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  • New AAV gene therapy reverses age-related macular degeneration

    New AAV gene therapy reverses age-related macular degeneration

    Neovascular age-related macular degeneration (nAMD) is a progressive eye disease characterized by choroidal neovascularization and subretinal hemorrhage and exudation, leading to vision impairment. Current first-line treatment for nAMD are anti-VEGF agents, which has shown promising therapeutics outcomes.

    Despite their efficacy, the anti-VEGF therapies require frequent intravitreal (IVT) injections and regular clinic visits to sustain their benefits, bringing significant challenges for long-term patient compliance and real-world effectiveness. As such, emerging long-term therapeutics strategies for nAMD need to be further studied.

    Research

    A groundbreaking study titled “An Engineered Intravitreal Injection Retinal-Pigment-Epithelium-Tropic Adeno-Associated Virus Vector Expressing a Bispecific Antibody Binding VEGF-A and ANG-2 Rescues Neovascular Age-Related Macular Degeneration in Animal Models and Patients” has unveiled a promising new gene therapy approach for treating nAMD. AAV is a widely used gene delivery tool in ocular gene therapy due to its safety and ability to provide long-term transgene expression in retinal cells.

    This research highlights the development of a novel engineered AAV vector (AAV-RPE) as well as a bispecific antibody (VEGF-Ang2) targeting both vascular endothelial growth factor-A (VEGF-A) and angiopoietin-2 (ANG-2), two key drivers of abnormal blood vessel growth and leakage in nAMD. A single intravitreal injection of the AAV gene therapy (XMVA09) contributes to long-term expression of the therapeutic antibody, especially in RPE cells.

    Preclinical study demonstrated that XMVA09 can effectively suppress neovascularization and vascular leakage in CNV models in both mice and non-human primates (NHPs). In mouse CNV models, compared to AAV2.7m8-aflibercept (ADVM022), XMVA09, AAV-RPE-aflibercept, and AAV2.7m8-VEGF-Ang2 show a significant advantage in therapeutic efficacy (Fig.1).

    NHP studies indicated that the gene therapy is safe with no evidence of retinal toxicity and low immunogenicity. Moreover, an investigator-initiated clinical trial demonstrated that the gene therapy is well-tolerated and of significant clinical benefit in nAMD patients.

    Conclusion and future prospects

    Collectively, the research represents an innovative gene therapy, which offers a safe and effective treatment option for nAMD. The research team plans to advance to larger clinical trials to confirm safety and efficacy. If successful, this approach could also be adapted for other retinal diseases driven by angiogenesis.

    Source:

    Science and Technology Review Publishing House

    Journal reference:

    Cai, Y., et al. (2025). An Engineered Intravitreal Injection Retinal-Pigment-Epithelium-Tropic Adeno-Associated Virus Vector Expressing a Bispecific Antibody Binding VEGF-A and ANG-2 Rescues Neovascular Age-Related Macular Degeneration in Animal Models and Patients. Research. doi.org/10.34133/research.0717

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  • Survival and Its Determinants of HIV/AIDS Patients Receiving Antiretro

    Survival and Its Determinants of HIV/AIDS Patients Receiving Antiretro

    Introduction

    HIV/AIDS continues to be a public health concern globally, particularly in low- and middle-income countries. According to the Global Health Observatory, as of 2023, 39.9 million people were living with HIV, with 1.3 million new infections, and 630,000 people died of AIDS-related illnesses.1 The report also added that of all HIV-infected individuals, 38.6 million were adults, 1.4 million were children aged 0–14 years, and more than half (53%) were females. In 2023, the WHO Africa Region remained the most impacted by HIV/AIDS, accounting for approximately 65% of the global infection burden.2 Treatment with combination antiretroviral therapy (ART) enables PLHIV to have prolonged and healthier lives. It also reduces their viral load significantly, which is essential in preventing onward transmission of HIV. In 2022, 76% of all HIV-positive individuals were accessing ART globally; moreover, countries in the African region reported that 90% of PLHIV knew their status, 82% were on treatment, and 76% had suppressed viral load.3

    According to the UNAIDS report, in 2023, the number of adults and children living with HIV/AIDS in Eritrea was estimated at 13,000: 12,000 adults and 1000 children aged <15 years, where 8900 of them were under ART treatment.4 The report also estimated the annual number of deaths due to HIV/AIDS among adults was less than 500.

    Several prospective and retrospective cohort studies have been conducted in different settings to investigate the survival and determinants of PLHIV after ART initiation. According to some studies, the overall mortality rate ranged from 2.03 to 4.18 per 100 person-years.5–8 In addition, several studies have reported high mortality of PLHIV in the first year of ART initiation.5,9,10 Moreover, various studies have documented the main predictors of survival of PLHIV on ART. Patients who started ART when their disease progression was advanced—at stage III or IV according to the WHO classification— or low baseline CD4 count were more likely to have shorter survival.5–7,10–12 Similar studies indicated that adherence was one of the main determinants of patients’ survival.11,12 Besides, patients’ survival was influenced by other factors such as sex, age, functional status, and anemia.5–8,10,12

    In situations where the key determinants for survival are not known, it is challenging to identify essential interventions and prioritize resources for the success of any HIV/AIDS control program. This study was therefore conducted to understand the survival of PLHIV on ART and explore its determinants for patients attending Halibet National Referral Hospital and Orotta National Referral and Teaching Hospital, located in Asmara, Eritrea.

    Materials and Methods

    Study Design and Setting

    This retrospective cohort study enrolled PLHIV aged 15 years and above who started ART between August 2005 (ART was introduced in Eritrea in 2005) and December 31, 2020 and followed until December 31, 2021. The study was conducted in the HIV care clinics of Halibet National Referral Hospital (HNRH) and Orotta National Referral and Teaching Hospital (ONRTH). These HIV care clinics, based in the capital – Asmara, provide services to adults (15 years and above) and residents of the capital city and all regions of the country who decided to attend these sites for their reasons. These hospitals were selected because they are the only national referral hospitals that provide HIV care services in the country, and a significant proportion of PLHIV on ART received care in these hospitals. Of the 8775 PLHIV on ART in 2021, 2559 (29.2%) patients received treatment in these national referral hospitals.

    Study Population

    All PLHIV aged 15 years and above who were on ART between 2005 and December 31, 2021, and attending HIV care clinics at Halibet National Referral Hospital and Orotta National Referral and Teaching Hospital were eligible for enrollment. Patients who had missed information on outcome, date event (outcome) happened, and ART started date were excluded. In addition, PLHIV who re-restarted ART were excluded to minimize bias since their baseline information might differ from their measurement during the restart of ART. Patients who initiated antiretroviral therapy (ART) before age 15 were excluded from the study. This exclusion was necessary because these patients had initially received care at other pediatric clinics and were subsequently transferred to the participating hospitals, which do not provide ART to patients under 15 years of age.

