Oral diseases are prevalent and linked to systemic health outcomes. People with HIV may face elevated oral disease risk, yet data on dental disease in this population remain limited. In this cross-sectional study, we analyzed oral health data collected from 2927 participants in the MACS/WIHS Combined Cohort Study (968 women with HIV [WWH], 450 women without HIV [WWoH], 941 men with HIV [MWH], 568 men without HIV [MWoH]) who had intraoral photographs collected and evaluated by dentist-researchers. We used log-binomial regression to examine associations between demographic and clinical characteristics and two outcomes: missing teeth and untreated caries or residual roots, stratified by sex. Among 2927 participants (median [interquartile range, IQR] age: WWH, 55.3 years [48.3–61.6]; WWoH, 53.3 [44.8–60.3]; MWH, 55.1 [42.6–62.9]; MWoH, 62.9 [50.1–69.5]), women experienced a higher prevalence of tooth loss and untreated decay than men. Among participants aged 65 years or older, 15

Hepatitis B virus (HBV) infection disproportionately affects people with HIV (PWH) due to shared transmission routes. Data from the 1990s-2010s showed that 5-10% of PWH had chronic HBV in the United States. In the past decade, broader use of HBV-active and inactive antiretroviral therapy (ART), improved HBV vaccinations, and increasing intravenous drug use (IDU) may have changed the landscape of HBV infection in PWH and people without HIV (PWoH), but this has not been well studied. This study aimed to describe the prevalence of HIV/HBV coinfection among participants enrolled across 13 U.S. MACS/WIHS Combined Cohort Study (MWCCS) clinical research sites. Between 11/2020 and 3/2024, participants underwent serologic testing for HBV. We defined a positive result for HBsAg (surface antigen) as a current infection; negative HBsAg and positive anti-HBV core antibody (anti-HBc) as past infection; and both negative HBsAg and anti-HBc as never infection. We used the Chi-squared or Fisher’s exact test to compare categorical variables and the Kruskal-Wallis test for continuous variables among three HBV serogroups.Figure 1:Age group distribution of all participants stratified by Hepatitis B (HBV) serologic status Among 2130 participants, HIV seropositivity was associated with higher rates of current (PWH 3.1% vs. PWoH 1.7%) and prior HBV infection (PWH 28% vs. PWoH 23%, P=0.006) (Table 1). Current HBV infection was more common in men (3.9% in males and 1.7% in females) and those in the 40-59 age group (3.8% in the 40-49 age group and 2.8% in the 50-59 group) (Figure 1). Prior HBV infection was associated with higher rates of substance use, especially injection drug use, and having been infected with hepatitis C (Table 1B). Among PWH, current HBV infection was more common in men than women (4.7% vs. 1.7%, Table 2A). HIV suppression, CD4 count and nadir, and HBV-active ART use were similar among PWH across HBV categories (Table 2B). In PWH who never had HBV infection, 39% did not have immunity against HBV. The prevalence of HIV/HBV coinfection in this selected group of the MWCCS cohort is 3.1%, lower than previously reported in the 1990s-2010s. Male participants in the age group of 40-59 years are at higher risk for current HBV infection. Our study also highlights the need to screen for HBV immunity in people who never had HBV but are at risk for HBV infection. Jennifer C. Price, MD, PhD, AbbVie: Grant/Research Support|Gilead: Grant/Research Support|VIR: Grant/Research Support Maria L. Alcaide, MD, Gilead: Advisor/Consultant Valentina Stosor, MD, American Physician Institute: Honoraria|CDC: Grant/Research Support Bernard JC Macatangay, MD, Merck: Grant/Research Support

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.

