BACKGROUND: Kaposi sarcoma herpes virus (KSHV)-associated inflammatory cytokine syndrome (KICS) is defined by clinical, laboratory, and radiographic findings and KSHV viremia. Whether the presenting clinical symptoms of KICS have prognostic value in patients with HIV-associated Kaposi sarcoma (HIV-KS) initiating therapy is unknown. SETTING: Two prospective clinical trials were conducted among participants with mild-to-moderate (A5264/AMC067) and advanced (A5263/AMC066) HIV-KS in low-income and middle-income countries. All participants received antiretroviral therapy, and chemotherapy was given according to the randomly assigned treatment arm. METHODS: We developed a Kaposi sarcoma clinical symptom score (KSCS score), derived from the previously described KICS definition to determine whether the score could inform prognosis. The score ranging from 0 to 3 was based on increasing severity of clinical manifestations. We evaluated the impact of baseline KSCS score on progression-free and overall survival using Cox proportional hazard regression. RESULTS: Of 190 participants in A5264/AMC067 and 329 in A5263/AMC066, 150 (78.9%) and 239 (72.6%) had KSCS score ≥1 and 15 (7.9%) and 95 (28.9%) had KSCS score 3, respectively. Independent of the treatment arm, participants with KSCS score 3 had a higher risk of death (A5264/AMC067: adjusted hazard ratio (aHR) = 9.17; 95% CI: 3.60 to 23.41; A5263/AMC066: aHR = 2.99; 95% CI: 1.69 to 5.28) and shorter progression-free survival (A5264/AMC067: aHR = 2.36 95% CI: 1.26 to 4.43; A5263/AMC066: aHR = 2.31; 95% CI: 1.23 to 3.60) compared with those with KSCS score ≤2. CONCLUSIONS: KSCS score symptoms are common, especially in advanced HIV-KS. KSCS score 3 is associated with higher risk of progressive KS disease or death, despite treatment with antiretrovirals and chemotherapy. This population may benefit from improved diagnostic and management options.
Background: criminal legal involved (CLI) persons who use drugs are at high risk of exposure to HIV, yet few initiate preexposure prophylaxis (PrEP). Understanding interest in PrEP and the different formulations of PrEP may improve uptake in this population.Methods: Participants were CLI adults aged 18 or older, used opioids and/stimulants, tested negative for HIV, and met Centers for Disease Control and Prevention PrEP eligibility criteria. Characteristics of persons interested in PrEP were compared with those who were not interested in PrEP at baseline. Among those interested in PrEP, characteristics were compared for those who preferred long-acting injectable (LAI) vs oral PrEP.Results: Of 566 persons enrolled, 35.1% (N = 199) were interested in PrEP; of those, 60.8% (N = 121) preferred LAI vs 39.1% (N = 78) preferred oral PrEP. PrEP interest was greater in persons from Texas (50%) vs Connecticut (18.3%). A significantly higher odds of being interested in PrEP was associated with having a methamphetamine use disorder and a higher self-perceived risk of HIV; and a history of sharing injection drug use equipment was associated with a higher odds of being interested in LAI vs oral PrEP.Conclusions: Among CLI persons who use drugs eligible for PrEP, persons in TX, were more interested in PrEP compared with persons in CT. Persons with a methamphetamine use disorder and a higher self-perceived risk of HIV were predictors of PrEP interest and sharing injection drug use equipment was a predictor of interest in LAI vs oral PrEP. More research on patient choice and shared decision making should be included to improve PrEP initiation.
Background: Individuals living with HIV often experience chronic pain, which contributes to diminished physical and mental health. Skills TO Manage Pain (STOMP), a pain self-management intervention tailored for individuals with HIV, has demonstrated immediate and sustained efficacy at reducing pain and strengthening pain self-efficacy. Evaluating STOMP’s effectiveness in real-world settings remains a critical next step in advancing its implementation. Methods: This article describes how we used implementation mapping to develop strategies aimed at strengthening the delivery and long-term sustainability of STOMP in HIV care settings. Results: Through semi-structured interviews with 17 key informants, we identified several barriers to and facilitators of STOMP implementation. Examples included patients potentially feeling their pain is being invalidated because they are being offered a behavioral rather than biomedical intervention; however, STOMP was also an adaptable, evidence-based CBT intervention that people may perceive as a better option than opioids for pain management. We also held a community engagement studio in which key informants provided insights on how to promote equitable implementation of STOMP in HIV clinics. Conclusion: Using a rigorous theory-based approach, we selected ten strategies to reduce barriers and strengthen facilitators for STOMP implementation in HIV care settings. This process involved qualitative interviews and a focus group with key informants, including people with lived experience. Implementation mapping appears to be a promising approach to bolster uptake of evidence-based interventions like STOMP. In our future research, we will evaluate both our implementation strategies and the effectiveness of STOMP for improving health in people with HIV and chronic pain.
