Five Years to 2030: Europe’s Race to End the AIDS Epidemic Congress Feature:
Interviews:
Miłosz Parczewski, Anne-Marie Wensing, and Esteban Martinez share key insights from EACS 2025
05 Welcome
Congress Review
06 Review of the 20th European AIDS Clinical Society (EACS) Conference, 15th–18th October 2025
Congress Feature
21 Five Years to 2030: Europe’s Race to End the AIDS Epidemic Ada Enesco
Abstract Reviews
26 Characterisation of Natural Killer Cell Subsets and Antibody-Dependent Cellular Cytotoxicity Function in a Case of Sustained HIV Remission After Allogeneic Stem Cell Transplantation (2nd Berlin Case)
Trenkner T et al.
29 Gaps and Gains in Pre-exposure Prophylaxis Continuity: Clinical and Programmatic Insights from Nigeria’s 2024 National Rollout
Magaji RA et al.
Congress Interviews
31 Miłosz Parczewski and Anne-Marie Wensing
35 Esteban Martinez
"Only by standing together can we push back against anti-science rhetoric, prejudice, and ignorance"
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This Publication
Publication Date: December 2025 Online ISSN: 2732-5326
All information obtained by EMJ and each of the contributions from various sources is as current and accurate as possible. However, due to human or mechanical errors, EMJ and the contributors cannot guarantee the accuracy, adequacy, or completeness of any information, and cannot be held responsible for any errors or omissions. EMJ is completely independent of the review event (EACS 2025) and the use of the organisations does not constitute endorsement or media partnership in any form whatsoever. The cover photo is of Paris, France, the location of EACS 2025.
Explore the evolution of HIV care in Europe with Jürgen Rockstroh, Past EACS President and recipient of the EACS Award 2025. From breakthroughs in antiretroviral therapy to managing complex co-infections and emerging threats, this episode examines the current state of HIV care and what the future may hold.
Topics covered include:
• Milestones in treatment access and patient outcomes
• Strategies for HIV/hepatitis co-infection and haemophiliac cohorts
• Adapting care for COVID-19, mpox, and other threats
• Treatment innovations driving toward remission or functional cure
Jürgen Rockstroh Professor of Medicine, Head of the HIV Outpatient Clinic, University Hospital Bonn, Germany
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Welcome
Dear Readers,
We are pleased to present this supplement of EMJ Microbiology & Infectious Diseases, featuring comprehensive coverage of the 20th European AIDS Clinical Society (EACS) Conference, held in Paris, France, from 15th–18th October 2025.
The conference brought together leading experts in HIV research and care from across Europe and beyond, fostering dialogue on the latest scientific advances, clinical developments, and strategies to achieve Europe’s goal of ending the AIDS epidemic by 2030.
This supplement brings you key congress highlights, notable abstract findings, and interviews with EACS leadership. Readers will find insights into a wide range of current HIV research, from advances in prevention programmes to novel findings on immune responses in exceptional cases. In addition, in-depth conversations with current and past EACS presidents provide valuable perspectives on guideline updates, patientcentred care, and the evolving landscape of HIV management in Europe.
We hope this supplement serves as a resource and inspiration for clinicians, researchers, and policymakers alike, offering a window into the progress being made and the challenges that remain. Through collaboration, innovation, and commitment, the EACS community continues to shape the future of HIV care and improve outcomes for all people living with HIV.
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EACS 2025
Only by standing together can we push back against anti-science rhetoric, prejudice, and ignorance
Review of the 20th European AIDS Clinical Society (EACS) Conference Congress Review
THE 20th European AIDS Clinical Society (EACS) Conference opened its doors in Paris, France, from 15th–18th October 2025, marking a landmark moment for the global HIV community. Gathering over 3,000 delegates from across the world and featuring a record number of more than 1,000 submitted abstracts, this year’s Conference reaffirmed the EACS’ role as a hub of scientific innovation, collaboration, and advocacy.
EACS President Miłosz Parcewski opened the ceremony by paying tribute to Paris as a historic centre of scientific progress and avant-garde thinking, an ideal host for a congress devoted to advancing HIV prevention, care, and research. He highlighted the Conference’s dynamic programme, which for the first time included a “Co-Chairs’ Choice” session showcasing cutting-edge, high-impact studies. The congress venue also featured several art exhibitions, among them the deeply moving ‘Dreams of Children in Ukraine’, which served as a poignant reminder of the human dimension behind global health challenges.
Parcewski reaffirmed the EACS’ enduring mission: to promote excellence in HIV care, research, and education across Europe, while standing firm for equity in access to healthcare. In a powerful address, he stated, “EACS stands against any form of aggression, war, and violation of human rights. We are deeply concerned by the ongoing wars and conflicts and their impact on HIV prevention and care. We stand by all communities, especially those most marginalised.”
EACS Co-Chair Bruno Spire, from the French National Institute of Health and Medical Research (INSERM), took the stage to reflect on France’s pivotal role in communitybased HIV work, emphasising the essential partnerships with affected populations: transgender people, men who have sex with men, people who inject drugs, migrants, and sex workers. Yet, he warned, this progress is increasingly at risk. “Freedom of communitybased activism is under threat,” he cautioned, pointing to rising conservatism, normalised transphobia and xenophobia, and shrinking public and international funding for HIV programmes. In this challenging environment, he called for renewed unity between science and activism: “Only by standing together can we push back against anti-science rhetoric, prejudice, and ignorance, and continue to advance public health.”
Co-Chair Karine Lacombe, Sorbonne Université, Paris, France, celebrated the extraordinary scientific journey since the discovery of HIV in Paris in 1983. In just over 3 decades, she noted, medical research has achieved what once seemed impossible: dramatically reducing new HIV infections
and bringing the life expectancy of people living with HIV close to that of the general population. She highlighted that this 20th EACS Conference would spotlight the latest breakthroughs in prevention, diagnosis, and treatment, alongside renewed attention to the ethics of care, diversity, and inclusion.
The opening ceremony also welcomed Anne Hidalgo, Mayor of Paris, who reaffirmed the city’s deep commitment to the fight against HIV. It was in Paris, in 2014, that mayors from cities around the world launched the Fast-Track Cities initiative, committing to meeting the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets by 2020 and ending the AIDS epidemic by 2030. She reminded the audience that Paris, one of the European cities hit hardest by the epidemic, has long been a refuge for those seeking to live and love freely. “The fight against HIV,” Hidalgo declared, “is a fight against discrimination, for dignity, and for humanity.” With only 5 years remaining to fulfil the promise of ending the AIDS epidemic, she urged continued investment in science, defence of human rights, and unwavering solidarity.
The ceremony continued with a moving series of reflections from long-standing voices in the global HIV response, including leading physician and diplomat Michel Kazatchkine of the Geneva Graduate Institute in Switzerland; French militant and activist Eve Plenel; and Caroline Andoum, managing director of ‘Bamesso et Ses Amis’, Paris, France, a humanitarian association promoting sexual health across migrant populations in France and Africa.
Finally, the 2025 EACS Awards honoured two individuals whose sustained contributions have shaped the field: Ben Collins, a veteran activist and community organiser instrumental in strengthening EACS partnerships in Eastern Europe, and Jürgen Rockstroh of the University of Bonn, Germany, recognised as a visionary clinician-scientist and dedicated mentor.
With these inspiring words and recognitions, the 20th EACS Conference set the stage for 4 days of community dialogue and shared commitment to ending the HIV epidemic, upholding human rights, and ensuring that progress leaves no one behind.
The fight against HIV is a fight against discrimination, for dignity, and for humanity
Suppression Through 96 Weeks
LATE-BREAKING findings presented at the 20th EACS Conference demonstrate that a once-weekly oral combination of islatravir (ISL) and lenacapavir (LEN) maintained durable virologic suppression and excellent safety through 96 weeks in adults living with HIV-1. The results, from an ongoing Phase 2 clinical trial, highlight the potential of ISL+LEN as the first complete, once-weekly, oral antiretroviral regimen.1
The randomised, open-label study enrolled virologically suppressed adults who were previously maintained on a daily fixed-dose combination of bictegravir/ emtricitabine/tenofovir alafenamide. Participants were randomised 1:1 to either continue bictegravir/emtricitabine/tenofovir alafenamide or switch to oral ISL 2 mg plus LEN 300 mg once weekly. Those receiving ISL+LEN and completing the initial 48week randomised phase were eligible to continue into a 48-week extension period, for a total of 96 weeks of treatment.
The results, from an ongoing Phase 2 clinical trial, highlight the potential of ISL+LEN as the first complete, onceweekly, oral antiretroviral regimen
Of the 52 participants who began weekly ISL+LEN (median age: 40 years; 19.2% female), 47 entered the extension phase. Adherence remained exceptionally high, with a mean of 99.3% through 96 weeks. No participants experienced viral rebound (HIV-1 RNA ≥50 copies/mL) or developed treatment-emergent resistance to either study drug. Safety outcomes were favourable: 10 participants (19.2%) reported
study drug-related adverse events, none of which were ≥Grade 3. Two participants (3.8%) discontinued the study due to adverse events considered unrelated to ISL+LEN.
