Five take-aways from the 2023 International AIDS Society Conference

Patricia Khomani our Blantyre Prevention Strategy Project Manager presenting at IAS

From July 23 to 26, Brisbane, Australia hosted the 12th International AIDS Society conference on HIV science. Over four days, 4,000 attendees shared the latest research on HIV bench research, epidemiology, implementation science, policy, behavioral science, and advocacy efforts. From our perspective at Cooper/Smith, the most critical breakthroughs from 2023’s IAS were:

1. What we still need to learn about delivery of long acting drugs. Long acting injectable drugs have been proven efficacious for HIV treatment, and at least one is effective at HIV prevention. While these long acting injectables offer potential relief from daily pill burden routines, there is much to learn about their delivery. Researchers reported on patient preferences for injectables, concerns over pain and needles, preference for integration with family planning or STI screening and treatment, desires for de-medicalized delivery via peer friendly or community services, concerns over the potential for HIV resistance, challenges to HIV testing sensitivity, and costs related to injectables. Our takeaway: these drugs are promising, but we can’t harness their full potential without better understanding these delivery dynamics.
2. Expanded Undetectable = Untransmissible guidelines. Some of the biggest news of the week dropped on the first day of the conference:The WHO announced the results of a systematic review where they concluded there was virtually no risk of HIV transmission when an index patient had a viral load less than 1,000 copies/mL. The WHO has already updated its Undetectable = Untransmissible (U=U) guidance to reflect this new systematic review.
3. Cardiovascular care is important for all people living with HIV. People living with HIV have long been known to have elevated risks of cardiovascular disease. In Brisbane, researchers announced findings from the REPRIEVE randomized trial of statin use among patients on ART aged 40 and up with low- to moderate-risk of cardiovascular disease. Remarkably, the researchers discovered a massive 35% reduction in cardiovascular events among this low-risk population for those receiving daily statins. This trial could be a gateway towards greater focus on cardiovascular health for people living with HIV, especially in low- and low-middle income countries.
4. Advances in STI Prevention. STIs have seen a resurgence in the past decade, reigniting concerns over their role in HIV programs. Researchers recently reported a highly successful trial of antibiotic use for preventing STIs. The implications of this research are that people could be on a combined regimen of antiretrovirals for HIV prevention and antibiotics for STI prevention concurrently. However, conference presenters highlighted the importance of continued surveillance, especially for emergence of antibiotic resistance in gonorrhea.
5. Barriers Towards Elimination of HIV Remain. Despite recent advances, there are considerable limitations for the HIV prevention landscape. Most concerningly, uptake and continuation of oral PrEP for HIV is woefully low. Conference presenters announced that globally, only four million initiations have ever occurred, a quarter of which were in South Africa and three million of which were funded by the U.S. government. Further, conference presenters highlighted the fact that beyond Lenacapavir, there are no other Phase 3 prevention technologies in the trials pipeline. This means that over the next three to five years we should not expect any further additions (i.e., drugs, vaccines, bnAbs, or devices) to prevention programme repertoires.

As usual, the IAS Conference on HIV Science disseminated world class, critical research from across the globe with tangible implications for patients and people at risk of HIV. Still, more work is required to realize the potential gains of this research. We are collaborating with Georgetown University on the newly announced “Path to Scale” in Malawi, which will help to ensure we achieve epidemic impact from injectable prevention. We are leading the roll-out of Malawi’s expanded SMS Viral Load Results Return project, which will become even more critical as new U=U guidelines are implemented. And finally, we are exploring options for novel surveillance approaches such as wastewater monitoring which could prove to be especially useful for identifying blips in emergent antibiotic resistant STIs.

We are excited to collaborate with our partners in research and program delivery to tackle these projects in the coming year. We look forward to sharing our progress and enabling others to apply these lessons in their own settings.