People With HIV Research Articles

Abstract Background People with HIV (PWH) have a higher incidence of heart failure (HF) and acute myocardial infarction (AMI) than people without HIV (PWoH). While hospital readmission is a common quality-of-care indicator, readmission risk for HF or AMI by HIV status is not well defined. Methods We included adults hospitalized for HF or AMI from the 2016-2022 Nationwide Readmissions Database. The outcome was 30-day all-cause unplanned readmission. We examined trends in readmission risk between 2016 and 2022, and subgroup-specific readmission risk in 2022, by HIV status. Crude and age-and sex-adjusted risk ratios (aRR) were calculated using marginal estimates from mixed-effects logistic regressions. Results From 2016 to 2022, 30-day readmission risk significantly declined among PWH hospitalized for HF(39.5%-to-33.0%), PWoH hospitalized for HF(22.9%-to-21.6%), and PWH hospitalized for AMI(19.3%-to-16.8%). In 2022, we included 1,062,309 weighted index hospitalizations for HF and 470,369 for AMI. PWH had significantly higher readmission risk than PWoH for both HF (aRR=1.46;95%CI=1.39-1.53) and AMI (aRR=1.59;95%CI=1.39-1.80). For HF, the most common readmission diagnosis for both PWH and PWoH was hypertensive heart and stage 1-4 chronic kidney disease with heart failure. For AMI, recurrent unspecified AMI was the most common readmission diagnosis in both groups. In age- and sex-stratified analyses, PWH consistently had higher readmission risk than PWoH for both HF and AMI, with the largest disparities in younger males and older females. Conclusions PWH had a significantly higher 30-day readmission risk after HF and AMI hospitalization. Targeted interventions, such as early follow-up and multidisciplinary care, are needed to reduce readmission risks.

Stigma is a deleterious force that is associated with poor health outcomes among people with HIV (PWH). The Finding Respect and Ending Stigma around HIV (FRESH) intervention is designed to combat HIV and related stigmas about PWH and their care providers. To evaluate the effects of the Spanish-language FRESH in the Dominican Republic, our team conducted a pilot trial, informed by the stepped-wedge model, at two HIV clinics to ascertain signals of potential value for PWH. Clinics were randomized to first and second receipt of the intervention; the intervention was delivered over 2days. In-person tablet-based digital surveys, including validated measures of stigma and discrimination, were administered to PWH (2021-2022, N = 419) every 6months aggregated to pre- and post-intervention periods for analysis. Analysis of variance (ANOVA) and general linear modelling were used to evaluate differences in stigma scores. All data collection occurred after an HIV clinic visit. Statistical analyses were performed using SPSS. Mean age of participants was 33.86 (standard deviation [SD] = 9.14; range = 18-70); respondents predominantly identified as male (N = 396, 94.5%) and multiracial (N = 330, 90.5%). Significant differences were observed across time, with decreases from pre- to post-intervention in public stigma (mean [M] = 3.92, SD = 1.25 to M = 3.47, SD = 1.41, p < .001) and perceived sexual orientation discrimination (M = .23, SD = .27 to M = .10, SD = .18, p < .001). Significant differences between clinics were also evident, with higher scores in clinic A compared to clinic B in disclosure concerns (M = 4.31, SD = .84 vs. M = 3.68, SD = 1.26, p < .001), perceived sexual orientation discrimination (M = .17, SD = .22 vs. M = .12, SD = .22, p = .030), and perceived discrimination related to race/ethnicity (M = .11, SD = .19 vs. M = .05, SD = .15, p = .002). The viral suppression rate in these clinics improved between pre-intervention and post-intervention periods, from 78 to 82%, but did not reach statistical significance. Substantive differences in clinics could have impacted the intervention's delivery and impacts. While there were significant associations of intervention experience with reductions in some forms of stigma among PWH, results should be extended cautiously considering the small size of this pilot. Data collection procedures were feasible and acceptable, and evidence was found to warrant full-scale testing of the intervention. NCT04491539, https://clinicaltrials.gov/study/NCT04491539?cond=NCT04491539&rank=1.

