This paper presents a supervised multi-label framework for detecting multidimensional perceived risk in HIV-related Reddit discourse. A longitudinal corpus of 329,707 texts collected from r/hivaids and r/HIV between 2015 and 2025 was analyzed to identify three risk dimensions: transmission risk, health deterioration risk, and social stigma risk. A stratified sample of 2,000 texts was annotated by domain experts, achieving substantial inter-annotator agreement (Cohen's κ = 0.74-0.81). A RoBERTa-base model was fine-tuned using class-weighted binary cross-entropy loss and per-class threshold optimization. The proposed model achieved a macro-F1 score of 0.87 and a macro-AUC-ROC of 0.97, outperforming 12 baseline models, including traditional machine learning, neural network, and alternative transformer-based approaches. Ablation experiments confirmed the importance of transformer fine-tuning and class weighting, while also showing that handcrafted features provided only marginal gains. Applied to the full corpus, the model revealed significant upward trends in transmission risk and health deterioration risk, strong co-occurrence between transmission and stigma-related discourse, and distinct information-seeking patterns across risk categories. The findings demonstrate that transformer-based multi-label learning can support scalable, reproducible analysis of HIV-related health perceptions in online communities, with potential applications in public health surveillance, communication strategy design, and digital intervention planning.
Globally, tuberculosis (TB) poses a severe threat to human health. Prior to the COVID-19 pandemic, TB was the commonest infectious cause of mortality, surpassing HIV/AIDS. A strong index of suspicion is required for the diagnosis of extrapulmonary tuberculosis (EPTB) because of the paucibacillary nature of biological specimens. Primary care physicians, as the first point of contact for patients, are in an ideal position to detect TB early due to its multisystemic nature and varied presentation. This study aims to determine microbiological, demographic, clinical, and changing trends of EPTB in our region. To study the clinico-microbiological and drug susceptibility profile of patients with confirmed EPTB. This was a prospective observational study in which all presumptive EPTB cases were screened, and confirmed EPTB cases were studied using various demographic criteria and clinical aspects. A total of 1425 extrapulmonary samples were obtained from suspected TB cases between 2023-24. Of these, 194 samples with various diagnostic modalities and 68 patients were selected for the study based on inclusion and exclusion criteria. The prevalence of EPTB cases was found to be more prevalent in males, with majority of cases belonging to the 21-30 years age group. The maximum positivity was reported in pleural samples, followed by lymph node aspirates. Cartridge-based nucleic acid amplification test (CBNAAT) was found to be having highest sensitivity followed by solid culture. Rifampicin resistance was 4.4% cases. Since most of the tests rely on the presence of mycobacteria in the specimen, none of them have a 100% sensitivity; thus, suboptimal performance of all assays in the diagnosis of EPTB cases underlines the continuing relevance of systematic clinical investigations for making the diagnosis of EPTB and also calls for the need for novel tests.
Opioid use disorder remains a critical public health challenge, marked by high prevalence, overdose deaths, and substantial societal burden. Despite the availability of effective medications for OUD (MOUD), treatment utilization remains suboptimal, particularly among special populations. Contributing factors include altered pharmacokinetics, complex comorbidities, heightened safety concerns, stigma, and limited clinician expertise. This review comprehensively summarizes the latest evidence and guidelines to inform approaches to medications for opioid use disorder in special populations, including individuals with hepatic, renal, or cardiovascular disease; HIV/AIDS; peripartum or breastfeeding status; concurrent alcohol or benzodiazepine use; perioperative care needs; and adolescence. Across these populations, MOUD are associated with reduced morbidity and mortality and should not be withheld solely due to medical comorbidity, pregnancy, concurrent substance use, or perioperative care needs. Methadone is consistently associated with the highest treatment retention but requires careful dosing and monitoring in patients with hepatic, renal, and cardiovascular disease and in those receiving interacting medications, including antiretroviral therapy. Buprenorphine demonstrates a favorable safety profile across medically complex populations and fewer clinically significant drug-drug interactions. Extended-release naltrexone may be appropriate for select patients who can maintain opioid abstinence prior to induction, though its use is constrained by initiation barriers and limited population-specific data. Persistent access gaps, particularly among adolescents, highlight the need for tailored implementation strategies and further research. Consequently, recognizing the distinct needs and barriers of special populations with OUD is essential, and tailoring care to these considerations can enhance treatment outcomes.