Immunologic and metabolic parameters remained stable. Mean change in cluster of differentiation 4+ T cell count from baseline to Week 96 was –33 cells/µL (95% CI: -86–20), and mean lymphocyte count decreased modestly by -0.2×10³ /µL (95% CI: -0.3–-0.1). Median weight and BMI changes were negligible, with +0.1 kg and +0.04 kg/m² respectively.
The sustained efficacy, favourable safety profile, and excellent adherence observed through nearly 2 years of follow-up support ISL+LEN as a promising alternative to daily oral therapy. Two Phase 3 trials, ISLEND-1 and ISLEND-2, are now underway to further evaluate the once-weekly combination’s potential to simplify long-term HIV treatment.
Participants were randomised 1:1 to either continue bictegravir/emtricitabine/ tenofovir alafenamide or switch to oral ISL 2 mg plus LEN 300 mg once weekly
Low Risk of Hepatitis B Virus Reactivation After Switching from Tenofovir
NEW data presented at the 20th EACS Conference provide reassuring evidence that hepatitis B virus (HBV) reactivation is rare among people with HIV who have previously been exposed to HBV and who switch from tenofovir-based to tenofovirsparing antiretroviral therapy (ART). The findings, derived from the Swiss HIV Cohort Study, offer valuable guidance as clinicians increasingly consider non-tenofovir regimens for long-term HIV management.2
Up to 30% of people living with HIV carry antibodies against the hepatitis B core antigen, indicating prior HBV infection. While tenofovir effectively suppresses both HIV and HBV, concerns have arisen that discontinuing HBV-active drugs might trigger viral reactivation in those with past exposure. This study aimed to assess whether such risk is clinically meaningful in people who are hepatitis B surface antigen-negative but hepatitis B core antibody-positive (those with resolved or occult HBV infection).
Researchers included 380 participants who had switched to non-tenofovir ART. Participants were grouped based on whether their new regimen contained lamivudine or emtricitabine (XTC group) or excluded both agents (non-XTC group). All had plasma samples available from before and at least 1 year after stopping tenofovir. The presence of HBV DNA was measured using highly sensitive assays.
After a median follow-up of 1.3 years, detectable HBV DNA was found in 5.3% of participants in the non-XTC group, compared with 1.6% in the XTC group. Crucially, all detected viral loads remained below the
quantification threshold, and the proportion of participants with elevated liver enzyme levels did not differ significantly between those with or without detectable HBV DNA.
Overall, only 3.4% of those switching to regimens without tenofovir showed evidence of HBV replication, none of which appeared clinically relevant. The study concludes that HBV reactivation in this population is uncommon and likely of minimal clinical consequence.
These findings support the safety of tenofovir-sparing ART strategies in individuals who are hepatitis B core antibody-positive, hepatitis B surface antigen-negative, and have HIV, providing important reassurance for both patients and clinicians as treatment paradigms evolve.
Only 3.4% of those switching to regimens without tenofovir showed evidence of HBV replication, none of which appeared clinically relevant
Majority of HIV Diagnoses Among Migrants Occur After Arrival
IMPORTANT research from the Swiss HIV Cohort Study (SHCS), presented at the 20th EACS Conference, reveals that most new HIV diagnoses among migrants in Switzerland occur after arrival in the country. The findings, spanning 15 years of data, reinforce the need for tailored HIV testing and prevention strategies to reach migrant populations at different stages of their migration journey.3
The analysis included 3,490 participants newly enrolled in the SHCS between 2010–2024, of whom 1,777 were Swiss nationals and 1,713 were migrants. Over time, the proportion of migrants among new enrollees steadily increased, reaching a median of 52% per year. Researchers classified participants as either Swiss nationals or migrants based on nationality and immigration information recorded in the SHCS, and examined whether HIV was diagnosed before or after migration.
Among migrants, 37.9% were diagnosed before migration, while 62.1% received their HIV diagnosis after arriving in Switzerland. Among those diagnosed post-migration, the main presumed mode of HIV acquisition was sex between men (43.1%), followed by heterosexual transmission among women (27.2%) and men (18.9%). Differences in immune status at diagnosis were observed: migrants diagnosed post-migration had significantly lower cluster of differentiation 4 counts compared with Swiss nationals, suggesting later diagnosis in this group.
Among migrants, 37.9% were diagnosed before migration, while 62.1% received their HIV diagnosis after arriving in Switzerland
The median time between immigration and HIV diagnosis varied by gender and mode of acquisition. Male heterosexuals experienced the longest delay (median: 6 years), followed by men who have sex with men (5 years) and female heterosexuals (2 years). This timing also differed according to region of origin, reflecting complex patterns of mobility, health-seeking behaviour, and access to testing.
Migrants diagnosed post-migration had significantly lower cluster of differentiation 4 counts compared with Swiss nationals, suggesting later diagnosis in this group
These findings indicate that more than half of all HIV diagnoses among migrants in Switzerland occur after arrival, suggesting ongoing risk and transmission within the country. The study highlights the importance of strengthening culturally sensitive prevention, early testing, and linkage to care initiatives for migrant communities to ensure equitable HIV outcomes across populations.
Doxycycline Post-exposure Prophylaxis Reduces Chlamydia and Syphilis but Not Gonorrhoea in the Swiss HIV Cohort
AN INTERIM analysis presented at the 20th EACS Conference provides real-world evidence from the Swiss HIV Cohort Study on the effectiveness of doxycycline postexposure prophylaxis (DoxyPEP) and the 4-component meningococcal B vaccine (4CMenB) in preventing bacterial sexually transmitted infections (STI) among men who have sex with men (MSM) living with HIV.4
Although clinical trials have demonstrated strong protective effects of DoxyPEP against certain STIs, its performance in routine practice has been less well characterised, and data on 4CMenB’s cross-protection against gonorrhoea remain inconsistent.
The observational study enrolled 157 MSM at high behavioural risk, defined by sex without a condom with occasional partners and/or a recent history of bacterial STIs. Participants opted to use DoxyPEP and/or 4CMenB as off-label prevention strategies and were followed prospectively for a median of 253 days. STI incidence after study enrolment was compared with each individual’s prior 3-year history using adjusted mixed negative binomial regression models.
Overall, DoxyPEP use was associated with a marked reduction in bacterial STIs, with incidence dropping from 56.26 to 30.23 cases per 100 person-years (incidence rate ratio [IRR]: 0.53; p<0.005). The strongest effects were observed for chlamydia (IRR: 0.20; p<0.005) and syphilis (IRR: 0.30; p<0.01), aligning with previous trial data and reinforcing DoxyPEP’s role as an effective targeted prevention tool in high-risk populations.
However, neither DoxyPEP nor 4CMenB demonstrated protective effects against gonorrhoea. IRRs were non-significant for both DoxyPEP-only users (IRR: 0.97; p≥0.05) and those receiving both interventions (IRR: 1.09; p≥0.05), indicating no measurable benefit. These findings contribute to ongoing uncertainty around 4CMenB’s potential cross-protection and highlight the persistent challenge of preventing gonococcal infections amid rising antimicrobial resistance.
DoxyPEP use was associated with a marked reduction in bacterial STIs, with incidence dropping from 56.26 to 30.23 cases per 100 person-years
In summary, the interim results confirm that DoxyPEP substantially reduces chlamydia and syphilis infections in real-world practice among MSM living with HIV, while showing no impact on gonorrhoea. Likewise, 4CMenB offered no observable protection. Continued follow-up and larger datasets will be important for refining prevention strategies and understanding longer-term outcomes.
Novel Chemsex Patterns and Emerging HIV Prevention Needs
A RECENT study presented at the 20th EACS Conference has examined chemsex, the use of drugs to enhance or maintain sexual experiences, which is increasingly recognised as being linked to heightened risks of HIV and other sexually transmitted infections (STI).5
While ‘classic’ chemsex substances such as methamphetamine, ketamine, gammahydroxybutyrate/gamma-butyrolactone, and mephedrone have long been documented, newer synthetic cathinones and hallucinogens are now broadening the chemsex landscape across Europe.
The study surveyed 14,652 men who are HIV-negative and have sex with men and transgender individuals across 20 European countries to explore how these ‘novel’ substances relate to STI prevalence and engagement in HIV prevention, particularly pre-exposure prophylaxis (PrEP).
Using latent class analysis, researchers identified five patterns of sexualised substance use. One group, defined by the use of novel chemsex drugs, reported the highest rates of recent STIs, including syphilis, gonorrhoea, and chlamydia. Despite relatively high oral PrEP uptake within this group, adherence was often inconsistent, potentially diminishing the drug’s protective effect. Another group, involving younger individuals engaging in moderate chemsex, showed lower uptake of oral PrEP and similarly high rates of suboptimal adherence and discontinuation, indicating additional barriers to sustained prevention.
