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EACS has selected a group of independent writers as the official providers of scientific news reporting for the 20th European AIDS Conference.
Gus Cairns, Roger Pebody, Keith Alcorn and Amelia Jones are reporting on key research presented at the Conference, publishing articles on the EACS website and those of partner organisations. Summary news bulletins will also be sent from the EACS mailing list. The writers are editorially independent of EACS and independent of study presenters.
A Dutch study presented at the 20th European AIDS Conference (EACS 2025) in Paris compared the health-related quality of life (HRQoL) in around 500 older people with HIV with the same number of carefully matched people without HIV for the last decade.
It found that although the people with HIV reported consistently lower quality of life as measured by a 36-point questionnaire, the difference was very slight and unlikely to be of clinical significance. There was also no decline seen in HRQoL in participants, regardless of HIV status, between their first assessment and their last, eight years later. (On average, they aged from 52-53 to 60-61 during that time.)
However, study participants also completed a questionnaire that asked about symptoms of depression. This found significantly more experience of depression among the HIV-positive participants than the HIV-negative ones, to the extent that the positive ones significantly exceeded the threshold score that would suggest clinical depression (16 points out of a maximum of 60). The HIV-negative participants did not.
Europe, taken as a whole, is losing some of the gains it has made in tackling the burden of HIV, the 20thEuropean AIDS Conference (EACS 2025) heard in Paris.
Teymur Noori of the European Centre for Disease Prevention and Control (ECDC) told delegates that Europe would miss out on achieving most of the targets UNAIDS had set for the year 2030.
UNAIDS first proposed the targets in 2014, although they were revised in 2021 to include interim targets for 2025, in recognition of the impact of the COVID pandemic. Since then, however, war in many places including Palestine and Ukraine, deep cuts to global HIV budgets from the US and European countries, and a general rightward shift in world politics have all served to deprioritise HIV as a global health issue. So falling short of those ambitious targets is no great surprise.
Although virological failure of injectable cabotegravir/rilpivirine is rare, viral rebound can lead to resistance mutations that may exclude future treatment with widely used antiretrovirals, studies presented last week at the 20th European AIDS Conference (EACS 2025) in Paris show.
While the integrase inhibitor cabotegravir has a high barrier to the development of resistance mutations, resistance to the non-nucleoside reverse transcriptase inhibitor (NNRTI) rilpivirine can emerge quickly after viral rebound. This is especially true if the virus already carries naturally occurring mutations that increase susceptibility to rilpivirine resistance.
Long-acting injectable treatment can overcome the adherence difficulties that often lead to treatment failure, but injectable cabotegravir/rilpivirine (CAB/RPV) treatment may fail due to other factors such as low drug concentrations. If treatment fails, the resistance profile is uncertain.
Two large studies of people switching to tenofovir-sparing regimens presented at the 20th European AIDS Conference (EACS 2025) in Paris show that hepatitis B reactivation is a rare event after the hepatitis B-suppressive drug is removed.
Hepatitis B virus (HBV) can be successfully suppressed by antiretroviral regimens containing tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF). Switching to a tenofovir-sparing, two-drug HIV treatment regimen poses a risk of hepatitis B reactivation in people with past hepatitis B exposure. As such regimens – including dolutegravir/lamivudine and cabotegravir/rilpivirine – are more widely used, there have been concerns that hepatitis B reactivation may be seen more frequently in people with HIV.
At the 20th European AIDS Conference (EACS 2025) in Paris last week, delegates received an update on a case of an apparent cure of HIV infection that was first presented at the 2024 International AIDS Conference in Munich.
The ‘second Berlin patient’ received a stem cell transplant in late 2015 that cured the acute myeloid leukaemia he was suffering from. It also appears to have cured his HIV infection, as he has now been off antiretroviral therapy (ART) for seven years without his HIV reappearing. Researchers have found no DNA in his cells capable of giving rise to new virus, and his antibody response to HIV is fading, indicating there’s no virus for the immune system to respond to.
Ukraine’s health services have been remarkably resilient in wartime, with technological innovations playing a key role in sustaining the delivery of care. At the 20th European AIDS Conference (EACS 2025) in Paris last week, Tetiana Deshko of the Alliance for Public Health outlined three key uses of artificial intelligence (AI) – ‘digital humans’ to answer queries and enhance access to health care; machine learning to better target the offer of HIV testing; and AI-guided analysis to help the organisation strengthen its resilience planning.
