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.

Objectives Since 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. Methods This 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. Results Of 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). Conclusions Under 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.

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.

COVID-19 pandemic known to affect health service deliveries including for HIV care support and treatment. In this retrospective study involving 2,780 people living with HIV (PLHIV), we evaluated impact of COVID-19 pandemic by comparing the proportion of PLHIV linked to care, started antiretroviral therapy (ART), retained in care (within the first 3 months of treatment), and adhered to ART (within the first 3 months of treatment) between the pre-pandemic period (2018–2019) and pandemic period (2020–2021) in Yogyakarta and Bandung, Indonesia. Our study showed that during the pandemic period the number of PLHIV linked to care was 18% lower (1,529 vs 1,251) and those retained in care was significantly lower (59.6% vs 53.3%, p = 0.0009) than the pre-pandemic period. Whereas, proportion in ART initiation (79.6% vs 78.3%, p = 0.3892) and ART adherence (50.0% vs 46.8%, p = 0.1010) were not statistically different. Multivariate analysis showed that ART initiation (aOR = 1.00, p = 0.996) nor retention in care (aOR = 0.90, p = 0.344) were not significantly different between two period cohorts. Adherence for the first three months of treatment, however, was significantly higher in the pandemic cohort (aOR = 1.53, p = 0.009). In the subgroup analysis, older PLHIV and those attending hospitals (tertiary versus primary care clinics) were significantly less likely to initiate ART, be retained in care, or adhere to ART. This study provides evidence of the impact of the COVID-19 pandemic on several characteristics of the HIV treatment cascade such as lower number of linkage to- and retention in care, lower number of older PLHIV, and attendance to tertiary care (hospital). General and HIV-specific mitigation strategies should be designed to minimise pandemic related disruptions and to support the continuity of HIV care to face possible future health crises.

BackgroundTo evaluate the outcomes of rapid antiretroviral therapy (ART) initiation following HIV diagnosis at 56 Dean Street in London, UK, following the implementation of the Rapid Initiation Option (RIO) in 2016.MethodsWe conducted a retrospective case-note review of all individuals newly diagnosed with HIV between 1 January 2017 and 31 December 2024. We analysed demographics, timing of ART initiation, and reasons for delayed treatment (>90 days). Differences between early (<2 days) and later ART initiators were assessed.ResultsOf 1081 individuals diagnosed, 1008 (93.2%) initiated ART at 56 Dean Street. Median time to ART initiation was 7 days (IQR 4-14), with 15.3% starting within 2 days. Median time to ART initiation remained stable from 2017 to 2024, despite disruptions due to the COVID-19 and mpox pandemics. Faster initiators were more likely to have recently acquired HIV, higher baseline viral loads, prior 56 Dean Street attendance, and prior PrEP use (all P < 0.05). Delayed initiation occurred in 2.2%, mainly due to poor attendance, personal choice, or being outside the UK. Demographic characteristics did not differ significantly between rapid and later initiators.ConclusionsRapid ART initiation has been sustained over 8years through the RIO pathway. The model remained robust during healthcare disruptions. Familiarity with services and recent testing were associated with more rapid initiation, supporting the importance of patient-centred, adaptable care pathways.

Introduction: Hepatitis B virus (HBV) infection remains a major global health problem, presenting with diverse clinical manifestations. The cholestatic form of acute HBV is rare and may indicate underlying comorbidities or coinfections. Human immunodeficiency virus (HIV) coinfection can profoundly alter the clinical course of HBV, leading to more severe and prolonged disease. Case Presentation: We report a 39-year-old man who presented with fatigue, anorexia, jaundice, and dark urine. Laboratory evaluation revealed markedly elevated bilirubin and transaminase levels, confirming acute HBV infection (HBsAg+, anti-HBc IgM+, HBeAg+). Initial virological assessment demonstrated HBV DNA 257,000 IU/mL, HIV RNA 77,800 copies/mL, and a CD4+ T-cell count of 374/mm3 at presentation. Antiretroviral therapy (ART) (bictegravir/emtricitabine/tenofovir alafenamide) was initiated but temporarily withheld when total bilirubin peaked at 29 mg/dL on day 19. Ursodeoxycholic acid was also withdrawn due to its potential contribution to cholestasis. The patient experienced persistent hyperbilirubinemia lasting 95 days, which gradually resolved with supportive therapy. The ART was successfully reintroduced without recurrent hepatotoxicity or immune reconstitution inflammatory syndrome (IRIS). At the third month of therapy, the HIV RNA level had declined markedly, and CD4+ counts had improved. Conclusions: This case highlights that prolonged cholestatic acute HBV may serve as the initial clinical clue to underlying HIV infection, reinforcing the importance of routine HIV screening in atypical HBV presentations and careful evaluation for viral versus drug-induced liver injury during ART initiation.

