At the 2026 Conference on Retroviruses and Opportunistic Infections (CROI), investigators presented updates on the global HIV epidemic. HIV incidence remains high among key populations, including female sex workers, men who have sex with men, people who inject drugs, and transgender women. Testing for recent infections can guide targeted HIV prevention services to interrupt ongoing transmission. In a cohort study of serodifferent couples in Africa, low-level viremia was associated with reduced but nonnegligible risk of HIV transmission. Sociostructural risk factors play a substantial role in driving new HIV transmissions. Several studies described the use of molecular epidemiology to characterize HIV transmission patterns and identify hot spots. Innovative strategies to increase HIV testing are being evaluated. In an oral preexposure prophylaxis (PrEP) study offering choice between daily and on-demand PrEP, HIV incidence was very low with either regimen. Follow-up data from 2 injectable lenacapavir PrEP trials demonstrated continued high efficacy with very rare breakthrough infections. Although awareness of long-acting PrEP is increasing, use remains low across various cohorts. Several studies reported on the use of PrEP in pregnancy, including a pharmacokinetic study showing no dose adjustment needed for long-acting injectable cabotegravir. Interventions to increase PrEP uptake and persistence show promise. A randomized clinical trial of the meningococcal vaccine did not show efficacy in preventing gonorrhea acquisition. Although doxycycline postexposure prophylaxis (doxy-PEP) use is increasing, it remained low among male veterans with a history of a sexually transmitted infection. Several studies reported on the impact of doxy-PEP on antibiotic use.
Background: The 2022 report from the Centers for Disease Control and Prevention (CDC) indicates that approximately one in five Americans is affected by a sexually transmitted infection (STI), with an estimated 68 million individuals living with an STI in the United States. Adolescents aged 15-24 years account for nearly half of all new STI diagnoses annually. In an urban West Texas county, rising STI rates have been associated with inadequate sexual health education and engagement in risky sexual behaviors. Objective: The purpose of this evidence-based nursing project was to improve sexual health outcomes among middle school students by delivering an abstinence-centered educational seminar designed to (a) increase understanding of the physical and emotional risks of sexual activity, (b) enhance students' self-efficacy in resisting unwanted sexual advances, and (c) promote abstinence until a committed, long-term relationship, such as marriage. Methods: A pre-post intervention design was used with a convenience sample of 69 middle school students. Participants attended an abstinence-centered seminar, and pre- and postseminar surveys were administered to measure changes in knowledge, self-efficacy, and behavioral intent related to sexual decision-making. Results: Postintervention survey results demonstrated statistically significant improvements in students' confidence and behavioral intent to abstain from sexual activity (p < .001). Knowledge scores also demonstrated a positive trend following the seminar. Conclusions: The abstinence-centered seminar was effective in improving self-efficacy and behavioral intent among middle school students. Educational interventions grounded in evidence-based nursing practice may contribute to improved adolescent sexual health outcomes. Implications for Nursing: Nurses play a critical role in promoting adolescent sexual health through early, developmentally appropriate education. School-based, nurse-led interventions can enhance knowledge, strengthen self-efficacy, and support healthy decision-making, thereby contributing to the reduction of STI rates in high-risk communities.
Understanding the role of other sexually transmitted diseases (STDs) in the transmission of human immunodeficiency virus (HIV), the role of STDs in progression of HIV disease, and the role of HIV infection in alterations of natural history, diagnosis, or response to therapy of STDs is critical to the development of optimal strategies for HIV control. One hundred sixty-three studies on the interrelationships between HIV infection and other STDs were examined. Of 75 studies on the role of STDs in HIV transmission, the 15 analyses of examination or laboratory evidence of STDs adjusted for sexual behavior showed that both ulcerative and nonulcerative STDs increase the risk of HIV transmission approximately 3- to 5-fold. Due to limited data, the role of STDs in progression of disease remains unclear. Preliminary data from 83 reports on the impact of HIV infection on STDs suggest that, at a community level, HIV infection may increase the prevalence of some STDs (e.g., genital ulcers). If coinfection with HIV prolongs or augments the infectiousness of individuals with STDs, and if the same STDs facilitate transmission of HIV, these infections may greatly amplify one another. This "epidemiological synergy" may be responsible for the explosive growth of the HIV pandemic in some populations. Effective STD control programs will be essential to HIV prevention in these communities.
