CROI 2024: The Challenges of Sustained Viral Suppression, Advanced HIV Disease, and Ending the HIV Epidemic Targets

Data on the HIV care cascade demonstrated challenges in achieving Ending the HIV Epidemic (EHE) targets across all 18 EHE focus metropolitan areas, but innovative adherence interventions using point-of-care tenofovir testing and motivational interviewing support care cascade outcomes in Namibia and South Africa, respectively. Data on treatment with long-acting injectable (LAI) antiretroviral therapy (ART) demonstrated high acceptability, retention, and virologic suppression including in groups that were not well represented in clinical trials including persons born female and persons with detectable viral loads. The adjuvanted hepatitis B vaccine appeared to be safe and appeared to be superior to conventional hepatitis B vaccines in persons with HIV (PWH) who were prior nonresponders to the hepatitis B vaccine. New therapies are in the pipeline for LAI hepatitis C medication that may cure hepatitis C with 1 injection. ACTG (AIDS Clinical Trials Group) A5359 showed that long-acting cabotegravir/rilpivirine (LA CAB/RPV) can be used effectively in PWH experiencing adherence challenges to oral ART and suggested a paradigm for treating this population with an unmet medical need. Studies on resistance mutations in SARS COV-2 show that treatmentrelated emergent resistance does not appear to contribute to viral rebound or have the potential for transmitted drug resistance. The data presented on HIV and maternal and pediatric health included findings from studies on the implementation of first-line dolutegravir-based ART in pregnant and postpartum women and children, along with results of a phase I/II trial involving LA CAB/RPV in adolescents. Additionally, various abstracts addressed hypertensive disorders in HIV during pregnancy and postpartum periods, as well as the intersection of HIV and mental health in women and youth.