Resistance-associated mutations (RAMs) limit treatment options for HIV. We evaluated virologic outcomes in people with HIV harboring RAMs who switched to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in a real-world cohort during 4 years of follow-up. Virologic suppression was sustained across RAM subgroups, including M184V/I with additional nucleoside reverse transcriptase inhibitor (NRTI)-RAMs. Stratification by genotypic susceptibility score (GSS) suggests robust effectiveness. B/F/TAF demonstrates durable long-term suppression in different resistance profiles, supporting its use in this population.

Estimated greenhouse gas emissions from active pharmaceutical ingredient (API) production were compared for oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) and long-acting injectable preexposure prophylaxis (PrEP) agents, cabotegravir (CAB-LA) and lenacapavir (LEN). For 2 million person-years of PrEP, TDF/FTC generated approximately 108 million kg CO2e, compared with 4.1 million kg for CAB-LA and less than 0.1 million kg for LEN. These findings suggest substantially lower emissions with long-acting agents, supporting consideration of environmental sustainability in HIV prevention strategies.

In people without HIV, raised coronary artery calcium scores (CACS) are linked to increased cardiovascular risk. HIV is associated with elevated CACS, but risk factors beyond smoking and diabetes are not well established. Data on 779 individuals with HIV who underwent a CACS scans (median age 55) were collected. CACS better predicted adverse outcomes (e.g. major adverse cardiovascular events (MACE), death, heart failure) than Q-risk scores. Advanced imaging research may improve major cardiovascular risk prediction in people ageing with HIV.