BACKGROUND:HIV-related stigma in healthcare settings remains a barrier to equitable care for people living with HIV. Data on HIV-related knowledge and stigmatizing attitudes among healthcare workers (HCWs) in Greece are limited. This study aimed to describe HIV-related knowledge, stigmatizing attitudes and discriminatory practices among HCWs in Greece and to identify factors associated with higher knowledge and stigma. METHODS:We conducted a secondary analysis of the Greek subset of the 2023 ECDC/EACS survey on HIV-related knowledge and stigma among HCWs. HIV knowledge was assessed using three items on undetectable equals untransmittable ('U=U'), post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), combined into a four-level ordinal variable. Stigmatizing attitudes were assessed using an eight-item mean score. Associations with knowledge were examined using proportional-odds ordinal logistic regression, and associations with stigma were assessed using a multivariable linear model. RESULTS:Among 826 respondents, correct knowledge was reported by 57.9% for 'U=U', 59.4% for PEP and 39.0% for PrEP. Nearly half answered no more than one item correctly. Higher knowledge was independently associated with younger age, male gender, doctor role, hospital-based practice and greater occupational contact with people living with HIV. The mean stigma score was 2.1 on a 1-5 scale. Higher stigma scores were independently associated with older age, lower HIV knowledge and absence of prior HIV stigma/discrimination training. Doctors had lower adjusted stigma scores than nurses in pairwise comparisons. CONCLUSIONS:Important gaps in HIV prevention knowledge and persistent stigmatizing attitudes were observed among HCWs in Greece. Findings support structured, decentralized educational and stigma-reduction interventions across healthcare settings.
OBJECTIVES:Dyslipidaemia is highly prevalent among people living with human immunodeficiency virus (HIV) and contributes to increased cardiovascular risk. Although lifestyle interventions are recommended, evidence specific to people living with HIV remains limited. Previous reviews have primarily focused on dietary interventions or low-density lipoprotein cholesterol (LDL-C). Here, we assessed the effects of dietary counselling and exercise training on serum lipid levels in people living with HIV. METHODS:We conducted a systematic review and meta-analysis of randomized controlled trials evaluating dietary and exercise interventions in people living with HIV, predominantly with dyslipidaemia. PubMed, CENTRAL, Cumulative Index to Nursing and Allied Health Literature and Web of Science were searched up to February 28, 2026. The primary outcome was the change in LDL-C level from baseline. Secondary outcomes included changes in total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels. Mean differences with 95% confidence intervals were pooled. RESULTS:Seven RCTs involving 474 participants were included. Dietary counselling significantly reduced LDL-C, TC and TG levels compared with usual care, with LDL-C reductions ranging from approximately 6 to 13 mg/dL. Evidence from two trials suggested that exercise training may increase HDL-C levels, with no consistent effects on LDL-C, TC or TG levels. Differences in exercise protocols may have contributed to these findings. CONCLUSION:Dietary counselling may improve LDL-C, TC and TG levels, whereas limited evidence suggests that exercise training may increase HDL-C levels in people living with HIV. Lifestyle interventions may serve as adjunctive strategies for lipid management, although further large-scale studies are needed, particularly to evaluate the effects of exercise.
BACKGROUND:Migration status is consistently associated with a higher risk of loss to follow-up (LTFU). We investigated how sex, sexual orientation and social vulnerabilities affect the association between migration status and LTFU for hospital care in people living with HIV, using data from the ANRS CO9-COPANA cohort linked to the nationwide French hospital database on HIV (ANRS CO4-FHDH). METHODS:The COPANA prospective cohort enrolled antiretroviral drug-naïve adults newly diagnosed with HIV-1 between 2004 and 2008 in France. LTFU in the hospital setting was defined as no clinical follow-up for ≥24 months before the study end. Fine and Gray models accounting for death as a competing event were used to assess factors associated with LTFU. RESULTS:The 616 participants included 333 born in France, 209 born in sub-Saharan Africa and 74 born in other regions. There were 432 male participants, including 281 men who have sex with men (MSM). The cumulative incidence of LTFU was 17% (95% CI: 14-20) at 10 years. Migrant MSM and migrant women had a higher crude risk of LTFU than French-born MSM. After adjustment for several social factors, the risk of LTFU remained higher in migrant MSM. Lack of psychological support and non-disclosure of HIV status to friends were associated with a higher risk of LTFU and had the greatest impact on the difference between crude and adjusted sub-distribution hazard ratios for LTFU in both male and female migrants. CONCLUSION:The higher risk of LTFU from hospital-based care in migrant MSM and women was attenuated after adjustment for social vulnerabilities, suggesting that these factors contribute to the observed association.
