Importance Human papillomavirus (HPV)-related cancers cause substantial morbidity and mortality. People with HIV (PWH) and solid organ transplant recipients (SOTRs) are at heightened risk due to impaired immune function, but direct comparisons of these groups within the same population are limited; understanding the relative risk and contributing factors is essential for targeted prevention and screening. Objective To compare the odds of HPV-related cancers in PWH and SOTRs with control participants and assess how clinical and sociodemographic factors modify these associations. Design, Setting, and Participants This nested case-control study used incidence density sampling within the Swedish population. Individuals born between 1940 and 2000 and who were a resident of Sweden from 1983 to 2024 were included. HPV-related cancer cases were matched 1:10 with controls based on sex, year of birth, and region of birth. Exposure HIV infection or history of organ transplant. Main Outcome and Measures The primary outcome was HPV-related cancers, identified via diagnostic codes from the Swedish Cancer Registry. Odds ratios (ORs) with 95% CIs of HPV-related cancers by immunosuppression were estimated using conditional logistic regression. In secondary analyses, comparisons were stratified by sex, age at cancer diagnosis, calendar period of diagnosis, HPV-related cancer site, region of birth, education, income, income type, and civil status. Results The study included 32 093 cases (21 206 female [65.5%]; 12 534 aged <50 years [39.4%]) and 320 930 matched control encounters (308 507 unique individuals; 201 667 female [65.4%]; 122 055 aged <50 years). Both PWH and SOTRs had elevated odds of HPV-related cancers compared with controls (PWH: adjusted OR [aOR], 4.50; 95% CI, 3.46-5.84; SOTRs: aOR, 2.23; 95% CI, 1.85-2.68). Among PWH, the highest site-specific odds were observed for anal (aOR, 58.79; 95% CI, 22.63-152.79) and penile (aOR, 8.05; 95% CI, 3.38-19.16) cancer. Among SOTRs, the highest odds were for vulvar (aOR, 7.07; 95% CI, 4.31-11.60) and penile (aOR, 6.01; 95% CI, 3.47-10.52) cancers, with variation by organ sites and time since transplant (>10 years posttransplant). In PWH, lower nadir (aOR 5.90; 95% CI, 4.04-8.61) and current (aOR, 8.62; 95% CI, 3.70-20.04) CD4 counts, shorter duration of viral suppression (aOR, 7.04; 95% CI, 4.40-11.27), and higher peak plasma HIV RNA levels (aOR, 5.66; 95% CI, 2.96-10.84) were associated with increased odds. In secondary analyses, sociodemographic factors such as lower income and nonmarried status were associated with elevated odds in both groups. Conclusions and Relevance In this case-control study of immunosuppressed populations, HPV-related cancer odds were increased among both PWH and SOTRs, with larger magnitudes of association observed in PWH; variation was observed by immune status, transplant characteristics, and sociodemographic factors. These findings highlight the need for enhanced prevention, including HPV vaccination, screening, and optimized immunosuppressive regimens.

Introduction There are currently no colorectal cancer (CRC) screening recommendations specifically outlined for people with HIV (PWH). Screening measures used for people without HIV (PWoH) have been previously discussed as sufficient for use among PWH, despite observations of higher CRC prevalence and CRC reportedly appearing at earlier ages among PWH in comparison to PWoH. Machine learning (ML) methods are regarded as robust approaches that may enhance predictive performance, particularly in the context of complex or high-dimensional data. This study aims to develop an ensemble ML model to predict CRC risk in PWH using comprehensive nationwide datasets. The model’s predictive performance will be evaluated and compared with a baseline Cox proportional regression model. The better-performing method will be implemented to develop a CRC risk prediction model with the aim of personalising screening recommendations for PWH. Methods and analysis The study population will include all PWH and PWoH born between 1940 and 2008, aged 18 or older and living in Sweden sometime between 1983 and 2024. The study population will be linked to six nationwide demographic and healthcare registers. Follow-up will continue until the first incident of CRC, emigration or death. The outcome of interest is CRC. PWH will be matched to negative controls 1:10. A Cox regression analysis will be completed first, and the results will be used as a baseline comparison to the ensemble ML results. A range of ML methods will be used to develop the ensemble model using stacking. Ethics and dissemination This study has ethical approval from the Regional Ethical Committee in Sweden (Dnr: 2024-04185-02, 2024-06783-02, 2023-00191-01, 2022-02897-02, 2022-05624-01, 2018/11-31/2). Given that the study is retrospective and register-based, using only pseudonymised data, there are minimal physical, psychological or privacy risks to included individuals. All results will be presented at the population level with no possibility of identification. The results of this study will be submitted for publication in a peer-reviewed journal.

