CROI 2025 Abstract eBook

Abstract eBook

Invited Session

27

HIV Acquisition and Prevention During Pregnancy and Postpartum John Kinuthia Kenyatta National Hospital, Nairobi, Kenya Background: This presentation will discuss HIV incidence during pregnancy and breastfeeding as well as factors (hormonal, immunological, behavioural, sexual and genital infections, and low male participation in antenatal care and HIV testing) that increase risk of HIV acquisition this period. In addition, we will look at the contribution of acute HIV infection to vertical HIV infection and underlying factors driving the increased risk of transmission. I will highlight existing HIV prevention interventions with focus on behavioural and biomedical interventions. Behavioural interventions discussed will include enhanced HIV counseling, use of lay community based workers to provide HIV prevention counselling and male partner referral for circumcision, sexually transmitted infections or HIV treatment implemented in several sub-Saharan African countries. The role of oral antiretroviral pre-exposure prophylaxis (PrEP) during pregnancy and breastfeeding, maternal and infant outcomes following PrEP use, importance of integrating PrEP delivery within maternal and child health clinics and whether a risk based approach is better compared to universal PrEP delivery model will be discussed. Barriers to oral PrEP uptake and continuation and perspectives of health providers on determinants that impact ability to deliver PrEP will be described. Strategies to promote PrEP use among pregnant and breastfeeding women including differentiated service delivery models will be discussed. The talk will also cover use of use of currently available long‐acting formulations that is carbotegravir, six-month injectable lenacapavir and dapivirine ring during pregnancy and breast feeding including efficacy, maternal and infant outcomes as well as effect of added choice of biomedical interventions on HIV prevention coverage. Potential challenges during implementation at scale and the role of all stakeholders including governments, donors, civil society, or manufacturers among others to ensure seamless and impactful rollout will be highlighted. There will be focus on requirements for provision of lenacapavir regarded as 2024 Breakthrough of the year by the Science Magazine. Lenacapavir represents a transformative opportunity to dramatically reduce the number of new HIV infections. Finally, we will deliberate on how to protect women through and NOT from research in order to reduce evidence gaps regarding safety and efficacy of new antiretroviral formulations during pregnancy and breastfeeding. Background: Although the development of effective vaccines has saved countless lives from infectious diseases, the basic workings of the human immune system are complex and have required the development of animal models, such as inbred mice, to define mechanisms of immunity. However, past results are not necessarily a reliable guide to the future, and a notable limitation of animal models has been their failure to accurately model some human diseases and their inability to predict human immune responses in many cases. In the past decade there has been an explosion of new approaches and technologies to explore the human immune system with unprecedented precision. Insights into the human immune response to vaccination, cancers, and viral infections such as COVID-19 have come from high-throughput “omics” technologies that measure the behavior of genes, mRNA, proteins, metabolites, cells, and epigenetic modifications, coupled with computational approaches. I will discuss how these “Systems Vaccinology” approaches are advancing our mechanistic understanding of the human system and its response to vaccines and infections and facilitating the development of vaccines against HIV and other infectious diseases. How HIV Capsid Breaches the Nuclear Envelope Through Karyopherin Mimicry David Jacques University of New South Wales, Sydney, Australia Background: As a lentivirus, HIV is capable of infecting non-dividing cells. For decades it has been understood that HIV must be able to deliver its genetic material across the nuclear envelope in order to establish infection. As the gatekeeper between the cytoplasm and the nucleus, the nuclear pore complex (NPC) represents an obvious entry point. During normal cellular function, the Systems Vaccinology Bali Pulendran Stanford University, Stanford, CA, USA

reproductive health for this unique cohort, born into a family living with HIV and the challenges of negotiating adolescence with a potentially sexually transmissible infection for the first and every subsequent sexual encounter and that sharing your status potentially discloses the status of other family members. We will focus on biomedical prevention strategies including sexual health education, vaccination, contraception and screening for sexually transmitted infections and for anogenital cancers. Increasing numbers of young people born with HIV are choosing to start families with pregnancy data emerging, including the early infant outcomes for a unique cohort of “3rd Generation” HIV exposed uninfected infants born to people who themselves have lived with HIV their entire lives. Finally we will identify data gaps in sexual, reproductive and pregnancy health for this cohort, highlighting future research questions and the importance of the meaningful inclusion of youth in setting the research agenda to support them in fulfilling their potential as adults, partners and parents. Immediate Challenges and Long-Term Goals of the HIV Response Jeffrey Imai-Eaton Harvard TH Chan School of Public Health, Boston, MA, USA Background: Over the past 25 years, the global HIV response has made remarkable progress at controlling HIV epidemics, including reducing new infections and ensuring healthy lives for people living with HIV. However, progress has not been equal across epidemic settings or populations affected by HIV, and overall remains off track to achieve targeted 90% reductions in new infections and AIDS-related deaths by 2030. This presentation will review immediate challenges impeding attaingment of these goals, including sustaining high coverage of effective programmes in high HIV burden settings, regions and epidemiologic settings with lagging in progress, and population groups with distinct unmet needs. Moreover, whilst there are opportunities to accelerate progress toward Ending AIDS as a Public Health Threat by 2030, even with a successful response the global community will continue to live with HIV for decades to come. We will discuss long-term goals in responding to HIV and needs and priorities to sustain effective HIV responses that safeguard and continue epidemiologic gains. Background: This presentation will delve into the complexities of sustaining the global HIV commitment amidst evolving health priorities and funding landscapes. This session will explore the opportunities and risks of integrating HIV care and prevention into broader health services. From innovative service delivery models to community-driven solutions, we will highlight how integration can enhance health system efficiency, reduce patient burden, and improve access to services. Participants will gain insights from global examples of successful integration strategies, and the challenges of maintaining focus on HIV in the face of competing priorities and declining donor funding. This presentation will discuss the dual imperatives of sustaining HIV-specific commitments and leveraging integration to achieve broader health goals. Discover how a people-centered, multisectoral approach can navigate risks such as weakened prevention efforts, service quality compromises, and fragmented systems. By addressing these challenges, we can seize the opportunities of integration to build resilient health systems and accelerate progress toward ending AIDS as a public health threat by 2030. Innovations in HIV Service Delivery: Building a Path Forward with Those Left Behind Izukanji Sikazwe Centre for Infectious Disease Research in Zambia, Lusaka, Zambia Background: Over the last 40 years, remarkable achievements have been recorded in the HIV response, with service delivery models that have increased access to HIV testing, expansion of the HIV prevention toolbox, availability of newer and less toxic antiretroviral therapy resulting in fewer people acquiring HIV in 2023 than at any point since the late 1980’s and almost 31 million people on treatment. Despite advances in science, individuals and communities continue to not access HIV prevention, care and treatment services. This session explores HIV service delivery innovations to bridge the gap and reach individuals and communities left behind. Integration and Stainability of the Global HIV Response Tsitsi Apollo Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe

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Invited Session

25

28

26

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10

CROI 2025