July 21, 2026
Studies revealing the real-world
impact of disruptions to the US President’s Emergency Plan
for AIDS Relief (PEPFAR) and important advances in
long-acting HIV prevention and treatment were announced
ahead of AIDS 2026, the
26th International AIDS Conference, which will take
place in Rio de Janeiro, Brazil, and virtually from 26 to 31
July.
Today’s scientific highlights press conference
previewed studies selected from thousands of abstracts that
will be presented next week, including:
- A pair of
studies that shed light on the real-world consequences of
PEPFAR disruptions - Findings from the open-label
extension phase of the PURPOSE 1 and 2 studies of
twice-yearly injectable lenacapavir for HIV
prevention - The first detailed results from the Phase
3 ISLEND-1 and ISLEND-2 trials of oral
islatravir/lenacapavir, which has the potential to be the
first complete once-weekly oral treatment for HIV - A
study showing that HIV-specific immune activity may persist
in the spinal fluid of adolescents with perinatally acquired
HIV, even when the virus is suppressed in the
blood
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Convened by IAS – the
International AIDS Society – AIDS 2026 will take place
at a crucial time in the HIV response. In the face of an
unprecedented funding crisis and major cutbacks to HIV
programmes, the conference will unite people living with
HIV, researchers, policy makers, healthcare professionals,
funders, media and communities with the theme Rethink.
Rebuild. Rise.
“Science is moving fast,
giving us more powerful HIV prevention and treatment tools.
But these advances cannot save lives if they never reach the
people who need them. That requires robust, stable financing
and steadfast political commitment,” Beatriz Grinsztejn,
IAS President, AIDS 2026 Co-Chair and Director of the
HIV/AIDS Clinical Research Unit at the Evandro Chagas
National Institute of Infectious Diseases – Fiocruz in Rio
de Janeiro, said.
PEPFAR disruptions have had
serious, far-reaching consequences worldwide
PEPFAR,
the US global HIV programme, has saved more than 26 million
lives since 2003 and changed the trajectory of the HIV
pandemic. PEPFAR was a success under the first Trump
administration, with major progress toward the 95-95-95
goals. Since the start of the second Trump administration,
however, it has undergone major disruptions.
Two
presentations at AIDS 2026 will demonstrate the real-world
impact of these disruptions. The first is based on the
PEPFAR Pulse Study – the first large-scale survey of
PEPFAR implementing partners to document the scale and scope
of PEPFAR disruptions globally. The survey reached 166
implementing partners in 46 countries.
The results are
deeply concerning. More than half (52%) of all implementing
partners had at least one terminated award, and 77% had been
asked to restrict their work to comply with an additional US
policy. Terminations led to 1,714 closed service sites,
including 1,010 public health facilities, 325 access points
and 126 drop-in centres. Locally based partners were
particularly impacted.
Partners were most likely to
have permanently stopped providing services for key
populations, the groups most vulnerable to HIV. Among
partners providing HIV treatment, more than one in five
(21%) had permanently stopped at least one HIV clinical care
activity. Many partners reported that they were unable to
obtain condoms (23%), lab commodities (23%), PrEP (22%) or
antiretroviral drugs (20%). Among partners with no
terminated awards, the majority had censored language (61%),
stopped a service (61%) or stopped services to specific
populations (44%) to continue receiving
funding.
According to presenter Elise Lankiewicz of
amfAR, the results make it clear that US funding and policy
changes have caused PEPFAR-wide disruptions, with a
disproportionate impact on local organizations and the
populations most vulnerable to HIV.
The second study,
based on a rapid analysis of newly released PEPFAR data for
fiscal year 2025, examined shifts in PEPFAR-supported
paediatric treatment following a year of disruption. To get
an accurate picture, the study team limited the analysis to
PEPFAR-supported treatment, meaning site-level service
delivery and technical assistance.
The team found that
globally, 77,163 fewer children living with HIV received
PEPFAR-supported treatment in fiscal year 2025 compared to
2024 – a decline of 14.2%. The team also examined data for
21 countries that have substantial numbers of children
living with HIV on PEPFAR-supported treatment. Among those
countries, all but one reported a decline in the number of
children receiving site-level treatment support from PEPFAR,
with proportional declines among children living with HIV
exceeding those among adults. South Africa recorded the
largest absolute decline, with 30,880 fewer children
receiving treatment support from PEPFAR – a 45% drop. The
team also conducted an analysis that suggests that declines
in five countries – Uganda, Haiti, Zambia, South Africa
and Kenya – represent potential departures from historical
trajectories.
According to presenter Ramona Godbole of
Heidelberg Institute of Global Health, Heidelberg University
Hospital and Clinton Health Access Initiative, these
findings warrant urgent country-level investigation and
restoration of public dissemination of routine
age-disaggregated PEPFAR data.
