AIDS Research and Human Retroviruses

With the widespread use of antiretroviral therapy, the clinical spectrum among people with HIV has evolved significantly. This study aims to investigate the dynamic changes in the primary indications and final diagnostic spectrum of bone marrow examinations in this population. We conducted a retrospective analysis of 154 hospitalized individuals with HIV who underwent bone marrow examination at Mengchao Hepatobiliary Hospital of Fujian Medical University, the largest designated HIV/AIDS care hospital in Southeast China, from September 2019 to December 2025. Demographic, laboratory, and pathological data were collected, and participants were stratified into tumor and nontumor groups based on final diagnosis for comparative analysis. Among the indications for bone marrow examination, the proportion of procedures performed due to cytopenia decreased from 55.55% in 2019 to 17.86% in 2025. Conversely, the proportion performed for suspected hematological malignancy or to assess tumor marrow infiltration increased significantly from 11.11% to 60.71%. Final diagnoses revealed that the proportion of malignant tumors increased from 11.11% to 53.57%, whereas the proportion of opportunistic infections showed a declining trend. The Cochran–Armitage trend test confirmed that the proportion of opportunistic infections decreased significantly (p = .002), while the proportion of malignancies increased significantly (p = .002). Compared to the nontumor group, individuals in the tumor group were older, had significantly higher proportions receiving antiretroviral therapy, higher rates of HIV RNA suppression, as well as significantly higher CD4⁺ T-cell counts, CD8⁺ T-cell counts, lymphocyte counts, platelet counts, and lactate dehydrogenase levels. Our findings demonstrate that the clinical indications for bone marrow examination in people with HIV have shifted from the evaluation of traditional opportunistic infections and unexplained cytopenia toward the diagnosis and staging of malignant tumors, particularly hematological malignancies. These results suggest that in the contemporary management of HIV, greater emphasis should be placed on screening for malignancies.

Natural killer (NK) cell activation and function are controlled by highly complex transcriptional programs. To leverage NK cells against human immunodeficiency virus and other diseases, a more complete understanding of signaling and metabolic dynamics is needed. In this study, we utilize a rhesus macaque (RM) model to define the transcriptomic profile of NK cells during acute lentiviral infection and to map the changes in this profile as infection progresses to the early chronic phase. Using a novel summary gene set for NK cell cytokine stimulation, we report synchronous metabolic and signaling transcriptional patterns that underlie established features of NK cell dysfunction. Assessing gene expression induced by the SARS-CoV-2 challenge allowed us to confirm a set of core conserved gene pathways central to RM NK cell activation across diverse acute viral contexts.

This prospective cohort study compared the efficacy of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and tenofovir/lamivudine/efavirenz (TLE) regimens in 88 treatment-naïve persons living with HIV. The BIC regimen achieved faster HIV-1 RNA suppression at week 12, with comparable suppression thereafter. Regarding HIV-1 DNA, the TLE group exhibited a more rapid decline, largely attributable to its higher baseline levels, while both groups converged to comparable levels at week 48; this difference was no longer significant after adjusting for baseline HIV-1 DNA levels. Notably, the BIC group had significantly lower baseline CD4⁺ counts, reflecting the real-world inclusion of individuals with more advanced disease. Cluster analysis within the BIC group revealed three distinct DNA decay trajectories. A subset of individuals with the lowest baseline CD4⁺ counts (Cluster 1, n = 16) showed stable HIV-1 DNA through week 48 followed by significant decline only after 72 weeks, with CD4/CD8 ratio recovery preceding the decline. The early DNA plateau may reflect the interplay between immune reconstitution and viral reservoir dynamics. These findings suggest that baseline immune status influences early viral reservoir dynamics and that the timing of reservoir reduction may be linked to immune restoration, highlighting the heterogeneity of integrase inhibitor responses and the potential value of baseline immune assessment in guiding individualized management.

HIV phylogenetics is a powerful tool for elucidating HIV transmission dynamics, but ethical concerns have been raised about its use. We conducted a cross-sectional online survey among HIV professional stakeholders in Uganda to explore their knowledge of HIV phylogenetics and associated ethical considerations. Thirty-two participants completed the survey. 87% correctly defined HIV phylogenetics, but some were unable to recognize potential individual harms associated with HIV phylogenetic research (HPR). The most common individual and societal harms of HPR recognized were identification as an HIV transmission source 25 (78%; 95% CI, 61–89%) and marginalization of certain groups 27 (84%; 95% CI, 68–93%), respectively. Most strongly agreed that obtaining community assent 17 (53%; 95% CI, 36–69%) and specific informed consent for viral sequences used in HPR 20 (63%; 95% CI, 45–77%) were critical. Risks associated with HPR appear to be incompletely understood, underscoring the need to raise awareness of them among various professional stakeholders.

The cocirculation of CRF01_AE and CRF07_BC among men who have sex with men (MSM) in China may facilitate the emergence of genetically complex HIV-1 recombinants. Here, we identified and characterized a novel second-generation HIV-1 CRF01_AE/CRF07_BC recombinant, designated GY0192, from a 25-year-old MSM individual in Guiyang, Guizhou Province, southwest China, using near full-length genome (NFLG) analysis. Recombination analyses identified four breakpoints at HXB2 positions 3,125, 5,687, 6,375, and 9,176, generating a distinct five-segment mosaic genome. Subregion phylogenetic analyses showed that the two CRF01_AE-derived fragments clustered with the CRF01_AE cluster 5 lineage, while all three CRF07_BC-derived fragments grouped with CRF07_BC lineages frequently circulating among MSM in China, indicating that both parental components of GY0192 were phylogenetically related to lineages frequently reported among MSM populations in China. The virus was also predicted to be CCR5-tropic, adding epidemiological relevance because CCR5-tropic viruses are commonly involved in transmission and early infection. Together, these findings identify GY0192 as a distinct CRF01_AE/CRF07_BC mosaic and suggest that cocirculating MSM-associated HIV-1 lineages may provide opportunities for interlineage recombination. This case expands the known spectrum of CRF01_AE/CRF07_BC recombinants in Guizhou and underscores the value of NFLG-based surveillance for detecting underrecognized HIV-1 genetic complexity in southwest China.