The stigmatized status of injecting illicit drugs use and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome in Pakistan, enlists HIV positive injection drug users (IDUs) at preeminent risk for poor mental health. This study aims to investigate the potential link between enacted HIV stigma, community attachment, and mental health problems in HIV-positive IDUs, along with mediating role of community attachment and moderating role of drug type. Correlation analysis revealed that enacted HIV stigma and community attachment were significantly negatively associated with mental health. Mediation analysis indicated that enacted HIV stigma influences mental health indirectly by shaping individuals' level of attachment to the community of IDUs. Moderation analysis revealed that synthetic illicit drugs significantly moderated the association between enacted HIV stigma and mental health. The findings highlight the need for targeted interventions addressing enacted HIV stigma among IDUs to effectively improve their mental health outcomes.

HIV remains a major global public health challenge. Although antiretroviral therapy (ART) effectively reduces morbidity and mortality, its success depends on sustained adherence to treatment. Barriers such as stigma, psychosocial problems, and limited access to healthcare continue to compromise adherence among people living with HIV (PLHIV). Adherence counseling (AC) has been increasingly implemented to address these challenges and improve treatment outcomes. This study aimed to map and synthesize the types and effectiveness of AC interventions in improving ART adherence among PLHIV. A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Literature searches were performed in Scopus, ScienceDirect, ProQuest, and PubMed using population, intervention, comparison, and outcomes-based keywords. Eligible studies evaluated AC interventions with ART adherence as an outcome and were published in the last 5 years. Of the 689 identified articles, 13 met the inclusion criteria. Most studies were conducted in Uganda and focused on intensive AC (IAC). IAC improves ART adherence and viral load suppression, particularly when delivered through structured, patient-centered approaches. However, the effectiveness varied according to social, health system, and contextual factors. Digital-based interventions, including real-time medication monitoring and mobile health applications, have also demonstrated promising effects on adherence. IAC plays an important role in improving ART adherence among PLHIV. Its effectiveness is influenced by the quality of counseling, social support, and health system integration. Combining face-to-face counseling with digital innovations and community-based support offers the most sustainable strategy for enhancing adherence and achieving viral suppression in PLHIV.

The use of authorized medicinal products under conditions other than those approved, commonly referred to as off-label use, is an increasingly frequent practice in health care. It is particularly relevant in the therapeutic management of human immunodeficiency virus infection, where treatment innovation often outpaces regulatory updates. In the absence of specific protocols to guide the appropriateness of off-label prescribing, this narrative review analyses, from an ethical and legal perspective, the conditions under which off-label use may be considered an appropriate therapeutic option. To this end, we examine the clinical foundations of off-label use, including the quality and certainty of the available scientific evidence and its impact on the benefit-risk and cost-benefit balance, the exceptional nature of its use, and the application of decision-making algorithms to guide prescribing. We also identify the main ethical dilemmas associated with off-label use from principlist, virtue-based, and utilitarian bioethical perspectives, as well as the principal conflicts of interest among the different stakeholders involved in the off-label use of antiretroviral drugs. Finally, we propose strategies aimed at promoting a more prudent, equitable, and transparent use of off-label medicines, strengthening responsible, patient-centered decision-making.

HIV testing is a critical tool for preventing HIV transmission, with early identification in key populations reducing onward spread. This study aims to evaluate risk prediction models, identify factors influencing HIV testing, and provide recommendations to enhance testing among key populations. Electronic databases were searched for peer-reviewed and gray literature published in English and Chinese from January 1, 1996, to November 14, 2025. Two reviewers independently assessed methodological quality and extracted data. The prediction model risk of bias assessment tool was used to evaluate bias and applicability. Of 3693 initially identified studies, seven met the inclusion criteria. Reported area under the curve (AUC) values ranged from 0.72 to 0.82, and the pooled AUC of validated models was 0.77 (95% confidence interval: 0.70-0.84), indicating moderate discriminative performance. However, most of the studies were assessed as having a high risk of bias, primarily due to insufficient reporting in the analysis domain, limiting the reliability of existing models for clinical or public health applications. Predictors of HIV testing were broadly grouped into sociodemographic, behavioral, knowledge-related, and structural factors, and predictors of HIV testing varied considerably across models, reflecting differences in study populations, behavioral characteristics, and contextual factors across settings. Overall, although existing models demonstrate moderate predictive ability, their methodological limitations and lack of external validation restrict their generalizability and practical utility. Therefore, reliable prediction models remain limited. Future research should develop high-quality models with larger sample sizes, robust designs, and multi-center external validation to support clinical application, improve practical relevance, and inform strategies to advance HIV testing. Beyond HIV testing prediction, this study highlights the need for broader prevention approaches, including sexuality education, risk awareness, and safe sexual behaviors, alongside targeted testing interventions.

