BACKGROUND:Data on arterial stiffness among adolescents with HIV remain limited, particularly in sub-Saharan Africa, where the HIV burden is high. OBJECTIVE:We aimed to assess arterial stiffness among adolescents with HIV, compare these measures with already published measures, and investigate factors associated with arterial stiffness. METHODS:A cross-sectional study among adolescents with HIV aged 10-17 years was conducted. Carotid-femoral pulse wave velocity (cfPWV) was measured to assess arterial stiffness using the SphygmoCor System (AtCor Medical), defined as a cfPWV ≥ the 90th percentile. Least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable linear regression, was performed to determine associated factors. RESULTS:Among 416 adolescents with HIV in Tanzania (mean age 14 years; 53% male), 9.6% (95% CI: 7.0-13.0) had a cfPWV ≥ the 90th percentile. The mean cfPWV in this cohort (4.77 ± 0.65 m/s) was lower than the estimates reported in several cohorts of adolescents with HIV in high-income countries and comparable to that reported in some cohorts in sub-Saharan Africa. Considering age, body mass index, and blood pressure as a priori confounders in multivariable analyses, higher cfPWV was independently associated with shorter sleep duration (β -0.04 per hour; 95%CI: -0.08, 0.0; P = 0.046), prolonged sleep latency ≥ 15 min (β 0.18; 95%CI: 0.05, 0.31; P = 0.006) and current use of a protease inhibitor antiretroviral regimen (β 0.3; 95%CI: 0.00, 0.61; P = 0.049). CONCLUSION:Early screening for arterial stiffness among adolescents with poor sleep behaviours, prior exposure to protease inhibitor-based regimens, and traditional CVD risk factors such as high BMI and blood pressure may provide an opportunity for early intervention through targeted lifestyle changes.
BACKGROUND:As progress toward the UNAIDS 95-95-95 goals has transformed HIV into a chronic, manageable condition, cardiometabolic disease has emerged as a critical determinant of long-term health among people living with HIV. Despite effective antiretroviral therapy, people with HIV remain at elevated risk for hypertension, diabetes, and cardiovascular disease, while HIV care models often prioritize viral suppression over integrated cardiovascular prevention. OBJECTIVE:This study aimed to explore the social and structural determinants that shape cardiovascular preventive health behaviors among people with HIV in the Southern United States to inform the development of interventions that promote sustained health outcomes. METHODS:We conducted a qualitative descriptive study with twenty people with HIV aged ≥ 35 years, each living with at least one cardiometabolic condition, recruited from three HIV clinics in the Southern United States. Photo-elicitation integrated with semi-structured interviews allowed participants to document and interpret their experiences related to diet, physical activity, lifestyle behaviors, and health monitoring. RESULTS:Thematic analysis mapped findings to five determinant domains: economic stability, neighborhood and environment, social and community context, education, and healthcare access and quality. Participants (median age 57; predominantly African American/Black; most living with HIV for more than 10 years) identified three intersecting, modifiable barriers: the high cost of healthy food, unsafe or poorly designed environments limiting physical activity, and family or peer norms reinforcing unhealthy behaviors. CONCLUSIONS:These findings highlight the need to embed food insecurity screening, context-tailored activity counseling, family engagement strategies, and structural supports within HIV care to advance equitable cardiovascular prevention for people with HIV.
BACKGROUND:Although analytical treatment interruptions (ATIs) protocols are essential for evaluating the efficacy of HIV cure-related interventions, little is known about how their health-related quality of life (HRQOL) changes when undergoing these trial requirements. OBJECTIVE:This study evaluated how HRQOL evolved over time among people with HIV (PWH) participating in HIV cure-related studies requiring ATIs and examined the role of baseline depressive symptoms, anxiety, and resilience in shaping these trajectories. METHODS:Seventeen PWH were included. Our analysis included data from two HIV cure-related studies involving ATIs: the UCSF SCOPE-ATI Study and the UCSF-amfAR Combination Trial. HRQOL was measured at baseline, pre-ATI, medication restart, and study completion. Baseline depressive symptoms, trait-based anxiety, and resilience were assessed using validated scales. Frequentist and Bayesian Linear mixed-effects models evaluated changes in HRQOL, the influence of baseline psychosocial factors, and potential moderating effects. RESULTS:In frequentist models, HRQOL significantly improved over time (β = 0.63, p = .016). Baseline depressive symptoms (β = -1.00, p = .048) and anxiety (β = -1.18, p = .001) were negatively associated with HRQOL, indicating that higher levels of these factors were linked to lower HRQOL. Resilience moderated improvements in HRQOL over time (time*resilience β = 0.36, p = .040), with higher baseline resilience associated with steeper increases in HRQOL. CONCLUSIONS:HRQOL improved over time in this sample despite ATI participation requirements. Findings underscore the need to address psychosocial factors, particularly depressive symptoms and anxiety, in HIV cure-related studies to optimize participant well-being and enhance the overall study experience.
