In 2014,the Joint United Nations Programme on HIV/AIDS(UNAIDS)first proposed the vision of“ending AIDS by 2030”,aiming to reduce new HIV infections and AIDS-related deaths to minimal levels while eliminating all for...In 2014,the Joint United Nations Programme on HIV/AIDS(UNAIDS)first proposed the vision of“ending AIDS by 2030”,aiming to reduce new HIV infections and AIDS-related deaths to minimal levels while eliminating all forms of HIVrelated stigma and discrimination(Kirby,2018).In 2021,the United Nations General Assembly adopted a new global political declaration on AIDS,which committed countries to achieving the“95-95-95”target by 2030.展开更多
Integrase Strand Transfer Inhibitors(INSTIs)have favorable safety and tolerability profiles,potent antiviral activity,and high resistance barriers,solving the limitations of previous antiretrovirals caused by resistan...Integrase Strand Transfer Inhibitors(INSTIs)have favorable safety and tolerability profiles,potent antiviral activity,and high resistance barriers,solving the limitations of previous antiretrovirals caused by resistant mutations.While first-generation INSTIs have exhibited emerging resistance challenges during extended clinical use,second-generation INSTIs provide enhanced resistance barriers and extended plasma half-lives relative to their predecessors.Optimized combination regimens incorporating these agents have substantially improved therapeutic convenience and long-term disease management in human immunodeficiency virus(HIV)care.Current investigations focus on multiple combination strategies employing second-generation INSTIs including dolutegravir(DTG)and bictegravir(BIC),with preliminary findings demonstrating substantial clinical benefits.The DTG/lamivudine(3TC)dual regimen in the GEMINI and TANGO studies achieved 92.1%–99.6%virologic suppression rates at week 48,maintaining efficacy through 144 weeks.The cabotegravir(CAB)/Rilpivirine(RPV)long-acting injectable combination in ATLAS trials demonstrated 92.5%suppression efficacy with validated every-two-month dosing intervals.The BIC/emtricitabine/tenofovir alafenamide triple regimen in studies 1489/1490 maintained>84%suppression at week 144 while retaining activity against resistant variants.Real-world data confirm that these regimens maintained a viral suppression rate of>90%in both treatment-na?ve and-experienced patients,with treatment interruption rates of<5%.Recent advances include the US Food and Drug Administration's approval of DTG/3TC for use in adolescents≥12 years old and adaptive studies of CAB/RPV in special populations.This article summarizes the research progress of current combination formulations based on second-generation INSTIs to provide new therapeutic options and clinical insights for the treatment of patients with HIV.展开更多
Prior research indicated low genotypic resistance testing(GRT)for human immunodeficiency virus(HIV)utilization in China due to partial cost coverage under national antiretroviral therapy policies,limited testing acces...Prior research indicated low genotypic resistance testing(GRT)for human immunodeficiency virus(HIV)utilization in China due to partial cost coverage under national antiretroviral therapy policies,limited testing accessibility,and financial barriers.Temporal and spatial data on GRT trends were also scarce.We analyzed GRT patterns among 6,895 untreated individuals at a tertiary hospital using Joinpoint regression,multivariable logistic modeling,and spatial analysis(GeoDa/SatScan).GRT rates showed a significant two-phase upward trend,increasing from 5.36%in 2014 to 74.17%in 2023,with an average annual percentage change of 31.30%(P<0.001).Beijing residency(adjusted odds ratio[aOR]=2.596,95%confidence interval[CI]:2.307-2.921)and older age were associated with higher GRT uptake.Specifically,ages 35-44 years(aOR=1.207,95%CI:1.026-1.420),45-54 years(aOR=1.335,95%CI:1.104-1.613),and≥55 years(aOR=1.424,95%CI:1.126-1.802)had significantly higher odds of testing.Lower testing rates were observed in individuals with lower education attainment(high school or technical secondary:aOR=0.827;junior high school:aOR=0.835;primary school:aOR=0.695),unknown sexually transmitted diseases(STDs)history(aOR=0.415),and non-heterosexual transmission routes(homosexual:aOR=0.834).Spatial analysis identified GRT clustering across Beijing until 2021,with two space-time clusters identified in 2019-2023 and 2018-2022.This study demonstrates substantial increase in GRT uptake achieving more balanced district-level distribution since 2021.Age,educational attainment,STDs history,and transmission route influence GRT utilization.Improving access,reducing costs,and implementing targeted interventions are critical for optimizing testing and guiding antiretroviral therapy decisions.展开更多
基金supported by the National Key R&D Program of China(2023YFE0116000,2023YFC2308300,2023YFC2308302)the High-Level Public Health Specialized Talents Project of Beijing Municipal Health Commission(2022-2-018)+1 种基金the Beijing Key Laboratory for HIV/AIDS Research(BZ0089)the Agence Nationale de Recherches sur le SIDA et les Hépatites Virales(ANRS)Investissements d’Avenir program managed by the ANR under reference ANR10-LABX-77 and EHVA(N°681032,Horizon 2020)。
文摘In 2014,the Joint United Nations Programme on HIV/AIDS(UNAIDS)first proposed the vision of“ending AIDS by 2030”,aiming to reduce new HIV infections and AIDS-related deaths to minimal levels while eliminating all forms of HIVrelated stigma and discrimination(Kirby,2018).In 2021,the United Nations General Assembly adopted a new global political declaration on AIDS,which committed countries to achieving the“95-95-95”target by 2030.
