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Children living with HIV in low-income countries contribute disproportionately to death after hospital discharge. This study investigates the effect of HIV on post-discharge mortality and readmission by exploring a wide range of clinical, maternal and socioeconomic variables. A secondary analysis of children under 5 years old admitted with suspected sepsis. Participants were enrolled from two multisite observational studies conducted from 2012 to 2013 and 2017 to 2020 across six hospitals in Uganda. Participants were excluded if admitted outside the catchment area, for trauma, short-term observation or if admitted immediately after birth without prior discharge. We used a robust Poisson regression to identify risk factors of post-discharge mortality for three separate HIV groups: children living with HIV (CLHIV), children HIV-exposed uninfected (CHEU) and children HIV-unexposed uninfected (CHUU). We implemented Kaplan Meier curves to compare rates of post-discharge mortality and readmission between the three groups. In addition, we compared the risk ratio of the two outcomes. Of the 7658 children who were discharged alive and completed the 6-month follow-up, 266 (3.5%) were CLHIV, 458 (6.0%) were CHEU and 6934 (90.6%) were CHUU. Post-discharge mortality was statistically significantly higher in CLHIV compared to the CHUU, with rates of 12.8% (34/266) and 5.8% (402/6934), respectively. Contrastingly, readmission was higher in CHUU (17.7% (1227/6934)) compared to CLHIV (11.3% (30/266)). Severe malnutrition, indicated by a weight-for-age z-score of less than -3, was associated with post-discharge mortality among all three groups with aRRs of 4.32 (95% CI: 1.89-9.81), 3.96 (95% CI: 1.75-8.95) and 4.84 (95% CI: 3.94-5.96) for CLHIV, CHEU and CHUU, respectively, compounded by the fact that severe malnutrition is disproportionately higher in those living with HIV. Variables associated with post-discharge mortality in this group were prior antimalarial use (aRR = 2.27 [95% CI: 1.16-4.47]) and moderate anaemia (aRR = 2.33 [95% CI: 1.12-4.89]). Children living with HIV represent an exceptionally vulnerable group following hospital discharge. Very low readmission rates alongside high mortality suggest that strategies to improve care transitions and follow-up in these children are essential to improving recovery and survival.

People diagnosed with advanced HIV disease (AHD) are at high risk for mortality even after starting antiretroviral therapy (ART). We determined characteristics, clinical outcomes, and risks of mortality among children and adolescents diagnosed with AHD in western Uganda. We conducted a retrospective cohort analysis of routinely collected program data of children and adolescents living with HIV (CALHIV) aged 0-19 years, from outpatient HIV clinic electronic medical records in 48 high-volume health facilities in two regions of western Uganda (Fort Portal and Hoima). Data for clients who initiated ART during January 2016-July 2023 were analysed. AHD was defined as a CD4 cell count <200 cells/&#x3bc;L, or WHO stage 3 or 4, or any child younger than 5 years of age living with HIV who had been on ART for more than 12 months and virally non-suppressed (&#x2265;1,000 copies). We used descriptive statistics (i.e., frequencies and percentages) to summarise characteristics and treatment outcomes. Kaplan-Meier curves were used to estimate survival overall and by clients' characteristics; log-rank tests were used to compare survival functions. A gamma-shared frailty model was used to determine factors associated with the rate of mortality. Effect measures were summarized using adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (95%CI). A total of 5,143 CALHIV, including 3,067 (59.6%) females, with a median (interquartile range [IQR]) age of 10 (9) years were assessed. Overall, AHD was high (18.1%) and varied by age-0-4 years (68.4%), 5-9 years (12.6%), 10-14 years (13.2%), and lowest among adolescents, 15-19 years (7.7%). Just over half of the CALHIV with AHD were active in care (51.5% [480/932]), about a quarter (26.4% [264/932]) had transferred out, 13.8% (129/932) were lost to follow-up, and 8.3% (77/932) had died. Survival was significantly higher in CALHIV who were not malnourished compared to those with malnutrition (p&#x2009;=&#x2009;0.001). Overall mortality rate per 100 person-years among CALHIV with AHD was 4.1 (95%CI:3.2-5.2) and was significantly higher among those who had been on ART for 3 months or less (27.3; 95%CI: 20.6-36.2) compared to 6 months or more (1.0; 95%CI: 0.6-1.7). Advanced HIV Disease among CALHIV in western Uganda was consistent with what has been published elsewhere. Risk of death differed by nutrition status and was high among those on ART three months or less. Early screening and management of malnutrition, as well as early ART initiation and adherence initiatives, might improve outcomes and reduce AHD-related mortality among CALHIV.