BACKGROUND:Hospital discharge represents a high-risk transition period for people living with HIV, particularly those with advanced HIV disease. In low-resource settings, substantial gaps persist in linking these individuals to outpatient HIV care following hospitalisation. This study explored barriers and facilitators to post-discharge linkage to care from the perspectives of patients and healthcare workers (HCWs) in Eastern Uganda. METHODS:We conducted a descriptive qualitative study at Mbale Regional Referral Hospital between May and October 2025. Guided by the capability, opportunity, motivation, and behaviour (COM-B) model, we conducted 20 in-depth interviews with adults with advanced HIV disease who had recently been discharged from the medical ward (10 who successfully linked to care and 10 who did not), alongside 10 key informant interviews with HCWs involved in their care. Data were analysed using a thematic framework approach aligned with the COM-B constructs. RESULTS:Patient-reported barriers included physical weakness (physical capability), limited knowledge of the linkage process (psychological capability), high transport costs and long travel distances (physical opportunity), and stigma or non-disclosure of HIV status (social opportunity). HCWs identified the absence of standardised linkage protocols, post-discharge follow-up mechanisms, and incentive structures as key systemic barriers (physical opportunity). Facilitators reported by patients included initiation or resumption of antiretroviral therapy (ART) before discharge (physical opportunity), support from peer supporters and disclosure to caregivers (social opportunity), and fear of clinical deterioration (reflective motivation). HCWs identified the existing TB-HIV linkage system (reflective motivation) and the presence of ward-based linkage counsellors (physical opportunity) as enabling factors. CONCLUSION:People living with advanced HIV disease face multiple, interrelated barriers to linkage with HIV care following hospital discharge, including physical debility, limited knowledge of the linkage process, financial and geographic constraints, and stigma. Conversely, pre-discharge ART initiation, peer support, and disclosure facilitate successful linkage. Strengthening post-discharge care will require standardised linkage protocols, structured follow-up mechanisms, and expanded use of peer supporters within health systems.
BACKGROUND:The combination of doravirine and islatravir (DOR/ISL) is a novel two-drug regimen for HIV-1. Early development faced challenges due to dose-dependent immunological signals. We aimed to synthesize the evidence on the efficacy and safety of DOR/ISL across all treatment-experience categories, specifically evaluating the impact of islatravir dosage (0.25 mg vs 0.75 mg) on clinical and immunological outcomes. METHODS:We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following PRISMA guidelines. We searched PubMed, Embase, Cochrane Library, and Google Scholar from inception through April 2026. Primary outcomes were virological suppression (<50 copies/mL) and mean change in CD4+ T-cell count at week 48. Data were pooled using random-effects models. Islatravir dose was evaluated as a pre-specified moderator. Quality was assessed using Cochrane RoB 2.0 and certainty of evidence was graded using the GRADE approach. RESULTS:Seven RCTs (n = 3,600 participants) were included. At Week 48, DOR/ISL showed non-inferior suppression rates (RR 1.01 [95% CI 0.99-1.02]; p = 0.516; moderate-certainty evidence) and a statistically significant reduction in virological failure risk (RR 0.55 [0.33-0.92]; p = 0.022) compared to active control. Overall CD4+ gain was lower with DOR/ISL (MD -34.55 cells/μL; low-certainty evidence); however, a profound moderator effect of dose was observed (p < 0.0001). The 0.75 mg dose was associated with significant CD4+ and lymphocyte declines, whereas the approved 0.25 mg dose was immunologically neutral. DOR/ISL was weight-neutral compared to bictegravir/emtricitabine/tenofovir alafenamide (MD -0.25 kg [-0.66 to 0.16]; low-certainty evidence). CONCLUSION:DOR/ISL 100/0.25 mg once daily achieved virological suppression comparable to standard-of-care ART regimens and was associated with lower rates of virological failure compared with active comparators. The immunological safety concerns observed in early trials were successfully resolved by dose optimization. These findings support the use of DOR/ISL (IDVYNSO) as a potential treatment option for both treatment-naïve and virologically suppressed adults while emphasizing long-term safety surveillance.