基金National Key R&D Program of China(2023YFC-2308300,2022YFC2305200)High-Level Public Health Specialized Talents Project of Beijing Municipal Health Commission(2022-2-018)+2 种基金Beijing Key Laboratory for HIV/AIDS Research(BZ0089)Postgraduate Research&Practice Innovation Program of Jiangsu Province(KYCX24_0484)SEU Innovation Capability Enhancement Plan for Doctoral Students(CXJH_SEU 24042)
文摘Integrase Strand Transfer Inhibitors(INSTIs)have favorable safety and tolerability profiles,potent antiviral activity,and high resistance barriers,solving the limitations of previous antiretrovirals caused by resistant mutations.While first-generation INSTIs have exhibited emerging resistance challenges during extended clinical use,second-generation INSTIs provide enhanced resistance barriers and extended plasma half-lives relative to their predecessors.Optimized combination regimens incorporating these agents have substantially improved therapeutic convenience and long-term disease management in human immunodeficiency virus(HIV)care.Current investigations focus on multiple combination strategies employing second-generation INSTIs including dolutegravir(DTG)and bictegravir(BIC),with preliminary findings demonstrating substantial clinical benefits.The DTG/lamivudine(3TC)dual regimen in the GEMINI and TANGO studies achieved 92.1%–99.6%virologic suppression rates at week 48,maintaining efficacy through 144 weeks.The cabotegravir(CAB)/Rilpivirine(RPV)long-acting injectable combination in ATLAS trials demonstrated 92.5%suppression efficacy with validated every-two-month dosing intervals.The BIC/emtricitabine/tenofovir alafenamide triple regimen in studies 1489/1490 maintained>84%suppression at week 144 while retaining activity against resistant variants.Real-world data confirm that these regimens maintained a viral suppression rate of>90%in both treatment-na?ve and-experienced patients,with treatment interruption rates of<5%.Recent advances include the US Food and Drug Administration's approval of DTG/3TC for use in adolescents≥12 years old and adaptive studies of CAB/RPV in special populations.This article summarizes the research progress of current combination formulations based on second-generation INSTIs to provide new therapeutic options and clinical insights for the treatment of patients with HIV.
基金supported by the National Key R&D Program of China(2023YFC2308300,2023YFC2308302,2023YFE0116000,2022YFC2305200,2022YFC2305202)Beijing Research Ward Excellence Program(BRWEP,2024W042180108)+2 种基金the High-Level Public Health Specialized Talents Project of Beijing Municipal Health Commission(2022-2-018,2022-1-007)the Beijing Key Laboratory for HIV/AIDS Research(BZ0089),the Postgraduate Research&Practice Innovation Program of Jiangsu Province(KYCX24_0484)the SEU Innovation Capability Enhancement Plan for Doctoral Students(CXJH_SEU 24042).
文摘Prior research indicated low genotypic resistance testing(GRT)for human immunodeficiency virus(HIV)utilization in China due to partial cost coverage under national antiretroviral therapy policies,limited testing accessibility,and financial barriers.Temporal and spatial data on GRT trends were also scarce.We analyzed GRT patterns among 6,895 untreated individuals at a tertiary hospital using Joinpoint regression,multivariable logistic modeling,and spatial analysis(GeoDa/SatScan).GRT rates showed a significant two-phase upward trend,increasing from 5.36%in 2014 to 74.17%in 2023,with an average annual percentage change of 31.30%(P<0.001).Beijing residency(adjusted odds ratio[aOR]=2.596,95%confidence interval[CI]:2.307-2.921)and older age were associated with higher GRT uptake.Specifically,ages 35-44 years(aOR=1.207,95%CI:1.026-1.420),45-54 years(aOR=1.335,95%CI:1.104-1.613),and≥55 years(aOR=1.424,95%CI:1.126-1.802)had significantly higher odds of testing.Lower testing rates were observed in individuals with lower education attainment(high school or technical secondary:aOR=0.827;junior high school:aOR=0.835;primary school:aOR=0.695),unknown sexually transmitted diseases(STDs)history(aOR=0.415),and non-heterosexual transmission routes(homosexual:aOR=0.834).Spatial analysis identified GRT clustering across Beijing until 2021,with two space-time clusters identified in 2019-2023 and 2018-2022.This study demonstrates substantial increase in GRT uptake achieving more balanced district-level distribution since 2021.Age,educational attainment,STDs history,and transmission route influence GRT utilization.Improving access,reducing costs,and implementing targeted interventions are critical for optimizing testing and guiding antiretroviral therapy decisions.