People living with HIV (PLHIV) often face nutritional deficiencies resulting from reduced food intake, malabsorption, and increased metabolic demands. Adequate nutrition is essential for optimizing antiretroviral (ARV) drug absorption, reducing treatment side effects, managing HIV-related malnutrition, and supporting immune recovery. In 2012, the Khomas Regional Council introduced a food support program for PLHIV on antiretroviral therapy (ART); however, its impact has not been systematically evaluated. This study aims to explore key informants' perspectives on the program's impact on the well-being of PLHIV receiving ART in the Khomas Region, Windhoek, Namibia. A qualitative phenomenological design was employed. Sixteen purposively selected key informants from eight constituencies in the Khomas Region participated in in-depth, semistructured interviews. Data collection occurred in two phases: June-August 2024 (n&#x2009;=&#x2009;8) and October 2025 (n&#x2009;=&#x2009;8). Interviews followed a guiding framework with probing questions, and data saturation determined sample adequacy. Ethical procedures, including informed consent, confidentiality, and the protection of participants' rights, were rigorously upheld. Three overarching themes emerged: (1) Positive impacts of the food support program, including noticeable weight gain among beneficiaries, improved ART adherence, reduced ART dropout rates, and increased confidence among PLHIV; (2) challenges affecting the program implementation, which included insufficient food supplies, limited funding resources, migration of beneficiaries, lack of transport for field workers, and persistent self-stigma among PLHIV; and (3) Strategies for strengthening the program, such as increasing the quantity of food provided, ensuring consistent and frequent food distribution, promoting income-generating activities, updating the beneficiary database, and intensifying efforts to address HIV-related stigma. Despite challenges, the food support program positively influenced the health and well-being of PLHIV. Strengthened collaboration between the Khomas Regional Council and ART clinics as well as awareness campaigns are recommended to broaden the program's reach.

Since February 2022, the war in Ukraine has led to large-scale displacement, including people living with HIV (PLWH). Early reports described predominantly virologically suppressed individuals with preserved immune function. Data on refugees with HIV presenting during later phases of the war are limited. We conducted a retrospective single-center study including adult refugees with HIV from Ukraine presenting to a tertiary care center in Germany. Paticipants were grouped by time of presentation: Cohort 1 (March-December 2022) and Cohort 2 (January 2023-February 2024). Clinical, immunological, and virological parameters were compared between cohorts. A total of 86 individuals were included (Cohort 1: n&#x2009;=&#x2009;46; Cohort 2: n&#x2009;=&#x2009;40). Participants in cohort 2 more frequently received their first HIV diagnosis after presentation in Germany, with no previously documented HIV diagnosis in Ukraine or elsewhere, compared with cohort 1 (67% vs. 5%; p&#x2009;<&#x2009;0.0001). Participants in Cohort 2 more often presented with detectable HIV RNA (65% vs. 29%; p&#x2009;<&#x2009;0.0001) and advanced immunodeficiency (CD4&#x2009;<&#x2009;200/&#xb5;L: 28% vs. 9%; p&#x2009;<&#x2009;0.05). Among individuals with prior HIV diagnosis, virological failure was more common in Cohort 2 (50% vs. 14%; p&#x2009;=&#x2009;0.006). AIDS-defining illnesses occurred more frequently in Cohort 2 (p&#x2009;=&#x2009;0.005). Serological evidence of HBV and HCV infection was high in both cohorts. Refugees with HIV from Ukraine presenting during later phases of the war exhibit more advanced disease and poorer virological control compared with earlier arrivals. These findings suggest increasing disruption of HIV care over time and highlight the need for low-threshold access to testing, comprehensive screening, and rapid initiation of antiretroviral therapy in this population.

