Search Results (1,528)

HIV-associated neurocognitive disorders (HAND) persist despite effective antiretroviral therapy, indicating that chronic neuroimmune dysfunction extends beyond active viral replication. Among HIV-1-derived factors, the viral proteins Tat and gp120 are contributors to sustained brain inflammation. Nevertheless, their comparative impact in genetically vulnerable neural environments remains unclear. Here, we performed a secondary transcriptomic analysis of publicly available RNA-seq data derived from the striatal tissue of hSNCA^A53T Gba1^+/L444P mice, a model combining α-synuclein overexpression with Gba1-associated lysosomal impairment, following unilateral intrastriatal injection of Tat or gp120. Both proteins induced robust transcriptional remodelling selectively in the injected striatum. Tat primarily elicited a broad inflammatory amplification programme encompassing innate immune sensing, chemokine recruitment, adaptive immune engagement, and loss of homeostatic support. gp120 preferentially activated antigen presentation, complement, oxidative stress, and lysosomal–phagocytic effector pathways consistent with immune-mediated synaptic stress. Despite these distinct profiles, Tat and gp120 converged on a shared microglia-centred effector core. Contralateral striatal tissue was analyzed as distal non-injected tissue to explore the spatial distribution of transcriptional responses and minimal and protein-specific effects were reported. These findings provide a mechanistic framework for HAND heterogeneity and suggest that HIV protein-driven neuroimmune transcriptional programmes may create a molecular environment compatible with increased neurodegenerative vulnerability in lysosome-compromised, α-synuclein-sensitized brains. Full article

Background: People living with human immunodeficiency virus (HIV) (PLWH) remain at increased risk of severe COVID-19 outcomes; however, conflicting evidence exists regarding the seroconversion rates of COVID-19 vaccines in this population. Methods: A systematic review and meta-analysis were conducted on studies reporting seroconversion outcomes following COVID-19 vaccination in PLWH. Results: Forty-four studies (5391 PLWH) were included in the meta-analysis. The overall pooled seroconversion proportion was 93.5%. Bootstrap analysis confirmed robustness (92.8%). Subgroup analyses revealed significantly higher seroconversion rates for mRNA vaccines (98.2%) compared to non-mRNA vaccines (80.5%). CD4 count demonstrated a graded association: <200 cells/mm³ (53.8%), 200–500 cells/mm³ (86.2%), and >500 cells/mm³ (93.5%). Prior COVID-19 infection (99.1% vs. 89.5%) and antiretroviral therapy (ART) status (93.5% vs. 49.6%) were significant determinants. Safety data demonstrated a favorable profile, with predominantly mild-to-moderate local (injection-site pain: 23.8%) and systemic (headache: 12.95%, fatigue: 6.4%) adverse events; serious adverse events were rare and no consistent association with HIV disease progression was observed. Conclusions: COVID-19 vaccination induces high seroconversion rates in PLWH, particularly among those receiving mRNA vaccines, with preserved CD4 counts, on ART, or with prior infection. Full article

Background: Despite improved outcomes with antiretroviral therapy, HIV-associated lymphoma (HAL) remains a major cause of mortality. Autologous stem cell transplant (ASCT) may be curative for relapsed/refractory (R/R) HAL, but HIV-related immunosuppression complicates management. We systematically reviewed prospective evidence on ASCT efficacy and toxicity in HAL. Methods: PubMed, Cochrane, Embase, and ClinicalTrials.gov were searched for publications between 1 January 1996 and 21 June 2026, with an initial search in January 2024 updated in June 2026. Non-English studies, retrospective analyses, studies with fewer than 10 eligible patients, and studies of primary CNS lymphoma were excluded. Studies of first-line ASCT were included for toxicity analysis but excluded from efficacy analysis. Analyses were performed using MedCalc v22.032. Results: 378 titles were screened, 350 underwent abstract review and 40 full-text review. Six non-randomized prospective studies were identified. Identified trials included a total of 134 patients (33 Hodgkin lymphoma, 101 non-Hodgkin lymphoma). Median age and CD4 counts reported by individual studies ranged from 39 to 47 years and 172–279 cells/µL, respectively; 94.2% of patients were male. All patients received antiretroviral therapy at time of ASCT. Pooled six-month non-relapse mortality (NRM) was 5.39% (95% CI: 2.28–9.73). Among the 52 R/R HAL patients with survival data available, estimated 2-year overall survival (OS) and progression-free survival (PFS) were 79.8% (95% CI: 68.1–89.3) and 77.9% (95% CI: 65.9–87.8), respectively. Conclusions: In this first systematic review and meta-analysis of ASCT for HAL, NRM post-ASCT is consistent with historical trial results in the non-HIV population. OS and PFS are encouraging, but prospective data are limited and comparative data is absent. Full article