To compare HIV diagnosis pathways, baseline clinical characteristics and treatment outcomes among cis-gender and trans-gender women newly diagnosed with HIV at two European centres-Padua University Hospital (Italy) and 56 Dean Street, Chelsea and Westminster Hospital (London, UK). A retrospective observational study was conducted including cis-gender and trans-gender women diagnosed with HIV between 2017 and 2024. Demographic, clinical and virological parameters were collected at baseline and during follow-up. Outcomes included baseline CD4 count, HIV-RNA, antiretroviral therapy (ART) regimen, time to ART initiation and time to viral suppression (<200 copies/mL). Comparisons were made by gender identity and by clinical centre. A total of 115 women were included (74 cis-gender, 41 trans-gender). Trans-gender women were older and more frequently of non-European origin. First-time HIV testing was significantly more common in Padua, where both cis- and trans-gender women presented with lower CD4 counts and higher HIV-RNA, indicating later diagnosis compared with London. Prior engagement with HIV prevention (PrEP/PEP and routine screening) was more frequent at 56 Dean Street. Despite baseline differences, ART regimens-predominantly integrase inhibitor-based-were similar across centres. Time to ART initiation and time to viral suppression did not differ significantly between groups or settings. Cis- and trans-gender women face persistent disparities in HIV diagnosis across European healthcare settings. Later presentation was more common in Padua, reflecting gaps in screening and prevention coverage. Once linked to care, treatment outcomes were similar. Strengthening gender-affirming, context-specific HIV testing and prevention strategies is essential to reduce diagnostic inequities.

To evaluate real-world outcomes of dolutegravir (DTG)-based first-line antiretroviral therapy (ART) among people with HIV in Thailand, where baseline HIV-1 RNA and resistance testing is not routinely available. This retrospective cohort study enrolled ART-naive Thai people with HIV aged ≥15 years who initiated DTG-based ART between 2020 and 2023 under the national Universal Health Coverage programme. People with HIV with ≥1 post-baseline HIV viral load (VL) measurement were included. Virological non-suppression (VNS) was defined as VL ≥1000 copies/mL after ≥6 months of ART. The primary outcome was the proportion achieving virological suppression (VL <50 copies/mL). Competing-risk regression was used to identify factors associated with VNS, accounting for death and loss to follow-up (LTFU). Mortality data were confirmed via the national death registry. Of 10 475 people with HIV initiating DTG-based ART, 84.5% achieved virological suppression and 95.3% achieved VL < 200 copies/mL within 1 year. The cumulative VNS incidence was 10.1% (95% confidence interval [CI]: 9.6%-10.5%), and highest among those with late ART initiation (10.6% [95% CI: 7.4%-14.3%]). VNS was significantly associated with younger age, 15-24 years (aSHR 2.28, 95% CI:1.66-3.12), 25-34 years (aSHR1.43, 95% CI:1.07-1.90), baseline CD4 < 100 cells/mm3 (aSHR 2.11, 95% CI: 1.36-3.27) and residence in northern (aSHR 1.64, 95% CI: 1.12-2.40) or southern Thailand (aSHR 1.99, 95%: 1.30-3.04). Same-day/rapid ART initiation, sex and WHO HIV clinical staging were not associated with VNS. Nationwide rollout of DTG-based ART achieved excellent virological outcomes in Thailand. However, higher VNS risk among adolescents, individuals with advanced HIV disease and those in specific regions underscores the need for targeted interventions to improve treatment equity and long-term viral suppression.