    Sampling Procedure and Power Calculation

    The current study implemented a census (complete enumeration) of PLHIV attending the two national referral hospitals. Even though all patients registered in these HIV care clinics were enrolled, a power calculation was done to ensure that the sample size in the dataset provides sufficient power to investigate research question.13 Power was calculated based on two population proportion formulas. Functional status (working, ambulatory, or bedridden) of patients during ART initiation—one of the exposure variables—was believed to provide an optimal number. It was assessed using the Stata command for power calculation stpower cox, n (133 38) hratio (2.49 2.88) for the hazard ratio of ambulatory and bedridden, respectively. This command produced a power ≥ 90%. Thus, the study with the available number of patients had adequate power.

    Data Sources

    The primary data sources for this study were the existing electronic medical records and physically available medical cards of PLHIV. First, data were retrieved from the electronic medical records and exported to MS Excel Spreadsheet 2019. Information missing from electronic medical records—such as details found on patients’ medical cards, laboratory results, and registries—was retrieved and manually entered into an MS Excel by data collectors.

    Variables

    Outcome Variable

    The outcome variable was a pair of variables. One variable was an event-occurrence indicator, equal to 1 if death was known to occur and equal to 0 if death did not happen during the observation period (censored). Censored referred to patients who lost to follow-up, withdrew from treatment, transferred out, and were on follow-up at the end of the study period. The second variable was the time-to-event, which was the time from the start of ART to either the occurrence of death or censored.

    Exposure Variables

    The exposure variables were characteristics related to sociodemographic factors (age, sex, marital status, educational status, employment status, residence, and region), clinical conditions during ART debut (WHO clinical staging, CD 4 count, functional status, body weight), ART information (date of ART initiation), and follow up outcomes (adherence). The exposure variables were categorized as it is depicted in Table S1. Moreover, the operational definitions of the variables considered in this study are provided in Supplementary Information 1.

    Table 1 Frequency and Mortality Rate of HIV/AIDS Patients Who Received Antiretroviral Therapy at Orotta National Referral and Teaching Hospital and Halibet National Referral Hospital Followed Up Between 2005 and December 31, 2021 (N=3646)

    Data Management and Analysis

    Data obtained from hospitals were exported to SPSS to be merged and cleaned; then, the dataset was exported to Stata version 13 for analysis. For categorical variables, data were presented as frequency and percent. Univariate and bivariate analyses were conducted based on all cases. However, missing values were dropped from the multivariate analysis; since they were small (3.3%), excluding them from the analysis was unlikely to introduce bias. Kaplan–Meier estimators and long-rank tests were used to assess the cumulative survival probability and survival curves. A hazard ratio with a 95% confidence interval and a two-sided chi-square significance test were used to measure the association between survival time and independent variables. Variables that were significant at a 0.2 significance level in the bivariate analysis were considered for the candidacy of the model building. Forward selection was used to select variables, and then multicollinearity was assessed. Moreover, the proportional hazard assumption was checked for every variable included in the model using Schoenfeld residual test and Schoenfeld scale. An extended Cox proportional hazards regression was used in multivariate analysis to identify the factors determining the survival time, as there were covariates that violated the proportional hazards assumption. P-value less than 0.05 was considered statistically significant.

    Ethical Considerations

    The Health Research Proposal and Ethical Committee of the Ministry of Health of Eritrea (reference number: 02/09/21) approved the study. In addition, permission was granted by the authorities of each ART care clinic to use the patients’ information for the study. Due to the study’s retrospective nature, the ethics committee waived the patient’s consent. However, the confidentiality of patients’ data was ensured by coding their identifiers and removing them from the final analysis. In addition, data extraction was done by a staff working in the specific center to prevent external persons from accessing patient data. The study followed the Helsinki Declaration.

    Results

    Demographic, Clinical, and Laboratory Characteristics of Respondents

    Overall, 4219 patients were assessed for eligibility, and 3646 (86.4%) were eligible for the study [Figure 1]. The median age of respondents was 36 years (Interquartile range [IQR]: 30–43). Sixty percent of the respondents were female, 58% were unemployed, and 48% were widowed. Over eight out of ten (84%) lived in urban areas, and 75% were from Zoba Maekel (central region). Most study participants (88%) had good adherence, and 56% were either in stage III or IV. Over a quarter (27%) started ART with a CD 4 count ≤ 200 cells/mm3, and 53% of respondents started ART with more than 350 cells/mm3. Most study participants (78%) started ART at working status, and 55% had a body weight between 45 and 60 kg (Table 1).

    Figure 1 Summary of eligibility and enrollment of study participants who received antiretroviral therapy at Orotta National Referral and Teaching Hospital and Halibet National Referral Hospital followed up between 2005 and December 31, 2021 (N=3646).

    Mortality Rate

    By the end of the study period, of those enrolled, 11.5% died, and 18.5% were lost-to-follow-up (Figure 2). The total observation time was 31870.3 person-years with a maximum observation time per person of around 17 years. The all-cause mortality rate was 1.32 per 100 person-years (95% CI: 1.20–1.44). The mortality rate was higher among those aged 46 years and above, males, divorced/separated, single, and patients living in Zoba Maekel. Mortality was also higher among those who started ART with WHO clinical stages III and IV, those who were ambulatory or bedridden, had a CD 4 count of ≤ 200 cells/mm3 and had a body weight ≤ 45 kg as well as those with poor adherence (Table 1).

    Figure 2 Follow-up outcome of HIV/AIDS patients who received antiretroviral therapy at Orotta National Referral and Teaching Hospital and Halibet National Referral Hospital followed up between 2005 and December 31, 2021 (N=3646).

    Survival Analysis

    At the end of the study period, 79.7% of the study participants survived—with a survival probability of 0.80 (survivor function = 0.797, 95% CI: 0.766–0.825) (Figure 3 and Table 2). The median follow-up time was 9.15 years (IQR: 4.55–13.22 years). Of all participants, 96.4% survived their first year and 95.3% second year of ART initiation. Among those who died, 13%, 20%, and 30% died within three, six, and twelve months yielding a median survival time of 3.68 years (95% CI: 2.87–4.45). In addition, among those who died, 70% survived their first year and 60% survived their second year of ART initiation. The Kaplan-Meier curve indicated that the survival probability was lower for males, those aged 45 years and above, those who were married, divorced or separated, or single, and those who were residents of Zoba Maekel (Figure 4 and Table S1: Supplementary Information 1). Furthermore, patients with body weight of less than 45 kg, those who had fair or poor adherence, were on WHO clinical stages III and IV, had ambulatory or bedridden functional status, and those who had CD4 count ≤100 cells/mm3 during ART initiation had a lower survival probability (Figure 5 and Table S1: Supplementary Information 1).

    Table 2 Survivor Function of Patients Who Received Antiretroviral Therapy at Orotta National Referral and Teaching Hospital and Halibet National Referral Hospital Followed Up Between 2005 and December 31, 2021 (N=3646)

    Figure 3 Kaplan-Meier survival estimate of patients who received antiretroviral therapy at Orotta National Referral and Teaching Hospital and Halibet National Referral Hospital followed up from 2005 to December 31, 2021 (N=3646).