“These studies
provide compelling new evidence that PEPFAR disruptions have
had negative, far-reaching consequences, particularly for
those most vulnerable people,” Kenneth Ngure, IAS
President-Elect and Associate Professor of Global Health at
Jomo Kenyatta University of Agriculture and Technology in
Juja, Kenya, said.
Abstracts and sessions:
Measuring PEPFAR disruptions at scale: Results from a
46-country implementing partner survey, “AIDS
2026 Co-Chairs’ Choice”; Shifts in
PEPFAR-supported pediatric treatment: rapid analysis of
fiscal year 2025 PEPFAR program data; “People
in crisis: Conflict, migration and sustaining HIV
care”
Open-label extension
studies confirm that twice-yearly lenacapavir for HIV
prevention is highly effective
Eagerly
awaited new data from the PURPOSE 1 and 2 studies confirm
that twice-yearly injectable lenacapavir for HIV prevention
is safe and highly effective.
Based on data from the
randomized blinded phases of PURPOSE 1 and 2, lenacapavir
for HIV prevention has already been approved by regulatory
authorities in many parts of the world, and global rollout
has begun. At AIDS 2026, study teams will present results
from the first 52 weeks of the open-label extension phase of
both studies.
PURPOSE 1 enrolled cisgender women in
South Africa and Uganda. Previously, data from the
randomized blinded phase showed that twice-yearly
lenacapavir for HIV prevention had superior efficacy to
daily oral emtricitabine/tenofovir disoproxil fumarate
(F/TDF) in cisgender women. Following the randomized blinded
phase, eligible study participants could choose to continue
receiving lenacapavir or switch from daily oral PrEP to
lenacapavir in the open-label extension. Overall, 95.2%
elected to receive lenacapavir in the open-label
extension.
During the first 52 weeks of the open-label
extension, there were zero new HIV acquisitions among
participants receiving lenacapavir. Looking cumulatively
from the start of the trial through week 52 of the
open-label extension, with more than 7,178 person-years of
follow-up among participants receiving lenacapavir, there
was one HIV acquisition in a participant receiving blinded
lenacapavir. An additional HIV acquisition occurred after a
participant switched from blinded lenacapavir to open-label
F/TDF. Adherence to injections at week 52 of the open-label
extension was 96%, and no new safety concerns were
identified. According to presenter Noah Kiwanuka of the
Makerere University School of Public Health, the results
reinforce lenacapavir as a transformative PrEP option for
cisgender women.
PURPOSE 2 enrolled cisgender men and
gender-diverse individuals in Argentina, Brazil, Mexico,
Peru, South Africa, Thailand and the United States.
Previously, in the randomized blinded phase, twice-yearly
lenacapavir for HIV prevention demonstrated superior
efficacy to daily oral F/TDF in cisgender men and
gender-diverse individuals. Following the randomized blinded
phase, 95% of study participants chose to receive
lenacapavir in the open-label extension.
Overall, from
the start of PURPOSE 2, representing more than 5,295
person-years of follow-up among participants receiving
lenacapavir, there were four HIV acquisitions in
participants on lenacapavir. Three occurred during the
randomized blinded phase (these were previously reported)
and one occurred on open-label lenacapavir. The participant
who acquired HIV during the open-label phase received all
lenacapavir injections on time and lenacapavir plasma level
assessment is ongoing. Adherence to injections at week 52 of
the open-label extension was 92% among those who switched
from active F/TDF.
According to presenter Marcelo
Losso of Hospital General de Agudos Dr. José María Ramos
Mejía, the results confirm that lenacapavir is a safe and
effective HIV prevention option for cisgender men and
gender-diverse people globally.
“If we deliver it
where it is needed most, lenacapavir for HIV prevention has
the potential to help curb the global pandemic,”
Grinsztejn, a member of the PURPOSE 2 study team, said.
“In Latin America, where many countries are excluded from
generic licensing and lack PEPFAR support, access hinges on
reaching affordable price agreements. We must resolve these
pricing barriers now to ensure the region is not left
behind.”
Abstracts and session: Zero HIV
acquisitions with twice-yearly subcutaneous lenacapavir for
PrEP during 52 weeks of open-label extension in PURPOSE 1;
High efficacy of twice-yearly subcutaneous lenacapavir for
PrEP through 52 weeks of open-label extension in PURPOSE 2,
“Moving
to long-acting PrEP”
Phase 3
trials demonstrate that once-weekly oral
islatravir/lenacapavir is efficacious and well tolerated in
people with virologically suppressed
HIV
While once-daily single-tablet regimens
have transformed the outlook for millions of people living
with HIV, daily pill fatigue and adherence challenges
remain. Many people with HIV want the freedom of a
long-acting option, but strict scheduling requirements are
associated with injectable medications.
