Dental procedures in people living with HIV: a narrative review.

Rational perspectives on risk and certainty for dentistry during the COVID-19 pandemic

Clonal hematopoiesis does not predict solid tumor malignancy in people living with HIV

Effective management of people living with HIV (PLWH) can block the sexual transmission as there is a zero risk of sexual transmission (by U=U campaign); however, few studies have aimed to addressed the risk of transmission among PLWH in China. We conducted a cross-sectional survey among PLWH in 2022. PLWH were categorized into four HIV transmission risk groups: on antiretroviral therapy (ART) and HIV viral load (VL) < 50 copies/mL as minimum risk; on ART and 50 ≤ VL < 1,000 copies/mL as low-risk; on ART and VL ≥ 1,000 copies/mL, or on ART but without VL testing as medium-risk; not on ART as high-risk. Multivariable logistic regression was used to identify risk factors associated with risk of HIV transmission. A total of 39,744 PLWH were enrolled in the study. The proportion of those at risk for HIV transmission was 11.4%: low-risk 3.4%, medium-risk 6.9% and high-risk 1.1%. 33,764 (95.0%) patients were tested for syphilis, of whom 5.6% (1,879) had a current syphilis infection. Multivariable logistic regression analysis showed that compared with patients at minimum risk of transmission, individuals who were male (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.06-1.29), 16-24 age group (aOR: 2.13, 95% CI: 1.75-2.60), primary school or literate (aOR: 1.50, 95% CI: 1.36-1.65), heterosexual route of HIV infection (aOR: 1.50, 95% CI: 1.38-1.63), with a non-local registered residence (aOR: 1.55, 95% CI: 1.39-1.72), current CD4 + T count ≤200 cells/μL (aOR: 5.03, 95% CI: 4.52-2.59), and follow-up years less than 2 years (aOR: 2.02, 95% CI: 1.77-2.30) were associated with increased odds of HIV transmission. Being married (aOR: 0.62, 95% CI: 0.55-0.69) was associated with a decreased risk of HIV transmission. We concluded that 8.0% of PLWH were at moderate to high risk for HIV transmission. 88.6% of HIV positive patients in Zhejiang province, China were found to be at minimum risk of HIV transmission. Promoting HIV knowledge and education among younger adults, while linking individuals to ART to reduce their viral load could help reduce the persistently risk of HIV transmission.

Decreased mortality, decreased risk of vertical HIV transmission, and many people living with HIV (PLWHIV) being of reproductive age have led many PLWHIV to consider pregnancy. However, scarce data exist regarding the conception planning resources required and available for PLWHIV to have safe and healthy pregnancies. This study aimed to identify gaps between the need for, knowledge of, and access to conception planning information and services among PLWHIV in Ontario, Canada. PLWHIV from three large and two small urban sites in Ontario were recruited (n = 63). Participants completed a cross-sectional survey assessing demographics, expectations and plans for conception, and knowledge about and access to existing conception information and services for PLWHIV. Univariate correlations and ranked analyses were used to assess the associations between the need for, knowledge of, and access to conception planning resources with various demographic variables. Participants’ median age was 40 years (interquartile range = 33–45) with 52% being female, 73% identified as heterosexual, and 27% as lesbian, gay, bisexual, queer, transgender, two-spirited, or other. Univariable analysis indicated that male PLWHIV and those from small urban areas were less likely to expect children in the future and less likely to speak to healthcare providers about conception planning. Although 63% of all participants intended to conceive and 44% had a plan for conception in the near future, only 30% had spoken to a healthcare provider about pregnancy and only 30% had some knowledge about conception planning and assisted reproductive services for safer conception for PLWHIV. Knowledge of and access to resources on conception planning for PLWHIV varied by sexual orientation and geographic location in Ontario. Our results show a gap between the need for conception information and knowledge of and access to adequate information and resources among PLWHIV in Ontario, which may impact the psychosocial well-being of PLWHIV and their children.

