IAS 2025 Kigali Rwanda
Day 2 Summary: International AIDS Society Conference 2025
July 16, 2025
The second day of the International AIDS Society (IAS) 2025conference featured comprehensive discussions across seven key areas of HIV research and care, highlighting both emerging challenges and innovative solutions in the global HIV response.
Mpox (Monkeypox) Update
Dr. Placide Mbala Kingebeni from the Democratic Republic ofCongo provided insights into the mpox outbreak evolution. Originally identified in 1970, mpox reemerged in urban areas between 2017-2019 after a 38-yearabsence, spreading particularly among men who have sex with men (MSM). Notably, researchers observed no difference in symptoms between people living with HIV and those without HIV.
The JYNNEOS vaccine shows 84% effectiveness in the general population but reduced to 35% effectiveness in people living with HIV, requiring a two-dose schedule 28 days apart. San Diego County has experienced cases but fewer in recent years, with a June 2024 update reporting seven new cases, four of which occurred in unvaccinated individuals.
Cervical Cancer Screening Advances
Drs. Gad Murenzi from Rwanda and Kathryn Anastos from Albert Einstein College of Medicine emphasized that cervical cancer is “100%preventable with vaccine, screening and treatment of dysplasia.” HPV types16 and 18 cause most cancers, making HPV “the most important syndemic in HIV.”
For women living with HIV, screening guidelines recommend starting at HIV diagnosis for those aged 21-29, with annual Pap testing initially, then every three years after three consecutive normal tests. Lifelong screening is recommended. Self-collection kits are being promoted as community-based alternatives, though they lack direct cervical visualization and pelvic examination benefits.
Harm Reduction Initiatives
Paul Dietze from Australia reported remarkable success in naltrexone training programs, with over 90% of participants learning effective overdose reversal techniques. However, PEPFAR and USAID funding cuts have limited access to this affordable, life-saving medication for people who inject drugs.
Cardiovascular Health in HIV
Dr. Franck Boccara from Sorbonne University highlighted that traditional cardiovascular risk calculators (SCORE2 in Europe, ASCVD in the US)significantly underestimate risk for people living with HIV. His recommendation: double the calculated risk scores for HIV-positive individuals.
Women living with HIV face particularly elevated cardiovascular disease risk. The REPRIEVE study marked a breakthrough as the first large study demonstrating that statins effectively reduce cardiovascular disease risk in this population.
Weight Gain Concerns
Dr. Nomathemba Chandiwana from South Africa addressed the concerning trend of weight gain across all antiretroviral (ARV) regimens, with women affected three times more than men. Most weight gain occurs within the first two weeks of treatment, with HIV-positive individuals gaining weight faster than HIV-negative counterparts.
The underlying mechanism appears to be inflammation and “leaky gut” from CD4 cell depletion in the gastrointestinal tract. Promising research with semaglutide showed that weight loss was associated with increased gut CD4 cells. The SLIM LIVER study demonstrated that 1mg weekly semaglutide safely reduced liver fat and improved cardiometabolic risk factors in people with HIV.
Viral Hepatitis Co-infections
Hepatitis C treatment duration has shortened to 1-3 months, though reinfection remains possible. For the 35-39 million people living with HIV globally and 260 million with hepatitis B, continued screening is essential for those at ongoing risk.
Aging with HIV
Dr. Pui Li Wong from Malaysia presented data showing the life expectancy gap between HIV-positive and HIV-negative individuals has narrowed dramatically. In 1996, the gap was 44 years; by 2015, it decreased to3-7 years for women and 1-4 years for men.
However, aging with HIV presents unique challenges, including increased frailty, falls, social isolation, and depression. The WHO’s healthy aging model focuses on six key areas: cognition, mobility, vitality, sensory function, and mental health. Innovative solutions include tablet-based neurocognitive screening tools and community programs like San Diego’s POZabilities organization to combat social isolation.
Community Leadership and Monitoring
The conference emphasized the growing importance of community-led monitoring in HIV programs, with affected communities taking leadership roles in program evaluation and implementation. This includes advancing big data science and systems integration for more effective HIV and cervical cancer monitoring.
Key Takeaways
Day 2 highlighted the evolution of HIV care from acute management to comprehensive chronic disease management, addressing comorbidities, aging concerns, and quality of life. The presentations demonstrated both significant progress in treatment outcomes and emerging challenges requiring innovative, community-centered solutions. The focus on prevention, early detection, and holistic care reflects the maturation of the HIV response into a sustainable, long-term health approach.