Cell signalling-mediated host responses. Predominantly, the TME comprises cellular, noncellular, supporting physical and chemical milieu characteristics signalling pathways and crosstalk mechanisms that modulate multi-dimensionally coordinated evolutionary interactions among the various subunits of the ecosystem. The cellular component includes cancer cells, T-lymphocytes, B-lymphocytes, natural killer (NK) cells, macrophages, dendritic cells, cancer-associated fibroblasts (CAFs), endothelial cells, neutrophils, adipocytes and immune cells [2]. The acellular components consist of extracellular matrix (fibronectin, laminins, collagens, proteoglycan, hyaluronan and thrombospondin), extracellular vesicles, apoptotic bodies, exosomes, tumour necrosis factor, interferon-gamma (IFN-γ), growth factors (plateletderived growth factor (PDGF), epidermal growth factor (EGF), nerve growth factor (NGF), transforming growth factor α and β (TGF-α and TGF-β)), chemokines, interleukins and stroma [3]. The supporting physical and chemical milieu of TME includes hypoxia (low oxygen levels), low pH (acidic), insufficient blood, and elevated interstitial fluid pressure (interstitial hypertension) [2, 3]. The TME not only plays a significant role in tumour initiation, proliferation and progression but also in host immunosuppression, immune evasion, metastasis, treatment failure and multidrug resistance and prognosis. Human immunodeficiency virus (HIV) has been around since the early 1980 s when the complications were discovered in five homosexuals. HIV-associated cancers are often the term used to denote acquired immunodeficiency syndrome (AIDs)-defining cancers (ADC) or "AIDS-defining malignancies (ADM) that people living with HIV manifest as a result of HIV/AIDS infection. Non-acquired immunodeficiency syndrome (AIDs)-defining cancers (NADC) are neoplasms developed by people living with HIV/AIDS that are not necessarily HIV/AIDS-related. Patients living with HIV might have double jeopardy of cancers, that is, ADCs

Telomere, also known as a “molecular clock”, is a specific, unique cap-like structure of nucleoprotein with repetitive, noncoding, guanine-rich tandem of nucleotide sequences of DNA-protein located at the ends of chromosomes fashioned in a duplex “D-loop-T-loop” appearance. The dynamic and equilibrium of telomere homeostasis is a function of competing pro-telomere lengthening and pro-telomere shortening factors in determining the telomere length and telomerase activity. While many studies have been done on telomere dynamics, few have been done on telomeres and HIV with a stark gap in knowledge on the impact lifestyle modifications have on the telomeres of people living with HIV. Development of “telomere check kits” in the future will go a long way to put the “molecular clock” within our reach and be directly involved and aware of where we are in the “time or clock” of our life. Having extensively and comprehensively reviewed the healthy lifestyle and the improvement of telomere length and enhancement of telomerase activity that can result in promoting longevity and maximizing health-related quality of life, a full integration of lifestyle modifications as part of the management of HIV disease is long overdue.

Introduction: Healthcare workers in the Pacific Islands are distributed across many geographically remote areas. Online learning has significant potential to increase the accessibility of education; however, little is known about its use in this region. The primary aim of this review was to investigate the distribution and effectiveness of online learning for Pacific Island healthcare workers, information that may be useful to inform future online educational practices to maximise their outcomes. Methods: The review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (ID: CRD42024502877). Six databases and two grey literature sources were searched over a 22-year period (2003–2025). Data were collected relating to learner populations, learning features, learning methods and outcome evaluation. Results were analysed and presented with descriptive statistics and narrative synthesis. Results: After retrieving 12,091 records, 42 studies were included. Learners were most often from Fiji (38%) or Vanuatu (31%), and the most prevalent groups were doctors (55%) and nurses (48%). Frequently used learning methods were lecture/seminar/conference (62%) and modular learning (36%). Where reported, learning approaches were balanced between asynchronous (31%), synchronous (29%) and mixed (31%). Twenty-six studies conducted outcome evaluation (62%), while eight programs (18%) analysed improvements using statistical methods. Thirty studies (71%) were published from 2021–2025. Conclusions: Online learning for healthcare workers has been increasingly used in the Pacific Islands. However, few studies conducted comprehensive evaluations, which limits conclusions regarding effectiveness. Publications often reported learning methods in limited detail. More robust research is needed to realise the full potential of online learning in the Pacific Islands.