Ongoing sexually transmitted infection (STI) transmission reflects inequitable access to sexual healthcare services. STI reinfection pre-HIV and post-HIV infection is a proxy measure of sexual behaviour for people with HIV (PWH). Surveillance data show that recommended screenings are not occurring, leading to missed opportunities. Gaps exist about the true picture of STI infection and reinfection among PWH from pre-HIV to post-HIV diagnosis. To end the HIV epidemic and achieve national HIV goals of preventing new infections, synergistic STI/HIV screening is important to limit coinfection and co-transmission of other STIs and HIV. We describe changes in STI patterns of infection among a statewide cohort of PWH (n=6896) in South Carolina pre-HIV and post-HIV diagnosis using linked HIV and STI surveillance data. We used multinomial logistic regression to examine and compare differences in pre- and post-HIV diagnosis for three STIs, namely chlamydia (CT), gonorrhoea (GC) and syphilis. Overall, 17.22% of PWH exhibited increasing or persistently high patterns of STI infection. Young adults (18-29) represented the largest proportion of PWH experiencing increasing (66.78%) and persistently high (80.00%) STI infection. Racial and gender minorities were disproportionately affected, with males and black individuals comprising the majority of those with increasing (males: 90.03%, black: 77.30%) and persistently high (males: 83.51%, black: 79.65%) STI infections. Post-diagnosis, syphilis remained the most prevalent STI (35.56%), chlamydia increased to 32.84% from 28.11% prediagnosis, and triple STI infection nearly doubled to 4.19%, corresponding to an approximate 200% increase relative to pre-HIV diagnosis. The persistent patterns of STIs among PWH call for a renewed focus on STI treatment and prevention as a central component for ending the HIV epidemic at the state and national levels.

People with HIV (PWH) who have chronic hepatitis B virus (HBV) coinfection are at increased risk of also having hepatitis D virus (HDV) infection given the shared transmission pathways. The current prevalence of HDV in Germany among people with HIV/HBV, however, is unknown. The aim of this study was to determine the percent with HDV screening as well as the current HDV prevalence among German PWH with HBV coinfection and underlying risk factors for HDV infection. 21 German HIV treatment centers (6 university clinics, 15 private practices) recruited all people with a confirmed HIV diagnosis and a positive hepatitis B surface antigen for more than 6 months, aged ≥ 18 years, and actively in care on December 31, 2023. We assessed the percent with anti-HDV antibody testing in the total cohort. In addition, we calculated the prevalence of individuals who ever had an anti-HDV positive serology (i.e., past/current infection) and the prevalence of individuals whose last HDV RNA result was positive (i.e., active infection). Overall, 458 PWH with HBV coinfection were included in the analysis. 17% of the participants were female and 83% male. Median age was 55 years (IQR 48-61). 99% of participants were receiving antiviral dual active therapy with 84% having undetectable HIV viral load and 90.8% having undetectable HBV-DNA. Anti-HDV antibody results were available in 370 (81%). Of these, 27 (7.3%) had a previous/current HDV infection. HDV RNA testing was performed in 24/27 participants with HDV-positive serology, of whom 14/24 (58%) were positive. In Germany, 7% of PWH with HBV coinfection who underwent HDV screening had HDV antibodies with only half showing signs of active HDV replication.

The aging population of people with HIV (PWH) raises heightened concerns regarding accelerated aging and dementia. Portable, low-field MRI (LF-MRI) is an innovative technology that could enhance access and facilitate routine monitoring of PWH. We sought to evaluate the feasibility of LF-MRI and apply a machine learning (ML) segmentation algorithm to examine atrophy and white matter hyperintensities (WMH) in PWH compared to people without HIV (PWoH) of similar age. Individuals with a confirmed diagnosis of HIV on antiretroviral therapy underwent LF-MRI (64 mT) acquisition in the outpatient neurology clinic. PWoH with > 1 vascular comorbidity (VC cohort, n = 25) or with mild cognitive impairment (MCI cohort, n = 24) due to Alzheimer's disease served as comparators. LF-MRI brain region segmentations were derived using the ML algorithm WMH-SynthSeg in FreeSurfer. Brain regions corrected for intracranial volume were compared between cohorts after adjusting for age and sex. Thirty virally suppressed PWH were included. LF-MRI derived brain volumes from PWH demonstrated a reduction in volume of the caudate relative to PWoH with VC (p < 0.05). Volume of the putamen and white matter was reduced in PWH compared to VC (p < 0.05). Hippocampal volume was comparable between PWH and PWoH (p ≥ 0.05), while volume of the amygdala was reduced in those with MCI alone (p < 0.05). No differences in WMH were seen between these cohorts (p > 0.05). LF-MRI is feasible in an outpatient setting, and ML algorithms enable detection of regional atrophy and WMH in PWH. LF-MRI may enable more frequent monitoring and earlier detection of atrophy in at-risk populations.