With the advancement of antiretroviral therapy, two-drug regimens have emerged as a viable and promising strategy for human immunodeficiency virus (HIV) care and management, offering potential advantages in safety, treatment adherence, and cost-effectiveness. Although scholarly interest in this field is growing, a comprehensive bibliometric analysis remains lacking; accordingly, this study aimed to map the research landscape, identify emerging trends, and explore collaborative networks in the field of two-drug HIV treatment regimens. To this end, studies on two-drug HIV treatment regimens were retrieved from the Web of Science Core Collection. After screening and deduplication, key bibliometric data were extracted. Subsequent analyses were performed using the Bibliometrix R-package and VOSviewer to visualize annual publication output, geographical distribution, institutional collaborations, journal influence, author networks, and keyword evolution trends. Ultimately, 3,262 publications were included, with an annual growth rate of 9.23%. The United States was the most productive country (974 publications, 29.9%), while Harvard University topped institutional rankings (430 publications). AIDS was the leading journal (199 publications), and core authors (e.g., Carr A) contributed substantially. Keyword analysis revealed that two-drug regimens are transitioning from "alternative options" to "mainstream choices" in HIV treatment, with their development reflecting a focus on balancing efficacy and safety, as well as aligning technological innovation with clinical demands. This bibliometric study delineates the evolving landscape of two-drug HIV treatment research, with North America and Europe making prominent contributions. It highlights key research foci and collaboration patterns, providing valuable insights for researchers, clinicians, and policymakers to prioritize future research and optimize HIV treatment strategies.

The human being is sexed, as there are men and women. The presence of two complementary sexes provides a biological mechanism for evolution and adaptation to changing environments through reproduction with the admixture of distinct genetic traits. Ultimately, this reproductive meaning of sex provides its most important biological foundation. In humans, sexuality also plays a significant role in interpersonal relationships and affection, uniquely contributing to personhood, well-being, and flourishing. In this way, both meanings of human sexuality, reproductive and affective, can be challenged in certain scenarios, such as when there are intersex states of biological basis, nowadays referred to as disorders or differences of sex development (DSD), same-sex orientation, or gender dysphoria. Following the approach taken for DSD, same-sex attraction and transgender identity could be categorized medically as differences in sexual orientation and self-identity, respectively. This could provide a respectful framework for conducting research about sexuality. Herein, we examine the spectrum of differences in the sexual sphere and update on major determinants. Whereas biological factors lead to DSD, psychological and sociocultural variables largely contribute to same-sex orientation and transgender identity. Inclusive efforts for persons with atypical sexuality must be encouraged to avoid discrimination. However, these conditions should not be overlooked medically. Denying their relevance might discourage research that would ultimately benefit these individuals.

HIV affects over 39 million people globally and remains a challenge in oral health care despite advances in antiretroviral therapy (ART). The oral cavity often reflects immune status and serves as a site for opportunistic infections, making dental care essential in HIV management. This review explores four main aspects of dental care for people living with HIV (PLHIV): HIV pathophysiology, transmission risk during dental procedures, infection control strategies, and pre-treatment clinical assessment. Using the population-concept-context framework, literature was reviewed from PubMed, Scopus, and Web of Science spanning 2000-2025. Oral conditions such as candidiasis, Kaposi's sarcoma, and periodontal disease remain prevalent in PLHIV and are closely linked to HIV progression. The risk of HIV transmission in dental settings is very low (< 0.3% for percutaneous exposure) when standard precautions are followed, though stigma among providers persists. Effective infection control includes personal protective equipment, sterilization, and aerosol reduction. Pre-procedural evaluation (CD4 count, viral load, and hematological status) is vital for safe care. In cases of neutropenia, antibiotic prophylaxis may be needed, and elective procedures should be deferred. Dental treatment for PLHIV is safe when guided by evidence-based protocols. Integrating infection control, risk assessment, and personalized planning strengthens the role of dentistry in comprehensive HIV care.

Same-day initiation of antiretroviral therapy (ART), known as same-day ART, has been endorsed by the World Health Organization since 2017 as a strategy to improve treatment coverage, reduce HIV transmission, and increase the survival of people living with HIV. This approach aims to minimize loss to follow-up (LTFU) and strengthen engagement in care, particularly in high-prevalence settings such as South Africa. This review aims to synthesize available data on the benefits, challenges, and impacts of same-day ART, with a particular focus on resource-limited settings. A literature review was conducted on published studies that addressed the effectiveness, adherence, retention in care, and clinical outcomes associated with same-day ART. The studies indicate that same-day ART is associated with a significant improvement in treatment initiation and reduced delays in therapy. However, its success depends on several factors, including patient acceptability, healthcare system capacity, and the quality of psychosocial support. Increased risks of long-term LTFU have also been reported among certain vulnerable populations. Same-day ART represents a major advancement in the fight against HIV, but its implementation requires a contextualized approach, adequate training of healthcare providers, and strengthened psychosocial support to ensure long-term retention in care.

Despite advances in antiretroviral therapy, developing an effective human immunodeficiency virus (HIV) vaccine remains pivotal for epidemic control. Through a scientometric analysis of 19,863 publications from the Web of Science Core Collection (1989-2023) using CiteSpace, this study delineates evolving trends and emerging frontiers in HIV vaccine research. The United States dominated contributions, with institutions like the National Institutes of Health and Harvard leading productivity. Clustering revealed two interconnected research trajectories, which are broad neutralizing antibody development, broad neutralizing antibody precursors, and immune mechanism exploration. Despite efficacy trials not resulting in licensed HIV vaccine advancements in antigen design and adjuvant strategies, they show promise. Key findings indicated structural biology, germinal center (GC) dynamics, antibody-dependent cellular cytotoxicity, and glycosylation shielding as pivotal research domains. Critical barriers include generating a specific immune response to new epitopes and glycosylation-mediated immune evasion. Future efforts should prioritize GC optimization to enhance B-cell affinity maturation, structure-guided epitope targeting through cryo-electron microscopy, and advances in antigen delivery. In addition, engineering vaccines to expand CXCR5+ T follicular helper cell populations may improve durable humoral immunity. This analysis underscores the necessity of multidisciplinary approaches to overcome HIV vaccine hurdles.