As individuals with HIV live longer, many now face the health consequences of aging and multimorbidity, known as disability. Exercise can mitigate disability; however, engagement in exercise among adults living with HIV varies. Technology-based interventions, such as telerehabilitation, may help mitigate geographical, financial, and time barriers to community-based exercise (CBE). However, little is known about the experiences with technology uptake and usage among adults living with HIV. Understanding these experiences is essential to inform the design of inclusive, accessible, and sustainable online interventions. This study aimed to describe experiences with technology uptake and usage among adults aging with HIV participating in a 6-month online CBE intervention and explore how these experiences changed over time, from baseline to postintervention. We conducted a longitudinal qualitative descriptive study and secondary analysis using interview data from adults living with HIV who were engaged in a CBE intervention study in Toronto, Canada. Participants engaged in a 6-month online CBE intervention consisting of thrice-weekly exercise supervised biweekly through online personal coaching sessions, weekly group exercise classes, and monthly self-management education sessions (via Zoom). The technology used included Zoom software and a webcam, as well as the Sweat for Good YMCA app and the YMCA Virtuagym website; participants wore a wireless physical activity monitor (Fitbit Inspire 2) throughout. Participants completed interviews at baseline and postintervention. We conducted a group-based content analysis of interview transcripts, focusing on digital access, setup, usage, and perceptions of technology. Questionnaire data describing digital literacy and access to technology provided additional context to the interview data. Eleven participants completed at least one interview. We analyzed 19 interview transcripts from 11 participants (women: n=6, 55%; men: n=5, 45%; median age 52, IQR 45-60 y). Experiences with technology uptake and usage among adults aging with HIV were characterized by four components: (1) preparations for technology (technology setup), (2) interactions with technology (preferences for different types of technology, preferences for mode of delivery, and ease of usage), (3) facilitators and satisfaction with technology (facilitators to technology uptake and usage and satisfaction with technology), and (4) challenges and frustrations with technology (barriers to technology uptake and usage and frustrations with technology). Experiences with technology across participants were influenced by intrinsic contextual factors (prior exposure to technology) and extrinsic contextual factors (COVID-19 pandemic and technological and social support). Experiences with technology among adults aging with HIV engaging in an online CBE intervention varied from increasing ease of use to increasingly burdensome over time. Results highlight the need to incorporate personal preferences and ongoing technological support when implementing online CBE with adults aging with HIV.

Stigma is multidimensional and undermines HIV care. We examined socio-environmental pathways linking HIV-related stigma, everyday discrimination and structural stigma to antiretroviral therapy (ART) adherence among men who have sex with men (MSM) and female sex workers (FSW) living with HIV in Kampala, Uganda. We conducted a cross-sectional survey (06/2024-02/2025) among MSM and FSW aged 18-35 receiving HIV services from a key population clinic in Kampala. ART adherence was assessed using the Wilson 3-item adherence scale. We conducted stratified multivariable linear regression and multi-group structural equation modelling (SEM) to estimate direct and indirect associations from stigma to adherence through socio-environmental stressors (traumatic exposure severity to extreme weather [TESS], food insecurity, water insecurity), adjusted for socio-demographic variables. Participants included MSM (n&#x2009;=&#x2009;225, mean age: 27.65, standard deviation [SD]&#x2009;=&#x2009;3.54) and FSW (n&#x2009;=&#x2009;240, mean age: 25.68, SD: 2.90). SEM showed acceptable fit. In adjusted SEM analyses (a) among MSM, higher TESS, HIV-related stigma and everyday discrimination were directly associated with lower ART adherence and (b) among FSW, higher TESS, HIV-related stigma, water and food insecurity were directly associated with lower ART adherence. There were significant indirect associations between HIV-related stigma and ART adherence via TESS for FSW and MSM, and between everyday discrimination and structural stigma with ART adherence via TESS for MSM. Stigma and socio-environmental stressors, including traumatic exposure to extreme weather events, were associated with reduced ART adherence among MSM and FSW participants. Population-tailored HIV care interventions may benefit from integrating intersectional stigma reduction with economic and disaster preparedness supports.

While there is broad research among caregivers in general, much less is focused on caregivers living with HIV, a gap we beging to fill here. Data come from the Columbus Healthy Aging Project (N=794) which assessed several domains of health among adults aged &#x2265;50&#x2009;years in Columbus, Ohio, USA. Using multivariable regression models, we examined the likelihood of being a caregiver, number of care recipients, and caregiver strain among people living with HIV alongside measures of aging concerns. People living with HIV (n=32) were more likely to serve as caregivers (aOR=2.92; 95% CI: 1.22, 7.02) and experience elevated caregiver strain (B=1.31; 95% CI: 0.06, 2.56) than those who are HIV-negative. There was no association nor moderation between HIV status, caregiver status, and general aging concerns. Separately, caregivers (B=1.02; 95% CI: 0.20, 1.83) and those diagnosed with HIV (B=2.13; 95% CI: 0.60, 3.67) each reported increased sexual identity-specific aging concerns. We also observed significant moderation between these variables (B=6.53; 95% CI: 3.61, 9.46). These results suggest there are unique forms of stress that are elevated among caregivers living with HIV, a critical area of research as elevated stress is well known to lead to comorbid conditions among those living with HIV.

