Introduction Excessive daytime somnolence is common in people with HIV. The importance of possible contributors such as mental health and obstructive sleep apnoea syndrome is poorly understood. We investigated the prevalence of daytime somnolence and obstructive sleep apnoea syndrome in people with HIV in the UK and assessed what factors were associated with somnolence. Methods In this cross-sectional study, adults with HIV attending Royal Free London HIV outpatient service appointments were recruited between May 2018 to October 2019. Participants completed questionnaires as outpatients assessing somnolence, sleep quality, fatigue, mental health symptoms and quality of life. Binary logistic regression was used to identify factors independently associated with excessive daytime somnolence (defined as Epworth Sleepiness Scale scores >10/24), and prevalence of somnolence and obstructive sleep apnoea syndrome were calculated with 95% confidence intervals. Results 313 adults (median age 52 years, body mass index (BMI) 25.9 kg/m 2 , and 80% male) participated. The excessive daytime somnolence prevalence was 72/313 (23%, 95% CI: 18.5-28.1). Somnolent individuals had more frequent and more severe: anxiety, depression, fatigue and poor sleep quality, with more reported cardiovascular and respiratory disease (p < 0.01). Factors independently associated with excessive somnolence included male gender (OR 3.45; 1.36-8.95; p < 0.01), poor sleep quality (OR 1.12; 1.02-1.22; p = 0.01) and fatigue (OR 1.04; 1.01-1.06; p < 0.01). The minimum detected prevalence of obstructive sleep apnoea syndrome was 8.6% (n = 27/313) in the study population – which represented 54% (n = 27/50) of those participants who had a sleep study. Conclusions Excessive daytime somnolence is common in people with HIV and frequently identified in individuals reporting poor mental health. Obstructive sleep apnoea syndrome is a potentially treatable contributor to daytime somnolence. Integrated screening for somnolence, sleep disorders and mental health within routine HIV care may improve identification and treatment of common, modifiable and interacting comorbidities.
Background Asymptomatic extragenital Neisseria gonorrhoeae (NG) infection contributes to ongoing transmission and may facilitate the emergence of antimicrobial resistance. This study aimed to determine NG prevalence, antimicrobial susceptibility patterns, and sequence types among transgender women (TGW). Methods Real-time PCR (qPCR) and culture for NG were performed on pharyngeal and rectal swabs and first-void urine (FVU) samples from TGW attending Fundación Huésped in Buenos Aires, Argentina (August 2021-March 2022). Quantification cycle (Cq) values from qPCR-positive samples were used as a proxy for bacterial load. Culture-positive isolates underwent antimicrobial susceptibility testing and NG multi-antigen sequence typing (NG-MAST). Participants were also tested for other sexually transmitted infections (STI) and sociodemographic and behavioral data were collected by questionnaire. Results We included 117 TGW: median age 32 (IQR 29-39), 55% had not completed high school, 54% were currently engaged in sex work, 55% had ≥ 5 sexual partners in the last month, and 68% reported recreational substance use in the previous year. At baseline, 46% were living with HIV, 20% had active syphilis, and 6% extragenital chlamydia. Global NG prevalence (determined by positive qPCR) was 9% (10/117) with 9 rectal infections (8%; 9/116), one pharyngeal infection (1%; 1/117), and none detected in FVU. Only three of nine PCR-positive rectal samples yielded a positive culture. All isolates were susceptible to ceftriaxone and azithromycin and showed intermediate susceptibility or resistance to tetracycline. Sequence types (ST) were ST21119, ST8202, and ST21122. No associations were found between asymptomatic extragenital NG infection and sociodemographic/behavioral factors. Seventy percent of positive PCR samples had a Cq ≥ 28, suggesting lower bacterial loads. Conclusion Asymptomatic extragenital NG infection prevalence among TGW in Buenos Aires was 9%, with no infections detected in FVU, underscoring the importance of extragenital screening. Limited culture recovery highlights the potential value of complementary approaches to antimicrobial resistance surveillance.
