Background: Diabetes mellitus and hypertension are the most prominent conditions causing chronic kidney disease and eventually end-stage renal disease. Renal replacement therapy, particularly hemodialysis (HD), is the mainstay of treatment. The aim of this study is to assess the overall survival status of HD patients and potential survival predictors at Saint Paul hospital millennium medical college (SPHMMC) and Myungsung Christian Medical Center (MCM) in Addis Ababa, Ethiopia. Methods: A retrospective cohort study was conducted on HD patients at SPHMMC and MCM general hospital from January 1, 2013 to December 30, 2020. Kaplan Meier, Log-rank, and Cox proportional regression models were used for the analysis. Estimated risks were reported as hazard ratios with 95% confidence intervals and P< 0.05 was considered as having a significant association. Results: A total of 128 patients were included in the study. Median survival time was 65 months. The predominant co-morbid condition was found to be diabetes mellitus with hypertension (42%). The total risk time for these patients was 143,617 person years. The overall incidence rate of death was 2.9 per 10,000 person years (95% CI=2.2– 4). Patients who developed blood stream infection were 2.98-times more likely to die than those without infection. Those using an arteriovenous fistula were 66% less likely to die than those using a central venous catheter. Additionally, patients treated in a government-owned facility were 79% less likely to die. Conclusion: The study identified that the median survival time of 65 months was comparable with developed nations. Significant predictors of death were found to be blood stream infection and type of vascular access. Government-owned treatment facilities showed better patient survival.

Chronic chikungunya arthritis is a debilitating post-viral inflammatory arthritis with no established evidence-based therapy. Regulatory T cell (Treg) dysfunction may contribute to persistent inflammation, and low-dose interleukin-2 (IL-2) may restore immune regulation. We evaluated the immunomodulatory effects of low-dose IL-2 using peripheral blood mononuclear cells from adults with laboratory-confirmed chronic chikungunya arthritis in Atlántico, Colombia. Cells were treated ex vivo with recombinant IL-2 or an IL-2/anti-IL-2 monoclonal antibody complex in the presence of CD2/CD3/CD28 stimulation beads, followed by flow cytometric assessment of effector T cells and Tregs. Low-dose IL-2 treatments ex vivo did not increase total Treg frequency but selectively increased activated suppressor Tregs while decreasing activated T effector cells, enhancing Treg CTLA-4 and HLA-DR expression, and reducing Ki67 expression in effector T cells. IL-2 complex treatment decreased cytokine-secreting Tregs, and IL-10 and TGF-β were not associated with IL-2 treatment status or with Teff/Treg balance, suggesting limited utility as pharmacodynamic biomarkers of low-dose IL-2 treatments. These findings support the use of activated suppressor Tregs, Treg CTLA-4, and HLA-DR expression as candidate biologic endpoints for evaluation in future trials of low-dose IL-2 in chikungunya arthritis.

Background: Cardiovascular disease (CVD) and stroke have emerged as leading causes of non-AIDS-related mortality among people living with HIV (PLWH) in the antiretroviral therapy (ART) era. As life expectancy in PLWH has approached that of the general population, the cardiovascular burden, driven by chronic immune activation, persistent systemic inflammation, ART-related metabolic effects, and endothelial dysfunction, has grown into a defining clinical challenge. Despite a well-documented 1.3 to 2-fold elevation in CVD risk relative to the general population, available risk prediction tools were developed exclusively in HIV-negative individuals and underestimate absolute cardiovascular risk in PLWH, with no validated stroke-specific prediction instrument currently existing for this population. Objectives: This narrative review synthesizes available evidence on: the biological mechanisms underlying excess CVD and stroke risk in PLWH; the epidemiological burden of CVD and stroke in this population; the performance and limitations of existing risk prediction tools; stroke-specific risk factor characterization; and primary prevention evidence, to provide a clinically integrated framework for improved risk stratification in PLWH. Methods: A purposive literature search was conducted across PubMed/MEDLINE, Embase, and Google Scholar from inception through April 2025 using terms including HIV, PLWH, cardiovascular disease, stroke, risk prediction, risk stratification, and antiretroviral therapy. References from key included articles were hand-searched for additional relevant literature. Study selection was based on relevance to the review objectives and methodological quality as assessed by the author. As a narrative review, no formal inclusion/exclusion criteria were applied, and no protocol registration was performed. Key Findings: PLWH face substantially elevated risks of dyslipidemia (HR 1.53), coronary artery disease (HR 1.37), myocardial infarction (HR 1.47), and stroke (OR 1.31) compared to the general population. Biological drivers include chronic immune activation, microbial translocation, endothelial dysfunction, and ART-related metabolic effects. All available CVD risk prediction tools, including the Framingham Risk Score (FRS), ACC/AHA Pooled Cohort Equations (PCE), and the HIV-specific D:A:D model, demonstrate only moderate discrimination (C-statistics 0.65-0.77) and consistently underestimate absolute risk, most severely in women, younger patients, and racial/ethnic minorities. Stroke-specific evidence from the D:A:D multicohort study demonstrates that ischemic and hemorrhagic strokes carry fundamentally different risk factor profiles in PLWH, with impaired renal function (HR 4.80) the dominant predictor of hemorrhagic stroke, a variable absent from all current risk tools. The REPRIEVE trial established a 35% reduction in major adverse cardiovascular events, including stroke, with Pitavastatin, demonstrating preventability while simultaneously exposing the inadequacy of current risk classification. Conclusions: Current CVD risk stratification tools fail PLWH through systematic underestimation and the absence of HIV-specific and stroke-subtype-specific predictors. The development of dedicated, validated risk instruments incorporating immunological biomarkers, renal function, and stroke-subtype awareness is an urgent clinical and research imperative.