Background: Co-infection with Talaromyces marneffei (TM) and Rhodococcus equi in HIV-positive patients is an extremely rare but life-threatening combination of opportunistic infections. We report a scarce case of an HIV-infected patient initially suspected of pulmonary tuberculosis, who was subsequently confirmed by culture and next-generation sequencing (NGS) to have a co-infection with R. equi and TM. Case Presentation: The patient was a 32-year-old male presenting with cough, sputum production, and chest tightness after exercise. He was admitted to our hospital for further diagnosis and treatment on June 25, 2025. The sputum acid-fast stain was positive for acid-fast coccoid organisms on June 26, 2025. Following the confirmation of R. equi sepsis on June 27, the antimicrobial regimen was adjusted to a combination of levofloxacin (0.5g qd), amikacin (0.4g qd), and azithromycin (0.25g qd). On June 29, amphotericin B was initiated for anti-TM therapy, starting at 5 mg and titrated daily. Due to severe gastrointestinal reactions, azithromycin and compound sulfamethoxazole were discontinued. On June 30, the antiretroviral therapy (ART) was optimized to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TDF/3TC/DTG). On July 1, the patient reported three episodes of watery diarrhea; examination revealed white pseudomembranes on the bilateral oral mucosa, suggestive of concurrent oral candidiasis, for which sodium bicarbonate mouthwash was prescribed. At 11:30 on July 7, the patient experienced sudden fatigue, chest tightness, and nausea, with blood pressure dropping to 87/56 mmHg, heart rate rising to 120 bpm, and oxygen saturation at 92%. Immediate resuscitation measures, including albumin supplementation and correction of electrolyte imbalances, stabilized his condition. By July 9, hemoglobin rose to 90 g/L, albumin was 18.0 g/L, and liver function tests showed AST at 92 U/L. With normalized body temperature and reduced coughing, the patient requested discharge. He was advised to continue oral itraconazole (0.2g bid), levofloxacin (0.5g qd), and antiviral medications, outpatient, with regular follow-ups. Conclusion: R.equi , being acid-fast positive, is easily misdiagnosed as tuberculosis; thus, clinicians must prioritize differential diagnosis for such infections. The key to success in this case lay in obtaining definitive etiological evidence through bronchoscopy and bone marrow aspiration, which prevented misdiagnosis and enabled a targeted combination therapy. This underscores the importance of employing multiple diagnostic methods to clarify clinical diagnoses.

The rapidly growing population of older people living with HIV-1 (PLWH) continues to experience persistent immune dysfunction despite viral suppression, yet the underlying mechanisms remain unclear. To investigate the molecular basis of the unique immunological defects in these elderly PLWH, we performed time-course transcriptomic analysis of CD3/CD28-stimulated CD4⁺ T cells from 58 participants (stratified by age and HIV status), validated through flow cytometry, qPCR, and cytokine profiling in 120 subjects. Gene modulated Jurkat cell models and pharmacological inhibition experiments were employed to dissect mechanistic pathways. Our results demonstrate that activated CD4⁺ T cells from older PLWH exhibited broad suppression of TNF, NF-κB and IL-17 signaling pathways, with 40 critical genes showing co-regulation by aging and HIV-1. Among them, the expression of stimulator of interferon genes (STING) was significantly elevated in older PLWH, correlating with CD4⁺ T cell depletion. Mechanistically, STING hyperactivation induced src homology 2 containing protein tyrosine phosphatase 1/2 (SHP-1/2) phosphorylation, which suppressed Janus kinase 1 (JAK1)-mediated phosphorylation of Signal Transducer and Activator of Transcription 1 (STAT1), thereby reducing IFN-γ production. STING inhibition with H151 restored IFN-γ secretion (3.1-fold increase) while reducing T cell activation markers (CD25⁺Ki67⁺ cells). Moreover, STING hyperactivation induced classical T cell exhaustion, characterized by TIM-3 upregulation, TOX-centered transcriptional programming, and loss of polyfunctional cytokine output; these changes were reversed by STING inhibition. This study identifies STING-mediated JAK-STAT suppression as a novel mechanism of immune dysfunction in aging PLWH, proposing targeted STING inhibition as a potential therapeutic strategy to improve immune recovery in this vulnerable population (Graphical abstract).