INTRODUCTION:HIV guidelines recommend switching from a three-drug regimen (3DR) to dolutegravir + lamivudine (DTG+3TC) for eligible individuals. This retrospective national cohort study used Swedish InfCareHIV registry data to evaluate long-term outcomes of adults with HIV RNA <50 copies/ml who switched to DTG+3TC or a guideline-recommended 3DR between July 2019 and May 2023 in routine clinical care. METHODS:Demographic and clinical data were obtained from InfCareHIV at baseline, 6, 12, 24, 36 and 42 months post-switch. The primary endpoint was virologic failure (VF) rates at each time point; secondary endpoints included VF rates in prespecified subgroups, time to VF, and incidence of viral blips and treatment-emergent resistance. Generalized estimating equations modelling was used to assess the effects of clinical predictors on VF. RESULTS:A total of 1125 individuals (46%) switched to DTG+3TC, and 1336 (54%) switched to 3DR. Adjusted VF rates post-switch were 0.1-2.9% in the DTG+3TC group and 0.3-2.2% in the 3DR group in the intent-to-treat analysis (0-0.4% and 0.3-2.3% in the on-treatment [OT] analysis, respectively). In the OT set, the odds of VF were significantly lower for DTG+3TC versus 3DR at 24, 36 and 42 months (p<0.001). Treatment-emergent resistance rates were low in both groups. CONCLUSIONS:In this long-term, real-world, national cohort, switching to DTG+3TC was associated with low rates of VF and antiretroviral therapy resistance, indicating that eligible individuals can be switched to DTG+3TC without increased risk of VF.

OBJECTIVE:To examine temporal changes in late diagnosis of HIV (LD) among migrant and non-migrant people with HIV in Sweden 2003-2023 and to assess demographic and socioeconomic risk factors for LD in these two populations. METHODS:People with HIV diagnosed with HIV-1 in Sweden 2003-2023 were included (n = 6278). LD was defined as a first CD4+ T-cell count <350 cells/μL or an AIDS-defining event within 3 months of diagnosis. People with HIV with evidence of recent infection were reclassified as non-late. Temporal changes in LD were examined using descriptive statistics and regression analyses. To assess risk factors for LD, modified Poisson regression was employed. Risk factor analyses were restricted to 2010-2020 when complete sociodemographic data were available (n = 2778). Data were obtained from Swedish national registries. RESULTS:The absolute incidence of total and late HIV diagnoses decreased over the study period, whereas the annual proportion of LD varied between 46% and 60% and trended upwards. LD occurred in 41% of non-migrant people with HIV and 58% of migrant people with HIV. Among non-migrant people with HIV, having an upper secondary education or less was associated with LD compared to post-secondary education, as was male sex with heterosexual HIV acquisition and higher age. For migrant people with HIV, neither lower education nor income was statistically significantly associated with LD. Instead, higher age, certain birth regions, heterosexual acquisition and male sex with acquisition through injection drug use were associated with LD. CONCLUSIONS:LD declined in absolute terms yet constituted a high and increasing proportion of new HIV cases in Sweden 2003-2023, with differing sociodemographic determinants by migrant status.