Kaposi sarcoma in people living with HIV (PLHIV) is the most common AIDS-associated malignancy. There is increased interest in Kaposi sarcoma in PLHIV with controlled HIV viremia. To describe Kaposi sarcoma occurring in PLHIV despite virological control and to compare their clinical presentations with viremic AIDS-Kaposi sarcoma (AIDS-KS) and classic Kaposi sarcoma (CKS). This was a monocentric retrospective study, including all Kaposi sarcoma patients registered between the 1 January of 2000 and 31 December 2017 in a comprehensive data bank for all cancers in the Hérault region, South of France. AIDS-KS were also described using chart reviews from the Infectious diseases Department, which followed more than 90% of PLHIV from the same region. We defined aviremic AIDS-KS as Kaposi sarcoma occurring in persons taking HAART with a HIV viral load less than 50 copies for more than 12 months. We compared clinical characteristics of persons with aviremic AIDS-KS, viremic AIDS-KS and CKS, using the Kriegel score and number and topography of skin lesions, and presence of lymphedema. We retrieved 187 Kaposi sarcoma cases, of which 12 occurred in PLHIV with aviremic AIDS-KS. Kriegel score stage I was found in 10 (83%) of the aviremic AIDS-KS, 34 (68%) of CKS and 38 (58.4%) of viremic AIDS-KS cases, with similar clinical presentations between aviremic AIDS-KS and CKS groups, and viremic AIDS-KS persons having more aggressive presentations. One person with aviremic AIDS-KS had visceral involvement. We showed that Kaposi sarcoma in PLHIV with controlled viremia were generally indolent, similarly to CKS. Visceral involvement is, however, possible.