By using molecular network technology to analyze the transmission characteristics of the CRF55_01B strain in Yunnan Province, we aimed to identify high-risk transmitters, trace the origin time, location, transmission routes and transmitted drug resistance(TDR) of the virus, and provide a data basis for subsequent surveillance. Demographic data and laboratory test results were collected from all newly diagnosed and treatment-naïve individuals infected with the CRF55_01B strain in Yunnan Province, from January 2020 to December 2024. The molecular network of the CRF55_01B strain was constructed via the paired gene distance method, with Cytoscape 3.10.1 software employed to visualize and analyze the network. BEAST software was used to construct the MCC tree and estimate posterior probabilities, while SpreaD3 was employed to visualize spatiotemporal diffusion and calculate Bayes factors for transmission path analysis. Drug resistance analysis was conducted via the Stanford HIV Drug Resistance Database (HIVdb). A total of 68 newly diagnosed and treatment-naïve patients infected with the CRF55_01B strain in Yunnan Province were enrolled. With 0.018 as the optimal genetic distance threshold, a molecular network was constructed, yielding a network access rate of 57.35

Autoimmune hepatitis (AIH) is an uncommon condition among persons living with HIV (PLWH), and its clinical presentation may be influences by immune reconstitution and viral reactivation, potentially affecting disease course and prognosis. In this retrospective case series, we aimed to describe the clinical features, pathological findings, treatment approaches, and outcomes of PLWH diagnosed with AIH in Yunnan Province, China, with a focus on region-specific clinical features. This single-center retrospective case series included PLWH diagnosed with AIH at Yunnan Provincial Infectious Diseases Hospital between June 2017 and February 2025, based on electronic medical records. AIH was diagnosed according to the simplified International Autoimmune Hepatitis Group criteria (definite ≥ 7 points; probable ≥ 6 points), with cases lacking liver biopsy classified as probable AIH. PLWH with other chronic liver diseases, substantial missing data, or follow-up shorter than 15 months were excluded. Among the eight PLWH, seven were female, with a median age of 46.5 years (IQR 39–51). All PLWH had been living with HIV for more than 5 years and were receiving antiretroviral therapy with well-controlled viral loads. Elevated transaminase and immunoglobulin G (IgG) levels were observed in all cases, and four of them presented with jaundice. All cases tested positive for ANA and ASMA autoantibodies; three were positive for LKM-1, two for SLA, and five for EBV-DNA (62.5

To report a novel HIV-1 circulating recombinant form (CRF) identified in Yunnan Province, China, through a molecular epidemiological study based on near-full-length HIV-1 genome sequencing and phylogenetic analyses. Plasma samples were collected from five HIV-1 seropositive individuals. Viral RNA was extracted, and near-full-length genomes (NFLG) were amplified and sequenced. Maximum likelihood (ML) phylogenetic analysis was performed using IQ-TREE v2.4.0. Recombination patterns were characterized using SimPlot v3.5.1. The time to the most recent common ancestor (tMRCA) was estimated using Bayesian phylogenetic analysis in BEAST v1.10.5. In the ML tree, the five NFLG sequences clustered into a distinct monophyletic clade. Recombination analyses revealed a mosaic genome composed of multiple fragments derived from subtype B and subtype C. Comparative genomic mapping and subregion phylogenetic analyses further confirmed that this strain represents a second-generation recombinant form derived from CRF07_BC and CRF08_BC, with CRF08_BC serving as the backbone and incorporating several fragments from CRF07_BC. The novel CRF was designated CRF182_0708. Bayesian analysis estimated that CRF182_0708 originated around 2002.7–2003.1. We identified a novel second-generation HIV-1 CRF derived from CRF07_BC and CRF08_BC, designated CRF182_0708, among HIV-1-positive individuals in relatively developed cities in Yunnan Province, China.

