搜索结果：International journal of STD & AIDS

The number of syphilis-related infections has increased annually worldwide and especially in the Americas, with emphasis on Brazil, although trends may vary according to country and period, with fluctuations occurring at different temporal intervals. The objective of this study was to characterize the cases of acquired (AS), gestational (GS), and congenital (CS) syphilis and to identify the multiple spatial and spatiotemporal clusters of these diseases, considering the period from 2018 to 2022, in order to analyze changes in the epidemiological pattern of syphilis during this timeframe. This exploratory multiple-group ecological study groups patterns of syphilis in the 645 municipalities of the Brazilian state of São Paulo, Brazil. The study population consisted of all reported cases of acquired (AS), gestational (GS), and congenital (CS) syphilis among residents of these municipalities during the study period. The analyses included the calculation of standardized rates (AS), detection rates (GS), and incidence rates (CS) using population estimates as denominators, as well as descriptive and spatial statistical analyses. Spatial and spatiotemporal clusters multiple, bivariate, and univariate were identified using scan statistics. All analyses were performed using open-access software, including SaTScan™ and QGIS™. 199,270 cases of AS, 72,132 of GS, and 20,059 of CS were reported. There was significant growth in 2022. In the purely spatial analysis, 19 high-risk clusters were identified. Of which seven were multivariate (AS, GS, and CS), six bivariate (AS and GS; GS and CS; AS and CS), and another six univariate (AS and CS), all distributed among 35 municipalities. The temporal analysis identified a multiple cluster for 2022. The spatiotemporal scan identified a multiple high-risk cluster, also in 2022, involving the municipalities of Diadema, São Caetano do Sul, São Paulo, and Taboão da Serra, coinciding with the cluster identified in the purely spatial analysis. The employed analysis proved to be a powerful tool to identify multiple, bi-, and univariate occurrences of AS, GS, and CS, indicating the municipalities with a significant occurrence of syphilis in the different population subgroups. Health managers should consider the extreme need in these locations for interventions related to the theme.

This study explores the impact of HIV/AIDS on urban slum dwellers in Dhaka, Bangladesh, addressing unique socio-economic challenges and limited health resources. Despite low overall prevalence, gender inequalities, economic disparities, and awareness gaps persist. The aim is to assess HIV/AIDS-related knowledge, attitudes, and practices among this population, informing targeted interventions. A cross-sectional survey was conducted using face-to-face interviews in Dhaka's slum areas between October and November 2023. The sample size was calculated as 453 participants through non-probability (convenient sampling) sampling. A structured questionnaire in Bengali assessed socio-demographic factors, HIV/AIDS-related knowledge, attitudes, and prevention practices. Data were analysed using descriptive statistics, bivariate, and multivariable linear regression by SPSS (version 26) and STATA (version 14). Urban slum dwellers exhibited limited average HIV/AIDS knowledge of 33.00%, favouring males. Positive association was found between daily physical exercise and knowledge, while insufficient sleep and lack of social media access were negative predictors. Average attitudes were generally positive (81.06%), influenced by factors such as gender, employment status, family history of STDs, and daily physical exercise. The average score of prevention practices was 60.6%, with positive predictors including male gender, cooperative family members, STD history, family history of STDs, acquaintance with HIV patients, and social media usage over 2 h. Younger age was negatively associated with prevention practices. This study pinpoints factors influencing HIV/AIDS knowledge and behaviours in Bangladeshi urban slum dwellers. Tailored interventions focusing on gender, and social media can enhance preventive measures. Acknowledging limitations, the study urges cautious interpretation due to potential biases in convenience sampling and self-reporting.

International migrants, especially those belonging to key populations, face a considerable HIV burden. However, continuity of HIV care for this group is often challenged along the migration route. We assess the available evidence on the existing interventions that aim to strengthen community and health systems to ensure the continuity of HIV care for international migrants. We did a systematic search of PubMed for publications from 1989 until 2023 focused on different stages of the HIV care continuum regardless of the geographical region. The literature was reviewed with a thematic approach. Globally, legal regulations can restrict access to HIV care and fuel fear of deportation among undocumented migrants. The intersection of HIV-related and migration-related stigma creates further challenges for uninterrupted access to HIV care along the migration route, with negative clinical and public health consequences. Different potential interventions were identified including: provision of HIV care regardless of migration status; utilisation of mobile health, mobile units, and community-led initiatives to bring HIV care to migrants; and utilisation of participatory and co-creation methods to develop tailored and sustainable HIV-related interventions with migrant communities. Improving access to the continuity of care for migrants requires a shift towards intersectional policies rooted in co-creation approaches to address the underlying multiple and mutually reinforcing inequalities.

