Recombination events are a key driver of human immunodeficiency virus type 1 (HIV-1) genetic diversity. In this study, HIV-1 samples were collected from two male patients in Shenzhen, China. Two novel recombinant forms (Ls6449 and Ls16801) derived from CRF01_AE and CRF07_BC were identified, and their near full-length genomes were obtained. Analysis of these two forms suggested that the recombination between CRF01_AE and CRF07_BC continued to occur in Shenzhen, potentially contributing to the increasing genetic complexity of the local HIV-1 epidemic. These findings highlight the need for enhanced molecular surveillance and genotyping targeting key routes, specifically sexual transmission and mobility-associated spread. It is expected to generate precise epidemiological evidence and inform local HIV prevention and control strategies.

The COVID-19 pandemic was an event involving an actual threat of death, serious injury, or harm to the integrity of self or others, which could have served as a precipitant for unmasking symptoms of post-traumatic stress disorder (PTSD). Persons living with HIV and those with hepatitis C (HCV) coinfection could be at increased risk of PTSD symptoms after a traumatic event, given their lifetime experiences of trauma, stigma, poverty, mental health conditions, and substance use. We measured PTSD symptoms at three time points during the COVID-19 pandemic using a 17-item questionnaire in two established cohorts of persons living with HIV in Canada-those with HCV coinfection and those aging with HIV-groups at risk for having symptoms. We found that twice as many persons in the HCV coinfection cohort had moderate to severe PTSD symptoms at baseline relative to the aging cohort (49% vs. 25%) and that these percentages remained high in the coinfection cohort but declined in the aging cohort with time. Notably, those who self-reported depression had increased rates of PTSD symptoms over time. Our data points to the potential long-lasting impact that the COVID-19 pandemic or other traumatic events could have on the mental health of persons living with HIV and those with coinfection, especially among those with underlying depression. We stress the need for increased awareness and management strategies of vulnerable groups during times of trauma.

The long-term co-circulation of various HIV-1 subtypes and circulating recombinant forms (CRFs) in China has created an environment conducive to viral recombination. This study identified a novel HIV-1 CRF resulting from the recombination of CRF07_BC and CRF55_01B in Xishuangbanna Prefecture, Yunnan Province. Nearly full-length HIV-1 genome sequences were obtained from three individuals with no epidemiological link, including two men who have sex with men and one individual with heterosexual contact. These individuals were reported in 2023. These sequences form a monophyletic clade that is distinct from all known subtypes and CRFs. Recombination and phylogenetic analyses revealed that this recombinant strain exhibited a consistent mosaic genomic structure, with the CRF55_01B backbone incorporating two CRF07_BC segments. Bayesian phylogenetic analyses indicated that this recombinant form originated around 2019. In accordance with standard nomenclature, it has been designated CRF200_0755. In addition, this recombinant strain carries the V179E resistance mutation from CRF55_01B. The discovery of this novel CRF highlights the ongoing evolution of HIV-1 amid the co-circulation of prevalent strains and population mobility. It also emphasizes the importance of continuous molecular surveillance in guiding public health strategies, given the potential presence of preexisting resistance mutations.

This prospective cohort study compared the efficacy of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and tenofovir/lamivudine/efavirenz (TLE) regimens in 88 treatment-naïve persons living with HIV. The BIC regimen achieved faster HIV-1 RNA suppression at week 12, with comparable suppression thereafter. Regarding HIV-1 DNA, the TLE group exhibited a more rapid decline, largely attributable to its higher baseline levels, while both groups converged to comparable levels at week 48; this difference was no longer significant after adjusting for baseline HIV-1 DNA levels. Notably, the BIC group had significantly lower baseline CD4[+] counts, reflecting the real-world inclusion of individuals with more advanced disease. Cluster analysis within the BIC group revealed three distinct DNA decay trajectories. A subset of individuals with the lowest baseline CD4[+] counts (Cluster 1, n = 16) showed stable HIV-1 DNA through week 48 followed by significant decline only after 72 weeks, with CD4/CD8 ratio recovery preceding the decline. The early DNA plateau may reflect the interplay between immune reconstitution and viral reservoir dynamics. These findings suggest that baseline immune status influences early viral reservoir dynamics and that the timing of reservoir reduction may be linked to immune restoration, highlighting the heterogeneity of integrase inhibitor responses and the potential value of baseline immune assessment in guiding individualized management.

