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Pathogens
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HIV/AIDS: Epidemiology, Drug Resistance, Treatment and Prevention
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HIV/AIDS: Epidemiology, Drug Resistance, Treatment and Prevention

A special issue of Pathogens (ISSN 2076-0817). This special issue belongs to the section "Emerging Pathogens".

Deadline for manuscript submissions: 15 July 2025 | Viewed by 6430

Special Issue Editors

Dr. Marta Pingarilho

E-Mail Website
Guest Editor
Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisboa, Portugal
Interests: epidemiology; transmission of infectious diseases; drug resistance; global public health
Dr. Mafalda N. S. Miranda

E-Mail Website
Guest Editor
Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisboa, Portugal
Interests: HIV-1; global health; drug resistance
Dr. Ana Barroso Abecasis

E-Mail Website
Guest Editor
Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Rua da Junqueira 100, 1349-008 Lisboa, Portugal
Interests: virology; evolution; bioinformatics; HIV- drug resistance; transmission of infectious diseases

Special Issue Information

Dear Colleagues,

Human immunodeficiency virus (HIV) is still a major public health concern worldwide. In 2022, there were 39 million individuals living with HIV, with 1.3 million new infections, 630,000 individuals dying from AIDS-related illness and 29.8 million individuals accessing antiretroviral therapy (ART) regimens.

With the increasing number of people under ART regimens and the improved genetic barrier of ARV regimens, the clinical outcomes of HIV-1-infected individuals significantly improved, thereby decreasing both mortality and morbidity rates. However, the emergence of HIV drug resistance is possible due to the fast evolutionary rate of HIV, its high level of genetic diversity and the selective pressure induced by ART.

Although some progress has been made toward achieving the UNAIDS goals for 2030 in some world regions, other regions are off-track. The transmission of HIV-1 is still occurring in the general population, and especially in specific populations such as men who have sex with men (MSM), intravenous drug users (IVDUs) and migrants.

While important and innovative prevention strategies, such as pre-exposure prophylaxis (PrEP), have shown success in preventing HIV-1 infection, their effectiveness in real-world situations is still under study. On the other hand, despite advances in HIV-1 treatment and prevention, the rate of HIV-1 drug resistance is still high and the emergence of drug resistance to second-generation integrase inhibitors is a major threat.

In this Special Issue, we want to invite you to submit your research to improve knowledge and spread awareness about this important topic that is still ongoing and can impact many lives.

Both original research and review articles are welcome. Potential topics include, but are not limited to:

  • Epidemiology of HIV;
  • Treatment and prevention of HIV;
  • HIV drug resistance;
  • HIV transmission and dynamics;
  • Artificial intelligence (AI) applied to HIV molecular epidemiology, treatment and prevention.

Dr. Marta Pingarilho
Dr. Mafalda N. S. Miranda
Dr. Ana Barroso Abecasis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pathogens is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • epidemiology of HIV
  • HIV drug resistance
  • HIV transmission
  • HIV treatment
  • HIV prevention

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Published Papers (5 papers)