Background:This study aimed to examine the prevalence of hepatitis B virus (HBV) in people with HIV (PWH) undergoing contemporary antiretroviral therapy and people without HIV and to understand the risk factors in people with HIV/HBV coinfection. This retrospective cross-sectional study included 5238 participants with HIV or at risk for HIV acquisition across 13 US sites in the MACS/WIHS Combined Cohort Study (Multicenter AIDS Cohort Study / Women Interagency HIV Study) between January 2018 and December 2024. Methods:The primary outcome was the prevalence of HBV infection and HIV/HBV coinfection. We defined a positive HBsAg (surface antigen) as chronic HBV infection, a negative HBsAg and positive anti-HBV core antibody as recovered infection, and a negative HBsAg and negative anti-HBV core antibody as never infection. The prevalence of chronic and recovered HBV infection was described in different risk groups. Results:In this cohort, the overall prevalence of chronic HBV was 2.4%, and HIV/HBV coinfection was 3.0% among PWH. Current and prior HBV infection was more common in men, and the prevalence of prior HBV increased with age. As compared with the other 2 groups, PWH with chronic HBV infection had lower CD4+ T-cell counts (567 vs 651 and 689 cells/µL), CD4+ T-cell nadirs (210 vs 245 and 258 cells/µL), and HIV viral suppression rate (71.7% vs 82.3% and 83.7%). Among PWH who never had HBV infection, 40.6% lacked seroprotection against HBV. Conclusions:HBV is still prevalent in PWH. HBV coinfection was associated with lower CD4+ T-cell counts and viral suppression rate in PWH. The low seroprotection rate in those without HBV underscores the need for improved screening and immunization.

This JAMA Insights discusses evidence-based updates to guidelines surrounding taking antiretroviral drugs during pregnancy and infant feeding for individuals with HIV.

HIV prevention efforts in the US have primarily focused on men who have sex with men, limiting pre-exposure prophylaxis (PrEP) awareness and uptake among women. This study examines PrEP use among reproductive-age women without HIV (WWOH) enrolled in the Study of Treatment and Reproductive Outcomes (STAR), the largest cohort of reproductive-age women in the Southern US. STAR is a longitudinal cohort of reproductive-age WWOH (eligible if aged 18-45 years and risk factors for HIV) in six cities (Miami, FL; Atlanta, GA; Chapel Hill, NC; Washington, DC; Birmingham, AL; Jackson, MS). Demographics, medical history, STI/HIV history, and PrEP use were self-reported. STI/HIV were assessed using commercially available tests. Among 362 WWOH eligible for PrEP, 36 (9.9%) reported ever using PrEP (24 current use and 12 prior use). Of those on PrEP who reported PrEP source, 6 obtained it through a clinical study, 12 from a healthcare provider, and 1 from non-medical sources. All participants who reported PrEP use had used tenofovir disoproxil/emtricitabine. Women who reported ever using PrEP were older (35 vs 31 years, p=0.001); the majority lived in Miami (53%, p=0.001); identified as non-Hispanic Black (66%, p=0.163); had an earlier sexual initiation (14.0 vs 15.8 years, p=0.004); reported more lifetime partners (34 vs 10, p=0.003); and had engaged in transactional sex in the prior 5 years (22% vs 10%, p=0.047). Though current STI rates (gonorrhea, chlamydia, syphilis, and trichomoniasis) did not differ by PrEP use, prior syphilis and chlamydia were higher among those who had ever used PrEP (19% vs 4.3%, p=0.002 and 58% vs 34%, p=0.007). Reasons to discontinue PrEP included medication cost (12, 100%), provider access (12, 100%), and periodic use (12, 100%). Despite high vulnerability to HIV among reproductive-age women in the Southern US, PrEP use was low in this sample, and discontinuation high. Affordable and accessible novel modes of PrEP delivery, and investigation on bundling HIV PrEP with DoxyPEP are urgently needed to promote access, uptake, and sustainment of PrEP use among young women. Daniel Westreich, PhD, Sanofi-Pasteur: Advisor/Consultant Maria L. Alcaide, MD, Gilead: Advisor/Consultant

