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[Articles] HIV-related mortality time trends among children and young adolescents on antiretroviral therapy by age, treatment duration, and region: a systematic review and meta-regression analysis

A comprehensive approach to paediatric HIV care is essential to improving outcomes for children and young adolescents living with HIV. Clinically, this approach includes strengthening the prevention of vertical transmission, ensuring early diagnosis in infants, and initiating treatment promptly—ideally at higher CD4 cell counts. From a policy perspective, health systems need to address disparities in treatment access and outcomes across regions, age groups, and sex. Efforts should also prioritise minimising treatment dropout and expanding access to high-quality HIV services.

[Articles] ART-free HIV-1 remission in children with in-utero HIV-1 after very early ART (IMPAACT P1115): a multicentre, open-label, phase 1/2 proof-of-concept study

This study shows that ART-free remission for 48 weeks or longer is achievable with very early ART in children with in-utero HIV-1, but close monitoring for viral rebound and acute retroviral syndrome during ATI is needed. These findings, observed in resource-constrained countries, exhibit the feasibility of testing at birth and initiating very early ART, show the potential to limit HIV-1 reservoirs for ART-free remission, and inform future remission strategies.

[Profile] Creating a space where young people with HIV can be free

For 5 days each year, around a hundred 11–17-year-olds living with HIV in the UK leave their families for a summer camp called Freedom 2 Be. For many of them, this is one of the only times outside of hospital appointments where they speak openly about HIV. Although most of the adolescents have been told that HIV treatments are effective, they may have picked up other messages from their families: you must keep this a secret, do not tell your friends, people are not going to accept you.

[Comment] Dolutegravir in neonates: finally we are getting there!

Dolutegravir, a potent second-generation integrase strand inhibitor (INSTI), is the backbone of HIV treatment regimens for most children aged 1 month or older, adolescents, and adults with HIV globally. Neonates (aged 28 days or younger) have been the last to benefit, receiving more toxic and less efficacious antiretroviral medications for both prophylaxis and treatment regimens. The paucity of safety and pharmacokinetic studies in this age group has been a major hurdle to accessing optimised therapeutic options.

[Comment] Hope for treatment-free remission in children born with HIV

Eliminating vertical transmission of HIV remains a priority in prevention policies promoted by WHO, and their implementation has led to substantial progress in the past 15 years in many countries. Still, UNAIDS estimates 1·4 million children are living with HIV worldwide and that HIV causes over 75 000 deaths annually.1

[Editorial] A field of possibilities for paediatric HIV

UN World Children's Day on Nov 20 is an annual reminder that every child deserves the chance not just to survive, but to thrive. In the field of paediatric HIV, these aspirations have special significance. As paediatric HIV enters its fifth decade as a global health challenge, scientific innovation, political will, and tireless advocacy have delivered progress. The global number of paediatric HIV acquisitions has declined by 62% since 2010, AIDS-related child deaths have fallen from 240 000 in 2010 to 75 000 in 2024, and 18 countries have been certified as having halted vertical transmission, with others, such as Botswana and Namibia, on the path to elimination.

Early Detection of Prostate Cancer — Time to Fish or Cut Bait

Approaches to early detection of cancer often seem contentious, but the big-picture view is actually one of remarkable consensus. All major guideline groups recommend the Papanicolaou smear, mammography, colonoscopy, and — in older adults with a substantial history of smoking — lung imaging; none recommend CA-125 for early detection of…

Surgical Meshes in Inguinal Hernia Repair

There are roughly 90 different surgical meshes for inguinal hernia repairs, with costs ranging from $100 to more than $1000. Very little exists to guide surgeons in the choosing of mesh beyond aggressive marketing by companies touting their product’s quality and justifying its cost. To complicate matters, surgical meshes on the market are cleared by the US Food and Drug Administration through the 510(k) process, which requires “substantial equivalence” to existing devices. Clinical trials are rarely required, and postmarket surveillance is conducted by the same companies that market the product. Occasionally surgeons and health systems report adverse events that may lead to product recalls. However, even recalled meshes can be used as “existing” devices, thereby serving as the standard for the introduction of new meshes. This underscores the importance of better assessment and more robust postmarket surveillance of surgical meshes.