Background The global shift of HIV to a manageable chronic condition necessitates a transformation in care delivery from disease-centered approach to patient-centered, comprehensive management. In response, Yunnan Province has initiated the standardization of HIV care clinics. However, the frontline perspective on implementation remains a key gap, hindering insight into the real-world mechanisms of success and challenge. Methods This qualitative study was conducted in Yunnan Province, China, between March and June 2025. Using maximum variation purposive sampling, we recruited 28 participants (including physicians, and case managers) from five hospitals at the provincial, prefectural, and county levels. Data were collected through five semi-structured focus group discussions. The audio-recorded discussions were transcribed verbatim and analyzed using the Framework Method. Results This study identified four core domains in the implementation of standardized HIV clinics through framework analysis: (1) Restructuring Workflow and Environment, which enhanced service efficiency and quality through coordinated procedural, spatial, and digital reorganization; (2) Deepening Patient‑Provider Interaction, shifting care from transactional exchanges to patient‑centered, relational communication; (3) Building Organizational Support and Team Capacity, realized through leadership endorsement, experiential training, and flexible adaptation; and (4) Navigating Persistent Challenges, including resource constraints, differential adaptation among patients and staff, and unaddressed emotional labor burden. These domains are dynamically linked: structured workflows enable higher‑quality interactions, while the trust built through these interactions in turn refines workflow details. Organizational support reinforces this cycle, driving the establishment and sustainment of clinic standardization. Conclusions Yunnan’s standardized HIV care clinic model demonstrates that effective, sustainable chronic care emerges from the dynamic interplay of system rationalization and human empowerment, offering a replicable framework for similar settings while underscoring the need to address persistent resource and well-being challenges.

Abstract Background To characterize HIV-1 molecular epidemiology and identify novel circulating recombinant forms (CRFs) among antiretroviral therapy (ART)-naïve heterosexuals in Yunnan, China, and evaluate their clinical impact. Methods This study examined 636 HIV-1 pol sequences to analyze genetic diversity, pretreatment drug resistance (PDR), and transmission networks. Near full-length genomes were obtained to identify and characterize novel recombinants, with their evolutionary history inferred by Bayesian analysis. Co-receptor tropism was predicted, and the five-year clinical outcomes (including immune reconstitution and virologic response) of patients infected with the novel CRFs were compared. Results The most prevalent type identified was CRF08_BC, accounting for 50.16% of cases. The prevalence of drug resistance was 5.97% (38/636), with the K103N mutation being the most common. An analysis of transmission networks revealed that 52.2% (272/521) of clusters were associated with CRF07_BC and CRF08_BC. Two novel second-generation CRFs were identified: CRF190_0708, with an estimated time to the most recent common ancestor (tMRCA) of 1998.9, and CRF191_0708, with a more recent tMRCA ranging from 2009.5 to 2011.6. During the five-year follow-up period, viral rebound was observed in 7 patients in the CRF190_0708 group and in 1 patient in the CRF191_0708 group. Drug-resistance mutations (M184V and K103N) were detected in a subset of rebound cases in the CRF190_0708 group. Conclusions This study identifies two novel HIV-1 recombinants, CRF190_0708 and CRF191_0708, highlighting ongoing viral evolution in Yunnan. Preliminary findings suggest possible clinical differences, warranting further investigation. Continued molecular surveillance is needed. Trial registration The clinical study was registered at ClinicalTrials.gov under the identifier NCT03852849. The date of registration was March 22, 2019.

Background Talaromyces marneffei (TM) is a thermally dimorphic fungus endemic to Southeast Asia and a major opportunistic pathogen in HIV/AIDS patients. We report a rare case of disseminated TM infection presenting with visible fungal spores on peripheral blood smear and complicated by acute pancreatitis. Case Presentation A 52-year-old man with AIDS (CD4⁺ count: 134 cells/µL) presented with prolonged fever, cough, and weight loss. Peripheral blood smear revealed numerous yeast-like fungal spores. Blood culture grew TM, confirmed by ITS sequencing. Despite antifungal therapy, the patient developed severe acute pancreatitis and multiorgan failure, and died on day 7. This is the first reported case of TM-induced acute pancreatitis likely triggered by fungal microembolization. Conclusions TM should be considered in HIV patients with unexplained pancreatitis, especially in endemic areas. Peripheral blood smear may serve as a rapid diagnostic clue in disseminated infection.

