Increasing evidence suggests that dolutegravir (DTG), endorsed by the WHO since 2018 for first-line antiretroviral therapy (ART), is associated with significant weight gain and potentially also with cardiometabolic disorders. In an effort to expand therapeutic options for people living with HIV (PLHIV), the EvaLuating the non-inferiority of DORAvirine vs DOlutegravir trial aims to compare the virologic efficacy of doravirine (DOR) and DTG-based regimens and to assess their safety, including a focus on cardiometabolic effects. This is an international, phase III, multicentre, open-label, non-inferiority, randomised trial that will enrol 610 ART-naïve PLHIV (HIV RNA≥1000 copies/mL at screening) across six countries (Brazil, Cameroon, France, Côte d'Ivoire, Mozambique and Thailand) spanning four continents. Key inclusion criteria include age ≥18 years, confirmed HIV-1 infection with plasma RNA levels ≥1000 copies/mL, indication for ART initiation and no prior ART exposure. Participants will be randomised in a 1:1 ratio to receive either DOR 100 mg once daily in combination with tenofovir disoproxil fumarate (TDF) (300 mg daily) plus lamivudine (3TC) (300 mg daily) or DTG (50 mg daily) in combination with TDF (300 mg once daily) plus either emtricitabine (FTC) (200 mg daily) or 3TC (300 mg daily). Randomisation will be stratified by screening HIV-1 RNA load (≤100 000 or >100 000 copies/mL) and by country. The primary outcome is virological efficacy, defined as the proportion of participants achieving HIV-1 RNA <50 copies/mL at week 48 on the assigned treatment (FDA Snapshot algorithm). Secondary outcomes include cardiometabolic safety endpoints (ie, weight gain, insulin resistance, hypertension, diabetes, waist and hip circumferences, waist-to-hip ratio, fasting glycaemia, insulin and fasting serum lipids), along with mental health, quality of life, virological and immunological parameters. Final data collection is expected by July 2028. Primary outcome results (week 48) are expected in early 2028. The project was submitted to and approved by national ethics committees and pharmaceutical regulatory authorities in all participating countries: Brazil (CEP INI FIOCRUZ (21.040-900)/CEP HGNI (26.030-380)); Cameroon (CNERSH (2024/09/1717/CE/CNERSH/SP)/Ministry of Public Health (D30-1464/AAR/MINSANTE/SG/DROS/CRC); Côte d'Ivoire: (CNESVS (0018224/MSHPCMU/CNESVS-km)/AIRP (1329/AIRP/DISMP/Om/kbaag); France (CTIS CPP/ANSM (2023-508626-10-00)); Mozambique (CNBS (20/CNBS/25)/ANARME (4635/380/ANARME)); Thailand: (IHRP (08/1944)/Thai FDA: ongoing on 19 January 2026). The trial received authorisation from the French National Commission for Data Protection and Liberties (CNIL) under approval number 924 302. Written informed consent is obtained from all participants prior to any study-specific procedures and trial enrolment, in accordance with the Declaration of Helsinki and applicable national regulations. Study findings will be disseminated through publication in peer-reviewed journals and presentations at national and international scientific conferences. Results will also be communicated to policymakers, healthcare professionals, community stakeholders and study participants through appropriate dissemination activities, including policy briefs, stakeholder meetings and lay summaries on dedicated and easily accessible platforms. NCT06203132; EU-CT, 2023-508626-10-00.

The study analyzed pregnancy outcomes among 498 women living with HIV in East Asia. We found 15% had pregnancies postdiagnosis, with 57% resulting in live births. Older age at antiretroviral therapy initiation and higher pre-antiretroviral therapy viral loads were negatively associated with pregnancy. High rates of unplanned pregnancies (61%) and terminations (26%) highlight the need for improved reproductive counseling.

