ART Resistance Research Articles

P-474. Effects of Antiretroviral Resistance on Outcomes and Healthcare Resource Use of People with HIV in the United States and Europe – A Real-World Survey

Abstract Background Resistance to key classes of ART leads to decreased treatment efficacy, virologic failure, and poorer clinical outcomes. Adding to current literature, this study reports current real-world trends between ART resistance mutations, healthcare resource use (HCRU), and people with HIV (PWH) outcomes. Methods Data were drawn from the Adelphi HIV Disease Specific Programme™, a real-world, retrospective, longitudinal survey from physicians and PWH in United States and Europe between July 2021-June 2023. Physicians provided medical chart data for PWH, including demographics, clinical characteristics, adherence, and hospitalization. Data were analyzed using bivariate comparisons, linear regressions, and negative binomial regressions. Results Physicians provided data for 2006 PWH. 14.3% of PWH had at least one mutation conferring resistance to an ART. PWH with a mutation (mPWH) received significantly more lines of ART than those without (nPWH) (mean ± SD: 2.2 ± 1.8 lines vs 1.8 ± 1.3 lines, respectively, p < 0.0001). More mPWH than nPWH had at least one side effect reported by the PWH themselves, (45.3% vs 39.2%, respectively, p = 0.058) and observed by their physician (35.1% vs 24.1%, respectively, p < 0.0001). Physicians reported fewer mPWH were considered to be “completely adherent” to their ART than nPWH (48.4% and 77.1% respectively, p < 0.0001). In total, 9.6% of all PWH had at least one HIV-related hospitalization in the past 12 months. Significantly more mPWH had at least one HIV-related hospitalization in the past 12 months than nPWH (18.0% vs 8.4% p < 0.0001); and among those, mPWH had a higher mean number of visits than nPWH (mean ± SD: 1.7 ± 1.3 vs1.3 ± 0.9, respectively p = 0.02). Having at least one ART resistance mutation doubled the risk of hospitalization in the 12 months prior to data collection (incidence rate ratio [95% confidence interval]: 1/2.04 [1.34, 3.10], p = 0.001). Conclusion In our secondary analysis of a real-world PWH database, mPWH had increased risk of hospitalization and side effects, and received more lines of ART, according to physicians. These findings show that ART resistance is associated with both higher HCRU and poorer PWH outcomes. Despite improvements in modern ARTs, treatment resistance still represents a significant burden on PWH and their healthcare systems. Disclosures Mary J. Christoph, PhD, MPH, AstraZeneca: Advisor/Consultant|AstraZeneca: Former employee|AstraZeneca: Stocks/Bonds (Private Company)|Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) Megan Chen, MSPH, Gilead Sciences, Inc.: Honoraria|Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) Seojin Park, PharmD, MS, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Woodie Zachry, RPh, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Cassidy Trom, PharmD, AAHIVE, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Private Company) Will Ambler, PhD, Adelphi Real World: Employee|ViiV Healthcare: The Adelphi Real World Disease Specific Programme is wholly owned by Adelphi Real World; ViiV healthcare is one subscriber and paid for the analysis Oliver-Thomas Carter, BSc, Adelphi Real World: Employee|ViiV Healthcare: The Adelphi Real World Disease Specific Programme is wholly owned by Adelphi Real World; ViiV healthcare is one subscriber and paid for the analysis Fritha Hennessy, PhD, Adelphi Real World: Employee|ViiV Healthcare: The Adelphi Real World Disease Specific Programme is wholly owned by Adelphi Real World; ViiV healthcare is one subscriber and paid for the analysis Hannah Jones, BSc, MRes, Adelphi Real World: Employee Tim Holbrook, BSc, Adelphi Real World: Employee|ViiV Healthcare: The Adelphi Real World Disease Specific Programme is wholly owned by Adelphi Real World; ViiV healthcare is one subscriber and paid for the analysis

Invisibility and silence: an extreme form of art resistance of Aaron Curme

ABSTRACT Social alienation necessitates a critique against social paradoxes that disregard individual experiences and portray societal failures as successes. Aaron Curme adopts the extremes of invisibility and silence to counteract these paradoxes and constructs an artistic identity of resistance, a demonstrative choice of resistance, an extreme, ironic and paradoxical behavior aiming to directly expose the core of problems. Employing auto-hermeneutics, the artist’s self-conscious artistic practices are observed that embody paradoxical empowerment through absence, and constantly transform the silence into a subtly communicative and aesthetically appreciative form that offers a novel interpretation towards the unheard perspectives of others.

