AIDS

BackgroundHIV incidence in sub-Saharan Africa has declined substantially since 2000 according to epidemic estimates published by UNAIDS. These estimates, derived by fitting mathematical models to national surveillance data, guide HIV programmes and epidemic response strategies. We assessed whether the level and age distribution of HIV incidence from modelled estimates were consistent with empirical HIV incidence observations, and whether incidence levels and trends were systematically different ...

BackgroundMaintaining viral suppression among people who inject drugs (PWID) living with HIV in sub-Saharan Africa remains critical to minimize drug resistance for dolutegravir (DTG)-based regimens. We evaluated PWID taking DTG to assess longitudinal rates of viral non-suppression and emergence of drug resistance mutations in Kenya. MethodsWe enrolled Kenyan PWID who had transitioned from an efavirenz (EFV) based regimen to tenofovir+lamivudine+DTG (TLD) [≥]6 months prior, and measured plasm...

ImportanceAs the population living with HIV in the US ages, state-level projections of the aging dynamics among people with diagnosed HIV (PWDH) will be needed to inform local planning and intervention efforts. ObjectiveWe sought to explore how aging dynamics of the population with HIV in the US are expected to differ at the state level between 2025 and 2040. Design, Setting, and ParticipantsWe projected epidemic trajectories from 2025 to 2040 in 24 US states comprising 86% of PWDH in the US u...

BackgroundHIV-specific broadly neutralising antibodies (bNAbs) can maintain viral control after interrupting antiretroviral therapy (ART). We investigated the duration and efficacy of Fc-engineered long-acting bNAbs (LS-bNAbs) in maintaining ART-free HIV control compared with placebo. MethodsRIO is a 1:1 randomised double-blind placebo-controlled trial of two LS-bNAbs (3BNC117-LS & 10-1074-LS) in individuals virally suppressed on ART initiated since early-stage HIV. Eligible participants interr...

BackgroundLong-acting injectable HIV pre-exposure prophylaxis (PrEP), including Lenacapavir, has the potential to accelerate HIV incidence declines in eastern and southern Africa (ESA). However, high product and delivery costs and constrained budgets necessitate efficient prioritization strategies to maximize impact and achieve cost-effectiveness. MethodsWe used district-level HIV incidence estimates published by UNAIDS to estimate the direct health and economic impact of prioritizing Lenacapav...

BackgroundMarked declines in pediatric HIV have been achieved across sub-Saharan Africa, yet progress among adolescents remains uneven and strongly patterned by place. Drawing on place-based perspectives in health geography, we conceptualize Eastern and Southern Africa (ESA) and West and Central Africa (WCA) not merely as epidemiological regions, but as dis-tinct assemblages of health systems, gender norms, and historical investment trajectories shaping HIV risk and care. Using UNICEF-harmonized...

BackgroundPeople with HIV (PWH) experience an increased burden of cardiovascular disease (CVD), partly driven by chronic immune activation despite antiretroviral therapy (ART). Tuberculosis (TB), a frequent co-infection, may leave persistent inflammatory sequelae even after cure, potentially accelerating hypertension and cardiovascular risk. Evidence on long-term cardiometabolic consequences of prior TB in virally suppressed PWH, particularly sex-specific effects, remains limited. MethodsIn a p...

IntroductionWomen living with HIV (WLHIV) face an increased risk of cervical cancer (CC). With inequitable HPV vaccine access and a programmatic focus on girls-only school-based delivery, many WLHIV in high HIV prevalence countries remain vulnerable to HPV infection and CC. We assessed the incremental impact of adding catch-up vaccination for WLHIV in South Africa. MethodsWe used two independently developed HPV/CC and HIV transmission models to predict the incremental impact of catch-up HPV vac...

BackgroundHuman immunodeficiency virus (HIV) disproportionately affects marginalized communities in the United States, with Black Americans comprising 42% of new diagnoses despite representing 13% of the population. Machine learning (ML) prediction models are increasingly deployed for HIV-related decision-making, yet whether they perform equitably across demographic groups remains largely unexamined. MethodsWe conducted a fairness audit using the Behavioral Risk Factor Surveillance System (BRFS...

The advent of antiretroviral therapy (ART) has led to substantial increases in life expectancy among persons with diagnosed HIV (PWDH), and in turn, an increasingly older population. This represents a public health challenge, as older PWDH are more susceptible to age-related health morbidities compared to the general population. In this study, we triangulate diverse data sources to reconstruct the Italian PWDH age structure over the past decade to better-understand recent trends, and provide dem...