Community health workers (CHWs) are central to primary healthcare (PHC) delivery and infectious disease control in low-income settings. In Madagascar, CHWs are mandated to contribute across multiple national disease programmes, yet evidence on their actual involvement and its determinants remains limited, particularly for HIV/AIDS and tuberculosis (TB). We conducted a cross-sectional survey between March and June 2024 among CHWs in four regions (Analamanga, Atsimo Andrefana, Androy and Anosy). Using two-stage cluster sampling, districts and public primary health centres were randomly selected and all eligible affiliated CHWs were invited to participate. We assessed CHWs' self-reported involvement in health domains and disease response programmes, including HIV/AIDS, TB and malaria, over the preceding 2 years. Mixed-effects logistic regression models with random intercepts at the health facility level were used to identify factors associated with involvement. Among the 408 participating CHWs (response rate 81.8%), engagement was near-universal in maternal and child health (100%) and malaria-related activities (98.5%), but was limited for TB (23.8%) and HIV/AIDS (21.6%). Across regions, involvement in HIV/AIDS and TB was largely limited to sensitisation activities. Possession of written work guidance and previous disease-specific training were consistently associated with higher odds of involvement in HIV/AIDS (OR 3.73; 95% CI 2.09 to 6.66) and TB (OR 2.55; 95% CI 1.48 to 4.40). Reliance on non-governmental organisation-led support was not associated with increased engagement. In rural Madagascar, CHW involvement in HIV/AIDS and TB is low compared with malaria and maternal and child health. Engagement in HIV/AIDS and TB is driven by the availability of clear work guidance and disease-specific training. Strengthening integrated responses can draw on the malaria platform and anchor both diseases within routine activities of the national operational framework for CHWs. Public health donors and actors need to align disease-specific investments and actions with core PHC structures.
The first year after an HIV diagnosis is a period of intense psychological vulnerability, with elevated rates of depression, anxiety, and adjustment problems documented in multiple settings. However, data from Albania and Western Balkan contexts are scarce. To assess psychological adjustment, coping responses, HIV knowledge, and antiretroviral treatment (ART) adherence among adults diagnosed with HIV within the previous 12 months in Tirana, Albania. A cross-sectional study was conducted with 120 patients registered at the ambulatory HIV/AIDS clinic at the Infectious Diseases Hospital in Tirana. patients diagnosed within the last 12 months. Measures included demographic data, an Albanian version of the Mental Adjustment to HIV Scale (MAHIVS), a researcher-developed, interviewer-administered structured HIV knowledge interview, and a short adherence assessment based on self-report and cross-checking against medical records/clinic records. The mean age was 34 years (SD = 5); 26.7% were female, and 47 males identified as homosexual. HIV transmission knowledge was high (78% answered correctly), while awareness of biomedical issues (PrEP/PEP, viral load, information regarding fertility) was low. Participants reported high ART adherence, supported by medical records. MAHIVS scores indicated high helplessness (M = 21/36) coexisting with strong adaptive coping: Fighting Spirit/Self-Efficacy (M = 14/24), Personal Control (M = 11/16), and Positive Coping (M = 11/20). Newly diagnosed Albanian patients show a mixed adjustment profile; notable psychological distress combined with moderate to high adaptive responses. Early psychosocial and educational support focused on reducing helplessness and increasing HIV knowledge within routine HIV care may improve adjustment trajectories during the first-year post-diagnosis.
Tuberculosis (TB) has continued to be one of the global threats, affecting millions of individuals globally, including the maternal and child health (MCH) populations and individuals with HIV/AIDS. TB infected 10.8 million individuals, leading to 1.25 million deaths across the globe annually, leaving 4 million missing cases contributing to the global TB burden. This study aims to unveil innovative approaches to TB diagnosis, challenges, and the future direction of this field. A comprehensive literature search was conducted to retrieve studies published between 2019 and 2024 from PubMed, Google Scholar, and Web of Science. The studies were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and screened using the Rayyan tool. The quality and risk of bias of the included studies were assessed using Quality Assessment of Diagnostic Accuracy Studies 2 for diagnostic accuracy studies and Strengthening the Reporting of Observational Studies in Epidemiology for observational studies. A random effects model was employed to calculate the pooled sensitivity and specificity, while Egger's test and funnel plots were utilized to evaluate publication bias. R and MetaDTA software were used for all the statistical analyses. The review included 25 studies with sample sizes ranging from 100 to 6,520 participants and assessed various innovative approaches for diagnosing TB, including molecular methods, biomarker-based techniques, and artificial intelligence (AI) applications. The most common approach was molecular testing, specifically cartridge-based tests. The overall sensitivity of these methods was 0.79 (95% confidence interval [CI]: 0.70-0.86), with a heterogeneity index (I²) of 92.9% and a p < 0.0001. The specificity was recorded at 0.93 (95% CI: 0.87-0.96), with an I2 of 94.8% and a p < 0.0001. This review reinforces the promise of innovative diagnostic methods, especially cartridge-based molecular tests, for improving TB detection. However, moderate sensitivity and high heterogeneity emphasize the need for cautious implementation and further validation of new tools such as the AI-based and biomarker-based. Strategic investment in research and contextual deployment is critical for closing the TB diagnosis gap globally.