Impact of different mutations on Kelch13 protein levels, ART resistance, and fitness cost in Plasmodium falciparum parasites.

Parasites with lowered sensitivity to artemisinin-based drugs are becoming widespread. However, even in these "resistant" parasites not all parasites survive treatment. We found that the proportion of surviving parasites correlates with the fitness cost of resistance-inducing mutations which might indicate that the growth disadvantages prevents resistance levels where all parasites survive treatment. We also found that combining two common resistance mutations did not increase resistance levels. However, selection through repeated ART-exposure did, even-though the known resistance genes, including k13, were not further altered, suggesting other causes of increased resistance. We also observed a disproportionally high fitness cost of a resistance mutation in resistance gene ubp1. Such high fitness costs may explain why mutations in ubp1 and other genes functioning in the same pathway as k13 are rare. This highlights that k13 mutations are unique in their ability to cause resistance at a comparably low fitness cost.

Artificial intelligence, racialization, and art resistance

Contemporary culture is shaped by information technology, in particular, artificial intelligence applications. One of the goals of this paper is to analyze how artistic practices could use machine learning algorithms as racial resistance. In addition, to remove from the black box how these applications work by relating the technical process that artists face. It will analyze the aesthetic and narrative perception around artificial intelligence, racism in the creation of data sets to train these algorithms and the possibilities that artificial intelligence opens to rethink concepts such as intelligence and imagination. This research is framed from the posthumanist subjectivity that uses critical imagination to question the classic and Eurocentric definition of human as a measure of what surrounds us. Finally, I will describe the work of the contemporary artist Linda Dounia and her interest in incorporating her experience as a Senegalese woman in the training of Generative Adversarial Networks models to reflect on her identity.

Riding against patriarchy

Equestrian portraiture has historically upheld gender norms by depicting powerful men and excluding women artists. 17th and 18th-century equestrian portraits of women depicted them as passive objects, often overshadowed by their male counterparts. These portraits reinforced traditional gender roles and upheld the patriarchal hierarchy prevalent during that time. This paper examines how Ghanaian contemporary artist Sarfowaa challenges patriarchal traditions through feminist self-portraiture in appropriated historical equestrian paintings. Through visual analysis of composition, techniques, symbols and contextualize selected artworks, this article explores how Sarfowaa subverts the equestrian genre by inserting herself into these male-dominated paintings. Her self-portraits provide a powerful statement of resistance that reclaims authority and agency for women. By contextualizing Sarfowaa's work within feminist art movements and theory, this paper analyzes how her art dismantles traditional gender roles and norms. The results demonstrate that Sarfowaa's portraits further the aims of feminist portraiture through their bold questioning of patriarchal power structures. This research expands current scholarship on the intersections of art, portraiture, feminism, and political resistance. It appeals to academics, artists, and audiences interested in the capacity of contemporary art to drive social change.

Evolution of genetic markers for drug resistance after the introduction of dihydroartemisinin–piperaquine as first-line anti-malarial treatment for uncomplicated falciparum malaria in Indonesia

