San Francisco Department of Public Health, California, USA.
Top Antivir Med. 2024 Jul 17;32(3):447-482.
At the 2024 Conference on Retroviruses and Opportunistic Infections (CROI), investigators presented updates on the global HIV epidemic, focusing on ongoing disparities by race/ethnicity in the US, the ongoing concentration of new infections among men who have sex with men (MSM) and transgender women in the Americas, and a shift to a greater total number of infections now in low versus high prevalence countries globally. HIV testing, the gateway to prevention and to treatment, has not fully rebounded from the substantial declines seen during the early COVID-19 pandemic in some settings, although innovative strategies including home testing and opt-out testing in clinical settings appear to be reaching populations in need of testing. Several investigators reported on the efficacy and effectiveness of doxycycline used as postexposure prophylaxis (doxy-PEP) to prevent bacterial sexual transmitted infections in MSM and transgender women in clinical trials and clinic settings; citywide rates of chlamydia and syphilis have decreased in San Francisco after the rollout of the first doxy-PEP guidelines in the US. Lack of doxy-PEP efficacy in cisgender women in Kenya appears due to low adherence in that trial. Rollout and persistence on oral HIV preexposure prophylaxis (PrEP) are associated with reduced seroincidence on a population and individual level. The rollout of long-acting injectable cabotegravir (CAB-LA) PrEP is proceeding slowly in the US. New, longer-acting oral and injectable agents are in development, with preclinical and early clinical trial data presented at CROI. Oral PrEP uptake among populations in sub-Saharan Africa remains low in most settings, suggesting the need for more options and more support; point-of-care tenofovir testing appear acceptable in various populations and may improve adherence and identify PrEP users needing more support. Choice of PrEP or PEP including CAB-LA combined with clinical support substantially increased biomedical prevention coverage in East Africa. Novel approaches to PrEP rollout, including delivery using mobile services and in nonclinical settings appear to show promise. HIV PEP continues to be underutilized.
在 2024 年逆转录病毒和机会性感染会议 (CROI) 上，研究人员介绍了全球艾滋病疫情的最新情况，重点关注美国种族/族裔之间持续存在的差距、美洲男男性行为者和跨性别女性中新感染的持续集中、以及现在感染人数的全球分布从高流行国家向低流行国家转移。艾滋病毒检测是预防和治疗的切入点，但在某些情况下尚未从 COVID-19 大流行早期的大幅下降中完全恢复，尽管包括家庭检测和临床环境中的默认检测在内的创新策略似乎正在为需要检测的人群提供服务。几位研究人员报告了多西环素（doxycycline）作为暴露后预防（doxy-PEP）在临床试验和临床环境中用于预防男男性行为者和跨性别女性中细菌性性传播感染的疗效和有效性；旧金山在全美推出第一套 doxy-PEP 指南后，淋病和梅毒的全市发病率有所下降。肯尼亚顺性别女性的 doxy-PEP 疗效不佳似乎是由于该试验中的低依从性所致。口服 HIV 暴露前预防 (PrEP) 的推广和持续使用与人群和个体层面的血清发病率降低有关。长效注射 cabotegravir (CAB-LA) PrEP 在全美推广缓慢。新的、作用时间更长的口服和注射药物正在开发中，在 CROI 上提交了临床前和早期临床试验数据。撒哈拉以南非洲的大多数地区，人口中口服 PrEP 的使用率仍然很低，这表明需要更多的选择和更多的支持；在各种人群中，即时检测 tenofovir 似乎可以接受，并且可能提高依从性并发现需要更多支持的 PrEP 用户。包括 CAB-LA 在内的 PrEP 或 PEP 的选择以及临床支持大大增加了东非的生物医学预防覆盖率。在 PrEP 推广方面的新方法，包括使用移动服务和非临床环境进行的药物交付，似乎显示出希望。HIV PEP 的使用率仍然很低。
