Abstract Background Sexually transmitted infections (STIs) remain a public health priority. The Centers for Disease Control (CDC) recommends comprehensive screening for STIs and HIV, defined as testing for gonorrhoea/chlamydia (GC‐CT), syphilis and HIV in persons undergoing STI evaluation. Many patients utilize emergency departments (EDs) for STI evaluation; however, HIV co‐testing rates remain low. Electronic Health Record (EHR)‐based clinical decision support (CDS) can help providers implement best practices. We assessed the impact of two CDS tools on HIV co‐testing rates with GC‐CT in freestanding EDs (FSEDs) of a statewide health system. Methods CDS Interventions included Comprehensive STI Order Set made available 1/2024 and a Comprehensive STI Pathway made available 1/2025. We included FSED encounters for adult patients with GC‐CT NAAT 1/1/2022–11/21/2025 and measured HIV co‐testing rates. Process measures included overall CDS utilization by FSED type (urban Denver sites, Metro; outlying Colorado sites, Outlying; aggregated sites, All Sites). Analysis included statistical process control charts and descriptive statistics. Results GC‐CT testing occurred in 11 087 patient encounters between 1/1/2022 and 11/21/2025. HIV co‐testing rates averaged 2.6% 2 years before the intervention (2022–2023). After the first intervention (2024), HIV co‐testing rose to 13.1%, with a positive shift in SPC charts across All Sites, Metro and Outlying. After the second intervention (2025), HIV co‐testing rose to 18.3%, with greater impacts at Metro FSEDs; positive shifts in SPC charts were seen across All Sites and Metro but not Outlying EDs. Conclusions EHR‐based CDS was effective for increasing HIV co‐testing in freestanding EDs.
Abstract Introduction Human immunodeficiency virus (HIV) is a rare cause of autoimmune haemolytic anaemia (AIHA) which requires prompt diagnosis and treatment. We compared clinical and laboratory findings in AIHA patients with and without HIV. Methods We included adults with severe AIHA (haemoglobin ≤8 g/dL) diagnosed at a tertiary academic centre between 2014 and 2020. Demographic data, laboratory findings, treatment and survival outcomes were compared by HIV status. Statistical comparisons used chi‐squared/Fisher's exact and Wilcoxon rank‐sum tests. Kaplan–Meier estimates assessed overall survival (OS). Results Fifty‐five patients were included, with a median age of 48 years (interquartile range [IQR] 31–64); 64% ( n = 35) were female and 38% ( n = 21) people living with HIV (PLWH). PLWH presented younger (median 37 vs. 60 years, p = 0.003) and with more severe anaemia (median haemoglobin 4.0 vs. 5.4 g/dL, p = 0.015); 71% had unsuppressed HIV viraemia. Additional AIHA triggers in PLWH included lymphoproliferative disorders (14%, n = 3), drugs (10%, n = 2), co‐infections and malignancy. PLWH received corticosteroids less frequently (61%, n = 11 vs. 88%, n = 30; p = 0.034) and had poorer OS (57% [95% CI 32–76] vs. 85% [95% CI 66–93] at 24 months, p = 0.016). PLWH with a CD4 count <200 cells/μL had an increased risk of death compared with HIV‐negative patients (HR 4.6; 95% CI 1.2–17.3; p = 0.023). Conclusions PLWH with severe AIHA were younger, had more severe anaemia, lower corticosteroid use and poorer OS than their HIV‐negative counterparts. The majority had uncontrolled HIV viraemia. These findings highlight the severity, complexity and clinical burden of AIHA in PLWH.
Abstract Objectives We evaluated the feasibility and outcomes of implementing comprehensive Point‐of‐care (POC) opportunistic infections (OIs) screening among people with Advanced HIV disease (AHD) in Guyana. Methods We conducted a prospective multicentre cohort study across seven sites between February 2024 and March 2025. Adults with suspected AHD, defined as CD4 <200 cells/mm 3 or signs/symptoms suggestive of OIs, were enrolled. All participants received a package for OI screening consisting of urinary TB‐LAM, serum cryptococcal antigen, urinary Histoplasma antigen and rapid CD4 testing. Outcomes at 30 and 90 days were recorded. Primary outcome was feasibility, measured as the proportion completing the full screening panel. Secondary outcomes included diagnostic yield, care‐package compliance and factors associated with negative outcomes (death or loss to follow‐up). Results We enrolled 112 individuals; 88.4% completed the full diagnostic panel. A total of 24 participants had positive tests (21.4%). At 90 days, mortality was 5.4% and loss to follow‐up was 11.6%. Positive diagnostic‐test results were associated with worse outcomes at 30 and 90 days. In multivariable analysis, not initiating ART, requiring hospitalization for OI care or treatment, and lower haemoglobin independently predicted negative outcomes. Only 37.5% of participants with positive results completed the disease‐specific diagnostic workup, and 41.7% initiated directed treatment for the detected OI. Conclusions Routine POC screening for OIs among people with AHD in Guyana is feasible and detects a high burden of OIs. However, major gaps in completion of diagnostic algorithms, inconsistent availability of OI treatments and delays in ART initiation reduce the potential clinical impact of early detection.