Theories on the early steps of the HIV-1 life cycle have been radically revised over the past five years. The long-held assumption that the capsid fully disassembles in the cytoplasm has given way to a more nuanced view: Cytoplasmic disassembly does occur and, in several myeloid systems, is increasingly linked to cytosolic cDNA sensing and to abortive infection. However, a substantial fraction of intact or nearly intact capsid cores instead traverse the nuclear pore complex (NPC) and, upon interacting with the host factor CPSF6, induce liquid–liquid phase separation. This leads to the formation of biomolecular condensates, termed HIV-1 membraneless organelles (HIV-1-MLOs), which subsequently merge with nuclear speckles (NSs). In this Perspective we read these condensates along five interlocking axes. First, the virus drives the host phase separation of cleavage and polyadenylation specificity factor 6 (CPSF6), which quickly fuses with another MLO: the NS composed of the speckle scaffold factors, SON and SRRM2. Second, the resulting condensate behaves as a catalytic site that concentrates the reverse-transcription machinery and thereby promotes integration of the viral DNA into speckle-associated chromatin (SPADs). Third, the same compartment is the final layer of a stratified programme of innate immune evasion, shielding nascent double-stranded DNA from cGAS–STING after cytoplasmic restriction factors and sensors have been outmanoeuvred. Fourth, although demonstrated only in vitro, stable HIV-1-MLOs can maintain the viral RNA genome in the presence of a reverse-transcription inhibitor. Upon removal of the inhibitor, reverse transcription resumes, mirroring, to some extent, the situation in individuals undergoing interruption of antiretroviral therapy and suggesting that these structures may act as a pre-integration reservoir. Fifth, and still largely unexplored, the sanctuary has a pharmacological dimension: anatomical lymphoid compartments, and possibly the condensate itself through selective small-molecule partitioning, may limit antiretroviral drug access. We situate HIV-1-MLOs within the convergent condensate strategies of SARS-CoV-2 and other viruses, and we discuss the clinical, diagnostic, therapeutic, and vaccine implications, including capsid inhibitors as “block-and-expose” tools. Full article

Sustained maternal HIV viral-load (VL) suppression during breastfeeding is essential for eliminating vertical HIV transmission in Sub-Saharan Africa. Although vertical transmission prevention programmes have improved antiretroviral therapy coverage and peripartum outcomes, viral control may deteriorate after delivery. This decline may result from psychosocial stressors, fragmented mother–infant services, and delayed return of results. This review examines post-delivery VL dynamics, breastfeeding-associated transmission risk, and the limitations of binary suppression thresholds. We suggest that post-delivery VL monitoring should be implemented as a rapid-action pathway. In this approach, detectable viraemia during breastfeeding should prompt a timely reassessment of adherence and repeat VL testing. Regimen review and additional measures to reduce the risks for both the mother and infant should be implemented where indicated. We also examine the individual, relational, structural, and health system determinants of post-delivery viraemia and lost to follow-up, including intimate partner violence. Finally, we highlight service delivery innovations that may improve maternal VL suppression and HIV-free infant survival rates. Full article