A notable finding was the strong interest in long-acting injectable PrEP (LAI-PrEP), especially among those using novel chemsex substances, suggesting that it may offer a practical alternative for people who struggle with daily pills. By contrast, those who did not use harder drugs showed the lowest interest in LAI-PrEP.
Overall, the study highlights that chemsex practices are evolving and that HIV prevention strategies must adapt accordingly. Expanding access to LAI-PrEP and developing tailored harm-reduction interventions could help address unmet prevention needs and reduce the elevated STI and HIV risks associated with novel chemsex use across Europe.
A notable finding was the strong interest in long-acting injectable PrEP (LAI-PrEP), especially among those using novel chemsex substances
Comparable Quality of Life in Well-Treated People with HIV
A NEW 8-year longitudinal analysis from the AGEhIV cohort, presented at the 20th EACS Conference, provides reassuring evidence that ageing people with HIV (PWH) who are well treated and virally suppressed can experience health-related quality of life comparable to peers who are HIV-negative.6
While HIV has historically been associated with accelerated ageing and increased comorbidity burden, there has been uncertainty about whether this translates to measurable differences in long-term physical and mental wellbeing.
The study followed 522 PWH and 532 demographically matched controls enrolled between 2010–2012, the majority of whom were men who have sex with men. Participants completed the 36-Item Short Form (SF-36) questionnaire at multiple time points over a period of 8 years, generating physical (PCS) and mental (MCS) component scores. Analyses excluded individuals not on antiretroviral therapy or with detectable viraemia, ensuring that the cohort reflected contemporary standards of effective HIV care. Mixedeffects regression models adjusted for sociodemographic factors, comorbidities, and time-updated lifestyle behaviours.
Overall, trajectories in both PCS and MCS did not differ between PWH and controls, indicating parallel patterns of change in quality of life with ageing. Although PWH had slightly lower adjusted mean PCS scores (by about 2 points on a 100-point scale), and marginally lower MCS scores, these differences were small and of uncertain
clinical significance. Importantly, no widening gap was observed over time, suggesting that effective HIV treatment and routine management of comorbidities largely mitigate health-related quality-of-life disparities.
These findings challenge assumptions that ageing with HIV necessarily entails accelerated physical or mental decline. Instead, the results reinforce that with sustained viral suppression and comprehensive care, middle-aged PWH can maintain levels of physical and mental wellbeing comparable to those of individuals who are HIV-negative over the long term.
The study provides valuable realworld evidence for clinicians counselling ageing patients with HIV and highlights the continued importance of early treatment, stable viral suppression, and proactive chronic disease management in supporting healthy ageing.
Effective HIV treatment and routine management of comorbidities largely mitigate health-related quality-of-life disparities
Switch to Doravirine Does Not Alter Metabolic Outcomes in HIV
RESULTS from the AIDS Clinical Trials Group A5391/DO-IT trial, presented at the 20th EACS Conference, revealed that switching from an integrase strand transfer inhibitor (INSTI) plus tenofovir alafenamide (TAF) regimen to doravirine (DOR)-based therapy, with or without tenofovir disoproxil fumarate (TDF), did not significantly affect weight, metabolic parameters, or body composition at 48 weeks among people with HIV and obesity.7
Weight gain associated with INSTI- and TAF-containing regimens has raised clinical concern, particularly for individuals who develop obesity or metabolic dysfunction during long-term antiretroviral therapy. The DO-IT study evaluated whether replacing INSTI+TAF with DOR, a nonnucleoside reverse transcriptase inhibitor, could improve metabolic outcomes while maintaining viral suppression.
In this RCT, USA participants with HIV, obesity (BMI >30 kg/m²), and stable viral suppression on INSTI+TAF regimens were assigned to switch to DOR+TAF/ emtricitabine (FTC), DOR+TDF/FTC, or to continue their existing therapy. Linear regression models adjusted for sex, race, and baseline values were used to compare 48-week changes in fasting lipids, insulin resistance (measured by homeostatic model assessment for insulin resistance [HOMA-
Among 145 participants initiating or maintaining study treatment, the median age was 49 years, with a median BMI of 34.9 kg/m² and a median HOMA-IR of 6.2
IR]), and body composition by dual-energy X-ray absorptiometry. Participants using lipid-lowering or insulin therapies were excluded from the relevant analyses.
Among 145 participants initiating or maintaining study treatment, the median age was 49 years, with a median BMI of 34.9 kg/ m² and a median HOMA-IR of 6.2, indicating substantial insulin resistance. Nearly half of participants (49%) were female, 53% were Black, and 18% were Hispanic/Latino.
No significant differences were observed between DOR-based and INSTI-based regimens for triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or HOMA-IR. Similarly, changes in total fat, trunk fat, and lean mass were comparable across groups. At 48 weeks, the estimated difference in total fat mass change versus INSTI+TAF/ FTC was +3.43 percentage points (p=0.13) for DOR+TAF/FTC and –0.09 points (p=0.97) for DOR+TDF/FTC. Differences for trunk fat and lean mass were also non-significant.
These findings indicate that switching to DOR-based regimens does not meaningfully improve lipid profiles, insulin resistance, or adiposity in people with HIV and obesity. Additional interventions beyond antiretroviral modification are needed to address metabolic complications in this population.
Injectable HIV Therapy Failure Linked to Drug Resistance
RECENT findings presented at the 20th EACS Conference revealed that virological failure on long-acting injectable cabotegravir (CAB)/rilpivirine (RPV) remains uncommon, but often leads to the emergence of drug resistance. This resistance may restrict future treatment options for people living with HIV.8
Researchers conducted a literature review up to January 2025 and identified 56 cases of virological failure. Resistance data were available for 46 individuals. Overall, 15/40 (37.5%) people experiencing failure showed suboptimal drug concentrations for either CAB or RPV. The most frequently detected resistance mutations were E148R/K/S (34.1%; 15/44) and N155H/S (22.7%; 10/44) in the integrase gene. Mutations in the reverse transcriptase gene included E138A/ K/T (47.7%; 21/44), Y181C (11.4%; 5/44), and K101E/P (25.0%; 11/44).
Resistance testing showed that 59% (26/44) had integrase inhibitor resistance and 81% (36/44) had non-nucleoside reverse transcriptase inhibitor resistance. In addition, 54% (25/46) carried resistance to both CAB and RPV. Rates were highest in individuals with HIV-1 subtype A. Resistance was detected in 92.3% (12/13) for CAB and 100% (14/14) for RPV, compared with 46.7% (14/30) and 75.9% (22/29) for non-A subtypes. These resistance mutations not only reduce the future effectiveness of CAB/RPV, but also limit options for other integrase (dolutegravir or bictegravir: 39% of cases) and non-nucleoside reverse transcriptase inhibitor drugs (etravirine: 32%; doravirine: 23%).
Researchers emphasised that real-world use of long-acting CAB/RPV requires vigilant monitoring. While most individuals maintained viral suppression, those with failure and resistance needed individualised rescue regimens. Selection of future drug options must consider observed resistance mutations and patient subtype. This highlights the importance of timely intervention and personalised follow-up. These findings reinforce the need to balance novel delivery approaches with careful management to sustain long-term HIV control.
These resistance mutations not only reduce the future effectiveness of CAB/RPV, but also limit options for other integrase and non-nucleoside reverse transcriptase inhibitor drugs
Mutations in the reverse transcriptase gene included E138A/K/T (47.7%; 21/44), Y181C (11.4%; 5/44), and K101E/P (25.0%; 11/44)
Long-Acting Cabotegravir Pre-exposure Prophylaxis Shows Good Safety
LATE-BREAKING findings presented at the 20th EACS Conference highlight the real-world tolerability and safety profile of long-acting cabotegravir (CAB-LA) for HIV pre-exposure prophylaxis (PrEP) in Italy.9
From December 2024–April 2025, 310 adults at hospital HIV prevention clinics in Milan and Rome, Italy, began CAB-LA PrEP. Of these, 255 received a second dose (98.8% on time) and 74 reached a third dose (100% on time). Pain at the injection site was the most frequent side effect, affecting 74.5% after the first dose and 58.1% after the second. Mean pain lasted 4.26 days after dose one and 3.7 days after dose two, with a mean severity score of 4.73 and 2.67 (out of 10) for the first and second doses, respectively.
Injection site nodules were reported in 22% of patients after the first dose and 13.5% after the second. Fever occurred in five patients after the first dose and two after the second. Four participants discontinued CAB-LA, three because of injection site pain and one due to entering a monogamous relationship. Two cases of gluteal phlegmon resolved with oral
antibiotics without interrupting treatment. No HIV seroconversions were observed during a median 78-day follow-up.
Preliminary real-world experience shows that CAB-LA PrEP is well-tolerated and highly acceptable, with most local reactions diminishing after the first dose. Discontinuation for adverse events was rare. No new HIV infections were recorded in the cohort, supporting CAB-LA as a promising option for PrEP.
