Adolescent girls and young women (AGYW) in sub-Saharan Africa experience disproportionately high HIV incidence, making pre-exposure prophylaxis (PrEP) a critical prevention strategy. While perceived HIV risk is known to influence PrEP initiation and continuation, the role of social support in shaping PrEP use among AGYW remains insufficiently understood. This study presents a secondary analysis of qualitative interview data collected as part of HPTN 082, an open-label PrEP trial conducted between 2016 and 2018 in Harare, Zimbabwe, and Cape Town and Johannesburg, South Africa. Participants were offered daily oral PrEP (tenofovir disoproxil fumarate/emtricitabine). Sixty-seven AGYW aged 16-24 were purposively sampled from the parent cohort of 426 participants, all of whom were identified as being at high risk for HIV using an empiric risk score. Participants completed in-depth interviews at 13 and/or 26weeks following study enrollment and PrEP initiation. Interviews explored motivations for PrEP use, experiences of adherence, and social influences. Analysts conducted thematic analysis to examine how social support and perceived HIV risk shaped PrEP initiation, adherence, and discontinuation. Three interconnected themes emerged: (1) multidimensional social support influencing PrEP adherence, (2) stigma, privacy constraints, and constrained adherence, and (3) perceived HIV risk as a key motivator for PrEP initiation and continuation. Emotional, instrumental, informational, and normative forms of support facilitated adherence in some contexts, while stigma, anticipated judgment, and limited privacy within households led to concealment, missed doses, and discontinuation in others. Perceived HIV risk, particularly related to partner infidelity or uncertainty, motivated PrEP initiation and persistence despite social barriers. Social support operates as a dynamic, double-edged influence on PrEP use among AGYW, simultaneously enabling and constraining adherence, depending on relational and structural contexts. Interventions that integrate stigma reduction, household- and community-level education, and strategies supporting autonomy and disclosure decision-making may improve sustained PrEP use. Addressing both social dynamics and risk perception remains critical to strengthening HIV prevention efforts.

The global incidence of syphilis has been rising, and atypical clinical presentations are increasingly recognized. Human immunodeficiency virus (HIV)-induced immune changes can alter syphilis progression and complicate diagnosis. Otosyphilis is a rare but potentially reversible cause of sensorineural hearing loss (SNHL). This study investigates otologic involvement in patients co-infected with syphilis and HIV. Medical records of patients diagnosed with both syphilis and HIV infection at Etlik City Hospital between January 2023 and June 2025 were retrospectively reviewed. Adults aged ≥ 18years with audiometry-confirmed SNHL were included. Other causes of hearing loss were excluded. Demographic, clinical, laboratory, radiologic, and treatment data were collected and analyzed. Among 591 patients diagnosed with syphilis, 152 were HIV-positive, and five met inclusion criteria. Four had newly diagnosed HIV infection. None reported hearing loss spontaneously; symptoms were identified through systematic questioning or physical examination. Serologic profiles varied: three showed combined TPHA and VDRL positivity, one had isolated TPHA positivity, and one had isolated VDRL positivity. Lumbar puncture (LP) in four patients revealed abnormalities in two, including one with cerebrospinal fluid VDRL positivity. One patient who declined LP had magnetic resonance imaging findings compatible with neurosyphilis. All patients received intravenous penicillin G and progressively tapered prednisone treatment for 14days, and clinically significant hearing improvement was observed in all cases; four of them were documented with audiometric measurements. Otosyphilis should be considered in individuals with HIV infection presenting with auditory symptoms, and syphilis testing should be performed in unexplained SNHL. Early recognition and appropriate treatment are critical to preventing irreversible hearing loss.

