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As part of the CASCADE study's aim to promote better understanding of effective health planning for people with HIV, insights from the study are disseminated through academic publication.
听Please see the below publications from the CASCADE study, in order of date of publication.
We have also published a lay summary of this paper,听which you can access here.
Background
Understanding the reasons for and consequences of bodyweight change in people living with HIV initiating antiretroviral therapy (ART) is crucial to optimising long-term health and wellbeing. We aimed to examine bodyweight trends and associated factors among individuals with well estimated dates of HIV-1 seroconversion.
Methods
In this cohort study, we pooled retrospective data from clinical records of participants in CASCADE aged 16 years and older recruited from clinics in France, Greece, the Netherlands, Spain, Sweden, the UK, and Canada. All participants had well estimated dates of HIV-1 seroconversion, seroconverted between Jan 1, 2007, and Dec 31, 2022 (HIV-1 positive antibody test within 12 months of an HIV-1 negative antibody test, or other laboratory evidence of seroconversion), initiated ART within 1 year of seroconversion, and were previously ART-naive. Participants were followed up to the time of data pooling (May 31, 2023). We modelled bodyweight changes after ART initiation by ART class, BMI categories, and other demographic characteristics using linear mixed models.
Findings
Of 15鈥�755 potentially eligible participants, 5698 met inclusion criteria. Of those, 5148 (90路3%) were assigned male at birth, 517 (9路1%) were assigned female at birth, and 33 (0路6%) had sex not known. 2778 (48路8%) participants initiated integrase strand transfer inhibitor (INSTI)-based ART regimens, 1809 (31路7%) initiated protease inhibitor-based regimens, and 1111 (19路5%) initiated non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. The majority of participants were men who have sex with men (MSM; 4519 [79路3%]). Median age at seroconversion was 33路7 years (IQR 26路9鈥�43路2). Bodyweight changes differed significantly by ART class within all baseline BMI categories (BMI <18路5 kg/m2 p=0路026, BMI 18路5鈥�24路9 kg/m2 p<0路0001, BMI 25路0鈥�29路9 kg/m2 p=0路0021, and BMI 鈮�30路0 kg/m2 p=0路0033; ART class and BMI interaction p=0路011). Participants with BMI less than 30 kg/m2 on regimens including both INSTI and tenofovir alafenamide gained 4路76 kg (95% CI 4路05鈥�5路46) or more at 3 years. Of those with baseline BMI 18路5鈥�24路9 kg/m2, 31路3% (95% CI 29路5鈥�33路1) on INSTI-based regimens, 25路3% (23路0鈥�27路7) on protease inhibitor-based regimens, 20路4% (18路8鈥�22路9) on NNRTI-based regimens, 37路4% (33路9鈥�40路9) on tenofovir alafenamide-based regimens, and 38路4% (34路6鈥�42路1) on tenofovir alafenamide and INSTI-based regimens had gained more than 10% of their baseline bodyweight at 3 years. The greatest 3-year bodyweight gains by individuals on INSTI-based regimens and with BMI 18路5鈥�24路9 kg/m2 were in women (5路63 kg [95% CI 4路92鈥�6路35]), and people originating from sub-Saharan African (5路76 kg [5路06鈥�6路46]), compared with MSM (3路82 kg [3路50鈥�4路13]).
Interpretation
Our findings suggest a direct effect of INSTIs and tenofovir alafenamide on bodyweight gain, rather than a return to health effect. Given the known risk for cardiometabolic disease, bodyweight management needs to be part of the overall care of individuals prescribed these drugs.
Link to publication:听
翱产箩别肠迟颈惫别(蝉)听
Recently acquired HIV is a critical time when people may experience debilitating symptoms and is when they are most likely to pass HIV on. Qualitative research offers insights into lived experiences and a deeper understanding of the contextual factors underlying HIV acquisition. We aimed to synthesize qualitative literature on recently acquired HIV.
顿别蝉颈驳苍听
Systematic review and textual narrative synthesis.
惭别迟丑辞诲蝉听
We searched MEDLINE, CINAHL Plus, PsycINFO and Sociology Database. Articles were screened, and two authors completed full text review and data extraction. Quality appraisal was conducted (Critical Appraisal Skills Programme Qualitative Studies Checklist) and certainty of findings graded (GRADE-CERQual).
搁别蝉耻濒迟蝉听
We reviewed 1890 articles (1554 following de-duplication), excluding 1539. Fifteen articles were included and an additional article was included after updating the search. We identified 15 themes, three of which we have high confidence in: recent acquisition of HIV facilitates understanding of circumstances of HIV acquisition; indeterminate HIV tests generate uncertainty and anxiety; and people with recently acquired HIV are motivated to reduce risk of onward transmission.
颁辞苍肠濒耻蝉颈辞苍蝉听
Our findings highlight the importance of continued research into recently acquired HIV, as well as the need for support to manage the emotional impact of indeterminate test results and negotiate risk reduction. We found no studies exploring sexual risk in the context of recently acquired HIV, or use of pre-exposure prophylaxis or treatment as prevention. The literature听is primarily focused on HIV acquisition from an individual and behavioural perspective, neglecting important aspects of lived experience such as immediate ART, stigma, and health and wellbeing.
滨苍迟谤辞诲耻肠迟颈辞苍听
Despite the availability of pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART), 21 793 people were newly diagnosed with HIV in Europe in 2019. The Concerted action on seroconversion to AIDS and death in Europe study aims to understand current drivers of the HIV epidemic; factors associated with access to, and uptake of prevention methods and ART initiation; and the experiences, needs and outcomes of people with recently acquired HIV.
Methods and analysis听
This longitudinal observational study is recruiting participants aged 鈮�16 years with documented laboratory evidence of HIV seroconversion from clinics in Canada and six European countries. We will analyse data from medical records, self-administered questionnaires, semistructured interviews and participatory photography. We will assess temporal trends in transmitted drug resistance and viral subtype and examine outcomes following early ART initiation. We will investigate patient-reported outcomes, well-being, and experiences of, knowledge of, and attitudes to HIV preventions, including PrEP. We will analyse qualitative data thematically and triangulate quantitative and qualitative findings. As patient public involvement is central to this work, we have convened a community advisory board (CAB) comprising people living with HIV.
Ethics and dissemination听
All respective research ethics committees have approval for data to contribute to international collaborations. Written informed consent is required to take part. A dissemination strategy will be developed in collaboration with CAB and the scientific committee. It will include peer-reviewed publications, conference presentations and accessible summaries of findings on the study鈥檚 website, social media and via community organisations.