Yunnan Province is recognized as a hotspot for the emergence of HIV-1 recombinant forms due to its complex epidemiological history. This study identified a novel circulating recombinant form (CRF) of HIV-1 in the region, designated as CRF203_cpx. Near-full-length genome sequences were obtained from three individuals infected through heterosexual contact in Wenshan Prefecture, an area located near the border with Vietnam. These sequences formed a distinct monophyletic clade with strong bootstrap support, separate from all known subtypes and CRFs. The genome of this strain can be divided into 14 subregions: S1, S4, S7, and S8 were derived from CRF55_01B; S2, S11, and S13 from CRF07_BC; and S3, S5, S6, and S12 from CRF01_AE. S9, S10 and S14 were likely derived from recombination between CRF01_AE and CRF55_01B. Bayesian Markov chain Monte Carlo analysis indicated that CRF203_cpx emerged between 2018 and 2021. To the best of our knowledge, this is the first time that a complex CRF comprising three CRFs (CRF01_AE, CRF07_BC, and CRF55_01B) has been definitively identified in China. This reveals the dynamic process by which circulating strains accumulate evolutionary changes through multilevel recombination, raising new considerations for current surveillance and control strategies.

The cocirculation of CRF01_AE and CRF07_BC among men who have sex with men (MSM) in China may facilitate the emergence of genetically complex HIV-1 recombinants. Here, we identified and characterized a novel second-generation HIV-1 CRF01_AE/CRF07_BC recombinant, designated GY0192, from a 25-year-old MSM individual in Guiyang, Guizhou Province, southwest China, using near full-length genome (NFLG) analysis. Recombination analyses identified four breakpoints at HXB2 positions 3,125, 5,687, 6,375, and 9,176, generating a distinct five-segment mosaic genome. Subregion phylogenetic analyses showed that the two CRF01_AE-derived fragments clustered with the CRF01_AE cluster 5 lineage, while all three CRF07_BC-derived fragments grouped with CRF07_BC lineages frequently circulating among MSM in China, indicating that both parental components of GY0192 were phylogenetically related to lineages frequently reported among MSM populations in China. The virus was also predicted to be CCR5-tropic, adding epidemiological relevance because CCR5-tropic viruses are commonly involved in transmission and early infection. Together, these findings identify GY0192 as a distinct CRF01_AE/CRF07_BC mosaic and suggest that cocirculating MSM-associated HIV-1 lineages may provide opportunities for interlineage recombination. This case expands the known spectrum of CRF01_AE/CRF07_BC recombinants in Guizhou and underscores the value of NFLG-based surveillance for detecting underrecognized HIV-1 genetic complexity in southwest China.

With the widespread use of antiretroviral therapy, the clinical spectrum among people with HIV has evolved significantly. This study aims to investigate the dynamic changes in the primary indications and final diagnostic spectrum of bone marrow examinations in this population. We conducted a retrospective analysis of 154 hospitalized individuals with HIV who underwent bone marrow examination at Mengchao Hepatobiliary Hospital of Fujian Medical University, the largest designated HIV/AIDS care hospital in Southeast China, from September 2019 to December 2025. Demographic, laboratory, and pathological data were collected, and participants were stratified into tumor and nontumor groups based on final diagnosis for comparative analysis. Among the indications for bone marrow examination, the proportion of procedures performed due to cytopenia decreased from 55.55% in 2019 to 17.86% in 2025. Conversely, the proportion performed for suspected hematological malignancy or to assess tumor marrow infiltration increased significantly from 11.11% to 60.71%. Final diagnoses revealed that the proportion of malignant tumors increased from 11.11% to 53.57%, whereas the proportion of opportunistic infections showed a declining trend. The Cochran-Armitage trend test confirmed that the proportion of opportunistic infections decreased significantly (p = .002), while the proportion of malignancies increased significantly (p = .002). Compared to the nontumor group, individuals in the tumor group were older, had significantly higher proportions receiving antiretroviral therapy, higher rates of HIV RNA suppression, as well as significantly higher CD4[+] T-cell counts, CD8[+] T-cell counts, lymphocyte counts, platelet counts, and lactate dehydrogenase levels. Our findings demonstrate that the clinical indications for bone marrow examination in people with HIV have shifted from the evaluation of traditional opportunistic infections and unexplained cytopenia toward the diagnosis and staging of malignant tumors, particularly hematological malignancies. These results suggest that in the contemporary management of HIV, greater emphasis should be placed on screening for malignancies.