OBJECTIVES:Material deprivation (MD), the inability to afford essentials, is linked with poorer HIV clinical outcomes. In Canada, migrants living with HIV are a growing group, yet little is known about their experience of MD, especially early in treatment. This study examined the prevalence, nature, sociodemographic and clinical correlates and longitudinal changes in MD among migrants living with HIV initiating antiretroviral therapy (ART). METHODS:Analyses used data from 56 ART-naïve migrants enrolled in the Antiretroviral Speed Access Program (ASAP), a cohort at the McGill University Health Centre, Montreal, Canada receiving access to rapid, no-cost and onsite bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF). MD was assessed at Weeks 4 and 48 using the 17-item Canadian Material Deprivation Index (CMDI), with deprivation defined as checking ≥2 items. Statistical tests included Fisher's exact, Wilcoxon signed-rank, McNemar's exact and correlation coefficients. RESULTS:At Week 4, 48 (85.7%) participants were materially deprived, most commonly reporting inability to cover an unexpected expense (87.5%), afford dental care (73.2%) or buy small gifts (73.2%). Week 4 MD was significantly associated with occupation (p = 0.020) and migration status (p = 0.016). No statistically significant associations were observed between MD and HIV clinical outcomes. Between Weeks 4 and 48, MD scores declined significantly (median: 7.5 to 4.0; p < 0.001), although 67.9% of participants remained deprived. CONCLUSIONS:Associated with occupation and migrant status, MD was highly prevalent and persistent among migrants living with HIV, despite partial improvement over time, underscoring the need for structural supports. Short-term HIV clinical outcomes appeared unaffected, which may reflect access to rapid, no-cost and onsite ART delivery.
OBJECTIVES:Migrants are disproportionately affected by HIV and face inequities in accessing care. This study examined the HIV care cascade among newly registered adults at the Chronic Viral Illness Service (CVIS). METHODS:We conducted a retrospective cohort study of adults (≥18 years) living with HIV and newly registered at the CVIS, in Montréal, Canada, between January 1st, 2022, and December 31st, 2024. Sociodemographic, clinical and care cascade data were extracted from electronic records. Multivariable logistic regression models, adjusted for age, gender, region of birth and diagnosis type, examined associations between seven migration status categories and cascade outcomes. RESULTS:Among 695 patients, 664 (95%) were born outside Canada and 528 (76%) were refugees/asylum seekers. Of these, 281/695 (40%) had a new HIV diagnosis. Among newly diagnosed refugees/asylum seekers, median time from diagnosis to linkage to care was 28 days (interquartile range [IQR]: 18-42). Median time from linkage to antiretroviral therapy (ART) prescription ranged from 0 (IQR: 0-0) to 18 (IQR: 9-27) days across groups. At 6 months, 618/695 (89%) were retained in care and 603/618 (98%) were on ART. At 12 months, 530/603 (88%) were in care and 511/530 (96%) were virally suppressed. In exploratory adjusted analyses, Canadian citizens had lower odds of retention (aOR 0.32, 95% CI 0.14-0.75) and viral suppression (aOR 0.33, 95% CI 0.15-0.75) at 12 months. CONCLUSIONS:Among newly diagnosed refugees/asylum seekers, linkage to care delays appear to have increased since pre-pandemic estimates. Meaningful heterogeneity across migration groups highlights the limitations of treating migrants as a homogeneous population in HIV care.