BackgroundDihydroartemisinin–piperaquine has been Indonesia’s first-line anti-malarial treatment since 2008. Annual therapeutic efficacy studies (TES) done in the last 12 years showed continued high treatment efficacy in uncomplicated Plasmodium falciparum malaria. Although these studies did not show evidence for artemisinin resistance, a slight increase in Late Treatment Failure was observed over time. It is highlight to explore the evolution of genetic markers for ACT partner drug resistance since adopting DHA–PPQ.MethodsDry blood spots were identified from a mass blood survey of uncomplicated falciparum malaria patients (N = 50) in Sumba from 2010 to 2018. Analysis of genotypic profile (N = 51) and a Therapeutic Efficacy Study (TES) from Papua (N = 142) from 2020 to 2021, 42-day follow-up. PCR correction using msp1, msp2, and glurp was used to distinguish recrudescence and reinfection. Parasite DNA from DBSs was used for genotyping molecular markers for antimalaria drug resistance, including in Pfk13, pfcrt, and pfmdr1, as well as gene copy number variation in pfpm2/3 and pfmdr1.ResultsThe study revealed the absence of SNPs associated with ART resistance and several novel SNPs such as L396F, I526V, M579I and N537S (4.25%). In Sumba, the mutant haplotype SDD of pfmdr1 was found in one-third of the isolates, while only 8.9% in Papua. None of the pfcrt mutations linked to piperaquine resistance were observed, but 71% of isolates had pfcrt I356L. Amplification of the pfpm2/3 genes was in Sumba (17.02%) and Papua (13.7%), while pfmdr1 copy number prevalence was low (3.8%) in both areas. For the TES study, ten recurrences of infection were observed on days 28, 35, and 42. Late parasitological failure (LPF) was observed in 10/117 (8.5%) subjects by microscopy. PCR correction revealed that all nine cases were re-infections and one was confirmed as recrudescence.ConclusionThis study revealed that DHA–PPQ is still highly effective against P. falciparum. The genetic architecture of the parasite P. falciparum isolates during 2010–2021 revealed single copy of Pfpm2 and pfmdr1 were highly prevalent. The slight increase in DHA–PPQ LTF alerts researchers to start testing other ACTs as alternatives to DHA–PPQ for baseline data in order to get a chance of achieving malaria elimination wants by 2030.Graphical

‘715 haven street: art looks back’: the archival question of art resistance for abolitionist futures in a pacified present

ABSTRACT In this article, I bring together the archive of institutional activism of Niara Sudarkasa in the U.S. and the posthumous impact of activist and public administrator Marielle Franco. The 1970s historical sources show Sudarkasa’s institutional solidarity with students and faculty in the creation of one of the first Africana Studies departments in the U.S. Reading them, I articulate an ethos for the curation ‘715 Haven Street: Art Looks Back,’ a public digital art gallery comprised of art and history found in the DAAS Papers (Department of Afroamerican and African Studies) housed in the Bentley Library’s digital and physical archives. The analysis of the primary sources is guided by an engagement with the ‘Marielle Effect,’ generating a historical parameter for Abolitionist solidarity between American, Brazilian, Latin American, African American, Diasporic, and ally scholarly communities. The discussion of these parameters is embedded in my discussion of the concept of pacification, a phenomenon of colonial and post-colonial policing that survives through the perpetuation of an extra-judicial policing impetus articulated along race, identity, legality, and sexual legitimacy of subjects.

Cytoprotective autophagy as a pro-survival strategy in ART-resistant malaria parasites

Despite several initiatives to subside the global malaria burden, the spread of artemisinin-resistant parasites poses a big threat to malaria elimination. Mutations in PfKelch13 are predictive of ART resistance, whose underpinning molecular mechanism remains obscure. Recently, endocytosis and stress response pathways such as the ubiquitin-proteasome machinery have been linked to artemisinin resistance. With Plasmodium, however, ambiguity persists regarding a role in ART resistance for another cellular stress defence mechanism called autophagy. Therefore, we investigated whether, in the absence of ART treatment, basal autophagy is augmented in PfK13-R539T mutant ART-resistant parasites and analyzed whether PfK13-R539T endowed mutant parasites with an ability to utilize autophagy as a pro-survival strategy. We report that in the absence of any ART treatment, PfK13-R539T mutant parasites exhibit increased basal autophagy compared to PfK13-WT parasites and respond aggressively through changes in autophagic flux. A clear cytoprotective role of autophagy in parasite resistance mechanism is evident by the observation that a suppression of PI3-Kinase (PI3K) activity (a master autophagy regulator) rendered difficulty in the survival of PfK13-R539T ART-resistant parasites. In conclusion, we now show that higher PI3P levels reported for mutant PfKelch13 backgrounds led to increased basal autophagy that acts as a pro-survival response to ART treatment. Our results highlight PfPI3K as a druggable target with the potential to re-sensitize ART-resistant parasites and identify autophagy as a pro-survival function that modulates ART-resistant parasite growth.

