Emily Burzynski

Objective: Adults living with HIV are at increased risk of vaccine-preventable infections, yet access to recommended vaccines varies globally. We evaluated national vaccination guidelines, public reimbursement, and on-site vaccination availability across countries with different income levels. Methods: We conducted a cross-sectional survey of HIV clinicians and experts representing 120 countries. The 26-item questionnaire assessed vaccination guidelines, recommendations, public reimbursement, and on-site vaccination availability. Countries were classified according to World Bank income group. Generalized linear mixed-effects models assessed routine recommendations, full reimbursement, and recommendation-reimbursement gaps by vaccine type and income group. Results: A total of 124 responses representing 120 countries were analyzed, including 38 low-/lower-middle-income (LIC/LMIC), 36 upper-middle-income (UMIC), and 50 high-income countries (HIC). HIV-specific national vaccination guidelines were reported by 37% of respondents, increasing from 18% in LIC/LMIC to 52% in HIC ( p =0.026). Only 30% reported full public reimbursement for all recommended vaccines (13% LIC/LMIC, 28% UMIC, 44% HIC; p =0.007). Mixed-effects analyses showed significant differences in routine recommendations and full reimbursement by vaccine type and income group. The adjusted probability of routine recommendation was lower in LIC/LMIC than HIC countries (52.6% vs 77.6%; adjusted p=0.0013). Among recommended vaccines, more than 94% of influenza, pneumococcal, and hepatitis B vaccinations lacked full reimbursement in LIC/LMIC, based on adjusted estimates. Reimbursement gaps for HPV and herpes zoster vaccines remained substantial even in HIC. On-site vaccination was also less available in LIC/LMIC than in HIC (55% vs 78%; p=0.020). Conclusions: Significant income-related disparities persist in vaccination policy and implementation for adults living with HIV. Gaps between recommendations and financial access are particularly pronounced in lower-income settings, while HPV and herpes zoster reimbursement remains limited across all income groups. Expanding HIV-specific vaccination policies, improving public reimbursement, and integrating vaccination into routine HIV services are essential to improve access to recommended vaccines for this population.

Human herpesvirus 8 (HHV-8) is associated with Kaposi sarcoma (KS), multicentric Castleman disease (MCD), and primary effusion lymphoma (PEL), important causes of morbidity among people living with HIV. Data on these diseases remain limited from Central and Eastern Europe compared with Western Europe. We conducted a multicentre cross-sectional survey, using an online questionnaire distributed to HIV physicians within the Euroguidelines in Central and Eastern Europe Network Group, comprising epidemiology, diagnostic capacity, and management of HHV-8-related diseases. Twenty-six HIV treatment centres from 22 countries participated, providing care for 36,845 people living with HIV. A total of 55 cases of KS (1.49 per 1000 PLWH) were reported, of which 35 (63.6%) had visceral involvement. MCD and PEL were uncommon, with 7 and 4 cases, respectively. Diagnostic capacity varied between centres: computed tomography was available in 80.8%, bronchoscopy in 30.8%, and gastroscopy in 23.1%. Antiretroviral therapy alone was the most common first-line treatment for limited KS, while pegylated liposomal doxorubicin was accessible as first-line and/or second-line treatment in 46.2% of centres. HHV-8-related diseases remain uncommon but clinically relevant complications of HIV infection in Central and Eastern Europe. Regional variability in diagnostic resources and treatment availability highlights the need for strengthened referral pathways and guideline-adherent care.

Context and objective: Post-amputation pain (PAP) is an umbrella term that includes residual limb pain (RLP) and phantom limb pain (PLP), posing a significant challenge to recovery and quality of life after limb loss. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has gained interest for its potential to manage PAP, particularly in refractory cases. This narrative review explores the efficacy of ketamine for PAP and the emerging role of pharmacogenomics in guiding its use. Methods: A literature review of PubMed, Embase, and Cochrane databases was conducted, focusing on clinical trials, systematic reviews, and genetic influences on ketamine metabolism and response. Studies suggest that perioperative ketamine can reduce PAP severity and opioid use. However, outcomes vary, with some patients experiencing transient relief and others achieving prolonged benefit. Results: This variability may be linked to genetic differences in CYP2B6, CYP3A4/5, COMT Val158Met, SLC6A2, and KCNS1, which affect ketamine’s metabolism, efficacy and side effect profile. Understanding these pharmacogenomic factors could enable more personalized and effective ketamine therapy. Conclusion: Despite its promise, inconsistent dosing regimens and limited integration of genetic data hinder standardization. Further research into genotype-guided ketamine protocols may improve treatment outcomes and support precision analgesia in amputee care.