Objectives The proportion of foreigners among newly diagnosed people with HIV in Taiwan has steadily increased. We evaluated HIV care quality indices among foreigners with HIV (FWH) and explored associated factors. Methods FWH who first sought care at 10 Taiwanese hospitals between 2017 and 2023 were included. Information on AIDS at presentation, antiretroviral therapy (ART) prescription, care retention, and viral suppression was collected. Factors associated with these indices were analyzed using logistic regression and Cox proportional hazards models. Results We included 144 FWH (median age of 32 years); 74.3% were from Southeast Asia. Overall, 58.3% remained in care at 1 year. Among 94 ART-naïve individuals, 47.9% presented with AIDS and 83.0% initiated ART; however, only 42.6% achieved viral suppression at 1 year. In multivariable analysis, white-collar occupations (vs blue-collar or unemployed) were associated with ART initiation (adjusted odds ratio [aOR], 5.481), while opportunistic infections decreased the odds (aOR, 0.284). ART prescription predicted care retention (adjusted hazard ratio, 6.03), and government-subsidized ART (vs self-funded ART) was linked to higher viral suppression rates (aOR, 3.817). Conclusions Substantial gaps in the HIV care cascade were observed among FWH in Taiwan. Strategies to promote earlier diagnosis and improve care retention are urgently needed.

BACKGROUND:Once-daily, single-tablet regimens have transformed care for persons living with human immunodeficiency virus type 1 (HIV-1); however, challenges to adherence continue to limit effective treatment. Long-acting oral-drug combinations could offer new options with less frequent dose administration. METHODS:We conducted a phase 3, double-blind, randomized, active-controlled, noninferiority trial in 12 countries to evaluate the efficacy and safety of a switch to once-weekly oral islatravir-lenacapavir (ISL/LEN) from once-daily oral bictegravir-emtricitabine-tenofovir alafenamide (B/F/TAF) in adults in whom HIV-1 had been virologically suppressed for at least 6 months while they were receiving B/F/TAF. Participants were assigned in a 1:1 ratio to receive once-weekly ISL/LEN (2 mg/300 mg) or to continue once-daily B/F/TAF for 96 weeks; all received matched placebo for the alternative regimen. The primary end point was the percentage of participants with an HIV-1 RNA level of 50 copies per milliliter or higher at week 48, as determined by the Food and Drug Administration-defined snapshot algorithm. Noninferiority was determined at a margin of 4 percentage points. RESULTS:A total of 607 participants underwent randomization; 304 were assigned to the ISL/LEN group and 303 to the B/F/TAF group. A total of 21% of the participants were women, 31% were Black, 26% were Hispanic or Latine, and 15% were 65 years of age or older. At week 48, an HIV-1 RNA level of 50 copies per milliliter or higher was reported in no participants in the ISL/LEN group and 1 (0.3%) in the B/F/TAF group (difference, -0.3 percentage points; 95.002% confidence interval [CI], -1.4 to 0.8); an HIV-1 RNA level of less than 50 copies per milliliter was reported in 284 (93.4%) and 280 (92.4%), respectively (difference, 1.0 percentage point, 95% CI, -3.2 to 5.2). The mean change in the CD4+ T-cell count at week 48 was -10 cells per microliter with ISL/LEN and -18 cells per microliter with B/F/TAF (least-squares mean difference, 12 cells per microliter; 95% CI, -16 to 39). The trial regimen was discontinued owing to adverse events in 6 participants (2.0%) in the ISL/LEN group and 5 (1.7%) in the B/F/TAF group; serious adverse events occurred in 16 (5.3%) and 14 (4.6%), respectively. CONCLUSIONS:Among persons with virologically suppressed HIV-1, once-weekly oral ISL/LEN was noninferior to once-daily B/F/TAF in maintaining HIV viral load suppression. (Funded by Gilead Sciences and Merck Sharp and Dohme; ISLEND-1 ClinicalTrials.gov number, NCT06630286.).