This multicentre study evaluated Health-related Quality of Life (HRQoL) and identified sociodemographic and clinical determinants of physical and mental health outcomes in a large national HIV cohort in Turkiye. This cross-sectional study included 1303 adults across 23 centres. HRQoL was assessed using the Turkish MOS-HIV Health Survey, yielding Physical Health Summary (PHSS) and Mental Health Summary (MHSS) scores. HRQoL scores were dichotomised into "higher" (>50) and "lower" (≤50) groups. Data were analysed via univariate tests and multivariable logistic regression. Participants (88.6% male; median age: 38) were primarily single, employed, and university graduates. The median CD4+ T-cell count and HIV RNA level were 627 cells/mm3 and <50 copy/mL, respectively. Median PHSS and MHSS were 57.25 and 50.57, respectively. While social/role functioning scored highest, health transition scored lowest. Lower PHSS was identified in 22.7% of participants, whereas 47.9% reported lower MHSS. Low education and high daily pill burden significantly increased the risk of lower HRQoL. Interestingly, lower income was independently associated with better HRQoL, while older age and psychiatric treatment correlated with better MHSS. Despite robust physical HRQoL, mental health remains a significant challenge. To achieve "Fourth 90" targets, interventions should prioritise health literacy and integrated mental health services within HIV care.​​Abbreviations: ART: antiretroviral therapy; CF: cognitive functioning; CI: confidence interval; EF: energy/fatigue; GH: general health perception; HAART: highly active antiretroviral therapy; HD: health distress; HIV: human immunodeficiency virus; HL: Hosmer-Lemeshow; HRQoL: health-related quality of life; HT: health transition; MHS: mental health summary; MHSS: mental health summary score; MOS-HIV: medical outcomes study HIV health survey; OR: odds ratio; P: pain; PF: physical functioning; PHS: physical health summary; PHSS: physical health summary score; PLWH: people living with HIV; QL: quality of life; RF: role function; RNA: ribonucleic acid; SF: social function; UNAIDS: joint United Nations programme on HIV/AIDS.
The enactment of the One Big Beautiful Bill Act (OBBBA) in July 2025 represents a fundamental shift in United States global health financing, with significant implications for African public health systems. For more than three decades, US development assistance for health particularly through initiatives such as the President's Emergency Plan for AIDS Relief (PEPFAR), the President's Malaria Initiative, and maternal and child health programs-has been central to disease control and health system strengthening across sub-Saharan Africa. OBBBA institutionalizes reduced funding baselines under an "America First Global Health Strategy," constraining bilateral assistance and limiting flexible mechanisms that previously supported surveillance, laboratory systems, workforce development, and pandemic preparedness. This perspective examines the anticipated consequences of OBBBA for African public health through three interconnected lenses: disease-specific impacts on HIV/AIDS, tuberculosis, malaria, and maternal and child health; systemic effects on health systems, including workforce sustainability, supply chains, surveillance, and research infrastructure; and broader economic and geopolitical implications for health sovereignty and partnership dynamics. Drawing on existing empirical evidence, modeling studies, and historical analogues of funding disruptions, we argue that abrupt reductions in US global health financing risk reversing hard-won gains in disease control, exacerbating health system fragility, and increasing vulnerability to emerging infectious threats. At the same time, the policy shift may accelerate diversification of partnerships and prompt renewed debates on domestic resource mobilization and African health sovereignty. We conclude that coordinated responses by African governments, regional bodies, international institutions, and development partners are urgently required to mitigate risks, protect treatment continuity, and sustain progress toward global health security and the Sustainable Development Goals.
Although maintenance dialysis (MD) affects only a small proportion of patients with tuberculosis (TB), individuals receiving dialysis are at increased risk of TB and may be more likely to experience unfavourable treatment outcomes. Evidence on this association remains limited in Brazil, particularly in high-burden settings characterized by geographic barriers and challenges in access to specialized healthcare services. We assessed the association between MD and unfavourable TB treatment outcomes in Amazonas, Brazil. We conducted a retrospective population-based cohort study including all new TB cases reported in Amazonas, Brazil, between 2001 and 2023. Probabilistic record linkage was performed between the state TB surveillance system (SINAN-TB) and a dialysis registry to identify patients receiving MD before TB diagnosis. The primary exposure was MD prior to TB diagnosis. Unfavourable outcomes comprised death from any cause, loss to follow-up, or treatment failure. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Among 58,611 TB cases included in the analysis, 112 (0.2%) had evidence of MD before TB diagnosis. MD was strongly associated with higher odds of unfavourable outcomes (aOR 5.45; 95% CI 3.60-8.24). Illicit drug use (aOR 2.18; 95% CI 1.97-2.40), HIV/AIDS (aOR 2.06; 95% CI 1.94-2.19), mental illness (aOR 1.53; 95% CI 1.27-1.83), alcohol use (aOR 1.38; 95% CI 1.29-1.48), and smoking (aOR 1.30; 95% CI 1.20-1.42) were also associated with increased odds of unfavourable outcomes. In contrast, directly observed therapy (DOT) (aOR 0.67; 95% CI 0.63-0.71), female sex (aOR 0.82; 95% CI 0.79-0.85), and diabetes mellitus (aOR 0.84; 95% CI 0.78-0.91) were associated with reduced odds. Within a large population-based TB cohort, MD was a rare but clinically important exposure that was strongly associated with unfavourable treatment outcomes. The protective effect of DOT highlights a feasible intervention pathway. These findings support the integration of TB care into dialysis services and reinforce the need to prioritize this population for targeted TB screening and preventive strategies in high-burden settings. Not applicable.