The extensive genetic diversity of HIV presents major challenges to treatment and prevention. We aimed to estimate the global and regional distribution of HIV-1 subtypes and recombinants during 1990-2024. We conducted a systematic literature review by searching PubMed, Embase, Global Health, and CINAHL for country-specific HIV-1 subtyping data published between Jan 1, 2022, and Jan 22, 2025, and a global survey of the Global HIV Molecular Epidemiology Collaboration for unpublished data collected between 2016 and 2024. We included primary HIV-1 subtyping data with ≥20 samples and known country and years of sample collection during 1990-2024. We excluded publications and survey responses that had no or incomplete subtyping data, were restricted to specific HIV-1 variants, included superinfections, or used secondary data. These data were combined with HIV-1 subtyping data previously collected between 1990 and 2021. Data were aggregated by country for six time periods (1990-99, 2000-04, 2005-09, 2010-14, 2015-19, and 2020-24). Proportions of HIV-1 subtypes, circulating recombinant forms (CRFs), and unique recombinant forms (URFs) were calculated by country and period and were weighted using UNAIDS country estimates of numbers of people living with HIV to estimate regional and global HIV-1 variant proportions. The systematic review is registered with PROSPERO, CRD42017067164. HIV-1 subtyping data were available for 1 395 222 samples from 154 countries during 1990-2024. In 2020-24, subtype C accounted for 48·7% (95% CI 48·3-49·1) of global HIV-1 infections, followed by subtype A (11·5%; 10·9-12·1), subtype B (10·3%; 10·0-10·5) URFs (5·3%; 4·4-6·3), CRF02_AG (5·1%; 4·5-5·8), CRF01_AE (5·1%; 4·8-5·4), other CRFs (3·9%; 3·3-4·5), subtype G (3·1%; 2·1-4·1), subtype D (3·0%; 2·7-3·3), and CRF07_BC (2·1%; 2·0-2·1). Subtypes F, H, J, K, and L combined accounted for 1·1% of infections and unspecified recombinants for 0·9% (0·7-1·0). HIV-1 variants are differentially distributed across regions, with subtype C dominating in southern Africa; Ethiopia, Eritrea, and Djibouti; and south Asia; subtype A in east Africa and eastern Europe and central Asia; subtype B in North America, Latin America, and western and central Europe; CRF01_AE in southeast Asia; and CRF07_BC in east Asia. Central Africa exhibited the greatest HIV-1 diversity. Global HIV-1 variant distributions were broadly stable during 2000-24, but notable regional changes included increases of HIV-1 recombinants in western and central Europe and of CRF07_BC in east Asia. Global and regional HIV-1 genetic diversity is complex and evolving, affecting the efficacy of diagnostic and viral load assays, emergence of drug resistance, and vaccine development. Continued surveillance of spatiotemporal trends in HIV-1 genetic diversity is essential. Nuffield Department of Population Health, University of Oxford, UK.

The single-tablet regimen Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate (DOR/3TC/TDF) has been included in international guidelines and recommendations and was approved by China's National Medical Products Administration (NMPA) in early 2021 for adult human immunodeficiency virus (HIV)-1 infections. This study presents real-world results of a retrospective analysis of patients who initiated DOR/3TC/TDF at a Chinese HIV center. This retrospective analysis was carried out on patients who received DOR/3TC/TDF (initial or switch) at the outpatient clinic of the Infection Center in Beijing Youan Hospital in China. Patients' baseline characteristics, reasons for switching to DOR/3TC/TDF, along with the preliminary clinical, laboratory - based efficacy, safety, and tolerability data, were collected. All evaluations were in strict accordance with the protocols of our center. The statistical analysis was mainly descriptive, aiming to assess the changes in laboratory parameters from the baseline to the data - collection deadline, which was December 31, 2024. From May 16 to October 29, 2024, 205 patients were prescribed DOR/3TC/TDF, either as an initiation or a switch. The cohort consisted mainly of males (96.1%), with a median age of 36.0 (31.0, 41.0) years. By the analysis deadline, the entire group had used DOR/3TC/TDF for 149.0 (90.0, 202.0) days. Among them, 40 patients were treatment-na&#xef;ve, with a median HIV-1 ribonucleic acid (HIV-1 RNA) of 4.1 (3.7, 4.6) log10 copies/mL. At weeks 12 and 24, 64.5% [95% confidence interval (CI): 45.4, 80.8%] and 91.3% (95% CI: 72.0, 98.9%) of the participants achieved HIV-1 RNA&#x202f;<&#x202f;50 copies/mL. Subgroup analysis showed that high viral load (VL) (&#x2265;105 copies/mL) and low CD4 counts (< 200 cells/&#x3bc;L) at baseline did not affect virological efficacy. The results of immune reconstitution were also satisfactory, with CD4 counts increased from 350 (264, 465) cells/&#x3bc;L at baseline to 541.0 (415.8, 789.5) cells/&#x3bc;L by the end of the follow-up (p&#x202f;>&#x202f;0.05). 165 patients (80.5%) had treatment experience, and the most common cause for switching was treatment simplification (40%). After the switch, an equally high proportion of patients [97.6% (95% CI: 93.7, 99.3%) vs. 96.4% (95% CI: 92.2, 98.7%)] achieved HIV-1 RNA undetectable or <50 copies/mL (p&#x202f;>&#x202f;0.05). Compared to baseline, there were no significant changes in liver enzymes and renal function (p&#x202f;>&#x202f;0.05), while body weight, random blood glucose and blood lipid levels decreased significantly (p&#x202f;<&#x202f;0.05). Among patients with central nervous system (CNS) symptom, both the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) scores, as well as the proportion of patients with scores greater than 7 points, decreased significantly post-switch (p&#x202f;<&#x202f;0.05). We provided an observational report on the effectiveness and safety of the short-term use of DOR/3TC/TDF in routine clinical practice.