Natural killer (NK) cell activation and function are controlled by highly complex transcriptional programs. To leverage NK cells against human immunodeficiency virus and other diseases, a more complete understanding of signaling and metabolic dynamics is needed. In this study, we utilize a rhesus macaque (RM) model to define the transcriptomic profile of NK cells during acute lentiviral infection and to map the changes in this profile as infection progresses to the early chronic phase. Using a novel summary gene set for NK cell cytokine stimulation, we report synchronous metabolic and signaling transcriptional patterns that underlie established features of NK cell dysfunction. Assessing gene expression induced by the SARS-CoV-2 challenge allowed us to confirm a set of core conserved gene pathways central to RM NK cell activation across diverse acute viral contexts.

HIV phylogenetics is a powerful tool for elucidating HIV transmission dynamics, but ethical concerns have been raised about its use. We conducted a cross-sectional online survey among HIV professional stakeholders in Uganda to explore their knowledge of HIV phylogenetics and associated ethical considerations. Thirty-two participants completed the survey. 87% correctly defined HIV phylogenetics, but some were unable to recognize potential individual harms associated with HIV phylogenetic research (HPR). The most common individual and societal harms of HPR recognized were identification as an HIV transmission source 25 (78%; 95% CI, 61-89%) and marginalization of certain groups 27 (84%; 95% CI, 68-93%), respectively. Most strongly agreed that obtaining community assent 17 (53%; 95% CI, 36-69%) and specific informed consent for viral sequences used in HPR 20 (63%; 95% CI, 45-77%) were critical. Risks associated with HPR appear to be incompletely understood, underscoring the need to raise awareness of them among various professional stakeholders.

Mutation and recombination are key mechanisms in the adaptation, spread, and genetic diversity of human immunodeficiency virus (HIV)-1. We identified two novel unique recombinant forms (URFs) from two persons living with HIV-1, both infected through homosexual contact in Hebei, China. Phylogenetic and recombinant analysis based on the near full-length genome (NFLG) sequences revealed that they originated from CRF01_AE and B. NFLG sequencing revealed complex recombinant patterns in both samples, indicating ongoing recombination and co-infection in men who have sex with men (MSM). The emergence of novel URFs underscores the complexity of the HIV-1 epidemic among MSM and highlights its evolving molecular diversity and epidemiological implications.

Long-acting injectable cabotegravir-rilpivirine (LA CAB/RPV) is an antiretroviral option for virologically suppressed people with HIV, but real-world discontinuation and failure patterns remain incompletely described. We retrospectively reviewed 201 adults who received LA CAB/RPV at a large academic infectious diseases clinic (January 2022-April 2025). Median time on therapy was 380 days (IQR 206-729). At the end of follow-up, 160 (80%) remained on LA CAB/RPV and 30 (15%) discontinued, most commonly due to insurance barriers (n = 8, 27%); adherence issues and patient preference each accounted for 23% (n = 7). Virologic failure occurred in 4 patients (2%) and was often accompanied by emergent or pre-existing non-nucleoside reverse transcriptase inhibitor and/or integrase strand transfer inhibitor resistance mutations; all patients achieved resuppression after switching back to oral ART. LA CAB/RPV was generally well tolerated, but system-level access and care-continuity barriers were major drivers of discontinuation, underscoring the importance of robust support systems and resistance-informed patient selection.