Men who have sex with men (MSM) with HIV are disproportionately affected by persistent human papillomavirus (HPV) infections and related anogenital cancers. No controlled trial has evaluated the efficacy of the nonavalent HPV vaccine (9vHPV) in this population. This prospective, controlled cohort study offered eligible MSM with HIV a 3-dose 9vHPV series and followed both the vaccinated group (vaccinees) and the unvaccinated group (controls). Anal specimens were collected for HPV genotyping, cytology, and microbiota profiling. The primary outcomes were the clearance and incidence of 9vHPV-covered HPV types. Baseline vaccine-type HPV prevalence was 41.0% in vaccinees (n = 39; median age, 33 y; median CD4, 682/μl) and 39.3% in controls (n = 56; median age, 35 y; median CD4, 679/μl) (P = .865). At month 3, 75.0% of vaccinees with prevalent HPV infection had cleared at least one genotype, and 85.7% of those with abnormal baseline cytology experienced regression. However, clearance rates (per 1000 person-months) were 46.3 (vaccine type) and 56.0 (non-vaccine type) in vaccinees versus 64.1 and 91.8 in controls (P = .456 and 0.371). HPV incidence was 19.5 (vaccine type) and 15.1 (non-vaccine type) in vaccinees versus 12.4 and 12.4 in controls (P = .378 and 0.710). 9vHPV vaccination was not associated with enhanced clearance (aHR, 0.27; 95% CI, 0.11-0.68) or decreased incidence of vaccine-type HPV (aHR, 0.44; 95% CI, 0.11-1.82). No significant differences were observed in anal dysplasia regression or anal microbiota composition over 12 months. Given the lack of short-term secondary benefit and persistence of HPV incidence, MSM with HIV require continued routine anal cancer screening.

Background:Both ceftriaxone (CRO) and doxycycline demonstrate activity against Treponema pallidum and bacteria causing sexually transmitted infections (STIs); however, the efficacy of their combination in a shorter duration remains unclear. We compared single-dose, 1-g CRO plus 7-day doxycycline (CRO/Doxy) with single-dose, 2.4-MU benzathine penicillin G plus 7-day doxycycline (BPG/Doxy) in treating early syphilis among people with HIV (PWH). Methods:In this pilot randomized clinical trial, eligible participants were randomized to receive CRO/Doxy or BPG/Doxy. Rapid plasma reagin (RPR) titers were determined at baseline and at weeks 4, 12, 24, 36 and 48. PCR assays were conducted at baseline and at week 4 to detect T. pallidum and other STI-causing bacteria in oral rinse, urethral swab, and rectal swab samples to assess microbiologic responses. The primary outcome was the serologic responses of syphilis, defined as a 4-fold or greater decline of RPR titer at week 24. Results:From March 2023 to September 2024, 56 and 53 PWH with early syphilis were randomized to receive CRO/Doxy and BPG/Doxy, respectively. At baseline, 31.2% (n = 34) had chlamydia, 13.8% (n = 15) gonorrhea, and 6.4% (n = 7) Mycoplasma genitalium coinfection. In the ITT analysis, compared to the participants receiving BPG/Doxy, those receiving CRO/Doxy showed a lower serologic response rate at 24 weeks (60.7% vs 75.5%; difference, -14.8 percentage points; 95% CI, -32.0 to 2.5). The microbiologic response rates of syphilis, chlamydia, and M. genitalium infection were comparable between groups. Conclusions:In the ITT analysis, CRO/Doxy was not noninferior to BPG/Doxy for early syphilis treatment among PWH at 24 weeks.