BACKGROUND:Italy has recently expanded access to oral pre-exposure prophylaxis (PrEP) and made rapid progress in long-acting PrEP (LA-PrEP) availability. These developments create a unique opportunity to assess population-level readiness for LA-PrEP and identify gaps that may limit its public health impact. AIM:To assess an extended PrEP cascade, quantify unmet prevention needs that LA-PrEP could mitigate, and identify determinants of LA-PrEP intention across key populations (KPs) in Italy. METHODS:We analysed data from the PROTECT cross-sectional survey (October 2023-April 2024), including participants without HIV in Italy (n = 2215): 1707 MSM, 32 trans* individuals, 267 cis-men, and 209 cis-women. We described PrEP cascades (oral PrEP awareness, uptake, adherence, discontinuation; LA-PrEP awareness, interest, intention), unmet prevention needs potentially addressable by LA-PrEP ( defined as no current oral PrEP use or suboptimal oral PrEP adherence combined with LA-PrEP intention), and regional differences. Open-ended responses on LA-PrEP perceptions were analysed. Determinants of LA-PrEP intention and unmet PrEP needs were explored using multivariable logistic regression. RESULTS:Overall, 19.0% (95%CI = 17.3-20.6) reported current oral PrEP use, of whom 19.8% (95%CI = 15.8-24.3) reported suboptimal adherence and 10.0% (95%CI = 8.3-13.9) had discontinued. Nearly half (47.0%, 95%CI = 44.9-49.8) expressed LA-PrEP intention. Unmet prevention needs potentially addressable by LA-PrEP were identified in 34.8% (95%CI = 32.8%-36.8%). MSM showed the highest PrEP engagement, whereas cisgender men had the lowest; unmet needs were greater in less-urbanised areas. Qualitative data reflected a positive outlook, framing LA-PrEP as safe, convenient, and empowering sexual freedom. Among MSM, unmet prevention needs potentially addressable by LA-PrEP were substantial among PrEP-naïve and discontinued users, although intention to use LA-PrEP was comparatively lower in these groups, indicating a mismatch between prevention need and acceptability. CONCLUSIONS:Despite low awareness, LA-PrEP intention is high in Italy, indicating strong readiness for rollout. However, a mismatch between prevention need and intention, particularly among PrEP-naïve individuals, may limit population-level impact. Yet, these findings should be interpreted considering the potential for selection bias associated with online convenience sampling and recruitment through social media and dating applications. Targeted, equity-oriented implementation strategies are required to ensure that LA-PrEP reaches populations experiencing substantial unmet HIV prevention needs.
BACKGROUND:In Romania, people living with HIV represent heterogeneous cohorts shaped by distinct epidemiological and social contexts. While antiretroviral therapy (ART) has markedly improved survival, quality-of-life (QoL) encompasses broader dimensions not fully captured by clinical indicators. Patient-reported outcome measures (PROMs) offer a valuable approach to understanding these dimensions in routine care. METHODS:We conducted a multicenter, cross-sectional study using the OCTAVE PROM to assess patient-reported health-related QoL among people with HIV in Romania. The self-completed questionnaire evaluates eight domains: ART, physical health, mental health, sleep quality, sexuality, emotional wellbeing, non-HIV-related health, social and professional life. Adults attending routine follow-up visits in HIV centers across Romania were consecutively enrolled between August 2024 and July 2025. RESULTS:In total, 1042 people with HIV completed the questionnaire (median age 36 years; 66.9% male). Over 95% of respondents reported being happy or very happy with treatment ease, adherence, tolerability, and information about ART. Lower levels of wellbeing were observed in the domains of sexuality (63.1%), sleep quality (74.8%), and social and professional life (77.0%). Sexuality was the most vulnerable domain and the only one showing consistent age-related differences, with progressively lower wellbeing reported in older age groups (all p < 0.001). Higher education was linked to better self-perceived physical functioning, emotional wellbeing, social integration, and financial security. CONCLUSIONS:This large, multicenter PROM-based study demonstrates that while treatment-related QoL among people with HIV in Romania is high, challenges persist in sexuality, sleep, and social wellbeing. Educational level emerged as key determinant of patient-reported outcomes. Integrating PROMs into routine HIV care can enhance patient-centered approaches by identifying unmet needs beyond virological control and informing targeted, individualized interventions.
