This review summarizes the epidemiology of Cytomegalovirus infections in children exposed to or infected with HIV and the impact of CMV infection on overall health outcomes in this population. CMV infections and cCMV remain a significant burden in HIV exposed and HIV infected children requiring close long-term follow-up. While CMV disease occurs rarely in HIV-infected individuals in the ART-era, the complex interplay between CMV and HIV could have a major impact on childhood health outcomes in HIV-infected and exposed children. Congenital CMV infection (cCMV) is well recognized as the most common congenital viral infection and the leading cause of sensorineural hearing loss (SNHL). CMV-HIV co-infections have been shown to increase the incidence of cCMV, but effect on long-term outcomes remains largely undetermined at this time.

The central nervous system (CNS) remains a relatively understudied reservoir of HIV that may have significant implications for HIV cure and the pathogenesis of cognitive disorders that persist despite viral suppression with antiretroviral therapy (ART). This review will describe our current understanding of the nature, size and composition of the CNS reservoir and the possible contribution of viral persistence in the CNS on viral replication, neuroinflammation and cognitive disease. Reservoirs of intact and defective HIV proviral DNA have recently been detected in both the brain parenchyma and cerebrospinal fluid (CSF) of ART-suppressed PWH. Moreover, viruses from these sites are transcriptionally and translationally active, with the potential to propagate infection ex vivo in the absence of ART. Ongoing viral persistence likely contributes to elevated risk of comorbid neurocognitive issues and measures of neuroinflammation support a pathological impact of HIV reservoirs on the brain. However, it is becoming clear that the sub-regions of the CNS including the brain parenchyma and CSF contain unique reservoir characteristics including cellular sources and reservoir dynamics which likely impart different effects on neuropathology. The CNS represents a heterogeneous reservoir of HIV with sub-regional differences in reservoir maintenance and cellular sources, highlighting the need to consider these nuances in HIV treatment, neuropathology and cure strategies.

This review discusses recent advances in understanding the mechanisms of CNS HIV invasion and persistence and examines how these processes relate to the neurologic complications of HIV. Recent studies have provided compelling evidence that HIV can persist within CNS macrophages and microglia despite long-term suppressive ART, supporting the existence of a CNS reservoir. Updates to treatment of neurosymptomatic CSF HIV RNA escape include evaluation of CNS-specific drug resistance patterns and ART optimization. Evaluation of cognitive symtpoms in persons with HIV should include a comprehensive medical and neurologic evaluation, cessation of Efavirenz, and evaluation of HIV disease activity and immune dysregulation. Novel HIV cure strategies, including shock-and-kill approaches, block-and-lock strategies, and broadly neutralizing antibodies have highlighted the importance of understanding CNS reservoir dynamics and potential neurotoxicity when designing HIV cure strategies. HIV enters the CNS during early infection and may establish a persistent viral reservoir. CNS HIV persistence has important clinical implications, including symptomatic CSF HIV RNA escape and cognitive dysfunction, and may represent a barrier to HIV cure.

PURPOSE OF REVIEW: This paper explores how womanist theory. a framework grounded in the lived experiences, cultural knowledge, and spiritual traditions of Black women, can enhance HIV implementation science. We ask: How can womanist theory advance more equitable, effective, and culturally congruent HIV prevention, care, and treatment for Black women? RECENT FINDINGS: Black women account for 55% of new HIV diagnoses in the U.S. despite being only 13% of the female population. Traditional implementation strategies often fail to account for the structural racism, gendered stigma, and socio-spiritual factors that shape their experiences. Recent womanist-informed interventions have centered radical subjectivity, community, and spiritual wholeness to transform engagement, care, and healing. Womanist theory offers a vital and underutilized paradigm for designing HIV implementation strategies thatprioritize the wellness, agency, and leadership of Black women. By integrating womanist principles into studydesign, implementation processes, and evaluation, researchers and practitioners can develop more just andsustainable approaches to ending the HIV epidemic among Black women.

The HIV-1 pandemic is characterized by extensive viral genetic diversity, with strains that can be classified into distinct clades or subtypes based on sequence relatedness. Biological differences between subtypes have also been reported. HIV-1 subtype B, predominant in North America and Europe is most studied, but non-B subtypes represent the majority of infections globally and in sub-Saharan Africa, which accounts for more than two-thirds of people living with HIV. Whereas the implications of genetic and biological diversity overall for HIV prevention, treatment and cure strategies are recognized, the impact of clade differences is contested. Here we review how viral and host diversity, including subtype-specific differences may shape HIV pathogenesis, reservoir characteristics and cure strategies, highlighting data from regions where non-B subtypes circulate. Studies from African and global cohorts highlight differences in epidemiological spread and disease progression among HIV-1 subtypes that may be attributed to viral genetic sequence variations and resultant distinct properties in viral replication capacity, immune evasion, interferon resistance, co-receptor usage, latency regulation and reservoir biology. HIV-1 diversity has implications for virus biology, transmission and clinical outcomes. Clade-specific differences therefore warrant consideration in the development and design of prevention, treatment and cure strategies, including diagnostic and monitoring assays. Incorporating multi-clade research and regionally relevant cohorts will advance and accelerate efforts toward a universally applicable HIV cure.

Weight gain and development of obesity has been well-described with contemporary antiretroviral therapy (ART), and management has proven difficult. It remains unclear whether weight gain can be mitigated or reversed by switching ARV classes. We aim to summarize recent literature on ART switch to attenuate weight gain. Recent studies have recognized integrase strand transfer inhibitors (INSTI) and tenofovir alafenamide (TAF) as significant independent contributors to weight gain. The mechanisms for weight gain may stem from adipose tissue hypertrophy and fibrosis. The reversibility of the weight gain appears to be limited, with trials evaluating switching to more “weight-neutral” ART not proving effective. Discontinuing INSTI- and/or TAF-based regimens has not led to significant changes in weight, suggesting that alternative strategies may be required to modify weight trajectories in individuals who experience excessive weight gain after initiating INSTI-based ART.