    Figure 4 Kaplan-Meier survival estimates of HIV/AIDS patients who received antiretroviral therapy by sociodemographic characteristics at Orotta National Referral and Teaching Hospital and Halibet National Referral Hospital followed-up between 2005 and December 31, 2021 (N=3646).

    Figure 5 Kaplan-Meier survival estimates by laboratory and clinical characteristics of HIV/AIDS patients who received antiretroviral therapy at Orotta National Referral and Teaching Hospital and Halibet National Referral Hospital followed up between 2005 and December 31, 2021 (N=3646).

    Predictors of Survival

    In bivariate analysis, sex, age, region, marital status, body weight, CD4 count, adherence, WHO clinical stage, and functional status at baseline were found to have a significant relationship with survival rates of PLHIV (Table 3). In multivariate analysis, patients who started ART above 45 years (HR=1.58, 95% CI: 1.05–2.37), who were ambulatory (HR=2.49, 95% CI: 1.79–3.47), or were bedridden (HR=2.88, 95% CI: 1.77–4.69), had poor adherence (HR=1.57, 95% CI: 1.09–2.28), or had fair adherence (HR=2.19, 95% CI: 1.66–2.89) had increased mortality. On the other hand, patients who started ART with a CD4 count (cells/mm3) of 101–200 (HR=0.38, 95% CI: 0.25–0.55), 201–350 (HR=0.18, 95% CI: 0.11–0.27), and over 350 (HR=0.05, 95% CI: 0.02–0.07), who had baseline body weight of 45–60 kg (HR=0.75, 95% CI: 0.59–0.94) and above 60 kg (HR=0.53, 95% CI: 0.39–0.72) had reduced mortality. In addition, those who were widowed (HR=0.49, 95% CI: 0.36–0.67) and those residing outside Zoba Maekel (HR=0.53, 95% CI: 0.34–0.82) had reduced mortality. The mortality risk also increased with age and treatment follow-up. Conversely, the disparities in mortality risk associated with regions, functional status, and CD4 count diminished with increased follow-up (Table 4).

    Table 3 Bivariate Analysis of Patients Who Received Antiretroviral Therapy at Orotta National Referral and Teaching Hospital and Halibet National Referral Hospital Followed Up Between 2005 and December 31, 2021 (N=3646)

    Table 4 Multivariate Analysis Patients Who Received Antiretroviral Therapy at Orotta National Referral and Teaching Hospital and Halibet National Referral Hospital Followed Up Between 2005 and December 31, 2021 (N=3529)

    Discussion

    In this study, the mortality rate of PLHIV on ART was generally low. The excess mortality rate related to HIV/AIDS, however, could not be calculated as data on the mortality rate in the general population in Eritrea is unknown. The all-cause mortality rate of people living with HIV (PLHIV) on ART in Eritrea, without adjusting for the background mortality risk of the general population, was comparable to the excess mortality rate of HIV/AIDS reported in Luzhou, China (0.8 deaths per 100 person-years), suggesting a relatively low overall mortality rate.14 Besides, all-cause mortality reported in this study was almost similar to those reported in Tokyo, Japan (0.6 deaths/100 person-years).15

    In the present study, a significant proportion of patients who started ART were lost to follow-up. However, this proportion was lower than that reported in studies conducted in Ethiopia (Benishangul-Gumuz), Sudan, and Kenya.16–18 Conversely, it was higher than the proportions reported in studies conducted in Uganda and eastern Ethiopia.19,20 The mortality rate of the present study was lower than the findings reported in India and a systematic review in sub-Saharan Africa.8,9,21 However, it was higher than the findings conducted in eastern and southern African countries.9,22 In this study, though it was difficult to identify HIV/AIDS-related deaths, as a cause of death was not well-documented in several patients, the majority of the all-cause deaths occurred in the first year of ART initiation, which is similar to findings reported elsewhere.5,9,10

    In this study, several sociodemographic and clinical characteristics were identified as determinants of survival: age, marital status, region, body weight, adherence, functional status, and CD4 count. Almost all are well-known risk factors for survival in PLHIV.6,21,23–26 This reflects that the time of initiation of ART and treatment adherence were the major modifiable determinants for improving survival. This is because early ART initiation with good treatment adherence can keep the immune system strong and help fight opportunistic infections that are among the common causes of death in PLHIV. This could ultimately improve body weight, patients’ functionality, CD4 cell count, quality of life of PLHIV, prevent transmission of HIV, and suppress viral load, among others.24,25,27 A nationwide study in Eritrea that enrolled 6803 PLHIV confirmed that more than one-fourth (25.6%) of the study participants could not maintain their viral load to an undetectable level.28 Coordinated efforts should be made to maximize the proportion of PLHIV with undetectable viral load count to cut the transmission cycle of HIV and ultimately achieve one of the three 95s of the 2025 AIDS Targets: 95% achieving suppression of their viral load.29,30

    The study’s findings have several clinical, programmatic, and policy implications. First, only a few patients have died while on treatment, and the majority of them were those who started their treatment late and during the first year of ART initiation. Thus, practitioners and the program should look at mechanisms that enhance early treatment-seeking behavior as well as care during the first year of treatment debut. Second, the National HIV/AIDS Control Program needs to identify mechanisms for the death audit of PLHIV and tracing lost-to-follow-up cases. Otherwise, it is difficult to know precisely HIV/AIDS-related mortality as, for several patients, the cause of death could not be qualified. Knowing the HIV/AIDS-related deaths would help the National HIV/AIDS Control Program in evaluating its performance. Third, individual, societal, and programmatic drivers/barriers that could affect knowing their HIV/AIDS status, early initiation of ART, and treatment adherence should be identified, and appropriate risk management plans need to be implemented. The National HIV/AIDS Control Program should enhance adherence, retention, and re-engagement support to improve treatment adherence among patients. This will ultimately help the country to achieve the globally set “95–95-95” AIDS targets at a reasonable time. Besides, this could prevent/minimize treatment failure and drug resistance. Fourth, in the current study, a significant number of participants attending the HIV care clinics of the national referral hospitals were coming from other zobas despite the availability of nearby ART sites. They might have opted to receive their treatment in a distant area, possibly due to concerns of disclosing their HIV/AIDS status to their community for fear of stigma and discrimination. Fear of stigma and discrimination not only discourages patients from being enrolled at a nearby HIV care clinic, but it could also increase reluctance to know their HIV status. The National HIV/AIDS Control Program should, therefore, identify barriers to getting services from nearby clinics, and a well-thought-out plan should be developed and implemented in a coordinated fashion. Furthermore, the National HIV/AIDS Control Program should enhance psychological support services for patients, enabling them to effectively cope with stigma and discrimination.