BACKGROUND:Integrase strand-transfer inhibitors (INSTIs) are associated with weight gain in people with HIV (PWH), particularly in women with HIV (WWH), but underlying mechanisms remain unclear. We used longitudinal untargeted metabolomics to identify metabolic signatures of INSTI-related weight gain in WWH. METHODS:We analyzed serum from 192 participants in the Women's Interagency HIV Study: 38 virologically suppressed WWH who initiated INSTIs (INSTI group), 88 virologically suppressed WWH who remained on their original antiretroviral therapy (non-INSTI group), and 66 women without HIV (WWoH). Samples were collected at baseline (6-12 months before INSTI initiation), 1-6 months post-initiation, and 1-2 years post-initiation, with matched visits for controls. High-resolution metabolomics was performed by liquid chromatography-mass spectrometry. Within each group, linear mixed-effects models adjusted for baseline age and BMI compared longitudinal metabolite changes between weight gainers and maintainers, and significant features were analyzed by Mummichog v2.0 pathway enrichment. RESULTS:Mean age was 45.7 ± 8.9 years and mean BMI 32.4 ± 8.3 kg/m2, with no differences across groups; within each group, gainers and maintainers were demographically comparable (p > 0.05). In the INSTI group, metabolites differentiating gainers from maintainers were enriched in 16 pathways across timepoints, predominantly lipid-related (56%), including the polyunsaturated fatty acid (PUFA) pathways linoleic acid and arachidonic acid metabolism. In the non-INSTI and WWoH groups, differentiating metabolites spanned a broader range of pathways, including amino acid metabolism. CONCLUSIONS:Weight gain among INSTI-treated WWH is characterized by a distinct, lipid- and PUFA-dominated metabolic profile, providing mechanistic insight that may inform therapeutic strategies.

Background:Despite increased access to antiretroviral therapy (ART) for women with HIV (WWH), poor postpartum HIV care retention persists. This analysis evaluates Intimate Partner Violence (IPV) and ART adherence in pregnant WWH. Methods:We analyzed secondary data from a US behavioral intervention trial to improve postpartum retention in WWH. Data were collected from the baseline survey including the Edinburgh Postnatal Depression Scale (EPDS), adverse childhood experiences (ACE), and HIV-related stigma scores, and the WHO Violence Against Women questionnaire to assess IPV. A multivariable logistic regression examined associations between IPV timing (before, during pregnancy, any) and type (physical, psychological, sexual) and ART adherence (≥80% ART doses in the prior month). Results:A total of 137 pregnant WWH enrolled between March 2020 and March 2024 were included: mean age was 30.5 (SD 5.6); 83% were Black, 14% Hispanic; mean number of pregnancies was 3.3 (SD 2.1). Depression, stigma, and ACEs were prevalent: EPDS scores of ≥10 were seen in 45% of women, ≥4 ACEs in 23%, and 51% reported HIV-related shame. Forty women (29%) reported IPV exposure. Higher EPDS, ACE, and stigma scores were seen in women exposed to IPV (P < .02). Physical IPV during pregnancy had the strongest association with decreased ART adherence in pregnancy (adjusted odds ratio = 0.10, P = .02). Psychological IPV and any IPV type during or before pregnancy were also associated with lower odds of adherence. Conclusions:We found high IPV rates and a significant negative association with ART adherence among pregnant WWH highlighting the importance of addressing IPV in HIV care.