In recent decades, progress has been made worldwide in the prevention and control of HIV infection. What is the status of HIV prevention and control in China? This issue of HIV Medicine highlights the current progress in the management of and clinical research on HIV/AIDS in China, providing readers with a brief overview of this field. The Chinese authorities have made several efforts regarding the prevention and treatment of AIDS. For example, HIV infections transmitted by illegal blood transfusions have been eradicated, and HIV transmission among injecting drug users (IDUs) has been markedly reduced due to the implementation of a needle and syringe exchange programme. With the launch of the National Free Antiretroviral Treatment (ART) Program in 2003 and the subsequent implementation of the Four Free and One Care policy in 2006 [1], people living with HIV (PLWH) are often diagnosed via voluntary HIV testing or routine health examinations and provided free access to ART. The Four Free and One Care policy covers the provision of free ART to rural and urban residents without medical insurance; free voluntary counselling and HIV testing; free prevention of mother-to-child transmission; free schooling for orphaned children of PLWH; and care and economic assistance to PLWH with financial difficulties. In particular, the immediate initiation of ART in PLWH since 2016 has significantly reduced not only HIV transmission and prevalence but also AIDS-associated mortality [2]. Two studies in this issue analysed the clinical characteristics of patients receiving ART and pointed out the challenges faced by healthcare providers in China. Zhao et al. [3] presented the demographic and clinical characteristics of the national ART cohort for 2019. Their study showed great progress in increasing ART coverage and provided evidence of viral suppression across China. However, key populations of PLWH still face challenges: many are IDUs, have a history of treatment failure, or are co-infected with hepatitis C virus. Liu et al. [4] analysed the barriers to early diagnosis and timely ART initiation among PLWH, and their findings indicate the need for additional screening and intervention to improve the clinical management of HIV/AIDS. Co-infection with other viruses and bacteria among PLWH is associated with an increased incidence of failed immune reconstitution during ART and leads to a mortality rate higher than that associated with HIV infection alone. Two papers highlighted coinfections with hepatitis B virus (HBV) and Mycobacterium tuberculosis in PLWH. Jiang et al. [5] examined the factors associated with immune reconstitution in individuals with HIV/HBV co-infection receiving ART. They found that the baseline HIV viral load was the only significant factor that negatively influenced CD4 T-cell restoration in this population. Qi et al. [6] investigated tuberculosis (TB)-associated mortality within 90 days of admission and its risk factors among PLWH. Their data showed the 90-day mortality rate in patients with co-infection to be 13.6%, and early TB-associated death was associated with central nervous system TB, not receiving ART within 3 months after admission, and serum albumin levels < 25 g/L. In the era of ART, mother-to-child HIV transmission has substantially decreased. However, anti-HIV antibodies may still be detected in uninfected infants of mothers with chronic HIV infection. On monitoring the dynamics of anti-HIV antibodies in these infants, Liu et al. [7] noted the clearance of anti-HIV antibodies at more than 18 months post-delivery in 5.8% of uninfected children. These findings indicate that positive results for anti-HIV antibodies in infants aged 18–24 months should be carefully interpreted. Simultaneously, additional nucleic acid tests are necessary to confirm a diagnosis of HIV infection. Although ART has increased the life expectancy and improved the quality of life of PLWH, non-AIDS-associated events remain an issue. Lin et al. [8] summarized the clinical characteristics of non-AIDS-associated events involving multiple organs, such as the liver and kidneys, and suggested that multidisciplinary management is necessary for PLWH. Ying et al. [9] investigated the epidemiology, clinical features, and prognostic factors of HIV-associated talaromycosis and found an increased prevalence in Guangdong, China. Typical skin lesions were noted in 44.5% of patients. Induction therapy with azole alone was associated with a higher mortality than therapy with amphotericin B deoxycholate. These results may serve as a guide for clinicians in the management of HIV-associated talaromycosis. The viral reservoir is the biggest hurdle in the race to cure HIV/AIDS. In the shock and kill strategy, the latent HIV reservoir is maximally activated by stimulation with latency reversal agents and further cleared by host immune surveillance. Li et al. [10] evaluated the safety and efficacy of chidamide, a histone deacetylase inhibitor, for HIV-1 latency reversal in seven participants with viral suppression. All participants exhibited robust and repeated plasma viral rebound and increased cell-associated HIV-1 RNA levels, but only grade 1 adverse events were reported. Chidamide seems to be an effective agent in disrupting HIV-1 latency and reducing HIV-1 DNA loads; however, these findings need to be confirmed in randomized controlled clinical trials. Zhang et al. [11] summarized recent findings regarding the role of CD8 T-cells in controlling HIV infection, highlighting the differences between conventional antigen-specific and innate-like CD8 T-cells. Antiviral activity of CD8 T-cells in PLWH receiving ART may not be achieved via an antigen-specific approach, as HIV-specific CD8 T-cells can sense, but not effectively eliminate, cells harbouring intact proviruses. By contrast, virtual memory CD8 T-cells, a semi-differentiated subset of CD8 T-cells, may be involved in controlling the HIV DNA reservoir in patients receiving ART. In China, although remarkable progress has been made in controlling the HIV epidemic, challenges remain. First, the absolute number of PLWH is approximately 1.2 million, and the annual number of newly identified HIV/AIDS cases has been determined to be 150 000 in the last 3 years. In particular, approximately 31% of PLWH were diagnosed in the advanced stage, with peripheral CD4 T-cell counts of less than 200 cells/µL [3, 12]. In-time HIV screening is necessary to identify PLWH at an early stage. Second, the choice of ART drugs for PLWH is limited; for example, integrase inhibitors have recently been included in the free ART regimen, but this programme does not cover all PLWH. Third, sexual transmission has become the main route of HIV spread, and such transmission needs to be reduced by efficient preventive programmes, such as those providing universal pre-exposure prophylaxis. The 90-90-90 goals put forth by the Joint United Nations Program on AIDS/HIV seek for 90% of PLWH to be diagnosed, 90% of those diagnosed to receive ART, and 90% of those receiving ART to show viral suppression. It is feasible to achieve these 90-90-90 goals during next 5 years in China, but we still have a long way to go for the development of a cure for HIV infection.