Preliminary real-world experience shows that CAB-LA PrEP is welltolerated and highly acceptable, with most local reactions diminishing after the first dose
Mean pain lasted 4.26 days after dose one and 3.7 days after dose two, with a mean severity score of 4.73 and 2.67 (out of 10) for the first and second doses, respectively
The PURPOSE 2 study compared twiceyearly subcutaneous lenacapavir with daily oral emtricitabine/tenofovir disoproxil fumarate (F/TDF) among cisgender gay, bisexual, and other men who have sex with men, as well as gender-diverse individuals. Lenacapavir had already shown superior efficacy in preventing HIV, and this analysis sought to understand whether its injectable delivery also supports better long-term persistence.
Participants were randomised to receive either twice-yearly lenacapavir injections or to take daily oral F/TDF. Persistence with PrEP was assessed after 1 year. For those receiving injections, persistence required an on-time Week 26 injection and an ontime follow-up visit at Week 52. For the F/TDF group, persistence was defined as maintaining dried blood spot levels consistent with taking at least four pills per week across four time points throughout the year.
Across PURPOSE 2, 66.2% of participants remained persistent with injections at 1 year, including both lenacapavir and placebo groups. In the randomly selected subgroup with dried blood spot samples, 61.2% of those receiving lenacapavir were persistent, compared with only 37.3% of those taking oral F/TDF. Notably, 68.6% of participants receiving placebo injections in the F/TDF arm also persisted, suggesting that the injection schedule itself may support routine adherence.
These findings indicate that twice-yearly injectable PrEP may help overcome challenges associated with maintaining consistent oral dosing, particularly for those who struggle with daily medication. The ongoing PURPOSE 5 study is now examining whether lenacapavir can similarly support improved PrEP persistence in real-world settings in the UK and France, which may further inform national HIV prevention strategies.
These findings indicate that twiceyearly injectable PrEP may help overcome challenges associated with maintaining consistent oral dosing
Across PURPOSE 2, 66.2% of participants remained persistent with injections at 1 year, including both lenacapavir and placebo groups
Prostate Cancer in People with HIV
FINDINGS presented at the 20th EACS Conference suggests that people living with HIV present with prostate cancer (PC) approximately a decade earlier, with more than a quarter of patients having metastatic disease at the time of diagnosis. These data emphasise the importance of tailored screening and treatment strategies in this population.11
PC is the most common malignancy in males living with HIV, but data on tumour stage at diagnosis and course of localised disease are limited. Researchers in Germany used a standardised questionnaire to collect data on HIV-related parameters, PC characteristics, and details of oncological and antiretroviral therapy from 16 HIV centres. They applied multivariable logistic discrete hazard models, adjusted for age at diagnosis, time since PC diagnosis, and CDC stage of HIV infection, to assess the impact of treatment strategies on overall survival (OS) and progression-free survival in patients with localised PC.
A total of 161 patients were included in the study (median age at PC diagnosis: 61 years). Of those with available staging data, 26% (31/118) had metastatic disease at presentation, and among those with localised PC, 29% were considered intermediate-risk and 59% high-risk for progression, based on the D’Amico classification. Over a 15-year period, there was no difference in progressionfree survival between treatment strategies; however, researchers found a significant association between treatment modality and OS, after adjustment for age and CDC stage, with the lowest OS in patients receiving radiotherapy.
The team concluded that, compared to the German cancer registry, people living with HIV presented with PC earlier and with advanced disease, highlighting the need for appropriate screening and treatment strategies.
Researchers found a significant association between treatment modality and OS
References
1. Colson AE et al. Oral weekly islatravir plus lenacapavir in virologically suppressed people with HIV-1: 96 week outcomes from a phase 2 study. PS15.5.LB. EACS Conference, 15-18 October, 2025.
2. Begré L et al. Low risk of HBV reactivation in HBcAb-positive/HBsAgnegative persons with HIV switching to non-tenofovir-based antiretroviral therapy. PS15.6.LB. EACS Conference, 15-18 October, 2025.
3. Duran Ramirez JJ et al. Trends and timing of HIV diagnoses among migrants: a 15-year analysis from the Swiss HIV cohort study. PS15.1. EACS Conference, 15-18 October, 2025.
4. Wimmersberger D et al. Doxycycline postexposure prophylaxis and the 4-component meningococcal B vaccine among persons living with HIV at high risk for bacterial sexually transmitted infections in Switzerland. PS15.2. EACS Conference, 15-18 October, 2025.
5. Wang H et al. Chemsex, novel chemsex substances, associated risks for STIs, and an extended PrEP cascade among HIV-negative MSM, trans* individuals in 20 European countries: a latent class analysis. PS15.3. EACS Conference, 15-18 October, 2025.
6. Moody K et al. Health-related quality of life in ageing people with HIV is not different to that of wellmatched controls without HIV: an 8-year longitudinal analysis from the AGEhIV cohort study on ageing and comorbidities. Abstract O1.7. EACS Conference, 15-18 October, 2025.
7. Koethe J et al. Metabolic and body composition outcomes at 48 weeks among people with HIV and obesity on integrase inhibitors and tenofovir alafenamide switching to doravirine with or without tenofovir disoproxil fumarate: ACTG A5391 (the DO-IT trial). PS15.4. EACS Conference, 15-18 October, 2025.
8. Mazzitelli M et al. Potential treatment options following virological failure with long-acting injectable cabotegravir and rilpivirine: an analysis based on reported cases. PS01.1. EACS Conference, 15-18 October, 2025.
9. Moschese D et al. Tolerability and safety of long-acting cabotegravir for HIV pre-exposure prophylaxis: preliminary data from a multicentre prospective observational study. PS08.3. EACS Conference, 15-18 October, 2025.
10. Ogbuagu O et al. Annual persistence to twice-yearly lenacapavir versus daily oral F/TDF for PrEP in the PURPOSE 2 trial. PS08.5. EACS Conference, 15-18 October, 2025.
11. Monin MB et al. Prostate cancer in people living with HIV (PLWH): results from a large retrospective multicentre analysis in Germany. PS06.3. EACS Conference, 15-18 October, 2025.
Five Years to 2030: Europe’s Race to End the AIDS Epidemic
WITH ONLY 5 years remaining to meet the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2030 target of ending AIDS as a public health threat, Europe stands at a pivotal moment. At the 20th EACS Conference, held in Paris, France, Teymur Noori of the European Centre for Disease Prevention and Control (ECDC) presented a detailed and sobering overview of the HIV epidemic across the continent. Drawing on regional data, Noori highlighted that while progress has been made in some areas, Europe remains far from reaching many of the key targets that underpin the 2030 ambition.
HIV IN EUROPE: WHERE THE EPIDEMIC NOW STANDS
Europe is home to 2.1 million people living with HIV (PLHIV), distributed unevenly across the continent: 57% in the East, 40% in the West, and 3% in the Centre.1 The region reported 110,000 new diagnoses in 2023, with 70% occurring in the East.1 Late diagnosis, he explained, is still one of the most significant barriers to progress, and 52% of all cases across the region are diagnosed late, affecting men, older people, and migrants disproportionately.1
Transmission patterns reveal deep regional divides. In the West and Centre, men who have sex with men account for 40% of cases, followed by heterosexual men and women (53–54%), and people who inject drugs (4%).1 In the East, the picture is reversed: heterosexual transmission dominates, injecting drug use accounts for 20%, and MSM transmission appears drastically low, and almost certainly underreported, at 4%,1 reflecting high levels of stigma and misclassification.
Migration plays a major role in shaping Western Europe’s epidemic. Six in 10 cases in the West occur among migrants, compared with 20% in the Centre and only 2% in the
East.2 Noori added that in the EU/EEA, 56% of all diagnoses occur in migrants, and in countries such as Ireland, Iceland, Norway, and Sweden, the proportion rises to 80–90%. France’s migrant HIV diagnoses predominantly involve individuals from subSaharan Africa, while in Czechia, for instance, most come from Central and Eastern Europe.2 These distinctions, Noori emphasised, show why interventions must be tailored, nuanced, and grounded in local realities.