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13 pages, 1019 KiB  
Article
HIV Drug Resistance Profile in Clients Experiencing Treatment Failure After the Transition to a Dolutegravir-Based First-Line Antiretroviral Treatment Regimen in Mozambique
by Nalia Ismael, Cidia Hussein, Cacildo Magul, Humberto Inguane, Aleny Couto, Amancio Nhangave, Ana Muteerwa, Mahoudo Bonou, Artur Ramos, Peter Wesley Young, Sonia Chilundo, Rhoderick Machekano, Lauren Greenberg, Juliana da Silva and Nilesh Bhatt
Pathogens 2025, 14(1), 48; https://doi.org/10.3390/pathogens14010048 - 9 Jan 2025
Viewed by 520
Abstract
Real-world data on HIV drug resistance (HIVDR) after transitioning to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) are limited. We assessed HIVDR rates and patterns in clients with virological failure (VF) after switching from an NNRTI-based regimen to TLD. A cross-sectional study was conducted in Gaza, [...] Read more.
Real-world data on HIV drug resistance (HIVDR) after transitioning to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) are limited. We assessed HIVDR rates and patterns in clients with virological failure (VF) after switching from an NNRTI-based regimen to TLD. A cross-sectional study was conducted in Gaza, Mozambique (August 2021–February 2022), including adults on first-line ART for ≥12 months who transitioned to TLD and had unsuppressed viral load (VL) ≥ 1000 copies/mL six months post-transition. After three adherence counseling sessions, participants with VF underwent genotyping for drug resistance mutations (DRMs) using the Stanford HIVdb Program. Of 717 participants (median age 39.2 years, 70.7% female), 217 (30.2%) had VF, 193 (88.9%) underwent genotyping, with 183 (94.8%) successfully genotyped. Intermediate–high dolutegravir (DTG) resistance was found in 19.6% (36/183). Unsuppressed VL before DTG transition was independently associated with VF (aOR: 2.14). Resistance patterns included 33.3% (12/36; 95% CI: 14.6–46.3) to all three TLD drugs, 55.6% (20/36; 95% CI: 39.3–71.9) to DTG and 3TC, and 11% (4/36; 95% CI: 0.8–21.3) to DTG only. Major drug resistance mutations to DTG included G118R (9.3%), R263K (6.6%), and Q148H/R/K (4.4%). This study highlights the need to consider virologic status before transitioning PLHIV to TLD and suggests that adherence counseling may not prevent resistance in those with unknown or prior VF. Full article
(This article belongs to the Special Issue HIV/AIDS: Epidemiology, Drug Resistance, Treatment and Prevention)
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9 pages, 1069 KiB  
Article
Estimating the Current Routes of Transmission in HIV-1 F1 Subtype Infected Persons in Romania: Differences Between Self-Reporting and Phylogenetic Data
by Robert Hohan, Simona Paraschiv, Ionelia Nicolae and Dan Oțelea
Pathogens 2024, 13(11), 960; https://doi.org/10.3390/pathogens13110960 - 4 Nov 2024
Viewed by 945
Abstract
Monitoring the HIV epidemic in Romania has proven challenging due to many factors, including the reluctance of newly diagnosed patients to disclose relevant epidemiological aspects during the clinical interview, such as sexual orientation or the existence of previous issues with injectable drug usage. [...] Read more.
Monitoring the HIV epidemic in Romania has proven challenging due to many factors, including the reluctance of newly diagnosed patients to disclose relevant epidemiological aspects during the clinical interview, such as sexual orientation or the existence of previous issues with injectable drug usage. We propose in this study a molecular approach to mitigate this problem with the help of bioinformatic tools, such as cluster analysis of phylogenetic trees. Both a maximum likelihood estimation, as implemented with FastTree, and a Bayesian approach, as used in BEAST, have been applied to our data set of 312 HIV subtype F1 pol gene sequences. ClusterPicker was used in order to identify groups of sequences and indicate similarities possibly related to the route of transmission. An important observation from this analysis is that transmission between men who have sex with men (MSM) is likely occurring in networks significantly larger than previously assessed by self-reported data (65% from the phylogenetic tree versus 37% from self-declared affiliation). Cluster analysis can help identify risk factors, reveal transmission trends, and, consequently, advise prevention programs. Full article
(This article belongs to the Special Issue HIV/AIDS: Epidemiology, Drug Resistance, Treatment and Prevention)
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11 pages, 556 KiB  
Article
Missed Opportunities for HIV Diagnosis and Their Clinical Repercussions in the Portuguese Population—A Cohort Study
by João Lourinho, Maria João Miguel, Frederico Gonçalves, Francisco Vale, Cláudia Silva Franco and Nuno Marques
Pathogens 2024, 13(8), 683; https://doi.org/10.3390/pathogens13080683 - 13 Aug 2024
Viewed by 1326
Abstract
Late human immunodeficiency virus (HIV) diagnosis has been associated with missed opportunities for earlier diagnosis. We conducted a retrospective, longitudinal, single-centre cohort study evaluating these missed opportunities and their clinical repercussions in adults with a new HIV diagnosis or who were drug-naïve, who [...] Read more.