HIV-serodiscordant heterosexual couples consist of one partner who is HIV-positive and the other who is HIV-negative. Our previous studies found that the HIV-negative female partner in no-prevention couples (NPC) may be affected by borderline personality disorder (BPD) and might have a history of child abuse, trauma, and neglect. These couples provide valuable insights into public health, particularly regarding health behaviors and psychosocial factors that influence the relationship between psychopathology, illness behaviors related to borderline personality disorder, and the transmission of sexually transmitted diseases. This study was conducted in three sequential phases. Phase One involved a cross-sectional, multicenter, anonymous survey of 175 HIV-serodiscordant couples, aimed at assessing preventive sexual behaviors. Participants reported sexual protection use during at-risk sexual encounters on a scale ranging from 0% ('never') to 100% ('always'). Phase Two, which constitutes the core of the present investigation, employed qualitative, unstructured interviews and narrative analysis with HIV-negative female partners in serodiscordant relationships. The analytic focus was on identifying patterns of psychopathological comorbidity and health-related behaviors. Through iterative narrative synthesis and thematic coding, the presence of Borderline Personality Disorder (BPD) emerged consistently across cases. The confirmation of BPD as a clinical diagnosis was thus an outcome of this phase, derived from converging narrative indicators and psychopathological profiles rather than a pre-established inclusion criterion. Phase Three, drawing on the findings from both preceding phases, involved developing a theoretical model of the observed behavioral patterns. Integrating quantitative trends from Phase One with the qualitative insights from Phase Two, we developed a conceptual framework to explain the interaction between BPD-related psychopathology, relational dynamics, and HIV (or other sexually transmitted diseases) risk behaviors. This model aims to guide future healthcare strategies for HIV-negative women with BPD in serodiscordant relationships, a group identified as particularly vulnerable to sexually transmitted HIV due to compromised primary prevention. Specific health belief models and behaviors related to health emerged among HIV-negative female partners with BPD who decline prevention during behaviors that put them at risk for HIV sexual transmission in stable relationships with HIV-positive males. Results illustrate that women with BPD who have a history of child abuse and trauma often exhibit comorbid self-defeating personality disorder (SDPD), dependent personality disorder (DPD), and complex post-traumatic stress disorder (CPTSD). We could not replicate similar findings in HIV negative males. The current study confirms that health behaviors and women's health may be influenced by underlying personality, behavioral, and psychosocial factors, which public health policymakers must address to improve primary prevention of transmissible diseases. We suggest that child abuse, neglect, and trauma may be connected to overlooked health behaviors across a person's entire life span.
Recently, human immunodeficiency virus (HIV) infection among young university students has garnered significant global attention. This study aimed to compare the demographics, behaviors, and knowledge of male and female college students, in addition to investigating the self-reported HIV-related behaviors and attitudes of sexually active college students in Zhejiang Province, eastern China. This cross-sectional study was conducted using stratified cluster sampling. A self-developed web-based questionnaire was used to collect demographic and sexual behavior data, and those only sexually active students were analyzed. The χ2 test was then used to compare the characteristics of the participants across different genders. A total of 3873 students who reported engaging in sexual activity were evaluated in this study, representing 12.2% of the total student population. Among them, 2734 were men, accounting for 19.1% of all male students (2734/14,320). Sexually active college students had an average age of 20.18 ± 1.37 years. Significant statistical differences were found between male and female students about age, grade, place of household registration, monthly living cost, family relationships, acquired immunodeficiency syndrome-themed lectures or health education courses, HIV testing publicity, HIV risk self-assessment, voluntary counseling and testing for HIV, acceptance of one-night stands and commercial sex, condom use self-efficacy, and casual sex. The findings highlight significant gender disparities in sexual behaviors and HIV-related awareness among sexually active students, suggesting the need for gender-tailored sexual health education programs that address socioeconomic factors (e.g., household registration disparities) while strengthening condom use self-efficacy interventions, particularly for male students exhibiting higher-risk sexual practices. Sexually active college students displayed high levels of sexual openness and knowledge regarding HIV testing, but low testing rates, condom use, and condom use self-efficacy. In addition, a higher proportion of male students engaged in casual sex.
