With the theme “Rethink, Rebuild, Rise“, AIDS2026 in July brought together more than 7,500 delegates. Running through the science was a strong sense of inequality, amplified by community protests highlighting the devastating impact of funding cuts to the global HIV response. Scientific advances mean little if all people living with HIV cannot access them.

Community activists at AIDS2026 demand equitable access to HIV treatment and prevention amid global funding cuts. Photo: Rogério von Krüger / IAS.

HIV cure to HIV remission

One of the biggest changes I noticed at AIDS2026 was the language. While subtle, there was less talk about an outright HIV cure and much more about HIV remission: finding therapies that allow our immune system to control HIV without continuous ART (antiretroviral therapy).

bNAbs: hope or hype?

Broadly neutralising antibodies (bNAbs) remain one of the most promising areas of cure (or let’s call it remission) research. Trials suggest bNAbs can delay viral rebound and enhance immune responses even after the infused antibodies have cleared, which also has researchers interested in their potential for an HIV vaccine. But bNAbs are unlikely to achieve remission alone and will probably need to be combined with immune-boosting therapies.

Long-acting ARVs: what’s in it for us?

Long-acting treatment was everywhere at AIDS2026. The highlight was the once-weekly combination of islatravir and lenacapavir. Clinical trial results showed people maintained an undetectable viral load after switching from daily ARVs. We could potentially see the first weekly HIV pill in Australia in about two years or sooner, depending on regulatory approval and PBS listing. Another weekly combination, islatravir/ULO, is also showing promising results.

Then there’s the possibility of treatment only twice a year. Lenacapavir combined with two bNAbs maintained viral suppression in 89% of participants after 52 weeks in an international study that included Melbourne participants. The research isn’t new, but the excitement remains. However, it won’t work for everyone because a person’s HIV must be sensitive to the bNAbs.

Other combinations discussed included pairing injectable lenacapavir with cabotegravir, although their different dosing schedules — every 26 weeks and every eight weeks — could mean more clinic visits. Researchers are also developing new capsid and integrase inhibitors that could eventually mean injections only every four to six months. But there’s that huge equity question again. While those of us in high-income countries may soon have several long-acting options, activists at AIDS2026 highlighted that long-acting treatment, available since 2021, remains almost non-existent in many low- and middle-income countries.

Australia’s HIV Unwrapped brings HIV science to the AIDS2026 Opening Ceremony through fashion, art and activism.

HIV prevention also had good news, with a once-monthly PrEP pill showing success in clinical trials and potentially becoming a very cheap prevention option under generic licensing. But activists protested that much of Latin America may miss out on generic access — including countries involved in the trials. Six-monthly injectable lenacapavir for prevention also remains out of reach for many globally.

Lenacapavir — beyond treatment and prevention?

The AIDS2026 poster exhibition showcases hundreds of snapshots of new HIV research, including findings that don’t make the main sessions. One poster particularly caught my attention. Lenacapavir is already a powerful capsid inhibitor for treatment and prevention, but early laboratory research suggests it may also help the immune system recognise the HIV reservoir. It’s very early and adds another intriguing possibility for lenacapavir in future HIV remission strategies.

Early research explores whether lenacapavir could do more than suppress HIV and potentially help the immune system recognise the HIV reservoir.

Stopping ARVs to find out if remission works

One difficult reality of cure research is the Analytical Treatment Interruption (ATI), where participants stop their antiretroviral treatment under careful monitoring to see if an experimental therapy can control HIV.

Most experience viral rebound within weeks, although studies presented at AIDS2026 showed it can take up to 24 weeks. A very small number control HIV for years. Known as Post-Treatment Controllers (PTCs), they raise an important question: is their control due to the cure drug being tested, or would they have controlled HIV anyway? Researchers have long tried to understand what makes their immune systems different, but the answer continues to elude them.

Researchers from around the world attending AIDS2026 shared emerging HIV science.

HIV remission: Does the answer lie with PTCs?