Despite South Africa being the epicentre of HIV, some progress was made in the fight against HIV, i.e., the implementation of HIV programmes, provision of antiretroviral therapy (ART), etc. However, little is known about the association between HIV testing modalities and ART initiation. This study aimed to determine the association between HIV testing modalities and ART initiation among men who have sex with men (MSM) in selected provinces of South Africa. Following a retrospective cohort design, this study analysed programme data on 3345 MSM aged 16 years and older who were living with HIV and eligible for ART initiation. Logistic regression assessed the association between HIV testing modalities and ART initiation, controlling for age group, location, and the COVID-19 period. All analyses were done using SPSS version 30. Significance was set at p &lt; 0.05. Participants who tested for HIV using the social network strategy (SNS) (98.6%) or index testing (96.3%) showed the highest proportions of ART initiation. Logistic regression showed that MSM who tested for HIV using the SNS had over 12 times higher odds of initiating ART (aOR = 12.166; 95% CI: 7.617–19.430; p &lt; 0.001), compared to those who used a rapid test. A significant association was observed between HIV testing modalities and ART initiation, with SNS and index testing demonstrating higher odds of ART initiation.

HIV and HBV frequently coexist, with an estimated 8% prevalence of chronic HBV among people living with HIV (PLWH). In profoundly immunosuppressed PLWH, initiation or reinitiation of antiretroviral therapy (ART) can trigger immune reconstitution inflammatory syndrome (IRIS). When directed against HBV, IRIS can manifest as a hepatic flare (IRIS-HF). The long-term clinical implications of IRIS-HF remain incompletely understood. We describe a 42-year-old man with HIV/HBV coinfection who had discontinued ART for one year. On ART reinitiation with bictegravir/emtricitabine/tenofovir alafenamide, his CD4 count was 2.3 cells/µL and HIV RNA was 4.8 × 10⁵ copies/mL. Five weeks later, he developed a severe hepatic flare (AST 987 U/L, ALT 968 U/L). The differential diagnosis included HBV-related IRIS, opportunistic infections (CMV hepatitis, disseminated MAC, EBV-associated lymphoma), and drug-induced liver injury. A liver biopsy revealed fatty degeneration and lymphocytic infiltration, consistent with HBV-related IRIS. Transaminases normalized by week 11. He subsequently achieved HBsAg loss with anti-HBs seroconversion within 2 years after ART reinitiation. This case illustrates HBV flare due to IRIS following ART reinitiation in a profoundly immunosuppressed patient. The subsequent HBsAg loss suggests that IRIS-HF may promote HBV clearance, highlighting its potential role in achieving a functional cure. Vigilant monitoring of liver function is essential during ART initiation or reinitiation in HIV/HBV coinfected individuals.

Co-infection with human immunodeficiency virus (HIV) and syphilis creates a clinical and diagnostic challenge due to overlapping transmission routes and immunosuppression secondary to HIV. We describe a case concerning possible serological rebound in syphilis, which may be attributed to delayed initiation of antiretroviral therapy (ART), although this was not confirmed by a repeat non-treponemal test. A 40-year-old man with HIV and symptomatic secondary syphilis delayed ART initiation in the setting of poor treatment adherence for three months after syphilis diagnosis. During that three-month delay, his toluidine red unheated serum test (TRUST) titer was noted to rebound from 1:32 to 1:128. After ART initiation, he achieved sustained viral suppression (< 20 cp/mL) and immune recovery (CD4 + T cell count: 577/µL) within eight months of ART initiation; however, his syphilis titer did stabilize at 1:32. There is a need for caution in evaluating whenever possible when two diseases share a diagnosis. Our case highlights may highlight possible effects of deferral of ART initiation on immunologic recovery and the serological response for syphilis, and a need for ongoing comprehensive follow-up and circumspection in evaluation of serological change overall. Interpretation was limited by the absence of parallel repeat TRUST testing and being unable to entirely rule out possible reinfection.

Delay antiretroviral therapy initiation and factors affecting it among patients on antiretroviral treatment at North Shewa zone public health facilities, Amhara region, Ethiopia, 2024: a mixed method approach.