In the USA, post-exposure prophylaxis (PEP) with doxycycline within 72 h after sex is recommended to prevent chlamydia, gonorrhoea, and syphilis in men who have sex with men (MSM) and transgender women. However, concerns surround potential expansion of Neisseria gonorrhoeae lineages harbouring antimicrobial resistance (AMR) in settings that implement doxycycline PEP. We aimed to assess the real-world effectiveness of doxycycline PEP in preventing sexually transmitted infections, and whether effectiveness against N gonorrhoeae infection was durable following doxycycline PEP implementation. We conducted a retrospective, test-negative, observational study in individuals receiving care from the Kaiser Permanente Southern California integrated health-care system. Eligible participants were assigned male at birth and living with HIV or receiving HIV pre-exposure prophylaxis or PEP at any time between July 1, 2021, and June 30, 2025. The primary outcomes were laboratory-confirmed chlamydia, gonorrhoea, and syphilis infections in eligible cohort members. Primary analyses used a test-negative design; we fit logistic regression models to estimate protective effectiveness of doxycycline PEP by comparing history of doxycycline PEP prescription fills 90 days or less before positive or negative tests for infection with Chlamydia trachomatis, N gonorrhoeae, and Treponema pallidum. In analyses defining doxycycline PEP effectiveness as a time-varying parameter, we assessed how effectiveness against gonorrhoea infection varied throughout the study period and in association with the proportion of local N gonorrhoeae isolates harbouring tetM, a plasmid-borne gene conferring high-level tetracycline resistance. 33 118 individuals met eligibility criteria, of whom 26 582 had one or more sexually transmitted infection tests between Jan 1, 2023, and June 30, 2025, and were thus included in the primary analyses. 2262 (8·5%) of 26 582 participants received one or more doxycycline PEP fills. Doxycycline PEP fills occurred 90 days or less before 39 (0·8%) of 4659 positive and 3288 (2·5%) of 130 138 negative C trachomatis tests; 212 (3·%) of 6539 positive and 3112 (2·4%) of 128 238 negative N gonorrhoeae tests; and 11 (0·5%) of 2169 positive and 794 (3·0%) of 26 913 negative T pallidum tests. Throughout the study period, preventive effectiveness of doxycycline PEP against chlamydia was 66·5% (95% CI 53·6 to 75·9), against gonorrhoea was -1·8% (-18·5 to 12·5), and against syphilis was 60·7% (28·3 to 78·5). Effectiveness against gonorrhoea decreased from 42·3% (2·7 to 65·8) before statewide doxycycline PEP implementation to -15·0% (-51·1 to 11·4) between January and June, 2025, in association with a rapid increase of tetM prevalence in circulating N gonorrhoeae lineages. Effectiveness during periods with tetM detected in 20·0-29·9% of N gonorrhoeae isolates was 47·2% (4·1 to 70·3), decreasing to -8·5% (-33·2 to 11·2) during periods with tetM detected in 50% or more of isolates. We report rapid loss of doxycycline PEP effectiveness against gonorrhoea within the first year after doxycycline PEP implementation in MSM and transgender women in southern California, associated with expansion of high-level tetracycline resistance in N gonorrhoeae. Whereas we report sustained doxycycline PEP effectiveness against chlamydia and syphilis more than 2 years after doxycycline PEP implementation, our findings suggest protection against gonorrhoea might not be durable. Risk-benefit considerations for doxycycline PEP implementation strategies should assume limited or transient benefits associated with gonorrhoea prevention, and address potential consequences of AMR expansion in N gonorrhoeae. US Centers for Disease Control and Prevention.
Childhood maltreatment is a major public health concern in the U.S. and globally with long-term consequences for physical and mental health. Whether childhood maltreatment predicts problematic reproductive health outcomes is unknown as the existing literature reveals mixed results with a heavy reliance on retrospective studies, and of the very few prospective studies, follow-up does not extend beyond 21 years of age. This study leveraged a unique prospective cohort with court documented cases of childhood abuse and neglect and 30-years follow-up in middle adulthood on pregnancy-related reproductive health outcomes. Conduct a rigorous, prospective study of associations between childhood maltreatment and reproductive health in middle adulthood, leveraging a unique prospective cohort, to overcome methodological weaknesses in previous studies that rely primarily on retrospective reports of childhood maltreatment. A prospective longitudinal follow-up of children aged 0-11 years with court documented cases of physical abuse, sexual abuse, and neglect, from a U.S. Midwestern County (1967-1971) and a demographically matched comparison group (original study of 1,575 children). At 30-years follow-up (2003-2005), 807 adult participants completed medical status examinations and comprehensive health interviews; the final sample includes N = 426 (52.7%) females, based on biological sex at birth, who responded to a module on reproductive health. In regression analyses, we investigated whether childhood maltreatment (any exposure) and subtypes of childhood maltreatment (physical abuse, sexual abuse, and neglect) affected giving birth preterm or to low birth weight infants, infertility, teen pregnancy, and breastfeeding, and explored gravidity (number of pregnancies) and parity (number of live births). Covariates considered were demographic factors and physical health indicators previously associated with childhood maltreatment and reproductive health, including poor glycemic control (indicator of risk for diabetes), high body mass index (BMI), sexually transmitted infections and diseases (STIs and STDs), hepatitis C, human immunodeficiency virus (HIV), and smoking. At 30-years follow-up, participants were mean age = 41.39 years (SD = 3.58, range 32-49). Adjusting for age, race, employment, marital status, and high school education (selected based on group differences p < .05), the childhood maltreatment group had increased odds of giving birth to low birth weight infants (< 5.5lbs; p < .05) and significantly higher gravidity (p < .05). By maltreatment subtype, the sexual abuse subgroup had increased odds for infertility (p < .05) and engagement with breastfeeding (p < .05), and the neglect subgroup had increased odds of giving birth to low birth weight infants (p < .01) and significantly higher gravidity (p < .05). Sensitivity analyses adjusting for poor glycemic control attenuated the associations. Childhood maltreatment influences reproductive health, in some instances leading to increased risk, such as infants born low birth weight, and in others leading to a positive health behavior, greater breastfeeding engagement. Maltreatment also led to higher gravidity (pregnancies) but not parity (live births), possibly indicating increased pregnancy loss. Poor glycemic control played an important role in understanding these associations, interpreted as possible chronic alterations in stress hormones affecting reproductive health. Findings suggest opportunity for trauma-responsive preventive interventions for individuals exposed to childhood maltreatment. Future research directions are the systematic examination of biological and behavioral mechanisms in these associations.