OBJECTIVES:Frailty is relevant to HIV care across middle and later life, yet Japanese data remain limited. We evaluated frailty, prefrailty and associated factors in Japanese people with HIV using the revised Japanese Cardiovascular Health Study (J-CHS) criteria. METHODS:We conducted a multicentre cross-sectional study at eight HIV care centres. Eligible participants were Japanese people with HIV aged ≥40 years on antiretroviral therapy for ≥12 months. Frailty was classified as robust, prefrail or frail. Multivariable logistic regression examined factors associated with frailty-related outcomes; sensitivity analyses excluded sex from the model and restricted analyses to men. RESULTS:Among 325 participants, median age was 55 [49-64] years and 311 (95.7%) were male; 70 (21.5%) were robust, 227 (69.8%) prefrail and 28 (8.6%) frail. Common components were low physical activity (36.6%), weight loss (33.2%) and slow gait (27.1%). In the frailty versus non-frailty model, higher PHQ-9 score (adjusted odds ratio [aOR] 1.12 per point, 95% confidence interval [CI] 1.04-1.21) and polypharmacy (aOR 3.34, 95% CI 1.23-9.10) were associated with frailty. In the prefrailty/frailty versus robust model, higher PHQ-9 score and body mass index were associated with the outcome. Sensitivity analyses yielded broadly consistent findings. CONCLUSIONS:Prefrailty was highly prevalent, and frailty was associated with depressive symptoms and polypharmacy. Frailty at a median age of 55 years suggests clinically relevant vulnerability in Japanese people with HIV, although longitudinal and comparative studies are needed. These findings support integrated HIV care combining mental-health screening, medication review and physical-function assessment.
OBJECTIVES:Low-level viraemia (LLV) persists in some people living with HIV despite antiretroviral therapy, raising concerns about virologic failure. We assessed the characteristics, management and outcomes of LLV in Greece, where next-generation sequencing, therapeutic drug monitoring and electronic adherence monitoring are unavailable. METHODS:This retrospective multicentre study included people living with HIV from four Greek clinics who had achieved virological suppression for at least 6 months. LLV was defined as two consecutive HIV-1 RNA measurements between 51 and 200 copies/mL. Patients were followed for 18 months, during which three subsequent viral load measurements were evaluated. Adherence was assessed using patient self-report and documentation in the medical record. RESULTS:Among 3800 patients, 35 (0.9%) experienced LLV. Median age was 49 years, and 69% were male. Patients were treatment-experienced (median 3.5 ART lines; median duration of viral suppression, 7 years), with 57% receiving high genetic-barrier regimens. Baseline genotypic resistance data were available for 30 of 35 patients (85.7%), and clinically relevant resistance-associated mutations were identified in 6 (20.0%). LLV resolved in 27 of 35 patients (77.1%), persisted in 7 (20.0%) and recurred in 1 (2.9%). No patient developed virologic failure. Presumed causes of LLV were unknown in 18 (51.4%), low adherence in 14 (40.0%) and drug-drug interactions in 3 (8.6%). ART was modified in 17 patients, of whom 13 (76.5%) achieved viral resuppression, most commonly after switching from lower- to higher-genetic-barrier regimens. One patient with persistent LLV developed lymphoma during follow-up. CONCLUSIONS:LLV was uncommon but clinically relevant in this multicentre Greek cohort and frequently resolved following targeted management. Adherence optimization and ART modification, particularly to higher genetic-barrier regimens, were associated with viral resuppression in this cohort. Ongoing monitoring remains essential, especially in settings with limited access to advanced diagnostic tools.
BACKGROUND:Earlier diagnosis of blood-borne viruses (BBVs)-HIV, hepatitis B (HBV) and hepatitis C (HCV)-remains a significant public-health focus. Opt-out testing in secondary healthcare settings can improve early diagnosis and linkage to care as part of BBV transmission elimination targets. This scoping review used APEASE criteria (acceptability, practicability, effectiveness, affordability, side-effects and equity) to evaluate opt-out BBV testing interventions in emergency departments (EDs) and medical assessment units (MAUs). METHODS:A systematic search of three databases was conducted for peer-reviewed literature up to 30th June 2025. Inclusion criteria were: (a) opt-out BBV testing intervention; (b) taking place within a secondary care setting; and (c) in the UK, Ireland, Australia and Canada. Data were extracted and analysed using APEASE criteria. RESULTS:Twenty-eight studies met inclusion criteria. Opt-out testing was acceptable to patients and healthcare professionals, particularly when supported by clear communication, staff training and leadership engagement. Practicability varied by setting; barriers included time constraints, unclear responsibilities and logistical challenges. Automation using electronic systems facilitated implementation. Effectiveness was demonstrated through increased testing uptake and case identification, especially in EDs. Minimal evidence exists on affordability and is likely to vary by population prevalence. No significant side effects (unintended outcomes) were reported, and universal testing was associated with reduced stigma. Opt-out testing can improve access to testing for underserved populations, supporting its role in promoting health equity. CONCLUSION:Opt-out BBV testing in secondary care settings (EDs and MAUs) is a feasible, effective and equitable intervention when supported by appropriate infrastructure and resources. Efforts should focus on optimizing implementation strategies and extending opt-out testing, including to lower-prevalence settings.