Brucellosis is a zoonosis in which hepatic involvement is common but usually mild. Acute liver failure and acute-on-chronic liver failure (ACLF) are rarely attributed to brucellosis, and even more rarely to people living with HIV (PLWH). We describe a 50-year-old man from Ghana with newly diagnosed advanced HIV infection and HBV reactivation (anti-HBc IgG positive, anti-HBc IgM negative) who developed ACLF shortly after starting antiretroviral therapy (ART). After an initial viro-immunological response to a bictegravir-based regimen, he experienced a paradoxical deterioration of liver function and was evaluated for liver transplantation. During this phase, he developed painful swelling of the left neck; imaging revealed osteo-articular and muscular lesions. Serology (Wright 1:320) was positive, blood cultures were negative and Brucella PCR was not available; therefore, disseminated brucellosis was considered probable based on serology, compatible clinical syndrome and complete response to anti-Brucella therapy. Targeted treatment with intravenous gentamicin plus oral doxycycline, with maintenance of ART, led to improvement of liver function, resolution of lesions and avoidance of transplantation. Based on timing, viro-immunological response and exclusion of alternative causes, we interpret this ACLF as likely precipitated by disseminated brucellosis in the setting of an unmasking immune reconstitution inflammatory syndrome (IRIS). Brucellosis should be considered as a potentially reversible cause of ACLF in PLWH from endemic areas, particularly soon after ART initiation.

Antiretroviral therapy (ART) initiated in the acute phase of HIV infection (AHI) results in a smaller viral reservoir. However, the impact of early HIV-specific T-cell responses on long-term reservoir dynamics is less well characterized. Therefore, we measured the size of the viral reservoir and functionality of HIV-specific CD8+ T-cell responses after the acute phase at 24 and 156 weeks after ART initiation in people with HIV who started treatment during AHI. A significant reduction in total and defective HIV DNA and a trend toward a reduction in intact HIV DNA were observed between 24 and 156 weeks. Functional CD8+ T-cell responses against HIV peptides Env, Gag, Nef, and Pol were maintained over 3 years after treatment initiation. The proliferative capacity of HIV-specific CD8+ T-cells at 24 weeks of ART was predictive of the degree of reduction in total and defective HIV DNA between 24 and 156 weeks, suggesting HIV-specific CD8+ T-cells may at least partially drive the decline of the viral reservoir. Therefore, enforcing HIV-specific immune responses as early as possible after diagnosis of AHI should be a central focus of HIV cure strategies.

IntroductionDespite significant progress in HIV care globally, a persistent 30–40% of people present with advanced HIV disease with ≤200 CD4 cells/µl. The Visitect CD4 Advanced Disease platform is a point‐of‐care CD4 test being implemented in resource‐limited settings. We sought to assess clinical outcomes of survival and retention‐in‐care among people with advanced HIV disease based on CD4 testing modality.MethodsWe performed a cluster randomized clinical trial to evaluate the Visitect CD4 compared with onsite standard laboratory‐based CD4 testing. The trial was conducted at 16 outpatient HIV clinics in Uganda. Those identified with CD4≤200 cells/µl received a standardized package of care for advanced HIV disease. The primary outcome was 24‐week survival with retention‐in‐care. A costing analysis was performed. Randomization by CD4 methodology was stopped on 18 June, 2024, as the Visitect CD4 Advanced Disease platform was being implemented widely in Uganda, and randomization to non‐Visitect CD4 platforms was unethical if no alternative CD4 strategies were available in a timely manner. We conducted a micro‐costing analysis to estimate the resources used for each trial participant over the 6‐month study period.ResultsBetween 5 May 2022 and 18 February 2025, 1724 participants were enrolled; 927 participants received Visitect CD4 testing (eight clusters), and 797 received standard CD4 testing (eight clusters). The composite endpoint of death or lost to follow‐up occurred in 7.0% (63/901) who received Visitect CD4 testing and 7.2% (57/788) who received standard CD4 testing (hazard ratio, 0.98; 95% CI, 0.69, 1.40). The estimated risk difference between arms was 0.01% (95% CI, −2.5, 2.5). Median time to antiretroviral therapy initiation was 0 days with Visitect testing versus 7 days with standard CD4 testing (adjusted hazard ratio, 1.23; 95% CI, 1.05, 1.45). Mean cost of 6‐month care was US$115 for Visitect CD4 testing versus US$131 for standard‐of‐care CD4 testing.ConclusionsImplementation of Visitect CD4 testing demonstrated more rapid initiation of HIV therapy with equivalent 24‐week survival and retention‐in‐care compared with other point‐of‐care CD4 strategies at equivalent cost. Despite its poor specificity, the Visitect CD4 platform remains a cost‐neutral option compared to standard CD4 modalities.Article Summary LineIn this cluster randomized trial, we identified that participants with advanced HIV disease who were randomized to receive the Visitect CD4 Advanced Disease platform had equivalent 24‐week survival with retention‐in‐care compared with standard CD4 testing strategies.