Older people living with HIV-1 (PLWH) experience a dual burden from the combined effects of aging and HIV-1 infection, resulting in significant immune dysfunction. Despite receiving HAART, immune reconstitution is not fully optimized. The objective of this study was to investigate the impact of aging and HAART on T cell subsets and function in PLWH across different age groups, thereby providing novel insights into the prognosis of older PLWH. This study was conducted at Yunnan AIDS Care Center, China, to explore the immunological responses of old PLWH to HAART and compared with the middle-age and the younger. Blood samples were collected from 146 PLWH to analyze T cell subsets and their functions, with a particular emphasis on markers related to T cell differentiation, activation, exhaustion, inflammation, and cellular function, using multicolor flow cytometry analysis. Older age may have a greater effect on long-term CD4+T cell recovery. Compared with young and middle-aged PLWH, older PLWH presented distinct alterations in their immune profile, including a decline in the Naïve CD4+T and CD8+T cell subsets, an expansion of effector memory cells, and other potential immune risk phenotypes, such as activation, exhaustion, and up-regulation of aging markers. In addition, we observed a significant association between the CD4 + EM3 subset and the CD8 + EM2 subset with HIV-1 progression, independent of age, suggesting their potential as reliable markers for assessing immune reconstitution in all PLWH. Our study extends previous findings showing that older participants exhibit a wide range of late differentiation, senescence, or exhaustion phenotypes in cells, including all the CD4+T and CD8+T subsets, consistent with an immunosenescent phenotype. This may accelerate poor immune recovery in older PLWH. Identifying new strategies to improve the immune risk phenotypes of older PLWH may help improve their immune reconstitution outcomes. The CD4 + EM3 subset and the CD8 + EM2 subset should be studied as additional markers of late presentation.

Talaromyces marneffei (TM) is a thermally dimorphic fungus endemic to Southeast Asia and a major opportunistic pathogen in HIV-1/AIDS patients. We report a rare case of disseminated TM infection presenting with yeast-like fungal structures on peripheral blood smear and complicated by acute pancreatitis. A 52-year-old man with AIDS (CD4+ count: 134 cells/μL) presented with prolonged fever, cough, and weight loss. Peripheral blood smear revealed numerous yeast-like fungal structures. Blood culture grew TM, confirmed by ITS sequencing(GenBank accession number: PX499650).Despite antifungal therapy, the patient developed severe acute pancreatitis(lipase 1746.9 U/L, > 3 times the upper limit of normal)and multiorgan failure.Extensive investigations excluded common infectious and non-infectious etiologies.The patient died on day 7.This is the first reported case of TM-induced acute pancreatitis likely triggered by fungal microembolization. TM should be considered in HIV patients with unexplained pancreatitis, especially in endemic areas. Peripheral blood smear may serve as a rapid diagnostic clue in disseminated infection,indicating potential organ involvement that may affect uncommon sites.