Mental health conditions, such as post-traumatic stress disorder (PTSD), anxiety and depressive symptoms, are more prevalent among in women living with HIV and immigrant women as compared with men living with HIV and the general population. However, less is known about the intersection of these identities and their impact on the mental health of immigrant women living with HIV. This cross-sectional analysis of survey data from the British Columbia CARMA-CHIWOS Collaboration (BCC3) Study estimates the prevalence of mental health conditions among immigrant women living with and without HIV and explores potential risk (i.e., experiences of racism, sexism, childhood violence and adulthood violence) and protective (e.g., resilience, social support) factors contributing to mental health. Among n&#x2009;=&#x2009;62 women living with HIV and n&#x2009;=&#x2009;79 women without HIV, the prevalence of PTSD (50.0% vs. 37.0%, respectively (X2(1)&#x2009;=&#x2009;1.994, p&#x2009;=&#x2009;0.16), anxiety (X2(1)&#x2009;=&#x2009;1.929, 29.0% vs. 17.7% (p&#x2009;=&#x2009;0.76)), and depressive symptoms (X2(1)&#x2009;=&#x2009;0.912, 50.0% vs. 40.5% (p&#x2009;=&#x2009;0.34)) did not differ significantly. Among all immigrant women (both living with or without HIV), lower resilience scores (aOR (adjusted odds ratio), 0.94 [95% CI, 0.89-0.97], p&#x2009;=&#x2009;0.004), lower social support (0.73 [0.63-0.83], p&#x2009;<&#x2009;0.001), higher experiences of sexism (1.08 [1.03-1.14], p&#x2009;<&#x2009;0.001), racism (1.06 [1.02-1.11], p&#x2009;=&#x2009;0.002) and childhood abuse (0.94 [0.90-0.98], p&#x2009;=&#x2009;0.003) were associated with higher odds of having one or more mental health conditions. Policies and interventions aimed at strengthening social networks, promoting resiliency and addressing systemic barriers such as racism and sexism are essential to improving mental health outcomes among immigrant women.

Although long-acting cabotegravir plus rilpivirine (CAB+RPV LA) has demonstrated high efficacy in clinical trials, real-world data on archived resistance and HIV-1 reservoir dynamics remain limited. Archived resistance profile and total HIV-1 DNA were assessed at baseline and over 52 weeks in 36 virologically suppressed participants who switched to CAB+RPV LA, followed at the Polyclinic of Foggia, Italy. Total HIV-1 DNA in whole blood was quantified by real-time PCR. Resistance and APOBEC-context mutations were assessed through the Stanford HIVdb algorithm. At baseline, participants had a median body mass index (BMI) of 26.1&#x202f;kg/m&#xb2; and prior virological suppression (VS) of 8.5&#x202f;years; none of them harboured A6 subtype. Thirty-four participants (94.4%) maintained VS after 52 weeks on CAB+RPV LA, with a stable total HIV-1 DNA (3.5 at baseline versus 3.7 log10 copies/10&#x2076; CD4 at week 52, p=0.324). Baseline prevalence of NNRTI and INSTI major mutations was 18.2% and 6.5%, respectively. NNRTI prevalence remained constant, while no major INSTI mutations were found at week 52. Excluding APOBEC-context mutations, NNRTI resistance prevalence was about 9% at both time points, while no INSTI major mutations were found. In the two participants who failed CAB+RPV LA, NNRTI resistance was detected at failure; they subsequently regained VS after treatment modification. In this real-world study, a stable HIV-1 DNA over 52&#x202f;weeks of CAB+RPV LA treatment was observed. A substantial proportion of participants harboured NNRTI or INSTI major mutations, mostly APOBEC-context, without conferring true resistance. These findings emphasize the importance of a careful interpretation of proviral resistance.