BACKGROUND The management of asymptomatic cryptococcal antigenemia in pregnant women with advanced human immunodeficiency virus (HIV) disease presents a therapeutic dilemma. Clinicians must balance the risks of vertical transmission, immune reconstitution inflammatory syndrome (IRIS), and antifungal teratogenicity. CASE SUMMARY We report a case of a 28-year-old HIV-positive woman in Kenya who presented at 34 weeks of gestation with symptoms suggestive of meningitis. She had self-discontinued her antiretroviral therapy (ART) 18 months prior. Laboratory investigations confirmed a positive serum cryptococcal antigen (CrAg) with a high HIV viral load (41200 copies/mL). Lumbar puncture ruled out meningeal involvement. A multidisciplinary team initiated preemptive therapy with high-dose fluconazole (800 mg daily). Faced with her advanced gestation and the imperative to prevent perinatal transmission, a calculated risk was taken to initiate ART (tenofovir/lamivudine/dolutegravir) after only 7 days, a significant deviation from standard guidelines. At 36 weeks, she had a spontaneous vaginal delivery complicated by uterine inversion and postpartum hemorrhage, which was managed successfully. She did not develop cryptococcal IRIS. At 3-month follow-up, her viral load was suppressed (51 copies/mL), and her infant was HIV-negative with normal development at 6 months. CONCLUSION This case highlights the importance of routine CrAg screening in pregnant women with advanced HIV. Preemptive fluconazole in the third trimester is feasible. The timing of ART initiation may need individualization to prevent vertical transmission in late gestation, particularly in the context of isolated antigenemia, where the IRIS risk profile may differ from cryptococcal meningitis. These decisions require multidisciplinary input and close monitoring.

Objective: To summarize the epidemiological trends of HIV Pakistan and address the major gaps in the prevention and access to treatment among key populations of HIV. Methodology: This narrative review was conducted between March-June 2025. PubMed, Scopus, The Lancet, Google Scholar, UNAIDS, the National AIDS Control Programme (NACP), WHO, and World Bank databases, as well as national and provincial reports were also searched to support evidence. The data were tabulated according to key populations, province, and chronology to identify the trends and treatment gaps. Pakistan focused sources that addressed prevalence, epidemiology, and access to care of interest to Pakistan were taken into considerations. Results: The HIV prevalence in Pakistan is approximately 0.1% with the estimated number of PLHIV being 260,000 though very high prevalence rates of HIV are reported among key populations of individuals at high risk, including transgender people and sex workers. The healthcare system is skewed towards metropolitan sites, and the antiretroviral therapy (ART) is more easily accessible there than in rural areas. The progress towards UNAIDS goals is insufficient and there is a significant gap in diagnosis, initiation of ART, and viral suppression, especially among vulnerable groups. Conclusion: The HIV epidemic in Pakistan is a high public health challenge and disproportionately affects key populations, and it rapidly affects marginalized populations despite the country having a low national prevalence. The persistence stigmatization, uneven access to ART, and health system limitations need to be addressed with decentralized rights-based HIV care and targeted preventive strategies to prevent further expansion of the epidemics.