Background Current research suggests that post-treatment HIV control may be possible for some people following antiretroviral treatment (ART) interruption. Although closely monitored analytic treatment interruption (ATI) studies can be performed safely and are crucial to determine who may no longer require ART, currently it is unknown how acceptable these studies will be in Botswana. Aim To determine the knowledge, attitudes and acceptability of ATI-inclusive studies in Botswana. Methods We employed a non-randomized purposive design to recruit study participants. We conducted face-to-face open-ended interviews with 12 young people living with HIV and 8 caregivers, 8 healthcare providers and 4 community advocates in Gaborone and Palapye. Results Thirty-two (32) participants consented to be interviewed. The median age of young people living with HIV was 29 years. All young people living with HIV indicated that they were on ART and acknowledged the benefits of being on ART. All young people living with HIV were unaware of ATIs, whereas 6 out of 8 caregivers, 6 out of 8 healthcare providers and 2 out of 4 community advocates had never heard of ATIs. Most participants found ATI research to be acceptable and believed that it would be beneficial provided there were adequate risk mitigations in place. Conclusions ATI studies were acceptable to both young people living with HIV and their caregivers. There was limited knowledge about ATI, highlighting a need to inform communities and health care providers on the scientific aspects of ATI and HIV cure research.
INTRODUCTION:In patients with severe surgical and gastrointestinal complications, standard oral combination antiretroviral therapy (ARV) may be temporarily impossible. Long-acting cabotegravir/rilpivirine (CAB/RPV LA) is approved for virologically suppressed individuals pretreated with oral therapy, but data on its use in treatment-naïve, critically ill patients with absent enteral absorption are extremely limited. CLINICAL PRESENTATION:We report a 26-year-old male admitted with fulminant hypertriglyceridaemic necrotizing pancreatitis complicated by abdominal compartment syndrome, multiple laparotomies, open abdomen with enteric fistulae, short bowel syndrome type I, chronic intestinal failure requiring parenteral nutrition, portal vein thrombosis, and prolonged intensive care. HIV-1 infection was diagnosed early (HIV RNA 5,000 copies/mL; CD4+ 780 cells/µL). Within three months, HIV RNA rose to 320,000 copies/mL and CD4+ declined to 570 cells/µL. Given absent gastrointestinal passage, standard ARV was initially deferred, but rapid virological rebound necessitated urgent treatment. An off-label fully parenteral regimen was initiated: intravenous zidovudine (AZT) with intramuscular CAB/RPV LA. Therapy was well tolerated alongside surgery, parenteral nutrition, antimicrobials, and anticoagulation. HIV RNA decreased to <20 copies/mL within 65 days and remained suppressed, with CD4+ recovery. Intravenous AZT was discontinued after 35 days, and CAB/RPV LA continued as maintenance during recovery and home parenteral nutrition. DISCUSSION:Fully parenteral ARV, including CAB/RPV LA, may provide a safe and effective bridge to durable viral suppression in patients with absolute contraindications to oral therapy, warranting further evaluation.