Aging-related comorbid conditions have major effects on the health, quality of life, and survival of people with HIV (PWH). The 2026 Conference on Retroviruses and Opportunistic Infections (CROI) featured a number of studies about various comorbid diseases in PWH. Cardiovascular diseases and hypertension were important topics at CROI, with ancillary analyses from the REPRIEVE (Pitavastatin to Prevent Cardiovascular Disease in HIV Infection) trial and studies from lower- and middle-income countries. Metabolic dysfunction-associated fatty liver disease was highlighted in a themed discussion and studies on glucagon-like protein-1 receptor agonists in PWH and antiretroviral-related weight gain were featured prominently in other sessions. Research focusing on aging in PWH was presented, including numerous studies examining the effects of exercise and physical activity and important studies documenting the high prevalence of osteoporosis and frailty in PWH in sub-Saharan Africa. This review focuses on the abstracts presented at CROI 2026 in these areas, highlighting those with the most clinical impact.
Background human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains a critical global public health concern. However, the short-term impacts of traffic-related air pollution (TRAP) on mortality from leading causes among people living with HIV/AIDS(PLHIV) have not been well characterized. Methods a time-stratified case-crossover study was conducted using mortality records of PLHIV in Anhui Province, China, from 2015 to 2022. Daily concentrations of traffic-related pollution, including fine particulate matter (PM₂.₅), inhalable particles (PM₁₀), nitrogen dioxide (NO₂), and carbon monoxide (CO), along with meteorological data, were incorporated into conditional logistic regression models.Lagged effects and exposure-response relationships were assessed, and subgroup analyses were stratified by sex, age, marital status, educational level, occupational category, seasons, and clinical stage. Results among the 2,739 recorded deaths, the leading causes were neoplasms (20.6%), respiratory diseases (20.3%), and circulatory diseases (16.9%). On case days, concentrations of PM₂.₅, PM₁₀, and NO₂ were modestly elevated compared to control days. Significant associations were observed between pollutant exposure and mortality risk, with PM₂.₅, PM₁₀, and NO₂ linked to increased risk in the neoplasm and respiratory groups, and CO exposure associated with circulatory-related deaths. Dose-response curves indicated monotonic increases in risk beyond pollutant-specific thresholds. Subgroups including men, people under 65 years of age, farmers, people with low educational attainment, unmarried, and individuals at the AIDS stage are more vulnerable. Conclusions short-term exposure to traffic-related air pollution significantly increases the risk of death from major comorbidities among PLHIV. These findings highlight the need for targeted environmental health interventions addressing vulnerable populations.
