The landscape of HIV prevention and treatment continues to evolve, but recent findings presented at the Conference on Retroviruses and Infectious Diseases (CROI) 2026 largely reinforce the effectiveness of current strategies, according to leading researchers. While concerns existed that budget cuts impacting global HIV and infectious disease efforts might dampen scientific engagement, attendance at the conference remained robust, signaling a continued commitment from the medical community. This year’s CROI focused heavily on expanding options for prevention, particularly through long-acting therapies, and refining existing treatment protocols.
The ongoing pursuit of more accessible and effective HIV prevention methods remains a central focus. New data surrounding pre-exposure prophylaxis (PrEP) dominated discussions, including the final results from the Purpose 1 and Purpose 2 trials evaluating lénacapavir, administered via injection every six months. While the initial efficacy of this long-acting injectable PrEP is promising, researchers are beginning to observe limitations, with a small number of breakthrough infections and the emergence of drug resistance. This is a critical consideration, as lénacapavir is also being investigated as a treatment option for HIV, meaning any resistance development requires careful monitoring. Understanding the nuances of resistance patterns is crucial for maintaining the long-term viability of these preventative measures.
Expanding PrEP Options and Addressing Disparities
Further bolstering the PrEP toolkit, results from the ANRS Prevenir study, an eight-year investigation conducted in the Paris region, demonstrated the high effectiveness of both daily oral PrEP and on-demand oral PrEP. The incidence of HIV among participants using either method was comparable to that observed with injectable PrEP. Though, long-acting injectable PrEP offers distinct advantages for individuals who struggle with adherence to daily oral regimens or are ineligible for oral PrEP, potentially leading to greater coverage of sexual activity. Cabotegravir intramuscular injection is now available in France for PrEP, administered every two months, providing a convenient alternative. Aidsmap provides further details on the approval and rollout of cabotegravir for PrEP in Europe.
Researchers are also exploring even longer-acting oral PrEP options. MK-8527, a once-monthly oral PrEP, generated interest, though currently only preliminary pharmacokinetic data have been presented. The overarching goal is to provide a diverse range of PrEP options to reach a wider population. In France, for example, there’s a concerning trend of increasing HIV diagnoses among men who have sex with men (MSM) born abroad and transgender individuals, even as diagnoses decrease by nearly 30% among MSM born in France. PrEP uptake remains low among heterosexual individuals. Long-acting injectable PrEPs are hoped to be more appealing and accessible to these underserved populations.
Advances in HIV Treatment: Long-Acting Combinations and the Pursuit of a Cure
The development of long-acting treatment options is also gaining momentum. Data presented at CROI highlighted new oral combinations, including an association of lénacapavir and islatravir, designed for once-weekly administration. While promising, these results remain preliminary. New fixed-dose combinations are also being evaluated, such as a combination of doravirine and islatravir, which demonstrated efficacy comparable to bictégravir/emtricitabine/tenofovir alafenamide, though with a slightly higher risk of resistance. The Artistry study focused on a daily single-tablet regimen of lénacapavir and bictégravir, showing equivalent results to existing combinations. However, a key limitation of this regimen is its lack of activity against hepatitis B, unlike traditional three-drug therapies. Determining the optimal place for these new combinations within the existing treatment landscape will likely depend on individual patient needs and tolerance.
The quest for a cure for HIV continues, with ongoing research into broadly neutralizing antibodies (bNAbs). Current results indicate limited durability of effect, but combining bNAbs with antiretroviral therapy is showing potential for extending the time between treatments – potentially to every four to six months – provided patients exhibit sensitivity to the antibodies, which must be tested beforehand.
Beyond HIV: Updates in STI and Tuberculosis Research
CROI 2026 also addressed other infectious diseases. Doxycycline post-exposure prophylaxis for sexually transmitted infections (STIs) continues to demonstrate effectiveness, with new data reinforcing its benefits. However, research into the use of the Bexsero vaccine for the prevention of gonococcal infections appears to be largely abandoned, with new results corroborating the negative findings of the French Doxyvac study. The UK government reported on the findings of the Doxyvac study, confirming the lack of efficacy.
A new class of anti-herpetic drugs, anti-helicases, showed promise in an international study, particularly for individuals with weakened immune systems where conventional anti-herpetics are becoming less effective due to resistance. Unfortunately, studies on tuberculosis yielded disappointing results, with intensification of treatment regimens failing to demonstrate any benefit in terms of mortality.
The findings presented at CROI 2026, while not necessarily revolutionary, underscore the importance of continued research and innovation in the fight against HIV and other infectious diseases. The focus on expanding prevention options, refining treatment strategies, and addressing disparities in access to care remains paramount. The development of long-acting therapies holds particular promise for improving adherence and reaching underserved populations.
Disclaimer: The information provided in this article is for general knowledge and informational purposes only, and does not constitute medical advice. We see essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
The next key checkpoint in HIV research will be the International AIDS Conference in July 2024, where further data and insights are expected to be presented. Stay informed and engaged in the ongoing efforts to combat HIV and improve global health. Share this article with your network to raise awareness and contribute to the conversation.