BACKGROUND:With zero HIV transmission by 2030 firmly on the agenda of the UK Government, the UK Health Security Agency (UKHSA), the National Health Service (NHS), and the voluntary sector in the United Kingdom (UK), therefore, the objective of this review is to explore whether this ambitious goal is possible. METHODS:EBSCO, PubMed, and CHINAL databases were searched using relevant keywords around stigma/stigmatisation in the NHS/UK health care settings. In addition, hand-searching and reference mining were conducted. Data were extracted, synthesised, and presented through a narrative analysis. RESULTS:Initial searching yielded 68 papers, and six papers were eligible for this review. Thematic methods were used to analyse and synthesise the included studies. The results indicated that people living with HIV continue to express concerns about stigma and discrimination when accessing health care. These issues remain significant barriers to accessing health care services. CONCLUSION:HIV-related stigma continues to undermine zero HIV transmission ambitions. Until this issue is effectively addressed, achieving the goal of zero HIV transmission by 2030 may remain challenging.
BACKGROUND:Long-acting injectable PrEP (LA-PrEP) is a novel HIV prevention modality recently approved in Europe, offering an important addition to HIV prevention options. Understanding user perceptions early is critical for anticipating uptake, addressing barriers, and shaping implementation. This study aimed to identify the latent qualitative themes surrounding LA-PrEP among Dutch-speaking men-who-have-sex-with-men (MSM) in the Netherlands and Belgium, and to assess how these perceptions associate with their intention to use LA-PrEP. METHODS:We utilised data from the cross-sectional PROTECT survey (October 2023-April 2024). Before questioning, participants were provided a standardised, objective explanation of LA-PrEP's efficacy, dosing schedule, and potential side effects to ensure a baseline understanding. MSM without HIV who completed the Dutch-language survey answered a single open-ended question: 'What does LA-PrEP mean to you?' Participants could provide multiple short terms or phrases. Responses were analysed directly in Dutch using Structural Topic Modelling (STM), an unsupervised machine learning approach, to estimate latent topics and their regression with LA-PrEP use intention. RESULTS:We analysed qualitative responses from 1,472 Dutch-speaking MSM without HIV. Overall expectations were highly positive. Six distinct conceptual topics were identified: empowerment (29% of the topic proportion), superiority (24%), concerns and uncertainties (13%), convenience and reliability (12%), peace of mind (12%), and ideal regimen (11%). While dominant themes emphasised freedom, safety, and reassurance, a notable subset expressed ambivalence. Topic regression revealed that responses strongly aligned with the concerns and uncertainties topic were significantly associated with a lower intention to use LA-PrEP (β = -0.021; 95%CI: -0.042 to -0.001). CONCLUSIONS:LA-PrEP is widely perceived as a promising and convenient HIV prevention option among Dutch-speaking MSM, but concerns about safety and necessity remain for a subset of individuals. Addressing these concerns through targeted, evidence-based communication will be essential to support informed choice and maximise uptake.
Background Achieving viral suppression goals for adolescents with HIV requires multifaceted strategies, including efficient and effective health systems to routinely monitor HIV viral load (VL) and support adolescents when adherence falters. Objective This study aimed to identify where gaps in information flow occur in return of HIV VL results to clinics and adolescents and to explore how providers determine ‘good adherence’ prior to confirmation of virological failure. Methods Four focus group discussions and ten in-depth interviews were conducted with purposively selected healthcare workers (n = 39) from various phases of VL information flow. We used thematic analysis to identify themes. Results Themes consisted of individual- and family-level challenges, facility-level barriers, supply chain constraints affecting laboratory-related delays, client-specific factors impacting dissemination of VL results, reluctance to repeat VL until adherence challenges are resolved. Conclusion The identified themes highlighted that individual, social, and health systems factors were perceived as contributing to success or delay in the ability to obtain timely VL results and repeat confirmatory VL testing.