BACKGROUND:Type 2 diabetes mellitus (T2DM) is common among people with HIV (PWH), although studies comparing T2DM-related complications in people with and without HIV (PWoH) remain limited. This was assessed using data from the Cohort Study on Morbidity and HIV in Sweden (COSMOHS). METHODS:Nationwide study including Swedish residents born 1930-2006, diagnosed with T2DM between 2010 and 2019, followed until 31 December 2024, using 7 national registers including national HIV and diabetes registers. Follow-up began at T2DM diagnosis. Outcomes included renal events, cardiovascular events, and all-cause mortality. Cox proportional regression estimated hazard ratios (adjHRs) by HIV status, stratified by propensity score quintiles of age, sex, migrant status, comorbidities, and socioeconomics. RESULTS:350 PWH and 311 668 PWoH were included, with similar median follow-up time (PWH, 7.8 years; PWoH, 8.8 years). PWH had higher renal risk than PWoH (major adverse kidney event: adjHR, 2.04; 95% CI, 1.57-2.65) but no significantly increased cardiovascular risk (major adverse cardiovascular event: adjHR, 1.18; 95% CI, .87-1.60) or all-cause mortality. Findings were consistent across sensitivity analyses, including competing-risk models for death and excluding PWH receiving tenofovir disoproxil fumarate at baseline. Accounting for the benign plasma/serum-creatinine increase associated with bictegravir, cobicistat, dolutegravir, and rilpivirine, the increased renal risk remained, although not statistically significant. The renal risk was most prominent in PWH with BMI ≥30 kg/m2. CONCLUSIONS:In this nationwide cohort, PWH with T2DM exhibited higher risk of renal complications than PWoH, indicating enhanced renal monitoring may be warranted. Further research should investigate underlying mechanisms, including antiretroviral therapy, to guide clinical management.

Background:Lung injury in COVID-19 is characterized by neutrophil invasion and the release of neutrophil extracellular traps (NETs). An aberrant NET formation may induce local inflammation and increase sputum viscosity. Inhalation of DNase I (dornase alfa) is a treatment option that degrades NETs in the airways. Previous case series have indicated positive clinical effects of inhaled dornase alfa. Methods:Patients admitted to the hospital with acute COVID-19 and hypoxia (oxygen saturation <90%) were randomly assigned to receive aerosolized dornase alfa twice daily for 5 days or a placebo in addition to standard of care. The primary outcome was discharge from the hospital or an oxygen saturation >93% without respiratory support. Results:In total, 76 patients were randomized. The study was stopped when the Omicron virus variant appeared. The clinical response rate did not differ between patients receiving the active substance and placebo. Secondary outcomes were similar across groups, such as mortality, a new episode of hypoxia, length of stay in the hospital, and adverse events. A subanalysis of patients older or younger than 65 years showed no differences in primary or secondary outcomes. Conclusions:Aerosolized dornase alfa failed to improve hypoxia in hospitalized patients with acute COVID-19. The study was conducted during a time of heterogeneity in viral variants and vaccination status of participants. Whether dornase alfa affects the outcomes in other respiratory infections requires further study.

An additional upsurge in bacterial STIs has been observed in Sweden following HIV pre-exposure prophylaxis (PrEP) implementation. From a prevention perspective, it is of relevance to optimize testing strategies within PrEP programmes to identify those most at risk. An open retrospective longitudinal observational cohort study was performed at three STI clinics in Uppsala, Gothenburg, and Malmö. A questionnaire and journal data regarding STI were collected from a sample of 199 MSM enrolled in the PrEP programmes and providing informed consent. Incident bacterial STIs during follow-up were analyzed with descriptive statistics, Poisson regression, and Cox regression. Median follow-up time was 632 days. A total of 270 gonorrhoea or chlamydia infections were recorded during PrEP follow-up, compared to 194 cases in the 2-year period prior to enrolment, giving an incidence rate ratio (IRR) of 1.56 (CI 95% 1.30–1.89). The testing frequency increased by 75% (IRR 1.69, CI 95% 1.60–1.90). For diagnoses of active syphilis, the increase was 108% (IRR 2.08. CI 95% 1.04–4.06), compared with a 5-year period preceding enrolment. The hazard ratio of time (days) until a first STI after PrEP initiation was 2.87 (CI 95% 1.72–4.80) for those having had a STI prior to PrEP initiation and 2.06 (CI 95% 1.03–4.13) for those reporting experience of group sex in the past year compared with those who had not. STI prior to PrEP initiation and group sex were associated with STI after initiation of PrEP, factors that could be considered if needing prioritizing the frequency of STI screening.

