BackgroundFemale sex workers (FSWs) face a disproportionately high risk of HIV acquisition, yet uptake of pre-exposure prophylaxis (PrEP) remains low in many settings. We examined PrEP awareness, utilization, and adherence, and identified predictors of uptake among FSWs engaged through One-Stop-Shop (OSS)-linked urban venues in Nigeria.MethodsA cross-sectional survey was conducted among 146 FSWs using venue-based time-location sampling. Structured, interviewer-administered questionnaires assessed socio-demographic characteristics, PrEP knowledge and use, and exposure to HIV prevention services. Multivariate logistic regression was used to identify independent predictors of PrEP uptake.ResultsPrEP awareness was high (76.7%), and among those aware, 92.0% had ever used PrEP. However, adherence was inconsistent: only 41.7% reported daily use, while the majority reported irregular or on-demand use. Peer educators and community-based HIV prevention workers were the most common information sources (69.6%). After adjusting for potential confounders, only participation in group sessions remained a significant independent predictor of PrEP uptake (adjusted Odds Ratio, aOR = 14.22; 95% confidence interval, CI: 1.44-31.61).ConclusionsFSWs linked to urban OSS platforms in Nigeria demonstrated high levels of PrEP awareness and use. The emergence of group HIV prevention sessions as an independent predictor of PrEP uptake reinforces the value of peer-led, community-based behavioral interventions in this setting.

A 19 year old man was diagnosed newly acquired HIV and prescribed bictegravir/emtricitabine/tenofovir alafenamide at his initial visit for HIV care. The genotype results from that initial visit returned two weeks later, showing high-level multi-class transmitted drug resistance, including multiple resistance-associated mutations (RAM) in the integrase gene. Although he had an initial substantial decline in viremia in the first 4 weeks, it was felt that the risk of subsequent failure was too high, and his antiretroviral treatment (ART) regimen was therefore changed to daily dolutegravir and darunavir/cobicistat/emtricitabine/tenofovir alafenamide, plus injected lenacapavir. He had durable virologic suppression on this new regimen for 12 months as of his last follow-up. This case of high-level multi-class transmitted drug resistance, in the context of rapid emergence of resistance to dolutegravir where it has been used as part of a salvage regimen, suggests that assessing for RAM in the integrase gene should be added to the currently recommended resistance testing for all patients with newly acquired HIV prior to initiating ART.

is the most prevalent bacterial sexually transmitted infection (STI) worldwide, often asymptomatic in women and associated with severe reproductive complications. In Brazil, population-based screening is not routinely implemented. This study aimed to evaluate the cost-effectiveness of screening among asymptomatic women in different age groups. A hypothetical cohort of 10,000 women was simulated in a Markov model over 10 years, stratified into three age groups: 14-25, 26-30, and 31-35 years. We compared three screening strategies: annual screening, screening every three to 4 years, and no screening. Clinical outcomes included pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and chronic pelvic pain. Costs were presented in Brazilian Reals (BRL) and U.S. Dollars (USD), and the main outcome was the incremental cost-effectiveness ratio (ICER) per significant case averted. Annual screening in women aged 14-25 was the most cost-effective strategy, preventing 7,274 significant health outcomes at a total cost of R$ 7.39 million (USD 1.48 million), resulting in an ICER of R$ 1,015 (USD 203) per case averted. For women aged 26-30, screening every 3 years was more cost-effective, while for those aged 31-35, screening every 4 years yielded the best value for money. targeted chlamydia screening strategies by age group are cost-effective in Brazil. Annual screening of women aged ≤25 years, in particular, offers substantial health benefits at acceptable costs and should be prioritized in STI control programs.