BACKGROUND:Coagulation abnormalities are an under-recognized complication among people living with HIV. Despite widespread antiretroviral therapy (ART), hematologic dysfunction, including coagulation and platelet abnormalities, continues to contribute to morbidity in sub-Saharan Africa. OBJECTIVE:This study aimed to determine the prevalence, associated factors, and clinical features of hypocoagulability among people with HIV at Hoima Regional Referral Hospital (HRRH). METHODS:We conducted a cross-sectional study at HRRH, Western Uganda, from May to July 2025. Sociodemographic, clinical, and behavioral data were collected via questionnaires and chart review. Laboratory evaluation included platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR). Hypocoagulability was defined as ≥ 1 abnormal parameter: PT > 13.5 s, aPTT > 35 s, INR > 1.2, or platelet count <150,000/µL. Multivariable logistic regression identified independent factors associated with hypocoagulability. RESULTS:The study enrolled 389 HIV-positive adults. Hypocoagulability was detected in 121 participants (31.1%). The most frequent abnormalities were prolonged PT (14.1%), elevated INR (11.8%), prolonged aPTT (11.1%), and thrombocytopenia (9.3%). Independent factors associated with hypocoagulability included older age (aOR: 2.012, 95% CI = 1.165-4.813), alcohol use (aOR: 2.177, 95% CI = 1.250-3.792), ART-naïve status (aOR: 3.159, 95% CI 1.057-9.364), and unsuppressed viral load (aOR: 2.235, 95% CI = 1.297-3.851). Clinically, affected participants more commonly reported easy bruising (33.1%), frequent nose bleeds (29.8%), and heavy menstrual bleeding among women (39.2%) compared to participants without hypocoagulability. CONCLUSION:These findings highlight the importance of early detection, promotion of ART adherence, targeted screening of high-risk groups, and integrated management strategies to reduce bleeding-related morbidity in HIV care.
BACKGROUND:HIV cure trials involving analytical treatment interruptions (ATIs) are expanding in resource-limited settings where HIV prevalence is highest, such as South Africa. Given the socio-economic challenges in these regions, ATI-inclusive trials may present unintended mental health risks to trial participants. To ensure participant safety, tailored mental health support should be part of the routine study implementation. While there is a trend toward more participant-centred study designs, less attention is focused on clinical research staff and their perceptions on managing participants with pre-existing or emerging trauma. METHOD:We explored the perspectives of clinical research staff at Females Rising through Education Support and Health (FRESH) involved in an ATI-inclusive study, by conducting in-depth interviews (IDIs). Interviews were audio-recorded, transcribed and analysed thematically. RESULTS:Clinical staff reported that participants were optimistic and hopeful about their involvement. However, staff expressed concerns about the psychological impact of going through the ATI, which was associated with emotional distress and, for some, triggered pre-existing trauma. The intersection of prior trauma and heightened anxiety around viral rebound warranted specific mental health support. Staff who counselled participants on HIV disclosure identified common barriers that hindered HIV status disclosure and trial participation. Staff expressed the need for specialised training to support participants' mental health. CONCLUSIONS:Including participant-centred psychosocial support in the design of ATI-inclusive HIV cure trials may improve study adherence and retention while protecting participants' mental health. Equipping clinical research staff with trauma-informed competencies should be considered a minimum standard in ATI-inclusive trials settings.
INTRODUCTION:This study evaluated the effectiveness of antiretroviral therapy (ART) and associated factors on viral suppression before, during, and after pregnancy (maternal timeline). METHODS:We conducted a cohort study, retrospectively reviewing records of 1291 pregnant and breastfeeding women on ART. Descriptive statistics summarised the demographics and clinical characteristics. Chi-square, Fisher's exact, and generalised estimating equations were used to assess variations in viral suppression across the maternal timeline. RESULTS:ART regimens comprised 62.5% dolutegravir (DTG)-, 28.8% efavirenz (EFV)-, 4.5% nevirapine (NVP)-, and 4.2% protease inhibitor (PI)-based therapy. Viral suppression rates before, during, and after pregnancy were DTG- (95.0%, 94.6%, 95.7%), EFV- (94.9%, 94.2%, 93.6%), NVP- (93.1%, 94.7%, 93.5%), and PI-based (79.6%, 88.0%, 85.7%). ART regimens varied in effectiveness, with statistical significance observed before (p < 0.001) and after (p = 0.018), but not during pregnancy (p = 0.678). PI-based regimens showed higher risk of non-suppression in the non-adjusted model (IRR = 3.20, 95% CI: 1.63-6.30, p = 0.001). In the adjusted model, poor adherence (aIRR = 7.80, 95% CI: 2.54-23.90, p < 0.001), fair adherence (aIRR = 5.03, 95% CI: 1.11-22.86, p = 0.036), second-line ART (aIRR = 3.14, 95% CI: 1.75-5.62, p < 0.001), and third-line ART (aIRR = 8.48, 95% CI: 1.82-39.43, p = 0.006) remained significant. CONCLUSION:ART effectiveness showed variation before and after, but not during pregnancy. EFV- and NVP-based regimens achieved suppression rates comparable to DTG across maternal timelines, with the exception of PI-based regimens. Adherence and ART drugs influence outcomes more than regimen choice alone, with good adherence essential for optimal maternal outcomes.