OBJECTIVES:Migrants account for a substantial proportion of people living with HIV in Europe, yet inequalities across the HIV care continuum remain insufficiently characterized. We examined migration-related differences in HIV diagnosis, treatment initiation and retention in care in Greece. METHODS:We analyzed data from the Athens Multicenter AIDS Cohort Study (AMACS), including individuals diagnosed with HIV between 1996 and 2024. Participants were classified by region of origin. Markers of HIV diagnosis (CD4 cell count, late presentation, advanced disease and time from seroconversion to diagnosis) and post-diagnosis outcomes (time to antiretroviral therapy [ART] initiation and loss to follow-up [LTFU]) were evaluated using appropriate regression and flexible parametric survival models. RESULTS:Among 11 467 individuals, 19.3% were migrants. Migrants presented with more advanced disease, including higher rates of late presentation (71.0% among those from Africa vs. 48.9% among Greek-born) and longer diagnostic delays (median 4.8 vs. 3.1 years, respectively). Over time, differences in late presentation narrowed, although advanced disease and diagnostic delay remained higher among some groups. Time to ART initiation decreased substantially with attenuated differences between groups after adjustment for CD4 levels at diagnosis. In contrast, recorded LTFU in AMACS increased over time and remained higher among migrants, reaching 49% within 3 years among individuals from Africa compared with 12% among Greek-born. CONCLUSIONS:Inequalities in HIV care outcomes across region-of-origin groups in Greece persist but have shifted along the care continuum. While timely ART initiation has largely equalized, disparities remain in delayed diagnosis and recorded follow-up. Targeted strategies to mitigate observed inequalities are essential.
INTRODUCTION:Pre-Exposure Prophylaxis (PrEP) is a cornerstone of HIV prevention, yet its population-level impact is limited by clinical attrition. This study analyses the sociodemographic and behavioural factors associated with follow-up abandonment in a tertiary hospital cohort in Madrid. METHODS:A retrospective cohort study (August 2022-July 2025) was conducted involving 665 participants who initiated oral FTC/TDF PrEP (of 693 individuals assessed) at Hospital Universitario Ramón y Cajal. Abandonment was defined as a >90-day lapse in contact beyond the scheduled visit or medication exhaustion. Independent predictors of discontinuation were identified using Cox proportional hazards regression. RESULTS:Follow-up abandonment occurred in 21.2% (n = 141) (median age: 36.5 years). Three HIV infections were recorded (3/693; 0.43%), with only one occurring during active use. Multivariate analysis identified younger age as the primary predictor of abandonment, with a 5% risk reduction for every additional year of age (HR 0.95; 95% CI 0.92-0.98; p < 0.001). Prior healthcare engagement, evidenced by HBV immunity (anti-HBs+), was significantly protective against attrition (HR 0.52; 95% CI 0.34-0.80; p = 0.003). Transgender women showed a trend towards higher abandonment (HR 3.11, p = 0.060). Notably, contracting a sexually transmitted infection (STI) during follow-up correlated with higher retention, likely due to increased clinical touchpoints and heightened risk perception. CONCLUSIONS:Younger individuals face the highest risk of PrEP discontinuation despite being the demographic most vulnerable to HIV acquisition. Retention is driven more by structural healthcare integration and age than by individual risk behaviours. To improve persistence, healthcare systems must transition towards flexible, digital and decentralized care models tailored to younger, system-naïve users.