BackgroundEgypt has fastest-growing HIV rate in the Middle East and North Africa. This study aimed to determine the prevalence of late diagnosis (LD) and examine the associated epidemiological and clinical characteristics in a cohort of Egyptian individuals living with HIV.MethodsA cross sectional study included newly diagnosed people living with HIV (PLHIV) who presented to the Cairo University HIV Clinic between September 2022 and May 2023. People with a CD4 + cell count <350 cells/µL or an AIDS-defining event were classified as Late disease (LD), while those who presented with a CD4 + cell count <200 cells/µL or an AIDS-defining event were classified as LD with advanced HIV disease (LDAD). Descriptive statistics were used to characterize the study population. Chi-square test and independent t-test were employed to compare categorical and continuous variables between groups. Logistic regression analysis was performed to identify factors associated with late diagnosis. Statistical significance was set at < 0.05.ResultsOut of 402 newly diagnosed individuals, 65 (16.2%) had LDAD and 172 (42.8%) had LD. The mean age of LD patients was 36.8 ± 10.5 years, and 82.6% were male. The majority (57.4%) had a viral load more than 10,000-100,000 copies/ml. AIDS-related conditions were observed in 52 patients (30.2%), with wasting syndrome (27%), lymphoma (19%), recurrent bacterial infections (19%), and tuberculosis (15%), being the most common..ConclusionThe high prevalence of LD among newly diagnosed PLHIV emphasizes the need for interventions for early HIV testing, and enhancing prevention programs to facilitate early diagnosis and timely initiation of treatment.

BackgroundIntegrase strand transfer inhibitor (INSTI)-based regimens, such as dolutegravir/lamivudine/abacavir (DTG/3TC/ABC) and bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), are recommended as first-line antiretroviral therapy (ART) for people living with HIV (PLH). This study compares their efficacy and safety in ART-naïve men living with HIV (MLH) in a real-world setting over 48 weeks.MethodsThis open-label, randomized clinical trial (February 2021-October 2024) at Hospital de Infectología "La Raza" enrolled ART-naïve MLH with HIV-1 RNA ≥500 copies/mL and creatinine clearance >30 mL/min. Participants were randomized 1:1 to BIC/FTC/TAF or DTG/3TC/ABC. The primary endpoint was undetectable viral load (<50 copies/mL) at week 48, with safety assessed by adverse events (AEs) per DAIDS criteria.ResultsOf 311 participants, 153 received BIC/FTC/TAF and 158 DTG/3TC/ABC. Virologic suppression was achieved in 90% of the BIC/FTC/TAF group and 86% of the DTG/3TCC/ABC group (p = 0.32). Median CD4+ counts were 649 cells/µL (BIC/FTC/TAF) and 723 cells/µL (DTG/3 TC/ABC) (p = 0.18). DTG/3TC/ABC had higher gastrointestinal AEs (21.5% vs 14.3%; p = 0.04) and grade 3 neuropsychiatric AEs. BIC/FTC/TAF showed higher insomnia rates. Abacavir-related hypersensitivity occurred in 0.6%.ConclusionBoth regimens showed high efficacy. BIC/FTC/TAF was more effective in patients with low baseline CD4 + counts, while DTG/3TC/ABC performed better with higher viral loads. DTG/3TC/ABC had more neuropsychiatric AEs and rare hypersensitivity reactions.

BackgroundBiopsychosocial comorbidities are common in chronic illnesses like HIV, often resulting in complex clinical presentations. The Clinical Complexity Rating Scale for HIV (CCRS-HIV) was developed to identify these factors. This study examined whether complexity, as measured by the CCRS-HIV, could change over time.MethodsPatients at The Albion Centre in Sydney were assessed at two time points (T and T) using the CCRS-HIV. Changes in total and subscale scores were analysed, along with the odds of scoring in the complex range (40+ or 45+). The impact of age and time between assessments was also evaluated.ResultsResults showed a significant decrease in total complexity scores from T to T, with improvements across four subscales-two psychological/behavioural, one social, and one biomedical. The proportion of complex cases declined, and participants were nearly twice as likely to be complex at T compared to T. Longer intervals between assessments were linked to greater improvements, while age and sex had no effect.ConclusionsThese findings suggest that complexity in people living with HIV (PLHIV) is modifiable and support the CCRS-HIV as a valuable tool for screening and tracking changes in clinical complexity.