BackgroundUntil December 2024, China had identified and named 66 new HIV-1 recombinant genotypes. Among them, CRF85-BC is showing a rapidly growing trend in popularity in southwestern China, especially in Sichuan and Yunnan. This genotype was first discovered and reported in Sichuan and is believed to have originated in Yunnan. However, there are relatively few reports on the comprehensive systematic transmission data in Yunnan. This study will further elucidate the accurate evolutionary origin time and epidemic transmission dynamics of CRF85-BC.MethodsWe obtained 496 partial pol and 47 near full-length genomic sequences of HIV-1 CRF85_BC from 28,384 individuals with treatment failure in Yunnan, 2009-2023. Bayesian coalescent phylogeny analysis was performed to investigate the origin and timeline of CRF85_BC. A molecular transmission network was constructed using the genetic distance method to evaluate the transmission pattern. Spatial analysis was used to reveal the geographic patterns of phylogenetic clustering rates.ResultsThe number of CRF85_BC sample cases increased significantly between 2009 and 2023, and showed resistance to reverse transcriptase inhibitors (M184V/I and K103N/S). Bayesian phylogeny of nearly full-length sequences indicated that the emergence time in Yunnan was between January 1989 (95% confidence interval [CI]: 1984.9-1992.8) and February 1992 (95% CI: 1986.1-1996.6). Molecular networks resolved 87 transmission clusters, and the differences in transmission patterns were mainly manifested in the high aggregation rate (63.29%; 95% CI: 55.69%-70.89%) and cluster size (average size: 8.3) in Sichuan, which were higher than those in Yunnan (40.33%; 95% CI: 36.19%-44.47%; average size: 2.5). And all of them were heterosexual people, with a predominance of 77.81% (256/329). Spatiotemporal analysis revealed that Yunnan significantly transmitted to Sichuan, with Zhaotong and Yibin serving as key transmission hubs in both provinces.ConclusionsThe CRF85_BC genotype from Yunnan has a growing transmission network, with the potential for further expansion.

OBJECTIVES:This study aimed to evaluate the prevalence and characteristics of drug resistance mutations (DRMs) in patients with low-level viremia (LLV) in Southwestern China, as it has become a growing challenge in AIDS clinical practice. METHODS:This cross-sectional study was performed in Yunnan Province, Southwestern China. LLV was defined as 50-999 copies/mL of plasma viral load with antiretroviral therapy (ART) for at least 6 months. HIV-1 DRM detection used validated in-house protocol. RESULTS:A total of 470 sequences were obtained, and 13 HIV-1 genotypes were identified, among which CRF08_BC (47.5%), CRF07_BC (22.3%) and CRF01_AE (10.0%) subtypes were the most prevalent. The overall prevalence of DRMs was 45.7% (215/470), and the prevalence of DRMs to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs) was 39.4% (185/470), 20.6% (97/470) and 5.3% (25/470), respectively. The most common NNRTI-associated mutations were K103N (16.0%), E138A (6.6%), V179D (6.6%) and P225H (4.9%), and those in NRTIs were M184V (17.0%), D67N (3.4%) and K65R (3.0%). PI-associated mutations were infrequent, occurring in less than 1.8% of cases. The prevalence of NNRTI-associated mutations (K101E and Y188C) was found to be statistically significant among various LLV groups. Additionally, significant variations were observed in the prevalence of NNRTI-associated mutations (V106I, V106M, E138A and P225H), NRTI-associated mutation (K65R) and PI-associated mutations (L33F and Q58E) across different subtypes. CONCLUSIONS:The prevalence of DRMs in ART-experienced patients with LLV was high, and HIV-1 genotypes exhibited diversity in Yunnan Province. These findings indicate that regular DRM monitoring during LLV episodes was essential for effective clinical treatment and management in this region.

Few studies have focused on the descriptive epidemiology and trends of HIV/AIDS since the publication of the Global Burden of Disease (GBD) study in 2021. Therefore, this study aims to analyze the trends and patterns of the HIV/AIDS burden at the global, regional, and national levels by sex, age and social development index (SDI). We also explored risk factors and predicted the GBD of HIV/AIDS until 2030. Data on the etiology of HIV/AIDS from 1990 to 2021 were collected from the 2021 GBD database. Estimated annual percent changes (EAPCs) were calculated to assess temporal trends in the age-standardized incidence rate (ASIR), age-standardized disability-adjusted life-year rate (ASDR) and age-standardized mortality rate (ASMR) of HIV/AIDS patients. Measures categorized by sex, region, age and SDI quintiles. In addition, an age‒period‒cohort model was established to forecast future trends of the HIV/AIDS burden to 2030. Globally, the incidence of HIV/AIDS reached 1.65 million (95