Late human immunodeficiency virus (HIV) diagnosis has been associated with missed opportunities for earlier diagnosis. We conducted a retrospective, longitudinal, single-centre cohort study evaluating these missed opportunities and their clinical repercussions in adults with a new HIV diagnosis or who were drug-naïve, who attended our Infectious Diseases Department between 2018 and 2023. We assessed missed opportunities in the two years prior to diagnosis or after the last negative HIV test. We compared clinical and laboratorial data from individuals with and without missed opportunities. The primary outcome considered was AIDS-defining conditions at diagnosis. Among the 436 included individuals, 27.1% experienced at least one missed opportunity. Those with missed opportunities were more likely to be female (p = 0.007), older at their first consultation (p < 0.001), born in Africa (p < 0.001) and in countries with a high HIV prevalence (p < 0.001), and have heterosexual transmission (p < 0.001). The adjusted analysis showed that missed opportunities were significantly associated with AIDS-defining conditions at diagnosis (OR 3.23, CI 95% [1.62–6.46], p < 0.001). These findings highlight the impact of missed opportunities on HIV severity, underscoring the need for more targeted interventions to reduce them. Full article
(This article belongs to the Special Issue HIV/AIDS: Epidemiology, Drug Resistance, Treatment and Prevention)
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14 pages, 293 KiB  
Article
Sociodemographic, Clinical, and Behavioral Factors Associated with Sexual Transmitted Infection among HIV-1 Positive Migrants in Portugal: Are There Differences between Sexes?
by Mafalda N. S. Miranda, Victor Pimentel, Jacqueline Graça, Sofia G. Seabra, Cruz S. Sebastião, António Diniz, Domitília Faria, Eugénio Teófilo, Fausto Roxo, Fernando Maltez, Isabel Germano, Joaquim Oliveira, José Ferreira, José Poças, Kamal Mansinho, Luís Mendão, Maria João Gonçalves, Margarida Mouro, Nuno Marques, Patrícia Pacheco, Paula Proença, Raquel Tavares, Ricardo Correia de Abreu, Rosário Serrão, Telo Faria, BESTHOPE Study Group, M. Rosário O. Martins, Perpétua Gomes, Ana B. Abecasis and Marta Pingarilhoadd Show full author list remove Hide full author list
Pathogens 2024, 13(7), 598; https://doi.org/10.3390/pathogens13070598 - 19 Jul 2024
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Abstract
Introduction: Sexually transmitted infections (STIs) continue to occur at high levels. According to the WHO, each year there are an estimated 374 million new infections with syphilis, gonorrhea, chlamydia, and trichomoniasis. STIs are associated with an increased risk of acquiring HIV infection. Migrants [...] Read more.
Introduction: Sexually transmitted infections (STIs) continue to occur at high levels. According to the WHO, each year there are an estimated 374 million new infections with syphilis, gonorrhea, chlamydia, and trichomoniasis. STIs are associated with an increased risk of acquiring HIV infection. Migrants are reportedly highly affected by STIs. Objectives: This study aims to characterize factors associated with STIs in a population of HIV-positive migrants living in Portugal. Methodology: This is a cross-sectional observational study of 265 newly diagnosed HIV-1 positive migrants, who were defined as individuals born outside Portugal. This group of people were part of the BESTHOPE study that was developed in 17 Portuguese hospitals between September 2014 and December 2019, and included information collected through sociodemographic and behavioral questionnaires filled in by the migrant patients, clinical questionnaires filled in by the clinicians and HIV-1 genomic sequences generated through resistance testing (Sanger sequencing). A multivariable statistical analysis was used to analyze the association between sociodemographic characteristics, sexual behaviors, HIV testing and sexual infections. Results: Most HIV-1 positive individuals included in the study were men (66.8%) and aged between 25 and 44 years old (59.9%). Men had a higher proportion of STIs when compared to women (40.4% vs. 14.0%) and the majority of men reported homosexual contacts (52.0%). Most men reported having had two or more occasional sexual partners in the previous year (88.8%) and 50.9% reported always using condoms with occasional partners, while 13.2% never used it. For regular partners, only 29.5% of the women reported using condoms, compared to 47.3% of men. Other risk behaviors for acquiring HIV, such as tattooing and performing invasive medical procedures, were more prevalent in men (38.0% and 46.2%, respectively), when compared to women (30.4% and 45.1% respectively) and 4.7% of men reported having already shared injectable materials, with no data for comparison in the case for women. Additionally, 23.9% of women reported having had a blood transfusion while only 10.3% of men reported having had this medical procedure. Meanwhile, 30.9% of the individuals reported having been diagnosed with some type of STI in the last 12 months. In addition, 43.3% of individuals that answered a question about hepatitis reported to be infected with hepatitis B, while 13.0% reported having hepatitis C infection. According to the multivariable analysis, the only transmission route was significantly associated with reports of previous STI infection: men who have sex with men (MSM) were 70% more likely to have been diagnosed with an STI in the past 12 months compared to the heterosexual route. Conclusion: HIV-1 infected men were more likely to report previous STIs than women. On the other hand, most migrant women had a regular sexual partner and never or only sometimes used condoms. This somewhat discrepant findings suggest that gender inequalities may make women unable to negotiate safe sexual practices, resulting in increased susceptibility to infection. However, since migrant women report less STIs, we cannot exclude that these STIs may remain undiagnosed. The implementation of safer sex awareness campaigns for condom use and screening for STIs in women is crucial. On the other hand, health education campaigns for STI knowledge need to be implemented for both MSM and women and their partners. Full article
(This article belongs to the Special Issue HIV/AIDS: Epidemiology, Drug Resistance, Treatment and Prevention)

