Jul 2026· The Lancet Regional Health - Americas· Vol 62, pp. 101555· 0 citations· 30 references
Medicine
TL;DR
Implementation of a structured inpatient HIV care model was associated with improved clinical outcomes among PLHIV with AHD and may represent a promising approach to strengthen delivery of WHO-recommended AHD care in hospital settings and warrants further evaluation in controlled studies.
Abstract
Summary Background Advanced HIV disease (AHD) remains a major cause of hospitalization and mortality among people living with HIV (PLHIV). We evaluated the association between implementation of a structured specialist-led inpatient HIV care model and clinical outcomes among hospitalized PLHIV in southern Brazil. Methods We conducted an observational before–after study at a tertiary public hospital in Porto Alegre, Brazil, comparing a pre-intervention period (January 2023–April 2024) with a post-intervention period (May 2024–August 2025). The intervention included a dedicated infectious diseases team, standardized protocols for AHD and opportunistic infections, and rapid antiretroviral therapy (ART) initiation during hospitalization. Adults admitted with AHD were included. Adjusted risk ratios (aRR) for mortality, ICU admission, and a composite adverse outcome were estimated using modified Poisson regression. Findings A total of 963 hospitalizations among 899 unique patients were included (406 pre-intervention; 557 post-intervention). Baseline characteristics were similar between periods. In-hospital mortality declined from 24% to 17% (p = 0.014). In adjusted analyses, the post-intervention period was associated with lower risks of in-hospital mortality (aRR 0.74, 95% CI 0.57–0.96), ICU admission (0.70, 0.57–0.86), and composite adverse outcomes (0.78, 0.67–0.92). Opportunistic infection screening increased, lumbar puncture was performed more frequently, and ART was initiated earlier. Interpretation Implementation of a structured inpatient HIV care model was associated with improved clinical outcomes among PLHIV with AHD. Structured multidisciplinary inpatient HIV care may represent a promising approach to strengthen delivery of WHO-recommended AHD care in hospital settings and warrants further evaluation in controlled studies. Funding Pan American Health Organization (PAHO), US Centers for Disease Control and Prevention (CDC), and Unitaid.
Mortality among PLHIV in this study was associated with advanced disease, opportunistic diseases, commorbidities and abnormal laboratory findings, and Strengthening early diagnosis, management of opportunistic infections, and monitoring of clinical and laboratory indicators may help reduce mortality in this population.
Faustus Ajamah, Jude Tsafack Zefack, Lucas Tanlaka Mengnjo et al.· World Journal of Advanced Re...· 0 citations
INTRODUCTION
Despite advances in antiretroviral therapy (ART), real-world data remain limited regarding clinical characteristics and healthcare utilization according to ART use among people living with human immunodeficiency virus (PLWH), as well as patterns of ART use in this population.
METHODS
This retrospective cohort study used a US healthcare claims database to identify adult PLWH from 2021 to 2024. Primary cohort included those with ≥3 human immunodeficiency virus (HIV)-1 diagnosis codes within 3 years (third code defined the index date). A nested cohort included PLWH with ≥1 ART prescription claim(s) within 180 days of follow-up. All-cause and HIV-related inpatient hospitalizations and emergency room (ER) visits were assessed before and after index date. Pharmacotherapy change within 180 days after index was assessed for the nested cohort.
RESULTS
In the primary cohort of 51,837 PLWH, mean age was 46.5 years; 17.5% were women, and 57.1% resided in the southern USA. Notably, 6.5% had no observed ART claim (never ART), and 92.5% had an observed ART claim at some point (ever ART). The never ART group had significantly higher hospitalizations (8.3% versus 5.2%; P value < 0.0001) and ER visits (23.6% versus 17.5%; P value < 0.0001), and fewer other drug prescriptions (antidiabetics, 3.4% versus 9.8%; antihypertensives, 9.7% versus 34.5%; statins, 5.2% versus 23.7%; P value < 0.0001 each) versus the ever ART group. Among 35,591 PLWH prescribed ART, 2% were newly observed ART initiators with first-line ART and 98% were prevalent users. Newly observed ART initiators had higher rates of all-cause inpatient hospitalizations (63.7 versus 39.9 per 1000 person-years) versus prevalent users. Overall, 32.3% of PLWH discontinued their index ART regimen within 180 days and did not restart ART during the analysis period.
CONCLUSIONS
Nearly one-third of PLWH discontinued their initial ART, and 6.5% were not on ART in the study period. PLWH without documented ART claims have greater healthcare utilization than those who received ART. Enhancing ART tolerability, dosing modalities, and convenience may improve treatment coverage and viral suppression outcomes, and reduce discontinuation rates.
