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[Position Paper] Research gaps for children who are HIV-exposed but uninfected: outcomes of a research prioritisation workshop

Globally, 16 million children are HIV-exposed but uninfected (HEU), with health disparities when compared with children who are HIV-unexposed. To identify current challenges, a research prioritisation exercise was conducted through an online survey and in-person workshop with diverse stakeholders, with the aim of identifying the top ten scientific priorities related to children who are HEU. Among 104 survey respondents (46% from Africa; 37% from Europe; 15% from the region of the Americas; and 2% from South-East Asia), 271 research questions were submitted.

[Review] Immunology of infants who are HIV-exposed uninfected in the parental combination antiretroviral therapy era

The introduction and programmatic scale-up of universal antiretroviral therapy in pregnancy (option B and option B+) and the subsequent universal test-and-treat approaches have dramatically reduced infant HIV-1 acquisitions globally, with a parallel increase in the number of infants who are HIV-exposed uninfected (HEU). Although infants who are HEU have historically had higher risk of morbidity and mortality than infants who are HIV unexposed, effective parental viral suppression has enabled people living with HIV to carry healthier pregnancies and realise the benefits of optimised feeding practices that support the transfer of key nutrients and immune factors through their parent's own milk.

[Articles] HIV-related mortality time trends among children and young adolescents on antiretroviral therapy by age, treatment duration, and region: a systematic review and meta-regression analysis

A comprehensive approach to paediatric HIV care is essential to improving outcomes for children and young adolescents living with HIV. Clinically, this approach includes strengthening the prevention of vertical transmission, ensuring early diagnosis in infants, and initiating treatment promptly—ideally at higher CD4 cell counts. From a policy perspective, health systems need to address disparities in treatment access and outcomes across regions, age groups, and sex. Efforts should also prioritise minimising treatment dropout and expanding access to high-quality HIV services.

[Articles] ART-free HIV-1 remission in children with in-utero HIV-1 after very early ART (IMPAACT P1115): a multicentre, open-label, phase 1/2 proof-of-concept study

This study shows that ART-free remission for 48 weeks or longer is achievable with very early ART in children with in-utero HIV-1, but close monitoring for viral rebound and acute retroviral syndrome during ATI is needed. These findings, observed in resource-constrained countries, exhibit the feasibility of testing at birth and initiating very early ART, show the potential to limit HIV-1 reservoirs for ART-free remission, and inform future remission strategies.

[Profile] Creating a space where young people with HIV can be free

For 5 days each year, around a hundred 11–17-year-olds living with HIV in the UK leave their families for a summer camp called Freedom 2 Be. For many of them, this is one of the only times outside of hospital appointments where they speak openly about HIV. Although most of the adolescents have been told that HIV treatments are effective, they may have picked up other messages from their families: you must keep this a secret, do not tell your friends, people are not going to accept you.

[Comment] Dolutegravir in neonates: finally we are getting there!

Dolutegravir, a potent second-generation integrase strand inhibitor (INSTI), is the backbone of HIV treatment regimens for most children aged 1 month or older, adolescents, and adults with HIV globally. Neonates (aged 28 days or younger) have been the last to benefit, receiving more toxic and less efficacious antiretroviral medications for both prophylaxis and treatment regimens. The paucity of safety and pharmacokinetic studies in this age group has been a major hurdle to accessing optimised therapeutic options.

[Comment] Hope for treatment-free remission in children born with HIV

Eliminating vertical transmission of HIV remains a priority in prevention policies promoted by WHO, and their implementation has led to substantial progress in the past 15 years in many countries. Still, UNAIDS estimates 1·4 million children are living with HIV worldwide and that HIV causes over 75 000 deaths annually.1

[Editorial] A field of possibilities for paediatric HIV

UN World Children's Day on Nov 20 is an annual reminder that every child deserves the chance not just to survive, but to thrive. In the field of paediatric HIV, these aspirations have special significance. As paediatric HIV enters its fifth decade as a global health challenge, scientific innovation, political will, and tireless advocacy have delivered progress. The global number of paediatric HIV acquisitions has declined by 62% since 2010, AIDS-related child deaths have fallen from 240 000 in 2010 to 75 000 in 2024, and 18 countries have been certified as having halted vertical transmission, with others, such as Botswana and Namibia, on the path to elimination.