The asymptomatic disease stage in HIV-2 infection is approximately twice as long compared to HIV-1 infection; and the majority of HIV-2 infected individuals progress to AIDS in the absence of antiretroviral treatment. In this study, we applied data-independent acquisition mass spectrometry analysis of blood plasma collected from HIV negative, and HIV-1 or HIV-2 infected individuals from Guinea-Bissau with an estimated date of HIV infection, to explore how alterations of the plasma proteome are associated with HIV disease progression. In total, 609 proteins were quantified and mapped towards publicly available data on tissue-enhanced genes, to provide insight on the tissue-specific origin of the detected proteins. The analysis suggested a larger leakage of proteins from the sigmoid colon in HIV-1 compared to HIV-2 infection. Moreover, the levels of sigmoid colon and spleen tissue proteins were associated with disease progression among all HIV infected individuals. We also identified ten proteins that could distinguish faster from slower HIV disease progression. In conclusion, these results encourage further research on the role of both target and bystander cells in HIV disease progression. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by funding from the Swedish Research Council (grant number 2020-06262 to J.E; 2016-02285, 2019-01439 to M.J.) and by The Swedish Fund for Research without Animal Experiments to MJ (N2019-0009, F2021-0010). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethical committee at Lund University gave ethical approval for this work The National Ethical Committee, Ministry of Public Health in Guinea-Bissau, gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Upon publication all codes will be made available at the systems virology GitHub website and the data will be uploaded to an appropriate repository.

Despite low or undetectable plasma viral load, people living with HIV-2 (PLWH2) typically progress toward AIDS. The driving forces behind HIV-2 disease progression and the role of viremia are still not known, but low-level replication in tissues is believed to play a role. To investigate the impact of viremic and aviremic HIV-2 infection on target and bystander cell pathology, we used data-independent acquisition mass spectrometry to determine plasma signatures of tissue and cell type engagement. Proteins derived from target and bystander cells in multiple tissues, such as the gastrointestinal tract and brain, were detected at elevated levels in plasma of PLWH2, compared with HIV negative controls. Moreover, viremic HIV-2 infection appeared to induce enhanced release of proteins from a broader range of tissues compared to aviremic HIV-2 infection. This study expands the knowledge on the link between plasma proteome remodeling and the pathological cell engagement in tissues during HIV-2 infection.

OBJECTIVE:To estimate the prevalence of the curable sexually transmitted infections (STIs) Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis and Treponema pallidum, to identify associated risk factors and to assess ciprofloxacin resistance in N. gonorrhoeae-positive specimens among female sex workers (FSWs) in Guinea-Bissau. METHODS:For this cross-sectional study, FSWs were recruited from October 2014 to May 2019. A questionnaire on STI risk factors was completed by the study participants, and the women were asked to provide a vaginal swab for nucleic acid amplification tests for C. trachomatis, N. gonorrhoeae, M. genitalium, T. vaginalis (Aptima, Hologica), as well as a blood sample for T. pallidum serological testing and discriminatory HIV-testing. The prevalence of STIs was determined, and multivariate logistic regression was used to identify STI risk factors. RESULTS:The study included 467 women. The prevalence of current infection with any curable STI was 46.7%, and the most common pathogen was T. vaginalis (26.3%), followed by M. genitalium (21.9%), C. trachomatis (11.8%), N. gonorrhoeae (10.1%) and T. pallidum (2.8%). The proportion of asymptomatic infections among the diagnosed STIs was 61.8%, 61.5%, 55.3%, 55.3% and 52.2% for C. trachomatis, T. pallidum, N. gonorrhoeae, T. vaginalis and M. genitalium, respectively. The prevalence of the gyrA S91F mutation conferring ciprofloxacin resistance in N. gonorrhoeae-positive specimens was 84.0%. Significant risk factors for having a curable STI were age and HIV-1 infection, while use of female condoms was a protective factor. CONCLUSION:This study demonstrated that the prevalence of curable STIs was high among FSWs in Guinea-Bissau during the study period, indicating an unmet need for STI services. Moreover, the results indicated that symptomatic treatment might be insufficient, highlighting a need for periodic aetiological testing to facilitate detection of asymptomatic as well as symptomatic STIs to stop ongoing transmission.

