AIDS 2026: New HIV Data Support More Personalized Treatment Options

New research presented at the International AIDS Conference (AIDS 2026) in Rio de Janeiro highlights how HIV treatment continues to evolve beyond viral suppression toward more personalized care, with studies demonstrating the effectiveness of 2-drug regimens, long-acting injectable therapies, and treatment strategies tailored to individual patient needs.

Jean van Wyk, MD, chief medical officer at ViiV Healthcare, discussed several of the company's key presentations at the meeting with Infection Control Today, emphasizing that expanding treatment options allows clinicians and patients to make decisions based on lifestyle, preferences, and long-term health goals rather than relying on a one-size-fits-all approach.

Head-to-Head Trial Supports 2-Drug Therapy

Among the most anticipated presentations was the VOGUE study, the first head-to-head comparison of the 2-drug regimen Dovato (dolutegravir/lamivudine) with the 3-drug regimen Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) in treatment-naive adults living with HIV.

Van Wyk explained that although both regimens are widely prescribed in the US and Europe, clinicians previously lacked direct comparative data.

"This study was specifically designed to test the 2-drug regimen of Dovato head-to-head with the 3-drug regimen Biktarvy in treatment-naive people," he said. "For the very first time, we're doing that."

The trial evaluated patients using a "test-and-treat" strategy, in which treatment begins immediately after diagnosis, often before resistance testing results are available.

According to van Wyk, the results demonstrated that Dovato achieved noninferior efficacy regardless of patients' viral load or CD4 cell count at treatment initiation.

"The results showed us that Dovato has noninferior efficacy to Biktarvy regardless of the viral load, regardless of the CD4 cell count, and you can use it with a good safety profile in a test-and-treat approach," he said. "You don't need that resistance result before you initiate therapy."

Reducing Lifetime Drug Exposure

Although both regimens suppress HIV effectively, van Wyk said reducing the number of medications patients take over decades of treatment may offer important long-term benefits.

"When somebody starts therapy, it's likely going to be lifelong. That can be 50 or 60 years because people with HIV live lifespans as long as people who don't have HIV right now," he said. "If we can reduce the number of medications that a person gets exposed to over this lifetime of treatment, we can potentially reduce the side effects that are associated with that third drug, or things like drug-drug interactions."

Van Wyk emphasized that the success of a 2-drug regimen depends on selecting medications with a high barrier to resistance, noting that Dovato has accumulated extensive real-world evidence involving more than 70,000 patients.

Long-Acting Therapy Continues to Show Promise

Another major focus at AIDS 2026 was long-acting injectable treatment.

Van Wyk discussed new real-world data comparing Cabenuva, the only currently approved complete long-acting injectable HIV treatment regimen, with daily oral Biktarvy.

The observational analysis found comparable viral suppression between the therapies while maintaining very low rates of virologic failure.

"What is really interesting with long-acting therapy is because it's directly observed treatment, you know the patient has to come to the clinic and a health care professional administers the injections," van Wyk said. "We see really high adherence rates to people returning to their injection visits."

For many patients, he said, the benefits extend beyond adherence.

"There's a real psychosocial burden," van Wyk explained. "It reminds you of the disease that you have every day when you have to open that bottle and take the medication."

Long-acting injectable therapy also addresses concerns surrounding HIV-related stigma.

"We found with long-acting injectable medications, because you don't keep the medications at home, it actually addresses a lot of these issues," he said. "It leads to improvements in quality of life, and people generally prefer it once they've tried it."

Meeting the Needs of Adolescents

Data presented from the long-acting treatment in adolescents (LATA) study demonstrated superior efficacy for long-acting injectable therapy compared with daily oral treatment among adolescents living with HIV.

Van Wyk said the findings reflect the unique challenges younger patients

face with daily adherence.

"Adherence is a real issue in adolescents," he said. "That's why long-acting injectables are a really good option for adolescents. This trial proved it with superior efficacy outcomes because you don't have to rely on somebody taking that tablet every day when they have so many other issues going on in their lives."

Shared Decision-Making Remains Essential

Despite growing treatment options, van Wyk said many patients still are not fully informed about available therapies.

He cited findings from the Ask Us Europe survey, which found that nearly 20% of respondents could not recall ever discussing treatment optimization with their clinician, while fewer than half had heard of long-acting injectable therapy.

"The important thing is clear communication and joint decision making," he said. "It's not for the physician to just decide what's best for the person sitting in front of them. It has to be a joint decision on what suits that person best."

Looking Beyond Viral Suppression

van Wyk noted that modern HIV care increasingly considers outcomes beyond virologic suppression.

"We have great options, but why is it that between a quarter and a third of people around the globe do not have virologic suppression? We still see more than 1.2 million new infections every year," he said. "There's clearly a big unmet medical need still, and that unmet medical need can be around things like quality of life, adherence, stigma, and a number of issues."

While viral suppression remains the foundation of HIV treatment, he believes patient preferences, quality of life, and long-term treatment satisfaction will continue to shape future therapeutic development.

Looking Ahead

Although significant progress has been made over the past 4 decades, van Wyk acknowledged that ending the HIV epidemic will require continued innovation, expanded access to treatment, and collaboration across the health care community.

"The whole model needs to be rethought. We have to think again about how we're going to approach this epidemic as a community together," he said. "It is possible, and I'm always an optimist. I know we will get there. We just have to all work together."