OBJECTIVES:Taiwan's universal infant hepatitis B virus (HBV) vaccination (1984-1986) and sanitation-driven loss of childhood hepatitis A virus (HAV) exposure have reshaped hepatitis immunity. During a 2025-2026 hepatitis A resurgence, joint susceptibility to vaccine-preventable hepatitis among people with HIV (PWH) and HBV serology of those starting tenofovir-sparing antiretroviral therapy (ART) remain undescribed. METHODS:We categorized 1202 adults newly diagnosed with HIV at six hospitals in Taiwan during 2018-2024 into eight 5-year birth cohorts. Multivariable logistic regression identified predictors of HAV susceptibility and the HBV-susceptible pattern (HBsAg, anti-HBs, anti-HBc all negative). HBV serology of tenofovir (TFV)-sparing ART initiators was characterized. RESULTS:Among 1055 PWH with complete HAV and HBV serology, immunity to both fell from 60.7% (<1970) to 10.0% (≥2000), while dual susceptibility rose from 4.5% to 41.7% (peak 46.5%, 1995-1999; P < 0.001). HBsAg positivity declined from 17.4% to 1.6% and anti-HAV seropositivity from 74.5% to 11.3% (both P < 0.001). Of 22.8% starting TFV-sparing ART, 43.0% were HBV-susceptible, and one had chronic HBV. CONCLUSION:A widening immunity gap in younger PWH reflects HBV vaccination and lost childhood HAV exposure. Systematic screening, immune-status-tailored vaccination, and HBV-informed ART selection at HIV diagnosis are warranted irrespective of perceived vaccination status.

Data on bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in people with both HIV-1 and HBV are limited, particularly for treatment-experienced people. ALLIANCE was a randomized, double-blind, active-controlled, phase 3 study of B/F/TAF versus dolutegravir (DTG) + emtricitabine/tenofovir disoproxil fumarate (F/TDF) in treatment-naïve adults with HIV-1 RNA ≥ 500 copies/mL and HBV DNA ≥ 2000 IU/mL. Participants received continuous B/F/TAF through 144 weeks (≥ 96 weeks of blinded treatment plus 48-week optional open-label extension [OLE]) or switched to B/F/TAF after ≥ 96 weeks of DTG + F/TDF through 48 weeks of OLE. Here we report outcomes from the OLE. 121 participants were included in the continuous B/F/TAF group; 89 in the switch group. Median B/F/TAF exposure was 186.4 and 48 weeks, respectively. HIV-1 and HBV suppression rates (missing = excluded) were maintained in both groups (B/F/TAF Week 144: 99.0

BICtegravir Single Tablet Regimen is a multiregional, observational cohort study assessing the effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in treatment-naïve (TN) and treatment-experienced (TE) people with HIV. We present 24-month data for the BICtegravir Single Tablet Regimen Asia cohort. Between December 2020 and March 2024, prospective and retrospective data were collected from TN and TE people with HIV receiving B/F/TAF in routine clinical care in the Republic of Korea, Singapore, and Taiwan. Endpoints at month 24 included effectiveness (HIV-1 RNA <50 copies/mL; missing = excluded and discontinuation = failure analyses), immunological endpoints (CD4 cell count and CD4/CD8 ratio), persistence, safety, and patient-reported outcomes (prospective cohort). Overall, 334 participants (252 prospective, 82 retrospective; 66 TN, 268 TE) were included in the analysis population. Most were male (97% TN, 93% TE) with ≥1 comorbidity (56% TN, 67% TE). At month 24, HIV-1 RNA was <50 copies/mL in 91% (50/55) of TN and 97% (225/331) of TE participants (missing = excluded analysis). Median (quartile [Q]1, Q3) CD4 count increased by +260 (155, 386; P < .001) cells/μL in TN and +40 (-65, 150; P = .008) cells/μL in TE participants. Median (Q1, Q3) CD4/CD8 ratio increased by +0.38 (0.21, 0.48; P < .001) in TN and +0.08 (0.00, 0.19; P < .001) in TE participants. Patient-reported outcomes indicated an improvement in mental health and a decrease in the number of bothersome symptoms in TN participants. Persistence at month 24 was high, with 98% (60/61) of TN and 97% (251/260) of TE participants remaining on B/F/TAF. Drug-related adverse events occurred in 9% (6/66) of TN and 8% (22/268) of TE participants, leading to B/F/TAF discontinuation in <1% (3/334) of participants, all of whom were TE. B/F/TAF demonstrated high levels of effectiveness, persistence, and tolerability over 24 months in people with HIV in Asia.

