognitive Impairment in HIV – Clinical Infectious Diseases


Cohort Study | Infection-unrelated cancers are increasingly more common than infection-related cancers among individuals with HIV

2 May, 2023 | 13:32h | UTC

Age and Cancer Incidence in 5.2 Million People With Human Immunodeficiency Virus (HIV): The South African HIV Cancer Match Study – Clinical Infectious Diseases (free for a limited period)

Commentary: Infection-Unrelated Cancers Predominant Among Older Adults With HIV – Cancer Therapy Advisor


Commentary on Twitter


Podcast | HIV in primary care

6 Apr, 2023 | 13:13h | UTC

#388 HIV in Primary Care with Dr. Jonathan J. “JJ” Nunez MD – The Curbsiders


Cohort Study | Barriers to starting direct-acting antiviral treatment despite access for HIV & hepatitis C patients

6 Apr, 2023 | 13:09h | UTC

Reasons for not commencing direct-acting antiviral treatment despite unrestricted access for individuals with HIV and hepatitis C virus: a multinational, prospective cohort study – The Lancet Public Health

Invited Commentary: The road to hepatitis C virus elimination – The Lancet Public Health


Long-acting injectable antiretroviral therapy: will it change the future of HIV treatment?

30 Mar, 2023 | 13:49h | UTC

Long-acting injectable antiretroviral therapy: will it change the future of HIV treatment? – Therapeutic Advances in Infectious Disease


M-A | Factors associated with post-treatment control of viral load in HIV-infected patients

29 Mar, 2023 | 12:56h | UTC

Factors Associated with Post-treatment Control of Viral Load in HIV-Infected Patients: A Systematic Review and Meta-analysis – International Journal of Infectious Diseases


Updated recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission

15 Mar, 2023 | 15:22h | UTC

Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States – Department of Health and Human Services

Commentary: Antiretroviral Therapy During Pregnancy and Interventions to Reduce Perinatal Transmission: 2023 Recommendations – Journal Watch


RCT | Long-term effects of early antiretroviral therapy initiation in HIV infection highlight the importance of early treatment

1 Mar, 2023 | 14:12h | UTC

Summary: The article discusses the long-term results of the Strategic Timing of AntiRetroviral Treatment (START) trial, which aimed to determine the effects of early initiation of antiretroviral therapy (ART) for individuals with HIV and CD4+ counts above 500 cells/mm3 compared to those who deferred treatment until their CD4+ count was below 350 cells/mm3. The trial found that immediate ART initiation reduced the risk of AIDS and serious non-AIDS (SNA) conditions compared to deferred treatment. The study’s long-term results also found that a persistent excess risk of AIDS and SNA conditions remained even after ART was initiated in those who initially deferred treatment. The study highlights the importance of early diagnosis and prompt initiation of ART for individuals with HIV.

Article: Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection – NEJM Evidence

Original Study: Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection – New England Journal of Medicine


M-A | Adverse perinatal outcomes associated with antiretroviral therapy in women living with HIV

27 Feb, 2023 | 12:48h | UTC

Adverse perinatal outcomes associated with antiretroviral therapy in women living with HIV: A systematic review and meta-analysis – Frontiers in Medicine


Mpox outbreak in advanced HIV cases | Global case series reveals higher mortality and clinical complications

23 Feb, 2023 | 13:44h | UTC

Summary: This article discusses a case series investigating monkeypox (mpox) in people with HIV and low CD4 cell counts. The mpox outbreak in 2022 has affected a significant percentage of people living with HIV, and data suggest worse clinical outcomes and higher mortality in those with more advanced HIV. The case series includes data from 382 confirmed mpox cases in people living with HIV from 19 countries. The individuals included were predominantly cisgender men, with a median age of 35. Most individuals were adherent to antiretroviral therapy, and the median CD4 count was 211 cells per mm3. Severe complications were more common in those with lower CD4 cell counts, including necrotizing skin lesions, lung involvement, secondary infections, and sepsis. Approximately 28% of individuals were hospitalized, and 25% of those hospitalized died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. The study reinforces the importance of HIV and CD4 testing in mpox cases, prioritization of preventive mpox vaccination in people with HIV and a CD4 cell count of less than 200 cells per mm3, and the use of potential mpox antivirals where available. The authors suggest that a severe, disseminated, and necrotizing form of mpox should be considered an AIDS-defining condition in CDC and WHO HIV disease classifications. Clinicians should also be aware that starting antiretroviral therapy in people with advanced HIV and mpox could contribute to deterioration and possible death, possibly as part of an immune reconstitution syndrome.

Article: Mpox in people with advanced HIV infection: a global case series – The Lancet (free registration required)

News Release: Clinicians identify severe form of mpox with high mortality in people with advanced HIV – Queen Mary University of London


Expert comment – Severe form of mpox identified in people with advanced HIV – London School of Hygiene & Tropical Medicine

Mpox: Clinicians identify severe form with high mortality in advanced HIV patients – The BMJ


Commentary from the author on Twitter (thread – click for more)


152-week results of a RCT | Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection

23 Feb, 2023 | 13:16h | UTC

Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection: 152-week results from ATLAS-2M, a randomized, open-label, Phase 3b, noninferiority study – Clinical Infectious Diseases


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