    The present study benefited from having adequate power (more than 90%)—the sample size was large as all eligible individuals in the national referral hospitals were considered. Moreover, the study had a long follow-up time, with a maximum of 17 years. However, the study had several limitations. This study used secondary data extracted from the ART follow-up database in the HIV care clinics of the national referral hospitals, and patient cards were reviewed to record missing values in the database. This resulted in missing information for some variables and characteristics that might have affected a patient’s survival. Furthermore, all-cause mortality was considered—as HIV/AIDS-related deaths were not well documented– and this could have overestimated the mortality rate of HIV/AIDS patients. In addition, since adherence was repeatedly taken during follow-ups, the most frequently reported value was considered. Finally, the result could not be generalized to patients who took ART treatment at other HIV care clinics, patients who started ART before the age of 15, and those who restarted ART at the study sites. In the future, a prospective cohort study should be conducted that addresses the limitations of the present study. In addition, qualitative research that could help understand why people initiate ART late and factors that affect adherence need to be uncovered. Furthermore, the quality of life of HIV/AIDS patients who receive ART should also be investigated.

    Conclusions

    This study investigated the survival status of patients receiving ART and identified significant determinants that affect their survival. Overall, all-cause mortality among PLHIV was relatively low compared to similar studies conducted in other settings. However, a substantial proportion of patients lost their follow-up appointments. Furthermore, more than three-fourths of the patients survived by the end of the study period, although most of the deaths occurred during the first year of ART initiation. The present study indicated that patients who started ART over the age of 45 were more likely to experience shortened survival. Additionally, starting ART at an advanced clinical stage (ambulatory or bedridden) and having poor to fair treatment adherence were identified as the significant modifiable determinants of survival. The fact that most of the deaths occurred during the first year of ART initiation reflects the need for early treatment-seeking behavior. Thus, it is important to stress patient education that focuses on early treatment, regular follow-up, and adherence to treatment to enhance the HIV/AIDS control strategies. In addition, the HIV/AIDS program should conduct an operational study to understand the barriers that hinder early ART initiation.

    Compliance with Ethics Guidelines

    The research was approved by the Health Research Proposal and Ethical Committee of the Ministry of Health of Eritrea (reference number 02/09/21). Besides, the authorities of each ART care site were asked for permission to use the patient’s information for the study. Due to the retrospective nature of the study, the ethics committee waived the patient’s consent. However, the confidentiality of patients’ data was ensured by coding their identifiers and removing them from the final analysis. In addition, data extraction was done by a staff working in the specific center to prevent external persons from accessing patient data. The study followed the Helsinki Declaration.

    Data Sharing Statement

    All data generated or analyzed during this study are included in this published article/as supplementary information files.

    Acknowledgments

    The authors would like to thank the HIV care clinic staff in both hospitals for their support and time during data retrieval and recordings.

    Author Contributions

    All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

    Funding

    This study was not funded by any organization.

    Disclosure

    The authors declare that they do not have a conflict of interest in this work.

    References

    1. World Health Organization. The Global Health Observatory: HIV. Available from: https://www.who.int/data/gho/data/themes/hiv-aids. Accessed April 7, 2025.

    2. World Health Organization. HIV and AIDS. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids. Accessed April 7, 2025.

    3. World Health Organization. HIV statistics, globally and by WHO region, 2023. Available from: https://cdn.who.int/media/docs/default-source/hq-hiv-hepatitis-and-stis-library/j0294-who-hiv-epi-factsheet-v7.pdf. Accessed November 4, 2025.

    4. UNAIDS. Country Factsheets Eritrea: HIV and AIDS Estimates. Available from: https://www.unaids.org/en/regionscountries/countries/eritrea. Accessed April 7, 2025.

    5. Biadgilign S, Reda AA, Digaffe T. Predictors of mortality among HIV infected patients taking antiretroviral treatment in Ethiopia: a retrospective cohort study. AIDS Res Ther. 2012;9(1):15. doi:10.1186/1742-6405-9-15

    6. Mengesha S, Belayihun B, Kumie A. Predictors of Survival in HIV-Infected Patient after Initiation of HAART in Zewditu Memorial Hospital, Addis Ababa, Ethiopia. Int Sch Res Notices. 2014;2014:250913. doi:10.1155/2014/250913

    7. Nigussie F, Alamer A, Mengistu Z, Tachbele E. Survival and Predictors of Mortality Among Adult HIV/AIDS Patients Initiating Highly Active Antiretroviral Therapy in Debre-Berhan Referral Hospital, Amhara, Ethiopia: a Retrospective Study. HIV. 2020;12:757–768. doi:10.2147/HIV.S274747

    8. Bajpai RC, Raj PY, Jha UM, Chaturvedi HK, Pandey A. Demographic Correlates of Survival in Adult HIV Patients Registered at ART Centers in Andhra Pradesh, India: a Retrospective Cohort Study. Public Health Res. 2014;4(1):31–38.

    9. Chakravarty J, Tiwary NK, Prasad SR, et al. Determinants of survival in adult HIV patients on antiretroviral therapy in Eastern Uttar Pradesh: a prospective study. Indian J Med Res. 2014;140(4):491–500.

    10. Kebebew K, Wencheko E. Survival analysis of HIV-infected patients under antiretroviral treatment at the Armed Forces General Teaching Hospital, Addis Ababa, Ethiopia. Ethiop J Health Dev. 2012;26:186–192.

    11. Abebe N, Alemu K, Asfaw T, Abajobir AA. Survival status of HIV positive adults on antiretroviral treatment in Debre Markos Referral Hospital, Northwest Ethiopia: retrospective cohort study. Pan Afr Med J. 2014;17(88). doi:10.11604/pamj.2014.17.88.3262

    12. Abose G. Survival Status among Patient Living with HIV Aids Who Are on Art Treatment in Durame and Hossana Hospitals. Thesis. Addis Abeba University; 2011. Accessed May 31, 2021. http://etd.aau.edu.et/handle/123456789/11800.

    13. Boo S, Froelicher ES. Secondary analysis of national survey datasets. Japan J Nurs Sci. 2013;10(1):130–135. doi:10.1111/j.1742-7924.2012.00213.x

    14. Niu D, Xiao T, Chen Y, et al. Excess mortality and associated factors among people living with HIV initiating highly active antiretroviral therapy in Luzhou, China 2006–2020. BMC Infect Dis. 2023;23(1):1–10. doi:10.1186/s12879-023-08165-4

    15. Tsuda H, Koga M, Nojima M, et al. Changes in survival and causes of death among people living with HIV: three decades of surveys from Tokyo, one of the Asian metropolitan cities. J Infect Chemother. 2021;27(7):949–956. doi:10.1016/j.jiac.2021.02.003

    16. Degavi G. Influence of Lost to Follow Up from Antiretroviral Therapy Among Retroviral Infected Patients at Tuberculosis Centers in Public Hospitals of Benishangul-Gumuz, Ethiopia. HIV. 2021;Volume 13(13):315–327. doi:10.2147/HIV.S306257

