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Background: Transactional sexual relations in the absence of condom use is a well-established behaviour that strongly contributes to HIV transmission if the infected person is not virally suppressed. In this study, we determined the trends and factors associated with VLNS among treatment-experienced FSWs in Kenya.

Methods: This retrospective cohort study used data collected from 7-sex workers outreach clinics between 2015 and 2022. VLNS trends were determined using the Modified Mann-Kendall test, and the effects of covariates on VLNS odds were examined using generalized estimating equations (GEE) with a logit link.

Results: 12,117 viral load tests were performed on samples collected from 1,947 FSWs. The prevalence of VLNS decreased from 25.5% (95%CI 17.6-34.6) in 2016 to 4.3% (95%CI 2.5-6.7) in 2021. The odds of VLNS decreased by 9% per year during the study period in the multivariable GEE analysis adjusted for covariates (regimen, age, and sex worker outreach program (SWOP) clinic), (OR 0.91, 95%CI 0.84-0.98; P = 0.005). Age was a significant factor associated with VLNS, with younger women (18-24 years) having 2.2 times higher odds of VLNS (OR 2.15 95%CI 1.10-4.20; P = 0.025) than those aged >55 years (reference). Subjects on dolutegravir (DTG)-based cART regimen had 64% lower odds of VLNS (OR 0.36, 95%CI 0.25-0.52; P < 0.001) compared to those on PI-based regimen.

Conclusions: There is a strong evidence of decreasing population level viremia among FSWs during the study period. To maintain the trend, it is necessary to continue supporting SWOP clinics in order to provide HIV treatment services to this key population.

HIV-1 remains a global challenge, especially in high-prevalence areas like South Africa. This study explores the relationship between inflammation and metabolism in people with HIV, focusing on immune markers and the tryptophan-kynurenine (Trp-Kyn) pathway. We examined immune markers (hsCRP, suPAR, IL-6, NGAL, and sCD163) and Trp-Kyn metabolites (QUIN, Trp, Kyn, Trp/Kyn ratio, and kynurenic acid) in n = 69 treatment-naive South African people with HIV. Using targeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) metabolomics and various assays, we observed significant associations between immune markers and Trp-Kyn metabolites. IL-6 was negatively associated with Trp (P < 0.001) and positively with the Kyn/Trp ratio (P = 0.005). hsCRP was positively associated with QUIN (P = 0.036). suPAR showed significant negative associations with Trp (P = 0.036), positive associations with the Kyn/Trp ratio (P < 0.001), and QUIN (P = 0.007). sCD163 negatively associated with Trp (P < 0.001) and positively with the Kyn/Trp ratio (P < 0.001). When participants were stratified by inflammation levels (based on CRP), IL-6 (P = 0.002), QUIN (P = 0.009), and Kyn (P = 0.032) were significantly higher in the high inflammation group. Specific associations were observed only in certain groups, such as IL-6 negatively associating with Trp and kynurenic acid in the high inflammation group, and suPAR associating negatively with Trp in the low inflammation group. These exploratory findings provide further insight into how peripheral inflammation and metabolism are interrelated in South African people with HIV, potentially guiding future therapeutic strategies.

Objectives: To determine baseline prevalence of proteinuria and albuminuria among participants from the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) and evaluate associated risk factors.

Design: Cross sectional analysis of a baseline sample of participants from the REPRIEVE Trial.

Methods: REPRIEVE is an international primary cardiovascular prevention randomized controlled trial (RCT) of pitavastatin calcium vs. placebo among people with HIV (PWH) on antiretroviral therapy (ART). A representative subset (2791 participants) had urine collected at study entry. Urine protein to creatinine ratios (uPCR) and albumin to creatinine ratios (uACR) were classified as normal, moderately increased and severely increased. These were dichotomized to Normal or Abnormal for log-binomial regression analysis. Demographic, cardiometabolic, and HIV-specific data were compared among those with normal versus abnormal results.