Abstract Background Despite advances in antiretroviral therapy (ART), inequalities in HIV outcomes persist by sex and migration status. Few studies have examined how these factors jointly relate to treatment outcomes across successive ART eras. Aim To examine differences in time to first viral suppression and life expectancy according to sex and migration status, and how these differences changed across successive ART eras. Methods We conducted a population‐based retrospective cohort study using the PISCIS cohort in Catalonia and the Balearic Islands, Spain. Participants aged ≥16 years diagnosed with HIV between 1998 and 2023, with a recorded ART initiation date and at least one viral load measurement within 12 months after ART initiation, were included. Time to first viral suppression (<50 copies/mL) was analysed using Kaplan–Meier methods and period‐specific (P1: 1998–2001; P2: 2002–2009; P3: 2010–2015; P4: 2016–2023) Cox proportional hazards models including an interaction between sex and migration status and adjusting for age at diagnosis, transmission group, baseline CD4 count, HIV‐RNA and socioeconomic deprivation. Life expectancy at age 20 was estimated using abridged life tables. A complementary analysis among participants with sexually acquired HIV examined differences in viral suppression according to migration status after further disaggregation into women, men who have sex with men (MSM) and heterosexual men. Results The analysis included 18 323 participants (16·0% women; 46.2% migrants). Time to viral suppression shortened substantially across all sex‐migration groups over successive ART periods. By the most recent period (P4), compared with migrant males, migrant females had a lower hazard of viral suppression (adjusted hazard ratios [aHR] 0.84, 95% CI 0.73–0.96), as did non‐migrant males (aHR 0.88, 95% CI 0.81–0.95), whereas non‐migrant females had comparable hazards (aHR 1.09, 95% CI 0.92–1.30). Complementary analyses of sexually acquired HIV revealed further heterogeneity in the most recent period (interaction p < 0.001): Migrant women had a lower adjusted hazard of viral suppression than migrant MSM (aHR 0.77, 95% CI 0.67–0.89), while a particularly low hazard was observed among migrant heterosexual men (aHR 0.60, 95% CI 0.51–0.69). Life expectancy at age 20 increased by approximately 12 years across all groups over the study period, with differences between groups narrowing over time. Conclusion Viral suppression and life expectancy improved substantially across all sex‐migration groups over 26 years. However, differences in time to viral suppression persisted in the most recent ART era, including slower suppression among migrant women compared with migrant men. Further disaggregation of sexually acquired HIV revealed additional heterogeneity, particularly between migrant MSM and heterosexual men. These findings highlight the importance of considering the intersection of sex, migration status and HIV acquisition group to better identify population‐specific inequalities in HIV care.
Abstract Background We aimed to describe baseline drug resistance in patients newly diagnosed with HIV in Brighton over a 12‐year period. Method As part of a quality improvement project, clinic data were collected for all patients newly diagnosed with HIV between January 2014 and December 2025. Locally, baseline genotypic resistance testing is routinely performed at diagnosis and assessed for resistance to nucleos(t)ide reverse transcriptase inhibitors (NRTIs), non‐nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). Since 2022, baseline resistance for integrase inhibitors (INIs) has also been performed. Transmitted drug resistance mutations for NRTIs, NNRTIs and PIs were defined according to the World Health Organization (WHO) criteria. Integrase resistance mutations were identified using the Stanford HIV Drug Resistance Database. Extracted data included patient demographics, date of HIV diagnosis, HIV subtype and previous HIV pre‐exposure prophylaxis (HIV‐PrEP) use. Results Three hundred and eighteen individuals newly diagnosed with HIV throughout the study period, of which 312 had a resistance report available for analysis. Overall, baseline drug resistance was found in 38/312 (12%, 95% CI 8.76–16.33). The median age was 37 years (IQR 30–46). 13 (39%) patients were non‐UK born and 17 (52%) had a non‐B subtype. There were 12 (4%) individuals with NRTI resistance mutations, 13 (4%) with NNRTI mutations and 5 (2%) with PI mutations. Integrase resistance mutations were found in 8/73 (11%) between 2022 and 2025, 3 of whom had no other class resistance. Baseline drug resistance was associated with non‐clade B genotypes (OR = 2.79, 95%CI = 1.34–5.79, p = 0.006) and previous HIV‐PrEP use (OR = 4.14, 95%CI = 1.66–10.4, p = 0.003). Conclusion This manuscript identified a number of cases where baseline integrase resistance was identified. These data suggest that more work is needed to establish whether baseline integrase inhibitor resistance testing is warranted in all individuals newly diagnosed with HIV.
