Search Results (566)

The HIV epidemic in Romania started in the late eighties with a large cohort of children nosocomially infected with subtype F1 strains, in parallel with sexual transmission. The purpose of the present study was to investigate the transmitted drug resistance (TDR), subtype distribution, and transmission clusters among persons diagnosed with HIV between 2019 and 2022 in Romania. The prototype of a person recently diagnosed with HIV in Romania is male, 20–50 years old, a late presenter, infected with F1, B, or A subtype. The rate of TDR varied over time, from 5% in 2019 to 15% in 2022. TDR affected mainly the first generation of NNRTIs and the PI class. The rate of late presentation was almost 60%, with 35% of persons qualifying as very late presenters. Subtype F1 is still preponderant in Romania, whereas other subtypes (B, A) and recombinants account for a quarter of HIV-1 new cases. Several transmission networks were identified in the study population, two of them associated with TDR in subtypes F1 and A1. The largest cluster consisted of 26 sequences, originating from Western Romania and introduced around 2007. Molecular clock analysis indicated different origin time points for different clusters, with the most recent in subtypes A1 and B, and the oldest in subtype F1. In conclusion, the HIV-1 epidemic in Romania is currently driven by sexual transmission, with MSM contribution continuously rising in recent years; there are also increases in TDR and the circulation of HIV-1 strains other than F1 (subtype B, A, recombinants). Full article

Since 1997, a laboratory-based survey on cryptococcosis has been conducted in Colombia. We present the results for the period 2017–2024. A total of 891 surveys were received. The overall incidence was 0.22 cases per 100,000 people. Among those living with HIV, the incidence was 38, and among HIV-negative people, it was 0.08. Cryptococcosis demonstrated a higher prevalence among men than women (3.2:1). Among patients living with Human Immunodeficiency Virus (HIV), the condition primarily affected younger adults (26–40 years). In contrast, among HIV-negative people, it was mostly observed in older adults (≥60 years). HIV infection was the most significant risk factor (63%), but another cause of immunosuppression was identified in 21.2% cases. Neurocryptococcosis was the most common form of presentation (62.2%), followed by disseminated cryptococcosis (31.1%). The diagnosis was confirmed by culture in 99.4% of patients; the most important sample was cerebrospinal fluid (67.3%), followed by blood (35.4%). Cryptococcus neoformans was identified in 93.1% of cases, and Cryptococcus gatti in 6.9%. Predominant molecular patterns were VNI (92.4%) and VGII (45.3%). The epidemiology of cryptococcosis in Colombia is changing, with a progressive decrease in HIV coinfection and an increase in other immunosuppressive conditions in older people. This study highlights the importance of cryptococcosis in Colombia and the need to report it in order to improve knowledge and thereby promote the quality of diagnosis and the opportunity for more effective treatment. Full article

National Tuberculosis Reference Laboratories (NTRLs) are central to tuberculosis (TB) control programs. Between 2018 and 2024, the Republic of Congo, a country of 6 million inhabitants, achieved a transformative strengthening of its TB diagnostic system, coordinated by the NTRL. Strategic investments, supported mainly by international partners, enabled a substantial decentralization of services, expanding the diagnostic network from 38 to 113 diagnostic and testing centers and increasing GeneXpert sites from 3 to 31. The expansion of the diagnostic network and specimen referral system was associated with a reduced structural gap in diagnostic coverage by extending access to GeneXpert testing to a larger number of peripheral and previously underserved centers. Critically, the establishment of a BSL-3 laboratory and the deployment of advanced assays like Xpert MTB/XDR ended the reliance on overseas testing by introducing in-country capacity for multidrug-resistant and pre-extensively drug-resistant TB detection. These systemic improvements were associated with significant positive outcomes, including an annual molecular testing surging from 11,609 in 2022 to over 27,000 in 2024 and bacteriological confirmation rates rising from 34 to 73%. This comprehensive laboratory systems strengthening, which also facilitated cross-programmatic initiatives like HIV and Mpox testing integration, underscores how sustained investment in infrastructure, logistics, and quality management is fundamental to improving case detection, surveillance, and progress toward the WHO End TB Strategy milestones. Full article