Central nervous system (CNS) toxoplasmosis represents one of the most common opportunistic complications in patients with advanced HIV/AIDS infection. A wide range of neurological symptoms may contribute to the clinical presentation of the disease. This paper reports the case of a 29-year-old man with untreated HIV infection, in whom neurotoxoplasmosis led to rapidly progressive, bilateral sensorineural hearing loss and severe disability. Appropriate neuroimaging diagnostics enabled the initiation of effective treatment; however, neurological sequelae, including hearing impairment, persisted. To the best of our knowledge, this type of complication has not been previously described in patients living with HIV and CNS toxoplasmosis. Toksoplazmoza ośrodkowego układu nerwowego (OUN) stanowi jedno z najczęstszych powikłań u pacjentów z zaawansowanym zakażeniem HIV/AIDS. Szereg objawów neurologicznych może składać się na obraz kliniczny zakażenia. W niniejszej pracy przedstawiono przypadek 29-letniego mężczyzny z nieleczonym zakażeniem HIV, u którego neurotoksoplazmoza doprowadziła do gwałtownie postępującego, obustronnego niedosłuchu-czuciowo odbiorczego i poważnej niepełnosprawności. Odpowiednia diagnostyka neuroobrazowa pozwoliła na wdrożenie skutecznego leczenia, jednak powikłania neurologiczne, w tym niedosłuch, utrzymały się. Według naszej wiedzy, nie opisywano do tej pory tego rodzaju powikłania u pacjentów żyjących z HIV oraz toksoplazmozą OUN.
Injuries represent a major public health issue, causing approximately 16,000 deaths globally each day (10% of all deaths), which is 32% more than the combined total caused by malaria, tuberculosis, and HIV/AIDS. Over the past 15 years, the WHO and regional initiatives have supported the piloting of trauma registries in low- and middle-income countries as essential tools for monitoring, planning, and prevention. This article aims to assess the feasibility and utility of implementing a national trauma registry in the Republic of Moldova, in order to improve injury surveillance and emergency service planning. In 2018, the pilot iCREATE trauma registry was tested for the first time in three countries: Moldova, Armenia, and Georgia. The data collection instrument was developed based on WHO recommendations, ICD-10, and IDB-JAMIE standards, under the guidance of partners from the University of Iowa and Babes Bolyai University, Cluj-Napoca. All trauma cases from the Institute of Emergency Medicine and the Valentin Ignatenco Municipal Clinical Children's Hospital in Chișinău were included in the registry. The analyzed sample consists of 7,942 individuals, predominantly male (57.3%). The most represented age groups were 19-29 years (17.8%) and 30-39 years (17.6%), while individuals aged 70 and above accounted for 11% of the total. Most incidents occurred in urban areas (76.9%). Of the total patients, 52.4% were treated and discharged, while 37.5% required hospitalization. Injuries occurred primarily at home (55.4%) and on public roads (24.7%). The leading mechanism of injury was falls (68.2%), followed by other causes (12.2%) and cut/pierce injuries (10.0%). The most frequently affected body regions were the head/skull (12.5%) and knee (11.8%), followed by the hip (6.7%) and wrist (6.4%). Fractures were the most common injury type (34.5%), followed by contusions (23.0%) and open wounds (14.7%). Several gaps in data collection and reporting were identified and should be considered in future efforts to enhance trauma surveillance. The data highlight the need to develop a national trauma registry as an essential tool for monitoring, prevention, and effective intervention, alongside health promotion campaigns targeting vulnerable groups and the involvement of relevant stakeholders.