Background People with HIV (PWH) have a high risk of cardiovascular events (CVEs). We investigated the incidence of CVEs in PWH and the usefulness of combining hepatic steatosis/insulin resistance (HS-IR) and risk of liver fibrosis for the evaluation of cardiovascular risk in PWH. Methods We retrospectively analyzed 7,286 PWH from the prospective CoRIS cohort. We calculated the baseline triglyceride-glucose index (TyG) and FIB-4 index to assess HS-IR and risk of fibrosis, respectively, and evaluated persons with abnormal values for both indices. The primary outcome was the incidence of CVEs, defined as myocardial infarction, coronary disease, stroke, transient ischemic attack, peripheral arterial obstruction, and/or cardiovascular death. The association between HS-IR and risk of fibrosis and incidence of CVEs was assessed using a univariable and multivariable competing risk survival regression analysis. Results The overall incidence of CVEs was 3.5 per 1,000 person-years. HS-IR and risk of fibrosis were significantly associated with an increased risk of CVEs. Individuals with HS-IR and risk of fibrosis experienced markedly more CVEs than those with normal values (10.6 vs. 1.4 per 1,000 person-years, p &amp;lt; 0.001). After correction for possible confounders and traditional cardiovascular risk factors, abnormal values for HS-IR and risk of fibrosis score were independently associated with CVEs of (HR, 2.21 [1.2–4.1]; p &amp;lt; 0.01). Conclusion HS-IR and risk of fibrosis before ART are associated with increased risk of CVEs in PWH. A combined risk assessment incorporating HS-IR and risk of fibrosis may improve cardiovascular risk stratification in this population. These readily accessible tools can facilitate early identification and intervention in high-risk individuals.

People with HIV (PWH) experience higher cardiovascular disease event rates not fully explained by traditional risk factors. Clonal hematopoiesis of indeterminate potential (CHIP), an emerging risk factor for cardiovascular disease in the general population, has been reported to be more prevalent in PWH. Using high-coverage targeted CHIP sequencing in the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) cardiovascular disease prevention trial, we investigated whether CHIP increases the risk of major adverse cardiovascular events (MACE) among PWH, as well as whether HIV-associated factors were associated with greater CHIP prevalence among PWH. We analyzed whole-exome and targeted sequencing from 4490 PWH without known cardiovascular disease; 1653 (36.8%) were female, and 2039 (45.4%) were Black. MACE was defined by including cardiovascular death, myocardial infarction, hospitalization for unstable angina, stroke, transient ischemic attack, peripheral artery disease, revascularization, or death from an undetermined cause. A total of 837 (18.6%) had CHIP driver mutations, with 385 (8.6%) at variant allele fraction ≥2% and 61 (1.4%) at variant allele fraction ≥10%. Although overall CHIP was not associated with MACE, the presence of large CHIP (variant allele fraction ≥10%) was associated with increased odds for the first occurrence of myocardial infarction or cardiac catheterization, or revascularization, despite low overall event rates. Adjustments for pitavastatin treatment did not attenuate this association. Furthermore, a larger CHIP clone size was associated with lower CD4 nadir and with increased risk of MACE. In PWH in the REPRIEVE trial who were low-to-moderate risk for incident cardiovascular disease, CHIP was not associated with increased prospective risk of MACE. However, a large CHIP was associated with increased risk of myocardial infarction and revascularization. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02344290.

Introduction/Background: People with HIV (PWH) in high-income countries experience an increased risk of ischemic heart disease and arrythmia. Little is known, though, about the relative frequency of electrocardiogram (ECG) abnormalities in PWH on modern ART in Africa. Research Questions: What is the prevalence of standard ECG findings in a typical East African population of PWH compared to HIV-uninfected community controls and test characteristics of ECG criteria for left ventricular hypertrophy (LVH)? Methods: We conducted a cross-sectional analysis of baseline ECG data from an ongoing prospective cohort of PWH and HIV-uninfected community controls enrolled from three public HIV clinics in Tanzania (the Mwanza HIV&amp;CVD Cohort). ECGs were coded by a cardiologist blinded to the patient’s clinical characteristics. LVH ECG criteria were compared to evidence of LVH on transthoracic echocardiogram (TTE). The prevalence of ECG findings in PWH and HIV-uninfected were compared using a chi-square test. Results: Of 1000 participants enrolled between March 2022 and May 2023, 999 had ECG completed (500 PWH and 499 HIV-uninfected). The median age was 44 years [IQR 38-50] and 69.8% were female. Among PWH, all participants had been on a combination of tenofovir, lamivudine, and dolutegravir for at least 3 months and 98% were virologically suppressed. The prevalence of hypertension according to office blood pressure was 13.4%. Sinus bradycardia was common in this population and more so in PWH (37.2%) vs. community controls (30.7%, p = 0.029) (Table 1). Atrial premature contractions were more common in HIV-uninfected (5.2% vs 1.2% in PWH, p = 0.048) while changes of anterior ischemia were more common in PLH (2.8% vs 0.8% in community controls, p = 0.018). ECG criteria for LVH had low sensitivity but high specificity when compared to TTE (for any level of LVH, sensitivity by specific ECG criteria ranged from 0 to 19.6% with specificity ranging from 89.7% to 99.6%) (Table 2). Conclusion: Sinus bradycardia, 1 st degree AV block, LVH, and atrial premature contractions were the most common ECG abnormalities observed in this East African population. PWH had more sinus bradycardia and anterior ischemia but less atrial premature contractions. ECG criteria for LVH had low sensitivity but high specificity. These findings will inform the clinical care of similar patients in the future, as baseline prevalence of these findings in East African populations is unknown.