Achieving complete immune reconstitution (CIR) in people living with human immunodeficiency virus (PLWH) following antiretroviral therapy (ART) is essential for preventing acquired immunodeficiency syndrome (AIDS) progression and improving survival. However, there is a paucity of robust prediction models for determining the likelihood of CIR in PLWH after ART. We aimed to develop and validate a CIR prediction model utilizing baseline data. Baseline data including demographic information, immunological profiles, and routine laboratory test results, were collected from PLWH in Yunnan, China. Baseline referred to the first recorded results after HIV diagnosis but before initiating ART, and these initial measurements served as the baseline data for analysis. The participants were divided into training and validation sets (7:3 ratio). To construct the model and accompanying nomogram, univariable and multivariable Cox regression analyses were performed. The model was evaluated using the C-index, time-dependent receiver operating characteristic (ROC) curves, calibration curves, and clinical decision curves to assess discrimination, calibration, and clinical applicability. Five thousand four hundred eight PLWH were included, with a CIR of 38.52

HIV-1CRF08_BC is the most prevalent epidemic subtype among heterosexual (HET) and intravenous drug users (IDUs) in Kunming, Yunnan. Using the pol region of gene sequences derived from molecular epidemiological surveys, we developed a molecular transmission network for the purpose of analyzing its epidemiological characteristics, assessing its epidemiological trends, identifying its potential transmission relationships, and developing targeted interventions. HyPhy 2.2.4 was used to calculate pairwise genetic distances between sequences; GraphPad-Prism 8.0 was employed to determine the standard genetic distance; and Cytoscope 3.7.2 was applied to visualize the network. We used the network analysis tools to investigate network characteristics and the Molecular Complex Detection (MCODE) tool to observe the growth of the network. We utilized a logistic regression model to examine the factors influencing clustering and a zero-inflated Poisson model to investigate the factors influencing potential transmission links. At the standard genetic distance threshold of 0.008, 406 out of 858 study participants were clustered in 132 dissemination networks with a total network linkage of 868, and the number of links per sequence ranged from 1 to 19. The MCODE analysis identified three significant modular clusters in the networks, with network scores ranging from 4.9 to 7. In models of logistic regression, HET, middle-aged and elderly individuals, and residents of northern and southeastern Kunming were more likely to enter the transmission network. According to the zero-inflated Poisson model, age, transmission category, sampling year, marital status, and CD4(+) T level had a significant effect on the size of links. The molecular clusters in Kunming's molecular transmission network are specific and aggregate to a certain extent. HIV-1 molecular network analysis provided information on local transmission characteristics, and these findings helped to determine the priority of transmission-reduction interventions.

Heterosexuals have become the most prevalent group of HIV-1 in Kunming, Yunnan Province. Utilizing the principle of genetic similarity between their gene sequences, we built a molecular transmission network by gathering data from earlier molecular epidemiological studies. This allowed us to analyze the epidemiological features of this group and offer fresh concepts and approaches for the prevention and management of HIV-1 epidemics. Cytoscope was used to visualize and characterize the network following the processing of the sample gene sequences by BioEdit and HyPhy. The number of possible links and the size of the clusters were investigated as influencing factors using a zero-inflated Poisson model and a logistic regression model, respectively. A scikit-learn-based prediction model was developed to account for the dynamic changes in the HIV-1 molecular network. Six noteworthy modular clusters with network scores ranging from 4 to 9 were found from 150 clusters using Molecular Complex Detection analysis at a standard genetic distance threshold of 0.01. The size of the number of possible links and the network's clustering rate were significantly impacted by sampling time, marital status, and CD4+ T lymphocytes (all p < 0.05). The gradient boosting machine (GBM) model had the highest area under the curve value, 0.884 ± 0.051, according to scikit-learn. Though not all cluster subtypes grew equally, the network clusters were relatively specific and aggregated. The largest local transmission-risk group for HIV-1CRF08_BC is now the heterosexual transmission population. The most suitable model for constructing the HIV-1 molecular network dynamics prediction model was found to be the GBM model.