A substance use disorder (SUD) treatment gap exists globally, with the greatest gaps in settings with the fewest resources. Integrating SUD care into primary care is needed to expand access to SUD care and support adherence to chronic disease services, especially HIV, in high-burden areas. Guided by stakeholder feedback, our team has previously adapted and piloted a peer-delivered behavioral intervention for antiretroviral therapy (ART) adherence for people with HIV and SUD in HIV care ("Khanya")-based on behavioral activation, problem-solving, motivational interviewing, and mindfulness-based relapse prevention skills-which was shown to be feasible, acceptable, and preliminarily effective. This study builds upon prior work to conduct a fully powered, randomized hybrid type 2 effectiveness-implementation trial (n=160) to evaluate the effectiveness of a stepped-care model of Khanya versus enhanced treatment as usual (ETAU) on ART adherence and substance use, implementation outcomes, and cost-effectiveness over 12 months. The trial is being conducted at two public primary care clinics that integrate HIV and other chronic disease services in a high-prevalence HIV setting in South Africa. We are recruiting people with HIV who self-report SUD and demonstrate one or more indicators of ART nonadherence. Eligible participants are randomized 1:1 to Khanya or ETAU. Participants randomized to Khanya first receive "step 1"-a single-session Life-Steps intervention for ART adherence delivered by a peer interventionist, followed by 2 weeks of real-time electronically monitored ART adherence using Wisepill to determine step-up decisions (ie, <80% triggers a step-up to receive the full 6-session Khanya intervention). The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework guided outcome measure selection, including effectiveness (ART adherence: Wisepill; substance use: urinalysis and WHO ASSIST [World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test]); implementation (feasibility, acceptability, fidelity, and uptake assessed using 2 validated quantitative measures and qualitative feedback over 6 months); and cost-effectiveness (microcosting, health care use, and health-related quality of life using the EuroQol-5D). Descriptive analysis will be used to summarize implementation outcomes, and intent-to-treat analysis using a linear mixed model will be conducted for effectiveness outcomes. Funded in August 2022, recruitment for the trial began in June 2023, and primary data collection is projected to be completed in February 2027. Recruitment for the clinical trial (n=162) was completed in March 2026. It is projected that all exit interviews will be completed by March 2027. This trial builds upon formative work to evaluate the effectiveness, implementation, and cost of a peer-delivered, stepped care intervention integrated into primary care. A stepped-care design to maximize optimal use of resources and integration into primary care is a necessary step to increase accessible intervention programs for people with HIV with comorbid SUD globally.

Community responses are essential to achieving the global goal of Ending AIDS by 2030, yet men who have sex with men (MSM) remain underrepresented and often tokenized within HIV initiatives. While community engagement is widely emphasized, far less attention has been given to leadership rooted in lived experience. Meaningful community engagement requires recognizing MSM not merely as a target population, but as leaders shaping HIV responses. This systematic review examines how MSM perceive the use of their lived experiences in HIV responses and how institutions incorporate these experiences into service delivery. Following PRISMA guidelines, we analyzed 40 peer-reviewed studies. Results show that across diverse contexts, MSM navigate systemic barriers-including intersecting systems of oppression-that hinder equitable access to HIV care. Despite these challenges, MSM assume (in)formal roles of leadership, negotiating power, and agency within institutions that have historically marginalized them. Using lived experience leadership as a framework in HIV services characterizes meaningful community engagement among MSM and their communities, including pathways for strengthening community-engaged HIV health promotion. This synthesis underscores the need to move beyond narrow notions of community engagement and toward recognizing MSM as leaders whose experiential expertise can enhance equity, relevance, and effectiveness in HIV health promotion programs and provides actionable insights for community-engaged service design and policy.