CD4+ T-cell enumeration remains critical for management of people with HIV (PWH). In resource-limited settings, point-of-care CD4 testing can increase accessibility and decrease turnaround time compared to flow cytometry. This study evaluated the performance of VITA point-of-care CD4 (Accesso Biotech; VITA CD4) compared to AQUIOS (Beckman Coulter; AQUIOS) flow cytometry. Remnant venous blood samples from PWH with known CD4 counts on FDA-cleared AQUIOS flow cytometry were tested twice with VITA ...

BackgroundAngiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are established antihypertensive treatments that reduce cardiovascular disease (CVD) risk. However, their comparative effectiveness in people with HIV (PWH) is not well examined. This study evaluated the comparative effectiveness of ACEIs and ARBs head-to-head and versus no antihypertensive treatment in preventing primary CVD. MethodsUsing a target trial emulation framework and data from the Nort...

BackgroundInterleukin-17A (IL-17A) is a key cytokine in inflammation and autoimmunity. However, its systemic correlates, particularly in a high HIV burden population, are not fully elucidated. This study aimed to identify the sociodemographic, clinical, inflammatory, metabolic, and renal factors independently associated with plasma IL-17A levels. MethodsThis cross-sectional analysis enrolled a cohort of adults from Livingstone Teaching Hospital in Zambia. Sociodemographic and clinical variables...

BackgroundAbrupt cessation of USAID and CDC resources to KwaZulu Natal province in South Africa, threatens the progress over decades to address HIV. MethodsWe used a previously developed validated HIV transmission model with input from the KZN Department of Health and local stakeholders to estimate impact of funding cuts on HIV incidence and mortality at 12-months and through 2030. We applied the model to estimate the impact of restoring funds on HIV incidence and mortality. ResultsHIV inciden...

IntroductionAchieving viral suppression is central to HIV epidemic control; however, routine viral load (VL) testing in many low- and middle-income countries is constrained by laboratory capacity, logistics, and cost. In Tanzania, disparities in VL coverage persist across age groups and geographical regions, limiting the timely detection of treatment failure. Pharmacy refill adherence is a low-cost, routinely collected objective indicator of treatment behavior. This study assessed whether pharma...

BackgroundFemale sex workers (FSW) are a key population for HIV prevention and care. Increasing evidence suggests that social and structural barriers are key drivers of HIV transmission. This global systematic review assesses whether experiencing violence is associated with worse HIV outcomes among FSW. Methods and FindingsWe searched MEDLINE, Embase, and PsycINFO databases for studies published from January 1st, 2010 to February 10th, 2025 assessing the impact of violence on HIV outcomes among...

ObjectiveTo quantify trends in annual mean healthcare costs per person living with HIV from 2003 to 2018 from a publicly funded healthcare system perspective. DesignWe conducted a retrospective population-based study using administrative health data in Ontario, Canada, including 25,842 people living with HIV diagnosed and entering care between 1992 and 2018. A nested cohort from the Ontario HIV Treatment Network Cohort Study (n=3,516) provided additional HIV-related characteristics. MethodsAnn...

BackgroundPeople living with HIV (PLWH) are more susceptible to persistent human papilloma virus (HPV) infection; however, data regarding oral HPV burden among youth with or without perinatal HIV exposure or infection in sub-Saharan Africa remain scarce. This study characterized how dental, immune and behavioral factors contribute to oral HPV susceptibility among youth and mothers across varying HIV exposure groups. MethodsThis baseline analysis leveraged data from a prospective cohort in Niger...

There is no readily accessible, scalable cure for HIV infection. Trials of HIV-specific broadly neutralising antibodies (bNAbs) demonstrate inhibition of viral replication and reduction of the reservoir of latently-infected cells, potentially offering new strategies for HIV eradication. Animal and human studies suggest bNAbs have multiple activities, including a direct antiviral action and a secondary induction of T cell responses, the vaccinal effect. The RIO trial assessed HIV-specific cell-m...

HIV testing remains the primary entry point to HIV prevention, treatment, and care. Although Zambia has made substantial progress in its HIV response, men remain less consistently reached by HIV testing services. This study assessed trends and determinants of HIV testing uptake among men aged 15-59 years in Zambia using repeated nationally representative survey data. We pooled mens data from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013/14, 2018, and 2024. The outcome...