Following Nepal's transition to a federal governance system under the 2015 Constitution and the COVID-19 pandemic, the Country Coordinating Mechanism (CCM) led a participatory process to identify national priorities for HIV, Tuberculosis (TB), and Malaria programs. The primary objective of this study was to analyze, in collaboration with community partners, the community and stakeholder engagement processes involved in priority setting. Between January and June 2020, a qualitative study was conducted, including a series of community group discussions across all seven provinces and 72 municipalities. This qualitative documentation process involved over 2,000 participants across 700 sessions across all three tiers of governance. These sessions included key and vulnerable people affected by TB and HIV, as well as at-risk populations for malaria. In addition, 100 key informant interviews were held with government officials, technical experts, and civil society leaders. The analysis used both deductive and inductive methods, with involvement and input from the community stakeholders. The engagement process offered a space for broad and inclusive participation, with most stakeholders involved in priority setting representing key or vulnerable populations. Participants reported that recommendations, such as establishing HIV testing points for migrants at border areas, were later included in national strategic documents. Many of the system gaps identified during multi-stakeholder discussions, including drug stock outs, stigma in care, and human rights and gender related barriers were reflected in national planning processes, indicating perceived influence of the engagement process. Participants also described practical recommendations, including integration of multi-disease diagnostic initiatives (for Tuberculosis and HIV for instance, using single platforms such as GeneXpert) and strengthening community-level surveillance systems, which were considered during strategic discussions. These priorities were reflected in strategic plans and referenced by the partners (e.g. Global Fund, USAID/PEPFAR). The government further pledged 20% domestic co-financing for the programs, contributing to a sense of ownership within Nepal's federal system. Participants further reported that the process supported transparency, trust and a sense of ownership. CSE helped ensure that national health priorities were grounded in community realities, broadly inclusive and strategically aligned with institutional frameworks. Engaging community members as active partners in data collection, interpretation, and validation reflected the participatory nature of the entire research process. This approach may offer insights for other low- and middle-income countries. Nepal&#x2019;s recent shift to a new federal system and the challenges of the COVID-19 pandemic created an urgent need for more inclusive decision-making in health. The Country Coordinating Mechanism (CCM), which oversees Global Fund-supported health programs, led a participatory process to set national priorities for HIV, tuberculosis (TB), and malaria programs for 2021&#x2013;2024. Community and stakeholder involvement was a key aspect of the process, including participation in data analysis, interpretation, and the preparation of this report. Between January and June 2020, more than 2,000 people took part in over 700 local consultation meetings across all seven provinces. These meetings included people living with HIV, TB survivors, sex workers, transgender people, people who inject drugs, migrants, prisoners, and female community health volunteers. Around 100 interviews were also held with government officials, experts, and civil society leaders to capture diverse viewpoints. This engagement process provided an opportunity for communities to contribute directly to national health planning. About 85% of participants were from key or vulnerable populations. Many of their ideas were later adopted in national strategies, such as establishing HIV testing sites for migrants at border areas, addressing stigma in TB care, and improving drug supply systems. Communities also recommended integrating TB and HIV testing using shared diagnostic machines like GeneXpert. Even during the pandemic, virtual consultations increased participation by about 40%, and the government committed 20% domestic co-financing for these programs, indicating increased ownership. This experience suggests that inclusive community and stakeholder engagement can support the development of more practical, equitable, and locally grounded health policies, offering valuable lessons for other countries with limited resources or transitioning governance systems.