OBJECTIVES:Doxycycline post-exposure prophylaxis (DoxyPEP) has been shown to reduce the risk of syphilis and chlamydia among at-risk populations. The impact of DoxyPEP on the trends of Mycoplasma genitalium infection and resistance-associated mutations (RAM) has not been assessed in Taiwan. METHODS:From September 2021 to September 2025, people with recent sexually transmitted infections (STIs) or at risk of STIs were screened for STIs using a multiplex PCR assay and were consulted for the use of DoxyPEP at a university hospital. All specimens tested positive for M. genitalium were determined for RAMs to macrolides, fluoroquinolones, and tetracycline using an in-house PCR assay. RESULTS:During the study period, 325 DoxyPEP users were included. After the implementation of DoxyPEP, the detection rate of M. genitalium among all tests did not change (6.2% vs 5.7%, P = 0.64). The overall prevalence of M. genitalium infection remained stationary (12.0% vs 12.6%, P = 0.81). Fifty-six cases of M. genitalium infection were detected during the follow-up and the incidences of M. genitalium infection were similar before and after implementation of DoxyPEP (0.26 vs 0.29 per 1000 person-days; incidence-rate ratio 0.89, 95% CI, 0.51-1.57, P = 0.68). The prevalence of RAM to tetracycline increased from 10.0% to 24.1% (P = 0.28) and that of the parC mutation increased from 28.6% to 34.5% (P = 0.66), while the prevalence of RAM to macrolides decreased from 33.3% to 13.8% (P = 0.15). CONCLUSION:After the introduction of DoxyPEP for prevention of syphilis and chlamydia among high-risk populations, the prevalence and incidence of M. genitalium infection remained stable. The increasing trend of RAMs to tetracycline warrants continued surveillance.

BACKGROUND:Tenofovir-containing antiretroviral therapy (ART) improves survival in hepatitis B virus (HBV)-coinfected people with HIV (PWH). We investigated the incidence of hepatitis D virus (HDV) infection and its clinical impact in HBV-coinfected PWH in the era of tenofovir-containing ART. METHODS:Between 2011 and 2022, HBV-coinfected PWH were included and followed until December 2023. Anti-HDV antibody screening was performed using sequentially archived blood samples. Timing of incident HDV infection was estimated as the midpoint between the last timepoint of anti-HDV-negative samples and the first timepoint of anti-HDV-positive samples. Differences in survival and liver-related outcomes between HDV-infected and -uninfected PWH were analyzed. RESULTS:534 HBV-coinfected PWH were included; 36 (6.7%) tested HDV-seropositive at baseline. During 3987.78 person-years of follow-up (PYFU), 50 (10.0%) of 498 anti-HDV-negative PWH seroconverted for HDV, with an overall incidence rate of 12.54 per 1000 PYFU; 88.0% (44/50) of HDV seroconverters were men who have sex with men. After a median follow-up of 10.2 years (84.7% of the follow-up period covered by tenofovir-containing ART), all-cause mortality was 4.7% (25/534). PWH with HDV had significantly higher rates of liver-related mortality (3.5% vs 0.4%, P = .032), cirrhosis (11.3% vs 3.6%, P = .008), and hepatitis flare (28.2% vs 14.2%, P = .001) than HDV-uninfected PWH. In multivariate Cox analysis, HDV infection was associated with liver-related mortality (adjusted HR, 9.696; 95% CI, 1.284-73.222, P = .028). Risk of hepatocellular carcinoma was similar for HDV-infected and HDV-uninfected PWH. CONCLUSIONS:HBV-coinfected PWH remain at risk of HDV superinfection and HDV infection is associated with liver-related death in the era of tenofovir-containing ART.