INTRODUCTION:As people living with HIV age, the absolute colorectal cancer (CRC) burden rises, yet the extent of routine CRC screening delivery and clinical yield is unclear. We synthesized evidence on screening uptake and lesion detection in people living with HIV, including comparisons with HIV-negative controls. METHODS:We searched PubMed, EMBASE and Cochrane CENTRAL through 8 November 2025. We included antiretroviral therapy-era studies of adults with HIV (mean/median age ≥50 years) reporting CRC screening uptake in routine care or pathology-confirmed lesions at screening lower endoscopy (colonoscopy/sigmoidoscopy). Random-effects restricted maximum likelihood (REML) meta-analyses pooled single-arm proportions and comparative risk ratios; sensitivity, influence and cumulative analyses were prespecified. RESULTS:Twenty-two studies were included. For screening uptake, 15 studies (people living with HIV n = 29 469) contributed single-arm estimates and 6 studies (people living with HIV n = 26 001; controls n = 858 658) contributed comparative data. Pooled uptake of screening among people living with HIV was 43% (95% confidence interval [CI] 36%-50%). Pooled detection of adenoma, villous/tubulovillous adenoma and CRC by screening lower endoscopy in people living with HIV was 27%, 3.8% and 1.4%, respectively. Screening uptake and lesion detection rates showed no significant difference from controls, though study numbers were limited and heterogeneous. CONCLUSION:In people living with HIV, CRC prevention is constrained by low and variable screening uptake. Screening lower endoscopy identifies clinically significant lesions, highlighting the need to improve CRC screening delivery in this population.
INTRODUCTION:Peer interventions may improve retention across the prevention of mother-to-child transmission (PMTCT) cascade in low- and middle-income countries (LMICs), where poor adherence to antiretroviral therapy (ART) remains a major barrier. This systematic review and meta-analysis evaluated the impact of peer support interventions on PMTCT outcomes to inform scalable strategies. METHODS:Following PRISMA guidelines, we searched PubMed, Cochrane Library, Scopus and Google Scholar (2008-2025) using terms including 'peer mentors,' 'PMTCT' and 'LMICs.' Independent reviewers conducted data extraction and quality appraisal using Cochrane risk-of-bias tools. Random-effects meta-analysis was performed in R (v4.4.3), with significance set at p < 0.05. Qualitative findings were thematically synthesized. RESULTS:Twenty-seven studies (n = 26 431) across 10 countries were included. Peer interventions improved ART adherence at one year (OR: 1.19, 95% CI: 1.05-1.35) and two years (OR: 2.04, 95% CI: 1.58-2.64), PMTCT retention at six weeks postpartum (OR: 2.63, 95% CI: 1.56-4.43), infant uptake of HIV prophylaxis (OR: 2.95, 95% CI: 1.90-4.59), early infant diagnosis (OR: 1.64, 95% CI: 1.01-2.67) and viral load testing (OR: 1.21, 95% CI: 1.07-1.38). No significant effects were observed for ART initiation, PMTCT retention at 12 months or HIV status disclosure. Most studies (75%) reported improved exclusive breastfeeding. Barriers included stigma, inadequate mentor training, logistical and economic constraints and poor male involvement; facilitators included training, incentives and community trust. CONCLUSION:Peer interventions improve adherence, infant prophylaxis and retention but have limited effects on viral suppression and disclosure. Addressing stigma, strengthening health systems and enhancing male engagement may optimize impact.