The South and Southeast Asia region has the second-highest number of people living with HIV globally. Despite progress in reducing HIV incidence and AIDS-related deaths, the region still has a long way to go in achieving the Joint United Nations Programme on HIV and AIDS (UNAIDS) 95-95-95 HIV testing, treatment and viral suppression targets. HIV self-testing (HIVST) is recommended by the World Health Organization as an additional approach to HIV testing. This paper provides a commentary on the implementation status, benefits, barriers and recommendations for HIVST implementation in South and Southeast Asia. Additionally, it presents perspectives from HIV testing service experts from 11 countries in the region to put forth recommendations to accelerate the implementation of HIVST in South and Southeast Asia. There is uneven progress in national HIVST policy development and implementation across the region. HIVST, as an additional testing approach, can help to enhance testing coverage, frequency and demand for follow-up HIV services among key populations. Key factors influencing the implementation and scale-up of HIVST include the degree of awareness of HIVST among general and key populations, the development and implementation of supportive national HIVST policies and the availability of public funding for HIVST. To address barriers and leverage enablers to HIVST implementation, generating evidence on cost-effectiveness and budget impact, developing multisectoral partnerships for market shaping, promoting differentiated and decentralized delivery models, and optimizing linkage to further testing and care are recommended. It is crucial to accelerate the implementation and scale-up of HIVST to differentiate and decentralize the delivery of HIV testing services in South and Southeast Asian countries. Sharing experiences among country experts is vital to foster the adoption of best practices and facilitate the trial-and-error process of HIVST implementation. Such collaborative approaches can help South and Southeast Asian countries attain the UNAIDS 95-95-95 targets, especially the first 95 on HIV diagnosis, and play a significant role in ending the global AIDS epidemic.

This study evaluated the initial phase of the #ShesWell campaign, which aimed to increase pre-exposure prophylaxis (PrEP) awareness and uptake among Black women in four Ending the HIV Epidemic jurisdictions. The initial phase of #ShesWell (March to August 2022) sought to increase demand for PrEP among Black women and build the capacity of healthcare providers (HCPs) to prescribe PrEP. In January-March 2023, a cross-sectional survey was conducted 10 months after the campaign was launched. Sexually active women aged 18-64 were recruited from an online panel. Outcome measures included campaign exposure, PrEP attitudinal beliefs, perceived norms toward taking PrEP, perceived behavioral control, and intentions to take PrEP in the next 6 months. A structural equation model analysis was conducted using data from the 396 Black women in the survey sample who were not currently taking PrEP to explore the associations between campaign exposure and the outcome measures. There is evidence of effects of #ShesWell exposure on attitudinal beliefs and norms and a related total effect of exposure on intention. The study confirmed the pathways from exposure to intention posited by the Integrative Model of Behavioral Intention. Specifically, the collective influence of attitudinal beliefs and normative pressure indirectly impacted Black women's intentions to take PrEP after exposure to #ShesWell campaign messaging. To address disparities in PrEP uptake and increase use of PrEP among Black women, communication campaigns should develop messages that speak to women's attitudinal beliefs and norms. HCPs should also endorse these types of messages with their patients.

This study aims to assess the cumulative incidence and rate of loss to follow-up (LTFU) among people living with HIV (PLHIV) in Nepal who begin antiretroviral therapy (ART) early, as well as to identify factors associated with LTFU in the context of the universal test and treat approach. Retrospective cohort study. We retrospectively analysed nationally representative routine programme data for all PLHIV initiated on ART from February 19, 2017, to February 18, 2020, and followed up until May 10, 2022. LTFU was defined as a client not returning to the HIV clinic for at least 3 months from the date of their last scheduled appointment. We calculated cumulative incidence rate (IR) and used a multivariable Cox proportional hazards regression model to identify factors associated with LTFU, reporting corresponding 95% confidence intervals (CI). Of the 8192 clients included in our sample, 6797 (82.9&#xa0;%) started ART within seven days following their HIV diagnosis. The overall IR of LTFU was 4.22 (95&#xa0;% CI&#xa0;=&#xa0;3.95-4.51) per 100 person years of observation. The cumulative incidence of LTFU increased over time on ART, from 3.81&#xa0;% (95&#xa0;% CI&#xa0;=&#xa0;3.40-4.26) at 6 months, 6.51&#xa0;% (95&#xa0;% CI&#xa0;=&#xa0;5.97-7.09) at 12 months to 13.41&#xa0;% (95&#xa0;% CI&#xa0;=&#xa0;12.51-14.37) at 48 months. In the multivariable model, factors associated with higher odds of LTFU included initiating treatment within 7 days of diagnosis, younger age, being unmarried, belonging to the Dalit caste, having WHO clinical stage 1&#xa0;at baseline, and initiation on a non-nucleoside reverse transcriptase inhibitors (NNRTI)-based regimen. Among key populations, sex workers, their clients, men who have sex with men and transgender, people who inject drugs were at higher risk of dropout compared to migrants. In this nationwide cohort, the risk of LTFU increased with time on ART. To optimize the test-and-treat strategy in Nepal, it is crucial to address the unique needs of youth and certain key populations and manage any early adverse drug reactions.