Background: People with HIV (PWH) have elevated cardiovascular risk, but acceptability of cardiovascular prevention strategies among PWH is unknown. Purpose: To identify preferred strategies to prevent cardiovascular disease among PWH. Methods: We created a survey to identify preferences for heart disease prevention strategies based on the Acceptability of Intervention Measure (AIM) scale. We surveyed a convenience sample in San Francisco in 2024-2025. We conducted semi-structured interviews among a subset of survey respondents using purposive sampling which we analyzed using rapid qualitative analysis. Results: We included 102 PWH, with a mean age of 60±11 years old; 86% male, 9% female; and 63% white, 19% Black and 19% Hispanic. Nearly all were on antiretroviral therapy (ART, 95%) with undetectable viral load (94%). Approximately half reported having hypertension, dyslipidemia, and/or family history of heart disease. 15 reported a prior myocardial infarction and 6 a prior stroke. About 2/3 had been prescribed a statin. Using the AIM scale (Likert 1-5, with 5=high acceptability, Figure ), lifestyle interventions had high acceptability (mean ± standard deviation 4.2±0.7), whereas pharmacologic strategies were moderately acceptable: oral polypills combining a statin with ART (3.6±1.0), and long-acting injectable lipid therapies (3.5±1.0), and oral statins (3.3±1.1). The most common first-choice prevention strategy was healthy lifestyle (46%), followed by long-acting injectable lipid therapies (30%), oral polypills (17%), and oral statins (12%). The most important factors in choosing a strategy were efficacy, side effects/risks, tailoring to individualized risk, and personalized recommendation from their care provider. We interviewed 15 PWH. Key themes are reported in the Table. Findings were consistent with the survey results, with many preferring lifestyle interventions as a first-choice strategy. Most were open to pharmacologic prevention, as long as it was tailored to their individualized risk and preferred delivery strategy (oral statin, oral polypill, or long-acting injectable). Conclusions: PWH are interested in lifestyle and pharmacologic interventions to prevent heart disease. These findings suggest that an individualized approach to pharmacologic interventions among PWH should be adopted for cardiovascular disease prevention. Future studies will be needed to evaluate the impact of this approach on adherence and prevention of cardiovascular events.

Background: People with HIV (PWH) remain at elevated risk for cardiovascular disease despite control of traditional risk factors and effective antiretroviral therapy. Vascular inflammation is a proposed contributor to this residual risk. Perivascular fat attenuation index (FAI), derived from coronary computed tomography angiography (CCTA), is a validated imaging biomarker of coronary inflammation. Lipoprotein(a) [Lp(a)], elevated in PWH, carries oxidized phospholipids that may drive this residual risk. This study assessed the association of Lp(a) and statin use on coronary inflammation (FAI) in PWH with undetectable HIV RNA. Research Questions: In PWH with undetectable HIV RNA, is Lp(a) associated with coronary inflammation (FAI)? Does statin use mitigate this association? Methods: We evaluated 299 men with HIV (MWH) with undetectable HIV RNA (&lt;50 copies/mL) from the Multicenter AIDS Cohort Study who underwent CCTA with FAI measurement. Lp(a) concentrations and other laboratory measures were obtained from the study visit closest to imaging. Associations were assessed using unadjusted and adjusted linear regression models with bootstrap 95% confidence intervals derived from 1000 replicates. Adjustments included age, race, statin use, BMI, diabetes, hypertension, and smoking history. Results: The median age was 52 [47-57] years; 61.7% White individuals, and 29.7% Black individuals. The median Lp(a) was 26 [9-75] nmol/L and 34% were on statin therapy. 98% were receiving antiretroviral therapy (Table 1). Among men with undetectable HIV, log[Lp(a)] was associated with LAD FAI in unadjusted (+3.21 HU; 95% CI: 1.60, 4.92; p=0.002) and adjusted models (+2.68 HU; 95% CI: 0.99, 4.48; p=0.008) (Table 2). Statin use was associated with lower LAD FAI regardless of Lp(a) (-2.89 HU; 95% CI:-4.57, -1.11; p&lt;0.001) and remained significant after further adjustment for age, race, and cardiovascular risk factors (-1.89 HU; 95% CI: -3.62, -0.30; p=0.024) (Figure 1). Conclusion: These findings offer important insights regarding an inflammatory driver of residual cardiovascular risk in PWH. Coronary inflammation was present and associated with Lp(a), in individuals with undetectable HIV, independent of age, race, statin use, and cardiovascular risk factors. Statin use was associated with a lower LAD FAI regardless of Lp(a). These results highlight Lp(a) as a potential therapeutic target to reduce vascular inflammation and cardiovascular risk in PWH.

