Top 5 HIV treatment stories from IAS 2023

Rhiannon Neale Photography

At the recent 12th International AIDS Society Conference on HIV Science (IAS 2023) in Brisbane, researchers presented the latest data on antiretrovirals, their side effects and how to best use them in medical care. Here are five highlights from this year’s conference.

At IAS 2023, Dr Andrew Hill spoke to NAM aidsmap's Roger Pebody about adherence counselling reversing viral rebound on dolutegravir.

One study found that adherence counselling reversed viral rebound on dolutegravir in 95% of cases, meaning people did not need to switch treatment. The study investigators say their findings support the recent South African guidelines on when to switch treatment in people taking dolutegravir. However, if this approach were to fail, it could expose a large number of people to the risk of developing integrase inhibitor resistance. So, further evidence is needed to inform the amount of counselling a person is given, and how long they can have a detectable viral load before needing to switch treatment.

Integrase inhibitors raise the risk of type 2 diabetes, regardless of weight gain, according to a large international cohort study. The research found that people with HIV taking an integrase inhibitor had a 48% higher risk of developing type 2 diabetes, but more research is needed to understand why. The increased risk was only seen after at least one year of treatment. The research also found that other factors, such as race, and CD4 count, influenced risk.

Two studies found that switching away from integrase inhibitors did not reverse weight gain, and instead, people who switched continued to gain weight at a similar rate to those who didn’t. One study looked at weight changes following a switch to a protease inhibitor-based regimen, the other following a switch to doravirine/islatravir. Researchers noted that in the future, managing weight gain could be very important for preventing metabolic disorders in people with HIV. This may include pharmaceutical interventions, but these are expensive, and studies looking at their effects on people living with HIV are needed.


integrase inhibitors (INI, INSTI)

A class of antiretroviral drugs. Integrase strand transfer inhibitors (INSTIs) block integrase, which is an HIV enzyme that the virus uses to insert its genetic material into a cell that it has infected. Blocking integrase prevents HIV from replicating.

detectable viral load

When viral load is detectable, this indicates that HIV is replicating in the body. If the person is taking HIV treatment but their viral load is detectable, the treatment is not working properly. There may still be a risk of HIV transmission to sexual partners.

virological suppression

Halting of the function or replication of a virus. In HIV, optimal viral suppression is measured as the reduction of viral load (HIV RNA) to undetectable levels and is the goal of antiretroviral therapy.


A group of diseases characterized by high levels of blood sugar (glucose). Type 1 diabetes occurs when the body fails to produce insulin, which is a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not produce enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst and extreme hunger. Some antiretroviral drugs may increase the risk of type 2 diabetes.

viral rebound

When a person on antiretroviral therapy (ART) has persistent, detectable levels of HIV in the blood after a period of undetectable levels. Causes of viral rebound can include drug resistance, poor adherence to an HIV treatment regimen or interrupting treatment.

Biktarvy (bictegravir, tenofovir alafenamide) is safe and effective in pregnancy according to a new study of its pharmacokinetics. Until now, there have been no data available on this. The study looked at viral suppression (below 50 copies) in 33 women, all switched to Biktarvy in the second or third trimester of pregnancy. All participants that remained in the study (32) maintained viral suppression at delivery and at 18-weeks postpartum.

Research from Uganda, Zambia, and Zimbabwe has found more safe and effective options for second-line HIV treatment in children. All children were randomised to take one of two NRTI backbone medicines. CD4 cell counts increased across all arms and there was no evidence of a difference according to either the NRTI or anchor regimen randomisation. The findings highlight the need to develop a child-friendly fixed-dose combination of tenofovir alafenamide fumarate and emtricitabine plus dolutegravir as an anchor medicine. Alternatively, darunavir or atazanavir could be used as the anchor.

Click on the links to find out more.

You can also read our selections of the top five stories on PrEP, co-infections and co-morbidities, HIV in Africa and HIV in Asia from IAS 2023.