BACKGROUND:The impact of long-term tenofovir-containing antiretroviral therapy (ART) on hepatitis B surface antigen (HBsAg) seroclearance in people with HIV (PWH) and HBV coinfection remains under-defined, particularly in HBV-hyperendemic regions with universal vaccination programs. METHODS:HBsAg-positive PWH receiving tenofovir-containing ART between 2011 and 2023 were followed until December, 2025. Demographics, HBV serologic markers, plasma HBV DNA, and liver fibrosis stage were collected. Cox proportional hazards models were used to identify factors associated with HBsAg seroclearance. Clinical and hepatic outcomes were compared by seroclearance status. RESULTS:After a median follow-up of 9.4 years, 35 (8.4%) of 415 PWH achieved HBsAg seroclearance during a total of 3,600 person-years of tenofovir-containing ART, corresponding to an incidence rate of 0.97 per 100 person-years. Among them, 37.1% (13/35) tested positive for anti-HBs at the time of seroclearance. In multivariable analysis, birth in universal neonatal HBV vaccination era (after July 1986) (adjusted hazard ratio [aHR] 13.56, 95% confidence interval [CI] 6.08-30.28, P<0.001), baseline HBsAg ≤250 IU/mL (aHR 7.36, 95% CI 3.29-16.50, P<0.001), and higher baseline ALT level (aHR 1.00 per 1-U/L increase, 95% CI 1.00-1.01, P<0.001) were independently associated with HBsAg seroclearance. None of PWH who achieved HBsAg seroclearance developed seroreversion, cirrhosis, or hepatocellular carcinoma, whereas 6.6% and 2.1% of PWH without seroclearance developed cirrhosis and hepatocellular carcinoma, respectively. CONCLUSIONS:Despite long-term tenofovir-containing ART, HBsAg seroclearance was uncommon (0.97% annually) among PWH with HBV coinfection. Birth in the neonatal HBV vaccination era and lower baseline HBsAg level were two independent predictors of HBsAg seroclearance.

BACKGROUND:There is a continued need to expand the repertoire of effective single-tablet regimens to address the diverse needs of people with HIV-1. We aimed to evaluate the safety and efficacy of switching to bictegravir-lenacapavir compared with continuing bictegravir-emtricitabine-tenofovir alafenamide in virologically suppressed people with HIV-1. METHODS:This double-blind, multicentre, randomised, controlled, phase 3, non-inferiority trial was conducted in 100 hospitals and HIV clinics across Argentina, Australia, Canada, Dominican Republic, Germany, Italy, Japan, Mexico, Puerto Rico, South Korea, Spain, Taiwan, the UK, and the USA. Eligible participants were aged 18 years or older, receiving bictegravir-emtricitabine-tenofovir alafenamide (for ≥6 months), and virologically suppressed (HIV-1 RNA <50 copies per mL for ≥6 months). Participants were randomly assigned (2:1) using an interactive response system (stratified by geographical region) to switch to bictegravir-lenacapavir (75-50 mg) or continue bictegravir-emtricitabine-tenofovir alafenamide (50-200-25 mg) once a day as single-tablet regimens for 48 weeks. The primary endpoint was the proportion of participants with HIV-1 RNA of 50 copies per mL or higher at week 48 (as per the US Food and Drug Administration Snapshot algorithm) assessed in the full analysis set (defined as all randomly assigned participants who received any dose of the study drug), with a non-inferiority margin of 4%. This trial is registered with ClinicalTrials.gov, NCT06333808 (active, not recruiting). FINDINGS:Between March 25 and Oct 30, 2024, 666 people with HIV-1 were assessed for eligibility, 89 were ineligible, and 577 were randomly assigned (384 to bictegravir-lenacapavir and 193 to continue bictegravir-emtricitabine-tenofovir alafenamide). 574 participants received at least one dose of the study drug (full analysis set). The median age was 49 years (IQR 39-58). 111 (19%) of 574 participants were female and 463 (81%) were male at birth. At baseline, the median duration of HIV-1 treatment was 12·0 years (6·5-18·7). At week 48, five (1·3%) of 383 participants in the bictegravir-lenacapavir group and two (1·0%) of 191 in the bictegravir-emtricitabine-tenofovir alafenamide group had HIV-1 RNA of 50 copies per mL or higher (percentage difference 0·3% [95·002% CI -1·9 to 2·4]), meeting the non-inferiority criteria. Drug-related adverse events occurred in 40 (10%) participants in the bictegravir-lenacapavir group versus 23 (12%) in the bictegravir-emtricitabine-tenofovir alafenamide group; and serious adverse events occurred in 27 (7%) versus 13 (7%), with none deemed related to treatment. One participant in the bictegravir-emtricitabine-tenofovir alafenamide group died due to coronary artery disease. INTERPRETATION:Bictegravir-lenacapavir has the potential to be a novel single-tablet antiretroviral regimen option for virologically suppressed people with HIV-1. FUNDING:Gilead Sciences.