It remains unclear which cardiovascular disease (CVD) risk scores are optimized for people living with treated HIV with high rates of viral suppression. We evaluated the performance of commonly used CVD risk scores in a population of primarily well-treated HIV patients in England. A multi-centre retrospective cohort analysis was performed, including people living with HIV (PLWH) above the age of 40 with no prior major adverse CVD events (MACE), regularly attending 7 HIV clinics in England during 2014. Outcomes were MACE over the following 5 years: myocardial infarction, invasive cardiac procedure e.g. primary angioplasty, cerebrovascular events, new heart failure, and CVD-related death. Clinical outcomes were aligned with the respective risk scores. The following CVD risk models were evaluated: the UK primary-care validated QRISK3, Framingham laboratory and non-laboratory (Office) scores, Data collection on Adverse events of anti-HIV Drugs (D:A:D), Pooled Cohort Equation (PCE), and the World Health Organization (WHO) laboratory and non-laboratory models. Models were scaled for 5-year CVD estimates. We assessed the discrimination and calibration of these 5-year models within our population. Multiple imputation was used to address missing data. Of 2582 people, 94 had at least one MACE documented during follow-up. All seven scores demonstrated moderate discrimination. QRISK3 demonstrated the best calibration in this cohort with an O:E ratio of 1.169, 95% CI 0.950, 1.439, mean calibration-in-the-large (CITL) value of 0.156 (95% CI -0.052, 0.364) and slope of 0.897 (0.682, 1.113). Framingham Office generally overpredicted risk, while WHO scores and D:A:D generally underpredicted risk. Imputing for missing data yielded results similar to the complete case analysis. CVD risk scores demonstrated moderate performance in a well-treated PLWH cohort. Our findings emphasize the need to calibrate each CVD risk score to the local population to guide prioritization of clinical resources for CVD prevention. Evidence before this study: We systematically searched Medline, Embase, and Cochrane Library database from January 1995 to August 2023, using the following terms 'HIV/AIDS and Cardiovascular Disease (CVD) outcomes', with an updated search to 2025. The risk of CVD has been reported to be up to two times that of people living without HIV, along with increased rates of heart failure and sudden death. Commonly used CVD risk scores have demonstrated variable performance for PLWH, and only the D:A:D study equation has been specifically validated in an HIV-positive population. Within an era of modern ART regimes and high rates of viral suppression, there have been numerous comparisons of CVD risk across scoring systems, but few studies with observed outcomes of CVD rates to validate the predictions. It remains unclear which CVD risk calculator is the most suitable for PLWH. The use of routinely collected clinical data may also impact the accuracy of results due to the presence of incomplete or missing data fields. In this study, we aimed to evaluate the performance of commonly used CVD risk scores in a population of primarily well-treated HIV patients in England using routinely collected clinical data. Added value of this study: We demonstrate that of the seven CVD risk scores evaluated (QRISK3, Framingham laboratory and non-laboratory (Office) scores, D:A:D, Pooled Cohort Equation (PCE), and the WHO laboratory and non-laboratory models), all showed moderate discrimination compared to observed major adverse cardiovascular events (MACE) rates in an English multicentre cohort of people living with HIV attending clinics. QRISK3, using a large UK primary care database to validate predicted CVD risk, appeared to be most closely calibrated to CVD outcomes in our cohort without the need for additional calibration. Our findings also suggest that the use of non-laboratory scores, which have been suggested for low and middle-income settings where laboratory results may not be available, should be interpreted with caution, and further testing may be required due to their miscalibration in this cohort. Implications of all the available evidence: Using real-world clinical data from people with HIV who are engaged in care in England, these findings emphasize the need to calibrate each CVD risk score to the local population it is used for in order to accurately guide prioritization of clinical resources for primary CVD prevention.
The present study employs a qualitative method to explore how stigma and discrimination shape the psychological health of transgender sex workers (m to f) who have faced heightened vulnerability in a heteronormative society. Drawing on 16 in-depth interviews conducted in India through purposive sampling, the study reveals that participants navigate dual forms of stigma which includes stigma attached to gender identity and stigma associated with sex work reflecting a layered form of marginalization. These intersecting stigmas contribute to persistent mental distress, manifesting through self-harming behaviors, social withdrawal, suicidal ideation, and past suicide attempts. Frequent encounters with body shaming, violence, harassment, forced sex, and unsafe sexual practices increase their susceptibility to sexually transmitted diseases (STDs), and HIV/AIDS. The study underscores the need for gender-affirmative, and inclusive mental health policies that address the intersecting marginalization of the transgender sex workers.