HIV pre-exposure prophylaxis (PrEP) is an effective biomedical intervention for preventing HIV acquisition. Using nationally representative data from Ghana, this study examined the factors associated with awareness of and positive attitudes toward PrEP among women of reproductive age. The study utilised nationally representative data from the 2022 Ghana Demographic and Health Survey, with a weighted sample of 13,980 women. The outcome variable was awareness of and positive attitudes toward PrEP, assessed based on whether respondents had heard of PrEP and approved of people taking it to prevent acquiring HIV. Data analysis was conducted using Stata 18, employing a multilevel logistic regression model to examine factors associated with awareness of and positive attitudes toward PrEP. Results were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Overall, 12.1% (95% CI: 11.1-13.3) of women were aware of PrEP and had positive attitudes toward it. The Ahafo region had the highest proportion of women with awareness of and positive attitudes toward PrEP (21.1% [95% CI: 15.7-27.7]), whereas the Savannah region had the lowest (7.2% [95% CI: 5.3-9.9]). Women with two or more sexual partners had lower odds of being aware of and having positive attitudes toward PrEP (aOR = 0.51, 95% CI: 0.28-0.96) than those with no partner. Women aged 25-29 (aOR = 1.75, 95% CI: 1.28-2.40), 30-34 (aOR = 1.61, 95% CI: 1.14-2.27), 35-39 (aOR = 1.69, 95% CI: 1.22-2.32), and 40-44 (aOR = 1.48, 95% CI: 1.03-2.12) had higher odds of awareness of and positive attitudes toward PrEP than women aged 15-19 years. Also, higher odds of awareness of and positive attitudes toward PrEP were observed among women who had heard about other sexually transmitted infections (STIs) (aOR = 1.79, 95% CI: 1.40-2.28), had secondary (aOR = 1.34, 95% CI: 1.06-1.70) and higher education (aOR = 3.27, 95% CI: 2.35-4.55), and listened to radio (aOR = 1.20, 95% CI: 1.01-1.43), compared with those who have not heard of STIs, those with no education, and those who did not listen to the radio, respectively. Additionally, women from Central (aOR = 3.28, 95% CI: 1.76-6.12), Volta (aOR = 3.28, 95% CI: 1.63-6.62), Western North (aOR = 2.59, 95% CI: 1.26-5.29), Ahafo (aOR = 5.02, 95% CI: 2.54-9.91), Bono (aOR = 2.87, 95% CI: 1.37-6.02), Bono East (aOR = 2.87, 95% CI: 1.56-5.26), Oti (aOR = 5.64, 95% CI: 3.06-10.39), Northern (aOR = 2.47, 95% CI: 1.10-5.51), Upper East (aOR = 4.17, 95% CI: 2.05-8.50), and Upper West (aOR = 3.62, 95% CI: 1.85-7.08) regions had higher odds of awareness of and positive attitudes toward PrEP than those in the Western region. About 1 in 10 women in Ghana were aware of PrEP and held positive attitudes toward it. The factors associated with awareness of and positive attitudes toward PrEP included women's age, educational level, number of sexual partners, listening to the radio, hearing about other STIs, and geographical regions. Policymakers and healthcare providers should focus on interventions that address regional inequalities and barriers to PrEP awareness and facilitate uptake to strengthen HIV prevention efforts in Ghana.
Neisseria gonorrhoeae is a sexually transmitted bacterial pathogen that deploys multiple mechanisms to evade the immune system, including rapid variation in surface antigens. One of the most abundant and diverse antigens are members of the opacity-associated (Opa) family, surface proteins that mediate gonococcal attachment to human receptors. Studies of Opa diversity and evolution have been limited by the inability of short-read sequencing to resolve the multiple copies of opa in each genome, preventing a comprehensive understanding of variation in gonococcal antigens for vaccine design and immunology studies. We assembled a dataset of 219 complete genomes from phylogenetically diverse clinical isolates using long-read sequencing and developed bioinformatics and phylogenetics tools to assess opa variation quantitatively. Each genome had on average 7 distinct opa alleles at 9-12 opa loci, and almost all isolates had at least one pair of identical or near-identical opa genes. Fewer opa genes were in frame (and thus inferred to be expressed) than expected by chance. While genomic distance between isolates correlated with overall opa allele sequence similarity, opa genes were on average 74 times more diverse than the rest of the genome. One opa locus evolved more rapidly than the other loci. There was little evidence that interspecies recombination contributed to N. gonorrhoeae opa diversity. Our findings reveal a continuously evolving opa repertoire that leads to diverse opa alleles even in closely related strains and indicate that there are likely unknown biological factors modulating opa reading frame.
Sexually transmitted infections (STIs) remain a major global public health concern, with a high proportion of asymptomatic cases. Undiagnosed infections may lead to significant clinical, economic, and epidemiological consequences. Patients with sterile pyuria and suspected urinary tract infection (UTI) represent a relevant target population for STI screening. We evaluated the real-world performance of a targeted STI screening strategy based on urine sample pooling in patients with suspected UTI, genitourinary symptoms, leukocyturia, and negative urine culture. Over a 15-month period, 2019 urine samples were analysed using pooled PCR testing, identifying 212 STI-positive patients (10.5%). Chlamydia trachomatis was the most prevalent pathogen, followed by Trichomonas vaginalis, Mycoplasma genitalium, and Neisseria gonorrhoeae. Pooling did not compromise analytical sensitivity, with comparable cycle threshold values between pooled and individual samples. Pooled PCR screening reduced testing volume while preserving diagnostic yield, supporting its use as an efficient and potentially cost-effective strategy for STI-screening.