Hollywood and the Advent of Afrofuturism: A Critical Study of Black Power and Cultural Aesthetics in Black Panther

The article entitled "Hollywood and the Advent of Afrofututrism: A Critical Study of Black Power and Cultural Aesthetics in Black Panther" depicts the importance of blacks in Hollywood from an Afrofuturistic point of view through the film. Afrofuturism in films seeks to restore black identity through art, culture and political resistance. The worlds imagined in this cultural form go beyond simple science fiction stories created by Blacks: these stories, art, and philosophies center Black Diasporic life and allow for a way of viewing black culture in a fantastical, creative and hopeful manner. This genre triumphed in mainstream American theatre with the enormous success of the film Black Panther

Introduction to Confronting Teacher Preparation Epistemicide: Art, Poetry, and Teacher Resistance

In this special issue, we present different perspectives from a documentary project on curricular epistemicide. We view curriculum epistemicide —the annihilation of curriculum—as an embodied process. It limits ways of knowing, questioning, and envisioning the world, and it constricts multiplicity and erases identity and culture. Authors within this volume responded to two requests: 1) they examined some form of epistemicide; and 2) they did not reinforce current systems of power and inequity. Throughout the issue, poetry and photography weave through theoretical papers and empirical studies. A range of methodologies are considered within the articles.

Writing for Print: Publishing and the Making of Textual Authority in Late Imperial China

Writing for Print: Publishing and the Making of Textual Authority in Late Imperial China

Highly dampened HIV-specific cytolytic effector T cell responses define viremic non-progression

This study reports on HIV-specific T cell responses in HIV-1 infected Viremic Non-Progressors (VNPs), a rare group of people living with HIV that exhibit asymptomatic infection over several years accompanied by stable CD4+ T cell counts in spite of ongoing viral replication. We attempted to identify key virus-specific functional attributes that could underlie the apparently paradoxical virus-host equilibrium observed in VNPs. Our results revealed modulation of HIV-specific CD4+ and CD8+ effector T cell responses in VNPs towards a dominant non-cytolytic profile with concomitantly diminished degranulation (CD107a+) ability. Further, the HIV specific CD8+ effector T cell response was primarily enriched for MIP-1β producing cells. As expected, concordant with better viral suppression, VCs exhibit a robust cytolytic T cell response. Interestingly, PuPs shared features common to both these responses but did not exhibit a CD4+ central memory IFN-γ producing Gag-specific response that was shared by both non-progressor (VC and VNP) groups, suggesting CD4 helper response is critical for non-progression. Our study also revealed that cytolytic response in VNPs is primarily limited to polyfunctional cells while both monofunctional and polyfunctional cells significantly contribute to cytolytic responses in VCs. To further understand mechanisms underlying the unique HIV-specific effector T cell response described here in VNPs we also evaluated and demonstrated a possible role for altered gut homing in these individuals. Our findings inform immunotherapeutic interventions to achieve functional cures in the context of ART resistance and serious non AIDS events.

Art Resistance against Russia’s “Non-Invasion” of Ukraine

When Russia invaded Ukraine in 2014, the Russian media ran what I propose to call a simulation of “non-invasion”—a spectacle aimed to distance Russia from the war. This essay explores activist art resistance against this simulation. Specifically, I discuss three art projects that were staged during the first, most violent year of the Russian-Ukrainian conflict: Mariia (Maria) Kulikovs'ka’s performance at “Manifesta 10” in St. Petersburg, Serhii Zakharov’s guerrilla installations on the streets of occupied Donetsk, and Izolyatsia’s #onvacation occupation of the Russian pavilion at the 56th Venice Biennale. These art projects, I argue, not only attacked the simulation from the outside as independent entities, but, by penetrating the simulation on site and online, they disrupted it from within. I offer three reasons to support this claim. First, these art projects superimposed images of the invasion over the physical sites where the “non-invasion” simulation dwelt and, in this way, not only made the war visible but also produced “a glitch in the matrix” effect—a conflict within the simulation visual regime that was inconsistent with its concealment function. Second, they “hailed” (in Louis Althusser’s terms) actants of the simulation as subjects of Putin’s regime, provoking suppressive reactions that proved Russia’s participation in the war—which the simulation, thus, failed to downplay. And third, with carefully orchestrated strategies of online outreach to the public, these art projects attached themselves to the media dimension of the simulation, making the simulation’s media proliferation work against itself.