Objective: To explore the impact of delayed diagnosis on the risk of all-cause mortality among sexually transmitted HIV infected patients in Yuxi Prefecture, Yunnan Province. Methods: Baseline, treatment and follow-up data were downloaded from the National Comprehensive HIV/AIDS Prevention and Care Information System, between Jan 1, 2016 and Dec 31, 2023. The HIV infected time was back-calculated based on the regular decrease trend of CD4+T lymphocyte counts among antiretroviral therapy naïve patients, and the time interval between HIV infected and diagnosed was defined as the delayed diagnosis time. The restricted cubic spline functions were used to explore the linear and nonlinear relationships between delayed diagnosis time and all-cause mortality, and the Cox proportional hazards regression model was employed to analyze the association between delayed diagnosis time and all-cause mortality among sexually transmitted HIV infected patients. Results: Among 1, 832 HIV/AIDS cases, the median delayed diagnosis time was 4.27 (1.67, 7.18) years, and the median follow-up time was 3.83 (2.00, 5.92) years. there were 184 all-cause deaths were found during follow-up time, with a death density of 2.61 (95%CI: 2.24-2.98) per 100 person-years. Restricted cubic spline analysis showed a positive linear association between delayed diagnosis time and all-cause mortality risk (Poverall<0.001,Pnonlinearity=0.055). After adjusted for confounders, each 1-year delay in diagnosis was associated with a 26% increase in all-cause mortality risk (HR=1.26, 95%CI: 1.21-1.31). The all-cause mortality risk in the late-diagnosed group was 6.31 folds higher than that in the early-diagnosed group (HR=6.31, 95%CI: 3.92-10.14). There were no interaction between delayed diagnosed and age on all-cause mortality (Pinteraction=0.548), but the mortality density in the late diagnosed-age ≥50 years group (11.13/100 person-years) was much higher than that in the late diagnosed-age <50 years group (4.62/100 person-years). There were multiplicative and additive interactions were observed between delayed diagnosis and ART. The all-cause mortality risk in the late-diagnosis-naïve-ART group were 130.14 folds higher than that in the early/mid-diagnosis-ART group (HR=130.14, 95%CI: 79.24-213.75). The relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were 118.77 (95%CI: 55.81-181.73), 12.45 (95%CI: 6.92-22.38) and 0.91 (95%CI: 0.86-0.96), respectively. Conclusion: There were an interaction between delayed diagnosed and ART status on all-cause mortality among sexually transmitted HIV infected patients. we should focus on the patients late diagnosed, especially the those aged more than 50 years and those ART naïve, and taken efforts to prevent their high risk of death within one year after diagnosed. 目的： 探讨延误诊断对经性传播人类免疫缺陷病毒（HIV）感染者的全因死亡风险影响。 方法： 通过国家艾滋病综合防治数据信息管理系统，下载云南省玉溪市2016年1月1日—2023年12月31日HIV感染者基线、治疗和随访等相关资料，根据感染HIV后未抗逆转录病毒治疗（ART）前CD4+T淋巴细胞计数随感染时间呈规律下降趋势来反推感染时间，将HIV感染到诊断发现的时间间隔定义为延误诊断时间。应用限制性立方样条函数分析延误诊断时间与全因死亡的线性和非线性关系，使用Cox比例风险回归模型分析延误诊断时间与全因死亡风险的关联。 结果： 共纳入1 832例HIV感染者，延误诊断时间为4.27（1.67，7.18）年，随访时间为3.83（2.00，5.92）年。随访期间全因死亡184 例，死亡密度为2.61（95%CI：2.24~2.98）/100 人年。限制性立方样条显示，延误诊断时间与全因死亡风险存在正向线性关联（P总体<0.001，P非线性=0.055）。调整混杂因素后，每延误诊断1年全因死亡风险增加26%（HR=1.26，95%CI：1.21~1.31）；晚期诊断的全因死亡风险是早期诊断的6.31 倍（HR=6.31，95%CI：3.92~10.14）；延误诊断与年龄对全因死亡的影响无交互作用（P交互=0.548），但晚期诊断-年龄≥50 岁组死亡密度（11.13/100 人年）远高于晚期诊断-年龄<50 岁组（4.62/100 人年）；延误诊断与ART情况间存在乘法交互作用和加法交互作用，晚期诊断-未ART组全因死亡风险是早/中期诊断-ART组的130.14 倍（HR=130.14，95%CI：79.24~213.75），交互作用超额相对危险度、交互作用归因比和交互作用指数分别为118.77（95%CI：55.81~181.73）、12.45（95%CI：6.92~22.38）和0.91（95%CI：0.86~0.96）。 结论： 延误诊断可显著升高经性传播HIV感染者全因死亡风险，需聚焦于晚期诊断患者群体，特别是其中年龄≥50 岁和未ART的脆弱人群，并着力防控其在确诊后1年内的高死亡风险。.
The life expectancy of people living with HIV (PLWH) has significantly increased, largely due to the antiretroviral therapy (ART) used very frequently. To explore the associated factors of abnormal serum cortisol levels in PLWH and the correlation between different ART regimens. A retrospective cross-sectional study was conducted using clinical data of people living with HIV between May 2017 and March 2025. In this study involving 117 PLWH, 56 cases (47.9%) exhibited an abnormal high cortisol level. Subjects were stratified into morning serum hypocortisolemia group (Group A), morning serum normocortisolemia (Group B), and abnormal morning serum hypercortisolemia (Group C). Group A exhibited significantly higher diastolic blood pressure, longer duration of HIV diagnosis, and higher ART utilization rate. Additionally, the duration of HIV/AIDS Group A diagnosis was significantly longer and exhibited significant differences (P < 0.05) when compared with Group C. The mean triglyceride (TG) level in Group C was significantly elevated compared to that in Group B, and the low-density lipoprotein cholesterol (LDL-C) level in Group A was significantly higher than that in Group C (P < 0.05). The final logistic regression model was statistically significant (χ2 = 138.00, P = 0.008), and the parallel lines test (χ2 = 18.998, P = 0.123). The duration of HIV diagnosis was associated with changes in blood cortisol levels (OR = 0.987, 95% CI: 0.97-0.99, P = 0.042). In phase II, among 73 PLWH individuals receiving stable ART regimens, the proportion of decreased cortisol differed significantly among ART regimen groups (P < 0.05). Binary logistic regression analysis showed that longer duration of HIV diagnosis (OR = 1.02, P = 0.021) and the regimen (nucleoside reverse transcriptase inhibitors plus protease inhibitors (NRTIs + PIs) (OR = 5.36, P = 0.034)) were independently associated with reduced cortisol levels. The NRTIs + PIs regimen was associated with a significantly higher likelihood of reduced cortisol compared with the NRTIs + NNRTIs regimen. This finding was supported by multivariate logistic regression, which indicated that regimen (2) (NRTIs + PIs) was an independent factor associated with decreased cortisol levels.