Neck of femur (NOF) fractures are a critical orthopaedic emergency with a high morbidity and mortality prevalence, particularly in people living with Human Immunodeficiency Virus (PLWHIV). A combination of HIV infection, combined antiretroviral therapy (cART), and compromised bone health further increases the risk of fragility fractures. Additionally, HIV-related immune dysfunction, cART-induced osteoporosis, and perioperative infection risks further pose challenges in ongoing surgical management. Despite the rising global prevalence of PLWHIV, no specific guidelines exist for the perioperative and post-operative care of PLWHIV undergoing NOF fracture surgery. This narrative review synthesises the current literature on the surgical management of NOF fractures in PLWHIV, focusing on pre-operative considerations, intraoperative strategies, post-operative complications, and long-term outcomes. It also explores infection control, fracture healing dynamics, and ART’s impact on surgical outcomes while identifying key research gaps. A systematic database search (PubMed, Embase, Cochrane Library) identified relevant studies published up to February 2025. Inclusion criteria encompassed studies on incidence, risk factors, ART impact, and NOF fracture outcomes in PLWHIV. Data were analysed to summarise findings and highlight knowledge gaps. Pre-operative care: Optimisation involves assessing immune status (namely, CD4 counts and HIV-1 viral loads), bone health, and cART to minimise surgical risk. Immunodeficiency increases surgical site and periprosthetic infection risks, necessitating potential enhanced antibiotic prophylaxis and close monitoring of potential start/switch/stopping of such therapies. Surgical management of neck of femur (NOF) fractures in PLWHIV should be individualised based on fracture type (intracapsular or extracapsular), age, immune status, bone quality, and functional status. Extracapsular fractures are generally managed with internal fixation using dynamic hip screws or intramedullary nails. For intracapsular fractures, internal fixation may be appropriate for younger patients with good bone quality, though there is an increased risk of non-union in this group. Hemiarthroplasty is typically favoured in older or frailer individuals, offering reduced surgical stress and lower operative time. Total hip arthroplasty (THA) is considered for active patients or those with pre-existing hip joint disease but carries a higher infection risk in immunocompromised individuals. Multidisciplinary evaluation is critical in guiding the most suitable surgical approach for PLWHIV. Importantly, post-operative care carries the risk of higher infection rates, requiring prolonged antibiotic use and wound surveillance. Antiretroviral therapy (ART) contributes to bone demineralisation and chronic inflammation, increasing delayed union healing and non-union risk. HIV-related frailty, neurocognitive impairment, and socioeconomic barriers hinder rehabilitation, affecting recovery. The management of NOF fractures in PLWHIV requires a multidisciplinary, patient-centred approach ideally comprising a team of Orthopaedic surgeon, HIV Physician, Orthogeriatric care, Physiotherapy, Occupational Health, Dietitian, Pharmacist, Psychologist, and related Social Care. Optimising cART, tailoring surgical strategies, and enforcing strict infection control can improve outcomes. Further high-quality studies and randomised controlled trials (RCTs) are essential to develop evidence-based guidelines.

BackgroundActivities to decrease the burden of tuberculosis (TB) among people living with HIV (PLHIV) include intensified TB case-finding (ICF), Isoniaizid (INH) preventive therapy (IPT) and infection control in health-care and congregate settings (IC). Information about the status of collaborative TB/HIV care services which decreases the burden of TB among PLHIV in Ethiopia is limited. The purpose of the study was to assess TB case finding and provision of IPT among PLHIV in Addis Ababa.MethodsA cross sectional, facility-based survey was conducted between June 2011 and August 2011. Data was collected by interviewing 849 PLHIV from ten health facilities in Addis Ababa. Both descriptive and inferential statistics were used to analyze findings and the results are described in this report.ResultsThe proportion of PLHIV who have been screened for TB during any one of their follow-up cares was 92.8%. Eighty eight (10.4%) of the study participants have been diagnosed for TB during their HIV follow-up cares. PLHIV who had never been diagnosed for TB before they knew their positive HIV status were nearly four times more likely to be diagnosed for TB during follow-up cares than those diagnosed before (AOR [95% CI]: 3.78 [1.69-8.43]). Nearly a third (28.7%) of all interviewed PLHIV self reported that they had been treated with IPT.ConclusionsIt can be concluded that ICF for TB and IPT among PLHIV in Addis Ababa need boosting. Hence, it is recommended to put into practice the national and global guidelines to improve ICF and IPT among PLHIV in the city.