Background: South Korea has documented HIV cases since 1985; however, comprehensive longitudinal analyses integrating incidence, mortality, transmission dynamics, and immunological staging across the full surveillance period remain limited. This study aimed to characterize epidemiological trends from 1985 to 2024 and project future trajectories through 2028. Methods: We analyzed nationally reported aggregate HIV/AIDS surveillance data from the Korea Disease Control and Prevention Agency (KDCA) via KOSIS (1985–2024). Annual HIV incidence, AIDS case notifications, HIV-related mortality, transmission route distributions, CD4+ T-cell counts at diagnosis, and cumulative prevalent cases stratified by sex were examined. Statistical methods included simple and multiple linear regression, Pearson and Spearman correlation, hierarchical regression analysis, and time series forecasting using Holt–Winters exponential smoothing and ARIMA (AutoRegressive Integrated Moving Average) modeling. Missing data in transmission route classification (29.6% non-response in 2024) were addressed through sensitivity analysis and explicit discussion of potential misclassification bias. Results: HIV annual incidence increased significantly from one case in 1985 to a peak of 1081 in 2014 (slope = +39.25 cases/year, R² = 0.912, p < 0.001), followed by a significant decline to 714 cases in 2024 (slope = −38.76 cases/year, R² = 0.879, p < 0.001). A strong positive correlation was observed between HIV and AIDS incidence (Pearson r = 0.627, p = 0.017; Spearman ρ = 0.785, p < 0.001). The AIDS/HIV notification ratio declined significantly from 0.307 in 2011 to 0.196 in 2024 (slope = −0.006/year, R² = 0.421, p = 0.012). The male-to-female notification ratio increased from 0.8:1 in 1987 to 22.0:1 in 2024 (R² = 0.600, p < 0.001). Among reported sexual transmissions, the proportion attributable to MSM increased from 0% in 1985 to 63.7% in 2024 (slope = +1.30%/year, R² = 0.804, p < 0.001). The proportional mortality rate declined significantly from 2.31% in 2011 to 0.93% in 2024 (slope = −0.105%/year, R² = 0.821, p < 0.001). Time series forecasting projected continued decline to approximately 666 new HIV cases and 105 AIDS notifications annually by 2028. Conclusions: The South Korean HIV epidemic has undergone a profound epidemiological transition—from heterosexual-predominant early growth through a 2014 peak toward a declining, MSM-concentrated trajectory—with mortality progressively decoupled from incidence through expanded antiretroviral therapy coverage. Targeted MSM-focused prevention, expansion of PrEP access, and sustained ART scale-up are essential to achieving national HIV elimination targets. Full article

Background/Objectives: Many HIV-positive (HIV+) males receiving highly active antiretroviral therapy (HAART) experience metabolic complications, including non-alcoholic fatty liver disease (NAFLD); lipodystrophy; and intestinal dysbiosis, often characterized by a Prevotella-rich enterotype. Gut microbial fermentation produces short-chain fatty acids (SCFAs), which play important roles in host metabolism. This study investigated the relationships among HAART, anthropometrics, diet, intestinal permeability, gut microbiota composition, and lipodystrophy in HIV+ males. Methods: Forty males aged 23–60 years were enrolled, including 19 HIV+ participants recruited from the East Tennessee State University (ETSU) Health Infectious Diseases Specialty Clinic and 20 HIV-negative (HIV−) controls recruited through standard methods. Participants provided a stool sample for 16S rRNA gene sequencing, SCFA analysis by gas chromatography, and proximate analysis, and completed a food frequency questionnaire. Lipodystrophy-related measures included body mass index (BMI), hip-to-waist ratio (H:W), and liver health assessment using FibroScan. Blood samples were collected by venipuncture. Serum markers of intestinal permeability, including Claudin-21, flagellin, and intestinal fatty acid-binding protein (IFABP), were quantified by enzyme-linked immunosorbent assay (ELISA). Results: HIV+ males exhibited significantly higher H:W ratios (p = 0.001) and hepatic steatosis (p = 0.0047) than HIV− controls (Welsh’s t-test). Concentrations of isobutyrate (p = 0.0024), isovalerate (p = 0.0008), and valerate (p = 0.0329) were elevated in HIV+ participants, whereas butyrate (p = 0.0014) and total acetate/propionate/butyrate (APB) (p = 0.0046) were higher in HIV− males (Welsh’s t-test). HIV+ participants also showed greater abundances of Prevotella and Lachnospiraceae (Analysis of Compositions of Microbiomes; ANCOM). Retrospective analysis revealed that all HIV+ participants were men who have sex with men (MSM). Conclusions: HIV+ males demonstrated distinct gut microbiome profiles, altered SCFA production, and markers of disrupted lipid metabolism. These findings provide a foundation for future investigations of microbiome-metabolism interactions in HIV+ MSM. Full article