    17. Wekesa P, McLigeyo A, Owuor K, Mwangi J, Ngugi E. Survival probability and factors associated with time to loss to follow-up and mortality among patients on antiretroviral treatment in central Kenya. BMC Infect Dis. 2022;22(1):522. doi:10.1186/s12879-022-07505-0

    18. Hassan RHA, Abdelaal AA, Mohammed HA, Elbashir MA, Khalid KB. Survival and Mortality Analysis for HIV Patients in Khartoum State, Sudan 2017. World J Public Health. 2018;3(4):118. doi:10.11648/j.wjph.20180304.13

    19. Argaw GS, Gelaye KA, Lakew AM, et al. Survival and predictors of mortality among HIV-infected adults after initiation of antiretroviral therapy in Eastern Ethiopia Governmental hospitals, from January 2015 to December 2021 (multi-center retrospective follow-up study). BMC Infect Dis. 2024;24(1):1352. doi:10.1186/s12879-024-10225-2

    20. Atuhairwe C, Atuhaire L, Wandera SO, Amongin D, Ochieng T, Misinde C. Predictors of survival among older adults with HIV in Uganda’s AIDS support organization centers of excellence (1987–2023): a retrospective longitudinal study. AIDS Res Ther. 2025;22(1):24. doi:10.1186/s12981-024-00687-4

    21. Joshi K, Lessler J, Olawore O, et al. Declining HIV incidence in sub-Saharan Africa: a systematic review and meta-analysis of empiric data. J Int AIDS Soc. 2021;24(10):e25818. doi:10.1002/jia2.25818

    22. Rezaianzadeh A, Abbastabar H, Rajaeefard A, Hgaem H, Abdollahi M. Determinant factors of survival time in a cohort study on HIV patient using by time-varying cox model: fars province, south of Iran. Int J Epidemio Res. 2017;4(2):145–155.

    23. Bhatta DN, Adhikari R, Karki S, Koirala AK, Wasti SP. Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, Nepal. BMJ Global Health. 2019;4(3):e001319. doi:10.1136/bmjgh-2018-001319

    24. Biset Ayalew M. Mortality and Its Predictors among HIV Infected Patients Taking Antiretroviral Treatment in Ethiopia: a Systematic Review. AIDS Res Treat. 2017;2017:e5415298. doi:10.1155/2017/5415298

    25. Kusumaadhi ZM, Farhanah N, Sofro MAU. Risk Factors for Mortality among HIV/AIDS Patients. Diponegoro Int Med J. 2021;2(1). doi:10.14710/dimj.v2i1.9667

    26. Kebede A, Tessema F, Bekele G, Kura Z, Merga H. Epidemiology of survival pattern and its predictors among HIV positive patients on highly active antiretroviral therapy in Southern Ethiopia public health facilities: a retrospective cohort study. AIDS Res Ther. 2020;17:49. doi:10.1186/s12981-020-00307-x

    27. Rai S, Mahapatra B, Sircar S, et al. Adherence to Antiretroviral Therapy and Its Effect on Survival of HIV-Infected Individuals in Jharkhand, India. PLoS One. 2013;8(6):e66860. doi:10.1371/journal.pone.0066860

    28. Russom M, Woldu HG, Berhane A, Jeannetot DYB, Stricker BH, Verhamme K. Effectiveness of a 6-Month Isoniazid on Prevention of Incident Tuberculosis Among People Living with HIV in Eritrea: a Retrospective Cohort Study. Infectious Dis Ther. 2022;11(1):559. doi:10.1007/s40121-022-00589-w

    29. 2025 AIDS TARGETS. Available from: https://www.unaids.org/sites/default/files/2025-AIDS-Targets_en.pdf. Accessed August 8, 2023.

    30. de Azevedo Meiners MM M, Araújo Cruz I, de Toledo MI. Adherence to antiretroviral therapy and viral suppression: analysis of three periods between 2011 and 2017 at an HIV-AIDS center, Brazil. Front Pharmacol. 2023;14:1122018. doi:10.3389/fphar.2023.1122018

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  • Rising Stars White triumphs in Independence Day hockey clash

    Rising Stars White triumphs in Independence Day hockey clash

    Rising Stars Hockey Club White sealed a 3–1 victory over Rising Stars Green in the Independence Day Exhibition Match at Shehnaz Sheikh Hockey Stadium, Rawalpindi. Organised by the Rising Stars Hockey Club, the exhibition match marked Pakistan’s 78th Independence Day with a spirited display of sportsmanship and international friendship.

    The event carried special charm as it featured diplomats, young players, and budding female athletes on the same field. His Excellency Neil Hawkins, High Commissioner of Australia to Pakistan, donned the Rising Stars Green jersey, while His Excellency Kamal Ahmed, High Commissioner of Brunei Darussalam, represented Rising Stars White. Their participation not only energized the crowd but also highlighted the growing role of sports diplomacy in strengthening people-to-people ties.
    The match began with fast-paced action, with Rising Stars Green pressing hard in the opening minutes. However, Rising Stars White quickly found their rhythm and took the lead midway through the first half. Despite a strong fightback from the Green side, including a penalty corner conversion, the White side proved too strong, scoring twice more to seal a 3–1 victory. A highlight of the Independence Day Cup was the participation of female players from the Rising Stars Girls Hockey Academy, who showcased their skills alongside senior players.

    Their involvement drew wide appreciation from the spectators, who praised the club’s efforts to encourage women’s participation in hockey.
    Following the match, both high commissioners and Eduard Preda, Deputy Head of Mission of the Romanian Embassy, joined the players in cutting a cake to mark the Independence Day celebrations.

    In their remarks, Neil Hawkins and Kamal Ahmed lauded the Rising Stars Hockey Club for organizing the event with such enthusiasm and inclusivity. They commended the management for creating a platform where youth, diplomats, and female players could come together in the spirit of sportsmanship.

    “This was more than just a match; it was an occasion to celebrate Pakistan’s independence, promote hockey, and build bridges of friendship,” said Kamal Ahmed. Neil Hawkins echoed similar sentiments, emphasizing that such initiatives reflect the true spirit of unity and celebration.

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  • New Caledonia stun hosts with second-half comeback in Group B thriller

    New Caledonia stun hosts with second-half comeback in Group B thriller

    New Caledonia have produced a stunning second-half fightback to defeat the Solomon Islands 5-2 in a pulsating Group B match at the OFC U-16 Men’s Championship in Honiara.

    In a match full of attacking intent and end-to-end drama, the visitors proved more clinical after the break, striking four times to silence the vocal home crowd.

    New Caledonia made the perfect start in the 8th minute when Hnoka Wetewea unleashed a superb right-footed strike past Solomon Islands goalkeeper Eddie Aefi.

    The hosts, however, responded with pace and power down the flanks, constantly troubling the New Caledonia backline. They drew level midway through the first half when Junior Sam converted from the penalty spot after being brought down by Typhan Dreuko.