Objectives: There is conflicting data regarding the response of older people with HIV (PWH) to antiretroviral therapy (ART). The objective of this study was to evaluate the long-term immunological and virological responses, changes in regimen, and adverse drug reactions (ADRs) in older participants (50+ years) compared with younger (18–34 years) and middle-aged (35–49 years) PWH. Methods: A retrospective review of medical records was conducted on 1622 participants who received ART in Yunnan Province, China, from 2010 to 2019. The study compared CD4 + T-cell counts, CD4 + /CD8 + ratio, and relative numbers between different groups using the Kruskal–Wallis test. Cox proportional hazards regression models were used to identify variables associated with the occurrence of immune reconstitution insufficiency. The rates of immune reconstitution, incidence of ADRs, and rates of treatment change were analyzed using the chi-squared test or Fisher's exact test. Results: Over 95% achieved viral load 200 copies/ml or less, with no age-related difference. However, older participants exhibited significantly lower CD4 + T-cell counts and CD4 + /CD8 + recovery post-ART ( P < 0.001), with only 32.21% achieving immune reconstitution (compared with young: 52.16%, middle-aged: 39.29%, P < 0.001) at the end of follow-up. Middle-aged and elderly participants changed ART regimens more because of ADRs, especially bone marrow suppression and renal dysfunction. Conclusion: Although the virological response was consistent across age groups, older individuals showed poorer immune responses and higher susceptibility to side effects. This underscores the need for tailored interventions and comprehensive management for older patients with HIV.

OBJECTIVE:Our objective was to evaluate the trajectory of immunology in patients with HIV with different baseline CD4 T-cell count strata after antiretroviral therapy (ART) under long-term viral suppression. METHODS:This was a sub-analysis focused on patients with virological suppression for at least 5 years after ART. Data were obtained from the Yunnan HIV cohort in China. Patients were categorized according to prespecified baseline CD4 T-cell counts. The trajectories of CD4 T-cell count, CD8 T-cell count, and CD4/CD8 ratio changing over time were fitted using a B-spline regression model. The Cox proportional hazards regression model was used to assess the association of baseline CD4 T-cell count with the risk of both immunological responder (IR) and CD4/CD8 ratio normalization. RESULTS:A total of 2618 patients with a median follow-up of 7.25 years (interquartile range [IQR] 5.92-8.75) were included. Over a period of 12 years, the mean CD4 T-cell count remained above 500 cells/μL in all groups. The mean CD4/CD8 ratio was solely normalized in patients whose baseline CD4 T-cell counts were above 350 cells/μL. Patients with higher baseline CD4 T-cell counts showed higher risks of both IR and CD4/CD8 ratio normalization than those with the lowest (all p trend <0.001). A higher baseline CD4 T-cell count predicted a shorter time for both IR and CD4/CD8 ratio normalization. CONCLUSIONS:Long-term, sustained viral suppression may not be able to fully normalize immunological functions in patients with HIV. A high baseline CD4 T-cell count benefits IR and CD4/CD8 ratio normalization.

•Inactivated vaccine breakthrough infection with ancestral variants induced nearly undetectable nAbs against XBB variants.•Inactivated vaccine breakthrough infection with Omicron BA.1 or BA.5 evoked very weak nAbs against XBB variants.•BA.5 infection induced higher nAbs against XBB variants than BA.1 infection.

云南省是受艾滋病影响较严重的省份之一,HIV感染者基数大,吸毒人群、外出务工人群、涉边婚姻人群占比较大.为深入推进云南省防治艾滋病工作,有效遏制艾滋病的传播与蔓延,云南省委省政府将艾滋病防治工作作为"人民战争"实施.本研究对云南省第四轮防治艾滋病人民战争(2016-2020年)艾滋病抗病毒治疗工作开展情况进行研究,提炼经验成效,总结困难和不足,为下一阶段云南省艾滋病抗病毒治疗工作的开展提出建议.