ObjectivesSince 2016, China has provided timely HIV antiretroviral therapy (ART) under the treat-all policy. This study aimed to evaluate the impact of rapid ART initiation (≤7 days post-HIV diagnosis) on loss to follow-up (LTFU), mortality, and virologic failure compared with that of delayed ART. MethodsThis study included adults with ART-naive HIV infection in Xi’an, China, between 2016 and 2022. Kaplan–Meier analysis was used to examine LTFU and death time for rapid and delayed ART initiation. Moreover, multivariate Cox regression was employed to evaluate the correlation between rapid ART initiation and LTFU/mortality, while logistic regression was utilized to assess the association between rapid ART and 12-month virologic failure. ResultsOf the 6992 participants, 770 (11.0%) initiated ART ≤7 days postdiagnosis. The percent of ART initiations in the first week postdiagnosis quadrupled from 4.2% in 2016 to 19.7% in 2022. The LTFU rate for rapid ART initiators was comparable to that in the 8–29- (P = 0.132) and ≥30-day groups (P = 0.432). Mortality was notably decreased in the rapid ART group (0.0%) than in the 8–29- (1.5%) and ≥30-day groups (2.2%). The rapid ART initiators demonstrated lower odds of developing virologic failure compared with delayed ART initiators (aOR: 0.50; 95% CI: 0.26–0.89; P = 0.028; ≤7 days versus ≥30 days). ConclusionsUnder China’s treat-all policy, rapid ART initiation showed equivalent LTFU but lower mortality and virologic failure. Chinese HIV patients may benefit from rapidly ART, but they require more intensive, tailored counseling to remain in treatment.

BackgroundAs HIV management grows increasingly complex, infectious disease (ID) clinicians continue to face challenges and must make nuanced decisions to improve patient outcomes.Knowledge Gains Across TopicsMethodsVindico Medical Education provided a live continuing education (CE) symposium featuring interactive cases at IDWeek 2024. Through real-time polling and expert-guided discussions, clinicians made decisions in realistic clinical scenarios related to antiretroviral therapy (ART) initiation, switching ART, weight management, and use of pre-exposure prophylaxis (PrEP). Baseline and post-education knowledge and confidence were measured via pre- and post-test data.ResultsA total of 206 clinicians involved in the management of patients with HIV attended the symposium. At baseline, 61% of participants did not identify the appropriate timing for initiating ART in a patient with advanced HIV, 37% were unfamiliar with outcomes associated with switching ART, and 64% did not recognize the US FDA/CDC-recommended screening for PrEP (Figure 1). Overall, knowledge increased 42%. Improvements in behaviors were also noted. For instance, while 48% of participants at baseline could not appropriately manage a patient with ART-associated weight gain, following discussion of a related case scenario, 60% recommended a GLP-1 receptor agonist, indicating alignment of knowledge with evidence-based decision-making. Similarly, at baseline, half of the participants noted that lack of awareness about PrEP was the biggest challenge in implementation; post-education, however, 99% plan to use strategies to improve the use of PrEP. Additionally, post-learning, there was a 44% increase in competence regarding when to initiate ART in a patient with a co-infection. At the end of the education, 83% were confident in making decisions related to switching ART.ConclusionStaying current on the latest evidence-based care regarding HIV PrEP and treatment is a persistent challenge for clinicians. This CE activity promoted significant improvements in knowledge, confidence, and decision making among clinicians who treat patients with and at risk for HIV. Such interactive, case-based CE is an important tool that can be used to address practice gaps as the HIV landscape continues to evolve.DisclosuresAll Authors: No reported disclosures

BackgroundTransgender women (TGW) face a disproportionately high HIV burden, yet real-world evidence on their engagement in the care cascade is scarce. This study analysed HIV care cascade outcomes and associated factors in a large Argentinian cohort to identify key challenges and inform public health strategies.MethodsThis was a retrospective cohort study of TGW with confirmed HIV linked to care at a public hospital in Buenos Aires (2011-2022). We analyzed 12-month retention in care, antiretroviral therapy (ART) use, and virologic suppression using bivariate and multivariate logistic regression.ResultsOf 240 TGW included, 186 completed 12-months follow-up. The cascade outcomes were: 71.5% retained in care; 87.9% on ART among those retained; and 70.7% virologically suppressed among those on ART. In multivariate analysis, ART initiation at linkage was the strongest predictor of retention (aOR: 35.93; 95%CI: 9.72-132.75), while baseline cocaine use was associated with a lower likelihood of being on ART (aOR: 0.17; 95%CI: 0.04-0.68).ConclusionsSignificant gaps persist in the HIV care cascade for TGW in this real-world setting. While immediate ART initiation is a powerful tool for retention, structural barriers like substance use require integrated interventions. This evidence is critical for designing effective public health strategies to improve health equity.