The European AIDS Clinical Society issued updated guidelines at its 20th European AIDS Conference (EACS 2025) in Paris last week, making new recommendations on infant feeding and diagnosis and management of obesity in people with HIV.
Antiretrovirals for treatment and prevention
The updated guidelines make no new recommendations on starting or changing treatment, except in relation to people who acquire HIV when using PrEP. In this case, the updated guidelines recommend that dual antiretroviral therapy (ART) regimens should be avoided. For people who acquire HIV when taking long-acting cabotegravir, treatment should start with boosted darunavir and two active nucleoside reverse transcriptase inhibitors.
Studies presented last week at the 20th European AIDS Conference (EACS 2025) in Paris highlighted the need for tailored cancer screening strategies in people with HIV.
The studies found that prostate cancer presents earlier and is more advanced in men with HIV and that women with a lower nadir CD4 count have greater risk of both anal and cervical cancer. A study of liver cancer screening showed that people with HIV without cirrhosis often fail to receive screening despite risk factors, while women with HIV often do not perceive themselves to be at risk of anal cancer despite a high prevalence of HPV associated with cancer among those screened.
Progress towards wider use of statins in people with HIV has been modest and LDL cholesterol control remains suboptimal in people with HIV at higher risk of cardiovascular disease, studies presented at last week’s 20th European AIDS Conference (EACS 2025) in Paris show.
In 2011, the European Society of Cardiology (ESC) recommended statins for people living with HIV with elevated cholesterol. Earlier this year, the ESC recommended statins for all people with HIV aged 40 and over, regardless of cardiovascular risk and LDL cholesterol levels, following the results of the REPRIEVE study. This international randomised study showed that statin treatment reduced the risk of major cardiovascular events by 36% in people with HIV with low-to-intermediate cardiovascular risk.
Switching to a two-drug regimen of dolutegravir/lamivudine (Dovato) resulted in significantly less weight gain after 96 weeks compared to a switch to tenofovir alafenamide/emtricitabine/bictegravir (Biktarvy), the final results of a large, randomised trial conducted in Spain have shown.
Dr Esteban Martinez of the Hospital Clinic Barcelona presented 96-week results of the PASO-DOBLE study last week at the 20th European AIDS Conference (EACS 2025) in Paris.
Some studies have ruled out any contribution of antiretroviral drug type to weight gain after starting or switching treatment. However, Professor Dominique Costagliola argued in a session on weight gain that studies consistently show a greater effect on weight associated with treatment containing tenofovir alafenamide (TAF), bictegravir or dolutegravir.
A significant number of presentations at last week’s 20th European AIDS Conference (EACS 2025) in Paris were concerned with the bacterial sexually transmitted infections (STIs) syphilis, gonorrhoea and chlamydia rather than HIV. This is largely because using the antibiotic doxycycline to forestall infection after possible exposures – doxyPEP – has become more common in western Europe.
This is despite doxyPEP being subject to differing opinions among experts. Whereas the UK’s STI professional society BASHH issued guidelines for doxyPEP use on 9th June this year, a year after the US CDC issued its own, the European equivalent, ECDC, has yet to release its guidelines, though a draft document is currently out for consultation. Reservations concerning doxyPEP centre on its limited efficacy against gonorrhoea and whether it will lead to an increase in antimicrobial drug resistance.
A study presented at the recent 20th European AIDS Conference (EACS 2025) has found that the apparent rise in sexually transmitted infections (STIs), at least in gay and bisexual men with HIV in France, are due to more frequent testing rather than more infections.
Dr Sophie Novelli of the Centre for Epidemiology and Population Health (CESP) of the French national scientific health research agency INSERM presented data from 2016 to 2023 taken from the PRIMO cohort.
The way gay and bisexual men are using drugs to enhance sex (chemsex) is changing in Europe, especially among younger men and those new to chemsex. They are turning to a new generation of drugs, generally with shorter half-lives. These include synthetic cathinones similar to mephedrone, but there are signs that hallucinogens like LSD are also regaining popularity.
People with newer patterns of drug use and new arrivals to the chemsex scene in general may be especially at risk of HIV and sexually transmitted infections (STIs), because their adherence to PrEP seems lower than among other groups, Professor Kai Jonas of the University of Maastricht told the recent 20th European AIDS Conference (EACS 2025) in Paris.