BACKGROUND:Integrase strand transfer inhibitors (INSTIs) are associated with body weight gain. We evaluated the association between plasma concentrations of dolutegravir (DTG), raltegravir (RAL), and elvitegravir (EVG) and body weight change in women with HIV (WWH). METHODS:We analyzed data from 2006 to 2017 among virologically suppressed (<200 copies/ml) WWH in the Women's Interagency HIV Study who switched or added either RAL, DTG, or EVG to their antiretroviral therapy (ART). Percent weight change was determined from weights collected 6-12 months before and after INSTI switch/add. Sparse plasma concentrations were measured 6-12 months after switch/add using LC/MS-MS assays. Area under the curve (AUC) was estimated from published models, refined using plasma concentrations. Linear models assessed the association between plasma concentration or AUC and weight change for each INSTI. RESULTS:176 WWH contributed plasma concentrations with an average follow-up of 1.5 years; 24% were on RAL, 49% on DTG, and 27% on EVG. Mean age was 50 years, 63% Non-Hispanic Black, and average BMI was 31.1 kg/m 2 . Weight gain averaged +2.4% in those reporting RAL, +3.1% for DTG, and +4.0% EVG. RAL concentration was associated with weight gain ( P = 0.0291, FDR = 0.0582), but no AUC or other drug concentration associations were found. CONCLUSION:Higher RAL plasma concentrations were only modestly associated with percent body weight gain in WWH, unlike DTG or EVG. These findings do not suggest a consistent exposure-response relationship between INSTI concentrations and weight gain.

Syphilis is resurging among reproductive-age women in the United States. Among 773 women with and without HIV enrolled in the Study of Treatment and Reproductive Outcomes (STAR), 2.9% had prior/current syphilis, including 1 pregnant participant. Factors associated with prior/current syphilis included lower education, unemployment, incarceration history, and history of transactional sex.

HIV Molecular Epidemiology (HME) uses viral genetic pol sequences to identify transmission networks and guide public health responses. While HME offers promises for addressing rapid or ongoing HIV transmission, concerns about privacy, informed consent, and potential criminalization have limited community trust and hindered widespread implementation. This study aims to explore the perceptions of public health officials (PHOs) and priority populations to inform community-centered HME practices.Characteristics of public health officials (PHOs)HME = HIV molecular epidemiologyDemographics of priority populationsMSM = men who have sex with men, TGW = transgender women, PrEP = pre-exposure prophylaxis, HME = HIV molecular epidemiology We conducted virtual focus groups discussions (FGD) with PHOs and Black cisgender women, Black and Latino men who have sex with men (MSM), and Latina/Latino transgender women (TGW) in Metropolitan Atlanta using a community-engaged, multi-method design. Participants were recruited in partnership with local trusted community-based organizations and prior to each FGD, watched a video explaining HME. Discussions explored (1) perceptions on HME, (2) key attributes for PHOs involved in HME, (3) HME-related training for PHOs, (4) HME communication practices, and (5) ethical HME practice. Data were analyzed using descriptive statistics and reflexive thematic analysis. Key considerations that emerged in discussions about HME with public health officials (PHOs) and priority populations The first column represents the five domains defined for the thematic analysis of qualitative data. The following columns list key HME-related perceptions and perspectives of PHOs and members of priority populations who participated in the research, organized by qualitative domains, with representative quotes in italics and converging views placed in between We conducted 18 FGDs among 92 research participants (Figure 1, Table 1). Our data showed that (1) HME holds promise for outreach and linkage but must overcome community mistrust tied to privacy, stigma, and criminalization fears; (2) lived experience, cultural understanding, and empathy must guide HME; (3) PHOs’ HME training must integrate trauma-informed care, privacy protections, community voices, and continuous skill-building; (4) simple, relatable communication and relationship-building are necessary for meaningful community engagement with HME, and that (5) ethical HME requires consent and dialogue, given existing fears about data misuse (Figure 2). Community-centered HME depends on transparency, individual agency, cultural sensitivity, engagement, and commitment. Strengthening trust requires centering lived experience, protecting privacy, enhancing current PHO training, and communicating HME-related information clearly. These elements are necessary for the successful implementation of HME in outreach, linkage, and public health equity. All Authors: No reported disclosures