    Eight minutes before halftime, Sam turned provider, bursting down the right before squaring for Junior Ben to slot home and give the Solomon Islands a 2-1 lead. The home side thought they had extended their advantage just before the interval, but Ben’s second goal was ruled out for offside, while Ben Filia’s long-range attempt whistled narrowly over the bar.

    The momentum shifted after the restart. In the 53rd minute, Darryl Hmaloko’s teasing free kick was met by Andre Menango, who rose highest to nod in the equaliser. Just four minutes later, Wetewea turned creator, whipping in a pinpoint cross for Lenddy Wede to head New Caledonia back in front.

    New Caledonia’s Sylvain Ipeze concedes a goal at the OFC U-16 Men’s Championship 2025, New Caledonia v Solomon Islands, National Stadium, Honiara, Solomon Islands, Monday 18 August 2025. Photo: DJ Mills / www.phototek.nz

    With the home side chasing an equaliser, space opened up at the back, and Wede made no mistake in the 69th minute, breaking clear before finishing calmly with his left foot to seal an impressive win.

    The referee added 18 minutes of extra time due to two cooling breaks and a lengthy stoppage as Solomon Islands keeper Eddie Aefi was stretchered off the field early in the second half. New Caledonia made sure of the result in the 7th minute of injury time, heading home his second goal of the game from a corner.

    New Caledonia now face New Zealand on Thursday, while the Solomon Islands will look to bounce back against Samoa.

    New Caledonia 5 (Hnoka WETEWEA 8’, Andre MENANGO 53’,90+7’, Lenddy WEDE 59’, 69’)

    Solomon Islands 2 (Junior SAM 23’ pen, Junior BEN 37’)

    HT: 1-2

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  • iPhone 17 Pro Camera Leak Points to a Major Telephoto Upgrade

    iPhone 17 Pro Camera Leak Points to a Major Telephoto Upgrade

    Every other day, we hear a new leak about the iPhone 17 series as its launch draws closer. The latest one suggests that the iPhone 17 Pro will receive a major upgrade to its telephoto camera, allowing it to switch between 5x and 8x optical zoom.

    We already knew that the iPhone 17 Pro and Pro Max would feature a 48 MP triple-camera setup. Now, a new leak from a well-known tipster, Instant Digital (source), hints at an even bigger boost in zoom quality. Shared on Weibo, the leak describes the upcoming iPhone as the “strongest telephoto phone,” but did not elaborate further.

    Image Credit: AppleInsider

    The leak also suggests that this new 48 MP telephoto lens will offer up to 8x optical zoom, according to Macrumors‘ tipster. More specifically, the lens will be able to switch between 5x and 8x zoom. This could explain the bigger camera bump that is part of the aluminum frame of the iPhone 17 Pro and the Pro Max models this year.

    Since a moving camera system requires more space to work, the 48 MP telephoto lens marks a big jump from the 12 MP sensor on the iPhone 16 Pro models. If the leak turns out to be true, the iPhone 17 Pro’s telephoto could be the strongest out there, rivaling some of the Chinese flagships like the Vivo X200 Ultra and Oppo Find X8 Pro.

    A moving sensor in an iPhone seems still seems unlikely, as it would require more internal space. Anyway, Instant Digital has also claimed that the base iPhone 17 Pro will start at 256 GB of storage with a $50 price hike. So we will have to wait until the September 9th event to see exactly what Apple has in store for us with the new iPhones.

    Anshuman Jain

    As a tech journalist, I dive into the ever-evolving tech landscape with a particular interest for smartphones, apps, and gaming. With a passion for sharing insights, my articles blend expertise with a friendly touch—think of me as your friendly neighborhood tech support.


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  • Google TV Streamer vs Apple TV 4K: Which streaming device wins?

    Google TV Streamer vs Apple TV 4K: Which streaming device wins?

    Streaming devices are a dime a dozen these days, but if you’re looking for the absolute best performance built on the most versatile interface, the Google TV Streamer and Apple TV 4K are the ones to get.

    Deciding which of these two to buy can be slightly tricky. The Google TV Streamer is the newer of the two, taking over for the now-defunct Chromecast. Up against it is the third-generation Apple TV 4K, which first launched in 2022. While it’s a few years older, it still remains one of the best streaming devices, offering blazing fast speeds and Apple’s interconnected OS ecosystem.

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  • Schools closed again amid heavy rainfall, flood alerts

    Schools closed again amid heavy rainfall, flood alerts

    MUZAFFARABAD – Authorities in Bagh, Azad Kashmir, have announced the temporary closure of all educational institutions in view of a high flood alert issued by the Meteorological Department.

    According to an official notification, both public and private schools across the region will remain closed on August 18 and 19, 2025.

    The precautionary measure aims to ensure the safety of students and staff as the region braces for potential flooding due to ongoing and forecasted heavy rainfall.

    The Met Office said districts including Muzaffarabad, Rawalakot, Bagh, Haveli, Kotli, Mirpur, and Bhimber are expected to receive heavy rainfall and thunderstorms in coming days.

    These conditions may trigger landslides and flash flooding, particularly in hilly areas, it warned.

    It further said heavy to very heavy rainfall/thunderstorms are expected in Islamabad over the next 24 hours with occasional gaps.

    Meanwhile, most parts of Punjab will see widespread rainfall/thunderstorms. Districts in the Potohar and northeastern parts, including Rawalpindi, Attock, Jhelum, Chakwal, Lahore, Gujranwala, Sialkot, Gujrat, Narowal, Hafizabad, and Mandi Bahauddin, are expected to face heavy to very heavy rainfall, increasing the chances of urban flooding.

    Central and southern districts such as Multan, D.G. Khan, Rajanpur, Layyah, Bhakkar, and Sahiwal will experience scattered thunderstorms, while Bahawalpur, Bahawalnagar, and Rahim Yar Khan may experience isolated light rainfall.

    The northern and upper districts of Khyber Pakhtunkhwa, including Swat, Buner, Shangla, Dir, Mansehra, Battagram, Abbottabad, and Malakand, are lexpected to witness heavy spells, with flash floods and landslides possible in hilly terrain over the next 24 hours.

    The Peshawar valley, covering Peshawar, Charsadda, Nowshera, Mardan, and Swabi, will see scattered thunderstorms, while southern KP districts such as D.I. Khan, Tank, Bannu, Lakki Marwat, Karak, and Kohat can expect scattered rainfall/ thunderstorms with occasional heavyfalls.

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  • NDMA continues to assist KP govt, PDMA in flood relief operations – RADIO PAKISTAN

    1. NDMA continues to assist KP govt, PDMA in flood relief operations  RADIO PAKISTAN
    2. ‘My heart breaks’: Malala offers condolences to flood victims  The Express Tribune
    3. Situationer: ‘It’s end of world’  The News International
    4. India, Pakistan floods: What exactly are cloudbursts?  Arab News PK
    5. NDMA advises public to avoid travel in mountainous areas amid heavy rains  Pakistan Today

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  • Syrian business delegation due in Riyadh

    Syrian business delegation due in Riyadh

    Saudi king, crown prince offer condolences to Pakistani president over flood victims 


    RIYADH: Saudi Arabia’s King Salman and Crown Prince Mohammed bin Salman on Monday condoled with Pakistan over the victims of floods that struck the country’s north, resulting in deaths, injuries, and missing persons.