Natural Killer (NK) cells kept appearing in cure discussions throughout AIDS2026. So did N-803, an immune-boosting therapy that activates NK and other immune cells. Researchers are investigating whether these could help explain — and perhaps reproduce — the treatment-free control seen in some PTCs.

Other futuristic approaches included CAR T-cell therapy, engineered NK cells and Melbourne-led research using HIV Tat mRNA to reveal HIV hiding in the reservoir. Other Melbourne research using cancer drugs called SMAC mimetics is exploring ways to expose and kill HIV-infected cells. Most of these studies remain years from clinical use and history tells us many will fail. But together they show just how diverse HIV remission research has become.

The role of CCR5 in HIV remission

CCR5 is also making a comeback in cure research. For those of us familiar with the antiretroviral Maraviroc, CCR5 is the doorway HIV commonly uses to enter immune cells. It is also central to several rare stem-cell transplant cases where people with HIV have achieved sustained remission. Two more cases were highlighted at AIDS2026, the Essen patient and the Kansas City patient, bringing the reported total to 13.

Another study used the CCR5-blocking antibody leronlimab with bNAbs and ART in infant macaques treated soon after SHIV infection. After treatment stopped, all eight receiving the combination remained without detectable virus during follow-up. It’s very different from established HIV in adults, but another clue that blocking CCR5 could play a role in remission.

What does an HIV cure mean for us?

Importantly, people living with HIV were also discussing what a cure means to us. At the Global Village there was excitement about no more medication and potentially ending stigma, but also concerns about equitable access, rebound monitoring, U=U messaging and whether support services and benefits might disappear.

Cure research cannot only be about what happens in the laboratory. People living with HIV need to help decide what a meaningful HIV cure (or remission), actually looks like.

Ageing with HIV: living longer and living well

For many of us who have lived with HIV for decades, ageing is now an important area of research. By 2040, more than half of the people living with HIV globally are expected to be over 50. The good news from the session: Ageing Across the Life Course came from Australia with a study highlighting that international research suggests around 70 per cent of people on effective HIV treatment are ageing well. But for some, persistent low-level inflammation may contribute to accelerated ageing and mild cognitive decline, with the HIV reservoir and gut damage among the possible drivers. For women, menopause may also play a role.

Researchers also reported persistent cardiovascular inflammation and reinforced the benefits of statins (medications that lower cholesterol). Neurocognitive screening was recommended as part of routine HIV care, although HIV-related dementia is now rare.

Brazilian researchers reported accelerated muscle loss associated with increased fat within muscle tissue in older people with HIV. The practical message is straightforward: strength training and maintaining a healthy weight become increasingly important as we age.

Interestingly, depression was more strongly associated with housing stress and unemployment than HIV itself. Healthy ageing isn’t simply medical. It’s also about financial security, social connection, mental health, exercise and having a reason to get out of bed each morning.

Emerging therapies included sialidase inhibitors, which may preserve protective sugars called glycans and reduce inflammation associated with ageing. It’s early research but shows how sophisticated the science of ageing with HIV is becoming.

Ageing with dignity: UNSW researcher Lucette Cysique highlighted that as the first generation living long-term with HIV grows older, the challenge is ensuring quality of life and ageing with dignity.

Liver, gut health and metabolism

With a 30-year history of taking ART, I found the session Spotlight on the Liver a little worrying. It focused on steatotic liver disease (SLD), where fat builds up in the liver, including in people who aren’t overweight. Data from an HIV clinic in the UK showed SLD affecting around a third of people with HIV, including many of normal weight. Older antiretrovirals and a history of lipodystrophy may contribute.

The researcher warned that normal BMI doesn’t mean we’re not at risk and recommended at least one liver fibrosis assessment as part of HIV care, although these scans aren’t readily available to everyone. Lifestyle changes before liver damage progresses were also stressed.