IntroductionNon-Hodgkin’s Lymphoma (NHL), Kaposi’s sarcoma and invasive carcinoma of cervix are AIDS defining cancers (ADCs) seen in people living with HIV (PLHIV). After the introduction of combination antiretroviral therapy (cART)...

PurposeThe South African HIV Cancer Match (SAM) Study is a national cohort of people living with HIV (PLWH). It was created using probabilistic record linkages of routine laboratory records of...

BACKGROUND The estimated number of people living with HIV (PLHIV) in India in 2023 is 2.54 million (range 2.16-3.03 million). With the initiation of antiretroviral therapy (ART) and the “Test and Treat” policy, the life expectancy of PLHIV on ART has substantially increased, consequently leading to a higher rate of comorbidities among PLHIV. The Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 targets aim for about 90% of PLHIV to have access to integrated and comprehensive health care services, with a concerted effort to reach the End of AIDS by 2030. Hence, the National Integrated Bio-Behavioral Surveillance (IBBS) among PLHIV (IBBS-PLHIV) has been implemented for the first time in India to establish a baseline understanding of the prevalence of sexually transmitted infections (STIs), noncommunicable diseases (NCDs), and related risk behaviors among PLHIV. OBJECTIVE The primary aim of IBBS-PLHIV is to estimate the levels of HIV-related risk behaviors and the prevalence of other STIs and NCDs among PLHIV. The specific objectives are identifying the levels of HIV-related sexual and injecting risk behaviors; estimating the prevalence of STIs such as syphilis, hepatitis B virus, and hepatitis C virus; estimating the prevalence of NCDs such as diabetes and hypertension; understanding the lifestyle and behavioral risks associated with NCDs; and assessing the levels of violence, stigma, and discrimination experienced by PLHIV. METHODS IBBS-PLHIV will be a cross-sectional, biennial surveillance among PLHIV aged 15 years or older. The first round will be implemented at 120 ART centers across 28 states, accounting for approximately 95% of the total estimated PLHIV. Consenting, eligible PLHIV will be recruited through consecutive sampling. The overall sample size at each ART center is approximately 225, and the surveillance period is 3 months. Behavioral data on demographics, reproductive and sexual health, lifestyle and sexual behaviors, stigma, and discrimination will be collected. Blood samples will also be collected to test for STIs and NCDs. RESULTS IBBS-PLHIV was initiated on January 1, 2024, in a phased manner. Data collection was carried out over 3 months and completed by June 2024 across all 120 sites. A total of 25,257 PLHIV were recruited for the surveillance, including 11,921 males, 11,855 females, and 1481 hijra/transgender individuals. Data entry, followed by data matching and validation of all records, was completed in December 2024. The data are currently being analyzed, and the final findings are expected to be disseminated by December 2025. CONCLUSIONS Data collected through IBBS-PLHIV will help monitor the levels of HIV-related sexual and injecting risk behaviors among PLHIV. Additionally, it will provide estimates of the prevalence of NCD comorbidities and STI coinfections such as diabetes, hypertension, syphilis, and viral hepatitis. These findings will serve as a baseline and are expected to offer valuable insights for facilitating comprehensive HIV care and management through the effective integration of HIV and broader health service delivery. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/58252