A Revision to Organ Failure Assessment in Critically Ill Patients

Modern intensive care of critically ill patients is evolving. Nearly 1 in 5 hospitalized patients receive intensive care, and there are new diseases, treatments, and approaches to organ support. Many intensive care unit (ICU) patients develop acute, vital organ failure—a nefarious and unremitting cause of death—and structured measures of vital organ function help to quantify illness severity. These scores were developed almost 50 years ago and were meant to be generic and independent of the cause of multiple organ failure. Now, organ failure scores are still incorporated into contemporary risk prediction models, syndromic criteria like Sepsis-3, and disaster triage tools and are also used to compare ICU populations and outcomes from randomized clinical trials. Organ failure scores are used widely by clinicians, researchers, and quality improvement teams. But how these scores should evolve with changes in modern intensive care is debated.

Sodium Bicarbonate in Severe Acidemia and Acute Kidney Injury

Severe acidemia commonly complicates critical illness. If unresolved or untreated, acidemia may exacerbate multiorgan dysfunction, prompt escalation in life support, and portend greater risk of adverse outcomes. Intravenous (IV) sodium bicarbonate is often used in clinical practice to buffer severe acidemia; however, existing evidence on its effectiveness remains inconclusive. The most recent iteration of the Surviving Sepsis Guidelines offers only a weak recommendation (low quality of evidence) for use of IV sodium bicarbonate therapy in patients with sepsis and shock, severe acidosis, and acute kidney injury (AKI). This recommendation was derived largely from the initial BICARICU trial, a multicenter, open-label, randomized clinical trial suggesting reduced mortality at 28 days and lower use of kidney replacement therapy (KRT) with IV sodium bicarbonate therapy in a prespecified subgroup of patients with severe acidemia (pH ≤7.20) and moderate to severe AKI.

Capillary Refill Time in Sepsis

Almost 25 years ago, a landmark trial of early goal-directed therapy (EGDT) by Rivers and colleagues reshaped the care of septic shock by introducing the concept that “early” management was crucial. Although implementation has varied across high- and low-resource settings, the importance of early sepsis recognition and treatment is now nearly universally accepted. In contrast, the specific manner by which goal-directed therapy for septic shock should be provided remains highly controversial. Conceptually, goal-directed therapy is a resuscitation protocol involving a goal to be achieved, serial assessments of the patient’s physiologic status, and administration of therapies that the assessments indicate will help achieve the goal. But what are the right goals, assessments, and therapies to improve outcomes for patients with early sepsis?

A Less Invasive Approach to Intensive Care

The intensive care unit (ICU) conjures images of unconscious patients surrounded by machines and penetrated by devices — endotracheal tubes, surgical drains, and urinary, venous, and arterial catheters. Although this scenario may be necessary for some patients, for many, high-quality studies have shown benefits of a different approach. The possibility…

[Series] Reframing remission in severe asthma: a conceptual framework for distinguishing disease activity versus damage

Remission is emerging as a feasible treatment goal in moderate-to-severe asthma, driven by the success of biologic therapies in controlling inflammation and reducing exacerbations. Yet current definitions of remission—focused on symptom control, lung function, and corticosteroid reduction—lack precision, can only be ascertained retrospectively, and do not reflect the underlying mechanisms and pathology that drive disease progression. This gap limits the clinical applicability of these definitions and might obscure opportunities for early, disease-modifying intervention.

[Series] Genetic and environmental risk factors for asthma: towards prevention

Asthma is a common chronic airway disease affecting an estimated 260 million individuals of all ages worldwide, contributing to substantial morbidity, mortality, and economic burden. Asthma is heterogeneous in age at onset (childhood vs adult onset), clinical presentation, type of underlying airway inflammation (type 2 high vs type 2 low), prognosis, and treatment response. Asthma is caused by multiple genetic and environmental factors, and possibly their interaction, across the life course. Genetic studies have provided important insights into the pathogenesis, biology, and immunology of asthma, fostering drug discovery.

[Articles] Assessment of the role of small airway dysfunction in relation to exacerbation risk in patients with well controlled asthma (ATLANTIS): an observational study

Recent surveys suggest that asthma remains inadequately controlled in more than 50% of adults with asthma despite guideline-based standard therapy. Small airways are often under-recognised as major sites of airway obstruction and inflammation. This might be related to lack of assessment with current tools such as impulse oscillometry, and thus under-treatment might explain inadequate control. Small airway dysfunction, which is common in adults with well controlled asthma, might represent an important biomarker of future risk of exacerbations.