    In a cable to President Asif Ali Zardari, King Salman extended his “deepest condolences and sincere sympathy” to the families of the victims and the people of Pakistan as a whole, praying for the “speedy recovery of the injured and safe return of the missing.”


    The crown prince sent a similar cable to Zardari, according to the Saudi Press Agency, or the SPA.


    Pakistani officials have said at least 344 lost their lives, mostly in Khyber Pakhtunkhwa province, where torrential rains and cloudbursts triggered massive flooding on Friday.  More than 150 were reported still missing.


     



     


    Homes were flattened by torrents of water that swept down from the mountains in Buner, carrying boulders that smashed into houses like explosions.


    The government said that while an early warning system was in place, the sudden downpour in Buner was so intense that the deluge struck before residents could be alerted.


    Lt. Gen. Inam Haider, chairman of the National Disaster Management Authority, told a hastily convened news conference in Islamabad that Pakistan was experiencing shifting weather patterns because of climate change. 


    Since the monsoon season began in June, Pakistan has already received 50 percent more rainfall than in the same period last year, he added.


    (With Agencies)


     

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  • Amnesty says Israel deliberately starving Gaza’s Palestinians

    Amnesty says Israel deliberately starving Gaza’s Palestinians


    LONDON: Eight months after the fall of the Bashar Assad regime, the world is watching and hoping that Syria, despite its fragility, can avoid partition along sectarian lines.


    The latest crisis erupted in mid-July in the southern province of Suweida. On July 12, clashes broke out between militias aligned with Druze leader Sheikh Hikmat Al-Hijri and pro-government Bedouin fighters, according to Human Rights Watch.


    Within days, the fighting had escalated, with interim government forces deploying to the area. On July 14, Israel launched airstrikes on government buildings in Damascus and Syrian troops in Suweida with the stated aim of protecting the Druze community.


    Although they constitute just three to five percent of Syria’s overall population, the Druze — a religious minority — make up the majority in Suweida, with further concentrations in Israel and the Israeli-occupied Golan.



    Syria’s Druze heartland in Soweida has seen a shaky calm since violence between the Druze and Bedouins in July killed thousands. (AFP)


    Diplomatic maneuvers quickly followed. On July 26, Israeli and Syrian officials met in Paris for US-mediated talks about the security situation in southern Syria. Syria’s state-run Ekhbariya TV, citing a diplomatic source, said both sides agreed to continue discussions to maintain stability.


    The human cost has been severe. Fighting in Suweida has displaced roughly 192,000 people and killed at least 1,120, including hundreds of civilians, according to the UN refugee agency, citing a UK-based monitoring group.


    The bloodshed in Suweida has cast a long shadow over Syria’s post-Assad transition. “Syria is already fractured,” Joshua Landis, director of the Center for Middle East Studies at the University of Oklahoma, told Arab News. “The Druze region is under Druze control and the much more important northeast is ruled by the Kurdish-led SDF (Syrian Democratic Forces).


    “The real question is whether (President Ahmad) Al-Sharaa’s new government can bring them back under government control.”


    FASTFACTS


    • Syria is home to eight major religious sects, including Sunni, Alawite, Twelver Shiite, Ismaili, Druze and several Christian denominations.


    • Its ethnic and cultural mosaic includes Arabs, Kurds, Turkmen, Assyrians, Armenians, Yazidis and others with distinct identities.


    Analysts say the surge in violence reflects the fragility of Syria’s political and social landscapes.


    “This violence is not only disturbing; it’s also revealing a lot about the internal dynamics inside Syria,” Ibrahim Al-Assil, who leads the Syria Project for the Atlantic Council’s Middle East programs, told CNN last month.


    “It also shows how fragile not only the ceasefires are but also the whole transition inside Syria.”


    Al-Assil said the turmoil also tests the ability of Syria’s government, its society, and regional powers — including Israel — to guide the country toward stability.


    Despite a US-mediated ceasefire declared on July 16, sporadic clashes persist. Residents report severe shortages of food, fuel and medicine, blaming a government blockade — an allegation Syria’s interim authorities deny.



    Syrian security forces deploy in Walga town amid clashes between tribal and bedouin fighters on one side, and Druze gunmen on the other, near the predominantly Druze city of Sweida in southern Syria on July 19, 2025. (AFP)


    Camille Otrakji, a Syrian-Canadian analyst, describes Syria as “deeply fragile” and so vulnerable to shocks that further stress could lead to breakdown.


    He told Arab News that although “officials and their foreign allies scramble to bolster public trust,” it remains “brittle,” eroded by “daily missteps” and by abuses factions within the security forces.


    From a rights perspective, institutional credibility will hinge on behavior. Adam Coogle, deputy Middle East director at Human Rights Watch, stresses the need for “professional, accountable security forces that represent and protect all communities without discrimination.”


    Coogle said in a July 22 statement that de-escalation must go hand in hand with civilian protection, safe returns, restored services and rebuilding trust.


    The battlefield map complicates the political storyline. Tensions between the SDF and government troops threaten an agreement reached in March to integrate the Kurdish-led coalition into the national military.



    Mazloum Abdi, commander-in-chief of the Syrian Democratic Forces (SDF), speaks during the pan-Kurdish “Unity and Consensus” conference in Qamishli in northeastern Syria on April 26, 2025. (AFP)


    Talks were set back earlier this month when the two sides clashed, with both accusing the other of striking first. The interim government announced it was backing out of talks planned in Paris in objection to a recent conference calling for a decentralized, democratic constitution.


    The August 8 meeting in the northeastern city of Hasakah brought together Kurds, Druze and Alawite figures and called for a new democratic constitution and a decentralized system that respects Syria’s cultural and religious diversity.


    State-run news agency SANA quoted an official accusing the SDF-hosted event of having a separatist agenda and of inviting foreign intervention.


    Meanwhile, religion and identity remain combustible. The coalition of rebel groups that ousted Assad in December was led by Hayat Tahrir Al-Sham, which was led by Al-Sharaa.



    Members of the former rebel group Hayat Tahrir al-Sham stand guard on a street in Damascus, Syria, on December 31, 2024,. to monitor security and prevent crime in their districts after the ouster of Syria’s Bashar al-Assad. (REUTERS)


    The insurgent pedigree of parts of the new administration fuels mistrust among communities already raw from years of war.


    Meanwhile, fear continues to grip Alawite communities in coastal areas amid reports of ongoing revenge attacks. Assad belonged to the sect and promoted many in his government, making them a target since his downfall, even though most had nothing to do with his repression.


    A UN-backed commission that investigated violence in coastal areas in March found that killings, torture, looting and burning of homes and tents primarily targeted Alawites and culminated in massacres.