Regular testing is recognized as a key strategy for HIV control. The 2023 Integrated Biological and Behavioral Survey (IBBS) in Cambodia revealed that nearly one-third of men who have sex with men (MSM) and one-fourth of transgender women (TGW) were never tested for HIV or not for more than 12 months. The majority of MSM and TGW were tested at community-based organizations (CBOs) facilities and by CBO outreach workers, while private facilities are poorly used for HIV testing (6% for MSM and 9% for TGW). Private pharmacies could be able to deliver HIV self-testing kits giving the advantage of confidentiality, anonymity, and time savings, in particular for those reluctant to visit CBOs. The recruitment of participants using a respondent-driven sampling method could provide the opportunity to reach MSM and TGW outside the network of CBOs. This pilot study aims to evaluate the feasibility of free HIV self-testing delivery by a private pharmacy combined with a respondent-driven sampling method to improve HIV testing among MSM and TGW in Phnom Penh, Cambodia. Both qualitative and quantitative approaches are used in this prospective feasibility study. The protocol was approved by the National Ethics Committee for Health Research in Cambodia (N0 351 NECHR). MSM and TGW aged more than 18 years old will be recruited via a respondent-driven sampling method with seeds recruited at hot spots and on social networks. The seeds will then distribute electronic and paper coupons to their networks physically and via social media, messaging, and calling applications. Each recruited peer will bring the coupon to receive direct and free access to one HIV self-testing kit at partner pharmacies as well as 10 additional coupons to recruit members of their networks. As for quantitative analysis, data from the study website will be imported, appended into a single matrix using Stata version 18SE (StataCorp), and analyzed using descriptive statistics, with a statistical significance level of .05. After 6 months, a qualitative assessment will be conducted among users, providers, and policymakers or key stakeholders to evaluate the acceptability and appropriateness of the strategy and to identify the barriers, facilitators, and recommendations. All transcripts will be analyzed according to the 6-phase reflexive thematic approach by Braun and Clarke. The results will be reported by participant-based and provider-based issues. QSR NVivo V.14 for Windows will be used to manage the data. The study was funded by Agence nationale de recherches sur le sida, les h&#xe9;patites, et les maladies infectieuses &#xe9;mergentes (ANRS) in September 2023. Approval of the study protocol was successfully obtained from the NECHR in Cambodia and the Commission Nationale de l'Informatique et des Libert&#xe9;s (CNIL) in France (Autorisation Tacite) in February 2025. Data collection will be conducted between September 2024 and December 2025. The initial results are expected to be published in February 2026. This public-private partnership intervention could allow the hidden population of MSM and TGW in Phnom Penh to be reached and tested. ClinicalTrials.gov NCT05745168; https://clinicaltrials.gov/study/NCT05745168. PRR1-10.2196/65351.

BACKGROUND: China&#x2019;s HIV-1 epidemic originated in the border regions of Yunnan Province in the late 1980s. Although domestic transmission has been effectively contained in recent years, the border regions continue to face public health challenges. In order to track the dynamic transmission of HIV-1, a molecular epidemiology study was conducted in a China-Myanmar-Laos border area. METHODS: Between 2022 and 2023, 570 individuals newly diagnosed with HIV/AIDS were recruited in Xishuangbanna prefecture. The viral gene sequences were obtained through amplification and sequencing. The characteristics of the HIV-1 genotype distribution, genetic drug resistance and molecular networks were analyzed to identify relevant influencing factors. RESULTS: Of 486 samples that were genotyped, 16 different HIV-1 genotypes were identified. The predominant strains were CRF08_BC (41.5%), CRF01_AE (20.1%), CRF07_BC (16.6%) and unique recombinant forms (URFs, 13.1%). The main HIV-1 genotypes exhibited specific associations with demographic factors, including registered residence, age, education level, infection status and reported area. The analysis of the dynamic molecular network revealed that local registered residence and age groups of 29 years and under and 50&#x2013;59 years, were linked to network expansion. The overall prevalence of sequences carrying drug resistance-associated mutations (DRMs) was 39.1% (195/499). HIV-1 genotypes were significantly associated with the distribution of DRMs. High-frequency resistance mutations exhibited genotype-specific distributions: V179D/VD and V179E of NNRTIs were significantly associated with CRF08_BC and &#x201c;other&#x201d; genotypes, respectively; S68G/SG of NRTIs was significantly associated with CRF01_AE. Drug-resistant strains were most prevalent among divorced/widowed individuals (OR&#x2009;=&#x2009;1.799, 95% CI: 1.025&#x2013;3.157) and in those infected with CRF08_BC (OR&#x2009;=&#x2009;2.981, 95% CI: 1.434&#x2013;6.194). URFs were found to have a significantly higher risk of resistance to PIs (OR&#x2009;=&#x2009;12.649, P&#x2009;=&#x2009;0.002), while CRF08_BC was found to have a higher risk of resistance to NNRTIs (OR&#x2009;=&#x2009;4.138, P&#x2009;=&#x2009;0.004). CONCLUSION: This study revealed the genetic diversity of HIV-1 and increasing drug resistance, as well as the transmission dynamics, in a high-risk transnational border region. The findings emphasized the importance of HIV-1 molecular surveillance in exploring high-risk populations and developing public health strategies to reduce HIV-1 transmission and control drug resistance in this area.