Antiretroviral drugs are associated with increased body weight and metabolic disorders. Fat gain and insulin resistance are commonly associated with abdominal obesity in people with HIV (PWH). There is currently an open ongoing discussion about how antiretroviral therapy affects body weight and its significance in hunger–satiety circuit alteration. Until now, the impact of the drug on this circuit has not been explored. This study aimed to assess the hormones involved in appetite and satiety regulation in the serum and hypothalamus after efavirenz (EFV) administration in mice. EFV (10 mg/kg) and distilled water (1.5 μL/kg) (control group) were orally administered for 36 days to CD1 mice. Body weight and food intake were determined throughout treatment. At the end of the treatment, the metabolic profile (glucose, triglycerides, cholesterol) was assessed, and leptin, soluble receptor of leptin (sOB-R), and ghrelin were measured in serum; moreover, we evaluated the expression of growth hormone secretagogue receptor 1a (GHS-R1a), neuropeptide Y receptor 1 (NPYR1), and leptin in the hypothalamus, and a sucrose preference test (SPT) was conducted. Outcomes showed an increase in serum ghrelin and the expression of GHS-R1a and NPYR1 receptors in the hypothalamus, coinciding with an increase in appetite and preference for sucrose in mice in the EFV group. Furthermore, serum leptin, sOB-R, and the free leptin index (FLI) showed that hunger is not related to a lack of satiety. Despite increased food intake, a reduction in body weight was observed, and triglyceride and cholesterol levels were increased. According to our findings, mice treated with EFV showed a decrease in body weight, despite increased food intake resulting from appetite stimulation, which is caused by specific compounds, hormones, and neural signals acting on the brain’s hunger centres, primarily in the hypothalamus, promoting eating behaviours. However, further studies are necessary to investigate the mechanisms of EFV’s effects on energy expenditure. Full article

Herpes simplex viruses (HSV-1 and HSV-2) are highly prevalent human pathogens that establish lifelong latency in sensory neurons, posing a persistent challenge to global public health. Their clinical manifestations range from mild, self-limiting orolabial lesions to severe, life-threatening conditions such as disseminated neonatal infections, focal encephalitis, and herpetic stromal keratitis, which can lead to irreversible corneal blindness. Beyond direct pathology, HSV-mediated genital ulcerative disease (GUD) significantly enhances mucosal susceptibility to HIV-1 and other sexually transmitted infections, amplifying co-infection risk and disease burden. Despite decades of clinical reliance on nucleoside analogues such as acyclovir, the therapeutic landscape has stagnated with rising antiviral resistance, toxicity associated with prolonged use, and the complete inability of current drugs to eliminate latency or prevent reactivation continue to undermine effective disease control. These persistent gaps underscore an urgent need for next-generation antivirals that operate through fundamentally new mechanisms. Marine ecosystems, the planet’s most chemically diverse environments, are providing an expanding repertoire of antiviral compounds with significant therapeutic promise. Recent discoveries reveal that marine-derived polysaccharides, sulfated glycans, peptides, alkaloids, and microbial metabolites exhibit remarkably potent and multi-targeted anti-HSV activities, disrupting viral attachment, fusion, replication, and egress, while also reshaping host antiviral immunity. Together, these agents showcase mechanisms and scaffolds entirely distinct from existing therapeutics. This review integrates emerging evidence on structural diversity, mechanistic breadth, and translational promise of marine natural products with anti-HSV activity. Collectively, these advances position marine-derived compounds as powerful, untapped scaffolds capable of reshaping the future of HSV therapeutics. Full article

The global distribution of HIV-1 subtypes exhibits significant regional variations, with evolving epidemiological patterns over time. China currently experiences concurrent circulation of multiple HIV-1 subtypes, and the transmission landscape is becoming increasingly complex and diversified. We performed prospective molecular surveillance and drug-resistance profiling of HIV-1 in Wuhan City to delineate the local genotypic structure and to guide antiretroviral therapy. A total of 149 whole blood samples from HIV-1-infected individuals preserved in 2022 at a hospital in Wuhan were selected. Peripheral-blood mononuclear cells (PBMCs) were isolated, total RNA extracted, and the Gag, Pol, and Env regions were amplified by nested RT-PCR and sequenced. The sequencing and phylogenetic tree results revealed that subtype B constituted the predominant clade (73/149, 49.1%), followed by CRF07_BC (20, 13.4%), CRF01_AE (13, 8.7%), CRF55_01B (2, 1.3%), and subtype C (1, 0.7%). Drug resistance mutations were detected in 36 cases, involving 41 mutation sites across 21 distinct types. Resistance profiles included two protease inhibitor-associated mutation sites (2 types), seven nucleoside reverse transcriptase inhibitor (NRTI)-related mutation sites (6 types), and 32 non-nucleoside reverse transcriptase inhibitor (NNRTI)-associated mutation sites (13 types). Full article