Herpes simplex virus (HSV) resistance is rare, but incidence is rising. Managing resistant HSV phenotypes in individuals living with human immunodeficiency virus (HIV) poses an increasing challenge. Here, we present two (2) cases where a short course of oral amenamevir (helicase-primase Inhibitor) for the treatment of thymidine analogue-resistant herpes simplex lesions.Case presentationsCase 1: 55-year-old Liberian man living with HIV presented with an enlarging, hypertrophic lesion on his inner thigh. This had been diagnosed as HSV-2 by PCR. Despite treatment with acyclovir, the lesion persisted. It had also failed to respond to topical therapies and cidofovir. Further molecular diagnostics showed that it was thymidine analogue-resistant HSV. A novel oral, anti-viral agent, amenamevir was used with success.Case 2A 37-year-old Ghanaian woman living with HIV presented with recurrent painful confirmed HSV-2 genital ulceration. Despite escalating treatment from acyclovir to cidofovir, the HSV lesions failed to respond. A seven-day course of oral amenamevir provided excellent resolution of the lesions.ConclusionThese two cases highlight the challenges in managing aciclovir-resistant herpes simplex lesions and the swift resolution following treatment with a novel therapeutic agent, amenamevir. Early recognition of resistant HSV lesions allows for prompt outsourcing of alternative, novel anti-viral therapies such as amenamevir.

BackgroundQuantitative HIV-1 DNA (qDNA) is a biomarker of the viral reservoir. We evaluated whether two-drug regimens (2DRs) maintain qDNA values comparable to those of three-drug therapies (3DRs).Materials and methodsWe collected data from people living with HIV (PLWH) undergoing qDNA testing. Total HIV-1 DNA was measured using the HIV-1 DNA Test PRO (Diatheva) on InGenius (ELITech) platform. Descriptive analyses and non-parametric tests were performed. Bivariate logistic regression was applied to identify predictors of qDNA levels ≥2.3 log copies/10 in peripheral blood mononuclear cells (PBMC).Results263 PLWH receiving antiretroviral therapy (ART) were included; 118 (44.9%) had qDNA ≥2.3 log copies/10 PBMC. Age (OR: 1.44 per 10-years increase, = 0.008) and prior CDC C stage events (OR: 2.26, = 0.025) were associated with qDNA >2.3 log copies/10 PBMC. Years of treatment (OR: 0.71 per 5-years increase, = 0.018) was associated to lower probability of qDNA >2.3 log copies/10 PBMC. No association was found between ART type (2DR vs 3DR) and qDNA levels ( = 0.441).ConclusionThe impact of 2DRs on the viral reservoir assessed by mean of qDNA is not different from what observed with 3DRs and may be a viable option for PLWH at risk of disease progression.

BackgroundSyphilis can cause significant clinical complications in adults and severe harm to fetuses and newborns through vertical transmission if it remains undiagnosed and untreated. With syphilis being on the rise in many countries, it causes a high and increasing burden of disease worldwide. Due to its high sensitivity and specificity, the TPPA (Treponema pallidum particle agglutination test) is considered the gold standard in serological syphilis diagnostic. However, the production of TPPA by the world's only manufacturer has stopped which has generated major gaps in diagnostic capabilities.MethodsFour polyvalent screening tests from Abbott, Roche, Diasorin and Euroimmun were evaluated on the base of negative, borderline and positive samples to develop an alternative diagnostic procedure of the highest possible quality. Additionally, alternative diagnostic threshold values of the test systems were evaluated for further optimization.ResultsA total of 1768 samples from different patient populations were analyzed. When performed according to the manufacturer's instructions, most tests achieved a high specificity. However, the sensitivity of the screening tests was not fully satisfactory, particularly in the early stages of infection, where sensitivity remained relatively low.ConclusionsBy lowering threshold values, the sensitivity could be significantly increased allowing for some of the evaluated assays to reach a test quality comparable to the TPPA, which is particularly relevant for samples from patients with higher risk of acquiring STIs. Moreover, the results of the polyvalent screening assays could also be used to monitor treatment success and detect possible re-infections.