The Phase 3
ISLEND-1 and ISLEND-2 trials evaluated an oral single-tablet
HIV treatment regimen taken once weekly that combines
islatravir and lenacapavir. This combination has the
potential to be the first complete, once-weekly oral
single-tablet treatment regimen for people with
virologically suppressed HIV.
Last month, Gilead and
Merck (known as MSD outside of the United States and Canada)
announced positive topline results from the first 48 weeks
of ISLEND-1 and ISLEND-2. The announcement indicated that
the companies plan to file ISLEND data with regulatory
authorities globally. At AIDS 2026, the ISLEND-1 and
ISLEND-2 study teams will present detailed findings for the
first time.
Jürgen Rockstroh of University Hospital
Bonn will present data from ISLEND-1, a double-blind,
active-controlled trial that enrolled virologically
suppressed adults with HIV taking
bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF),
also known by the brand name Biktarvy®. Half of
participants were randomly assigned to switch to a weekly
pill combining islatravir and lenacapavir; the other half
continued to take B/F/TAF daily. The study found that the
weekly pill was efficacious, well tolerated and
statistically non-inferior to B/F/TAF.
Amy Colson of
Community Resource Initiative and the Zinberg Clinic at
Cambridge Health Alliance will present findings from
ISLEND-2, an open-label trial that enrolled virologically
suppressed adults with HIV taking various standard of care
oral daily antiretroviral regimens. Half of participants
were randomly assigned to switch to the weekly pill, and the
other half continued to take standard of care oral daily
regimens. The weekly pill was efficacious, well tolerated
and statistically non-inferior to standard of care oral
daily regimens.
“Treatment needs to fit into
people’s lives, not the other way around,” Ngure said.
“People living with HIV need new treatment options that
offer flexibility, and a weekly pill could broaden the
choices available for adults with virological suppression.
We are excited to share these results at AIDS
2026.”
Abstracts and sessions: Once-weekly oral
islatravir/lenacapavir (ISL/LEN) versus daily
bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in
virologically suppressed adults with HIV-1: Week 48 results
of the ISLEND-1 phase 3 trial, “ARTistic
strategies 2: The long game”; Once-weekly oral
islatravir/lenacapavir (ISL/LEN) versus daily
standard-of-care therapy in virologically suppressed adults
with HIV-1: week 48 results of the ISLEND-2 phase 3 trial,
“AIDS
2026: Co-Chairs’
Choice”
HIV-specific immune
activity may persist in the spinal fluid even when the virus
is suppressed in the blood
Finally, AIDS 2026
will include a study that explores a critical frontier in
HIV cure research: the central nervous system. This study
looked at a group of 79 adolescents in South Africa who
acquired HIV around the time of birth and started
antiretroviral treatment in infancy. They have been followed
for 16 years, making them one of the earliest-treated and
longest-followed paediatric HIV cohorts in the
world.
The study team investigated whether suppressing
HIV in the blood means the central nervous system is also
“quiet” or shows no detectable HIV-specific immune
activity. To find out, they took paired samples of each
participant’s blood and spinal fluid.
Among the
adolescents whose HIV was suppressed in their blood, 19%
still showed persistent HIV-specific immune activity in
their spinal fluid. Individuals in that subgroup tended to
have a longer history of HIV treatment
interruptions.
According to presenter Shalena Naidoo
of Stellenbosch University, the findings suggest that
monitoring HIV in the blood alone may not fully capture
ongoing HIV-specific immune activity in the central nervous
system. They also highlight the importance of including
central nervous system-focused assessments in HIV cure and
analytical treatment interruption studies.
About the
International AIDS Conference
The International
AIDS Conference is the premier global platform to
advance the HIV response. As the world’s largest
conference on HIV and AIDS, it sits uniquely at the
intersection of science, policy and advocacy, bringing
together researchers, policy makers, healthcare
professionals, people living with HIV, funders, media and
communities. Since its start in 1985, the conference has
served to strengthen policies and programmes that ensure an
evidence-based response to HIV and related epidemics. AIDS
2026, the 26th International AIDS Conference, will take
place in Rio de Janeiro, Brazil, and virtually on 26-31 July
2026. Around 7,000 people are expected to
attend.
About the International AIDS
Society
IAS – the International
AIDS Society – convenes, enables, empowers and
advocates for a world in which HIV no longer presents a
threat to public health and individual well-being. After the
emergence of HIV and AIDS, concerned scientists created the
IAS to bring together experts from across the world and
disciplines to promote a concerted HIV response. Today, the
IAS and its members unite scientists, policy makers and
activists to galvanize the scientific response, build global
solidarity and enhance human dignity for all those living
with and affected by HIV. The IAS also hosts the world’s
most prestigious HIV conferences: the International AIDS
Conference, the IAS Conference on HIV Science and the HIV
Research for Prevention
Conference.