OBJECTIVES:Since the 2022 global Mpox outbreak, vaccination programmes using the MVA-BN vaccines have been widely implemented. However, the durability of vaccine-induced immunity remains incompletely understood. METHODS:Men who have sex with men aged ≥18 years who completed two-dose MVA-BN vaccination were enrolled in a prospective vaccination cohort. Participants with PCR-confirmed Mpox were enrolled as a comparison cohort. Anti-A29 and anti-H3 IgG were determined serially up for 24 months after vaccination or Mpox diagnosis. The primary outcome was the proportion of participants remaining seropositive for the two antibodies at 2 years. Secondary outcomes included antibody kinetics, breakthrough infection, and serological evidence suggesting asymptomatic infection. RESULTS:A total of 452 participants were enrolled, including 425 in the vaccination cohort and 27 in the Mpox cohort. At 2 years after vaccination, anti-A29/anti-H3 IgG seropositivity was 19.5%/12.6% among people with HIV, 18.4%/9.2% among people without HIV, and 48.9%/51.1% among participants with prior smallpox vaccination. In addition, among participants with natural Mpox infection, 2-year seropositivity for anti-A29 and anti-H3 IgG was 18.2% and 72.7%, respectively. Prior smallpox vaccination and natural Mpox infection were independently associated with a lower risk of seroreversion. During follow-up, six breakthrough Mpox infections were identified at a median of 828 days after vaccination. Breakthrough cases generally presented with fewer extragenital lesions than unvaccinated cases, although severe disease still occurred. Twenty participants demonstrated ≥4-fold increases in both anti-A29 and anti-H3 IgG without compatible symptoms, suggesting asymptomatic infection. CONCLUSIONS:Humoral immunity after two-dose MVA-BN vaccination wanes over time, particularly among individuals without prior smallpox vaccination, whereas natural Mpox infection is associated with more durable Mpox virus-specific IgG responses. Breakthrough infections may occur more than 2 years after vaccination despite generally attenuated disease. These findings highlight the need for continued surveillance, consideration of booster vaccination strategies, and further investigation into immune correlates of protection against Mpox.