The estimated number of people living with HIV (PLHIV) in India in 2023 is 2.54 million (range 2.16-3.03 million). With the initiation of antiretroviral therapy (ART) and the "Test and Treat" policy, the life expectancy of PLHIV on ART has substantially increased, consequently leading to a higher rate of comorbidities among PLHIV. The Joint United Nations Programme on HIV/AIDS (UNAIDS) 2025 targets aim for about 90% of PLHIV to have access to integrated and comprehensive health care services, with a concerted effort to reach the End of AIDS by 2030. Hence, the National Integrated Bio-Behavioral Surveillance (IBBS) among PLHIV (IBBS-PLHIV) has been implemented for the first time in India to establish a baseline understanding of the prevalence of sexually transmitted infections (STIs), noncommunicable diseases (NCDs), and related risk behaviors among PLHIV. The primary aim of IBBS-PLHIV is to estimate the levels of HIV-related risk behaviors and the prevalence of other STIs and NCDs among PLHIV. The specific objectives are identifying the levels of HIV-related sexual and injecting risk behaviors; estimating the prevalence of STIs such as syphilis, hepatitis B virus, and hepatitis C virus; estimating the prevalence of NCDs such as diabetes and hypertension; understanding the lifestyle and behavioral risks associated with NCDs; and assessing the levels of violence, stigma, and discrimination experienced by PLHIV. IBBS-PLHIV will be a cross-sectional, biennial surveillance among PLHIV aged 15 years or older. The first round will be implemented at 120 ART centers across 28 states, accounting for approximately 95% of the total estimated PLHIV. Consenting, eligible PLHIV will be recruited through consecutive sampling. The overall sample size at each ART center is approximately 225, and the surveillance period is 3 months. Behavioral data on demographics, reproductive and sexual health, lifestyle and sexual behaviors, stigma, and discrimination will be collected. Blood samples will also be collected to test for STIs and NCDs. IBBS-PLHIV was initiated on January 1, 2024, in a phased manner. Data collection was carried out over 3 months and completed by June 2024 across all 120 sites. A total of 25,257 PLHIV were recruited for the surveillance, including 11,921 males, 11,855 females, and 1481 hijra/transgender individuals. Data entry, followed by data matching and validation of all records, was completed in December 2024. The data are currently being analyzed, and the final findings are expected to be disseminated by December 2025. Data collected through IBBS-PLHIV will help monitor the levels of HIV-related sexual and injecting risk behaviors among PLHIV. Additionally, it will provide estimates of the prevalence of NCD comorbidities and STI coinfections such as diabetes, hypertension, syphilis, and viral hepatitis. These findings will serve as a baseline and are expected to offer valuable insights for facilitating comprehensive HIV care and management through the effective integration of HIV and broader health service delivery. DERR1-10.2196/58252.

BackgroundPublic Health and Social Measures (PHSM) are among the commonly used methods to prevent the spread of Corona Virus Disease of 2029 (COVID-19). Vaccination has also been an integral component of infectious disease prevention and control and it has been used widely to protect humans against some of the very serious diseases such as COVID-19. People living with HIV (PLHIV) are known to be more vulnerable to the severest form of COVID-19 than the general population. Other groups of people likely to get the severe form of COVID-19 include the elderly and those with co-morbidities such as cancers, cardiovascular diseases, diabetes, etc.ObjectivesThe main objective of the study was to establish socio-demographic factors that could determine COVID-19 vaccination status among PLHIV in selected regions in mainland Tanzania and to provide insight into ways to increase COVID-19 vaccine coverage in Tanzania.MethodsA facility-based cross-sectional study was conducted between March and April 2022 among PLHIV in four conveniently sampled regions of Tanzania namely Kagera, Tabora, Geita, and Dar es Salaam. A total of 25 Care and Treatment Centres (CTCs) were randomly selected with a probability proportion by size in each region. In each CTC, 11 PLHIV eligible for vaccination were systematically selected to participate in the study. Face-to-face interviews were conducted using a structured questionnaire and Open Data Kit (ODK) software was used to record and transfer data to a designated server. Data cleaning and analysis were done using Stata version 14.0. A chi-square test was used to assess the association between socio-demographic characteristics and COVID-19 vaccination status. A generalized linear mixed-effects model was fitted to determine factors associated with COVID-19 vaccination status.ResultsOut of 1,100 PLHIV interviewed, 696 (63.3%) were found to be vaccinated against COVID-19. Level of education, age, occupation, employment status, location, and level of health facilities were found to be significantly associated with of COVID-19 vaccination status among PLHIV in the study areas. PLHIV who had college and university education, elderly, farmers, and those employed and living in a rural setting were found to be more likely to be vaccinated than other comparison groups in the categories analyzed.ConclusionThis facility-based cross-sectional study showed a higher COVID-19 vaccination rate (63.3%) among PLHIV compared to the general population. This could be explained by efforts by both public and private sectors to promote COVID-19 vaccination among PLHIV have had a positive impact on vaccination uptake. However, to meet the World Health Organization (WHO) target of 60% vaccination coverage, additional tailored interventions are required. These should include specific strategies that could be effective in urban areas, expanding vaccination access by increasing the number of vaccinations centers, supporting those who face barriers to vaccination, and actively engaging not only elderly individuals but also middle-aged and younger members of the community and PLHIV networks. Moreover, greater involvement from higher levels of health service provision, such as health centers and hospitals, will be likely increase vaccination coverage and address the unmet needs of this population.