Peer supporters are instrumental for the successful navigation of prevention of mother-to-child human immunodeficiency virus (HIV) transmission services, including maternal viral load suppression and early infant HIV diagnosis. These outcomes are critical for the elimination of mother-to-child HIV transmission. We assessed the impact of continuous quality improvement (CQI) services on assignment to peer supporters and undetection of the viruses among pregnant women living with HIV (WLHIV) and mother-to-child transmission of HIV (MTCT) rates among HIV exposed babies in Rwanda. To assess the impact of CQI services on assignment to peer supporters and undetection of the viruses among pregnant WLHIV and MTCT rates among HIV exposed babies in Rwanda. Between 2021 and 2022, CQI services were implemented in 18 of the 38 healthcare facilities included in this analysis. Healthcare workers in 18 facilities used CQI approaches to key predictors of, and contributors related to, the implementation of the prevention of MTCT (PMTCT) program to improve maternal and infant outcomes. This was a secondary data analysis that explored the association between CQI and assignment to peer supporters, undetection of the virus, and MTCT rates. To assess the impact of CQI on these outcomes, a multivariable logistic regression model was used to compute adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI). A total of 1145 mother-baby pairs were included, of whom 558 (48.7%) were from facilities that implemented CQI. At the end of evaluation, 1043 (91.0%) either completed 24-months of follow-up or remained in care in the same facilities. Of 102 not available at the evaluation, 84 were transferred out, and 18 were dead or lost to follow-up. Overall, 405 (35.4%) women were assigned to peer supporters, 1004 (87.7%) had undetectable viruses, and 8 (0.7%) infants were infected with HIV. Compared to women from non-CQI facilities, those from CQI implementing facilities had 32% higher odds of being assigned to peer supporters (aOR = 1.32; 95%CI: 1.02-1.71). Similarly, disclosing HIV status (aOR = 1.53; 95%CI: 1.10-2.14) and a higher number of health care workers per 1000 active patients (> 4 vs &#x2264; 4) (aOR = 1.34; 95%CI: 1.05-1.75) were associated with higher odds of being linked to peer supporters. Having a formal education was associated with reduced odds of being linked to peer supporters compared to those with no education. Compared to women from non-CQI facilities, those from CQI implementing facilities had 51% higher odds of having undetectable viruses (aOR = 1.51; 95%CI: 1.05-2.18). CQI was associated with fewer transferred out compared to non-CQI facilities (6.0% vs 8.8%; P = 0.07). Nearly 3 in 10 pregnant WLHIV in Rwanda were linked to peer support to support the successful navigation of PMTCT services, and CQI increased this linkage and aided the achievement of undetectable viruses. Implementing CQI and promoting HIV status disclosure is critical to facilitate peer support linkage and improve maternal and infant outcomes.

Objectives. To estimate the number of US transgender women living with HIV and compare determinants of health between US transgender women and presumed cisgender men. Methods. We analyzed cross-sectional interview and medical record data (2015-2022) from the Medical Monitoring Project, a nationally representative sample of people living with HIV in the United States. Results. Weighted estimates suggest that 21&#x2009;088 US transgender women are living with HIV. Across nearly every domain, transgender women reported greater barriers to care than did presumed cisgender men, including higher rates of hunger or food insecurity (34% vs 18%), unstable housing or homelessness (33% vs 18%), and lower rates of viral suppression (66% vs 74%). Conclusions. Transgender women living with HIV face greater and distinct barriers to wellness and care engagement across multiple domains than their cisgender male counterparts. Public Health Implications. Transgender identity is a critical factor in HIV-related health equity. Future research is urgently needed to understand how to support transgender women living with HIV in accessing the services they need to live healthy lives. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308497).

Depressive symptoms are common among people living with HIV (PLWH) and may adversely affect sexual function. However, the relationship between HIV infection and premature ejaculation (PE) has not been clearly defined. This study aimed to evaluate depressive symptoms in HIV-infected men and investigate their association with PE. This multicenter case-control study included 112 HIV-infected men and 110 age-matched healthy controls who presented to infectious diseases outpatient clinics between March and September 2025. All participants completed the Turkish validated versions of the Premature Ejaculation Diagnostic Tool (PEDT) and the Beck Depression Inventory (BDI). PE was defined as a PEDT score&#x2009;&#x2265;&#x2009;11. The mean age of PLWH was 36.3&#x2009;&#xb1;&#x2009;11.9 years, compared with 39.6&#x2009;&#xb1;&#x2009;10.8 years in the control group. Both PEDT and BDI scores were significantly higher in PLWH than in controls (p&#x2009;<&#x2009;0.001 for both). PE was present in 49 (43.8%) HIV-infected men and 23 (20.9%) controls (p&#x2009;<&#x2009;0.001). Among PLWH, those with PE had significantly higher BDI scores than those without PE (16.8&#x2009;&#xb1;&#x2009;10.1 vs. 10.7&#x2009;&#xb1;&#x2009;8.9, p&#x2009;=&#x2009;0.009). In multivariable logistic regression analysis, BDI score remained independently associated with PE after adjustment for erectile function, age, and disease duration. HIV-infected men demonstrated higher rates of PE and more severe depressive symptoms compared with healthy controls. Among PLWH, depressive symptom severity remained significantly associated with PE after adjustment for erectile function, age, and disease duration.