BACKGROUND:People using pre-exposure prophylaxis (PrEP) for HIV are at high risk of acquiring sexually transmitted infections (STIs). We aimed to assess the impact of doxycycline post-exposure prophylaxis (doxy-PEP) on the incidences of STIs among PrEP users in the real-world setting. METHODS:From February 2022 to November 2025, participants aged ≥18 years receiving HIV PrEP were prospectively enrolled. STI testing at baseline and follow-up included syphilis serology and multiplex real-time PCR assays for Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium. Beginning in November 2023, doxy-PEP was provided during follow-up visits. STI incidence rates before and after the first documented doxy-PEP prescription were compared within the same participants. RESULTS:A Total of 397 participants were included, with a median age of 32 Years. All participants were cisgender men; 90.9% Were men who have sex with men, 7.3% Were bisexual cisgender men And 1.8% Were heterosexual cisgender men. At enrolMent, 3.3% (13/397) Had reactive syphilis serology, 15.5% (60/386) Tested positive for C. trachomatis, 13.7% (53/386) For N. gonorrhoeae And 5.2% (20/386) For M. genitalium. Compared with the pre-doxy-pep period, the post-doxy-pep period had significantly lower incidence rates of syphilis (2.0 Vs 6.4 Per 100 person-years; incidence rate ratio (Irr) 0.3, 95% CI 0.1 To 0.8) And Chlamydia (8.8 Vs 31.9 Per 100 person-years; irr 0.3, 95% CI 0.2 To 0.4). No significant difference was observed for N. Gonorrhoeae Infection (21.0 Vs 26.3 Per 100 person-years; irr 0.8, 95% CI 0.6 To 1.1) Or M. genitalium Infection (12.7 Vs 9.5 Per 100 person-years; irr 1.3, 95% CI 0.8 To 2.3). CONCLUSION:In this real-world HIV PrEP cohort, doxy-PEP was associated with significant reductions of syphilis and chlamydia.

OBJECTIVES:To compare 12-month serologic responses to three benzathine penicillin G (BPG)-based regimens among people with HIV (PWH) and early syphilis. METHODS:We retrospectively included syphilis episodes treated with BPG, BPG plus 7-day doxycycline (BPG/doxycycline), or BPG/doxycycline plus single-dose ceftriaxone during 2018-2024. Episodes with baseline rapid plasma reagin (RPR) titers <1:4 or exposure to other Treponema pallidum-active antibiotics were excluded. Serologic response was defined as a ≥4-fold RPR decline at 12 months. Intention-to-treat (ITT) with last-observation-carried-forward and per-protocol analyses were performed. RESULTS:Among 1,077 episodes in 762 PWH, 453 received BPG, 570 BPG/doxycycline, and 54 BPG/doxycycline/ceftriaxone. ITT response rates were 74.6%, 83.2%, and 88.9%, respectively (P < .001); per-protocol rates were 74.4%, 83.4%, and 89.8% (P < .001). Higher baseline RPR titers and doxycycline-containing regimens were independently associated with response. In analyses directly comparing BPG/doxycycline with and without ceftriaxone, adding ceftriaxone to BPG/doxycycline was not significantly associated with a higher serologic response. CONCLUSIONS:BPG/doxycycline was associated with a higher likelihood of 12-month serologic response. The incremental association of ceftriaxone remained uncertain because of the small number of ceftriaxone-treated episodes.

OBJECTIVES:Lymphogranuloma venereum (LGV) caused by Chlamydia trachomatis genotypes L1-L3 has been resurging among men who have sex with men (MSM) and people with HIV (PWH) in Western countries. While historically attributed to tropical regions, rectal LGV has been rarely recognised in Asia, with Taiwan recently becoming the second Asian country to report cases. METHODS:A multicentre, laboratory-based surveillance was conducted from January 2020 to December 2023 in Taiwan. Specimens were collected from MSM through syndromic testing and screening of high-risk populations. C. trachomatis was identified using commercial multiplex PCR assays, with genotyping performed through ompA gene sequencing. LGV-positive samples underwent multilocus sequence typing (MLST) following established protocols. RESULTS:Among 446 C. trachomatis-positive samples, 391 (87.7%) underwent successful ompA sequencing. Genovariant L2b accounted for 9.7% of cases, predominantly among PWH with rectal chlamydia (18.2%). PWH accounted for 85.7% of all genovariant L2b cases. Of 38 genovariant L2b samples from 35 cases, 34 (84.2%) samples completed MLST, revealing sequence type (ST) 53 as the predominant strain (74%). ST39 and ST63 were identified as unreported STs in Western countries, along with previously reported ST58. The four identified STs formed a cluster. CONCLUSIONS:Our findings indicate the clonal spread of C. trachomatis L2b-ST53 among MSM in Taiwan, primarily affecting PWH. The predominance of ST53 suggests potential international and domestic spread, indicative of the need for enhanced surveillance.