PRE-EXPOSURE PROPHYLAXIS IMPLEMENTATION ACROSS EUROPE AND CENTRAL ASIA
Noori then turned to pre-exposure prophylaxis (PrEP), describing implementation as a story of rapid expansion but also stark inequality. By the end of 2024, 27 of 52 countries in Europe and Central Asia had national guidelines and funded programmes. Since then, Greece, Cyprus, Romania, and Lithuania have committed to implementation.3
PrEP use has expanded dramatically, from 22,000 users in 2018 to approximately 345,000 in 2024.3 Some countries, like Ukraine, are scaling up impressively, with up to 50% first-time users among PrEP
recipients.3 However, the region is still short of the target of 500,000 PrEP users, and the uptake is highly concentrated: 71% of all PrEP users live in just four countries: the UK, France, Germany, and Spain.3
Reaching key populations remains a major challenge, with women profoundly underrepresented. While the UK and Ukraine report the highest numbers of women on PrEP, and Ukraine stands out with 27% of users being women, across Europe and Central Asia, women accounted for only 2.5% of all PrEP users in 2024.3 This is a critical equity issue, highlighted Noori, and the picture is similar for migrants. Although the Netherlands, Portugal, Italy, and Switzerland lead in PrEP uptake among migrants, overall proportions remain extremely low. Alarmingly, while 56% of all HIV diagnoses in the EU occur among migrants, they represented just 4% of all PrEP users in 2024.3
Another key barrier includes persistent cost issues. Even as generic PrEP prices fall, many countries still list cost as a barrier, and out-of-pocket payments remain common. Long-acting cabotegravir, Noori added, currently costs around 1,400 EUR,
even after reimbursement, and its rollout will require close monitoring to prevent widening disparities.3
PROGRESS TOWARD THE UNAIDS 95-95-95 FRAMEWORK
Noori framed the 95-95-95 UNAIDS targets as a lens through which to view both Europe’s successes and the persistent gaps that threaten progress. Each target reveals not only the effectiveness of testing and treatment programmes but also the inequities that shape the epidemic across the continent.
First 95: Knowing Your HIV Status
The first target, ensuring that 95% of PLHIV know their status, remains out of reach in much of Europe. Across the region, 86% of PLHIV are aware of their infection, but progress is uneven. While the West is approaching the target with 94%, the Centre lags at 88% and the East trails further behind at 80%. Ten countries have met the goal, 15 are close, but 21 countries remain well below target.4
Noori explained that, overall, there has been meaningful improvement. Since 2016, the proportion of people living with undiagnosed HIV has dropped from 25% to 14% in 2024, equivalent to 225,000 additional people now aware of their status. Yet, late diagnosis continues to pose a serious challenge. In 2023, 50% of people diagnosed in the WHO European Region were diagnosed late, defined as having a CD4 count <350 cells/mm³ at diagnosis. Men, especially heterosexual men, older adults, and people living in the East and Centre, are disproportionately affected.4 This delay not only threatens individual health but also sustains ongoing transmission in the population.
Second 95: ART Coverage
The second target, ensuring that 95% of diagnosed people are on antiretroviral therapy (ART), shows similar mixed progress. The regional average is again 86%, with significant differences between subregions. Western Europe has reached 96%, surpassing the target, while Eastern Europe remains at 79%. Between 2017–2024, Europe added 540,000 more people on ART, demonstrating substantial progress, yet gaps remain. When considering all PLHIV, treatment coverage falls further: only 71% of PLHIV in Europe are on ART, below the global average of 77%.4
Third 95: Viral Suppression
Viral suppression among people on ART is the single 95 goal that Europe has achieved at a regional level. However, the broader target, 86% of all PHLIV being virally suppressed, remains elusive. Across 38 countries with available data, the regional average is only 70%, ranging from 85% in the West to only 59% in the East. Data limitations complicate the picture: 17 of 55 countries were unable to report sufficient information, suggesting the regional average may overestimate the progress.4
Noori highlighted the human implications behind the numbers. Around 620,000 people in Europe and Central Asia, or 30% of all PLHLIV, still have transmissible levels of virus.4 Nearly 500,000 of them live in the East, where half are undiagnosed, and alarmingly, 42% are diagnosed but not on ART.4 “We’ve done the hard work, but we are not putting them on treatment programmes. That is something we need to do better on.” Representing both a human and public health urgency, these populations are at the greatest risk of disease progression. Reaching them is one of Europe’s most urgent and complex challenges.
STIGMA: A PERSISTENT BARRIER
Noori then shifted to stigma, which continues to undermine every aspect of the HIV response. The UNAIDS target is for <10% of PLHIV to experience stigma and discrimination by 2025. However, the data show a far different reality.
According to ECDC data, one-third of PLHIV have never disclosed their status to a family member, one in five have never told a friend, and 22% have never told their current sexual partner.5 In healthcare settings, around onethird worry about being treated differently, and amongthose who worry, one-third avoid seeking healthcare.6
Even more concerning are findings from the ECDC/EACS stigma survey of over 18,000 healthcare workers. A total of 39% did not know what Undetectable=Untransmittable means, 44% did not know what postexposure prophylaxis is, and 59% were unaware of PrEP.6 Stigmatising attitudes were also widespread: 12% believed PLHIV had “too many sexual partners,” 22% felt that HIV is acquired through “irresponsible behaviour,” and 26% believed that people with detectable viral loads should not engage in sexual activity. A full 30% had observed discriminatory remarks about PHLIV in the past year.6 Noori stressed that stigma-reduction interventions must be revitalised and expanded.
ARE WE ON TRACK?
To close, Noori addressed the central question: is Europe on track to reduce HIV incidence? The answer, he explained, is clearly no. Instead of achieving a 75% reduction in new infections by 2025, the WHO European Region has seen a 5% increase. AIDS-related deaths, which were meant to fall by 90% by 2030, have instead increased by 37% as of 2024.
Noori concluded with a sobering assessment: the only target Europe has reached is viral suppression among people on treatment. All others, the first and
References
1. European Centre for Disease Prevention and Control (ECDC). HIV/ AIDS surveillance in Europe. Available at: https://www.ecdc.europa.eu/ sites/default/files/documents/HIV_ Surveillance_Report_2024.pdf. Last accessed: 17 November 2025.
2. European Centre for Disease Prevention and Control (ECDC). HIV and migrants in the EU/EEA. Available at: https://www.ecdc.europa. eu/sites/default/files/documents/ hiv-migrants-dublin-declarationnovember-2024.pdf. Last accessed: 17 November 2025.
second 95s, overall viral suppression, PrEP scale-up, stigma reduction, incidence, and mortality targets, are not within reach. Yet, he stressed that progress in several countries across all subregions should be recognised and celebrated. Integrated testing, community-led prevention, and highly effective treatment systems represent genuine achievements.
Nevertheless, disparities remain stark, and political commitment and sustained funding are essential. With 5 years left, Noori said, we must recognise that most targets will not be met, but our efforts cannot stop in 2030. People’s lives depend on what we do next.
3. European Centre for Disease Prevention and Control (ECDC). Pre-exposure prophylaxis for HIV prevention in Europe and Central Asia. Available at: https://www.ecdc.europa. eu/sites/default/files/documents/ PrEP-europe-central-asia-2024progress-report.pdf. Last accessed: 17 November 2025.
4. European Centre for Disease Prevention and Control (ECDC). Progress towards reaching the Sustainable Development Goals related to HIV in the European Union and European Economic Area. Available at: https://www.ecdc.europa. eu/sites/default/files/documents/ hiv-evidence-brief-progress-towardssustainable%20development-
goals-2023_11.pdf. Last accessed: 17 November 2025.
5. European Centre for Disease Prevention and Control (ECDC). Stigma: survey of people living with HIV. Available at: https://www. ecdc.europa.eu/sites/default/files/ documents/hiv-stigma-surveymonitoring-dublin-declaration.pdf. Last accessed: 17 November 2025.
6. European Centre for Disease Prevention and Control (ECDC). HIV stigma in the healthcare setting. Available at: https://www.ecdc.europa. eu/sites/default/files/documents/ Dublin%20-%20HIV%20stigma%20 2024-final-with-covers.pdf. Last accessed: 17 November 2025.
EACS 2025
Abstract Reviews
The following two abstracts from EACS 2025 showcase the breadth of innovation driving today’s HIV response, from cellular mechanisms underlying rare cases of post-transplant HIV remission to the real-world performance of national pre-exposure prophylaxis programmes. Together, they highlight how immunological advances and public health efforts are equally vital to global, long-term HIV prevention and control.
Characterisation of Natural Killer Cell Subsets and Antibody-Dependent Cellular Cytotoxicity Function in a Case of Sustained HIV Remission After Allogeneic Stem Cell Transplantation (2nd Berlin Case)
Authors: Timo Trenkner,1,2 Samad Kor,3-5 Tom Kraus,1,2 Henning Gruell,6 Philipp Schommers,7-9
Olaf Penack,3,4,5,10 Christian Gaebler,11,12 *Angelique Hoelzemer1,2,13
1. First Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany
2. Institute for Infection and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, Germany
3. Department of Hematology, Oncology and Tumor Immunology, Charité –Universitätsmedizin Berlin, Germany
4. German Cancer Consortium (Deutsches Konsortium Für Translationale Krebsforschung, DKTK), Berlin, Germany
5. National Center for Tumor Diseases (NCT), Berlin, Germany
6. Laboratory of Experimental Immunology, Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
7. Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Germany
8. German Center for Infection Research (DZIF), Cologne, Germany
9. Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
10. Berlin Center for Translational Vascular Biomedicine, Germany
11. Laboratory of Translational Immunology of Viral Infections, Department of Infectious Diseases and Critical Care Medicine, Charité –Universitätsmedizin Berlin, Germany
12. Berlin Institute of Health, Germany
13. German Center for Infection Research (DZIF) – Site Hamburg-Lübeck-Borstel-Riems, Germany
*Correspondence to a.hoelzemer@uke.de
Disclosure: Gaebler has received support for the present manuscript from the HJH Foundation, the Hector-Foundation, the National Institutes of Health (REACH Delaney grant UM1 AI164565 subaward), and the DZIF (German Center for Infection Research, TTU 04.823); honoraria for lectures from GSK; support for attending meetings from Gilead; and is a CharitéFoundation Recruiting Grantee. Hoelzemer has received support for the present manuscript from the Federal Ministry of Research, Technology and Space (01KI2110), the iSTAR
program from the Federal Ministry of Research, Technology and Space, and the DZIF (German Center for Infection Research, TTU 04.823).