But one of the most fascinating pieces of research for me involved the gut and loss of a protective sugar called α1,2-fucose. Its loss can disrupt gut bacteria and weaken the gut lining, contributing to inflammation even when HIV is suppressed. Interestingly, this sugar is also found in breast milk and supports infant gut health. Researchers found that supplementation with 2′-fucosyllactose (2′-FL), now commercially produced through microbial fermentation, could potentially help restore this protection. But this is still very early laboratory research.

Australian women as HIV peers, researchers and clinicians at AIDS2026 in Rio.

AI and the future of HIV care

If one topic felt like it had suddenly moved from the future into the present, it was AI. With global funding cuts affecting peer support and education, and healthcare professionals increasingly time-poor, AI chatbots are already filling some gaps.

One example really stood out. South Africa’s Coach MPILO HIV chatbot operates through WhatsApp. Starting with one clinic in September 2025, nearly a year later it had engaged around 100,000 people across 151 clinics, connecting people to HIV testing, PrEP, treatment and ongoing care.

The strong message was AI combined with human peer support, not replacing it. AI can provide information when someone is alone at 2am and needs an answer, while human peers offer something technology cannot: lived experience and genuine human connection.

10 Years of U=U

AIDS2026 started for me two days earlier at the Living2026 pre-conference celebrating 10 years of U=U, followed by the HIV Cure and Women Know What Works pre-conferences. Wow, has it really been 10 years since Undetectable equals Untransmittable gave us back our sexual freedom and the confidence to enjoy condomless sex without fear of passing HIV to our lovers?

Discussion focused on the next 10 years. The general public is still pretty much oblivious to U=U and some healthcare workers remain reluctant to promote it due to fears of rising STIs.

Breastfeeding and U=U: not yet

Six recent studies (five from high-income countries and one from Tanzania) reported no HIV transmissions among nearly 500 mother-infant pairs where mothers were on treatment and virally suppressed. This follows the nearly decade-old PROMISE study in Africa, which found a transmission risk of 0.3%. But we’re not at U=U for breastfeeding yet. The current message remains: on ART with an undetectable viral load, the risk is below 1%, but not zero.

Celebrating 10 years of U=U at the Living 2026 pre-conference.

My key takeaway from AIDS2026 is that HIV science continues to advance at an extraordinary pace.

Long-term HIV remission is looking increasingly possible, while an actual cure remains elusive.

New long-acting treatments will offer greater choice, improved adherence and less risk of unwanted disclosure. But for now, these advances are unlikely to reach the majority of the nearly 41 million people globally living with HIV.

People are still dying from AIDS, experiencing stigma and facing enormous inequities, made worse by global funding cuts. In Nigeria, for example, there’s been an 83% drop in people starting PrEP, a 70% drop in HIV testing and 50% drop in HIV education. It doesn’t take a clever HIV scientist to figure out what that could mean for HIV transmission globally.

AIDS2026 showed me just how far HIV science has come, but its theme Rethink, Rebuild, Rise was also a reminder of what’s at stake. The challenge now is to rebuild a global HIV response where everyone rises with the science, not just the lucky few.

Heather Ellis attended AIDS2026 in person with a partial scholarship managed by NAPWHA and partial funding from The Peter Doherty Institute for Infection and Immunity and Positive Women Victoria as well as self-funding. 

Links

You can read the AIDS2026 Rapporteur summaries of key research for FREE.

Session recordings from AIDS2026 will be available FREE to the public end September 2026.

Weekly ARV Pill article in Positive Living: You can read more about the weekly pill in this previously published Positive Living feature, where two people with HIV in the clinical trial share their experience.

mRNA therapy: Read more about the Melbourne-led research using mRNA delivered through lipid nanoparticles to target the HIV reservoir.

HIV cure research in Melbourne: If you’re interested in learning more about HIV Cure research, visit HIVcure.com.au

HIV cure is an Australian community-focused website developed by NAPWHA in association with the Doherty Institute and Alfred Health.

Science For The Community: A FREE community-focused HIV Cure Symposium in Melbourne. In person and online – Sunday, 13 September from 3:30pm to 5:30pm. Details and Register