Penile intraepithelial neoplasia is an uncommon precancerous genital lesion that may progress to invasive penile squamous cell carcinoma in the absence of proper therapeutic management. The recent trend of increasing incidence because of a heightened burden of genital human papillomavirus (HPV) infection emphasizes a need for effective diagnostic and management strategies. This article provides a clinicopathologic overview focusing on updates in tumor classification and prognostication not previously summarized. We examine changes in classification and nomenclature based on the 2022 World Health Organization guidelines and explore differences in pathogenesis and prognosis between HPV-associated and HPV-independent tumors. This article emphasizes the need for more robust molecular genetic studies to further elucidate prognostic biomarkers and explores the increasingly distinct role of immunohistochemistry in stratifying subtypes. Also, we present an illustrative case to highlight the significance of accurate diagnosis and prompt management.

The objective was to estimate the prevalence and identify factors associated with syphilis among adolescent men who have sex with men (AMSM). This cross-sectional, multicentric study recruited 199 AMSM aged 15 to 19 through the respondent-driven sampling (RDS) method between December 2020 and August 2022, using questionnaires and rapid tests in Fortaleza and São Paulo. Estimates were calculated using STATA 17, considering a 95% confidence interval after weighting the data in each city and combining adolescents from both capitals into a single database. A multivariate model was constructed based on bivariate analyses with p < 0.20. The prevalence of syphilis was 10.9% (95%CI: 6.7-17.3). In the final model, higher odds of syphilis infection were associated with AMSM having received money for sex (PR 2.9; 95%CI: 1.1-7.3), having taken a rapid HIV test before the study (PR 2.6; 95%CI: 1.0-6.7), and having used illicit drugs in the past three months (PR 4.4; 95% CI: 1.2-15.4). The results show a high prevalence of syphilis among AMSM, highlighting the high vulnerability of these to HIV and other STIs. They reinforce the importance of developing and implementing public policies aimed at AMSM to reduce their vulnerability.

The purpose of this article is to analyze factors contributing to treatment discontinuation among people living with HIV (PLHIV). The study draws on qualitative data from 30 in-depth interviews conducted in three Brazilian cities: Porto Alegre (9), Rio de Janeiro (10), and Manaus (11). In Manaus, respondents emphasized inadequate healthcare experiences and changes in primary providers as key triggers for discontinuity. In Rio de Janeiro, organizational dynamics within health services-such as failure to honor scheduled appointments-were identified as significant, often compelling individuals to miss work or arrive late, creating tensions between health and livelihood. In Porto Alegre, life-course disruptions were particularly salient, as they sever ties with providers and require effort to reestablish care. A paradox emerges wherein improved health and quality of life from antiretroviral therapy (ART) leads individuals to suspend treatment when they feel well. Despite these challenges, participants acknowledged the benefits of ART and expressed willingness to resume treatment, framing the interview process as an opportunity for reflection on adherence.

Acquired syphilis is a sexually transmitted infection. This ecological study analyzed the spatiotemporal heterogeneity of incidence and associated factors of acquired syphilis in Minas Gerais, Brazil, from 2011 to 2021, based on data from the Minas Gerais Health Surveillance Portal, distributed by Planning Regions according to João Pinheiro Foundation. Generalized additive models investigated the relationship between incidence rates and year, while spatiotemporal analyses were conducted using the Satscan software. Correlations between incidence and social inequality indicators (Gini Index, Human Development Index) as well as Family Health Strategy coverage were assessed using Spearman and bivariate Moran analyses for the period 2017-2019. A conditional autoregressive model estimated risks in municipalities. A total of 83,432 cases of acquired syphilis were reported, predominantly among men, pardos individuals, those with a high school education, and aged 20-29 years. Municipalities with risks greater than 1 were concentrated in the Central region. Higher coverage was associated with lower disease incidence. Expanding access to primary care is essential to reduce the impact of regional disparities on the incidence of diseases like syphilis.