Adolescents living with HIV experience persistent challenges in achieving optimal adherence to antiretroviral therapy (ART), threatening viral suppression and long-term treatment success. In sub-Saharan Africa, including Ethiopia, developmental transitions, limited resources, and socio-cultural factors further complicate adherence. This study aims to develop and validate a model of antiretroviral therapy (ART) adherence determinants among Ethiopian adolescents living with HIV by extending the information-motivation-behavioral skills (IMB) model through the integration of HIV-related stigma as an additional construct, given its significant influence on adherence in this population. A cross-sectional study was conducted from March to October 2024 among 219 adolescents living with HIV in ALERT hospital, Addis Ababa. The data were analyzed via SPSS and the lavaan 0.6-18 package in R. The pathways through which the study constructs influenced ART adherence were estimated via the diagonally weighted least squares (DWLS) method. Model fit was evaluated via the chi-square to degrees of freedom ratio (χ²/df), comparative fit index (CFI), Tucker-Lewis index (TLI), and root mean square error of approximation (RMSEA). A total of 210 adolescents were included in the final analysis, of whom 68.6% were adherent to ART. The proposed model demonstrated excellent fit to the data (χ²/df = 1.23, CFI = 0.99, TLI = 0.98, RMSEA = 0.033). Treatment self-efficacy mediated the effects of ART knowledge and ART attitude on ART adherence. While social support exerted both significant direct (β = 0.20, p = .029) and indirect effects via treatment self-efficacy, resulting in a significant total effect on ART adherence (β = 0.26, p = .004), HIV-related stigma did not demonstrate significant direct or indirect effects on ART adherence. Interventions that strengthen ART-related knowledge, foster positive treatment attitudes, enhance social support, and build treatment self-efficacy may substantially improve ART adherence among adolescents living with HIV.

Second-line antiretroviral therapy (ART) failure remains a challenge in HIV Programs. We conducted a cross-sectional study among people living with HIV on second-line ART in Eastern Uganda to determine the prevalence and associated factors of virological failure and to assess elevated serum bilirubin as a surrogate marker of adherence. The prevalence of virological failure was 7.5%. Elevated bilirubin showed poor sensitivity and specificity for predicting adherence or virological failure. The findings highlight the need for routine viral load monitoring, as bilirubin is not a reliable surrogate marker of treatment adherence or virological failure.

The role of body mass index (BMI) as an effect modifier for readmission risk in people with HIV (PWH) remains underexplored. To compare factors associated with two-year all-cause readmission in PWH, stratified by baseline BMI. A retrospective matched (1:1 by age/sex) cohort study was conducted at a major public infectious diseases hospital in Shenzhen, China, serving a diverse urban population including migrants and low-income individuals. Adults admitted (Jan-Jun 2020) were stratified into underweight (BMI < 18.5kg/m², n = 80) and normal/overweight (BMI 18.5-<28kg/m², n = 231) groups. Multivariable logistic regression and ROC analysis were performed within each stratum. The readmission rate was higher in the underweight group (61.3% vs. 46.8%, p = 0.023). For underweight PWH, unemployment (adjusted Odds Ratio [aOR] = 8.11, 95% CI 1.82-36.16) and lower nadir CD4 + count (aOR = 0.994 per cell/µL decrease, 95% CI 0.989-0.999) were independent risk factors. For normal/overweight PWH, unemployment (aOR = 2.21, 95% CI 1.12-4.38) and longer time since diagnosis (> 5 vs. 0-1 years, aOR = 4.28, 95% CI 2.02-9.07) were risk factors, while being widowed/divorced was protective (aOR = 0.30, 95% CI 0.10-0.86). Predictive models showed good to excellent accuracy (AUCs: 0.820 and 0.748, respectively). Risk factors for readmission differ markedly by baseline BMI, confirming its role as an effect modifier. Interventions should be tailored: integrated nutritional and immunological support for underweight PWH, and chronic disease management with attention to social determinants for others.

In Ethiopia, young people are often underserved in HIV programs, with limited access to counseling, treatment, and care. Most research on youth and HIV has focused on epidemiology and prevention among 15–24-year-olds, while little attention has been paid to the lived experiences of youth living with HIV. This study explored the lived experiences of youth living with HIV who receive services from Jimma Health Center and Jimma University Medical Center. A descriptive phenomenological design was employed to explore the experiences of purposively selected youth living with HIV, regardless of the mode of acquisition. Eleven participants (eight females and three males) were interviewed in-depth using a semi-structured guide. Data were managed and analyzed using Atlas.ti version 7.5.18, and trustworthiness was ensured through multiple validation procedures. Participants reported receiving support from families, ART clinics, and youth clubs; however, fear of disclosure and HIV-related stigma remained major challenges. Many concealed their status due to fear of rejection and discrimination. Psychological distress, including guilt, low self-esteem, and boredom with lifelong medication, was common. Coping strategies included self-concealment, religiosity, and escape avoidance. Youth living with HIV face stigma, rejection, and limited support, which hinder access to healthcare and contribute to psychological suffering. Differentiated service delivery models that address the specific needs of youth in a respectful and supportive manner are recommended to strengthen the continuum of HIV care.