The existing literature on the effects of semaglutide in people with HIV (PWH) and diabetes mellitus remains limited. The aim of the present study is to evaluate the effect of semaglutide on weight control and inflammation in PWH. This is a prospective observational study that included PWH with type 2 diabetes mellitus monitored at the HIV Unit of the University General Hospital of Alexandroupolis and a matched control group of non-HIV individuals. Demographic, anthropometric, and clinical characteristics, including HIV-related data and comorbidities were reported. All participants received semaglutide with a gradual dose increase to 1 mg once weekly. Body Mass Index (BMI), glycosylated hemoglobin (HbA1c), and inflammatory markers (IL-6, TNF, hsCRP, sCD14, CD4/CD8 ratio) were recorded at baseline and at 6, 12, 18, and 24 months. A total of 50 participants (PWH: n=25; non-HIV: n=25) were included. At baseline, the mean BMI was 35.2±8.0kg/m2 for PWH and 36.1±6.0kg/m2 for non-HIV controls. Semaglutide treatment resulted in significant and sustained weight loss in both groups (p<0.001). At 24 months, the median weight loss was -14.6 kg in the PWH group and -18.8 kg in the non-HIV group for those with a baseline BMI >35kg/m2. Glycemic control also improved significantly, with mean HbA1c decreasing from 7.7%±1.23 to 5.2%±1.02 in PWH (p<0.001), and from 7.9%±1.16 to 5.6%±1.21 in non-HIV controls (p<0.001). Significant reductions were observed in hsCRP and sCD14 levels in both cohorts. A unique finding was the significant increase in the CD4/CD8 ratio in the PWH group, from a mean baseline of 0.54±0.12 to 0.83±0.14 at 24 months (p<0.001), a change not seen in the non-HIV controls. Semaglutide appears to be an effective and safe option for weight reduction and inflammation control in PWHIV. Further studies with a larger number of patients are necessary to substantiate these findings.

Background/Introduction: Atherosclerotic cardiovascular disease (ASCVD) risk calculators perform poorly among people with HIV (PWH). Non-calcified coronary plaque (NCP) volume measured using coronary computed tomographic angiography (CCTA) predicts future ASCVD events in the general population, and NCP is increased among PWH. However, the ability of ASCVD risk calculators to predict NCP among PWH is unknown. Methods: We included individuals ages 40-79 with treated and suppressed HIV and ≥ 1 additional cardiovascular risk factor besides HIV. We measured blood pressure and fasting lipid panels. CCTA was performed according to standard research protocol and interpreted by a blinded core lab. The primary outcome was non-calcified plaque volume (excluding calcified plaque). We calculated predicted 10-year atherosclerotic ASCVD risk using four equations: Predicting Risk of cardiovascular disease EVENTs (PREVENT), Pooled Cohort Equation (PCE), Data Collection on Adverse Events of Antiretroviral Drugs (DAD-reduced)-an HIV specific calculator, and Framingham. We used linear regression to assess the amount of variation in log-transformed NCP volume explained by each risk prediction equation. Results: We included 81 individuals with mean age of 60 years, 4% female (Table) . The mean total cholesterol, calculated LDL-C, HDL-C, and triglycerides were 190 mg/dl, 113 mg/dl, 49 mg/dl, and 143 mg/dl, respectively. The mean predicted 10-year ASCVD risk was 5.4% using PREVENT, 12.3% using PCE, 11.5% using DAD, and 17.0% using Framingham. Predicted risk with each of the four equations correlated with NCP volume (p&lt;0.01 for each), and predicted risk was higher among those with more plaque with all four ( Table ). However, the proportion of variance in NCP volume explained by each model was low with R 2 values of 16.4%, 11.1%, 11.7%, and 11.1% for PREVENT, PCE, DAD, and Framingham, respectively ( Figure , p&lt;0.01 for each). Among those with &lt;5% calculated 10-year risk (“low risk”), median plaque volume was 69 mm 3 for PREVENT (45 people), 23 mm 3 for PCE (15 people), 14 mm 3 for DAD (11 people), and 8 mm 3 for Framingham (2 people). Conclusions: Both traditional and HIV specific ASCVD risk prediction equations only explain a small amount of the variation in NCP volume among PWH at elevated cardiovascular risk; this finding may underlie the poor performance of these risk calculators to predict cardiovascular events among this high-risk population.

