[HIV. Long-acting treatment : clinical experience, limits and future perspectives]. / VIH. Traitement à longue durée d'action : expériences cliniques, limites et perspectives.

In this article, we first present the current administration criteria, the risk factors for virological failure, and our practical experience with the first long-acting injectable HIV treatment available in Switzerland (the combination of cabotegravir/rilpivirine). We then discuss the theoretical and practical potential, as illustrated by an innovative study in San Francisco, provided by administering long-acting treatment outside the current criteria. This approach could notably offer antiretroviral treatment to particularly vulnerable populations for whom oral antiretroviral therapy is sometimes challenging. Finally, we touch upon the future drug prospects of long-acting treatments under study for HIV.

Dans cet article, nous présentons les critères d'administration actuels, les facteurs de risque d'échec virologique et notre expérience pratique sur le premier traitement à longue durée d'action injectable contre le VIH disponible en Suisse (l'association de cabotégravir/rilpivirine). Nous abordons également le potentiel théorique et pratique offert par l'administration de traitements à longue durée d'action hors des critères actuels, illustré par une étude novatrice à San Francisco. Cette extension des critères d'administration permettrait notamment d'offrir un traitement antirétroviral à des populations particulièrement précarisées, pour lesquelles un traitement antirétroviral oral est parfois difficile. Enfin, nous évoquons les futures perspectives de traitements à longue durée d'action en étude pour la prise en charge du VIH.

[News in HIV infection, long-acting injectable treatments]. / VIH : zoom sur les traitements injectables à longue durée d'action.

Long-acting injectable therapies have been added to the pharmacological arsenal available for the management of HIV infection, whether in the form of monotherapy (injectable cabotegravir) as part of pre-exposure prophylaxis (PrEP) or dual therapies (injectable cabotegravir/rilpivirine) for the treatment of HIV. These treatments are the subject of new international recommendations following the publication of pivotal trials, the results of which will be presented in this review. We will also discuss the practical modalities of their implementation as well as the challenges to be faced in the future.

Les traitements injectables à longue durée d'action complètent les options pharmacologiques disponibles dans la prise en charge de l'infection par le VIH, que ce soit sous la forme de monothérapie (cabotégravir injectable) en prophylaxie pré-exposition (PrEP) ou de bithérapie (cabotégravir/rilpivirine injectables) en traitement. Ces molécules font l'objet de nouvelles recommandations internationales suite à la publication d'essais déterminants dont les résultats sont détaillés dans cet article. Nous abordons également les modalités pratiques de leur implémentation ainsi que les défis auxquels nous devons nous préparer.

[HIV and COVID-19: two viral pandemics in interaction]. / VIH/sida - VIH et Covid-19 : deux pandémies virales en interaction.

First AIDS cases have been described 40 years ago in June 1981. Today we see the major impact of COVID-19 pandemic on that of HIV/AIDS. Data tends to show frequency of severe forms of COVID-19 increased in people living with HIV. We review the current knowledge about COVID-19 and its impact on people living with HIV.

Les tout premiers cas de sida ont été décrits il y a 40 ans, en juin 1981. Aujourd'hui, on constate l'impact majeur de la pandémie de Covid-19 sur celle du VIH/sida. Les données tendent à montrer que la fréquence des formes graves de Covid-19 est augmentée chez les personnes vivant avec le VIH. Nous faisons le point sur les connaissances actuelles concernant le Covid-19 et son impact sur la prise en charge des personnes vivant avec le VIH.

[HIV in the time of COVID-19 : the meeting between two pandemics]. / VIH/sida - VIH au temps du Covid-19 : rencontre de deux pandémies.

The current COVID-19 pandemic is the main topic of news worldwide by its magnitude and consequences across the entire planet. From a medical point of view, several risk factors for developing severe illness have been reported in the literature, notably an immunosuppressed status. For people living with HIV, several questions have been raised concerning not only their vulnerability, but also in relation to an eventual protection conferred by antiretroviral therapy. This article will address these two pandemics by looking at the potential impact of SARS-CoV-2 on people living with HIV and, in parallel, exploring similarities and differences in terms of treatment, potential for recovery, prevention and their impact on clinical research. We review also future novel therapies for the treatment of HIV.

La pandémie de Covid-19 est le sujet d'actualité mondial tant par son ampleur que par ses immenses conséquences. Du point de vue médical, plusieurs facteurs de risque de développer une maladie sévère ont été établis dans la littérature, et l'immunosuppression en fait partie. Concernant les personnes vivant avec le VIH, plusieurs questions se sont posées : sont-elles plus vulnérables à l'acquisition de SARS-CoV-2, ou à une maladie Covid-19 sévère ? Ou au contraire sont-elles protégées par les antirétroviraux ? Cet article aborde ces deux pandémies et recherche des similitudes et des différences en termes de traitement, de guérison, de prévention et de recherche clinique. Nous décrivons brièvement quelques-uns des traitements antirétroviraux les plus innovants.

[Antiretroviral treatments : towards simplified regimens ?] / Traitements antirétroviraux : vers un allègement ?

