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It has been a pleasure to meet in person again for IAS 2023, the 12th IAS Conference on HIV Science. We’ve also been delighted to welcome delegates online from around the world.
Over 5,000 people, including about 320 scholarship recipients, participated in IAS 2023 in person and virtually. We thank every one of you.
In just four days in Brisbane and virtually, we have been enriched by more than 1,400 abstract presentations that stretch across the spectrum of science. Please find a selection of that groundbreaking science below.
As the closing session panellists pointed out, the unprecedented success of the COVID-19 response was built on decades of scientific breakthroughs and investment in HIV. The shortcomings of the COVID-19 response, however, reflect what was not integrated from the lessons of the HIV response: failing to prioritize equitable access to essential prevention, diagnostic and treatment tools – failing to put people first.
There is still much work to do before we meet again next year at AIDS 2024, the 25th International AIDS Conference, in Munich, Germany, and virtually from 22 to 26 July 2024. We look forward to seeing you there!
Yesterday
26 July recap
Key takeaways from yesterday are:
Prevention: Cisgender women in seven countries in Africa – nearly eight in 10 of 2,500 participants in the open-label extension of HPTN 084 – prefer long-acting injectable cabotegravir (CAB-LA) over daily oral TDF/FTC as pre-exposure prophylaxis (PrEP) when given the choice. These findings were reinforced by HPTN 084-01, which showed that 92% of female adolescents in South Africa, Uganda and Zimbabwe chose to stay on CAB-LA; some participants, however, still preferred oral tablets for reasons that included fear of the injection.
Cure: Understanding the HIV reservoir, including elite control and new approaches to measurement, was the focus of a plenary with Ya-Chi Ho (Yale University School of Medicine), Asier Saez-Cirion (Institut Pasteur), Thumbi Ndung'u (University of KwaZulu-Natal) and Sharon Lewin (University of Melbourne).
COVID-19 and HIV: Mortality due to COVID-19 among HIV-negative people decreased drastically after vaccination, but there was only a modest reduction (38-39% in the Omicron and Delta waves) for people living with HIV, especially those with low CD4 counts, an analysis of data from the World Health Organization (WHO) Global Clinical Platform comprising more than 821,000 people hospitalized with COVID-19 showed. According to the study team, the findings highlighted the need to implement WHO recommendations for giving booster vaccine doses to all people living with HIV.
TB and HIV: Among people living with HIV, tuberculosis is the leading cause of death, and TB-related mortality increased during the COVID-19 pandemic. A study of 10,555 cisgender women in 11 African countries, with research led by people living with HIV (2020-2022), showed that employment discrimination – being refused a job, income or promotion due to HIV status – may impede HIV and TB outcomes among women living with HIV and may be a determinant of TB progression regardless of antiretroviral therapy (ART) use. Establishment and enforcement of non-discrimination protections for women living with HIV may improve economic stability, support TB control and reduce deaths among people living with HIV.
IAS 2023 scientific highlights
Cure: Delegates were introduced to the “Geneva Patient”, the sixth person considered “cured” of HIV. The Geneva Patient is a Caucasian male whose viral load remains undetectable 20 months after discontinuing ART. In 2018, he received chemotherapy for biphenotypic sarcoma following a stem cell transplant from an unrelated HLA-matched wild-type CCR5 donor. The donor had normal or “wild type” stem cells – meaning they were susceptible to HIV. The others received stem cell transplants from donors whose cells have a rare mutation that makes them resistant to HIV, known as the CCR5-delta32 mutation.
We gained understanding of why single cells harbouring HIV are latent. Researchers highlighted advances in our understanding of HIV persistence that have been possible through the development of single-cell methods allowing the analysis of proviruses, integration sites and gene expression of infected cells that can persist despite ongoing immunologic pressure.
A treatment for certain types of blood cancer, venetoclax, can preferentially prime latent cells to die and facilitate clearance of the viral reservoir. Using a humanized mouse model, researchers found that daily doses of venetoclax for six weeks significantly delayed viral rebound following cessation of ART.
Game changer for heart disease: People living with HIV are substantially more likely to develop cardiovascular disease. Full results from the Randomized Trial to Prevent Vascular Events (REPRIEVE), released at IAS 2023 for the first time, point to a game changer: participants living with HIV who took a daily statin (pitavastatin) lowered their likelihood of major adverse cardiovascular events by 35%. Across 12 countries, participants in the treatment group were 21% less likely than those in the placebo group to experience major cardiovascular events.
 Prevention: Prevention was a big topic at IAS 2023. WHO revealed in a policy brief that people living with HIV who have an undetectable viral load, as shown in any WHO-approved test, and continue taking medication as prescribed have “zero risk” of transmitting HIV to their sexual partner(s). This is a massive boost to the undetectable equals untransmittable (U=U) messaging; the IAS has created a resource, which summarizes what you need to know. A handful of other prevention highlights from IAS 2023 include:
- Delegates heard that the inner-city area of Sydney had virtually eliminated HIV transmission, reducing new acquisitions by 88%, which is within easy reach of the UNAIDS targets. Australia may now become the first country to eliminate HIV transmission.
- Voluntary medical male circumcision (VMMC) reduces HIV acquisition among men who have sex with men, the first-ever randomized controlled trial on VMMC among men who have sex with men found. The study from China of nearly 250 HIV-negative men who predominantly practiced insertive anal sex and were willing to undergo VMMC found that there were no HIV seroconversions in the intervention arm (immediate VMMC) and five in the control arm (delayed VMMC).