Penack has received grants from José Carreras Leukämie-Stiftung (23R/2021), Deutsche Krebshilfe (70113519), Deutsche Forschungsgemeinschaft (PE 1450/7-1, PE 1450/9-1, PE 1450/10-1, PE 1450/11-1) and Stiftung Charité BIH (BIH_PRO_549, Focus Group Vascular Biomedicine), with payments to the institution; consulting fees from Apogepha, Alexion, Equillium Bio, Jazz, Gilead, Novartis, MSD, Omeros, Orca Bio, Priothera, Sanofi, Shionogi, and SOBI; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Alexion, Gilead, Jazz, MSD, Neovii, Novartis, Pfizer, and Therakos; research support from Incyte, Gilead, and Priothera outside of the present manuscript; holds a leadership or fiduciary role as the Chairperson of the EBMT Transplant Complications Working Party; and holds stock/ stock options in Orca Bio. Gruell has received payments from the University of Cologne for licensed patent applications relating to HIV neutralising antibodies. Trenkner has received support for the present manuscript from the Federal Ministry of Research, Technology and Space(01KI2110). Schommers has received support for the present manuscript from the German Research Foundation (DFG, Emmy Noether Program Nr. 495793173), the Else Kröner Fresenius Foundation (EKFS), and the German Center for Infection Research (DZIF); and payments from the University of Cologne for licensed patent applications relating to HIV neutralising antibodies. Kraus has received support for the present manuscript from the Federal Ministry of Research, Technology and Space (01KI2110). Kor has declared no conflicts of interest.
Acknowledgements: The authors thank the second Berlin patient (B2) and all study participants for their willingness to collaborate, and Quirin Hammer for their assistance with the design of the adaptive NK cell panels.
Keywords: Allogeneic stem cell transplant, antibody-dependent cellular cytotoxicity (ADCC), HIV cure, HIV remission, natural killer (NK) cells.
Natural killer (NK) cells are increasingly studied in HIV cure research as certain subsets have been linked to natural HIV control, enhanced antibody-dependent cellular cytotoxicity (ADCC), and reduced viral reservoirs.1-6 Elite controllers (EC) often display higher envelope (Env)-specific ADCC activity,7 and the only moderately successful HIV vaccine trial to date, RV144, identified ADCC as a correlate of reduced acquisition risk.8
METHODS
Based on these findings, the authors performed in-depth phenotyping and functional testing of NK cells from the second Berlin individual (B2), who displayed
sustained HIV remission after allogeneic stem cell transplantation with heterozygous CCR5Δ32 donor cells. Peripheral blood mononuclear cells were genotyped for killer-Ig-like receptor genes, and NK cells were analysed by multiparameter flow cytometry, as well as standardised ADCC assays, against rituximab-coated target cells. HIV-1-specific ADCC capacity was tested in longitudinal plasma samples from B2, employing a degranulation assay against immobilised Env protein, in comparison with plasma from ECs and broadly neutralising antibodies (Figure 1).
RESULTS
B2 displayed an NK cell phenotype with a markedly higher frequency of natural killer group 2 member A (NKG2A)⁺ cluster of
Figure 1: HIV-specific antibody-dependent cellular cytotoxicity activity of the second Berlin individual’s plasma.
Summary of cumulative ADCC responses. NK cells (N=4 biological replicates) were incubated with Env-coated wells treated with PBS, plasma from a donor who is HIV-negative (1:1000 dilution; black), bnAbs (PG-16, 1–18, VRC01, and 10–74; 10 µg/mL; white), plasma from five ECs (1:1000; dark grey), or longitudinal B2 plasma samples (1:1000 dilution; purple). The bar shows the median with the IQR.
differentiation (CD)57⁺ NK cells compared to controls who were HIV-negative and cytomegalovirus-positive, and previously published data on allogeneic stem cell transplantation recipients.9 This subset did not undergo downmodulation of promyelocytic leukaemia zinc finger and Fc ɛ receptor γ chain characteristics of adaptive-like NK cells, but nonetheless contributed substantially to ADCC-activity upon encountering rituximab-coated targets. Around transplantation, B2’s plasma mediated high HIV-specific ADCC activity, surpassing EC plasma (N=5) and monoclonal broadly neutralising antibodies. ADCC activity mediated by B2’s plasma declined substantially in the years following transplantation (Figure 1).
CONCLUSION
Taken together, the authors observed an NK cell phenotype in B2 characterised by the expansion of mature NKG2A+ NK cells, alongside potent HIV-specific plasma ADCC activity. These data, together with findings from the first case of HIV-1 remission after transplantation with wild-type CCR5 donor cells (the Geneva Case),10 suggest a potential contribution of NK cell-mediated mechanisms to modulate the HIV reservoir, independent of CCR5Δ32 homozygosity.
References
1. Trenkner T et al. Characterization of NK cell subsets and ADCC function in a case of sustained HIV remission after allogeneic stem cell transplantation (2nd Berlin Case). Abstract PS07.4.LB. EACS Conference, 15-18 October, 2025.
2. Essat A et al.; ANRS PRIMO cohort; VISCONTI study. A genetic fingerprint associated with durable HIV remission after interruption of antiretroviral treatment: ANRS VISCONTI/PRIMO. Med. 2025;6(8):100670.
3. Huot N et al. SIV-induced terminally differentiated adaptive NK cells in lymph nodes associated with enhanced MHC-E restricted activity. Nat Commun. 2021;12(1):1282.
4. Gondois‐Rey F et al. NKG2C+ memory-like NK cells contribute to the control of HIV viremia during primary infection: Optiprim-ANRS 147. Clin Transl Immunology. 2017;6(7):e150.
5. Martin MP et al. Epistatic interaction between KIR3DS1 and HLA-B delays the progression to AIDS. Nat Genet. 2002;31(4):429-34.
6. Tomescu C et al. Identification of the predominant human NK cell effector subset mediating ADCC against HIV‐infected targets coated with BNAbs or plasma from PLWH. Eur J Immunol. 2021;51(8):2051-61.
7. Lambotte O et al. Heterogeneous neutralizing antibody and antibody-dependent cell cytotoxicity responses in HIV-1 elite controllers. AIDS. 2009;23(8):897-906.
8. Haynes BF et al. Immune-correlates analysis of an HIV-1 vaccine efficacy trial. N Engl J Med. 2012;366(14):1275-86.
9. Horowitz A et al. Regulation of adaptive NK cells and CD8 T cells by HLA-C correlates with allogeneic hematopoietic cell transplantation and with CMV reactivation. J Immunol. 2015;195(9):4524-36.
10. Sáez-Cirión A et al. Sustained HIV remission after allogeneic hematopoietic stem cell transplantation with wild-type CCR5 donor cells. Nat Med. 2024;30(12):3544-54.
Gaps and Gains in Pre-exposure Prophylaxis Continuity: Clinical and Programmatic Insights from Nigeria’s 2024 National Rollout
Authors: *Ramatu Aliyu Magaji,1 Lawrence Kwaghga,¹ Idoteyin Ezirim,¹ Joy Egwu¹
1. Research, Monitoring and Evaluation Department, National Agency for the Control of AIDS (NACA), Abuja, Nigeria *Correspondence to ramatualiyumagaji@gmail.com
Disclosure: The authors have declared no conflicts of interest.
Acknowledgements: The authors would like to thank the Federal Ministry of Health (FMoH), the National Agency for the Control of AIDS (NACA), and development partners, including the Global Fund and PEPFAR, for their support in implementing and monitoring Nigeria’s national PrEP programme. Appreciation is also extended to the State AIDS Control Agencies (SACAs), implementing partners, and PrEP service providers for their commitment to accurate reporting through the electronic Nigeria National Response Information Management System (eNNRIMS).
Despite the rapid expansion of oral preexposure prophylaxis (PrEP) services in Nigeria, programmatic data continue to highlight critical challenges in continuity and HIV seroconversion prevention among key populations. To address these gaps, this study analysed national PrEP data1 to identify typology-specific vulnerabilities and inform targeted retention strategies that can improve long-term outcomes.