The dual epidemic of HIV/AIDS and extensively drug-resistant tuberculosis (XDR-TB) remains a critical public health challenge in South Asia. HIV/AIDS compromises immune function, heightening susceptibility to opportunistic infections like TB, while XDR-TB, characterized by resistance to isoniazid, rifampicin, fluoroquinolones, and second-line injectables, severely complicates treatment and increases mortality risk. Despite global efforts, such as the WHO's End TB Strategy, progress in South Asia has been uneven, with limited exploration of regional and sex-specific mortality disparities. This study leverages Global Burden of Disease (GBD) 2021 data to analyze temporal trends and regional variations in HIV/AIDS and XDR-TB mortality across South Asia from 1993 to 2021, aiming to guide targeted public health interventions. We performed a retrospective, population-based analysis of HIV/AIDS and XDR-TB mortality trends in five South Asian countries (Nepal, Pakistan, Bhutan, Bangladesh, India) and the region overall, using GBD 2021 data. Annual mortality rates (AMR) per 100,000 population were extracted for both diseases, stratified by sex. Joinpoint regression analysis was utilized to evaluate temporal trends, detecting significant changes in AMR through Annual Percent Change (APC) and Average Annual Percent Change (AAPC), reported with 95 % confidence intervals (CIs) and p-values. From 1993 to 2021, HIV/AIDS and XDR-TB co-infection mortality exhibited significant increases across South Asia, with marked regional and sex-specific variations. Pakistan recorded the highest AAPC for both sexes combined (43.75 %, 95 % CI: 36.91-56.57, p < 0.000001), reflecting a persistent and substantial rise, followed by Bangladesh with an AAPC of 31.43 % (95 % CI: 24.97-40.61, p < 0.000001). Nepal showed an AAPC of 22.52 % (95 % CI: 12.09-35.81, p < 0.000001), while India and Bhutan had comparatively lower AAPCs of 8.06 % (95 % CI: 1.70-16.33, p = 0.0168) and 6.99 % (95 % CI: 3.79-10.50, p < 0.000001), respectively. Regionally, South Asia's AAPC was 7.98 % (95 % CI: 1.91-15.99, p = 0.011). Sex-stratified analyses highlighted disparities, with females in Pakistan exhibiting the highest AAPC (46.00 %, 95 % CI: 38.72-59.59, p < 0.000001), followed by females in Bangladesh (32.77 %, 95 % CI: 26.24-41.93, p < 0.000001). Joinpoint regression for South Asia identified six distinct segments, with an early peak APC of 393.84 % (1993-1995, 95 % CI: 336.40-463.07, p < 0.000001), driven by limited antiretroviral therapy (ART) and diagnostic access, followed by a significant decline from 2008 to 2021 (APC: -5.69 %, 95 % CI: -6.48 to -5.14, p = 0.0016). Country-specific trends revealed steep increases from 1993 to 2005 across all nations, with Nepal, Bangladesh, and India showing significant declines from 2018 to 2021 (e.g., India: APC -6.08 %, p = 0.0012), likely due to improved ART coverage and TB management. Pakistan, however, showed no decline, with a sustained APC of 6.50 % (2013-2021, p < 0.000001). Females in India experienced a sharper decline from 2019 to 2021 (APC: -17.38 %, 95 % CI: -22.64 to -9.38, p < 0.000001) compared to males (APC: -7.15 %, p < 0.000001), suggesting sex-specific treatment access differences. South Asia faced substantial HIV/AIDS and XDR-TB co-infection mortality increases from 1993 to 2005, with recent declines in Nepal, Bangladesh, and India reflecting enhanced treatment access and healthcare improvements. Pakistan's persistent mortality rise underscores ongoing challenges, including drug resistance and limited healthcare infrastructure. Sex-specific disparities emphasize the need for tailored interventions.