BackgroundDepression care in Kenya has limited access due to a shortage of specialists and inadequate finances for mental health services. This study aimed to determine the prevalence and barriers to accessing depression care among people living with HIV in Juja Sub-County, Kiambu County, Kenya.MethodsA quantitative analytical cross-sectional study was used. A total of 329 people living with HIV receiving comprehensive care at six public health facilities in Juja Sub-County were selected using a stratified sampling technique. Data were collected using interviewer-administered questionnaires after obtaining informed consent from each study participant. The prevalence of depression was assessed using the PHQ-9 scale. Data analysis was done using R. Descriptive statistics were computed. An ordinal logistic regression model was used to determine the factors associated with the prevalence of depression. A binary logistic regression model was used to determine the individual barriers to accessing depression care. Adjusted odds ratios (AORs) with a 95% confidence interval were used to measure the association, and a p-value of less than 0.05 was considered statistically significant.ResultsThe prevalence of depression was 27.4% (95% CI: 22.7-32.6), and 84.4% of affected participants did not access depression care. Depression was significantly associated with poor adherence to HIV medication (AOR = 2.42; 95% CI: 1.53-3.85), poor social support (AOR = 0.57, 95% CI: 0.33-0.99), and high perceived HIV stigma (AOR = 1.85; 95% CI: 1.18-2.93). Additionally, poor adherence to HIV medication (AOR = 0.21; 95% CI: 0.04-0.76) emerged as a significant barrier to accessing depression care.ConclusionsA severe treatment gap exists, with 84.4% of depressed people living with HIV not receiving needed care despite a high depression prevalence of 27.4%.

Few effective treatments exists for the elimination of persistant genital warts and recurrences are common. We report the cases of two healthy HIV negative and immunocompetent men with a longstanding history of refractory to treatment and recurrent genital warts were treated with intralesional nonvalent HPV vaccine together with CO2 laser to prevent relapses. One patient developed a severe flare of the disease with multiple tiny lesions and both developed movable, asymptomatic and painless nodules at the sites of injection still present 2 months after treatment. Those are the first reported cases of this adverse reaction after intralesional treatment of HPV vaccine.

complex (MAC) is a common opportunistic infection in advanced human immunodeficiency virus (HIV), but splenic abscess formation is rare. We report a 35-year-old man with newly diagnosed HIV who presented with chronic cough, fever, abdominal discomfort, and pancytopenia. Imaging revealed a solitary splenic abscess. Cultures from sputum, stool, and abscess drainage in addition to lymph node and duodenal biopsies confirmed disseminated MAC. Additional diagnoses included cytomegalovirus viremia, esophageal candidiasis, and MAC-related granulomatous hepatitis. He was treated with rifabutin, ethambutol, and azithromycin) and started on antiretroviral therapy (ART) during admission. The patient was discharged on ongoing MAC therapy and ART. This case highlights a rare presentation of disseminated MAC as a solitary, drainable splenic abscess in severe immunosuppression, underscoring the need to consider atypical focal infections in advanced HIV.

Given limited treatment options for (TV) in patients with metronidazole allergy and waiting times for desensitization leaving patients in significant discomfort, it is imperative to find alternative options. This case study highlights an example of cure of TV using 24 nightly dequalinium chloride pessaries in a patient with metronidazole allergy, thus presenting a potential treatment option for further study.

BackgroundSexually transmitted infections (STIs) continue to cause morbidity among women in resource-constrained settings, where asymptomatic infections are often overlooked due to syndromic management protocols. We investigated correlates of asymptomatic STIs among women in the Dominican Republic (DR).MethodsWe analyzed data collected from cisgender women in DR between 2015 and 2019. Classified groups included pregnant youth (PY), people with HIV (PWH), residents of bateyes (RB), and sex workers (SW). Nucleic acid amplification or rapid plasma reagin tests detected STIs (Chlamydia/Gonorrhoeae/Syphilis/Trichomonas). Asymptomatic comprised no self-reported vaginal discharge, dysuria, groin lymphadenopathy, and genital/anal pain/ulcers. Logistic regressions identified sociodemographic, clinical, and behavioral correlates.ResultsAmong 833 asymptomatic women (median age 29, IQR 19-37), 35% were PY, 27% PWH, 11% RB, and 27% SW. STI prevalence was 24%: most (61%) had Chlamydia and few (≤25%) had Gonorrhoea, Syphilis, or Trichomonas. Asymptomatic STI correlates included age ≤24 (Adjusted Odds Ratio [aOR] = 2.32, [1.65-3.28]), early (≤14) sexual debut (aOR = 1.56, [1.11-2.18]), greater mobility (aOR = 1.41, [1.01-1.97]), lack of regular doctor (aOR = 1.42, [1.01-1.99]), and drug use in last 6 months (aOR = 1.88, [1.07-3.26]).ConclusionsCorrelates of asymptomatic STIs-age, sexual debut, mobility, healthcare access, and drug use-should inform targeted screening and prevention efforts where diagnostic testing is not widely available.