HIV-1 integrase strand transfer inhibitors (INSTIs) are pivotal to antiretroviral therapy. However, the emergence of drug-resistant mutations necessitates the development of new agents. Here, we present ACC017 as a novel INSTI candidate. ACC017 demonstrated potent activity against the laboratory-adapted HIV-1_IIIB strain (EC₅₀ = 0.59 nM; SI > 34,525) and maintained efficacy against a panel of drug-resistant strains (EC₅₀ range from 0.34 to 9.12 nM) and clinical isolated strains (EC₅₀ range from 0.11 to 1.78 nM). Mechanism of action studies confirmed its ability to inhibit the integrase enzyme (IC₅₀ = 9.19 nM) and effectively block viral genome integration. Notably, in vitro resistance selection primarily yielded D232N and R263K mutations, without the emergence of G140S/A/C/R or Q148H/R/K. This promising profile, combined with synergistic interactions with other antiretroviral drugs, positions ACC017 as a potential therapeutic option. Full article

The increasing proportion of HIV-1 infections transmitted via non-marital non-commercial heterosexual contact (NMNCHC) in China necessitates a deeper understanding of its local characteristics. This study investigated the epidemiological, molecular network, and drug-resistant profiles among 400 newly diagnosed HIV-1 patients infected via non-marital heterosexual contact (NMHC), specifically its non-commercial subtype, in Lishui from 2020–2024. HIV-1 pol gene sequences were analyzed for subtypes, drug resistance mutations, and transmission clusters using phylogenetic and network methods (genetic distance threshold: 0.9%). The overall prevalence of transmitted drug resistance (TDR) was 13.3%, an intermediate level exceeding the national average, driven predominantly by NNRTI resistance (6.3%). High-level resistance to NVP (3.0%) and EFV (2.75%) was observed. CRF08_BC (43.8%) was the dominant subtype. Multivariate analysis identified female gender and higher education as significant risk factors for NMNCHC acquisition. Molecular network analysis incorporated 55.3% of cases, revealing clusters predominantly composed of middle-aged and elderly males, with CRF08_BC and CRF01_AE showing higher NMNCHC transmission risk within networks. These findings underscore an evolving epidemic with significant TDR and highlight the urgent need for targeted interventions, including enhanced resistance surveillance and focused strategies for the concealed NMNCHC population, to curb local HIV-1 transmission. Full article

Objective: The six-helix bundle (6-HB) is critical for HIV-1 membrane fusion. To disrupt this process, peptide inhibitors have been meticulously designed to target interactions within the 6-HB regions, thereby blocking membrane fusion and exerting inhibitory effects. Current peptide inhibitors like Enfuvirtide suffer from drug resistance and short in vivo half-life. This study aims to design novel anti-HIV-1 peptides by integrating heptad-repeat rules and membrane-anchor strategies. Methods: Artificial peptides were designed using HR rules from the HIV-1 gp41 6-HB motif and membrane-anchor modifications. Results: EK35S-Palm has emerged as a highly promising candidate for HIV-1 inhibition, exhibiting robust binding affinity to the target and effectively impeding the 6-HB spontaneous formation. Discussion: HR-based design avoids viral sequence homology, and membrane anchoring enhances local agent concentration, improving pharmacokinetics. The HR binding and membrane stabilization of EK35S-Palm provide synergistic inhibition. Conclusions: Integrating HR structural design with membrane-anchor strategies yields potent HIV-1 fusion inhibitors. EK35S-Palm demonstrates superior efficacy and stability over current therapies. These approaches hold great potential for overcoming the current therapy limitations and advancing the more effective and durable HIV-1 fusion inhibitors. Full article