Women with HIV (WWH) have up to five times higher risk for cardiovascular disease compared to age-matched women without HIV, and this risk is pronounced in reproductive-aged women. Pregnancy promotes systemic inflammation, leading to remodeling of the heart’s structure and changes in function during and after pregnancy; therefore, we sought to examine the association of pregnancy history and number of live births with changes in cardiac structure and function in women with and without HIV (WWoH). Cross-sectional data from the Multicenter AIDS Cohort Study/Women’s Interagency HIV Study Combined Cohort Study (MWCCS) were analyzed using univariate and multivariable logistic and linear regression models. Data from participants with echocardiograms conducted during or after their last pregnancy were included. The association between echocardiographic parameters and ever having had a live birth and number of live births was examined by HIV status. Of 1,646 women (1,156 WWH and 490 WWoH), 83

Women have reported abnormal uterine bleeding (AUB) during the COVID-19 pandemic. Evaluating AUB among women living with HIV (WWH) and women without HIV (WWoH) during the COVID-19 pandemic is key to understanding reproductive health in the setting of viral co-infections. From 2021 to 2023, the Study of Treatment and Reproductive Outcomes (STAR) collected cross-sectional data from WWH and WWoH 18–45 years-of-age across the southern United States without conditions known to interfere with menses. Women completed surveys on COVID-19 testing, COVID-19 vaccination, AUB (spotting, missed periods, early/late periods), stress, and demographics. We tested plasma from participants at two study sites for COVID-19 antibodies. We defined “prior SARS-CoV-2 infection” as having detectable anti-nucleocapsid antibodies or a self-reported positive COVID-19 test. We examined AUB in association with COVID-19 vaccination and infection stratified by HIV status. Among 188 eligible women, 61

BackgroundDigital cognitive assessments are increasingly used in large-scale studies to assess brain health, offering scalable, standardized, and self-directed testing solutions. Cognitive function remains a concern for people with HIV despite antiretroviral therapy. The BRACE (BrainBaseline Assessment of Cognition and Everyday Functioning) is a validated tablet-based screener for cognition in people with HIV. Preliminary pilot norms were established in a small sample (n=144), but full regression-based normative data have not yet been developed. Consequently, HIV serostatus differences based on standardized BRACE scores and cognitive correlates have not been systematically examined. ObjectiveThis study aims to develop regression-based normative data for BRACE performance in people without HIV who were demographically and behaviorally comparable to people with HIV within biological sex; to examine differences in cognitive performance by HIV status and biological sex; and to evaluate sociodemographic, behavioral, and clinical correlates of BRACE performance. MethodsA total of 2937 participants (1063 people without HIV [499 women] and 1874 people with HIV [1053 women]) in the Multicenter AIDS Cohort Study/Women’s Interagency HIV Study Combined Cohort Study completed BRACE once between November 2020 and March 2025. BRACE includes the Trail Making Test (A and B), Stroop-Color, and visual spatial learning. Regression-based norms were derived from people without HIV using multiple demographic models (eg, age-only, age + education, and age + education + sex). The age + education model was selected for primary analyses because it provided the best balance of interpretability, parsimony, and generalizability while avoiding race-based corrections. HIV serostatus and sex differences were examined using ANOVA and χ2 tests, with effect sizes calculated using Cohen’s d. ResultsCognitive performance was largely comparable between people with HIV and people without HIV across all BRACE outcome measures. Statistically significant differences were very small in magnitude (all effect sizes<0.11) and primarily observed among men on Stroop-Color. Across groups, older age and fewer years of education were associated with poorer raw BRACE performance, although these associations attenuated after demographic adjustment using T-scores. Most clinical and behavioral factors (eg, hypertension, smoking, and noncannabis substance use) were related to poorer raw scores but not standardized performance. However, diabetes and cannabis use remained independently associated with T-scores across multiple measures—diabetes with poorer scores and cannabis use with higher scores, an association that should be interpreted cautiously. HIV-specific clinical factors, such as nadir CD4 count and antiretroviral therapy duration, were linked primarily to raw scores. ConclusionsThis study establishes the first regression-based normative data for BRACE, derived from a large, demographically diverse people without HIV, and demonstrates its applicability for evaluating cognitive function in people with HIV. Findings indicate minimal cognitive differences between people with HIV and people without HIV and highlight the influence of common sociodemographic and metabolic factors. These results support BRACE as a scalable, reliable, and self-administered digital tool for assessing cognitive health in diverse populations and underscore its potential for longitudinal monitoring and precision phenotyping in both research and clinical contexts.

