What we learned at IAS 2021

What we learned at IAS 2021

By Adeeba Kamarulzaman, IAS President

In the 40 years since AIDS was first reported, nearly 35 million people have died from AIDS-related causes.

Today, thanks to scientific inquiry, a positive HIV test no longer means fear and despair. A mother living with HIV can give birth without passing it on to her child, and an undetectable viral load is untransmittable between partners. Each year, our treatment and prevention efforts improve. And each year, we continue unlocking the mysteries of how HIV interacts with the human body.

Another pandemic – COVID-19 – prevents many of us from meeting in-person to share the latest breakthroughs in science, medicine, health policy and programme implementation. So, IAS – the International AIDS Society – held the IAS Conference on HIV Science virtually for the first time.

Despite COVID-19 lockdowns, curfews and supply disruptions, the IAS delivered a robust scientific programme at IAS 2021 – the 11th IAS Conference on HIV Science. Highlights included advancements in the search for an HIV cure, analysis of the impact of COVID-19 on the global HIV response and the specific obstacles faced by women and girls.

Let’s look back on our week in Berlin and virtually to recap some key themes that emerged from IAS 2021:

Advances in PrEP: Dozens of sessions and presentations focused on new approaches to lowering barriers to PrEP. Under the spotlight were the impact of COVID-19 on HIV prevention and positive changes it fuelled, scaling up U=U and better integrating U=U advocacy into existing prevention and treatment programmes, and effectiveness of PrEP rollout strategies to ensure that programmes work for the populations they intend to reach. From vaginal rings to implants to long-acting injectables, a plethora of speakers explored novel HIV prevention interventions and the potential of these tools to reach specific populations.

Dual pandemics: Pivoting HIV prevention, treatment and care during a parallel pandemic was a major focus area throughout IAS 2021. In the opening session panel discussion, global experts warned that HIV must not be left behind in the COVID-19 response. Experts reviewed the latest developments in monoclonal antibodies and their role in prevention and treatment of both HIV and COVID-19. Key studies examined the impact of COVID-19 on HIV treatment interruption and clinical characteristics and prognostic factors in people living with HIV hospitalized with COVID-19, reaffirming the IAS’s call for people living with HIV to be a priority population as countries plan COVID-19 vaccine rollout.

Global perspectives: Experts from Latin American and the Caribbean, the Middle East and North Africa and southern Africa discussed many of the limitations, advantages and parallels between SARS-CoV-2 and HIV around stigma and discrimination and service access and delivery. Speakers proposed solutions to address challenges for increasing testing and improving retention in care while focusing on advancing the HIV agenda after the COVID-19 crisis. 

Co-infections: Several presentations addressed advancements in diagnosing and treating HIV syndemic co-infections, including TB, COVID-19 and viral hepatitis. Leading experts reviewed the current states of the HIV and TB syndemic, viral hepatitis cascade of care and age-related illnesses in people growing old with HIV.

Personalized care: The individualization of care and implementation of population-based interventions was one of many trending topics at IAS 2021. Among proposed solutions to addressing barriers to care were improvement in testing and linkage to care, along with integrating gender-affirming hormone therapy into HIV prevention services. Clearly, delivering person-centred quality STI and HIV services will continue to be a priority for healthcare practitioners everywhere.

HIV cure research updates: The IAS 2021 programme featured the latest HIV cure research, including updates on HIV reservoirs. Sessions provided updates on HIV reservoir regulation and cure, as well as expanding on current understanding of the sources of rebound viruses and the cellular and viral determinations of rebound. Studies on the passenger hypothesis, reservoirs in vertically infected children and host genetic determinants of reservoir markers were presented during an oral abstract session on untangling HIV reservoir dynamics.

Tackling stigma: Sessions on overcoming stigma and discrimination, including HIV-related internalized stigma in clinical practice, drew rich engagement. Interactive panels explored how stigma influences interactions in healthcare systems and wider social structures and proposed ways to actively silence and measure HIV-related stigma across regions, populations, ages and genders.

Service delivery: Timed with IAS 2021, WHO issued its latest consolidated HIV guideline and its first-ever guidelines on hepatitis C self-testing. Speakers also sought input on global health sector strategies and shared what’s new in differentiated service delivery for HIV treatment. Beyond the WHO recommendations, presenters showcased lessons in service delivery integration. Scientists shared the latest on studies of conditional cash transfer measures in Brazil, combined interventions to accelerate delivery for young children in southern Africa and multi-disease health screening campaigns in the Democratic Republic of the Congo.  

The latest on COVID-19: IAS 2021 featured critical discussions on the latest evidence on COVID-19 prevention and treatment. Presentations highlighted research on COVID-19 variants, COVID vaccines and antibodies and what works and what doesn’t for COVID-19 treatment. A symposium on new ways of communicating in an era of multiple crises and fake news pointed out that the COVID-19 pandemic has shown the importance of evidence-based communication around many global threats to human health.

We are thrilled to see that HIV research has not been completely brushed aside during the past year and a half of the COVID-19 pandemic. Just as 40 years of HIV experience informed the COVID-19 response, the scientific breakthroughs and political will achieved in that response must now propel our efforts to end AIDS.

Our focus is to keep this momentum going. As IAS 2021 brought home to us, we now have new opportunities to adapt and enhance COVID-19 approaches and sustain global attention and commitment to prioritizing public health.

I will look forward to continuing to follow the science at AIDS 2022 next year.