Emerging evidence indicates a high rate (>10%) of drug resistance (DR) associated with integrase strand transfer inhibitors (INSTIs) in developed countries, although there is limited information on DR during INSTI treatment in Uganda. With the increased use of INSTIs as standard first-line treatment, monitoring for DR using next-generation sequencing (NGS) has become essential. NGS can detect the lower-frequency variants that may be missed by traditional Sanger sequencing (SS). This study evaluates the diagnostic accuracy of next-generation sequencing (NGS) compared to Sanger sequencing for detecting HIV-1 INSTI resistance mutations and estimates the prevalence and factors associated with drug resistance among adults with virologic failure on INSTI-based regimens in Uganda. Utilizing the Illumina MiSeq platform for NGS, data was analyzed using STATA V.18 and a logistic regression model at 5% level of significance. This study demonstrates that NGS achieved 100% sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in detecting major mutations. NGS identified INSTI DRMs in 4% of adults at a ≥20% threshold and was able to detect both high- and low-abundance variants, which could have important implications for clinical outcomes. This study emphasizes the need for HIVDR testing before antiretroviral therapy (ART) initiation, given the increasing use of INSTIs. We recommend that healthcare providers adopt more sensitive diagnostics such as NGS and use detailed resistance profiles to tailor antiretroviral therapies. This approach is critical for effectively managing and preventing drug-resistant HIV strains. Full article

Background/Objectives: Treatment adherence challenges affect 10–20% of tuberculosis patients globally, contributing to drug resistance and continued transmission. While artificial intelligence approaches show promise for identifying patients who may benefit from additional treatment support, most models lack the interpretability necessary for clinical implementation. We aimed to develop and validate an integrated artificial intelligence framework combining traditional machine learning (interpretable algorithms like logistic regression and decision trees), explainable AI (methods showing which patient characteristics influence predictions), deep reinforcement learning (algorithms learning optimal intervention strategies), and natural language processing (clinical text analysis) to identify tuberculosis patients who would benefit from enhanced treatment support services. Methods: We analyzed 103,846 pulmonary tuberculosis cases from São Paulo state surveillance data (2006–2016). We evaluated models using precision (accuracy of positive predictions), recall (ability to identify all patients requiring support), F1-score (balanced performance measure), and AUC-ROC (overall discrimination ability) while maintaining interpretability scores above 0.90 for clinical transparency. Results: Our integrated framework demonstrated that explainable AI matched traditional machine learning performance (both F1-score: 0.77) while maintaining maximum interpretability (score: 0.95). The combined ensemble delivered superior results (F1-score: 0.82, 95% CI: 0.79–0.85), representing a 6.5% improvement over individual approaches (p < 0.001). Key predictors included substance use disorders, HIV co-infection, and treatment supervision factors rather than demographic characteristics. Conclusions: This multi-paradigm AI system provides a methodologically sound foundation for identifying tuberculosis patients who would benefit from enhanced treatment support services. The approach delivers excellent predictive accuracy while preserving full clinical transparency, demonstrating that the accuracy–interpretability trade-off in medical AI can be resolved through the systematic integration of complementary methodologies. Full article

Background/Objectives: The emergence of drug-resistant HIV-1 strains challenges the long-term efficacy of current antiretroviral therapies. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are critical in HIV-1 treatment; however, the need for new candidates with improved resistance profiles and pharmacokinetics remains. This study aims to design and evaluate novel NNRTIs targeting both wild-type (WT) and mutant-type (MT) HIV-1 reverse transcriptase (RT) using integrated computational strategies. Methods: We conducted a 3D-QSAR study on 33 naphthyl-diarylpyrimidine derivatives using CoMFA and CoMSIA models. We designed thirty-five novel molecules based on contour map insights. We applied ADMET and drug-likeness filters to prioritize ten candidates. Molecular docking was performed on WT (PDB: 3HVT) and MT (PDB: 4PUO) RT structures. The top candidates underwent 100 ns molecular dynamics (MD) simulations. We analyzed structural stability via RMSD, RMSF, and Rg, while we used SASA and MolSA to assess solvent exposure and surface compactness. Results: The CoMFA and CoMSIA models demonstrated robust predictivity (R² = 0.979/0.920, Q² = 0.643/0.546, R²_test = 0.747/0.603). P14 and P43 showed higher binding affinities than nevirapine and favorable ADMET profiles. MD simulations confirmed stable binding in WT-RT and adaptive flexibility in MT-RT. SASA and MolSA analysis revealed favorable conformational compaction. Drug-likeness profiles indicated optimal log P, strong hydrogen bonding, and acceptable bioavailability. Conclusions: P14 and P43 demonstrate strong potential as NNRTI leads, combining binding affinity, structural stability, and favorable pharmacokinetics, supporting further experimental development. Full article