Results: Overall, median age 49 years, 41% female sex, 47% black or African American race, 36% had estimated glomerular filtration rate (eGFR) less than 90 ml/min/1.73 mm 2 . For uPCR, 27% had moderately or severely increased values. For uACR, 9% had moderately or severely increased values. In the fully adjusted model for proteinuria, female sex, older age, residence in sub-Saharan Africa or East Asia, lower BMI, lower CD4 + cell count, and use of tenofovir disoproxil fumarate (TDF) were associated with abnormal values. In the fully adjusted model for albuminuria, a diagnosis of hypertension (HTN) was associated with abnormal values.

Conclusion: Abnormal proteinuria and albuminuria remain common (27 and 9%) despite controlled HIV. Lower current CD4 + count and TDF use were strongly associated with proteinuria. Certain modifiable comorbidities, including HTN and smoking, were associated with abnormal values. In PWH with preserved eGFR, urine measures identify subclinical kidney disease and afford the opportunity for intervention.

Objective: The Dutch HIV preexposure prophylaxis (PrEP) pilot provided subsidized PrEP care to maximum 2900 individuals at a time in Amsterdam. Populations with expected barriers to accessing PrEP elsewhere were prioritized for program inclusion. We evaluated their prior sexual health service engagement and PrEP need.

Design: Cross-sectional analysis using enrolment data.

Methods: We included individuals ever enrolled in the PrEP program at the Center for Sexual Health (CSH) Amsterdam between 2019 and 2023. We calculated the proportion belonging to higher-priority groups (i.e., <25 years old, transgender, sex worker, uninsured or migrant). We defined classes of sexual health service engagement in the 12 months preceding enrolment using latent class analysis (LCA). We compared engagement classes, sexual behavior and positivity of HIV and sexually transmitted infections (STI) between higher- and lower-priority groups.

Results: 2004/4075 (49%) individuals enrolled belonged to higher-priority groups. LCA showed three classes of prior engagement: "newly engaged" (14%, n  = 551) were new to the CSH-Amsterdam; "PrEP initiators" (40%, n  = 1642) previously visited the CSH-Amsterdam but had not used PrEP; "PrEP experienced" individuals (46%, n  = 1882) previously accessed PrEP. Higher-priority groups were more often "newly engaged" or "PrEP-initiators" than "PrEP-experienced". Higher-priority groups less often had condomless anal sex with casual partners or chemsex in the prior 6 months. Positivity of bacterial STI was similar between higher-priority ( n  = 300/2004, 15.0%) and lower-priority ( n  = 315/2071, 15.2%) groups. 13/14 HIV diagnoses at enrolment were in higher-priority groups.

Conclusion: Higher-priority populations had less often previously used sexual health services and accounted for most new HIV diagnoses at enrolment. Engaging these populations in sexual healthcare, including PrEP, should be stressed.

Objective: Children with HIV (CWH) are at increased risk for cognitive and developmental delays, although HIV's influence on reading development remains unclear. Research using internationally validated reading measures with control for factors known to influence literacy outcomes is needed. The Early Grade Reading Assessment (EGRA) is a tool for assessing students' progress toward reading that has been validated across countries. It was administered to a cohort of children living with and without HIV (CWH/CWOH) and data on other factors that might affect literacy were also measured.

Design and methods: 388 children [217 children without HIV (CWOH) and 171 CWH; ages 3-8] drawn from a longitudinal study in Dar es Salaam, Tanzania completed the EGRA. EGRA performance between CWH and CWOH was compared adjusting for age, socioeconomic status, years of education, English learning, and type of school (public or private).

Results: Despite the biological and environmental confounders, CWH performed significantly worse than CWOH on the Letter Name Knowledge subtest, the Syllable subtest, the Non-Word subtest, and the Reading Comprehension subtest. The difference approached significance for the Oral Reading Fluency subtest.

Conclusions: CWH performed worse than CWOH on the EGRA, indicating literacy skill development in CWH needs early intervention. Longitudinal analyses, including electrophysiological and behavioral data, are needed to find the factors associated with poor reading and literacy performance in CWH.