INTRODUCTION:Disability disproportionally impacts people living with HIV (PLWH). The burden and determinants of disability among PLWH in Asia have not been well studied. METHODS:We conducted a multi-country observational cross-sectional study in five cities in Asia involving PLWH and age- and sex-matched controls living without HIV from March 2020 to November 2023. We compared the prevalence of disability (measured by World Health Organization Disability Assessment Schedule 2.0, WHODAS 2.0) between PLWH and controls, and determined the association between living with HIV and disability using multivariable logistic regression and mediation analysis. RESULTS:A total of 1004 PLWH and 416 age- and sex-matched controls were enrolled. PLWH (mean age 53.6 ± 10.3 years, 84.4% male, 72.2% ≥1 comorbidities) had a higher Charlson Comorbidity Index, more depression, anxiety, stress, social isolation and loneliness, and poorer cognitive performance. The prevalence of disability was 50.9% among PLWH and 40.6% among controls (p<0.001). PLWH had significantly higher WHODAS 2.0 complex score, and significantly more PLWH had impairments in all of the six domains of disability. The presence of disability correlated with living with HIV after adjusting for demographic characteristics, physical health parameters and cognition, but not after adjusting for socio-behavioural variables and mental health parameters. Mediation analysis showed that living with HIV had a significant indirect effect on disability mediated by social isolation, mental health disorders and poor cognitive performance. CONCLUSIONS:PLWH in Asia had a higher burden of disability as compared with matched controls. The effect of living with HIV on disability was mediated by social isolation, mental health disorders and impaired cognition. Future work should be directed to developing interventions that mitigate these conditions with the goal of reducing disability among PLWH.

Objectives: We investigated the use of Treponema pallidum DNA (TP-DNA) for diagnosis, resistance identification, and treatment outcome prediction in early syphilis among men who have sex with men (MSM). Methods: MSM seeking care for sexually transmitted infections were prospectively enrolled from September 2021 to August 2024. Oral rinse, rectal swab, and urethral swab samples were tested for TP-DNA. Resistance-associated mutations (RAMs) to macrolides and tetracyclines were identified. Treatment responses were compared between syphilis cases with detected TP-DNA and those without. Results: Of 656 MSM enrolled, TP-DNA was most frequently detected in oral rinse samples (37.8% [193/510]), followed by rectal swab (20.2% [103/510]) and urethral swab samples (11.6%, 59/510) in clinic visits for early syphilis. TP-DNA was detected in 45.7% (233/510) of early syphilis cases and 0.7% (1/141) of cases without syphilis, resulting in a specificity of 99.3% (95% CI: 96.1-100%) and sensitivity of 45.7% (95% CI: 41.3-50.1%). Secondary syphilis cases had the highest yield of TP-DNA detection (67.6% [117/173]), followed by primary (48.7% [19/39]) and early latent syphilis cases (32.6% [97/298]). The Ct values of T. pallidum PCR in oral rinse samples were significantly lower in cases of higher rapid plasma reagin (RPR) titres (p < 0.001). The rate of T. pallidum harbouring RAMs to macrolides was 58.9% (139/236), increasing over 6-month intervals, from 32.4% (12/37) in 2021 to 77.8% (21/27) in 2023. Cases of detected TP-DNA had greater serological responses to treatments than those without: 80.3% (159/198) vs. 67.0% (156/233) at month 6 (p 0.002) and 84.1% (143/170) vs. 70.3% (137/195) at month 12 (p = 0.002). Discussion: T. pallidum PCR showed high specificity for the diagnosis of early syphilis, which correlated with RPR titres and treatment response, and lower Ct values in oral rinse samples correlated with higher RPR titres. The high prevalence of T. pallidum strains with RAMs to macrolides argues against using azithromycin to treat syphilis in Taiwan. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).