Immune reconstitution inflammatory syndrome (IRIS) refers to an exaggerated inflammatory response to existing infections or latent pathogens that occurs during rapid immune recovery in immunocompromised hosts, paradoxically leading to clinical deterioration despite appropriate treatment. IRIS is commonly observed in patients with human immunodeficiency virus (HIV)-associated tuberculosis and cryptococcal meningitis after starting antiretroviral therapy. However, it can also occur in immunocompromised individuals without HIV, which remains relatively under-recognized, particularly following neutrophil recovery after chemotherapy for acute leukemia or hematopoietic stem cell transplantation, during the post-operative phase of anti-rejection therapy following solid organ transplantation, or after the rapid reduction or withdrawal of corticosteroids or immunosuppressants, etc. This article summarizes the definition, clinical characteristics, diagnosis, treatment, and prevention of IRIS associated with invasive pulmonary fungal diseases. Clinical management requires accurate identification and careful evaluation to guide optimal and prompt intervention. Appropriate timing of antifungal treatment, initiation of antiretroviral therapy, and adjustment of immunosuppressive agents are crucial to reduce the risk of IRIS and prevent related morbidity and mortality. 免疫重建炎症反应综合征（IRIS）好发于HIV相关结核病、隐球菌脑膜炎患者ART治疗期，但近年来发现，IRIS同样好发于非HIV真菌感染患者免疫功能快速恢复期，如急性白血病化疗或造血干细胞移植患者粒细胞缺乏恢复期、实体器官移植术后抗排异治疗期、糖皮质激素等免疫抑制剂的快速减量或停用时，但临床对其认识相对不足。本文聚焦于侵袭性肺真菌病相关IRIS的定义、临床特征、诊断标准、治疗和预防，旨在为该病的早期识别和规范管理提供参考。.
Understanding syndemic effects of COVID-19 and HIV/AIDS can inform future public health preparedness. This study quantifies the all-cause excess death rate of people living with HIV/AIDS (PWHA) during the 2020-2022 COVID-19 pandemic in the United States (U.S.), including stratifications by sex, age, race/ethnicity, and region. Using publicly available data from the CDC AtlasPlus dashboard, we employed ensemble n-subepidemic modeling framework (SubEpiPredict toolbox). This dynamic parametric approach is well suited for counterfactual forecasting with relatively short time series and was used to generate expected deaths among PWHA for 2020-2022 based on pre-pandemic trends. The models were calibrated using 12 years of pre-pandemic mortality trends (2008-2019), with the median excess death rate calculated as the difference between forecasted and observed death rates. Overall excess mortality among PWHA was estimated at 7,783 crude excess deaths (95% prediction interval [PI]:5,098-10,525), corresponding to 2.77 excess deaths per 100,000 people (95% PI:1.81-3.75), with the largest burden observed in 2021. Excess death rates were highest among male (3.39), age 55-64 (4.94), multiracial (12.82), and Northeast (4.12) groups. The largest crude number of excess deaths occurred among male (4,692), age 65 + (2,560), Black/African American (3,969), and Southern (4,025) groups. These systematic, model-based results reveal stark heterogeneities among PWHA by exposing recent mortality patterns that may not be captured by disease-specific mortality reporting alone. These findings provide a robust, reproducible benchmark for assessing pandemic-related disparities and can inform future public health resource allocation and tailored interventions for vulnerable populations.
Persistent infection with carcinogenic human papillomavirus (HPV) is the necessary cause of cervical cancer. However, the distribution of transcriptionally active high-risk HPV genotypes across age groups and geographic regions in China remains insufficiently characterized. We aimed to define the nationwide epidemiologic profile of HPV E6/E7 mRNA positivity in China and to evaluate age-, region-, and proxy-defined source-population heterogeneity. In this retrospective cross-sectional study, 11,118 female cervical specimens retrieved for HPV E6/E7 mRNA testing between August 14, 2024 and October 23, 2025 were analyzed from seven geographic regions of China. Fourteen high-risk HPV genotypes were detected using the Biotron HPV E6/E7 mRNA Genotyping Assay. Descriptive, co-detection, and multivariable logistic regression analyses with institution-level cluster-robust standard errors were performed. Overall high-risk HPV E6/E7 mRNA positivity was 16.32% (1,815/11,118). HPV52, HPV58, and HPV16 were the dominant genotypes, followed by HPV18 and HPV51. Overall positivity varied significantly across age groups, regions, institution-level proxy categories, and department-based clinical-context proxy categories. Central China had the highest overall positivity rate, whereas East China had the lowest. Significant age-related heterogeneity was observed for several major genotypes, especially HPV52, HPV58, and HPV16. Multi-type positivity accounted for 11.8% of positive samples, with HPV52 and HPV58 forming the most prominent co-detection pattern. In multivariable analyses, older age and several non-East regions were associated with higher odds of overall positivity, whereas the opportunistic screening proxy group showed markedly lower odds of positivity than the gynecology-related clinical attendance proxy group. Transcriptionally active high-risk HPV infection in China is characterized by dominance of HPV52, HPV58, and HPV16 and by marked heterogeneity across age, geography, and proxy-defined testing contexts. These findings may support more refined HPV surveillance and risk-adapted prevention strategies.
