Journal of the International AIDS Society最新文献

Introduction: HIV guidelines recommend switching from a three-drug regimen (3DR) to dolutegravir + lamivudine (DTG+3TC) for eligible individuals. This retrospective national cohort study used Swedish InfCareHIV registry data to evaluate long-term outcomes of adults with HIV RNA <50 copies/ml who switched to DTG+3TC or a guideline-recommended 3DR between July 2019 and May 2023 in routine clinical care.

Methods: Demographic and clinical data were obtained from InfCareHIV at baseline, 6, 12, 24, 36 and 42 months post-switch. The primary endpoint was virologic failure (VF) rates at each time point; secondary endpoints included VF rates in prespecified subgroups, time to VF, and incidence of viral blips and treatment-emergent resistance. Generalized estimating equations modelling was used to assess the effects of clinical predictors on VF.

Results: A total of 1125 individuals (46%) switched to DTG+3TC, and 1336 (54%) switched to 3DR. Adjusted VF rates post-switch were 0.1-2.9% in the DTG+3TC group and 0.3-2.2% in the 3DR group in the intent-to-treat analysis (0-0.4% and 0.3-2.3% in the on-treatment [OT] analysis, respectively). In the OT set, the odds of VF were significantly lower for DTG+3TC versus 3DR at 24, 36 and 42 months (p<0.001). Treatment-emergent resistance rates were low in both groups.

Conclusions: In this long-term, real-world, national cohort, switching to DTG+3TC was associated with low rates of VF and antiretroviral therapy resistance, indicating that eligible individuals can be switched to DTG+3TC without increased risk of VF.

Introduction: Remarkable progress has been made in response to the global HIV epidemic, yet critical gaps and inequities remain, combined with challenges stemming from the current threats to global funding, complacency and competing global health priorities. These constraints threaten to unravel the hard-won gains and to stall progress towards control of the HIV epidemic. In response to this rapidly changing landscape, the integration of HIV services into primary care has emerged as a potential solution to this crisis that would bring possible efficiencies and sustainability of the response.

Discussion: Recognition that persons with HIV often experience a range of other health challenges over their lifetime has compelled the need for integration of non-HIV services into HIV programmes to allow for delivery of comprehensive person-centred care. However, most attention at present is centred on the integration of HIV treatment into primary care, raising concerns about whether this might risk the quality of care for persons with HIV. The limited availability of primary care services that offer comprehensive and effective continuity care in many low- and middle-income countries presents a major challenge to providing such care. Nonetheless, such integration offers a historic opportunity to enhance healthcare for all people with chronic health conditions, including for persons with HIV.

Conclusions: The integration of non-HIV services into HIV programming is recognized as necessary to meet the needs of persons with HIV, enhancing their quality of life and health outcomes. At the same time, the imperative for integration of HIV treatment into primary care programmes raises an important question. Can primary care programmes be transformed to allow for the provision of the necessary continuity care with the required supportive services that persons with HIV need? Accomplishing this goal may present a pathway to sustaining the HIV response in the current resource-constrained context while enabling the long-desired transformation of primary care services to effectively deliver on their potential for advancing the health of all people.

Introduction: The 13th IAS Conference on HIV Science, held in Kigali, Rwanda (13-17 July 2025), highlighted key advances in clinical research. Presentations focused on sustaining HIV treatment and prevention amid financial constraints, innovations in long-acting oral antiretrovirals, and the management of comorbidities and co-infections, particularly tuberculosis (TB) and mpox.

Discussion: Significant progress was reported on long-acting oral antiretrovirals, including a weekly treatment regimen and a promising monthly option for pre-exposure prophylaxis. These strategies could expand the current antiretroviral therapy (ART) portfolio to better meet individual needs. Additionally, the use of currently available long-acting regimens in non-suppressed individuals warrants further exploration, supported by growing evidence of their potential in this clinical context. Intermittent ART, previously studied as a means to reduce toxicity, is now gaining attention as a potential cost-saving strategy. However, more research is needed to define its role across diverse settings. While data from high-income countries is encouraging, results have been less favourable in resource-limited settings and among key populations such as adolescents. Two-drug and injectable regimens, increasingly used and supported by international guidelines in high-income settings, are now being explored in resource-limited contexts and incorporated into clinical guidelines-narrowing the gap between recommendations for high- and low-income regions. As the ART portfolio evolves towards regimens without tenofovir, hepatitis B reactivation emerged as a key topic at the conference. Management of TB, a long-standing clinical challenge, was also addressed in Kigali with trial data supporting early empiric TB treatment and the safety of same-day ART initiation in selected clinical scenarios. The UNITY trial on tecovirimat for mpox treatment showed no significant clinical benefit, underscoring the need to revise current management guidelines. Research on comorbidities examined ART-associated weight gain, showing that switching ART once obesity is established has a limited impact on weight outcomes. Studies in paediatric populations highlighted predictors of treatment failure and the benefits of dolutegravir-based regimens.

Conclusions: In the face of growing economic pressures, innovation in HIV treatment and prevention remains essential. The conference emphasized the importance of sustainable public health strategies and individualized care approaches to ensure continued progress in the global HIV response.