Background: In 2021, Panama identified structural and operational gaps in its national HIV viral load (HIV VL) testing network, in the context of low testing coverage. A phased strategy was implemented to strengthen testing capacity, quality, geographic access, and referral pathways. Setting: Panama’s national HIV VL testing network. Methods: We conducted a retrospective program assessment of the national HIV VL network optimization strategy implemented from 2021–2025. A 2021 baseline assessment included two HIV VL reference laboratories and 13 antiretroviral therapy (ART) clinics representing 93% of the ART cohort reported in the programmatic data used for the assessment. Findings informed phased optimization, including redistribution of testing, establishment of regional capacity, and differentiated use of GeneXpert for priority HIV VL testing. Programmatic data were used to assess HIV VL coverage, viral suppression, testing distribution, and turnaround time. Results: HIV VL testing increased from 6,967 tests in 2021 to 15,897 in 2025, while the ART cohort increased 25%, from 14,560 to 18,200. HIV VL coverage increased from 47% to 89%, and viral suppression from 78% to 94%. Testing was redistributed across the laboratory network. Post-optimization routine turnaround time was approximately 1 week at the regional Veraguas laboratory and 10 days at ICGES; priority GeneXpert testing provided results in approximately 24 hours. Conclusion: Panama’s phased optimization was associated with expanded HIV VL testing access, increased coverage, redistributed testing capacity, and more timely testing pathways. These findings represent programmatic trends and should not be interpreted as causal effects of the strategy.
Introduction: Clinical trials for the evaluation of novel diagnostics and treatments for HIV-associated opportunistic infections have historically excluded pregnant persons. Little information is available regarding the clinical outcomes and pregnancy outcomes of pregnant persons with advanced HIV disease while taking opportunistic infection prophylaxis for tuberculosis (TB) and cryptococcosis. In this study, we describe characteristics at enrollment, clinical outcomes, and birth outcomes of pregnant people with advanced HIV in Uganda. Methods: We prospectively enrolled pregnant adults with advanced HIV disease within an on-going pragmatic cluster randomized clinical trial evaluating an enhanced screening and prophylaxis package for opportunistic infections (NCT05085171). The trial began enrollment in May 2022 and continues in 26 outpatient HIV clinics in the Kampala and Wakiso districts of Uganda. We present an analysis of pregnant participants enrolled through April 30, 2025, including their characteristics at study enrollment, opportunistic infections, and birth outcomes. Results: Overall, 15% (114/766) of female participants with advanced HIV disease were pregnant. Median CD4 cell count was 124 cells/µL (IQR: 82-170). Median time since HIV diagnosis was 7 days, and 45% were ART-naive at enrollment. Compared with non-pregnant female participants, pregnant participants were less likely to have a positive cryptococcal antigen (CrAg) test (2% vs 7%, p=0.023), to have a positive Alere tuberculosis (TB) lipoarabinomannan (LAM) test (11% vs 28%, p<0.001), and to be receiving active TB treatment (14% vs 39%, p<0.001). Overall, 18% (21/114) experienced at least one opportunistic infection during the study, of which 71% (n=15) were attributed to TB. Eighty-six percent (98/114) of pregnancies were carried to term. Participants on TB preventive therapy (TPT) had 94% of deliveries at term (51/54), compared with 80% (36/45) among participants who did not receive TPT (OR = 4.25, 95%CI:1.07-16.80), and 67% (8/12) among participants on active TB treatment (OR = 8.50, 95%CI: 1.60-45.25). Conclusions: Although the incidence of opportunistic infections is less commonly reported among pregnant women with advanced HIV disease, TB is the most frequent opportunistic infection. Participants on TPT had 4-fold higher odds of having a term delivery compared with those not on TPT and 8-fold higher odds compared with those with active TB.