Unknown authors· Infectious Disease and Thera...· 0 citations
Background Advanced HIV disease (AHD) remains a major contributor to HIV‐related morbidity and mortality. While HIV screening strategies in Brazil emphasize populations traditionally considered at high risk, a significant number of individuals without previous HIV infection present with AHD despite lacking recognized risk profiles. This study aimed to define the sociodemographic and behavioral characteristics of patients presenting with advanced HIV at diagnosis, with the goal of identifying gaps in current HIV screening efforts. Methods We conducted a retrospective cohort study of patients hospitalized in the infectious diseases ward of a tertiary referral hospital between January 2015 and December 2024. We included individuals previously unaware of their HIV status who met World Health Organization (WHO) criteria for AHD, defined as CD4 count < 200 cells/mm3 and/or a WHO Clinical Stage 3 or 4 condition. Sociodemographic characteristics, behavioral risk factors, and clinical data were abstracted from medical records and standardized epidemiologic intake forms. Descriptive analyses compared characteristics across sexuality and gender groups. Results Among 1615 unique patients hospitalized with AHD, 407 (25%) were newly diagnosed with HIV during hospitalization. The median CD4 count at diagnosis was 53 cells/mm3 (IQR 27–110), reflecting profound immunosuppression. Most patients identified as heterosexual men (49%), while only 10% identified as sexual or gender minorities. Fewer than one‐quarter (24%) had psychosocial risk factors commonly emphasized in HIV screening strategies. Heterosexual men were predominantly employed, married or partnered, and had children, while women and sexual and gender minority patients were older and younger, respectively, and reported fewer risk factors. Injection drug use history and homelessness were rare across all groups. Conclusions AHD at first diagnosis was not concentrated within traditionally recognized high‐risk populations. The diversity of patients presenting with AHD at first diagnosis suggests that reliance solely on traditional risk‐based screening strategies may be insufficient to ensure timely detection. Expanded routine, opt‐out HIV testing across healthcare settings, as well as indicator‐based testing, self‐testing, and pharmacy‐based testing may help reduce missed opportunities for diagnosis and prevent severe immunosuppression.
C. Hernandez, P. M. Fonseca, Andressa Noal et al.· AIDS Research and Treatment· 0 citations
The incidence of LTFU among adults on ART in Guji zone was high, particularly during the first year of treatment, and targeted interventions including enhanced counseling for high-risk groups, community-based ART refill models, and active phone-based tracking systems should be implemented to improve retention.
Human immunodeficiency virus type 1 (HIV) infection is one of the leading causes of morbidity and mortality worldwide. The goal of antiretroviral therapy (ART) is viral suppression. Despite numerous efforts through public policy, the failure to achieve viral suppression remains a major concern for the Chadian healthcare system. The objective of this study was to analyze the challenges of managing patients on ART at the Mother and Child University Hospital in N'Djamena.
Methodology: A cross-sectional study was conducted from August 7 to September 6, 2025, among 422 women living with HIV/AIDS, followed at the HIV Treatment Center (CTA) of the Mother and Child University Hospital in N'Djamena. Data were collected using a structured questionnaire and medical records. Statistical analysis was performed using SPSS software, and associations between variables were assessed using bivariate and multivariate logistic regression.
Results: As a result, the prevalence of unsuppressed viral load was 36.49%, compared to 14.45% of suppressed loads (50–1,000 copies/ml) and 49.05% undetectable loads, for an overall suppression rate of 63.5%. Challenges such as stigmatization (OR = 9.18; p = 0.001) and recourse to traditional healers (OR = 22.42; p = 0.001); high stress (OR = 268.64; p = 0.001), alcohol or tobacco use (OR = 19.58; p = 0.001), and associated hepatitis (OR = 1; p = 0.003) were the main factors associated with patient management.
Conclusion: Ultimately, achieving care objectives requires an integrated and multidimensional approach to treatment.
Wilfried Tiam KAMKUIGNI*, Rayam Kouladoum, Kouamé Stanislas Kafflouman et al.· International Journal of Med...· 0 citations
Abstract Background Despite national guidelines recommending universal HIV screening, opportunities for testing are frequently missed in the emergency department (ED), a setting many vulnerable populations rely on for primary care. We describe a collaborative ED-based program created to reduce barriers to HIV screening. Methods This was a retrospective, observational study describing a best practice alert (BPA)-based opt-out HIV screening program established in an ED in Detroit, Michigan, in 2019. A key program efficiency feature was collaboration between ED and infectious disease (ID) teams. Medical records for patients who had a newly diagnosed HIV infection from a screening test during an ED visit between 2019 and 2025 were analyzed. Demographic and clinicopathologic features were described. Primary outcomes included annual rates of newly diagnosed HIV infections, linkage to care, time to initial clinical visit and antiretroviral therapy, and posttreatment viral suppression. Results Of 75 914 patients screened for HIV after program implementation, 176 (0.23%) were newly diagnosed with HIV. Almost 60% of newly diagnosed patients were linked to medical care (n = 104) within 90 days (median, 13 days). Median time to antiretroviral treatment initiation was 9 days, and 54 patients (72.9%) showed evidence of viral suppression at 12 months. Conclusions Through close collaboration between ED and ID teams, a BPA system for ED HIV screening can remove structural barriers and reach patients with limited access to care, advancing equitable access to diagnosis, linkage to care, and HIV treatment.
Brianna Hohmann, Madison Patrus, S. Gudipati et al.· Open Forum Infectious Diseas...· 0 citations
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