CD16+ monocytes are a minor subset of the total monocyte population that play a disproportionate role in contributing to neuroinflammation in human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND). This has been evidenced by the enhanced transmigration of CD16+ monocytes into the brain compared to their CD16- counterpart. CD16+ monocytes can be activated by HIV ssRNAs through toll-like receptors (TLR) 7 and TLR8, and subsequently interact with brain-resident cells, including astrocytes. Previous studies from our laboratory identified monocyte-derived IL-1&#xdf; as an inducing cytokine for astrocyte-derived neuroinflammatory factors. Despite cannabis use among the HIV community, the mechanisms by which immune-modulating cannabinoids, &#x394;9-tetrahydrocannabinol (THC) and cannabidiol (CBD), alter human immune responses in the context of HAND-associated neuroinflammation remain elusive. We hypothesized that THC and CBD suppress CD16+ monocyte-induced astrocyte secretion of inflammatory mediators and monocyte recruitment via chemotaxis in the context of HIV. Results from this study show that THC and CBD impair CD16+ monocyte IL-1&#xdf;-mediated astrocyte production of IL-6, IL-8, and MCP-1 when these two cell types are cocultured in the presence of TLR7 or TLR8 stimulation. Additionally, monocytes from HIV+ subjects exhibited enhanced migration compared to monocytes from HIV- subjects, which was suppressed by THC treatment but not by CBD. The effects on migration were associated with reduced cellular expression of polymerized actin and high-affinity conformation integrin receptors. Collectively, these findings suggest that THC, and to a lesser extent CBD, may have therapeutic potential for mitigating CD16+ monocyte-mediated neuroinflammation associated with HAND.

Globally, 301 million face anxiety disorders, notably common among people living with human immunodeficiency virus (PLHIV), causing major challenges and reduced quality of life. This review assesses India's prevalence, offering evidence to guide targeted interventions. A systematic literature search was conducted across PubMed, Excerpta Medica database (EMBASE), Scopus, and Web of Science up to November 2024. Observational studies using validated tools to assess anxiety prevalence in PLHIV were included. The pooled prevalence of anxiety disorders was estimated using a random-effects meta-analysis. Subgroup and sensitivity analyses were conducted to explore sources of heterogeneity. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Between-study heterogeneity was evaluated using Cochran's Q and I&#xb2; statistics. Fifteen studies (5,336 PLHIV) were included. The pooled prevalence of anxiety was 36% (95% confidence interval: 24%-47%), with higher prevalence in hospital-based studies (39%) compared to community-based studies (23%). Females had a higher prevalence (46%) than males (36%), though this difference was not statistically significant. Diagnostic tools influenced prevalence estimates, with self-report measures (e.g., Hospital Anxiety and Depression Scale [HADS] and Depression Anxiety and Stress Scale [DASS]) reporting higher prevalence (48%-49%) than structured interviews (ICD-10: 7%, DSM-IV: 1%). Subgroup analysis revealed significant heterogeneity across study settings and diagnostic tools. This meta-analysis demonstrates a high prevalence of anxiety disorders among PLHIV in India, underscoring the need for integrated mental health services within HIV care frameworks. Routine anxiety screening, stigma reduction initiatives, and gender-sensitive interventions are essential to address this mental health burden effectively. Future research should focus on longitudinal outcomes and community-based approaches to improve mental health care for PLHIV.