[Viewpoint] Lenacapavir-associated drug resistance: implications for scaling up long-acting HIV pre-exposure prophylaxis

Although drug resistance could emerge if lenacapavir is initiated during undiagnosed acute infection or if infection occurs during the drug's pharmacokinetic tail, these cases will not compromise the effectiveness of WHO-recommended therapies, as there is no cross-resistance between lenacapavir and other licensed antiretroviral drugs. Lenacapavir pre-exposure prophylaxis (PrEP) is also unlikely to drive population-level lenacapavir resistance given the rarity of breakthrough infections and the reduced replication capacity of most lenacapavir-resistant variants, which most likely reduces their transmission potential.

[Personal View] Lessons for long-acting lenacapavir: catalysing equitable PrEP access in low-income and middle-income countries

Despite substantial advances in biomedical HIV prevention, including long-acting injectable pre-exposure prophylaxis (PrEP) options such as cabotegravir, barriers to widespread adoption and scale-up persist in low-income and middle-income countries. Long-acting injectable lenacapavir is a potentially transformative HIV prevention tool, providing an unprecedented opportunity to accelerate progress. However, the global HIV response is under threat like never before, with drastic funding cuts undermining the gains of the past 25 years.

[Articles] The impact of cuts in the US President's Emergency Plan for AIDS Relief funding for HIV pre-exposure prophylaxis in sub-Saharan Africa: a modelling study

Our projections show the substantial detrimental impacts that cuts to PEPFAR funding could have. Mitigation measures, including funding through alternative international donors or domestic government budgets, are needed to maintain and increase existing coverage levels of PrEP and therefore prevent the detrimental impact of PEPFAR's funding cuts, particularly in high coverage countries.

[Articles] Dynamic choice HIV prevention with long-acting injectable cabotegravir pre-exposure prophylaxis in east, central, southern, and west Africa: a cost-effectiveness modelling analysis

Offering structured PrEP and PEP choice including long-acting cabotegravir and enabling risk-informed use could reduce HIV incidence by a third over 10 years. If projected generic production costs of long-acting cabotegravir can be realised, it is likely to be cost-effective across multiple settings in east, central, southern, and west Africa.

[Articles] Epstein–Barr virus and cytomegalovirus co-infections and mortality risk in patients with HIV-associated cryptococcal meningitis: a post-hoc analysis of a prospective nested cohort in the AMBITION-cm randomised controlled trial

These data indicate that cytomegalovirus might be an important copathogen in this context, and that cytomegalovirus viraemia represents a potentially modifiable risk factor to reduce mortality among adults with HIV-associated cryptococcal meningitis. Interventional trials are now required and planned to determine whether treatment of cytomegalovirus viraemia improves outcomes in advanced HIV disease.

[Articles] Safety, tolerability, and immunogenicity of an adult-specific pneumococcal conjugate vaccine, V116, in people living with HIV (STRIDE-7): a two-part, parallel-group, randomised, active comparator-controlled, international, phase 3 trial

V116 was well tolerated and immunogenic for all 21 serotypes, supporting the use of this vaccine in adults living with HIV. Adults at high risk of pneumococcal disease due to underlying comorbid conditions, such as HIV, might benefit from receiving V116. The serotypes in V116, including the eight unique serotypes, are expected to provide broader protection against pneumococcal disease than currently licensed vaccines.

[Culture] Iconic AIDS memorial on show

The US AIDS Memorial Quilt long outgrew the National Mall in Washington, DC, USA where it was first displayed in 1987. There are currently almost 50 000 panels (and counting), arranged in blocks of eight, honouring over 110 000 individuals. Stretched out, the Quilt would span 1·2 million square feet. It is easily the biggest piece of communal folk art ever created.