Long term dual antiretroviral therapy: A real life retrospective countrywide Israeli study

AimCombined antiretroviral treatment (cART) traditionally consists of three antiretroviral medications, while two-drug regimens (2DR), historically used infrequently, recently been suggested to be non-inferior to three-drug regimens, is emerging as a potential treatment option and is currently a recommended option for treatment initiation in many guidelines.PurposeCharacterize the indications and clinical efficacy of 2DR use at a real-life setting in a nation-wide survey.MethodsA cross-sectional survey of Israeli patients treated by 2DR until July 2019, included demographic, immunologic, virologic, genotypic and biochemical/metabolic parameters at diagnosis, ART initiation, 2DR initiation and following 24, 48, 96 and 144 weeks of 2DR treatment.Results176 patients were included in the study. In contrast to historical data implicating ART resistance and adverse effects as the major reasons leading to 2DR switching, treatment simplification was the main reason leading to 2DR treatment in 2019. 2DR that included INSTI and PI were more commonly used in cases of drug resistance, while a combination of INSTI and NNRTI was used in all other 2DR indications. A switch to 2DR induced a mean CD4 T cell increase from 599 cells/μl at treatment initiation to 680 cells/μl at 96 weeks of treatment p<0.001 and viral suppression improvement from 73.9% at initiation to 87.0% at 48 weeks of treatment (p = 0.004). PI and INSTI 2DR was inferior in suppressing viral levels compared to other 2DRs but used for subset of more complex patients.Conclusions2DR in a large-scale real-life nation-wide survey proved to be safe and effective. Most 2DRs, other than PI and INSTI, were similarly effective in suppressing HIV viremia and in elevating CD4 T cell counts.

The outcome of prevention of mother-to-child transmission of HIV infection at King Abdulaziz University Hospital, Western Region of Saudi Arabia: A Descriptive Study.

Objectives:To describe the effectiveness of HIV guidelines in prevention of mother-to-child transmission (PMTCT).Methods:A retrospective review from January 2009 to December 2018 at the King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. The main outcome measures were characteristics of HIV-exposed patients and transmission rate.Results:A total of 18 HIV-positive mothers and their 26 infants were included. The mean age of mothers at delivery was 31.69 years, and 50% were under 30 years old. All mothers received lifelong ART, except one who was not diagnosed until the 27th week of gestation. Among the mothers, 83% complied with treatment regimens, and 11% had ART resistance. Human immunodeficiency virus polymerase chain reaction (PCR) was undetectable in 19 pregnancies. Seven mothers had opportunistic infections and treatment was immediately initiated. After reviewing the infants’ HIV PCR tests, the transmission rates of HIV were 0% for both spontaneous vaginal delivery and cesarean section.Conclusion:Many challenges face the efforts to decrease vertical HIV transmission, and a particular focus on the transitions between stages of care is needed. We believe that early screening, counseling, and regular follow-up have contributed to MTCT elimination.

Resistance to artemisinin in falciparum malaria parasites: A redox-mediated phenomenon

Malaria remains a major public health disease due to its high yearly mortality and morbidity. Resistance to the gold standard drug, artemisinin, is worrisome and needs better understanding in order to be overcome. In this work, we sought to study whether redox processes are involved in artemisinin resistance. As artemisinin is known to act among others via production of reactive species, we first compared the production of reactive oxygen species and concomitant protein oxidation in artemisinin-sensitive and artemisinin-resistant parasites when treated with artemisinin. The results undoubtedly demonstrated, using different original methods, that the level of ROS, including superoxide production, and oxidized protein were lower in the resistant strain. Interestingly, the major in-between strain difference was reported at the earlier ring stages, which are the forms able to enter in a quiescence state according to the ART resistance phenomenon. Moreover, we demonstrated a better homeostasis regulation in relation with higher expression of antioxidants in the artemisinin-resistant parasites than their sensitive counterparts after artemisinin exposure, notably, superoxide dismutase and the glutathione (GSH) system. These findings enrich the body of knowledges about the multifaceted mechanism of artemisinin resistance and will help in the design and development of newer antimalarials strategies active against resistant parasites.