Antiretroviral therapy (ART) is highly effective for treating HIV, but it is associated with metabolic alterations, such as insulin resistance (IR), which can be assessed using HOMA-IR, or using more accessible alternatives such as triglyceride-glucose (TG) index, which has been validated in Mexican population with a cut-off point of 4.68, with sensitivity of 96.5% and specificity of 85%. However, there are no studies analyzing the applicability and changes of the TG index after ART initiation in HIV-positive patients. To describe the frequency of IR using the TG index in HIV patients without previous treatment (naive) before and one year after starting ART. Comparative cross-sectional study. The Internal Medicine and Infectology Department records of patients recently diagnosed with HIV from a third-level hospital during 2010-2025 were reviewed. Biochemical, clinical, and anthropometric data were collected at baseline and one year after treatment initiation. Variables were recorded and analyzed blindly using SPSS, v. 25, with nonparametric statistics. It was considered significant a p with a < 0.05 value. 86 cases, 88.4% men, with a median age of 34.5 years (IQR 24-44.25), had a TG index of 4.70 (IQR 4.55-4.89) at baseline and 4.77 (IQR 4.63-4.89) at 1 year, with a statistically significant increase (p = 0.025). Out of patients with naive HIV and normal baseline TG index, 64% exhibited an elevation above the IR threshold (> 4.68) after one year of ART. In contrast, among those with an already elevated baseline TG index, 72% remained elevated after one year of treatment.

IntroductionEarly initiation of antiretroviral therapy (ART) and adequate adherence are associated with sustained viral load (VL) suppression and effective treatment in people living with HIV (PLHIV). Enhanced adherence counseling (EAC) has been recommended for PLHIV on therapy with a VL >1000 copies/mL. We developed a digital application, "Samvaad," for counselors at ART centers to document the barriers to poor adherence and to provide thematic EAC for registered PLHIV under the aegis of the Mumbai District AIDS Control Society. The objectives of this study are to document the barriers to ART adherence in PLHIV who require EAC and to report the suppression outcomes in those who received EAC using Samvaad.MethodsThis study is a pre-post analysis of retrospective programmatic data from 674 PLHIV across 16 ART centers in Mumbai, India, from September 2020 to July 2022. We included only PLHIV who had unsuppressed VL and/or ART adherence <95% for the present analysis. The main outcome was the change in VL status, from unsuppressed at baseline to suppressed at follow-up assessment. We collected demographic information, ART-related information (duration of ART and type of ART regimen), and CD4 counts at the time of EAC. We also documented barriers to ART adherence using "Samvaad."ResultsThe mean (SD) age of PLHIV was 37.1 (9.9) years; 60.7% (n=409) were male, and 39.3% (n=265) were female. The most common barrier at baseline was "I have not been adequately informed about the dose and schedule of medications" (65.1% (n=439)), followed by "I do not have a fixed time to take my medicines" (63.2% (n=426)). The least common barriers were "I skip medications in the morning whenever I have alcohol the previous night" (4.2% (n=28)), "I skip medications whenever I have a fight with my partner/lover" (4.5% (n=30)), and "I live with a lot of people and hence I am unable to keep the ART medications at home" (4.5% (n=30)). The most common domains were "pill-taking practices" (68.3% (n=460)) and "ART knowledge/behavior" (67.7% (n=456)). At follow-up assessment, about 90% of PLHIV had suppressed VLs. In the multivariate analysis, males were significantly more likely to be virally suppressed compared with females (OR: 1.99, 95% CI: 1.07-3.68; p=0.029). PLHIV on third-line ART (OR: 0.30, 95% CI: 0.11-0.85; p=0.024) and those with the practices barrier domain (OR: 0.44, 95% CI: 0.22-0.90; p=0.024) were significantly less likely to achieve VL suppression at follow-up.ConclusionsThe majority of PLHIV in our study were between 26 and 45 years of age, were male, had been on ART for more than five years, and were on first-line ART. The main barriers were a lack of adequate knowledge about dosage and side effects, as well as not having a fixed schedule for taking pills. Viral suppression was reported in approximately 90% of PLHIV after EAC sessions. However, VL suppression was less likely in those who did not have a fixed time for taking medicines. This is a practical problem that needs to be addressed by developing treatment plans that consider time spent away from home or in transit. The development of a digital app was useful to document key barriers and domains in PLHIV with poor adherence and to provide thematic EAC at ART centers. The app can be used in urban as well as rural ART centers to provide client-centric thematic adherence counseling.