Low-level viremia (LLV) remains common in the modern HIV treatment era. We sought to clarify a unified definition of LLV, examine current LLV risk factors, assess outcomes for people with LLV, explore sex and gender differences, and evaluate management updates for people who develop LLV. There continue to be varied definitions of LLV without standardization, making comparison of clinical research findings challenging. Potential LLV risk factors have expanded and early data suggest that poor antiretroviral therapy adherence is unlikely to be the cause of most LLV; further, integrase strand transfer inhibitor use may be protective. Recent studies confirm that LLV is associated with virologic failure among other negative outcomes including a trend toward development of non-AIDS comorbidities; these effects may be more pronounced among women. Additional research, including randomized clinical trials, evaluating different strategies for managing LLV is urgently needed to prevent negative outcomes in persons with HIV.

PURPOSE:The role of partners on an individual's cardiometabolic risk status in same-sex relationships is underexplored to date, despite significant health disparities impacting sexual minority individuals. This study investigated cardiometabolic risk concordance in same-sex older adult couples in the United States. METHODS:We conducted a pooled analysis of seven study waves of the University of Michigan Health and Retirement Survey (2006-2019) and estimated concordance of hypertension and overweight/obesity among same-sex couples. RESULTS:Among 81 same-sex couples, we observed high concordance of hypertension and overweight/obesity among sexual minority male couples (39 couples, hypertension: 72.4 %, overweight/obesity: 64.2 %) and sexual minority female couples (42 couples, hypertension: 61.0 %, overweight/obesity: 35.6 %). CONCLUSIONS:Our findings signify a need for longitudinal studies among same-sex couples to better characterize mechanisms of influence on partners' cardiometabolic health, as well as a potential role for couple-level interventions targeting cardiometabolic risk.

OBJECTIVES:To explore the prevalence of depressive symptoms and associated factors among reproductive-aged women participating in the Study of Treatment and Reproductive outcomes (STAR) cohort. DESIGN:Cross-sectional analysis. METHODS:We analyzed baseline data from women with HIV (WWH) and women without HIV (WwoH) but at risk for HIV enrolled in the STAR, a prospective observational cohort of reproductive-aged women in six Southern US states. We used the Center for Epidemiologic Studies Depression (CES-D) scale to measure depressive symptoms. Crude prevalence ratios were used to describe depressive symptoms by sociodemographic, substance use, psychological, and reproductive characteristics. RESULTS:A total of 473 WWH [median age 37, interquartile range (IQR): 32-42] and 286 WwoH (median age 32, IQR: 26-40) enrolled as of August 2023 in the STAR. Thirty-eight percentage of WWH and 34% of WwoH reported a CES-D score at least 16 (henceforth 'depressive symptoms'; WWH: median score 11, IQR: 5-21 and WwoH: median score 10, IQR: 6-21). Hazardous alcohol use and history of using crack/cocaine were each associated with increased prevalence of depressive symptoms. The prevalence of depressive symptoms rose with each one standard deviation increase in loneliness, perceived stress, and lack of neighborhood safety. In contrast, we found a lower prevalence of depressive symptoms with increasing resilience and social support scores. CONCLUSION:Depressive symptoms are common among reproductive-aged women regardless of HIV status. Future analyses will help to confirm these initial findings and begin to identify intervention targets to alleviate depressive symptoms.