Introduction Despite durable viral suppression, neuroinflammation and neurocognitive complications remain common yet poorly understood in people with HIV (PWH). HIV alters human viromes, and virome perturbations have been linked to neurocognitive issues in people without HIV. Recently characterized, the brain and cerebrospinal fluid (CSF) viromes represent a new avenue to understand brain and mental health in PWH. Methods This cross-sectional study analyzed 85 CSF samples (74 from PWH on suppressive antiretroviral therapy, and 11 from controls without HIV, CWH) through shotgun metagenomics for DNA and RNA viruses. Taxonomic composition (reads and contigs), diversity, and relative abundance (RA) of prokaryotic (PV), human eukaryotic (hEV), and non-human eukaryotic viruses (nhEV) were evaluated in relation to HIV status, markers of neuroinflammation/neurodegeneration, cognitive functions, and depressive symptoms. Sensitivity analyses and post-hoc cluster analysis on the RA of hEV, non-human viruses (NHV) and blood–brain barrier permeability were performed. Multivariable models assessed the relationship between cognition and clusters. Results Of 46 read-positive CSF samples, 93.5% contained PV sequences, 47.8% hEV, and 45.6% nhEV. PWH displayed lower α diversity, although p &amp;gt; 0.05. At β diversity analysis, HIV status explained 3.4% of the variation in viral composition ( p = 0.016). Contigs assembly yielded 13 samples positive for 8 hEV, 2 nhEV, and 6 PV. Higher RA of PV was correlated with higher CSF S100β (rho 0.36, p = 0.002) and β-Amyloid 1–42 fragment (βA-42, rho 0.27, p = 0.026), whereas higher RA of nhEV with poorer cognitive performance (rho 0.26, p = 0.022). Conversely, higher RA of hEV correlated with better cognition (rho −0.38, p = 0.003) and lower βA-42 (rho −0.30, p = 0.012). Sensitivity analyses restricted to only CSF samples with detectable reads confirmed these findings. Three CSF clusters were identified and showed differences in astrocytosis, βA-42, tau protein, and cognitive functions. Participants with hEV-enriched CSF showed better cognitive performance compared to those with virus-devoid and NHV-enriched CSF (all p &amp;lt; 0.05). Conclusion This study provides the first comprehensive description of the CSF virome in PWH, revealing associations with neuroinflammation and cognition. These findings highlight the potential involvement of the CSF virome in brain health and inform about its composition, origin, and potential clinical implications in people with and without HIV.

Background: HIV infection is associated with increased risk of heart failure (HF). The American Heart Association recently developed the Predicting Risk of Cardiovascular Events (PREVENT) equations, which includes a calculator for 10-year risk of HF events. This calculator has not yet been validated among people with HIV (PWH) at risk for HF. Purpose: The purpose of this study was to evaluate the PREVENT 10-year HF risk prediction calibration and discrimination among a diverse, multicenter cohort study of PWH with physician-adjudicated heart failure events. Hypothesis: The PREVENT 10-year HF equations will have acceptable discrimination and strong calibration. Methods: We included adults ages 30-79 years old with HIV and without HF enrolled in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) Cohort at two sites (University of Washington and University of Alabama at Birmingham) that participated in physician adjudication of HF events from 2008 to 2021. We calculated predicted 10-year HF risk at baseline using the PREVENT 10-year base equation. HF events were adjudicated according to a standard protocol by two cardiologists independently, with discrepancies resolved by a third reviewer. Follow-up was until first HF event, death, loss to follow-up, or end of the study period. We used Harrell’s C-index to assess discrimination and the Kaplan-Meier approximation of the Greenwood-Nam-D’Agostino estimator (to account for variable follow-up time) and goodness-of-fit test to assess calibration. Results: We included 4,970 individuals with a mean age of 44 and 20% female ( Table ). The mean predicted 10-year risk of HF by PREVENT was 2.5% (SD: 4.9) [median=1.1% (IQR: 0.5-2.5)]. Over a median of 6.1 years of follow-up (IQR: 2.4-9.4), 125 individuals had an incident HF event. Discrimination by Harrell’s C-index was 0.760 (95% CI: 0.713-0.808). Using the Greenwood-Nam-D’Agostino estimator, the ratio of observed events to predicted events by the PREVENT HF equation over ten years was 1.47 (p&lt;0.001). The calibration slope by decile of predicted risk was 1.035 for PREVENT ( Figure ). Conclusions: Among a cohort of people with HIV in the United States, the PREVENT 10-year HF equation has acceptable discrimination but is poorly calibrated, with the observed probability of events ~50% higher than the predicted risk across deciles of predicted risk.