Pyrvinium pamoate can overcome artemisinin\u2019s resistance in anaplastic thyroid cancer

BackgroundAnaplastic thyroid carcinoma is a highly lethal subtype of thyroid cancer without effective therapies. Drug resistance in anaplastic thyroid carcinoma poses a significant problem. Although artemisinin exerts antitumor effects, but its efficacy in anaplastic thyroid carcinoma is unknown.MethodsWe used RNA sequencing to identify differentially expressed genes. Next, we determined the cause of ART resistance by testing the expression and activity of β-catenin, and enhanced ART activity with a WNT signaling inhibitor.ResultsArtemisinin suppressed the growth of BHT-101 but not human thyroid anaplastic carcinoma (CAL-62) cells. The mechanism of artemisinin resistance in CAL-62 was associated with the aberrant activation of WNT signaling. Pyrvinium pamoate, an inhibitor of WNT signaling, was used to overcome ART resistance in CAL-62 cells. The combination of artemisinin and pyrvinium pamoate suppressed the growth of CAL-62 cells and induced the apoptosis.ConclusionsOur study is the first to prove the efficacy of ART as monotherapy or in combination with PP in the management of anaplastic thyroid cancer, and that the inhibition of WNT signaling may overcome ART resistance.

Recommendations for Increasing Physician Provision of Pre-Exposure Prophylaxis: Implications for Medical Student Training.

There is growing evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition. However, in the United States, approximately only 4% of people who could benefit from PrEP are currently receiving it, and it is estimated only 1 in 5 physicians has ever prescribed PrEP. We conducted a scoping review to gain an understanding of physician-identified barriers to PrEP provision. Four overarching barriers presented in the literature: Purview Paradox, Patient Financial Constraints, Risk Compensation, and Concern for ART Resistance. Considering the physician-identified barriers, we make recommendations for how physicians and students may work to increase PrEP knowledge and competence along each stage of the PrEP cascade. We recommend adopting HIV risk assessment as a standard of care, improving physician ability to identify PrEP candidates, improving physician interest and ability in encouraging PrEP uptake, and increasing utilization of continuous care management to ensure retention and adherence to PrEP.

Prevalence of drug resistance mutations in HIV-infected individuals with low-level viraemia under combination antiretroviral therapy: an observational study in a tertiary hospital in Northern Taiwan, 2017-19.

Effective ART is crucial for combating the HIV pandemic. Clinically, plasma viral load monitoring to achieve virological suppression is the guide for an optimal ART. The presence of low-level viraemia (LLV) below the definition level of virological failure is a risk factor for ART failure. However, there is no treatment consensus over LLV yet, mainly due to the limitation of standard HIV-RNA genotyping and the resultant insufficient understanding of LLV characteristics. To better profile drug resistance mutations (DRMs) and the associated factors in cases experiencing LLV. A prospective observational study was conducted from 2017 to 2019. HIV-DNA was used as an alternative to HIV-RNA for HIV genotyping coupled with deep sequencing for ART-naive and ART-failure cases, as well as those with LLV. Eighty-one ART-naive, 18 ART-failure and 16 LLV cases received HIV genotyping in the study. Three-quarters (12/16) of cases experiencing LLV harboured DRMs. Cases with LLV had higher prevalence of DRMs to NNRTIs than the ART-naive group (69% versus 20%, P < 0.001), but lower DRM prevalence to NRTIs than the ART-failure group (25% versus 61%, P < 0.001). Approximately half of the LLV cases had issues of suboptimal ART compliance/ART interruption, and 68.8% (11/16) did not display drug resistance to their ART at the time of LLV. HIV DRM profiles in LLV cases were significantly different to those in ART-naive and ART-failure cases. Approaches to consolidate ART compliance and early exploration of potential ART resistance may be needed for cases experiencing LLV episodes.

HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross-sectional study.

IntroductionGiven intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali.MethodsMSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade.ResultsA total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p < 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection.Overall, 61% (45/74) of respondents reported knowing their HIV‐positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut‐off of <200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed.ConclusionsThese data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV‐related outcomes for MSM in Rwanda.