    Families of Syria’s Alawite minority cross the Nahr al-Kabir river, forming the border between Syria’s western coastal province and northern Lebanon in the Hekr al-Daher area on March 11, 2025, to enter Lebanon while fleeing from sectarian violence in their heartland along Syria’s Mediterranean coast. (AFP/File)


    These developments across the war-weary country have heightened fears of sectarian partition, though experts say the reality is more complex.


    “The risk is real, but it is more complex than a straightforward territorial split,” Haian Dukhan, a lecturer in politics and international relations at the UK’s Teesside University, told Arab News.


    “While Syria’s post-2024 landscape is marked by renewed sectarian and ethnic tensions, these divisions are not neatly mapped onto clear-cut borders.”


    He noted that fragmentation is emerging not as formal borders but as “pockets of influence” — Druze autonomy in Suweida, Kurdish self-administration in the northeast, and unease among some Alawite communities.


    “If violence persists,” Dukhan says, “these local power structures could harden into semi-permanent zones of authority, undermining the idea of a cohesive national state without producing formal secession.”


    In Suweida, communal confidence is buoyed by a sense of agency — and by outside deterrence. Al-Hijri, the most prominent of Syria’s three Druze leaders, has resisted handing control of Suweida to Damascus.



    “There is no consensus between us and the Damascus government,” he told American broadcaster NPR in April. Landis, for his part, argues that Israel’s military posture has been decisive in Suweida’s recent calculus.


    Taken together, these incidents underscore the paradox of Syria’s “local” conflicts: even the most provincial skirmishes are shaped by regional red lines and international leverage.


    Against this backdrop, Damascus has drawn closer to Turkiye. On August 14, Reuters reported the two had signed an agreement for Ankara to train and advise Syria’s new army and supply weapons and logistics.


    “Damascus needs military assistance if it is to subdue the SDF and to find a way to thwart Israel,” Landis said. “Only Turkiye seems willing to provide such assistance.”


    Although Landis believes it “unlikely that Turkiye can help Damascus against Israel, it is eager to help in taking on the Kurds.”


    While the SDF has around 60,000 well-armed and trained fighters, it is still reliant on foreign backers. “If the US and Europeans are unwilling to defend them, Turkiye and Al-Sharaa’s growing forces will eventually subdue them,” said Landis.



    US forces patrol in Syria’s northeastern city Qamishli, in the Hasakeh province, mostly controlled by Kurdish-led Syrian Democratic Forces (SDF), on January 9, 2025. (AFP)


    For Ankara, the endgame is unchanged. Turkiye’s strategic aim is to prevent any form of Kurdish self-rule, which it views as a security threat, said Dukhan.


    “By helping the government bring the Kurdish-led SDF into the national army and reopening trade routes, Turkiye is shaping relations between communities and Syria’s place in the region.”


    Could there be more to Syria’s flareups than meets the eye? Ghassan Ibrahim, founder of the UK-based Global Arab Network, thinks so. “It looks like a sectarian conflict, but at the same time, it has a strong element of political ambition,” he told Arab News.


    He pointed to the unrest in Suweida as one example. “On the surface, what happened there looks sectarian, but at its core, it’s more about political autonomy.”


    Elaborating on the issue, he noted that Al-Hijri had long supported Assad and believed Suweida should have a degree of independent self-rule.


    “When that ambition was crushed — by the (interim) government — things spiraled out of control, taking on a stronger sectarian appearance,” he said. “But I still see it mainly as a struggle for power — each side is trying to bring areas under its control by force.”



    Syrian government security forces set up a checkpoint in the town of Busra al-Hariri, east of the city of Sweida, on July 20, 2025, to prevent armed tribal fighters from advancing towards the city.


    This perspective dovetails with Dukhan’s view that “sectarian identity in Syria is fluid and often intersects with economic interests, tribal loyalties and local security concerns.”


    He noted that “even in areas dominated by one community, there are competing visions about the future.” That fluidity complicates any blueprint for stabilization. Even if front lines quiet, the political map could still splinter into de facto zones where different rules and loyalties prevail.


    To Landis, the government’s current instinct is consolidation. He believes the leadership “has chosen to use force to unify Syria,” which he adds “has proven successful” in the coastal region “because the Alawites are not united and had largely given up their weapons.”


    Success by force in one region, however, does not guarantee the model will travel. In Suweida, Israel’s tripwire and Druze cohesion have raised the price of any government offensive. In the northeast, the SDF’s numbers, organization, and foreign ties complicate any quick military integration.


    If raw power cannot produce a durable settlement, what could? For Dukhan, the transitional government’s challenge is “to prevent local self-rule from drifting into de facto partition by offering credible political inclusion and security guarantees.”


    That formula implies a real negotiation over autonomy, representation, and local policing — sensitive subjects that arouse deep suspicion in Damascus and among nationalists fearful of a slippery slope to breakup.


    Landis agrees that compromise is possible, but unlikely. “Al-Sharaa has the option of compromising with Syria’s minorities, who want to retain a large degree of autonomy and to be able to ensure their own safety from abuse and massacres,” he said. “It is unlikely that he will concede such powers.”



    Syria’s President Ahmed al-Sharaa (R) and SDF chief Mazloum Abdi seal their agreement with a handshake in Damascus on March 10, 2025, to integrate the institutions of the semi-autonomous Kurdish administration in the northeast into the national government. (AFP)


    Still, experts say Syria can avoid permanent fracture if all sides — domestic and foreign — work toward reconciliation.


    As Syria’s conflict involves multiple domestic factions and foreign powers, Ibrahim said international actors could foster peace by pressuring their allies on the ground. Responsibility, he stressed, lies with all sides.


    “The way forward is cooperation from all,” he said. “For example, Israel could pressure Sheikh Al-Hijri and make it clear that it’s not here to create a ‘Hijristan’.”


    Ibrahim was referring to the Druze leader’s purported ambition to carve out a sovereign state in Suweida.


    Otrakji said that “after 14 years of conflict, Syria is now wide open — a hub not just for diplomats and business envoys, but also for military, intelligence and public relations operatives.”



    Representatives and dignitaries of Syrian communities attend a two-day national dialogue conference called for by the country’s new authorities in Damascus on February 24, 2025.


    The previous regime was rigid and combative, he said, but the new leadership “seems intent on pleasing everyone.”


    That balancing act carries dangers — overpromising at home, underdelivering on reforms, and alienating multiple constituencies at once.


    Otrakji stressed that without full implementation of UN Security Council Resolution 2254, Syria will remain trapped “on a dizzying political rollercoaster” and in uncertainty.


    The UNSC reaffirmed on August 10 its call for an inclusive, Syrian-led political process to safeguard rights and enable Syrians to determine their future.


    Global Arab Network’s Ibrahim concluded that Syria does not need regime change, but rather reconciliation, education and a leadership capable of dispelling the idea that this is a sectarian war.


    Sectarian and religious leaders, he said, “must understand that Syria will remain one unified, central state with some flexibility — but nothing beyond that.”

     



     

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