People with HIV (PWH) who transition back into the community after incarceration often experience treatment disruptions, increasing the risk of poor outcomes. We examined factors associated with sustained viral suppression (SVS) after release. We analyzed 2015-2022 data from a nationally representative sample of PWH (N = 1012). We used weighted percentages and 95% CIs to describe the characteristics of recently incarcerated PWH by postrelease SVS status. We calculated prevalence ratios (PRs) to identify factors associated with SVS. Among PWH who were incarcerated at least once in the past 12 months, only 30.0% achieved SVS postrelease. PWH aged 18 to 29 years (PR = 1.16; 95% CI, 1.01-1.32) and 30 to 39 years (PR = 1.20; 95% CI, 1.06-1.35) were significantly more likely to not have SVS than PWH aged ≥50 years. PWH released within 180 days (≤60 days: PR = 1.44; 95% CI, 1.29-1.61; 61-180 days: PR = 1.18; 95% CI, 1.03-1.34) were significantly more likely to not have SVS than PWH released after ≥181 days. PWH with ≥3 incarcerations within the past 12 months were significantly more likely to not have SVS than PWH who were incarcerated once (PR = 1.25; 95% CI, 1.12-1.39). PWH with SVS were significantly more likely to be retained in HIV care (PR = 1.55; 95% CI, 1.40-1.70), taking antiretroviral therapy (ART) (PR = 1.20; 95% CI, 1.14-1.28), or adherent to ART (PR = 1.34; 95% CI, 1.15-1.56) than PWH without SVS. SVS outcomes among recently incarcerated PWH could improve through adherence support, discharge planning, and postrelease support, particularly for young or frequently incarcerated individuals.

ABSTRACT HIV-related stigma affects the well-being and quality of life of people with HIV (PHIV). To evaluate the impact of HIV-related stigma on the quality of life among PHIV in Dar es Salaam, we conducted a qualitative study between December 2021 and June 2022. We enrolled participants in the Dar es Salaam Urban Cohort Study who were from the Ilala Municipality of Dar es Salaam. Using a semi-structured discussion guide, three focus group discussions (FGDs) were conducted with the 33 participants. FGDs were audio-recorded, transcribed verbatim and analyzed thematically. The impact of stigma on quality of life was grouped into three themes: (1) health impact manifested as failure to attend clinic as scheduled, poor adherence to medication and appetite and weight loss; (2) psychosocial impact manifested as fear, stress, depression, family instability, limited social interaction and a difficult learning environment and (3) economic impact manifested as denied employment opportunities, loss of job, denied financial support and a lack of economic support. PHIV experience stigma, which affects their economic status, health and well-being. Therefore, strengthening programmes, such as community education, awareness campaigns, peer support groups among PHIV and the establishment of microeconomic groups for PHIV may reduce stigma and improve quality of life.

Background and Aim: People with HIV (PWH) have historically been excluded from cancer immunotherapy trials due to concerns over immune dysregulation and safety. This systematic review evaluates the safety, efficacy, and immunologic outcomes of Programmed death-1 (PD-1) inhibitors in PWH diagnosed with non-small-cell lung cancer (NSCLC). Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Scopus, Web of Science, and Medline through January 2025. Studies were included if they reported outcomes of ICIs in PWH with NSCLC. Data extraction included progression-free survival (PFS), overall survival (OS), immune-related adverse events (irAEs), antitumor response, HIV viral control, and immunologic parameters. Study quality was assessed using the Joanna Briggs Institute (JBI) checklist. Results: Six cohort studies (n = 762 patients) met inclusion criteria. ICIs used included nivolumab, pembrolizumab, atezolizumab, and durvalumab, with treatment durations ranging from 3.1 to 5.4 months. Median PFS ranged from 3.0 to 6.3 months, and OS ranged from 10.0 to 66.0 months. Overall response rates (ORRs) varied from 13% to 75%, and disease control rates (DCRs) ranged from 47% to 62.5%. irAEs occurred in 25% to 75% of patients, with 6–20% experiencing grade 3–4 events. Corticosteroids were required in 13–29% of patients, and treatment discontinuation due to toxicity occurred in up to 30%. Most patients had controlled HIV, with CD4 counts typically above 300 cells/μL and undetectable viral loads. Conclusions: ICIs appear safe and effective in PWH with NSCLC, with toxicity and efficacy outcomes comparable to the general population. While immunotherapy should not be withheld based solely on HIV status, better standardization in reporting HIV-related variables is needed to optimize patient selection and management.