BackgroundDespite Antiretroviral Therapy (ART) progress, Human Immunodeficiency Virus (HIV) remains a major issue in Tanzania (4.65% prevalence). World Health Organization (WHO) introduced Enhanced Adherence Counselling (EAC) in 2016 to improve adherence, but many patients still struggle to suppress viral load after EAC.ObjectiveThis study evaluated the effectiveness of Enhanced Adherence Counselling for people living with HIV with unsuppressed viral load in Ilala, Dar es Salaam.MethodsA cross-sectional study was conducted in eight Ilala Care and Treatment Clinic (CTCs), selected using multistage sampling based on patient volume, for this study, patient volume was defined as the number of CTC clients, with high-volume facilities referring to those serving more than 1000 patients. Records of patients with unsuppressed viral load (≥1000 copies/mL) in 2023 were reviewed. Data were analysed in STATA SE 14 using descriptive, ordered, and multivariable logistic regression, with significance set at p < 0.05.ResultsOut of 361 people living with HIV with high viral load, 86.2% enrolled in EAC and 70.9% completed it. Among completers, 68.4% achieved viral suppression. Viral load suppression was significantly associated with age and initial viral load, with younger individuals being less likely to achieve suppression, while those with lower initial viral load (VL) had a higher likelihood of suppression. Median EAC initiation time was 27 days, with most completing it within 3 months.ConclusionThe study reveals gaps in transitioning people living with HIV with unsuppressed viral load to EAC enrolment and completion, undermining EAC's effectiveness. While 68% viral load suppression among those who completed EAC is promising, low enrolment and retention into EAC may impact overall success. Further research is needed to explore barriers to full participation into EAC sessions and its impact on viral load suppression.

We report a man in his thirties living with advanced HIV presenting with Pneumocystis pneumonia, cytomegalovirus colitis and HIV retinopathy. Initial HIV screening was positive, and immunochromatographic testing demonstrated simultaneous p24 antigen and antibody bands, an exceptionally rare finding outside the acute seroconversion phase. Despite profound immunosuppression (CD4 3 cells/µL), initiation of antiretroviral therapy led to rapid disappearance of the p24 antigen, while antibody positivity persisted. This case illustrates how severe cellular immune deficiency can allow concurrent antigen/antibody positivity, likely due to high viremia and impaired antibody responses. Clinicians should be aware that point-of-care HIV test results may vary depending on the stage of infection and the timing of therapeutic intervention.

BackgroundThis study investigates drug-drug interactions (DDIs) in people with HIV (PWH) receiving antiretroviral therapy (ART) with comorbidities. We focus on pharmacological factors and evaluate DDI notifications from online databases, emphasizing the clinical relevance of pharmacokinetic, pharmacodynamic, and pharmacogenomic variations.MethodsA comprehensive literature search was conducted using PubMed, ScienceDirect, Google Scholar, and the Cochrane Library for studies published between January 2019 and September 2024. Newly identified DDI evidence was analyzed by comparing DrugBank, Drugs.com, and the Liverpool HIV databases.ResultsEleven studies met the inclusion criteria. The findings of these studies showed the critical importance of considering DDIs in PWH with (TB), malaria, and pulmonary hypertension. Severe adverse drug reactions associated with ARTs, including efavirenz, darunavir, nevirapine, and atazanavir-ritonavir, especially when combined with treatments for TB and malaria. Key interactions included reduced drug levels from rifampicin and QT prolongation from artemether-lumefantrine. Pharmacogenomic factors, such as slow metabolism during pregnancy, influenced outcomes. Database discrepancies were noted, especially for riociguat interactions and ritonavir through inhibition of P-gp or OATP1B1 functions.ConclusionsDDIs in PWH receiving ART with comorbidities have highlighted the crucial need for personalized treatment. Incorporating pharmacokinetic, pharmacodynamic, and pharmacogenomic factors is essential for optimizing therapy outcomes.