BackgroundSweden reached the UNAIDS 90-90-90 target in 2015. It is important to reassess the HIV epidemiological situation due to ever-changing migration patterns, the roll-out of PrEP and the impact of the COVID-19 pandemic.AimWe aimed to assess the progress towards the UNAIDS 95-95-95 targets in Sweden by estimating the proportion of undiagnosed people with HIV (PWHIV) and HIV incidence trends.MethodsWe used routine laboratory data to inform a biomarker model of time since infection. When available, we used previous negative test dates, arrival dates for PWHIV from abroad and transmission modes to inform our incidence model. We also used data collected from the Swedish InfCareHIV register on antiretroviral therapy (ART).ResultsThe yearly incidence of HIV in Sweden decreased after 2014. In part, this was because the fraction of undiagnosed PWHIV had decreased almost twofold since 2006. After 2015, three of four PWHIV in Sweden were diagnosed within 1.9 and 3.2 years after infection among men who have sex with men and in heterosexual groups, respectively. While 80% of new PWHIV in Sweden acquired HIV before immigration, they make up 50% of the current PWHIV in Sweden. By 2022, 96% of all PWHIV in Sweden had been diagnosed, and 99% of them were on ART, with 98% virally suppressed.ConclusionsBy 2022, about half of all PWHIV in Sweden acquired HIV abroad. Using our new biomarker model, we assess that Sweden has reached the UNAIDS goal at 96-99-98.

Background All-cause and AIDS-mortality in Europe has been decreasing between 1996 and 2020. However, regional differences as well as their drivers remain unclear. This study investigates mortality differences and their drivers, including usage of and response to antiretroviral therapy (ART) and active tuberculosis (TB), among people with HIV across Europe. Methods People with HIV enrolled in EuroSIDA were followed from 2001 through 2020. Immunologic-virologic status (IVS) was categorized as poor (CD4-cell count <= 350 cells/mm(3) and viral load (VL) > 200 copies/ml), good (CD4 >= 500 and VL < 200), or intermediate (remaining combinations). Participants missing either CD4-cell count or VL were categorized as unknown. Regional differences in mortality were analyzed using multivariable Poisson regression with interaction analyses between regions of Europe and IVS, ART, or TB status. Findings 20,364 people with HIV were included: 13,715/20,346 (67.3%) from Western, 3020/20,364 (14.8%) from Central Eastern, and 3629/20,364 (17.8%) from Eastern Europe. At enrolment, median age was 40 years (inter-quartile range (IQR): 33-48), median CD4-cell count 449 cells/mm(3) (IQR: 291-638), and most were male 14,993/20,346 (73.3%). A total of 2639 died during 192,591 person-years of follow-up (crude mortality rate 13.7/1000 person-years, 95% CI: 13.2-14.2), 519/2639 (19.7%) from AIDS (2.7/1000 person-years, 2.5-2.9). All-cause and AIDS-mortality rates decreased over time but remained higher in Eastern Europe after adjusting for confounders. Being off ART (aIRR 2.42; 95% CI 2.14-2.74), poor IVS (aIRR 4.2; 95% CI 3.39-5.20) and prior TB (aIRR 3.33; 95% CI 2.75-4.03) were associated with higher all-cause mortality. For all-cause mortality the effect of ART (test for interaction: p < 0.001) and IVS (p = 0.02), but not TB (p = 0.5) varied across regions. Interpretation Overall mortality and AIDS-mortality rates decreased over time, but remained higher in Eastern Europe. A poor IVS, being off ART and prior active TB were related to higher mortality. Eastern Europe had the highest proportion of people with poor or unknown IVS, emphasizing the continued need to improve HIV care with a focus on early diagnosis, ART initiation, and adherence.