People living with HIV (PLWH) are at increased risk of cancer, both non-AIDS- and AIDS-defining malignancies (NADM and ADM). Systemic chemotherapy also predisposes to secondary cancers. The potential contribution of systemic liposomal anthracycline chemotherapy (SLAC) to the development of second cancers in PLWH is unknown. Since 1998, we have treated 495 PLWH and Kaposi's sarcoma (KS) with a stage-stratified approach including 163 who received SLAC as first-line treatment for KS. Subsequent ADM and NADM diagnosed in this population were recorded. More patients who received SLAC had T1 stage disease (p < 0.0001) and lower CD4 cell counts (p < 0.0001) in line with the stage-stratified treatment, but there were no significant differences in age (p = 0.29), gender (p = 0.18), prior AIDS-defining illness (p = 0.45), plasma HIV viral load (p = 0.15), or HHV8 viral load (p = 0.39) between the two groups. During a median follow-up of 4.6 years (maximum 15 years) from KS diagnosis, 28 patients developed a second cancer (5 ADM and 23 NADM). The 5-year cumulative risk of second cancer is 5.8 % (95 % CI 3.0-8.6 %), and there is no significant difference in the rate between those treated with SLAC and those not (log rank p = 0.19). Most patients (n = 131) were treated with daunoxome (liposomal daunorubicin) chemotherapy, and there was no significant correlation between risk of second cancer and cumulative dose of daunoxome (p = 0.23). Although the risk of second cancer after a diagnosis of KS in PLWH is high, systemic liposomal anthracycline chemotherapy does not appear to increase the risk.

Although immunotherapy has emerged as a therapeutic strategy for many cancers, there are limited studies establishing the safety and efficacy in people living with HIV (PLWH) and cancer. PLWH and solid tumors or Kaposi sarcoma (KS) receiving antiretroviral therapy and a suppressed HIV viral load received nivolumab at 3mg/kg every 2weeks, in two dose deescalation cohorts stratified by CD4 count (stratum 1: CD4 count > 200/µL and stratum 2: CD4 count 100-199/µL). An expansion cohort of 24 participants with a CD4 count > 200/µL was then enrolled. A total of 36 PLWH received nivolumab, including 15 with KS and 21 with a variety of other solid tumors. None of the first 12 participants had dose-limiting toxicity in both CD4 strata, and five patients (14%) overall had grade 3 or higher immune related adverse events. Objective partial response occurred in nine PLWH and cancer (25%), including in six of 15 with KS (40%; 95% CI, 16.3-64.7). The median duration of response was 9.0months overall and 12.5months in KS. Responses were observed regardless of PDL1 expression. There were no significant changes in CD4 count or HIV viral load. Nivolumab has a safety profile in PLWH similar to HIV-negative subjects with cancer, and also efficacy in KS. Plasma HIV remained suppressed and CD4 counts remained stable during treatment and antiretroviral therapy, indicating no adverse impact on immune function. ClinicalTrials.gov Identifier: NCT02408861.