MATERIALS AND METHODS
A retrospective analysis was conducted using PrEP data reported through Nigeria’s electronic National Response Information Management System (eNNRIMS)2 between January–December 2024. Monthly submissions from all 36 states and the Federal Capital Territory were disaggregated by key population typology: sex workers (SW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender individuals (TG). Core indicators assessed included PrEP initiation, discontinuation, repeat HIV testing, and seroconversion. Descriptive statistics were applied to measure reach, retention, and programme outcomes, leveraging one of the largest programme-based PrEP datasets in sub-Saharan Africa, with real-time data from over 37 subnational entities.
RESULTS
Overall, 249,478 individuals initiated PrEP nationwide, including 123,843 SW, 69,427 MSM, 51,585 PWID, and 4,623 TG. Among these, 38,662 individuals discontinued PrEP during the reporting period, with discontinuation highest among SW (16,901) and PWID (11,146). However, proportional dropout rates were greatest among PWID (17.7%) and TG (17.4%), highlighting potential adherence and access challenges in these groups. A total of 94,543 individuals returned for repeat HIV testing and remained HIV negative, while 394 seroconversions were recorded, 232 among SW, 115 among MSM, and 47 among PWID. No seroconversions were documented among TG. Notably, the presence of silent seroconversions despite negative repeat tests suggests possible adherence gaps and emerging concerns about drug resistance or testing intervals.
The findings demonstrate that, while Nigeria’s national PrEP programme has achieved broad key population coverage, typology-specific discontinuation and seroconversion trends expose significant retention weaknesses. These vulnerabilities underline the need for more responsive, differentiated approaches to PrEP service delivery. Strengthening adherence support, integrating real-time monitoring systems, and expanding access to long-acting PrEP formulations could improve continuity and reduce new infections among high-risk groups.
CONCLUSION
This national analysis provides rare, largescale, programmatic evidence on PrEP implementation across multiple typologies in Nigeria.1 The insights contribute to the global body of knowledge on how to sustain PrEP use, and effectiveness in low- and middle-income settings.
By aligning with global HIV prevention recommendations,3 and identifying where and among whom discontinuation and seroconversion occur most frequently, the study offers practical evidence for designing typology-specific interventions to strengthen HIV prevention outcomes in Nigeria and similar contexts globally.
References
1. Aliyu Magaji R et al. Gaps and gains in PrEP continuity: clinical and programmatic insights from Nigeria’s 2024 national rollout. Abstract 527. EACS Conference, 15-18 October, 2025.
2. National Agency for the Control of AIDS (NACA). Electronic Nigeria National Response Information Management System (eNNRIMS) dataset: PrEP programme data, January-December 2024. Abuja, Nigeria: NACA; 2024. Internal dataset, not publicly accessible.
3. World Health Organization (WHO). Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 2021. Available at: https://www.who.int/publications/i/ item/9789240031593. Last accessed: 11 October 2025.
Congress Interviews
In these conversations, the European AIDS Clinical Society (EACS) leaders discuss key trends and priorities shaping HIV care in Europe. Miłosz Parczewski and Anne-Marie Wensing highlight initiatives such as cross-border collaboration, equitable access, and long-acting therapies, while Esteban Martinez explains the major updates in the 2025 EACS Guidelines, including person-centred care and comprehensive comorbidity management. Together, the interviews provide a clear view of the challenges, innovations, and policy developments influencing the next phase of HIV prevention and treatment.
Featuring: Miłosz Parczewski, Anne-Marie Wensing, and Esteban Martinez
Miłosz Parcewski,1
Anne-Marie Wensing2
1. President of the European AIDS Clinical Society (EACS); Head - Department of Infectious Diseases, Pomeranian Medical University in Szczecin, Poland
2. Secretary of the European AIDS Clinical Society (EACS); Clinical Virologist, University Medical Center Utrecht, the Netherlands; Honorary Professor, Ezintsha, Johannesburg; Department of Health, University of the Witwatersrand, Johannesburg, South Africa
Q1As leaders of the European AIDS Clinical Society (EACS), how do you see the Society shaping HIV care and research over the next few years? Are there any new priorities or initiatives that you are particularly excited about?
Parczewski: As the current EACS President, and the first from Central and Eastern Europe, I see several priorities for the coming years from this perspective. The HIV epidemic in Central and Eastern Europe continues to expand, and as a Society of strong researchers and clinicians, our goal is to strengthen and connect expertise across European regions. We also want to further involve the community, something we’ve always aimed to do, by building on the expertise of multiple countries, both clinically and scientifically, to excel in patient care delivery. We currently
have several projects running. One focuses on standards of care, where we aim to harmonise prevention and treatment across European countries to ensure a minimum standard for HIV care. This includes standards for preexposure prophylaxis (PrEP), testing, antenatal screening, treatment, and management of comorbidities. It’s a major, ongoing effort in collaboration with the European Centre for Disease Prevention and Control (ECDC).
We also have other initiatives, such as Women Against Viruses in Europe (WAVE), programmes for young researchers, and clinical exchange programmes, which form the building blocks of our Society. Looking forward, we are planning to establish a virtual clinic, a joint project with Anne-Marie, to provide shared expertise in case by case clinical management across regions.
We recognise that the world is changing, with funding cuts and major shifts in HIV prevention and care, such as the introduction of long-acting injectables for both prevention and treatment. We want to ensure that these innovations are implemented equitably across all regions of Europe and, ideally, beyond.
Wensing: I completely agree. What’s especially important now is that there are certain issues that can only be solved at a European level. We must strengthen our collaboration now more than ever. For instance, the migrant issue cannot be addressed by one country alone. We need to take collective European responsibility, as people move across borders and require continuity of care. Finding solutions that move with populations is only possible through European collaboration. Although that can be politically difficult, it’s something that we, clinicians, nurses, and communities, can help achieve. The community has become increasingly vital; they’ve proven capable of setting up initiatives and providing care within their own settings. What truly distinguishes EACS, however, is the way it now tries to connect scientific, clinical, and community perspectives to help shape policy across Europe. This collaborative model. rather than traditional topdown advocacy, is what makes EACS unique among medical societies.
Q2
Looking at HIV today, what are the biggest challenges that clinicians and researchers face right now, and where do you see the most progress being made?
Wensing: Population movement has changed everything. Problems that used to be confined to one country no longer are. For example, HIV subtype diversity has evolved: where we used to see subtype B in Europe, C in much of Africa, and AE in Asia, these are now all mixing, reflecting migration of people with HIV. This means that we need to build a more global understanding of HIV together.
Parczewski: From a community perspective, we are also seeing new challenges with changing patient demographics related to migration. Stigma remains a major issue, especially among migrant populations, along with language and cultural barriers that can hinder prevention, testing, and management of comorbidities and sexually transmitted infections. Often, cultural norms make it difficult to talk openly about sexual health. These are challenges we must address as part of the broader movement to improve sexually transmitted infection and HIV care.
Q3 Drug resistance continues to be a major concern. How is EACS helping clinicians and researchers keep up with emerging resistance patterns? And are there any recent trends that stand out?
people it affects, it remains extremely serious. Because it’s discussed less now, expertise has diminished. In the past, every hospital had its own resistance specialist, but that’s no longer the case. So, we need to share knowledge more broadly. One idea, as Miłosz mentioned, is to establish a virtual clinic. Most individuals with HIV do well and don’t require complex discussions among different specialists, but for the 5–10% who do not, clinicians and nurses across Europe should have access to expert support, even in smaller or remote locations. This would be a very practical way to ensure equal access to specialised knowledge.
Parczewski: There’s also growing anticipation around long-acting PrEP agents, such as lenacapavir and cabotegravir. However, we still lack systematic data on how their widespread use might influence transmitted resistance patterns. Understanding and monitoring this will be a key research priority going forward.
Q4
With new tools like long-acting PrEP, HIV prevention has significantly advanced. How do you see these strategies evolving, and what is EACS’s role in ensuring they reach the right populations?
We must strengthen our collaboration now more than ever
Wensing: Drug resistance has always been a key focus for us, and it’s also my area of expertise. I’ve always felt welcomed within EACS as a clinical virologist. While resistance has become a smaller issue overall, for the
Parczewski: Long-acting PrEP is a powerful tool for ending the HIV epidemic, with strong data from studies such as PURPOSE 1 and 2 on lenacapavir, and HPTN 083 and 084 on cabotegravir. We now have long-acting injectables administered every 2–6 months, with potential for even longer intervals. The challenge is equitable implementation. Access shouldn’t be limited to countries where PrEP is already well established, such as high income countries (e.g.
Long-acting PrEP is a powerful tool for ending the HIV epidemic
France, UK, USA). We must also reach populations in lower and middle income regions, for example, Ukraine, Belarus, and Russia. Importantly, migrants face increased transmission risk, often both in their home and host countries. As many European countries are classified as middle- to high-income, access to these drugs isn’t prioritised by industry. We need to find new funding models, involving both governments and industry, to ensure that these preventive tools reach those who need them the most.