A rapid CRISPR/Cas12a-based assay for the detection of HIV-1 Clade C in infants.

Impact of integrase strand transfer inhibitors on cardiovascular disease in people with HIV.

People living with HIV (PLWH) have an increased risk of cardiovascular disease (CVD), but longitudinal data from middle-income settings remain limited. This study examined the association between HIV, antiretroviral therapy (ART), and pulse wave velocity (PWV), a marker of arterial stiffness and CVD risk. A longitudinal analysis from the Ndlovu Cohort Study, South Africa. The study included 705 participants (325 PLWH, 81% on ART at baseline, 19% initiating ART at baseline, and 380 HIV-negative people. Demographic data, HIV/ART status, and covariates were collected at baseline, while PWV was measured at 12 and 36 months. Mixed-effects models were used to analyse PWV changes over time, adjusting for age, sex, and systolic blood pressure (SBP). Results were reported as beta coefficients (β) with 95% confidence intervals (CI). At baseline, PLWH were older and predominantly female (67%) compared to HIV-negative people. At 12 months, median PWV was higher in PLWH (7.3 m/s) than in HIV-negative people (7.0 m/s, p=0.001). Over 36 months, PWV increased by 0.30 m/s in PLWH and 0.20 m/s in HIV-negative people (p = 0.002). ART-naïve individuals had the largest PWV increase after starting ART (6.8 m/s at 12 months to 7.4 m/s at 36 months, p = 0.001). HIV (β=0.65, 95% CI: 0.24-1.06, p = 0.002) and time (β=0.31 m/s per year, p < 0.001) were significantly associated with higher PWV. PWV increased over time, particularly in PLWH, with ART initiation linked to rapid increases. These findings highlight the need for early CVD risk monitoring, especially post-ART initiation, in resource-limited settings.

HIV/AIDS continues to be a major global public health issue and a significant cause of death. While the WHO advocates for viral load testing as the primary approach to monitor treatment and detect antiretroviral therapy (ART) failure, the factors affecting viral load trends are frequently neglected. This study exclusively analyzes viral load trajectories, identifying predictors of virological suppression independent of adverse outcomes. This study aimed to assess predictors of longitudinal viral load suppression HIV patients on first-line ART in Central Ethiopia: a mixed-effects analysis. A retrospective follow-up study was conducted in public hospital in Central Ethiopia. A total of 376 adult patients who started first-line ART and had at least two viral load measurements between March 1, 2017, and November 30, 2021, were selected using simple random sampling. Follow-up continued until November 30, 2022.Variables with a univariable association (p < 0.20) with viral load changes were included in the multivariable analysis. A linear mixed-effects model was applied, with statistical significance set at 5%, using adjusted coefficients and 95% confidence intervals. To maintain focus on viral load trends, we excluded time-to-event endpoints and adverse reaction analyses. A total of 376 adult patients on anti-retroviral therapy were assessed. WHO clinical stage (stage II) (B = 0.199: p < 0.0001), (stage III) (B = 0.2: p = 0.0318), (stage IV) (B 0.37: p = 0.0011), CD4 count ( > = 200) (B = − 0.2: p = 0.0070) and poor adherence increased log VL by 0.36, p < 0.001 were found to have a significant effect on the log of viral load. In this study, we have found an overtime decrement in the log of the Viral Load of patients with HIV on ART. Factors such as baseline CD4 count, WHO clinical stage, and adherence were found to be significant predictors of log Viral Load evolution. In order to maximize the results of the policy of test and treat, we suggest that health professionals focus on the interventions that will result in the initiation of ART and long-term viral suppression.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-29159-z.