Family communication dysfunction significantly impacts HIV medication adherence and mental health outcomes among adolescents in sub-Saharan Africa, yet evidence-based family interventions remain scarce in resource-limited settings. This qualitative descriptive study examined family communication transformation following culturally adapted Multiple Family Group Therapy (MFGT) for adolescents living with HIV and their families in rural Ghana. Focus group discussions were conducted with 20 caregivers and 19 adolescents who completed the 11-session intervention. All core therapeutic content was delivered across sessions 1 through 10; the 11th session comprised a graduation ceremony and sustainability planning. Reflexive thematic analysis revealed four major themes: preintervention dysfunction (public shaming, adolescent defiance, spousal teknonymy, extended family triangulation); MFGT-facilitated skills (tone modulation, privacy-preserving correction, active listening); postintervention transformation (caregiver behavioral consolidation, adolescent reciprocal adaptation, spousal reconnection); and sustaining mechanisms (observational learning, metacognitive awareness, positive reinforcement, peer accountability). Communication improvements occurred bidirectionally, with caregiver changes catalyzing adolescent adaptations. Findings are theoretically interpreted through family systems theory, communication accommodation theory, social cognitive theory, and self-determination theory. Culturally adapted MFGT successfully transformed communication patterns while preserving traditional authority structures, suggesting potential for integration within HIV care systems in resource-limited settings.

Characterizing dolutegravir penetration into the central nervous system is important for optimizing human immunodeficiency virus treatment outcomes, yet population-specific pharmacokinetic data describing cerebrospinal fluid disposition and equilibration kinetics remain lacking. This study characterizes dolutegravir pharmacokinetics in plasma and cerebrospinal fluid to describe the plasma-to-cerebrospinal fluid equilibration rate constant and cerebrospinal fluid-to-plasma pseudo-partition coefficient. Sparse pharmacokinetics samples were collected from 121 antiretroviral therapy-experienced adults who are predominantly overweight or obese (body mass index: 32.2 ± 8.7 kg/m2) receiving daily dolutegravir (50 mg)-based therapy. The model was developed using nonlinear mixed-effects modeling in NONMEM. Plasma dolutegravir pharmacokinetics were best described by a one-compartment model with first-order absorption and elimination. The population estimate for apparent oral clearance was 1.38 L/h/70 kg. Cerebrospinal fluid data were modeled using a sequential approach with a hypothetical effect compartment linked to plasma to estimate equilibration kinetics and relative cerebrospinal fluid exposure at steady-state. Key cerebrospinal fluid penetration parameters included a plasma-to-cerebrospinal fluid equilibration rate constant of 0.38 h-1, corresponding to an equilibration half-life of 1.82 h, and a cerebrospinal fluid-to-plasma pseudo-partition coefficient of 0.0015, indicating 0.15% cerebrospinal fluid penetration relative to plasma. Post hoc estimated area under the concentration-time curve (0-24) demonstrated a moderate inverse correlation with body mass index (r = -0.34), indicating that dolutegravir exposure decreases with increasing body mass index. The model revealed rapid plasma-to-cerebrospinal fluid equilibration kinetics with low steady-state cerebrospinal fluid penetration in this predominantly overweight and obese population.

The use of antiretroviral (ARV) medications for HIV treatment and prevention is a potential blood safety concern. HIV screening algorithms rely on the predictable appearance of viral RNA, p24 antigen, and anti-HIV antibodies during acute and early infection. However, exposure to ARVs can alter these biomarker dynamics and potentially compromise HIV detection. Evidence indicates that early initiation of antiretroviral therapy (ART) can suppress viremia, leading to incomplete seroconversion, reduced serologic reactivity, and seroreversion. HIV acquisition may also occur in individuals receiving pre- or postexposure prophylaxis (PrEP/PEP), resulting in delayed or altered progression of virologic and serologic markers. Long-acting injectable PrEP formulations, particularly cabotegravir, have been associated with prolonged delays in HIV diagnosis, Undisclosed ART among donors who have HIV infection has been reported in studies from South Africa, Brazil, and the USA. Undisclosed PrEP use has been reported in Canada, the Netherlands, the UK, and the USA. This has the potential to lead to undetected HIV infections in blood donors. Broader availability of ARVs and implementation of HIV treatment and prevention programs increase the relevance of this issue for blood safety. A limitation for defining ARV-associated HIV transfusion transmission risk is the availability of high-quality evidence on the likelihood of donations with altered biomarkers of infection. A framework for risk assessment in the context of sparse data is described. Additional evidence and evaluation of known or potential undisclosed ART, PrEP or PEP use in donors is required before more precise risk estimates are possible.

The immature HIV-1 virion is assembled by the Gag polyprotein using inositol hexakisphosphate (IP6) as an essential assembly co-factor. Gag binds the genomic RNA Psi packaging signal via the nucleocapsid (NC) domain and associates with the plasma membrane via the matrix (MA) domain. Previous studies revealed that Gag exists in both compact (C) and extended (E) conformational states in solution. Only E-Gag formed virus-like particles with the correct size and IP6 shifted the equilibrium of DNA-bound Gag to the E state. The influence of specific RNA elements on this conformational change is unknown. In this work, a dual dye-labeled Gag was prepared for probing the effect of RNA binding on Gag conformation using Förster resonance energy transfer (FRET). In low salt and in the absence of other factors, Gag was primarily in the C state. Psi RNA binding induced a more significant FRET decrease than binding to non-Psi RNAs, consistent with a shift to E-Gag. IP6 alone also promoted the E-Gag state in the absence and presence of RNA. Atomistic molecular dynamics simulations are consistent with and provide detail into the role of NC-Psi RNA binding in the conformational switch of C-Gag to assembly-competent E-Gag. Simulations also showed that this switch is driven by capsid (CA) linker domain orientational flexibility and MA-CA unbinding dynamics. Thus, the highly flexible multi-domain Gag polyprotein leverages both viral and host cell factors to sample and stabilize distinct conformations, thereby orchestrating the viral assembly process.

The American Heart Association's PREVENT equations offer a contemporary, race-free alternative to the Pooled Cohort Equations (PCE), incorporating kidney function to estimate 10- and 30-year risks of atherosclerotic cardiovascular disease (ASCVD), heart failure, and total CVD. PREVENT-ASCVD is now recommended for primary-prevention risk assessment in the 2026 multisociety dyslipidemia guidelines, replacing the PCE, making its real-world performance immediately consequential. PREVENT generally preserves discrimination, but calibration varies across populations, with possible overestimation or underestimation. It often lowers estimated risk and modeled eligibility for statin or antihypertensive therapy versus the PCE. Performance is favorable in several general and older-adult cohorts, but underestimation is concerning in people with HIV, rheumatoid arthritis, selected international cohorts, and statin-naïve adults. Coronary artery calcium can refine selected estimates, though no trial has shown PREVENT-guided care improves outcomes. This narrative review appraises external validation, calibration, and reclassification behavior, evaluates effects on treatment eligibility, and identifies evidence gaps, concluding that implementation should remain population-sensitive with local validation and recalibration when appropriate.