HIV and HBV frequently coexist, with an estimated 8% prevalence of chronic HBV among people living with HIV (PLWH). In profoundly immunosuppressed PLWH, initiation or reinitiation of antiretroviral therapy (ART) can trigger immune reconstitution inflammatory syndrome (IRIS). When directed against HBV, IRIS can manifest as a hepatic flare (IRIS-HF). The long-term clinical implications of IRIS-HF remain incompletely understood. We describe a 42-year-old man with HIV/HBV coinfection who had discontinued ART for one year. On ART reinitiation with bictegravir/emtricitabine/tenofovir alafenamide, his CD4 count was 2.3 cells/µL and HIV RNA was 4.8 × 10⁵ copies/mL. Five weeks later, he developed a severe hepatic flare (AST 987 U/L, ALT 968 U/L). The differential diagnosis included HBV-related IRIS, opportunistic infections (CMV hepatitis, disseminated MAC, EBV-associated lymphoma), and drug-induced liver injury. A liver biopsy revealed fatty degeneration and lymphocytic infiltration, consistent with HBV-related IRIS. Transaminases normalized by week 11. He subsequently achieved HBsAg loss with anti-HBs seroconversion within 2 years after ART reinitiation. This case illustrates HBV flare due to IRIS following ART reinitiation in a profoundly immunosuppressed patient. The subsequent HBsAg loss suggests that IRIS-HF may promote HBV clearance, highlighting its potential role in achieving a functional cure. Vigilant monitoring of liver function is essential during ART initiation or reinitiation in HIV/HBV coinfected individuals.

Central nervous system (CNS) infections are an important cause of morbidity and mortality among people living with HIV (PLWHIV), particularly in resource-limited settings. Cryptococcosis, toxoplasmosis and cerebral malaria often present with overlapping neurological symptoms, complicating diagnosis where confirmatory tests are unavailable. This study aimed to determine the prevalence and associated signs and symptoms of parasitic and fungal infections with neurological tropism in PLWHIV hospitalized in Libreville. A retrospective review was conducted at the Infectious Diseases Ward of the Centre Hospitalier Universitaire de Libreville (IDW-CHUL) between April and September 2021. Data were recorded from the medical files of PLWHIV hospitalised for suspected cryptococcal meningoencephalitis presenting with fever and headache alone or associated with other neurological signs. Diagnoses of cryptococcosis, toxoplasmosis, and malaria were based on microscopy, cryptococcal antigen testing, and brain CT scan. Cases of tuberculosis, other bacterial or viral meningitis were not included. Sociodemographic, clinical, and immunological data were analysed, and associations between symptoms and CNS infections were assessed. Among 255 hospitalised PLHIV, most were aged under 55 years (86.3%, n = 220), female (72.5%, n = 185), and severely immunosuppressed (CD4 < 200 cells/mm³, 57.2%, n = 127). Parasitic or fungal infections were identified in 32.9% (n = 84) of cases: cryptococcosis (14.5%), cerebral toxoplasmosis (13.7%), and complicated malaria (9.8%), with 5.1% presenting co-infections. Advanced HIV disease (WHO stage III-IV) was significantly associated with cryptococcosis and toxoplasmosis (p < 0.01). Fever and headache (81.2%, n = 207) were the most common symptoms. According to diagnosis, fever, headache, seizures, and/or focal deficits were more suggestive of toxoplasmosis (cOR 3.5, 95%CI [1.0-12.4], p = 0.05), while prostration was more frequent in malaria (cOR 2.9, 95%CI [0.98-9.0], p = 0.05), and neck stiffness was characteristic of cryptococcosis. Parasitic and fungal CNS infections remain frequent and severe in hospitalised PLWHIV in Libreville, mainly in advanced disease with profound immunosuppression. In the absence of diagnostic tools, recognition of symptom clusters may guide syndromic triage and empirical therapy.