BACKGROUND:The use of antiretroviral therapy (ART) in the management of HIV/AIDS has greatly increased the life expectancy of people living with HIV. However, longer life spans have been accompanied by a growing burden of non-communicable diseases (NCDs). This study assessed healthcare satisfaction and the prevalence of diabetes and hypertension among older adults living with HIV (50 years and above) at Mbale Regional Referral Hospital in Eastern Uganda. METHODS:A cross-sectional study was conducted at Mbale Regional Referral Hospital (MRRH) involving 400 HIV-positive patients aged more than 50 years on ART. The sociodemographic information, ART history, and comorbidities were obtained. Bivariate and multivariable logistic regression analyses were performed to identify predictors of comorbidities. RESULTS:The prevalence of DM and HTN were 28.3% and 27.1%, respectively. Participants aged ≥64 years had significantly higher odds of HTN (AOR: 2.25; 95% CI: 1.27-3.19; p = 0.029). Changing ART regimens three or more times was associated with HTN (AOR: 2.55; 95% CI: 1.08-4.73; p = 0.015). Living 6-10 km from a health facility increased the odds of DM (AOR: 5.46; 95% CI: 1.12-26.54; p = 0.044). Overall, 91% of the participants reported satisfaction with the healthcare received. CONCLUSION:DM and HTN are highly prevalent among older adults living with HIV in Eastern Uganda and are associated with advanced age, ART regimen changes, and healthcare access challenges. The integration of NCD screening and management into HIV care are key for improving long-term outcomes in this population.
Background Long-acting injectable antiretroviral therapy (LAI-ART) is an emerging alternative to daily oral ART, offering the potential to improve adherence, reduce dosing frequency, and alleviate treatment fatigue among people with HIV. There is limited evidence on its real-world acceptability, feasibility, and implementation challenges in low- and middle-income countries, such as Pakistan, where structural barriers and health system limitations may influence uptake. Objective This study explores the perspectives on the feasibility and acceptability of LAI-ART among people currently receiving oral ART in Pakistan. Methods A qualitative study was conducted from November 2024 to January 2025, involving in-depth interviews from people in the ART center in Islamabad and community-based organizations, and one focus group discussion (FGD) with participants who are actively engaged in community-based peer advocacy across Pakistan. The data were analyzed using conventional thematic analysis with inductive coding. Results We conducted interviews with 37 participants, with one-to-one discussions with 31 people with HIV and 6 participants in FGD. Participants perceived LAI-ART as beneficial due to the elimination of pill burden, improved adherence, fewer side effects, lesser logistical demands, and greater privacy. However, injection-related adverse events, longer clinic waiting times, and limited availability were key barriers to its implementation. Those unwilling to adopt LAI-ART cited trust in oral ART, the convenience of multi-month refills, concerns of reduced adherence, work-related constraints. Conclusion LAI-ART is acceptable to people with HIV in Pakistan, offering adherence and privacy benefits. However, successful implementation depends on addressing concerns around safety, supply, and access through responsive, stigma-free, and people-centered care models.
