International Journal of STD & AIDS最新文献

IntroductionDetectable plasma HIV viral loads remain a major public health concern due to its association with increased HIV transmission and disease progression. The aim of this study is to assess the factors associated with a detectable HIV viral load in People Living with HIV (PLHIV) aged between 15 and 60 at the Cité des Palmiers District Hospital in Cameroon.MethodologyThis is a cross-sectional study conducted between July 2023 and January 2024 using a non-probability convenience sampling method. Data were collected using a semi-structured questionnaire administered to PLHIV aged between 15 and 65 years (n = 309). Analyses were performed using logistic regression, with a p-value <0.05.ResultsOut of 511 patients recruited, 309 consented to participate, representing a participation rate of 60%. Among the participants, 17% had a detectable viral load. Analyses revealed that living in a rural area [aOR = 4.40, p-value = 0.040], having a primary education as the highest level attained [aOR = 4.82, p-value = 0.025], frequently forgetting to take medication [aOR = 5.67, p-value = 0.002], eating only one meal a day [aOR = 13.02, p-value = 0.007], and fearing that therapy would no longer be effective in the future [aOR = 4.45, p-value = 0.009] significantly increased the probability of having a detectable HIV viral load.ConclusionThese result provide insight into targeting adherence support for PLWH in Cameroon to reduce the community HIV viral load. By improving access to care and providing psychosocial support, it may be possible to reduce community viral load, and reducing HIV transmission.

Transient detection of hepatitis B surface antigen (HBsAg) following hepatitis B vaccination is a rare but recognized phenomenon that may be misinterpreted as acute hepatitis B virus (HBV) infection. We report a case illustrating this diagnostic challenge in an HIV pre-exposure prophylaxis (PrEP) user. A 36-year-old man presented in October 2025 for PrEP initiation. He reported condomless sex with multiple male partners and occasional on-demand use of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) obtained from a partner. Screening for sexually transmitted infections in August 2025 showed negative viral hepatitis serologies. Two days prior to the PrEP consultation, he received a combined hepatitis A/B vaccine in preparation for travel to Thailand.Routine baseline testing revealed isolated HBsAg positivity. The patient was asymptomatic and recalled for further evaluation. Repeat testing eight days later showed HBsAg negativity, newly positive anti-HBs antibodies, undetectable HBV DNA, negative hepatitis D serology, and normal liver enzymes. Follow-up serology fourteen days later confirmed sustained HBsAg negativity with isolated anti-HBs positivity. The rapid resolution of HBsAg in close temporal proximity to vaccination, together with the absence of hepatitis B core antibodies and undetectable HBV DNA, supported transient post-vaccination antigenemia rather than acute HBV infection.Transient HBsAg positivity after vaccination has previously been described, particularly among hemodialysis patients. Retrospective studies indicate that circulating recombinant HBsAg may be detected shortly after immunization, most commonly within five days but occasionally up to twenty days. To our knowledge, this is the first reported case of transient HBsAg positivity in a PrEP user. This is clinically relevant given the anti-HBV activity of TDF and evidence suggesting that TDF-based PrEP reduces HBV acquisition. As incident HBV infection during PrEP use is uncommon, isolated HBsAg positivity shortly after vaccination may create diagnostic uncertainty. Awareness of this phenomenon is essential to avoid misdiagnosis, unnecessary anxiety, and inappropriate interruption of PrEP.

This case report describes the first documented use of lenacapavir in the setting of Y188L NNRTI resistance mutation during pregnancy, resulting in successful maternal viral suppression and prevention of vertical transmission of HIV. A 24-year-old woman with prior poor adherence, socioeconomic instability, and NNRTI resistance (Y188 L mutation) presented with uncontrolled viremia during her second pregnancy. After consultation with perinatal HIV experts, she initiated a long-acting injectable regimen combining lenacapavir (927 mg subcutaneous every 6 months) and cabotegravir/rilpivirine (600/900 mg intramuscular every 2 months). Rapid viral load reduction was achieved, declining from 147,351 to 67 copies/mL within weeks. Despite transient hepatotoxicity, the patient delivered an HIV-negative infant at term. Maternal HIV RNA remained <50 copies/mL postpartum and became undetectable by January 2025. The infant remained HIV-negative at 18-months follow-up. This case demonstrates the potential role of long-acting antiretroviral therapy (ART) in achieving sustained virologic control among pregnant patients with adherence challenges and drug resistance. While lenacapavir shows promise as a biannual agent addressing barriers to adherence, its pharmacokinetics and safety during pregnancy remain uncharacterized. These findings underscore the urgent need for systematic studies and pregnancy registries evaluating long-acting ART agents in maternal populations to optimize outcomes and eliminate vertical transmission in hard-to-treat cases.

BackgroundYoung women in South Africa experience a disproportionate burden of HIV transmission. Oral pre-exposure prophylaxis (PrEP) offers an additional HIV prevention option; however, its acceptability and use among young, female university students remain underexplored.MethodsThis qualitative study explored perceptions, awareness, and acceptability of oral PrEP among female university students in Durban, South Africa. Semi-structured, in-depth interviews were conducted with 12 female students aged 18-24 years. Data were thematically analysed to identify key factors shaping PrEP awareness, attitudes, and perceived barriers and facilitators to use.ResultsParticipants demonstrated varying levels of awareness of PrEP, often informed by informal sources such as peers, social media, and healthcare encounters. While PrEP was viewed as a potentially empowering HIV prevention option, misconceptions, fear of side effects, stigma associated with HIV-related medication, and concerns about partner reactions constrained acceptability and uptake. Structural barriers, including limited access to youth-friendly services, further influenced interest in PrEP.ConclusionThe findings highlight the complex social and structural contexts shaping PrEP acceptability among female university students and point to the need for targeted, youth-friendly communication and service delivery approaches.