The recent mpox outbreak has caused public health concern worldwide and continues to represent significant challenges. This article aims to analyze the epidemiological scenario (incidence and distribution in subgroups) of confirmed and probable cases of mpox, and describe the demographic characteristics related to sexual activity, type of contact with a suspected case, symptoms, comorbidities, characteristics of the lesion and evolution of the case, in the state of Minas Gerais, Brazil, from June 2022 to May 2023. Epidemiological, cross-sectional study, with confirmed and probable cases of mpox in Minas Gerais, Brazil. 759 confirmed and probable cases of mpox infection were reported, with 81.16% confirmed and 18.84% probable. Significant associations (p<0.05) were identified between cases and variables such as sex at birth, education, gender identity, sexual orientation, sexual behaviors, close exposure, probable form of transmission, immunosuppression and co-infection with HIV. The majority of cases occurred in men, homosexuals or men who have sex with men, with prevalence among individuals with multiple sexual partners. The findings allow improvements to be implemented in the information system and planning of preventive measures.

BackgroundOwing to a longer life expectancy, the first large cohort of women living with HIV are experiencing menopause. While the biological and social impacts of menopause have been well documented, research regarding medical and personal support systems to help navigate the menopause transition, especially in the setting of HIV, is scarce.ObjectivesThis study explored factors influencing a supported menopause transition for women living with HIV.DesignWe conducted a qualitative study examining factors influencing menopause support for women living with HIV guided by the socio-ecological model of health and an intersectional framework.MethodsWomen living with HIV who self-identified as perimenopausal or postmenopausal at time of the study were recruited through purposive and snowball sampling across British Columbia (BC) and Ontario (January to August 2023). Seven focus groups (n=40) were conducted in-person (n=4) and virtually (n=3) to explore women's menopause experiences. Reflexive thematic analysis was conducted using NVivo.ResultsParticipants had a median age of 52 years (interquartile range 47-58). Forty four percent (44%) identified as African/Caribbean/Black, 31% White, 18% Indigenous and 8% South Asian/multiracial. Participants highlighted the need for increased menopause awareness among women and providers, destigmatization, and holistic support that acknowledges diverse cultural contexts. Living with HIV influenced women's support-seeking behaviors, shaped by positive and negative impacts of long-term healthcare engagement and experience of intersecting stigmas related to HIV, menopause, and ageism. Women underscored the importance of peer and experiential support, as well as timely menopause education, particularly before and during midlife clinical visits.ConclusionFindings underscore the need for holistic menopause support by, with, and for women living with HIV. Many women felt inadequately supported, emphasizing the importance of expanding educational resources for women and healthcare providers, adopting a person-centered approach that prioritizes peer-led initiatives, and integrating culturally safe practices into menopause care.

The HIV reservoir that establishes early upon infection and persists in tissues remains the primary barrier to a functional cure. While progress has been made to study the reservoir in blood compartments and specific cell types, knowledge gaps remain on the tissue microenvironment that facilitates persistence. The development of a novel immunoPET/CT-guided spatial transcriptomics pipeline has enabled the localization of foci of viral infection in tissues, rare events that are challenging to sample. Prior studies leveraging the pipeline have characterized the viral microenvironment (VME) gene signatures, cell types and interactions, and host transcriptome gene drivers of viral persistence. Detailed characterization of the VME revealed multiple shared features with certain tumor microenvironments (TMEs), suggesting shared immunoregulatory and survival mechanisms. In this study, we apply the immunoPET/CT-guided spatial transcriptomics pipeline in the SIVmac239/rhesus macaque model to define immune mechanisms underlying persistent versus transient HIV/SIV reservoirs. We utilize a systematic approach to highlight correlates between the VME and TME transcriptional programs, gene pathways, local tissue neighborhoods, cell-cell interactions, and host transcriptomic drivers. Analysis of broad transcriptional programs revealed SIV-localized spatial enrichment of genes associated with multiple cancer subtypes. The persistent reservoir was characterized by gene pathways of "cold" TMEs (e.g., epithelial to mesenchymal transition, TGFβ activation) whereas the transient reservoir was comparable to "hot" TMEs with cytotoxic immune activation. Cell-cell interaction analysis identified regulatory T cells as a key mediator of interactions in both persistent and transient reservoirs. Machine learning identified KRT8, EPCAM, and RRM2, genes with known roles in mediating carcinogenesis, among the top host transcriptomic drivers of the TME phenotype of the persistent VME. Collectively, the findings of this study provide novel and transformative insights on key mechanisms of HIV/SIV persistence and reveal potential targets for immunotherapeutic strategies aimed at reservoir disruption or clearance towards a functional HIV cure.