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15 pages, 1247 KiB  
Systematic Review
Respiratory Syncytial Virus among People Living with HIV: Is There a Case for Rolling Out Prophylaxis? A Viewpoint Based on a Systematic Review
by André Almeida, Raffaele Aliberti, Arianna Aceti and Matteo Boattini
Pathogens 2024, 13(9), 802; https://doi.org/10.3390/pathogens13090802 - 16 Sep 2024
Viewed by 1601
Abstract
Respiratory Syncytial Virus (RSV) is responsible for a considerable burden of respiratory disease among children and older adults. Several prophylactic strategies have recently been introduced. We review the available evidence on the interplay between RSV infection and HIV, looking at the specific role [...] Read more.
Respiratory Syncytial Virus (RSV) is responsible for a considerable burden of respiratory disease among children and older adults. Several prophylactic strategies have recently been introduced. We review the available evidence on the interplay between RSV infection and HIV, looking at the specific role of RSV prophylactic strategies in individuals affected by or exposed to HIV. We conducted a systematic review on the association between HIV infection and RSV incidence and severity. We searched in PubMed/MEDLINE for clinical epidemiological studies covering outcomes such as RSV-associated illness, severity, and mortality in individuals affected by or exposed to HIV. A total of 36 studies met the inclusion criteria and were included, the majority conducted in sub-Saharan Africa. There was no compelling evidence suggesting a higher incidence of RSV illness among HIV-infected people. A higher risk of severe disease was consistent among both HIV-positive and HIV-exposed but uninfected (HEU) children. Case fatality rates were also higher for these groups. Evidence on a differing risk among adults was scarce. HIV-positive pregnant women should be given priority for recently approved RSV vaccination, for protection of their newborns. HIV-infected and HEU infants should be considered risk groups for nirsevimab prophylaxis in their first year of life and possibly beyond. Full article
(This article belongs to the Special Issue HIV/AIDS: Epidemiology, Drug Resistance, Treatment and Prevention)
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