Hepatitis B virus (HBV) infection remains a major driver of liver-related morbidity and mortality among people living with HIV (PLWH), yet vaccine-induced protection is frequently suboptimal. HIV-associated immune dysfunction, including CD4⁺ T-cell depletion, altered antigen presentation, impaired T follicular helper cell support, and B-cell dysregulation, reduces seroprotection after standard recombinant HBV vaccines and may limit durability of antibody responses. Vaccine response is further influenced by HIV viral suppression, age, comorbidities, prior vaccine history, and baseline HBV serologic status, including isolated hepatitis B core antibody (anti-HBc) and occult HBV infection (OBI) considerations. Although antiretroviral therapy (ART) improves vaccine responsiveness, many PLWH fail to achieve protective hepatitis B surface antibody (anti-HBs) titers (≥10 mIU/mL) after conventional schedules, or experience antibody waning over time. Current guidelines recommend HBV vaccination for all susceptible PLWH with post-vaccination serologic testing and revaccination for nonresponders. Persistent implementation barriers, including incomplete series, vaccine hesitancy, stigma, and logistical constraints, continue to limit real-world impact. Emerging clinical trial data support CpG-adjuvanted HBV vaccines (HepB-CpG/Heplisav-B) and intensified dosing and schedules (double-dose or four-dose regimens) to improve seroprotection and generate higher peak anti-HBs titers, which may enhance durability. This review synthesizes guideline recommendations, immunologic mechanisms of hyporesponsiveness, predictors of vaccine response, and practical strategies to optimize HBV vaccination in PLWH. Full article

Background: The Eastern Cape Province carries the second-highest antenatal HIV prevalence nationally (32.9%), yet province-level longitudinal data on HIV incidence among pregnant and breastfeeding women (PBW) remain limited. This study examined trends in HIV incidence, HIV prevalence, mother-to-child transmission (MTCT), and antiretroviral therapy (ART) coverage among PBW in the Eastern Cape from 2000 to 2023. Methods: A quantitative ecological design was employed using secondary analysis of modelled estimates from the Thembisa Provincial HIV Model, version 4.8. Annual HIV incidence in PBW, HIV prevalence in pregnant women (overall and by five-year maternal age group), MTCT rate, new MTCT cases, and ART coverage were extracted with 95% confidence intervals (CIs) for the Eastern Cape, 2000–2023. Descriptive analysis characterised temporal trends at seven reference years, and formal trend significance was assessed using the Mann–Kendall test and log-linear regression. Results: HIV incidence in PBW declined from 3.8% (95% CI: 3.7–3.9) in 2000 to 1.8% (95% CI: 1.3–2.4) in 2023, a relative reduction of approximately 53%. ART coverage rose from 0% to 71.6%, coinciding with an 88% reduction in MTCT rate from 31.3% to 3.6%. By 2023, the MTCT rate had crossed below the World Health Organization 5% elimination threshold. HIV prevalence among pregnant women remained high at 25.0% despite declining incidence. The age distribution of HIV burden shifted markedly toward older maternal cohorts: prevalence among women aged 40–49 years increased from 9.9% in 2000 to 46.5% in 2023, while prevalence in the 15–24 age group declined substantially. New MTCT cases fell from 9990 in 2000 to 1236 in 2023. Conclusions: Declining HIV incidence in PBW coincided with substantial ART scale-up in the Eastern Cape, while HIV prevalence among pregnant women remained persistently high, a divergence that reflects the accumulating, ART-sustained pool of women living with HIV who survive into older reproductive age rather than a reversal of programmatic progress; this divergence between declining incidence and persistent, ageing prevalence is the central epidemiological finding of this study. Targeted interventions, including age-responsive antenatal protocols and strengthened PMTCT retention, alongside more careful consideration of expanded pre-exposure prophylaxis (PrEP) access, are needed to achieve elimination of mother-to-child transmission. Full article

Tuberculosis, malaria, and HIV are infectious diseases that have become major global health problems. Efforts to reduce the incidence and mortality of tuberculosis have undergone a long process, resulting in a significant annual decrease of up to 2%. In a single year, malaria cases can reach nearly 230,000,000, with up to 400,000 deaths worldwide. Meanwhile, approximately 37,000,000 people were living with HIV worldwide in 2020, with about 690,000 deaths due to AIDS reported in the same year. Within the framework of the Sustainable Development Goals (SDGs), particularly Goal 3 on good health and well-being, one of the key targets is to end the epidemics of tuberculosis, malaria, and HIV. This research examines the effects of various interventions on tuberculosis, malaria, and HIV coinfection. The interventions considered include preventive measures, mosquito nets, insecticides, contraception, tuberculosis treatment, malaria treatment, and antiretroviral (ARV) therapy for HIV. The mathematical model of tuberculosis, malaria, and HIV coinfection is well-defined, as it is proven to have non-negative solutions, to be bounded, and to remain within the positive invariant region. The tuberculosis, malaria, and HIV sub-models each have an asymptotically stable equilibrium when the basic reproduction number is less than one. Based on the results of numerical simulations of the sub-models, it can be observed that when the basic reproduction number exceeds one, the disease spreads throughout the population. Full article