INTRODUCTION:It remains unclear which cardiovascular disease (CVD) risk scores are optimized for people living with treated HIV with high rates of viral suppression. We evaluated the performance of commonly used CVD risk scores in a population of primarily well-treated HIV patients in England. METHODS:A multi-centre retrospective cohort analysis was performed, including people living with HIV (PLWH) above the age of 40 with no prior major adverse CVD events (MACE), regularly attending 7 HIV clinics in England during 2014. Outcomes were MACE over the following 5 years: myocardial infarction, invasive cardiac procedure e.g. primary angioplasty, cerebrovascular events, new heart failure, and CVD-related death. Clinical outcomes were aligned with the respective risk scores. The following CVD risk models were evaluated: the UK primary-care validated QRISK3, Framingham laboratory and non-laboratory (Office) scores, Data collection on Adverse events of anti-HIV Drugs (D:A:D), Pooled Cohort Equation (PCE), and the World Health Organization (WHO) laboratory and non-laboratory models. Models were scaled for 5-year CVD estimates. We assessed the discrimination and calibration of these 5-year models within our population. Multiple imputation was used to address missing data. RESULTS:Of 2582 people, 94 had at least one MACE documented during follow-up. All seven scores demonstrated moderate discrimination. QRISK3 demonstrated the best calibration in this cohort with an O:E ratio of 1.169, 95% CI 0.950, 1.439, mean calibration-in-the-large (CITL) value of 0.156 (95% CI -0.052, 0.364) and slope of 0.897 (0.682, 1.113). Framingham Office generally overpredicted risk, while WHO scores and D:A:D generally underpredicted risk. Imputing for missing data yielded results similar to the complete case analysis. CONCLUSIONS:CVD risk scores demonstrated moderate performance in a well-treated PLWH cohort. Our findings emphasize the need to calibrate each CVD risk score to the local population to guide prioritization of clinical resources for CVD prevention. EVIDENCE IN CONTEXT:Evidence before this study: We systematically searched Medline, Embase, and Cochrane Library database from January 1995 to August 2023, using the following terms 'HIV/AIDS and Cardiovascular Disease (CVD) outcomes', with an updated search to 2025. The risk of CVD has been reported to be up to two times that of people living without HIV, along with increased rates of heart failure and sudden death. Commonly used CVD risk scores have demonstrated variable performance for PLWH, and only the D:A:D study equation has been specifically validated in an HIV-positive population. Within an era of modern ART regimes and high rates of viral suppression, there have been numerous comparisons of CVD risk across scoring systems, but few studies with observed outcomes of CVD rates to validate the predictions. It remains unclear which CVD risk calculator is the most suitable for PLWH. The use of routinely collected clinical data may also impact the accuracy of results due to the presence of incomplete or missing data fields. In this study, we aimed to evaluate the performance of commonly used CVD risk scores in a population of primarily well-treated HIV patients in England using routinely collected clinical data. Added value of this study: We demonstrate that of the seven CVD risk scores evaluated (QRISK3, Framingham laboratory and non-laboratory (Office) scores, D:A:D, Pooled Cohort Equation (PCE), and the WHO laboratory and non-laboratory models), all showed moderate discrimination compared to observed major adverse cardiovascular events (MACE) rates in an English multicentre cohort of people living with HIV attending clinics. QRISK3, using a large UK primary care database to validate predicted CVD risk, appeared to be most closely calibrated to CVD outcomes in our cohort without the need for additional calibration. Our findings also suggest that the use of non-laboratory scores, which have been suggested for low and middle-income settings where laboratory results may not be available, should be interpreted with caution, and further testing may be required due to their miscalibration in this cohort. Implications of all the available evidence: Using real-world clinical data from people with HIV who are engaged in care in England, these findings emphasize the need to calibrate each CVD risk score to the local population it is used for in order to accurately guide prioritization of clinical resources for primary CVD prevention.
INTRODUCTION:Hypertension is a major cardiovascular risk factor and has increased among people living with HIV. However, evidence on its association with HIV status remains inconsistent. This systematic review aimed to assess the association between HIV status and hypertension and to examine, through subgroup analyses, whether this association varies according to specific participant characteristics. METHODS:Searches were conducted in PubMed, Embase, Web of Science and Global Index Medicus, with an additional manual search of reference lists. Eligible observational studies included participants aged ≥18 years, with no geographical restrictions and defined hypertension using medical diagnosis, self-reported hypertension, antihypertensive medication use or electronic health records. Studies involving individuals <18 years, pregnant women, non-systemic hypertension and other study designs were excluded. RESULTS:Twenty-six studies were included in the systematic review, and 23 cross-sectional studies were incorporated into the meta-analysis. In a synthesis of unadjusted associations, no association was observed between HIV status and hypertension (RR: 0.94; 95% CI: 0.79-1.12). Subgroup analyses by sex, overweight and obesity also showed no association. Among PLHIV with diabetes, a lower association with hypertension was observed compared with people without HIV with diabetes, although this finding should be interpreted with caution (RR: 0.32; 95% CI: 0.12-0.88). Substantial heterogeneity was observed (I2 = 99.5%). Five studies were of low methodological quality and 18 of moderate to high quality. The funnel plot showed no asymmetry, confirmed by Egger's test. CONCLUSION:Although no association between HIV status and hypertension was observed, substantial heterogeneity and variable methodological quality limit definitive conclusions. High-quality studies are needed to clarify whether HIV status modifies hypertension risk.