ObjectiveTo systematically evaluate the attrition rate of PWH undergoing ART and its influencing factors.MethodsWe systematically searched Embase, PubMed, Web of Science, The Cochrane Library, VIP, WanFang, CNKI, and the Chinese Biomedical Literature Database for studies on the attrition rate and/or influencing factors of ART in PWH. The search period covered from database inception to January 2025. Two researchers independently screened the literature, extracted data, and appraised the quality of the included studies. Data analyses were performed using RevMan 5.3 and Stata 16.0 software.ResultsA total of 19 studies were ultimately included, of which 11 were cohort studies, 4 were case–control studies, and 4 were cross-sectional studies. The meta-analysis showed that the attrition rate among PWH receiving ART was 4.0 per 100 person-years (95% CI: 2.0–5.0 per 100 person-years). Factors identified as influencing attrition among PWH included age(OR = 1.51, 95%CI:1.46,1.64), male gender(OR = 1.30, 95%CI:1.17,1.44), unmarried or living alone(OR = 1.43, 95%CI:1.30,1.59), alcohol consumption(OR = 8.48, 95%CI:1.33,53.74), infection via intravenous drug use(OR = 2.15, 95%CI:1.89,2.46), initial treatment regimen including protease inhibitors (PI) (OR = 1.58, 95%CI:1.34,1.86), baseline CD4⁺ T lymphocyte count > 350/µL(OR = 1.84, 95%CI:1.11,3.05), adverse drug reactions(OR = 1.71, 95%CI:1.26,2.34), inconvenient access to medication(OR = 5.38, 95%CI:1.79,16.18), low family support(OR = 4.81, 95%CI:1.86,12.44), passive acceptance of treatment(OR = 16.04, 95%CI:1.72,149.42), interval from diagnosis to ART initiation > 1 year(OR = 1.20, 95%CI:1.10,1.53), and ART initiation year in 2016 or later(OR = 1.57, 95%CI:1.28,1.93). (P < 0.05). For some factors(alcohol consumption, inconvenient access to medication, low family support, passive acceptance of treatment), the small number of included studies and/or substantial heterogeneity limits the certainty of the evidence and the stability of the findings; therefore, they should be interpreted with caution.ConclusionOur meta-analysis indicates that ART attrition among PWH in China is relatively high and influenced by multiple factors. Accelerating ART initiation, optimizing medication access and adverse-event management, and strengthening social and family support may reduce attrition and improve treatment outcomes.Trial registration This study has been registered in PROSPERO under the registration number CRD420251023033.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12981-025-00813-w.

BackgroundC-X-C motif chemokine ligand 10 (CXCL10) is implicated in HIV-associated neuroinflammation, yet its association with HIV-associated neurocognitive disorders (HAND) remains unclear. We conducted a meta-analysis to evaluate cerebrospinal fluid (CSF) CXCL10 differences between people living with HIV (PLWH) with and without HAND and to assess the odds of HAND in relation to high versus low CSF CXCL10 levels.MethodsPubMed, Embase, and Web of Science were systematically searched. Observational studies reporting CSF CXCL10 levels in adult PLWH with and without HAND were included. Standardized mean difference (SMD) and odds ratio (OR) were pooled using random-effects models accounting for the potential influence of heterogeneity.ResultsEleven studies involving 1,536 PLWH were included. Compared to those without HAND, PLWH with HAND had significantly higher CSF CXCL10 levels (SMD: 0.56, 95% CI: 0.17–0.96; p < 0.001), with high heterogeneity (I² = 86% and τ² = 0.31). The 95% prediction interval (PI: − 0.78 to 1.91) indicated substantial between-study variability. Subgroup analyses showed significantly greater CXCL10 elevation in studies with ≤ 50% ART coverage (SMD: 0.90 vs. 0.17; p = 0.04) and in those evaluating HIV-associated dementia (SMD: 1.45 vs. 0.37; p < 0.001). Meta-regression did not identify any statistically significant moderators, although ART proportion and CD4 + count explained 29.2% and 25.6% of the variance, respectively. No significant association was found between high CSF CXCL10 and HAND (OR: 1.41, 95% CI: 0.90–2.22; p = 0.13).ConclusionElevated CSF CXCL10 may be associated with HAND in PLWH, particularly among ART-naïve individuals and in more severe cognitive impairment. However, substantial heterogeneity and a wide PI suggest that the strength of this association varies across populations. CSF CXCL10 remains a promising but not definitive biomarker for HAND risk stratification.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12981-025-00804-x.