Background: Timely initiation of antiretroviral therapy (ART) is critical for optimal HIV management. However, psychiatric comorbidities may influence treatment adherence, healthcare engagement, and overall outcomes. This retrospective cohort study explored the impact of major depressive disorder (MDD), generalized anxiety disorder (GAD), and schizophrenia on the time to initiation of ART for HIV management. Methods: Using TriNetX, a de-identified database encompassing 66 U.S. healthcare organizations, adults aged 18 and older with an HIV diagnosis were identified through insurance billing codes. Participants were categorized into four groups based on psychiatric history: MDD, GAD, schizophrenia, or no psychiatric diagnosis. Each psychiatric group was propensity score–matched to a control group without a prior psychiatric history to minimize bias. Measures of association and Kaplan-Meier survival analyses were conducted to assess time to ART initiation. Results: There was an observed association between having a psychiatric diagnosis prior to acquiring HIV and a higher likelihood of initiating ART, compared to controls. Additionally, those with a psychiatric diagnosis were observed to have initiated ART sooner. The median time to ART initiation was 136 days for MDD, 129 days for GAD, and 163 days for schizophrenia, compared to 312, 229, and 302 days in their respective control groups. Conclusion: Individuals with psychiatric comorbidities were more likely to begin ART earlier than those without a psychiatric condition. This may reflect increased healthcare engagement among patients with established psychiatric care, highlighting the importance of integrated behavioral and medical health services for improving HIV treatment outcomes.

ABSTRACT Community-based HIV testing can identify high-risk adolescents and young adults living with HIV (AYALH), but data on long-term outcomes of AYALH identified via community-based testing is limited. We compared outcomes among AYALH 15–24 years identified in community-based campaigns to those who self-presented to an HIV clinic in Haiti. We measured retention 12-months after antiretroviral therapy (ART) initiation and factors associated with retention including time to ART initiation, assessed as a binary variable: immediate (≤7 days from HIV diagnosis) or delayed (>7 days from HIV diagnosis). Focus group discussions with providers highlighted AYALH’s experience of entering care via both routes and recommendations for improving outcomes. 606 AYALH tested HIV-positive: 191 community-testers and 415 clinic-testers. Sociodemographic characteristics differed between groups: mean age 21 vs. 22 (p < 0.01), 88% vs. 74% female (p < 0.01), and 90% vs. 74% reported no income (p < 0.01). 12-month retention was 57% among community-testers and 68% among clinic-testers (p = 0.05). Those who immediately initiated ART had higher odds of non-retention (aOR, 1.62; 95%CI: 1.04–2.54; p = 0.03). Qualitative data suggested community-testers lack social support and were less emotionally prepared for diagnosis. Community-testers who immediately initiated ART were at highest risk of non-retention and are in need of enhanced psychosocial and clinical support to optimize outcomes.

Since 2016, all people living with HIV (PLHIV) in China have been recommended to initiate antiretroviral therapy (ART) regardless of CD4 count. This study examined the associations of social determinants and disease characteristics at diagnosis with ART initiation timing, and assessed the impact of initiation timing on clinical outcomes. We conducted a retrospective cohort study using data from 31,819 PLHIV diagnosed in Hunan Province between 2016 and 2021, with follow-up until 2023. Outcomes included HIV viral suppression, CD4 recovery, and all-cause mortality. Multivariable Cox regression models were applied to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), using a significance level of α = 0.05. The mean age of participants was 46.12 years, 45.92% were over 49 years, and 77.16% were male. Median ART initiation time was 17 days (interquartile range, 8–35). Social determinants and disease characteristics significantly influenced initiation timing. Delayed initiation beyond 30 days was associated with reduced viral suppression (aHR 0.879, 95% CI 0.867–0.891), lower CD4 recovery (aHR 0.817, 95% CI 0.802–0.832), and increased all-cause mortality (aHR 1.299, 95% CI 1.200–1.406). No significant differences were observed between 0–7 days and 8–30 days. These findings underscore the importance of initiating ART within 30 days of diagnosis.