Background HIV self-testing (HIVST) has the potential to increase testing uptake among populations underserved by facility/clinic-based services, including African migrants in Europe. However, research on HIVST among African migrants in Europe and other high-income countries remains limited. Objective To explore perspectives on HIVST, identify barriers and facilitators to uptake, and provide recommendations to inform effective implementation among African migrants in the Netherlands. Methods Between February 2021 and May 2023, semi-structured interviews were conducted with 26 African migrants and 13 key informants, including healthcare providers (general practitioners, HIV specialists, testing service providers), policy and research professionals, and migrant community representatives. Data were analyzed using an inductive thematic approach. The Consolidated Framework for Implementation Research (CFIR) was applied post hoc to contextualize study findings within a broader implementation context. Results Participants’ perspectives on HIVST centered on three themes: enhanced autonomy in decision-making and testing processes; navigating autonomy and support for self-testing and care linkage; and HIVST within the Dutch context and prevention landscape. Factors potentially influencing successful uptake and implementation were identified across multiple CFIR domains, including perceived relative advantage over facility/clinic-based testing, evidence on reliability, and procedural complexity (Innovation Characteristics); low self-efficacy, self-testing and linkage to care support needs (Individual Characteristics); HIV stigma, limited awareness and low visibility of HIVST (Outer Setting); and perceived incompatibility with existing healthcare systems (Inner Setting). Conclusions Although HIVST can address key testing barriers among African migrants, targeted implementation strategies are needed to guarantee equitable access, proper use, and optimal outcomes. These include enhanced dissemination of HIVST information, normalization of HIV testing and self-testing, provision of person-centered support, and establishing clear pathways for timely care linkage when required.
BACKGROUND:Tuberculosis screening is recommended for people living with HIV. The QuantiFERON-TB test measures the cell-mediated response against M. Tuberculosis. The Gold-In-Tube measures the response of CD4+ T-cells, often leading to indeterminate results. The new Gold-Plus (QFT-GP) also measures CD8+ T-cells response, thus reducing uncertainties. However, studies on people living with HIV, that would benefit from a test independent from CD4+ T-cells, are scarce. OBJECTIVE:This study addresses this gap by evaluating the performance of QFT-GP specifically in a large cohort of people living with HIV in a low TB-endemic setting. METHODS:We retrospectively evaluated the frequency of indeterminate QFT-GP tests in a cohort of people living with HIV with at least one test. We collected demographic data, CD4+ and CD8+ T-cell count at nadir and at the time of testing, and history of prior TB infection or treatment. We correlated the QFT-GP results to the CD4+ T-cell count. RESULTS:Six hundred and ninety five patients were included (males/females 72.5/27.5%), median age was 51 ± 14 years. Only 1,2% of tests were indeterminate, and there was no association with the CD4+ or CD8+ T-cell count at the moment of the test or at the nadir. CONCLUSIONS:QFT-GP has few indeterminate results, even in patients with a low CD4+ T-cell count.
Background Pneumocystis jirovecii pneumonia (PJP) remains a leading opportunistic infection in people with HIV and severe immunodeficiency. While PJP treatment has been well studied, the clinical significance of cytomegalovirus (CMV) DNA detection during PJP and the role of specific anti-CMV therapy remain uncertain. Objectives To examine associations between CMV DNA detection, anti-CMV therapy, and clinical outcomes in people with HIV hospitalized with PJP. Methods This retrospective cohort study examined people with HIV hospitalized with PJP between 2008 and 2022 at University Hospital Bulovka. A customized severity index was developed for this cohort. In-hospital mortality, one-year survival, and disease severity were assessed, focusing on CMV DNA detection and its treatment. Data were analyzed using Firth penalized logistic regression to identify associations with clinical outcomes, and ordinal logistic regression to assess predictors of severity scores in this observational cohort. Results One hundred and one patients were included. In unadjusted analyses, CMV DNA detection was associated with higher odds of both in-hospital and one-year mortality, and anti-CMV therapy was associated with increased in-hospital mortality. In multivariable analyses, CMV DNA detection was not independently associated with in-hospital or one-year mortality, although point estimates consistently suggested higher odds of death. Receipt of anti-CMV therapy was not independently associated with mortality after adjustment. The severity index was independently associated with both in-hospital and one-year mortality. CMV DNA detection and anti-CMV therapy were independently associated with greater disease severity in ordinal regression analyses. Anti-CMV therapy was more frequently administered to patients with more severe disease and was also associated with in-hospital mortality. Conclusions CMV DNA detection in people with HIV hospitalized with PJP was associated with worse outcomes. Anti-CMV therapy was more often used in severe cases and showed an association with in-hospital mortality in unadjusted analyses. The observational design precludes determination of causality.