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.

BackgroundChronic kidney disease (CKD) is a frequent non-communicable complication in people living with HIV (PLHIV), influenced by antiretroviral therapy (ART), comorbidities, and healthcare setting. The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) CKD risk score is widely applied internationally, while the Thai CKD risk score, developed for the general Thai population, has not been validated in HIV cohorts. This study compared the predictive accuracy of the DAD models and the Thai CKD risk score in Thai people living with HIV receiving ART.MethodsA retrospective cohort analysis was conducted using electronic medical records of adults (≥18 years) living with HIV at Warinchamrap Hospital between January 2020 and May 2024. Patients with pre-existing CKD or incomplete data were excluded. CKD was defined per Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Model calibration was assessed with the Hosmer-Lemeshow test, and discrimination with the C-statistic.ResultsAmong 901 PLHIV receiving ART, 104 (11.5%) developed incident CKD during a median follow-up of approximately 4 years. Patients who developed CKD were more likely to be male and have a lower baseline estimated glomerular filtration rate, and higher prevalence of proteinuria and comorbidities. All evaluated models stratified CKD risk; however, the full and short DAD scores showed moderate discrimination (C-statistics ≈0.76) with evidence of risk underestimation and suboptimal calibration. The Thai CKD risk score demonstrated higher discrimination (C-statistic 0.93), sensitivity (88.5%), and better calibration in this cohort.ConclusionsIn this Thai HIV cohort, all evaluated risk models provided CKD risk stratification, but the Thai CKD risk score showed more reliable discrimination and calibration than the DAD models. These findings highlight the importance of population-specific validation when applying CKD risk prediction tools in HIV care.

BackgroundSexual health service (SHS) delivery in England shifted substantially with rapid expansion of online services during the COVID-19 pandemic. While digital services may improve reach, limited data exist on unmet need for in-person SHS in England, especially among men and gender-diverse individuals who have sex with men, key populations disproportionately affected by sexual health inequalities.MethodsWe analysed data from "Reducing inequalities in Sexual Health" (RiiSH) 2024 (Nov/Dec 2024), an online survey of UK-resident men and gender-diverse individuals having sex with men. We assessed in-person SHS access and unmet need (tried but failed to access a SHS in-person) over the past year. Bivariate and multivariable logistic regression was used to examine associations with unmet need.ResultsAmong 2404 participants living in England (median age 45 years, 88% White, 95% cisgender), 86% had ever accessed in-person SHS and 59% in the past year. Of those who tried to access in-person care in the past year, 12% (95% CI: 11%-14%) experienced unmet need, especially Outside London (15% vs 8% in London). Common barriers included unavailable (50%) or inconvenient (41%) appointment times. In adjusted multivariable analysis, unmet need continued to be lower among participants living in London (aOR: 0.64 [95% CI: 0.44-0.92]), those financially comfortable (aOR: 0.69 [0.49-0.97]), and those reporting ≥1 marker(s) of sexual risk (e.g. HIV-PrEP use in the last year and/or in the last 3-4 months, the report of a bacterial STI diagnosis, engaging in chemsex, having had ≥10 male physical sex partners; aOR: 0.14 [0.10-0.20]). Unmet need was higher among participants with limiting long-term physical health conditions (aOR: 1.61 [1.12-2.30]) and those who reported ever using online postal self-sampling services for STI testing (OPSS) (aOR: 1.50 [1.07-2.09]).ConclusionsDespite high SHS engagement, one-in-eight reported unmet need for in-person SHS. Local service delivery guided by joint strategic needs assessments could help address unmet need for SHS.

BackgroundTopical antiviral agents, particularly acyclovir, are standard over-the-counter treatments for minor herpes simplex infections. However, natural products such as propolis and honey have drawn attention for their potential antiviral and wound healing-promoting properties. This meta-analysis aimed to systematically evaluate and compare the efficacy and safety profiles of propolis and/or honey with 5% topical acyclovir in the management of labial and genital herpes.MethodsA systematic search of PubMed, Scopus, Europe PMC, and the Cochrane Library was performed to identify studies comparing topical propolis and/or honey with 5% acyclovir for herpes simplex lesions. Clinical outcomes were synthesized using random-effects models, with outcomes reported as mean difference (MD) and odds ratio (OR).ResultsSeven studies were included in the analysis. Treatment with propolis and/or honey was associated with quicker lesion resolution (MD: -1.87 days; 95% CI: -2.73 to -1.01; p < 0.0001) and higher healing rates by day 7 (OR: 4.71; 95% CI: 2.70-8.25; p < 0.00001). No significant difference was observed in the number of aborted attacks (p = 0.66). Propolis and/or honey also reported reduced pain duration (MD: -0.96 days; p = 0.03) and pain intensity (MD: -6.53; p = 0.0002), with more patients reporting being symptom-free by day 3. No significant difference was observed in adverse events (AEs) rates between the natural therapy and acyclovir groups.ConclusionsPropolis and/or honey demonstrated superior lesion healing and pain relief compared to 5% acyclovir, with comparable safety, supporting their potential as safe and effective alternatives to conventional antiviral therapy.