Human endogenous retroviruses (HERVs) originate from ancient retroviral integration into the primate germline. Although most are defective proviruses, the most recently endogenized groups, like the HERV-K family, retain intact ORFs encoding retroviral proteins. HERVs usually remain transcriptionally silent, yet this status is reversible. Multiple HIV-HERV interactions, mainly mediated by the HIV Tat protein, lead to HERV transcription and protein production. The present study investigates HERV-K transcription in particular of Human MMTV-like (HML) group-2 and 6 in peripheral blood of people with HIV (PWH). Using different experimental approaches—such as single-cell and plasma transcriptomics-, we found that HERV-K transcripts may be detected during both acute and chronic phases of the infection, with HML-6 showing higher expression compared to HML-2, predominantly within myeloid cells. Effective combined antiretroviral therapy (cART) was able to significantly reduce HML-6 transcription, regardless of whether the treatment was initiated in the acute or late chronic phases of HIV infection. Notably, chronic infections showed higher HML-6 transcript levels compared to acute infections in both naïve and successfully cART-treated subjects, potentially associated with persistent immune dysregulation observed in chronic HIV infection, although a direct causal role of HML-6 expression remains to be established. Full article

Background: Opportunistic infections remain a significant cause of morbidity among people living with HIV (PLHIV) in sub-Saharan Africa despite expanded access to antiretroviral therapy (ART). This study evaluated the association between immune status, viral load suppression, ART adherence, and the risk of opportunistic infections among HIV-positive patients receiving ART in the rural Eastern Cape, South Africa. Methods: A retrospective cross-sectional study was conducted using clinical records of HIV-positive patients attending an HIV clinic in Mthatha between January 2021 and December 2024. Demographic characteristics, CD4 counts, viral load results, ART regimens, adherence status, and documented opportunistic infections were extracted. Viral load suppression was defined according to WHO guidelines as <1000 copies/mL. CD4 counts were categorized as <200, 200–499, and ≥500 cells/mm³. Multivariable logistic regression analysis was performed to identify independent predictors of opportunistic infections. Results: A total of 155 patients (105 females, 50 males) were included. Females demonstrated significantly higher mean CD4 counts than males (p = 0.037) and better ART adherence (p < 0.001). Tuberculosis, hepatitis B virus, and herpes simplex virus infections were more prevalent among males, whereas candidiasis was significantly more common among females (p = 0.034). In multivariable analysis, CD4 count < 200 cells/mm³, unsuppressed viral load, and poor ART adherence were independently associated with increased odds of opportunistic infections. Conclusions: Immune suppression and suboptimal ART adherence significantly increase the risk of opportunistic infections among HIV-positive patients in rural South Africa. Strengthening adherence interventions and early immune monitoring may reduce infection burden in high-prevalence settings. Full article