People with human immunodeficiency virus (HIV, PWH) exhibit increased cardiovascular disease (CVD) risk and accelerated biological aging. REPRIEVE demonstrated that pitavastatin reduced major adverse cardiovascular events (MACE) in antiretroviral therapy (ART)-treated PWH with low-to-moderate traditional cardiovascular risk. It remains unknown whether statin therapy can modulate epigenetic aging in PWH. We assessed epigenetic aging biomarkers using DNA methylation profiles from peripheral blood mononuclear cells (PBMCs) in a subset of 99 randomly selected US REPRIEVE participants (65 pitavastatin, 34 placebo) at baseline and 24 months. The primary outcomes were changes in second- and third-generation epigenetic clocks PCGrimAge (trained on mortality risk) and DunedinPACE (trained on rate of age-related multi-organ decline). Median chronological age was 57.0 (Q1, Q3: 56, 58) years and 100% of participants demonstrated epigenetic age acceleration, measured by the difference in PCGrimAge and chronological age (median difference 7.08 years [Q1, Q3: 4.69, 9.64]) at entry. Over 24 months, PCGrimAge remained accelerated with no significant differences between treatment arms (P = .89). However, the median pace of aging by the DunedinPACE increased in the placebo arm (0.036, Q1, Q3 [-0.018, 0.10], P = .021) but not in the pitavastatin arm (0.001, Q1, Q3 [-0.031, 0.036], [P = .77]), treatment group difference (P = .049). In this pilot study of REPRIEVE, epigenetic age acceleration was demonstrated at trial entry. The biological pace of aging increased over 24 months in the placebo group as compared to the statin group. These preliminary findings suggest pitavastatin may prevent an increase in the pace of biological aging in PWH and support further research into statin therapy as a potential intervention to mitigate accelerated aging. NCT02344290 (date of initial registration: 22 January 2015).

BackgroundThe global emergence of antimicrobial-resistant Neisseria gonorrhoeae represents a major public health concern. In particular, strains carrying the mosaic penA-60.001 allele have been associated with resistance to extended-spectrum cephalosporins and high-level resistance to azithromycin, threatening current treatment strategies. We describe an extensively drug-resistant Neisseria gonorrhoeae (XDR-NG) strain belonging to sequence type (ST) 16406, detected in Northern Italy in April 2025.MethodsThe N. gonorrhoeae strain was recovered from a urethral swab collected from a 28-year-old male at the Microbiology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna. Antimicrobial susceptibility testing was performed using E-test strips and interpreted according to EUCAST breakpoints. Whole-genome sequencing (WGS) was conducted using Illumina technology, and genomic characterization included MLST, NG-MAST, NG-STAR typing, resistance gene detection, and phylogenetic analysis with publicly available ST16406 genomes.ResultsThe isolate exhibited high-level resistance to tetracycline (MIC = 16&#xa0;mg/L) and ciprofloxacin (MIC = 4&#xa0;mg/L), very high azithromycin MIC (>256&#xa0;mg/L), and resistance to both injectable and oral ESCs (ceftriaxone MIC = 0.25&#xa0;mg/L, cefixime MIC = 1&#xa0;mg/L). WGS assigned the isolate to MLST ST16406 and identified the mosaic penA-60.001 allele, the A2059G mutation in all four 23S rRNA alleles, mutations in gyrA and parC associated with fluoroquinolone resistance, and tetracycline resistance determinants including tet(M). The A39T mutation was identified in the mtrR repressor gene. No plasmids were detected using PlasmidFinder. Phylogenetic analysis demonstrated close genetic relatedness to previously reported ST16406 isolates from Europe and Asia.ConclusionsThis study reports the first detection in Italy of an XDR N. gonorrhoeae ST16406 isolate carrying the penA-60.001 allele. The finding highlights the ongoing international dissemination of this resistant lineage and underscores the importance of maintaining culture-based diagnostics to ensure effective antimicrobial resistance surveillance.