This study aimed to assess the genetic diversity of HIV-1 in the Far Eastern Federal District (Russia) to implement effective anti-epidemic measures, including the development of an anti-HIV vaccine and the selection of optimal antigens. The first stage of the study included an analysis of HIV-1 nucleotide sequences obtained in Khabarovsk city from 2022 to 2024. The second stage of the study included an additional download of nucleotide sequences from the Los Alamos HIV Sequence Database for phylogenetic cluster analysis. Additionally, an analysis of drug resistance mutations was conducted. The results showed the following distribution of HIV-1 genetic variants: A6—72.15%, CRF63—10.13%, URFs—7.59%, C—5.06%, B—3.8%, and CRF157—1.27%. The phylogenetic cluster analysis revealed a statistically significant difference in the number of clusters depending on the genetic variant. Among drug resistance mutations (DRMs), those associated with nucleoside reverse transcriptase inhibitors (NRTIs) were the most frequently observed, accounting for 55.7% (95% CI: 44.75%—66.65%). The most commonly detected NRTI DRMs were A62V (43.04%) and M184V (13.92%). The results of this study highlight several important indicators for public health, particularly in the development of vaccines aimed at combating HIV infection. Full article

Background: Antiretroviral adherence for incarcerated individuals living with HIV/AIDS in correctional service facilities remains a challenge. This study examined the experiences of professional nurses related to this issue in Limpopo Province, South Africa. Method: A qualitative, exploratory, descriptive, and contextual approach was employed in the Correctional Services Department facilities within the Vhembe District. The professional nurses were purportedly sampled. Data were collected through semi-structured telephone interviews and analysed thematically. Results: Three themes emerged: (1) professional nurses’ experiences with incarcerated individuals from foreign countries; (2) manipulative behaviours; and (3) misuse of antiretroviral therapy (ART) medication by incarcerated individuals. Conclusion: For public policy, the findings require the development of standardised guidelines for the management of foreign national incarcerated individuals and the implementation of anti-diversion strategies to prevent misuse of medications. For nursing practice, the results emphasise the importance of specialised training programmes that equip nurses to manage manipulative behaviours, enhanced supervision systems addressing moral distress, and structured adherence monitoring, including direct observed therapy for high-risk incarcerated individuals. These evidence-based interventions are essential to improve the outcomes of ART adherence, reduce treatment failure and drug resistance, and decrease HIV-related mortality in correctional settings while protecting general public health. Full article

The increasing prevalence of HIV drug resistance poses a significant challenge. This study aimed to investigate the epidemiological dynamics and molecular characteristics of pretreatment drug resistance (PDR) and acquired drug resistance in Shaoxing, Eastern China. Methods: From 2022 to 2024, 571 newly diagnosed HIV-infected individuals and 119 individuals with antiretroviral treatment failure were enrolled. Molecular transmission networks and Bayesian analysis were employed to identify key drug-resistant clusters and trace their origins. Results: The overall PDR prevalence was 14.4% (85/571). PDR to non-nucleoside reverse transcriptase inhibitors (NNRTIs) was 9.8% (56/571), significantly higher than to NRTIs (1.1%, 6/571) and PIs (3.7%, 21/571) (χ² = 50.014, p < 0.001). Molecular network analysis identified large clusters harboring K103N and Q58E resistance mutations within the CRF07_BC subtype. Bayesian analysis estimated their introduction into Shaoxing from Guangdong Province around 2016 and 2017, respectively. Integrated network analysis revealed close linkages between virological failure and newly diagnosed cases, highlighting the role of treatment failure in resistance transmission. Conclusion: Targeted interventions against specific subtypes and transmission clusters, alongside continuous resistance surveillance, are essential to curb the spread of drug-resistant HIV and optimize ART regimens. Full article