OBJECTIVES:Dolutegravir (DTG) has been associated with weight gain in women with HIV, Black people with HIV and people with HIV60 years. This study aimed to characterise DTG population pharmacokinetics (PopPK) in a diverse population including these sub-populations. METHODS:We conducted an intensive PK study nested within the Multicenter AIDS Cohort Study (MACS)/Women's Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS) and retrospectively quantified DTG plasma concentrations in historical specimens from participants in the WIHS and the MACS over several study visits. PopPK models were developed using NONMEM; covariate searches included relevant demographics and co-medications. RESULTS:The analysis included 44 people with HIV from the MWCCS (56.8% women, 72.7% Black, 40.9% 60 years), 193 WIHS women (52.8% Black, 25.4% 60 years) and 137 MACS men (19.7% Black, 53.3% 60 years). A one-compartment model with first-order absorption and elimination and an absorption lag time (ALAG) best described DTG PK. Apparent clearance (CL/F) was 1.21, 1.26 and 0.95 L/h; apparent volume of distribution (V/F) was 21.2, 38.9 and 19.8 L, in the MWCCS, WIHS and MACS, respectively. For all three models, ALAG was 0.35 h. Sex, race and age were not statistically significant covariates. In the WIHS, lower total bilirubin and current cigarette smoking were significantly associated with higher CL/F, and higher body weight was significantly associated with higher V/F. CONCLUSIONS:Our analysis did not support different DTG PK in women with HIV, Black people with HIV and people with HIV aged 60 years compared to other sub-populations; causal analysis between DTG concentrations and weight gain over time are ongoing.
OBJECTIVES:Stigma is multidimensional and undermines HIV care. We examined socio-environmental pathways linking HIV-related stigma, everyday discrimination and structural stigma to antiretroviral therapy (ART) adherence among men who have sex with men (MSM) and female sex workers (FSW) living with HIV in Kampala, Uganda. METHODS:We conducted a cross-sectional survey (06/2024-02/2025) among MSM and FSW aged 18-35 receiving HIV services from a key population clinic in Kampala. ART adherence was assessed using the Wilson 3-item adherence scale. We conducted stratified multivariable linear regression and multi-group structural equation modelling (SEM) to estimate direct and indirect associations from stigma to adherence through socio-environmental stressors (traumatic exposure severity to extreme weather [TESS], food insecurity, water insecurity), adjusted for socio-demographic variables. RESULTS:Participants included MSM (n = 225, mean age: 27.65, standard deviation [SD] = 3.54) and FSW (n = 240, mean age: 25.68, SD: 2.90). SEM showed acceptable fit. In adjusted SEM analyses (a) among MSM, higher TESS, HIV-related stigma and everyday discrimination were directly associated with lower ART adherence and (b) among FSW, higher TESS, HIV-related stigma, water and food insecurity were directly associated with lower ART adherence. There were significant indirect associations between HIV-related stigma and ART adherence via TESS for FSW and MSM, and between everyday discrimination and structural stigma with ART adherence via TESS for MSM. CONCLUSIONS:Stigma and socio-environmental stressors, including traumatic exposure to extreme weather events, were associated with reduced ART adherence among MSM and FSW participants. Population-tailored HIV care interventions may benefit from integrating intersectional stigma reduction with economic and disaster preparedness supports.