People with HIV (PWH) are at elevated cardiovascular risk, but existing calculators have suboptimal calibration for this population. The American Heart Association developed new prediction equations (PREVENT) to replace the pooled cohort equations (PCE). PREVENT has not been validated among PWH. Within the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort, we included individuals aged 40-75 without myocardial infarction or stroke at baseline from 2001 to 2021. We calculated predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk at baseline using the PCE and the PREVENT 10-year ASCVD base equation. Myocardial infarction and stroke were systematically adjudicated. To assess discrimination, we calculated Harrell's C -index and to assess calibration we used the Greenwood-Nam-D'Agostino goodness-of-fit tests. We included 13 135 individuals from five sites across the United States. Mean age at enrollment was 44 ± 9 years and 18% were female. Mean predicted 10-year ASCVD risk was 5.8% by PCE and 2.9% by PREVENT. Over 5.7 ± 3.5 years of follow-up, 628 individuals had myocardial infarction or stroke. Discrimination was improved with PREVENT compared to PCE, with Harrell's C -indexes of 0.722 (95% CI 0.701, 0.741) and 0.708 (95% CI 0.687, 0.729), respectively ( P = 0.008). Both equations underpredicted risk: the observed-to-expected ratio was 2.69 for PREVENT ( P < 0.001) and 1.35 for PCE ( P < 0.001). Calibration slopes were 1.998 for PREVENT and 0.932 for PCE, respectively. Among this cohort of PWH, the PREVENT 10-year ASCVD equations were poorly calibrated and underestimated composite risk for myocardial infarction and stroke, with observed risks more than double predicted risks.

South Africa implemented the World Health Organization-recommended Targeted Universal Tuberculosis Testing (TUTT) among high-risk groups regardless of symptoms in 2021, a shift from the former symptom-based testing approach. We assessed the TUTT care cascade to describe its implementation within the care continuum. A descriptive retrospective analysis of routine TB/HIV program data from people with HIV (PWH) in high-burden districts-1 rural and 1 urban-was conducted for fiscal years (FY) 2022-2023. In total, 104,139 and 104,431 PWH presented to care in FY2022 and FY2023, respectively. In FY2022, 33.1% received an Xpert MTB/RIF Ultra (Xpert) test, 4.8% tested positive, and 96.3% started treatment. Likewise, in FY2023, the Xpert testing coverage was 32.3%, test positivity was 4.8%, and 95.6% started treatment. In FY2022, 46.5% of PWH in the rural district received an Xpert test, and 2.5% tested positive, whereas in the urban district, 20.3% received an Xpert test, and 9.7% tested positive. In FY2023, Xpert test coverage in the rural district declined slightly to 43.6%, with 2.7% testing positive, whereas in the urban district, Xpert tests increased slightly to 21.7%, with 8.9% testing positive. Tuberculosis treatment initiation was high in both rural (95.2% in FY2022 and 94.8% in FY2023) and urban districts (96.9% in FY2022 and 96.1% in FY2023). Low Xpert test coverage indicates inconsistent TUTT implementation, highlighting the need for better training, mentorship, and supervision. The differences between rural and urban districts reflect variations in epidemiology, health care infrastructure, and testing practices.

Stigma impedes the HIV care continuum and contributes to problematic mental health outcomes, nonadherence, and reduced quality of life. We prospectively analyzed changes in HIV stigma measures for 10 years among older people with HIV (PWH). PWH participating in the AGE h IV Cohort Study completed the full Berger HIV Stigma Scale (HSS) between 2012 and 2014 (T0) and 2 of the HSS subscales-that is, disclosure concerns and negative self-image (range per subscale: 3 to 12)-10 years later (T1) as part of routine clinical care. We assessed changes in scores over time using paired samples t-tests. We assessed sociodemographic and clinical factors associated with these changes at T1 using linear regression, and factors associated with higher or lower scores over time using linear mixed models. Disclosure concerns scores decreased significantly, albeit minimally, between T0 and T1; negative self-image scores remained stable. No factors were associated with changes in disclosure concerns scores. Higher disclosure scores were positively associated with living in households with 3 or more people. Women experienced significantly higher increases in negative self-image scores. Higher negative self-image scores were associated with being attracted to both men and women, compared with only men, and having moderate-to-severe depressive symptoms. Both HSS domains were negatively associated with more years since HIV diagnosis. In this cohort of predominately older, White, Dutch male PWH mostly with suppressed HIV, disclosure concerns and self-image did not improve over time. HIV stigma worsened in women and was worse for those in large households and with moderate-to-severe depression.