- Despite COVID-19 disruptions in service delivery, PrEP among key populations in 30 PEPFAR-supported countries has been substantially scaled up, particularly among people who inject drugs and people in prisons. Programme modifications, such as HIV self-testing, telemedicine and community-based deliveries, may have played a role.
- A study from Zimbabwe showed that 77% of 1,466 adolescent girls and young women in Zimbabwe prefer the dapivirine vaginal ring to daily oral PrEP for HIV prevention.
Long-acting injectable antiretrovirals: Long-acting antiretrovirals (ARVs) boost the likelihood of adhering to treatment and overcoming the barriers of stigma and pill burdens. Not surprisingly, sessions at IAS 2023 explored all aspects of long-acting injectable options, including how to ensure they reach all people who need them. Long-acting ARVs were described as probably the greatest advancement in the HIV field in recent years. The question now, however, is how to scale up these agents to ensure population-level effectiveness. Also:
- Researchers have successfully developed a process that transforms short-acting tenofovir, lamivudine and dolutegravir (TLD) to long-acting TLD in a single subcutaneous injectable product.
- We gained insight into how currently available treatment, including long-acting ART, can be implemented in low-, middle- and high-income countries, as well as how injectable therapies can be made available to everyone in different resource and service settings.
Innate sex differences: Boys may have a better chance of sustained HIV remission than girls due to innate immune sex differences, results from a longitudinal study in KwaZulu-Natal, South Africa, of 281 mother-child pairs following in utero HIV transmission showed. All children in the study received ART at birth; 92% also received ARVs prior to birth through their mothers. The study identified five boys (and no girls) born with HIV who maintained undetectable viral load despite low adherence or non-adherence to ART.
Communities: Placing communities at the centre was a strong thread throughout IAS 2023. As delegates heard, the ability of communities to engage with science and create knowledge is still underestimated; key populations and people living with HIV are often excluded from research. However, community researchers are leading some important science, and researchers can learn from best practices for meaningful community engagement, from conceptualization to implementation.
Moving towards equity: So often, HIV science produces biased knowledge that does not address real-life problems and contributes to structural inequalities. Delegates explored the decolonization of HIV science, drawing on learnings from projects that reframe the way research is done in a way that is equitable and free of ideology.
Intersections: IAS 2023 heard multiple presentations on intersections between HIV, COVID-19, tuberculosis, mpox, hepatitis and other public health concerns. The following is a small selection:
- Researchers shared the latest data on COVID-19 vaccine effectiveness by HIV status and injection drug use history. This analysis of 2,700 people living with HIV and 375,043 matched HIV-negative individuals (40.7% and 4.3% had a history of injecting drug use, respectively) showed that people who inject drugs may experience lower vaccine effectiveness against COVID-19 acquisition, particularly if they are also living with HIV. This underlines the importance of prioritizing people living with HIV and people who inject drugs for booster shots.
- In 2018, the US President’s Emergency Plan for AIDS Relief (PEPFAR) committed to providing tuberculosis preventive treatment (TPT) to all people living with HIV receiving ART through PEPFAR-supported programmes; 11.3 million completions were reported and the overall TPT completion rate was 78%. Researchers concluded that although progress has been made in providing lifesaving TPT to people living with HIV, gaps remain. Improved searches for active TB cases, surge-and-sustain campaigns, shorter TPT regimens and enhanced reporting and recording systems may expand TPT coverage.
- WHO’s 2022 global surveillance mpox analysis showed that people living with HIV who contracted mpox were not more likely to be hospitalized unless they were immunosuppressed, but uncontrolled HIV might lead to disproportionate mpox morbidity. Health systems should ensure that people living with HIV are aware of their diagnosis, linked to care, on effective ART and achieve viral suppression – and mpox testing can be an opportunity to do that.
- A study of mpox vaccination among gay, bisexual and other men who have sex with men in the United States showed that HIV status was significantly associated with any mpox vaccination, but not mpox vaccine completion. The researchers pointed to further integration of mpox vaccination with sexual health services, as well as complementary vaccine delivery strategies to reach men who have sex with men who are less connected to sexual health delivery systems.
- HIV/HCV service integration at ART clinics and community settings in Nigeria has been a successful strategy to dramatically expand HCV screening and treatment among HIV clients and a critical step to achieving HCV micro-elimination in people living with HIV. This is despite the effects of the COVID-19 pandemic and financing barriers that necessitated domestic resource mobilization.
HIV unmuted - the IAS podcast
In this episode of HIV unmuted, the award-winning IAS podcast, we take a deep dive into the breaking science being released at IAS 2023, and explain why these breakthroughs are so important for people living with and affected by HIV.
In the news
Pegiat Desak Australia Cabut Pembatasan Visa Bagi Mereka yang Hidup dengan HIVABC News (Indonesia)
Australien könnte HIV-Epidemie bald besiegt haben Süddeutsche Zeitung (Germany)
Bictegravir safe and effective in pregnancy NAM aidsmap (United Kingdom)
People with HIV, mpox not at increased risk for hospitalization unless immunosuppressedInfectious Diseases News (United States)
Snapshots from IAS 2023
Official media partner coverage
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