Mitochondrial dysfunction is a hallmark of aging and age-related physical decline in people living with HIV (PLWH) who experience accelerated aging. This pilot study investigated the relationships between platelet mitochondrial function, physical performance, and body composition in older, sedentary PLWH compared with older, sedentary HIV-negative controls. Platelets have the potential to act as minimally invasive and easily accessible biomarkers for systemic mitochondrial bioenergetics and may serve as a practical biomarker in aging-related research. We analyzed correlations between mitochondrial parameters, protein levels, and measures of physical performance and body composition in a cohort of predominantly African American men (n = 7 PLWH, n = 7 controls). Body composition was assessed using dual-energy X-ray absorptiometry (DXA), and exercise capacity through VO2 peak and strength tests. Platelet mitochondrial bioenergetic parameters were measured by oxygen consumption rates (OCR) and extracellular acidification rates (ECAR). Key mitochondrial proteins SIRT3, COXII, DRP1, and OPA1 were evaluated by Western blotting. The PLWH and HIV-negative control groups were similar in age and cardiorespiratory fitness. In PLWH, basal OCR and ATP-linked respiration showed strong positive correlations with VO2 peak (r = 0.874, p < 0.05 and r = 0.862, p < 0.05, respectively) and negative correlations with BMI (r = -0.856, p < 0.05 and r = -0.849, p < 0.05, respectively). SIRT3 emerged as a potential key player, demonstrating strong positive correlations with basal OCR (r = 0.804, p < 0.05), ATP-linked respiration (r = 0.787, p < 0.05), and VO2 peak (r = 0.970, p < 0.001), and negative correlations with BMI (r = -0.830, p < 0.05) and fat mass (r = -0.827, p < 0.05) in PLWH. Analyses focused on within-group associations in PLWH because bioenergetic measures were obtained using different Seahorse platforms in PLWH and controls, precluding valid direct quantitative comparisons between groups. Our findings provide evidence for significant associations between platelet mitochondrial bioenergetics, specific mitochondrial proteins (particularly SIRT3), and key physical attributes in older, sedentary PLWH. These preliminary findings suggest that platelets may serve as minimally invasive biomarkers of systemic mitochondrial health, contribute to our understanding of mitochondrial function in HIV-associated accelerated aging, and inform future interventions to enhance mitochondrial function and improve health outcomes in this vulnerable population. However, results should be interpreted cautiously given the small sample size and exploratory design and should be considered hypothesis-generating rather than definitive. Larger, demographically more diverse studies that include HIV-negative controls are needed to validate these associations and determine their clinical relevance.
The digital age has profoundly transformed public health communication. This study investigated the interplay between vaccine-related informational milestones, social media discourse, and vaccine administration trends for human papillomavirus (HPV) and measles, mumps, and rubella (MMR) vaccines from 2011 to 2019. The goal was to understand how vaccine-related public health and policy events align with online discourse and vaccination behaviors. This retrospective study utilized sentiment analysis of Reddit, X, and YouTube posts categorized as positive, neutral, or negative. Medical claims data from the Merative MarketScan Commercial Database were analyzed to track HPV and MMR vaccine administration rates. Vaccine-related informational milestones were compiled from the Immunization Action Coalition, Centers for Disease Control and Prevention, Food and Drug Administration, and Advisory Committee on Immunization Practices. A total of 110 informational milestones were identified. Social media discussions were primarily neutral (59%), with positive sentiments declining from 35% to 24% between 2011 and 2019. HPV vaccine discussions demonstrated a stable positive-to-negative sentiment ratio (2.75:1 by 2019), while MMR discussions surged during specific events, notably the 2015 Disneyland measles outbreak. Informational milestones often coincided with increased social media activity. HPV vaccination rates peaked in August, and MMR rates showed gradual increases with consistent seasonal peaks. Although increased online discussions rarely correlated with immediate behavioral changes, our analysis reveals intricate relationships between informational milestones, social media sentiment, and vaccine administration rates. Public health communication strategies should consider the nature of these events and the timing of announcements to effectively engage the public and promote vaccination.
Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) are chronic viral infections, sharing similar transmission routes. This study investigates the perceptions, preferences and acceptability of people who inject drugs (PWID) and healthcare providers (HCP) on multiplex rapid diagnostic tests (RDT) intended for self-testing (ST) for HIV, HBV and HCV. This was a qualitative study conducted in Indonesia and Kyrgyzstan. This study employed focus group discussions (FGDs) and semi-structured interviews (SSIs) to obtain general perceptions and theoretical acceptability on multiplex ST and cognitive interviews to optimize instructions for use (IFU). The IFU used were from four different manufacturers: PMC dual (HIV/HCV) ST in Kyrgyzstan, Mylab triple (HIV/HCV/HBV) ST in Kyrgyzstan, BioLytical (HIV/HCV), dual ST in Indonesia and Bioera Triple (HIV/HCV/HBV) ST in Indonesia. Eleven SSIs and twelve FGDs were conducted across both countries. A total of 110 participants were included in SSI and FGD: five stakeholders, 27 PWID, and 24 HCP in Kyrgyzstan and six stakeholders, 24 PWID, and 24 HCP in Indonesia. Participants reported the main factors that would facilitate the use of multiplex ST 1) quick time to results, 2) easy to use, 3) affordability, 4) confidentiality, and 5) ability to diagnose several infections at once. A total of 118 participants were included in cognitive interviews. Cognitive interviews led to recommendations for improving IFU, including larger fonts and simplified language. This study demonstrates initial acceptability of multiplex ST for HIV/HCV/HBV among PWID, HCP, and stakeholders. Still, communication strategies, tailored IFU, targeted training to HCP and counseling to PWID are needed for future implementation.
Antibodies mediate a wide range of antiviral functions, including neutralization and diverse Fc-dependent effector activities. Among these, antibody-dependent cellular phagocytosis (ADCP) has emerged as an important mechanism contributing to pathogen clearance, including during HIV-1 infection. Conventional bead-based ADCP assays typically rely on recombinant envelope glycoprotein (Env), which offers practical advantages but fails to fully recapitulate the native structural, conformational, and glycan features of virion-associated Env. This limitation reduces the physiological relevance of these assays for evaluating antibody function in vivo. We developed a virus particle-based ADCP assay designed to preserve the native membrane-embedded conformation and glycosylation of HIV-1 Env. The assay uses sucrose-purified, inactivated HIV-1 virions coupled to fluorescent beads as phagocytic targets, and the THP-1 human monocytic cell line as effector cells. The assay was optimized for sensitivity, reproducibility, and high‑throughput compatibility, and was applied to evaluate ADCP responses mediated by both monoclonal and polyclonal antibodies across multiple species. The virus particle-based ADCP assay enabled robust and reproducible measurement of antibody-mediated phagocytosis in a biologically relevant antigen format. Using this system, we observed Env isolate-specific differences in Fc‑mediated activity that were not fully captured using recombinant gp120‑based assays. Direct comparison revealed that ADCP readouts obtained with recombinant Env proteins did not consistently mirror those measured using native virion-associated Env, highlighting qualitative differences in antibody engagement and Fc effector function depending on antigen presentation. These findings demonstrate that preservation of native Env structure and glycosylation is critical for accurate assessment of Fc-dependent effector functions such as ADCP. The virus particle-based assay described here provides a practical and scalable framework for functional profiling of antibody responses in the context of HIV-1 infection and vaccination. By revealing antigen context-dependent differences in Fc‑mediated activity, this approach reinforces the importance of using antigenically authentic, virion-based systems to better reflect in vivo antibody function and inform vaccine and immunotherapeutic strategies.
Following the introduction of antiretroviral therapy (ART), the prognosis after being diagnosed with HIV infection has changed from a universally fatal disease to a largely manageable chronic condition. Despite these advances, opportunistic infections remain a central challenge, particularly in individuals with declining CD4 T-cell counts. The authors review the pathologic conditions unique to patients living with HIV infection at various levels of disease progression, based on CD4 cell thresholds, and examine how radiologic patterns at CT can guide differential diagnoses in the post-ART age. A CT pattern-based radiologic approach-such as consolidation, ground-glass opacities, cavitation, and nodularity-enables radiologists to distinguish between typical bacterial infections, opportunistic fungal or mycobacterial processes, and less common viral causes in addition to their many mimics. Immune reconstitution inflammatory syndrome (IRIS) further complicates the diagnostic algorithm, as newly reconstituted immune activity after initiation of ART can unmask previously subclinical infections or worsen known ones. The overlapping clinical and imaging features of IRIS with opportunistic disease underscore the need for vigilant monitoring and a nuanced interpretation of radiologic findings. Additionally, lymphadenopathy in patients living with HIV infection is a common CT finding with a broad differential diagnosis, which can be narrowed if one is attuned to certain characteristics useful in differentiating underlying disease. In this comprehensive overview, the authors highlight the critical role of using CD4 cell counts with a pattern-based approach to interpreting radiologic studies in optimizing care for people living with HIV infection. ©RSNA, 2026 Supplemental material is available for this article.