Wensing: I fully agree. In Africa, global collaborations between governments and organisations have made major projects possible. In Europe, however, we tend to rely on national
systems, which are not sufficient for addressing migration and conflict-affected areas. This is a superior prevention method, , and from a human rights perspective, it should be implemented. The question isn’t whether we should, but how we are going to organise it. Funding is important, but the first step is to agree on what’s needed and then find the partners to make it work.
Parczewski: Exactly. According to the latest ECDC report, 36% of new HIV diagnoses are among migrants, which underscores how critical this is. In Poland, we’re seeing a worrying trend of late diagnoses among migrant populations. It’s heartbreaking.
Wensing: Yes, and with the current political climate, many
people are becoming more marginalised. If prevention measures aren’t offered openly and safely, people will not be able to protect themselves, making the situation even harder to manage. We must keep this an open and inclusive conversation, even when it’s politically challenging.
Q5
HIV is a global issue. How does EACS work with partners around the world to improve treatment access and prevention strategies?
Parczewski: We have a broad network of collaborations, both institutional and professional. We work with the ECDC on joint projects and collaborate with other societies worldwide, for example, with the Japanese Society and the Argentinian Society through a memoranda of understanding. EACS is also becoming more active in policy advocacy. Traditionally, as a clinical society, our focus was on implementation and clinical care rather than politics. Now, with the help of our policy
consultant, Gonzalo Lobo, we are engaging with governments to advocate for state-funded PrEP programmes, standardof-care initiatives, and tools for auditing and quality improvement. We’ve issued several policy statements on funding cuts, on discrimination against Lesbian, Gay, Bisexual, Transgender, Queer, or Questioning people, and in response to the war in Ukraine, and we’re working to act on them at local and regional levels.
Wensing: That’s very well summarised. We’re also engaging with the European Commission and the WHO to explore how we can strengthen collaboration and support, especially in light of current funding challenges.
Q6 There’s growing excitement about potential HIV cures. From your perspective, what are the most promising approaches, and the biggest challenges, right now?
Wensing: Complex problems rarely have a single solution, and this is no different. We’ve seen remarkable cases like the Düsseldorf, Germany, and London, UK, patients, which prove that a cure is possible, even if still exceptional. Each new case strengthens the belief that an HIV cure can be achieved. But different people may require different solutions. For some, long-acting treatment given once a year might be sufficient; for others, a cure remains essential.
For some, long-acting treatment given once a year might be sufficient; for others, a cure remains essential
There is still excess morbidity from HIV even in those people with suppressed viral replication, so a cure would always be preferable to lifelong control. We must pursue both paths in parallel, as no single approach will work for everyone.
Q7
Finally, what lessons stand out when it comes to HIV treatment, resistance, and access to care across continents?
Wensing: In Europe, we’ve always practiced individualised treatment, while many African programmes have followed a government-led, programmatic model. Both have their strengths and weaknesses. Programmatic care works well for most individuals, but the 10% who need more support can fall through the cracks. In contrast, Europe’s individualised approach offers excellent care but may overextend resources. We can learn from each other: loosen up for those doing well, and focus resources on those who are not. For the first time in HIV history, we’re also seeing a two-way exchange, with Europe learning from Africa, not just the other way around. Africa’s models of access and prevention can teach us a lot, especially as Europe faces rising HIV rates among migrants and in Eastern Europe. It’s an urgent issue, and we must ensure Europe does not fall behind.
Esteban Martinez
Immediate Past President of the European AIDS Clinical Society (EACS); Senior Consultant in Infectious Diseases, Hospital Clínic of Barcelona; Associate Professor of Medicine, University of Barcelona, Spain
Q1The 2025 European AIDS Clinical Society (EACS) Guidelines include major updates spanning antiretroviral therapy (ART) initiation, longacting therapies, and comorbidity management. Which of these changes do you think will have the greatest clinical impact, and what drove their inclusion?
I think that the most transformative changes are those that bring HIV care closer to the way people actually live. The updated guidance on longacting therapies is a very good example. We now have clearer, more practical recommendations on injectable treatment and prevention, including how to navigate missed doses, how to handle interactions with genderaffirming hormones or substances associated with chemsex, and how to support people who travel frequently or have unpredictable schedules. These therapies free many people from the burden of daily pills, and that shift is huge.
But I also believe that the emphasis on comorbidities will be equally impactful. People with HIV are ageing, and the guidelines finally reflect that reality in a very comprehensive way. Cardiovascular prevention, metabolic dysfunction-associated steatotic liver disease, sleep, frailty, menopause, cognitive health, obesity, and metabolic issues are now addressed with a depth we didn’t have before. This moves us from a model centred on the virus to a model centred on the person, which in my view is the direction HIV care must go.
Q2 The guidelines place stronger emphasis on person-centred care, including patient-reported outcome measures, shared decisionmaking, and ageing. How do you see these approaches shaping HIV care in Europe as the population grows older?
This evolution feels both natural and necessary. Clinical markers tell us if the virus is controlled, but they don’t tell us if a person is sleeping well, if they are struggling with stigma, if they feel safe in their relationships, or if they have fears about ageing. Patient-reported outcomes help us understand these aspects in a structured way, and shared decision-making gives people agency in their own health.
As more people with HIV reach older age, these conversations become essential. Ageing brings its own challenges: polypharmacy, frailty, cognitive changes, loneliness, and financial stress. When we integrate the person’s voice, we start addressing the whole picture rather than focusing on a single disease. I think that this shift will make HIV care more compassionate, more responsive, and ultimately more effective.
Q3 The new sections on long-acting preexposure prophylaxis (PrEP) and ART signal a major shift towards sustained-release therapies. What opportunities and challenges do these bring for patients and healthcare systems?
Long-acting therapies offer a level of freedom that many people have been waiting for. For
prevention, injectable PrEP is a game changer. It can dramatically reduce the impact of adherence on effectiveness and give people an option that fits easily into their lives. For treatment, long-acting ART empowers individuals who prefer discretion, who struggle with pills, or who simply like the idea of fewer treatment decisions every day.
The challenge is that these therapies require strong organisational support. You need reliable systems for appointments, reminders, follow-up, and transitions. If someone misses an injection or needs to travel, the clinic must be able to adapt quickly. That means rethinking workflows and making sure that healthcare teams are prepared. But if we invest in these systems, the benefits for both individuals and public health can be profound.
Q4
With expanded guidance on cardiovascular risk, metabolic complications, metabolic dysfunction-associated steatotic liver disease, and cognitive health, multidisciplinary care is increasingly important. What are the key priorities for collaboration between HIV specialists and other disciplines?
In practice, we need to stop working in silos. HIV clinicians cannot manage every aspect of ageing, and we shouldn’t expect to. Cardiologists, endocrinologists, hepatologists, psychiatrists, geriatricians, and primary care physicians all have essential roles. What the guidelines offer is a common language, a shared framework that helps different specialists collaborate rather than duplicate or contradict each other.
The priorities are simple: clear referral pathways, rapid communication, respect for
HIV care must be inclusive, modern, and respectful of the broad spectrum of identities, bodies, and experiences
each other’s expertise, and an understanding that HIV is now a chronic condition intertwined with many others. When care is coordinated, the person in front of us doesn’t experience fragmentation, just good medicine.
Q5 New guidance on gender-affirming therapies, chemsex, and diverse prevention contexts reflects a broader inclusivity. How does this illustrate EACS’s commitment to addressing the realities and diversity of people living with HIV today?
To me, it shows a maturity and a genuine openness to the lived realities of people with HIV. The new guidance on gender-affirming hormones is detailed, practical, and respectful. It acknowledges transgender and gender-diverse people not as an afterthought, but as a central part of the HIV community. The same is true for the updated approach to obesity, which moves away from simplistic weight-based definitions and recognises the complex biology behind metabolic health.
The prevention guidance also embraces diversity, from long-acting PrEP to updated sexually transmitted infection management, and more nuanced recommendations for people with hepatitis B. All of this reflects a clear intent: HIV care must be inclusive, modern, and respectful of the broad
spectrum of identities, bodies, and experiences.
Q6 Having helped shape EACS and its global collaborations, how do you see the next phase of guideline development, particularly in balancing global harmonisation with flexibility for regional needs and new evidence?
I see it moving in two directions at the same time. On one hand, we need strong global coherence. Scientific evidence, especially around treatment and prevention, moves fast and should be communicated consistently across regions. On the other hand, HIV care is delivered in very different systems across Europe. What works in a large, well-resourced clinic may look very different in a smaller setting.
The shift to a continuously updated online format is a major step forward. It allows the guidelines to evolve almost in real time, incorporating new evidence as it appears. But I also think the future will involve more dialogue with communities, more practical tools for implementation, and even greater inclusion of multidisciplinary voices. Ultimately, the goal is simple: to create guidance that is scientifically rigorous, clinically useful, and deeply connected to the needs of the people we serve.
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