People aging with HIV (PAWH) experience greater impairment in physical and pulmonary function than individuals aging without HIV. We examined whether baseline physical function was associated with subsequent pulmonary impairments. Associations of frailty and physical function (gait speed [m/s], grip strength [kg]) with pulmonary function (<80% predicted diffusing capacity for carbon monoxide [DLCO] and forced expiratory volume [FEV1]) 3 years later were modeled; age, HIV status, and smoking were assessed as effect modifiers. Among 1,024 men (54% PAWH, 10% frail, 51% prefrail), mean (SD) age = 53 (12) years, cumulative smoking = 12 (19) pack-years, gait speed = 1.1 (0.2) m/s, and grip strength = 36.6 (9.2) kg. Frailty, prefrailty, and weak grip strength were associated with higher odds of subsequent impaired DLCO and FEV1. Slow gait speed was associated with higher odds of DLCO impairment but not FEV1. No statistically significant modifications were found. Interventions to improve physical function may help preserve pulmonary function.

Porphyrins, a class of heterocyclic macrocycles, have garnered significant attention for their potential antiviral properties, particularly against human immunodeficiency virus (HIV). This review explores how porphyrins and their derivatives inhibit HIV replication, focusing on their interactions with key viral components, including reverse transcriptase, protease, and integrase. In addition, the review highlights the role of porphyrins in photodynamic therapy (PDT) as a novel approach to targeting HIV-infected cells. Recent studies have demonstrated that metalloporphyrins, in particular, exhibit enhanced antiviral activity due to their unique structural and electronic properties. Despite promising in vitro and preclinical results, challenges such as cytotoxicity, bioavailability, and resistance mechanisms remain unaddressed. This review provides a comprehensive analysis of the current state of research on porphyrins as anti-HIV agents, emphasizing their potential as a therapeutic strategy and identifying key areas for future investigation. The findings underscore the importance of porphyrins in the ongoing search for effective antiviral therapies against HIV.

Advancements in antiretroviral therapy (ART) have significantly improved morbidity and mortality rates among people with human immunodeficiency virus (HIV) (PWH), leading to prolonged survival, and many are now living into middle and old age. However, this population now faces aging-related comorbidities, including cachexia HIV-associated wasting (HIVAW), which remains inadequately addressed in the context of contemporary ART. Effective management of HIVAW requires a multifaceted approach that targets underlying causes while addressing coexisting health conditions. Currently, recombinant human growth hormone (rhGH) (somatropin) is the only FDA-approved treatment for HIVAW that increases body weight and lean body mass and improves physical endurance. However, the lack of standardized definitions and clear treatment guidelines may contribute to the underdiagnosis and suboptimal management of HIVAW. This study aimed to assess health care providers' (HCPs) knowledge, attitudes, and contemporary clinical practices regarding HIVAW through a cross-sectional survey conducted in collaboration with the American Academy of HIV Medicine. Approximately half of the respondents recognized a 3% prevalence rate of HIVAW, noting its association with increased morbidity and health care resource utilization. However, nearly one-third faced challenges in diagnosing HIVAW due to unclear definitions, highlighting the need for standardized clinical guidelines. Less experienced providers demonstrated less familiarity with treatment options like rhGH compared to their more experienced colleagues. While 88.4% identified nutritional supplements as a management strategy, only 32.2% were aware of an FDA-approved treatment for HIVAW, indicating a substantial knowledge gap. This study underscores the need for enhanced educational initiatives and clear treatment guidelines to improve the recognition and management of HIVAW, particularly among less experienced HCPs.

Extensive cocirculation of CRF01_AE and CRF07_BC in China has created favorable conditions for ongoing intersubtype recombination, contributing to increasing genetic complexity within the local HIV-1 epidemic. In this study, two novel unique recombinant forms composed of CRF01_AE and CRF07_BC were identified in Shenzhen, Guangdong Province. Near-full-length genome sequences were obtained for isolates LS11654 and LS16824. Phylogenetic analysis indicated that both sequences clustered within a CRF01_AE-/CRF07_BC-related lineage but were distinct from previously reported strains. Recombination analysis revealed markedly different mosaic structures: LS11654 contained two recombination breakpoints, whereas LS16824 exhibited a more complex genome with eight breakpoints and multiple inserted fragments. Subregion phylogenetic analysis further confirmed the parental origins of the recombinant segments. These findings reflect ongoing recombination driven by sustained cocirculation of CRF01_AE and CRF07_BC in Shenzhen and highlight the importance of continued molecular surveillance.