Abstract Background People with HIV (PWH) face a growing burden of cardiovascular disease. Integrase strand transfer inhibitors (INSTI) have been linked to weight gain and possibly hypertension, but head-to-head data among contemporary regimens are scarce, and few studies analyze older and modern regimens together. We evaluated the incidence of hypertension in antiretroviral therapy (ART)-naïve PWH initiating Spanish guidelines-recommended first-line regimens since 2009. Methods Retrospective cohort of ART-naïve adults initiating first-line regimens from 2009 to 2024, grouped into NNRTI, INSTI, and boosted PI-based classes. Incident hypertension was defined by a composite of clinical diagnosis, antihypertensive initiation, or two consecutive measurements ≥ 140/90 mmHg. Time to hypertension was analysed using Kaplan-Meir methods and Cox regression, with a pre-specified INSTI subanalysis. Results Among 1,134 participants (median age 34.1years; 89.8% male), 205 (18.1%) developed hypertension over a median of 135.9 weeks (incidence 4.9/100 person-years). Hypertension free survival differed by class (log-rank p = 0.005); INSTI-based ART was independently associated with higher risk than NNRTIs (adjusted HR 1.61; 95% CI 1.20-2.17). Within the INSTI subgroup (n = 437; incidence 7/100 person-years), 5-year cumulative hypertension ranged from 9% (EVG/c/FTC/TAF) to 37% (dolutegravir-based); dolutegravir-based regimens carried a > 2-fold adjusted hazard versus EVG/c/FTC/TAF. Higher BMI was independently predictive but did not abolish this signal. Conclusions In ART-naïve PWH, INSTI-based regimens were associated with a higher incidence of hypertension than NNRTI-based regimens, whereas the comparison with PI-based regimens were not statistically significant. Dolutegravir-containing regimens were independently associated with incident hypertension supporting systematic blood pressure surveillance and further comparative studies.
Abstract Background People with substance use disorders living with human immnunodeficiency virus (HIV) experience overlapping structural and clinical barriers to care. Long-acting injectable antiretroviral therapy (LAI-ART) may improve treatment adherence and may strengthen engagement in health services. Whether initiation of LAI-ART is associated with subsequent uptake of medications for opioid use disorder (OUD) is unknown. Methods We conducted a retrospective descriptive cohort study of people with HIV and a history of a substance use disorder (SUD) who initiated long acting cabotegravir-rilpivirine (LA-CAB + RPV) at a low-barrier social services and public health organization between February 1, 2022, and June 30, 2025, and received at least six months of follow up. We evaluated whether initiation of this regimen improved HIV and substance use disorder outcomes, including uptake of medications for opioid use disorder (MOUD), sustained treatment engagement, reduced opioid use, and viral suppression. Results Forty patients initiated LA-CAB + RPV. . Viral suppression improved from 73% at baseline to 98% at follow up. Adherence was high, with only one missed scheduled dose and no recorded deaths from HIV-related causes. At baseline, 81.1% reported active opioid use and 32.4% were receiving medications for OUD. MOUD utilization increased to 78.4% at six months and 89.2% at end follow up, while opioid use declined to 59.5% and 48.6%. Among those initiating medications for OUD after CAB + RPV, 90.9% remained on treatment, with 40% initiating within two months. Most patients remained engaged in HIV care. Conclusions Integrated low barrier care models may improve continuity of care for marginalized populations.
Abstract In a study of oral linezolid among 18 patients with early syphilis, fifteen showed adequate serological response by six months. Among six patients treated with benzathine penicillin G, five showed adequate serological response. There were no serious adverse events. Linezolid shows promise for the treatment of early syphilis.
Abstract Background Screening, diagnosis, and treatment for hepatitis C and hepatitis B can be limited due to challenges in accessing in-person health care. This study explored the alternative method of dried blood spot (DBS) collection, specifically through mail-based self-collection. Methods A total of 388 patients were recruited by phone from the Toronto Centre for Liver Disease and the Toronto Western Family Health Team, who were seropositive for hepatitis C virus (HCV), hepatitis B virus, and/or SARS-CoV-2 or had unknown serostatus. Participants were mailed a collection kit, paper instructions/QR code for video instructions, demographic/acceptability questionnaires, a return envelope, and laboratory requisition. DBS cards and phlebotomy were tested for hepatitis B surface antigen, HCV antibody, and SARS-CoV-2 antibody. DBS results were compared against conventional phlebotomy as the gold standard. Results Of the 388 recruited participants, 110 completed the study by returning their DBS cards and completing conventional phlebotomy and questionnaires. For hepatitis B surface antigen, self-collection DBS testing showed 100% sensitivity and specificity, with 31 true positives and 79 true negatives. For HCV antibody, self-collection DBS testing showed 96.2% (25/26) sensitivity and 96.4% specificity (81/84), with 25 true positives, 81 true negatives, 3 false positives, and 1 false negative. SARS-CoV-2 testing also showed 100% sensitivity and specificity, with 108 true positives and 2 true negatives. Acceptability was high with 78.3% (101/129) participants rating the process easy or very easy. Conclusions Mail-based self-collected DBS enables remote testing by allowing nonmedically trained individuals to reliably collect their own samples. High concordance and acceptability indicate that this method is viable for addressing health care access challenges, particularly in populations motivated to seek testing.