Background Antimicrobial resistance is increasingly challenging the clinical management of Mycoplasma genitalium infections. This study aimed to characterize the genomic diversity, population structure, molecular typing profiles, and distribution of antimicrobial resistance-associated determinants among publicly available M. genitalium genomes. Methods All 64 M. genitalium genomes publicly available in NCBI and PubMLST at the time of data collection were included. Genomes were characterized by mgpB and MG309 molecular typing and screened for mutations associated with macrolide and fluoroquinolone resistance. Phylogenetic relationships were investigated using a recombination-filtered core-genome alignment, and molecular typing and antimicrobial resistance profiles were mapped onto the resulting maximum-likelihood phylogeny. Results Substantial molecular diversity was observed, with 29 mgpB and 21 MG309 types identified. Macrolide resistance-associated 23S rRNA mutations were detected in 34/64 (53%) genomes. The fluoroquinolone resistance-associated ParC substitutions S83I and S83 R were detected in 14 (22%) and one genome, respectively. Relevant GyrA substitutions were less frequent and occurred exclusively in genomes also carrying ParC S83I. Overall, 15/64 (23%) genomes exhibited a dual-resistance genotype, whereas 19/64 (30%) carried macrolide resistance-associated mutations without concomitant fluoroquinolone resistance markers. Resistance-associated genotypes occurred across multiple phylogenetically distinct genomic backgrounds, while clusters of closely related isolates sharing molecular typing and resistance profiles were also identified. Conventional mgpB and MG309 typing did not consistently recapitulate whole-genome phylogenetic relationships. Conclusions These findings reveal substantial genomic diversity and a high frequency of resistance-associated determinants among publicly available M. genitalium genomes, supporting the expansion of geographically representative genomic surveillance to monitor the emergence and dissemination of antimicrobial resistance.
Background Herb-drug interactions can affect the outcomes of antiretroviral regimens among people living with HIV. Our study aimed to assess perceptions and practices regarding herbal medicine use among people living with HIV attending Bushenyi Health Center IV in Western Uganda. Methods We conducted a cross-sectional, interview-based survey in September 2025 using a pre-validated questionnaire to assess their perceptions and practices of herbal medicine. Participants who were aged more than 18 years, of both genders, on antiretrovial therapy, and who consented to participate were enrolled. Herbal medicine use was defined as the current use of herbal medicine alongside ART. Binary and multiple logistic regression analyses were applied to identify associations with herbal medicine use. Results Among 375 participants, 108 (29%) were concurrently using herbal medicine with ART. Ginger (21%) and garlic (27%) are the commonly consumed herbal products. General health (75%) and boosting immunity (22%) were common reasons for taking herbal medicine. Sixty five (60%) of herbal medicine users did not disclose their use of herbal medicine to their healthcare providers. Low perceived concern (vs. high; AOR = 2.77; 95% CI 1.13-6.82) was positively associated, while low perceived benefit (vs. high; AOR = 0.06; 95% CI 0.02–0.25) was negatively associated with herbal medicine use. Presence of comorbidities, opportunistic infections, experience of side effects of antiretroviral therapy, and non-antiretroviral therapy medication use were significantly associated with herbal medicine use in unadjusted analysis. Conclusion Our study findings underscore the need for open patient-provider communication through co-designed, participatory education models to engage both people living with HIV and healthcare providers in promoting the safe use of herbal medicines alongside antiretroviral therapy. These models address the disclosure gaps and reduce the risk of potential herb-drug interactions.
We report a case of HIV diagnosis in a 36-year-old man who has sex with men receiving daily oral PrEP (emtricitabine/tenofovir) in Argentina, where viral load or HIV PCR testing is not routinely available before or during prophylaxis. In 2022, PrEP was initiated after a diagnosis of primary syphilis, with a non-reactive fourth-generation HIV test performed 13 days earlier (outside the recommended window), so very early infection already present at initiation cannot be excluded. Self-reported adherence was >95%. Serology was negative at day 23 and became reactive at day 73, with an indeterminate Western blot (gp120 only), undetectable plasma HIV-RNA and preserved lymphocyte counts; dolutegravir was added to complete antiretroviral treatment. Standard diagnostic algorithms were initially inconclusive, and confirmation required approaches beyond routine practice: HIV-1 RNA was detected only after ultracentrifugation of 14 mL of plasma (55 copies), and low-level proviral HIV-1 DNA was identified after analysis of an extensive number of cells; Nef- and p24-specific T-cell responses were also detected. No resistance-associated mutations were found on proviral DNA (integrase region). The Western blot eventually became positive at day 382, while a rapid immunochromatographic assay remained negative at 34 months. Atypical presentations of this kind have been reported under oral TDF/FTC PrEP and were subsequently characterized as long-acting early viral inhibition (LEVI) syndrome, predominantly in the context of long-acting cabotegravir. The present case illustrates the extent of non-routine investigation required to confirm HIV acquisition, and the challenges this poses in settings where oral PrEP is the only available option and HIV-1 RNA PCR cannot be routinely deployed. PrEP should be initiated promptly following a negative HIV test performed on the same day, or as close as possible to PrEP initiation, particularly when recent exposure is possible. HIV testing should be repeated sequentially after initiation, and discordant results should prompt continued serological and molecular evaluation.