BACKGROUND:Children living with HIV in low-income countries contribute disproportionately to death after hospital discharge. This study investigates the effect of HIV on post-discharge mortality and readmission by exploring a wide range of clinical, maternal and socioeconomic variables. METHODS:A secondary analysis of children under 5 years old admitted with suspected sepsis. Participants were enrolled from two multisite observational studies conducted from 2012 to 2013 and 2017 to 2020 across six hospitals in Uganda. Participants were excluded if admitted outside the catchment area, for trauma, short-term observation or if admitted immediately after birth without prior discharge. We used a robust Poisson regression to identify risk factors of post-discharge mortality for three separate HIV groups: children living with HIV (CLHIV), children HIV-exposed uninfected (CHEU) and children HIV-unexposed uninfected (CHUU). We implemented Kaplan Meier curves to compare rates of post-discharge mortality and readmission between the three groups. In addition, we compared the risk ratio of the two outcomes. RESULTS:Of the 7658 children who were discharged alive and completed the 6-month follow-up, 266 (3.5%) were CLHIV, 458 (6.0%) were CHEU and 6934 (90.6%) were CHUU. Post-discharge mortality was statistically significantly higher in CLHIV compared to the CHUU, with rates of 12.8% (34/266) and 5.8% (402/6934), respectively. Contrastingly, readmission was higher in CHUU (17.7% (1227/6934)) compared to CLHIV (11.3% (30/266)). Severe malnutrition, indicated by a weight-for-age z-score of less than -3, was associated with post-discharge mortality among all three groups with aRRs of 4.32 (95% CI: 1.89-9.81), 3.96 (95% CI: 1.75-8.95) and 4.84 (95% CI: 3.94-5.96) for CLHIV, CHEU and CHUU, respectively, compounded by the fact that severe malnutrition is disproportionately higher in those living with HIV. Variables associated with post-discharge mortality in this group were prior antimalarial use (aRR = 2.27 [95% CI: 1.16-4.47]) and moderate anaemia (aRR = 2.33 [95% CI: 1.12-4.89]). CONCLUSIONS:Children living with HIV represent an exceptionally vulnerable group following hospital discharge. Very low readmission rates alongside high mortality suggest that strategies to improve care transitions and follow-up in these children are essential to improving recovery and survival.
OBJECTIVES:Long-acting (LA) intramuscular injections of cabotegravir (CAB) and rilpivirine (RPV) are an effective maintenance therapy for people living with HIV who are virologically suppressed. However, virological failures (VFs) have been reported, often associated with elevated body mass index (BMI), potentially due to inadequate intramuscular drug delivery. Current recommendations mainly rely on BMI to guide needle length selection and do not routinely incorporate imaging techniques. Furthermore, they do not recommend the use of ultrasound as an investigative tool in cases of LA treatment failure. METHODS:We retrospectively reviewed anonymized records of two patients experiencing virological rebound under LA CAB/RPV. Clinical, virological and resistance data were extracted from their medical records. RESULTS:The first case involves an obese patient. Ultrasound revealed subcutaneous adipose tissue thickness >3 cm and intra-adipose injection granulomas, suggesting non-intramuscular injections. After adapting needle length, virological suppression was restored. The second case involves a patient with a normal BMI in whom ultrasound revealed a gluteal subcutaneous adipose tissue thickness of 45 mm and bilateral subcutaneous granulomas. CONCLUSION:Ultrasound is a simple and accessible tool to help optimize drug injection in case of obesity or gynoid fat distribution and investigate injection technique-related issues in cases of VF.
Objectives Cardiovascular disease (CVD) is a major comorbidity and leading cause of morbidity and mortality in people with HIV (PWH). The REPRIEVE trial demonstrated that statin therapy significantly reduces cardiovascular events in PWH, prompting updated recommendations from major international societies. We assessed awareness and early implementation of the European AIDS Clinical Society (EACS) statin guidance among HIV clinicians in Europe.Materials and Methods We conducted an anonymous cross-sectional online survey among members of the EACS Young Investigators Network Group (YING). The questionnaire evaluated clinician characteristics, reported awareness and implementation of statin guidance, cardiovascular risk assessment practices, prescribing patterns and perceived barriers. Descriptive analyses were performed.Results Of 125 individuals invited to take part in the survey, 22 (18%) physicians from multiple European countries responded. All respondents were aware of the EACS statin guidance, and 91% reported that it influenced clinical practice. Cardiovascular risk was routinely assessed by most clinicians (77% always or often), with HIV physicians primarily responsible for statin prescribing (59%). Structural barriers reported included reimbursement limitations, fragmented care pathways and patient-level barriers, such as low perceived CVD risk and statin hesitancy.Conclusions Awareness of EACS statin guidance among this cohort of HIV clinicians in Europe who are YING members is reported as high, but implementation gaps remain. Addressing structural and patient-level barriers and improving guideline implementation will be essential to optimize CVD prevention in PWH.