BACKGROUND: The global Mpox epidemic has disproportionately affected men who have sex with men (MSM). This study describes the factors associated with Mpox infection among Chinese MSM and examines whether these factors differ between HIV-positive MSM and HIV-negative MSM. METHODS: We conducted online cross-sectional surveys in August-September 2023 and 2024, recruiting 15,848 MSM from 30 provinces in China. Weighted logistic regression models were then used to estimate the self-reported Mpox infection, stratified by HIV status. RESULTS: Among 170 reported Mpox cases, 47.1% were HIV-positive. In the overall sample, higher education and income were associated with lower risk, while international travel was associated with higher risk. When stratified by HIV status, the associated factors differed. For HIV-positive MSM, having sexual partners with skin rash symptoms and STD infection were significantly associated with Mpox infection. For HIV-negative MSM, group sex and lower attention to Mpox information were significantly associated with infection. CONCLUSION: HIV status defines divergent Mpox risk profiles among Chinese MSM. An effective response requires differentiated strategies: integration of Mpox prevention into HIV care cascade systems for people living with HIV, and the implementation of behavior-focused interventions for HIV-negative MSM. Longitudinal studies grounded in behavioral and network theories are now urgently needed to establish causal pathways, elucidate the mechanisms driving these divergent risk architectures, and evaluate the long-term effectiveness of stratified intervention approaches.

Depressive disorders are highly prevalent among people living with HIV (PLWH), severely impairing quality of life and antiretroviral therapy (ART) adherence. While ART advances call for reassessing depressive disorders among PLWH prevalence, most studies rely on self-report tools rather than standardized clinical diagnoses. Linked to HIV stigma, low CD4+ T-cell counts, and ART-related side effects, depressive disorders among PLWH requires targeted prevention and intervention strategies. An extensive search was conducted across PubMed, Web of Science, and Embase databases up to 30 June 2025 to identify relevant studies. After selecting the appropriate studies that depressive disorders were confirmed through ICD/DSM criteria, a random-effects meta-analysis was performed to estimate the incidence of depressive disorders among PLWH using the event rate. Additionally, we conducted subgroup meta-analyses to explore any discrepancies among different groups. The Joanna Briggs Institute's Quality Assessment Checklist was utilized to evaluate the quality of the included studies. We employed I2 and Q-tests to assess both the magnitude and statistical significance of heterogeneity. The final analysis includes 15 studies with sample sizes ranging from 60 to 124,766. The estimated prevalence of depressive disorders among PLWH was 23.2% (95% CI 14.9-34.2). Significant factors associated with depressive disorders among PLWH were race, alcohol abuse, higher baseline and current CD4+ T-cell count, and longer HIV diagnosis duration (time from HIV diagnosis to depressive disorders diagnosis) (P&#xa0;&#x2264;&#xa0;0.001). Depressive disorders are significantly more prevalent among PLWH than in the general population, with potential associations with race, CD4+&#xa0;T-cell counts, HIV infection duration, and alcohol misuse.

Certain subpopulations (i.e., <25 years, transgender, sex worker, uninsured or migrant) were prioritized for inclusion in the Dutch preexposure prophylaxis (PrEP) pilot. We compared incidence of sexually transmitted infections (STI) during and drop-out from HIV PrEP care between prioritized and nonprioritized subpopulations. Retrospective longitudinal study using routinely collected data at the Centre for Sexual Health Amsterdam, 2019-2024. We modelled incidence rates (IR) for any STI while on PrEP using Poisson regression, adjusting for testing frequency and calendar time. We modelled the probability of early loss-to-follow-up (LTFU) (i.e., no PrEP follow-up visit within 12 months of enrolment) using logistic regression, adjusting for sexual behaviour. We modelled the probability of later LTFU (i.e., no PrEP visit within 12 months of a prior PrEP follow-up visit) using competing risk regression, adjusting for sexual behaviour. We added subpopulations as indicator variables to all models to compare endpoints between groups. Of 4781 individuals included (median age 32 years, IQR = 26-40), 50.2% ( n = 2402) belonged to prioritized subpopulations. The IR of any STI was 101.6/100 person-years. STI IR were higher among those belonging to prioritized groups (except for the transgender group). 494 individuals had early LTFU, which was associated with age <25 years, reporting sex work, and being a migrant. Later LTFU occurred 933 times and was associated with age <25 years, being transgender, and reporting sex work. People belonging to prioritized subpopulations had more STIs and were more often LTFU from PrEP care. Targeted interventions to support PrEP retention and prevent STIs are needed.