The chronicity of HIV infection and the use of antiretroviral therapy among all individuals living with HIV necessitate new treatment strategies. Alternatives to lifelong tri-therapy treatment are under investigation with the aim to improve the quality of life of patients. New therapies with longer half-lives or « biological ¼ treatments are also under study in clinical trials in order to develop streamlined maintenance strategies. These simplified therapies represent the near future of HIV management both with regards to less toxic molecules and a change in the traditional dogma of tri-therapy, including the daily dose thanks to the possibility of dosage only on certain weekdays or via molecules under development with a long duration of action.

La chronicisation de l'infection VIH et l'utilisation des antirétroviraux chez l'ensemble des personnes vivant avec le VIH rendent nécessaires de nouvelles stratégies de traitement médicamenteux. Des alternatives au traitement à vie par une trithérapie sont étudiées pour améliorer la qualité de vie des patients. De nouveaux médicaments, avec des demi-vies prolongées, ou des traitements dit « biologiques ¼ sont également en phase d'étude clinique afin d'élaborer des stratégies de maintenance.L'avenir proche de la prise en charge du VIH s'inscrit dans ces allègements thérapeutiques par exemple en utilisant des molécules moins toxiques, moins dosées, des bithérapies à longue durée d'action ou encore des molécules.

Prevalence of HIV-related stigma among people with HIV in Switzerland: addressing the elephant in the room.

OBJECTIVES: We aimed to determine the prevalence of HIV-related stigma among people with HIV (PWH) in Switzerland. DESIGN: A cross-sectional multicenter study nested within the Swiss HIV Cohort Study (SHCS). METHODS: We included adult PWH enrolled in the SHCS, attending follow-up between March 1, 2020, and January 31, 2021. Inability to speak English, French, German, or Italian was the only exclusion criterion. Participants were invited to complete a validated 12-item HIV-stigma questionnaire comprising four stigma subscales (negative self-image, personalized stigma, disclosure concerns, and concerns regarding public attitudes), plus two healthcare-related stigma items. Questionnaire responses were graded using a four-point Likert-type scale, higher scores indicating higher stigma. "Non-applicable," inferring HIV-status non-disclosure, was possible for personalized stigma; stigma scores from participants answering "non-applicable" to at least one item were analyzed separately. Factors associated with HIV-stigma were identified through multivariable linear models. RESULTS: Of 9643 PWH with a SHCS visit, 5563 participated in the study: 26% were female, 13% Black, and 37% heterosexual; median age was 53 years (interquartile range 44-59); 2067 participants (37%) gave at least one "non-applicable" response. Disclosure concerns had the highest stigma scores and were reported by 4656/5563 (84%). HIV-stigma was reported across all demographic groups. However, being female, Black, and heterosexual were independently associated with higher scores. Higher education and longer follow-up duration were associated with lower scores. Healthcare-related stigma was reported in 37% of participants. CONCLUSION: HIV-stigma was prevalent across all demographic groups. The association with being female and Black suggests that HIV-stigma accentuates preexisting sex and race inequalities.

Cerebrospinal Fluid HIV-1 Escape in Patients With Neurocognitive Symptoms: Pooled Data From a Neuro-HIV Platform and the NAMACO Study.

BACKGROUND: Despite modern antiretroviral therapy, human immunodeficiency virus-1 (HIV-1) ribonucleic acid (RNA) escape into the cerebrospinal fluid (CSF) may occur. We examined the prevalence of and factors associated with CSF HIV-1 escape among people living with HIV (PLWH) in Switzerland. SETTING: The Neurocognitive Assessment in the Metabolic and Aging Cohort study is an ongoing, prospective, longitudinal, multicenter study within the Swiss HIV Cohort Study. The neuro-HIV platform is a multidisciplinary, single-day outpatient consultation at Lausanne University Hospital. METHODS: We pooled data from the Neurocognitive Assessment in the Metabolic and Aging Cohort study and the neuro-HIV platform participants who underwent lumbar puncture between 2011 and 2019. Both patient groups had neurocognitive symptoms. Cerebrospinal fluid HIV-1 escape was defined as the presence of quantifiable CSF HIV-1 RNA when plasma HIV-1 RNA was suppressed or CSF HIV-1 RNA greater than plasma HIV-1 RNA when the latter was detectable. RESULTS: Of 1166 PLWH assessed, 288 underwent lumbar puncture. Cerebrospinal fluid HIV-1 escape was observed in 25 PLWH (8.7%) of whom 19 (76%) had suppressed plasma HIV-1 RNA. Characteristics of PLWH were comparable whether they had CSF HIV-1 escape or not, including comorbidities, time since HIV diagnosis (15 vs 16 years, P = 0.9), median CD4 nadir (158.5/mm 3 vs 171/mm 3 , P = 0.6), antiretroviral CSF penetration-effectiveness score (7 vs 7 points, P = 0.8), and neurocognitive diagnosis based on Frascati criteria and radiological findings. CONCLUSIONS: In this large pooled sample of PLWH with neurocognitive symptoms, CSF HIV-1 escape occurred in 8.7% of PLWH. People living with HIV with CSF HIV-1 escape presented no distinctive clinical or paraclinical characteristics. We conclude that lumbar puncture is unavoidable in confirming CSF HIV-1 escape.