Background: Demonstrating durable viral suppression after switching to dolutegravir/lamivudine in clinical practice solidifies its use. Methods: This was a prospective cohort (DUALING) study conducted in 24 Dutch HIV treatment centers. HIV-RNA-suppressed cases undergoing triple-drug antiretroviral therapy without prior virological failure or resistance who switched to dolutegravir/lamivudine (cases) were 1:2 matched to controls, who remained on triple-drug antiretroviral therapy. Matching was stratified by dolutegravir use in the triple-drug antiretroviral therapy, and further by age, sex, HIV acquisition route, CD4⁺T-cell nadir, and HIV-RNA zenith. The primary endpoint was the treatment failure rate at 2 years, determined using intention-to-treat and on-treatment analyses with a 5% noninferiority margin. Results: The 2040 mostly male (84.3%) participants included 390 cases of dolutegravir-based triple-drug regimens with 680 controls, and 290 cases of non-dolutegravir-based triple-drug regimens with 580 controls. In the dolutegravir-based cases and controls, treatment failure occurred in 12.6% and 23.3% of patients in the intention-to-treat analysis (difference: −10.7%, 95%CI: −15.3% to −6.1%) and 2.6% and 2.4% of patients in the on-treatment analysis (difference: +0.2%, 95%CI −1.9% to +2.3%). The treatment failure risk in non-dolutegravir-based cases and controls was 15.2% and 19.9% in the intention-to-treat analysis (difference: −4.7, 95%CI: −10.0% to +0.6%) and 1.2% and 1.9% in the on-treatment analysis (difference +0.7%, 95%CI −2.6% to +1.1%). Therapy modifications unrelated to virological failure explained the higher treatment failure rate in the intention-to-treat analysis. In dolutegravir/lamivudine cases, a shorter time of prior triple-drug antiretroviral therapy, age < 50 years, and non-Western origin were associated with treatment failure in the multivariable analysis. Viral blips occurred in 6.8% of cases and 5.1% of controls. In the post hoc analysis, discontinuing tenofovir disoproxil fumarate-based triple-drug antiretroviral therapy led to weight gain in people with (+2.7 kg) and without (+2.3 kg) prior dolutegravir use. Conclusions: In this nationwide clinical practice study, switching to dolutegravir/lamivudine was noninferior to continuing triple-drug antiretroviral therapy after 2 years of follow-up. Full article

Background: The fight against HIV in the Democratic Republic of Congo (DRC) is hindered by systemic challenges; notably, limited access to HIV viral load (VL) testing. Achieving VL suppression is the primary global target for eliminating HIV as a public health threat by 2030. This study aimed to determine the rate of VL suppression and identify associated factors among people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Bunia. Methods: A descriptive and analytical cross-sectional study was conducted among PLHIV receiving care at treatment sites in Bunia over a period of 11 months. Participants were selected using a two-stage sampling approach, consisting of non-random quota sampling followed by simple random sampling. The primary endpoint was the proportion of PLHIV achieving VL suppression, while associated factors were identified using multiple logistic regression analysis. Results: Overall, 603 PLHIV were enrolled, including 180 males (29.9%) and 423 females (70.1%). The median age was 40 years (IQR: 32–48), median duration on ART was 38 months (IQR: 15–91), and VL suppression was achieved by 75% of the participants. While this indicates significant progress, it remains below the UNAIDS 95-95-95 targets. Adherence to antiretroviral therapy (aOR = 139.43; 95% CI: 66.63–291.76; p < 0.001) and being female (aOR = 2.15; 95% CI: 1.02–4.53; p = 0.044) emerged as independent predictors of virological success. Conclusions: Enhancing access to VL testing and optimizing ART adherence support strategies are critical to improving VL suppression rates in Bunia. Addressing these gaps is essential for the DRC to align with the global health objectives. Full article

Glutathione (GSH), the most abundant intracellular antioxidant, plays a central role in maintaining redox homeostasis, regulating immune responses, and protecting cellular integrity. In chronic diseases such as type 2 diabetes mellitus (T2DM), GSH deficiency is a consistent hallmark, contributing to oxidative stress, mitochondrial dysfunction, inflammation, and progressive organ damage. This review critically examines the efficacy and safety of GSH supplementation and precursor strategies, synthesizing evidence across mechanistic studies, clinical trials, and translational research. In T2DM, GSH augmentation has been linked to improved insulin sensitivity, reduced oxidative damage, and better microvascular outcomes, although findings remain preliminary and heterogeneous. Safety profiles across populations are highly favorable, with gastrointestinal discomfort being the most reported adverse effect and serious toxicities rare. Importantly, both acute and chronic studies reinforce the compatibility of GSH and its precursors with standard antiretroviral and antidiabetic therapies. Despite this encouraging data, significant research gaps remain. Standardization of biomarkers, dose–response mapping, and long-term outcomes are urgently needed to move from proof-of-concept to clinical trials. Future directions include integrating mechanistic endpoints such as mitochondrial function and multi-omic profiling, exploring targeted delivery systems, and embedding implementation science to ensure real-world feasibility and equity. Collectively, the emerging evidence supports GSH-centered strategies as promising adjuncts for oxidative stress-driven chronic disease. Rigorous, well-designed trials are now required to define their definitive role in clinical care. Full article