BackgroundHealth Frontiers in Tijuana, a binational collaboration between Californian and Mexican universities, cares for housing-insecure patients that suffer from inequitable access to health care in urban Tijuana. This study aimed to identify the prevalence and sociodemographic correlates of HIV testing in our catchment area, as well as the prevalence and correlates of HIV status among those tested.MethodsAnalysis was performed on electronic medical record data from clinic visits during 2022-2024. Demographics and diagnostic categories were tabulated, and logistic regression was performed to determine predictors of HIV status.Results2390 attendances by 1158 patients were analysed. Among 180 patients tested for HIV during this time period, 18(10%; 95% CI: 6%-15%) had a new diagnosis of HIV, which is up to 50 times greater than the national 0.19% prevalence of people living with HIV in Mexico. Women (aOR: 3.5, 95% CI: 1.8-6.7), people who use drugs (aOR: 5.2, 95% CI: 2.1-13.1), and people with another sexually transmitted infection (aOR: 3.3, 95% CI: 1.6-6.7) had significantly greater risk for HIV.ConclusionsOur data identified a niche population in Tijuana with substantially higher risk for HIV acquisition and transmission compared to the general public. This suggests a need for greater accessibility of HIV rapid testing in this group, as well as enhanced linkage to care for HIV pre-exposure prophylaxis candidates.

Tuberculosis (TB) treatment completion rates in high-burden countries like Uganda often fall short of the WHO End TB Strategy target of &#x2265;90%. This study evaluated multilevel determinants of treatment completion to guide evidence-based improvement strategies in rural Western Uganda. We conducted a cross-sectional, multi-center analytical study of 224 patients with drug-susceptible TB across four public health facilities in Kakumiro District. Eligible participants had been on treatment for at least six months. Data collected via structured questionnaires were validated against facility TB registers. Multivariable logistic regression identified independent predictors, reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). The treatment completion rate was 82.6% (185/224), with a 30.4% TB-HIV co-infection rate. Significant positive predictors included high TB knowledge (AOR&#x2009;=&#x2009;14.0; 95% CI: 3.06-24.5), high economic status (AOR&#x2009;=&#x2009;7.2; 95% CI: 1.63-31.5), belief in treatment efficacy (AOR&#x2009;=&#x2009;6.2; 95% CI: 2.02-18.8), and respectful health worker behavior (AOR&#x2009;=&#x2009;5.0; 95% CI: 2.15-11.83). Community-level support was critical, specifically religious/community leader advocacy (AOR&#x2009;=&#x2009;4.2; 95% CI: 1.84-9.51) and community health worker (CHW) home visits (AOR&#x2009;=&#x2009;3.5; 95% CI: 1.64-7.72). Waiting time less than 30 minutes (AOR&#x2009;=&#x2009;6.3, 95% CI: 1.91-20.96) also positively impacted TB treatment completion. Major negative predictors were male gender (AOR&#x2009;=&#x2009;0.3; 95% CI: 0.11-0.86), drug stockouts (AOR&#x2009;=&#x2009;0.3; 95% CI: 0.11-0.70), belief in traditional cures (AOR&#x2009;=&#x2009;0.3; 95% CI: 0.13-0.71), and stigma (AOR&#x2009;=&#x2009;0.4; 95% CI: 0.16-0.80). Achieving the WHO End TB targets requires integrated, multilevel interventions. Efforts should focus on male-targeted engagement, strengthening supply chains to eliminate drug stockouts, enhancing CHW-led community outreach, and reducing stigma to ensure equitable treatment success.

BackgroundThe scale-up of antiretroviral therapy (ART) has enabled more children living with HIV to reach adolescence and become sexually active. We investigated pregnancy incidence and outcomes among adolescents with perinatally acquired HIV enrolled in a multi-country trial of vitamin D and calcium carbonate supplementation (VITALITY; PACTR202009897660297).MethodsBetween February and November 2021, 842 adolescents aged 11-19 years from Zambia and Zimbabwe on ART for at least 6&#xa0;months were enrolled. Pregnancies occurring during 96 weeks of follow-up (February 2021-October 2023) were identified through self-report or testing. Pregnancy incidence rate was calculated among post-menarche participants using survival time analysis.ResultsThirty-five adolescents (median age 18, range 13-22) became pregnant, 21 in Zambia, 14 in Zimbabwe. Overall pregnancy incidence was 4.6 per 100 person-years (95% CI 3.3-6.4), higher in those &#x2265;15 years (6.8 per 100 person-years, 95% CI 4.8-9.7). Three pregnancies ended in miscarriage; 32 resulted in live births. Of the 30 adolescents with live births and available data, 26 (86.7%) infants were tested for HIV at birth: 24 were HIV-negative, two had unknown results. Twenty-nine received HIV prophylaxis. At 6&#xa0;weeks, 19/30 infants were retested for HIV: 16 were HIV-negative. Twenty-one of 32 pregnant adolescents were in school at conception, and 4 (19.0%) returned post-pregnancy. Overall, 23/33 (69.7%) started contraception, a median of 9 weeks after delivery/miscarriage.ConclusionPregnancy incidence is high among adolescents with HIV, especially older adolescents. While prevention of vertical HIV transmission is effective, education re-integration and timely contraception uptake remain limited.