Oral lesions remain common among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and may serve as important clinical indicators of immune status and disease progression, particularly in resource-limited settings. However, data from Indonesia remains limited. This hospital-based cross-sectional study aimed to characterise the spectrum of oral lesions and identify clinical and behavioral determinants associated with their occurrence among people living with HIV/AIDS (PLWHA) attending a tertiary referral hospital in West Java, Indonesia. A total of 254 PLWHA were enrolled. Sociodemographic, behavioral, and clinical data were collected through interviews and medical records, and comprehensive intraoral examinations were performed by an oral medicine specialist. Multivariable logistic regression analyses were used to identify independent determinants of oral lesions. Oral lesions were identified in 75.6% of participants, with acute pseudomembranous candidiasis (27.2%), oral hairy leukoplakia (20.1%), and recurrent aphthous stomatitis (15.1%) being the most frequent diagnoses. Significant determinants of oral lesions included age&#x2009;&#x2265;&#x2009;46 years (AOR 7.71; 95% CI: 1.38-43.21), underweight body mass index (AOR 4.14; 95% CI: 1.63-10.53), poor oral hygiene (AOR 4.43; 95% CI: 1.06-18.44), smoking (AOR 3.26; 95% CI: 1.51-7.08), and advanced HIV clinical stage (AOR 3.69; 95% CI: 1.71-7.95). Clinical and behavioral factors play an important role in the development of oral lesions among PLWHA, underscoring the importance of integrating routine oral examinations and targeted oral health strategies into HIV care, particularly in settings with limited access to health care.

Cannabis co-use is common among people with HIV (PWH) who smoke cigarettes yet is infrequently measured in smoking cessation trials. We report the relationship of baseline co-use status, HIV-related variables, and factors associated with tobacco treatment success (e.g., psychosocial characteristics) among PWH enrolled in an ongoing RCT evaluating a tailored app-based smoking cessation treatment. U.S. adults who smoked &#x2265;5 cigarettes per day and were willing to set a quit date were recruited nationally online and via community-based HIV clinics in Florida. At baseline, HIV-related variables, socio-demographics, psychosocial characteristics, tobacco use history, cannabis use history and modality, and other substance use were assessed. Participants were classified as co-using at baseline if they reported using any form of cannabis in the past 30 days. Participants who co-used cannabis (n=142, 28%) vs. did not (n=370, 72%) were more likely to be younger, Black, lesbian, gay, or bisexual, live in a household with another person who smokes, use other combustible tobacco products, report other recreational drug use in the past year, and have higher self-reported health. Compared to participants who did not use cannabis, co-use participants more often reported missed doses of ART in the past month (53% vs. 37%), loss of appetite or change in the taste of food (48% vs. 38%), frequent alcohol use, financial strain, loneliness, discrimination, and better perceived general health (p values < .05). They frequently reported blunt use and same-occasion cannabis and tobacco use. Study findings indicate that PWH who co-use experience elevated behavioral and psychosocial risk factors associated with reduced smoking cessation success and worse HIV-related outcomes.

Data on women ageing with HIV in Australia are limited, particularly regarding those in midlife and experiencing menopause. The aim of this study is to describe the demographic characteristics of cisgender women living with HIV who attend the Alfred Hospital, Monash Medical Centre and Melbourne Sexual Health Centre for primary HIV care. In particular, we sought to identify whether documentation of menopausal status, menopausal symptoms, use of menopausal hormone therapy (MHT) and comorbidity screening had occurred in these women. Cisgender women currently in care (defined as attending the clinic between 1/7/2022 and 1/7/2024) were identified and a medical record review was conducted to identify demographic information, menopausal status, menopausal symptoms, use of MHT and documentation of related comorbidity screening results (cervical screening test [CST], mammogram, fracture risk (FRAX), bone density (DEXA), cardiovascular disease [CVD] risk). A total of 462 women were identified across the three sites. Median age was 47&#x2009;years (range 20-85, interquartile range [IQR] 39-56) and the majority (342, 70%) were born overseas. Of these, 148 (32%) were pre-menopausal, 47 (10%) perimenopausal and 145 (31%) post-menopausal. Menopausal status was unable to be determined from clinical records for 122 (26%). Menopausal symptoms were documented for 70 women (age range 38-85, IQR 48-57). Cervical screening was completed in the last 3&#x2009;years for 293 women (66%) aged 25-74&#x2009;years, 58 (30%) over 50&#x2009;years had documentation of a mammogram in the last 2&#x2009;years, 105 (39%) over 45&#x2009;years had CVD risk calculated and 17 (29%) over 50&#x2009;years had FRAX calculated. Approximately half the women in this study were aged 40-56&#x2009;years, yet menopausal status was unable to be determined for over a quarter of the cohort. Documentation of menstrual or menopausal symptoms was poor and significant gaps were identified in comorbidity screening. Further research is needed to understand the impact of menopause on women living with HIV in Australia. Clinical guidelines need updating to include gender-specific health needs of women living with HIV and to consider the impact of menopause on comorbidity management.