Introduction: Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) profoundly increases susceptibility to opportunistic ocular infections, most notably Cytomegalovirus (CMV) retinitis. The degree of immunosuppression, particularly CD4+ T-cell counts below 50 cells/μL, is the primary risk determinant. Despite advances in antiretroviral therapy (ART), CMV retinitis remains a leading cause of vision loss in advanced AIDS, especially in resource-limited settings. Methods: A systematic review was conducted by performing a PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library search across over 138 million academic papers. 40 studies meeting predefined inclusion criteria—focusing on HIV/AIDS populations, quantitative ocular outcome data, and appropriate study designs—were selected for final analysis. Data on study design, population characteristics, ocular manifestations, risk factors, diagnostics, treatments, and outcomes were extracted and synthesized. Results: CMV retinitis is the most common intraocular infection in AIDS, with a pooled prevalence of 14.0% in low- and middle-income countries. A majority (73.4%) of cases occur at CD4+ counts &lt;50 cells/μL. Vision loss affects approximately one-third of patients. Treatment modalities include systemic antivirals (ganciclovir, valganciclovir, foscarnet, cidofovir), local therapies (intraocular implants, intravitreal injections), and combination regimens. Ganciclovir implants demonstrated the longest median time to disease progression (191-226 days). ART, particularly protease inhibitors, drastically reduces the incidence and recurrence of CMV retinitis. For patients achieving sustained immune reconstitution (CD4+ &gt;75 cells/μL on ART for ≥18 months), discontinuation of CMV maintenance therapy is safe with a low relapse risk. Discussion: The relationship between HIV/AIDS and CMV retinitis is directly mediated by immunosuppression. Disparities in prevalence across settings are explained by late HIV diagnosis and ART initiation. Optimal management balances superior local control (e.g., implants) with systemic protection against contralateral and extraocular disease. In resource-limited settings, intravitreal injections offer a viable alternative. Crucially, early screening and diagnosis, prior to significant vision loss, are paramount as visual outcomes are largely determined by timing of intervention rather than treatment choice alone. Conclusion: CMV retinitis remains a significant cause of morbidity in advanced HIV/AIDS, tightly linked to severe immunosuppression. Successful management hinges on early diagnosis through regular ophthalmologic screening in high-risk patients (CD4+ &lt;100 cells/μL), prompt initiation of combined local and systemic antiviral therapy, and sustained immune recovery via ART. Future efforts should focus on improving early HIV detection, expanding access to ART and antiviral therapies in resource-limited regions, and standardizing screening protocols to prevent irreversible blindness.

BackgroundAdult men living with HIV are less likely than women to adhere to antiretroviral therapy (ART). This highlights the need to understand factors driving nonadherence and how adherence behaviors and barriers change with age. However, existing HIV surveillance data often collapse ages into broad groups, limiting life‐course analysis. This study addresses this gap by examining the time from HIV diagnosis to ART initiation and subsequent adherence barriers among men, using women as a comparison group, in Greater Gaborone, Botswana. To explore these dynamics, we employed a cross‐sectional survey design tailored to capture age‐specific patterns of ART initiation and adherence.MethodsA cross‐sectional survey was conducted with a stratified random sample of 239 men and 428 women attending 21 HIV treatment clinics. Semistructured questionnaires captured life‐course characteristics, including the stage of HIV disease at ART initiation and individual‐level factors affecting adherence.ResultsThe results showed that men (n = 239) initiated ART medication during Stage 1 (n = 165, 61.9%), early Stage 2 (n = 46, 19.2%), late Stage 2 (n = 17, 7.1%), and Stage 3 (n = 11, 4.6%). Most men (69.1%) were diagnosed in Stage 1 of HIV disease compared to early Stage 2 (19.2%), late Stage 2 (7.1%), and Stage 3 (4.6%). Majority of the men (n = 63, 38.2%) diagnosed in Stage 1 were aged 40–49 years, followed by those aged 30–39 years (n = 38, 23.0%). ART nonadherence rates were 46.0% for men and 29.1% for women. Men who were more likely to be ART nonadherent (compared to women) were aged 30–39 years (OR = 2.05, 1.06–3.56), 40–49 years (OR = 1.91, 1.06–3.45), and 50+ years (OR = 3.95, 1.73–8.97). Other risk factors for ART nonadherence were recently sick, comorbidities, and taking other medications.ConclusionDespite free ART and medical care in Botswana, men face barriers related to comorbidities, highlighting the need for targeted gender‐specific interventions to improve ART adherence.