Despite substantial progress in the fight against HIV/AIDS, the epidemic continues to pose a major global public health challenge, with persistent residential disparities. However, the contributing factor for urban-rural disparities in Ethiopia is limited. Therefore, this study aims to identify inequalities in HIV testing across residences and identify contributing factors in Ethiopia. A cross-sectional study design was used to analyse secondary data. We used Individual Recode (IR) dataset, which includes women of reproductive age, and the Male Recode (MR) dataset, which includes men aged 15-59 years, from the 2016 Ethiopian Demographic and Health Survey (EDHS). Descriptive statistics summarised participants' socioeconomic and demographic characteristics. A multivariate decomposition analysis was employed to assess residential disparities in HIV testing. Overall, 44.9% of participants reported having been tested for HIV. Uptake was substantially higher among urban residents, with 69.3% reporting HIV testing compared with 38.3% of rural residents. The urban-rural gap was explained by both differences in participant characteristics and differences in the effects of those characteristics. Overall, 23.5% of the disparity was attributable to compositional factors, while 76.5% was attributable to coefficient effects. Being married (-12.7%), secondary (12.2%), and higher education (17.3%), and metropolises (3.7%) were the major compositional factors. There was a substantial disparity in HIV testing between urban and rural residents in Ethiopia. The residential difference in HIV testing was largely driven by differences in characteristics such as marital status, education level, and metropolises, which influenced HIV testing. Policy makers should strengthen interventions aiming to increase HIV testing, particularly in rural areas, with a focus on enhancing education and engagement with health services.
Infectious and parasitic diseases remain a significant cause of mortality in the state of Amazonas, and are shaped by structural, environmental, and social vulnerabilities. This descriptive, population-based study examines the temporal evolution and spatial distribution of mortality caused by infectious disease in Amazonas between 2013 and 2024. We analyzed monthly mortality rates using data from the Mortality Information System (SIM), focusing on International Classification of Diseases, 10th Revision (ICD-10) Chapter I (A00-B99) and selected codes from Chapter X (J09-J18). Despite initial stability (2013-2018), mortality rates increased markedly from 2019 to 2021, associated with the direct and indirect impacts of the Coronavirus Disease (Covid-19) pandemic. After 2022, rates stabilized but remained elevated, indicating a shift toward a new endemic level. Spatial analysis revealed a persistent concentration of deaths in metropolitan areas and riverine municipalities, with recent expansion into medium-sized towns of the interior. Pneumonia, human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS), septicemia, and tuberculosis accounted for most deaths, with a predominance of older adults and people identified as mixed race or Indigenous. High proportions of ill-defined causes and non-specific diagnoses, particularly in pneumonia and sepsis, highlight diagnostic limitations and the urgent need to strengthen death investigation services and expand etiological investigation. Our findings highlight persistent inequalities in health access and call for integrated public health strategies, including improved surveillance systems, expanded diagnostic capacity, and intersectoral approaches adapted to the Amazonian context.
Health inequities in Latin America are rooted in historical systems of oppression, including slavery, patriarchy, and colonialism, which disproportionately affect socially marginalized groups. Intersectionality theory offers a framework to examine how overlapping social markers interact to shape health outcomes. While HIV/AIDS research has explored the effects of individual markers, few studies have addressed their intersections. We conducted a retrospective cohort study using data from 28.3 million Brazilians aged ≥13 years. We examined associations between race/ethnicity, education, and wealth-individually and in combination-stratified by gender. Over nine years, AIDS incidence was 23.37 and 18.63 per 100,000 person-years among men and women, respectively; mortality rates were 8.06 and 5.81 per 100,000 person-years. Isolated markers of social difference were associated with increased risk, but combined markers revealed pronounced intersectional effects. Here we show that intersections of race/ethnicity, education, and wealth substantially amplify the risk of AIDS-related illness and death in Brazil, with greater effects among women. These findings underscore the necessity of incorporating intersectionality into public health research and policy, and of addressing structural racism, sexism, and poverty through coordinated intersectoral actions to reduce HIV/AIDS inequities.
The Eastern Cape of South Africa carries the highest crude AIDS mortality rate nationally (135.86 per 100,000 in 2023), yet a province-specific, age-sex disaggregated analysis extending beyond 2012 does not exist. This study examined AIDS mortality trends in the Eastern Cape from 2000 to 2023. A quantitative ecological design was employed using secondary analysis of modelled estimates from the Thembisa Provincial HIV Model version 4.8. Annual AIDS deaths across nine age-sex subgroups and crude AIDS mortality rate were extracted from the Eastern Cape, 2000-2023, with provincial comparisons for 2023. Total AIDS deaths declined by 72.1% from 33,301 in 2005 to 9300 in 2023. Child deaths fell 96.1% from peak. Male youth deaths (15-24) plateaued after 2015. Adults aged 50 and older constituted 24.1% of deaths in 2023, with numbers increasing since 2019. Despite substantial gains, three unresolved gaps persist: a male youth mortality plateau, an ageing epidemic burden, and the highest provincial AIDS mortality rate nationally. Targeted differentiated interventions are urgently needed.