Purpose The Swedish InfCareHIV cohort was established in 2003 to ensure equal and effective care of people living with HIV (PLHIV) and enable long-term follow-up. InfCareHIV functions equally as a decision support system as a quality registry, ensuring up-to-date data reported in real time.Participants InfCareHIV includes data on >99% of all people with diagnosed HIV in Sweden and up to now 13 029 have been included in the cohort. InfCareHIV includes data on HIV-related biomarkers and antiretroviral therapies (ART) and also on demographics, patient-reported outcome measures and patient-reported experience measures.Findings to date Sweden was in 2015 the first country to reach the UNAIDS (United Nations Programme on HIV/AIDS)/WHO’s 90-90-90 goals. Late diagnosis of HIV infection was identified as a key problem in the Swedish HIV-epidemic, and low-level HIV viraemia while on ART associated with all-cause mortality. Increased HIV RNA load in the cerebrospinal fluid (CSF) despite suppression of the plasma viral load was found in 5% of PLHIV, a phenomenon referred to as ‘CSF viral escape’. Dolutegravir-based treatment in PLHIV with pre-existing nucleoside reverse transcriptase inhibitor-mutations was non-inferior to protease inhibitor-based regimens. An increase of transmitted drug resistance was observed in the InfCareHIV cohort. Lower efficacy for protease inhibitors was not due to lower adherence to treatment. Incidence of type 2 diabetes and insulin resistance was high in the ageing HIV population. Despite ART, the risk of infection-related cancer as well as lung cancer was increased in PLHIV compared with HIV-negative. PLHIV were less likely successfully treated for cervical precancer and more likely to have human papillomavirus types not included in current HPV vaccines. Self-reported sexual satisfaction in PLHIV is improving and is higher in women than men.Future plans InfCareHIV provides a unique base to study and further improve long-term treatment outcomes, comorbidity management and health-related quality of life in people with HIV in Sweden.

BackgroundThe global distribution of HIV-1 subtypes is evolving, which is reflected in the Swedish HIV cohort. The subtype HIV-1A6, which may be prone to developing resistance to cabotegravir, is the most common subtype in Ukraine.AimWe aimed to examine trends in HIV-1 subtype distribution in Sweden, with a special focus on HIV-1A6, and to describe the virology, demography and treatment of Ukrainian people living with HIV (PLWH) who migrated to Sweden in 2022.MethodsData about PLWH in Sweden are included in a national database (InfCareHIV). We used the online tool COMET to establish HIV-1 subtypes and the Stanford database to define drug resistance mutations. We investigated the relation between virological characteristics and demographic data.ResultsThe early epidemic was predominated by HIV-1 subtype B infections in people born in Sweden. After 1990, the majority of new PLWH in Sweden were PLWH migrating to Sweden, resulting in an increasingly diverse epidemic. In 2022, HIV-1A6 had become the sixth most common subtype in Sweden and 98 of the 431 new PLWH that were registered in Sweden came from Ukraine. We detected HIV RNA in plasma of 32 Ukrainian patients (34%), of whom 17 were previously undiagnosed, 10 had interrupted therapy and five were previously diagnosed but not treated. We found HIV-1A6 in 23 of 24 sequenced patients.ConclusionThe molecular HIV epidemiology in Sweden continues to diversify and PLWH unaware of their HIV status and predominance of HIV-1A6 should be considered when arranging care directed at PLWH from Ukraine.

Limited data are available on the pathogenesis of HIV-2, and the evolution of Env molecular properties during disease progression is not fully elucidated. We investigated the intra-patient evolution of molecular properties of HIV-2 Env regions (V1–C3) during the asymptomatic, treatment-naïve phase of the infection in 16 study participants, stratified into faster or slower progressors. Most notably, the rate of change in the number of potential N-linked glycosylation sites (PNGS) within the Env (V1–C3) regions differed between progressor groups. With declining CD4+ T-cell levels, slower progressors showed, on average, a decrease in the number of PNGSs, while faster progressors showed no significant change. Furthermore, diversity increased significantly with time in faster progressors, whereas no such change was observed in slower progressors. No differences were identified between the progressor groups in the evolution of length or charge of the analyzed Env regions. Predicted virus CXCR4 use was rare and did not emerge as a dominating viral population during the studied disease course (median 7.9 years, interquartile range [IQR]: 5.2–14.0) in either progressor groups. Further work building on our observations may explain molecular hallmarks of HIV-2 disease progression and differences in pathogenesis between HIV-1 and HIV-2.