Studies highlighted at IAS 2021 – the IAS Conference on HIV Science – include global WHO analysis indicating HIV is a
significant independent risk factor for severe COVID-19 illness at hospitalization and for in-hospital death.
New evidence on HIV and TB drug resistance, updates on acceptability of HIV prevention tools and increased risk faced by
women and girls under COVID-19 lockdowns will also feature at virtual conference.
New studies to be presented at IAS 2021 – the 11th IAS Conference on HIV Science
– show important progress in HIV prevention, treatment and cure efforts despite major disruption to HIV programmes and
research during the COVID-19 pandemic.
Several studies spotlight the intersection of the HIV and COVID-19 pandemics, including new evidence from a large-scale
World Health Organization (WHO) analysis that HIV is a significant independent risk factor for severe COVID-19 illness
at hospitalization and in-hospital death. There is also evidence from Uganda that women face increased risk of
gender-based violence and HIV during COVID-19 lockdowns.
Convened by IAS – the International AIDS Society – the virtual conference will expect around 6000 participants from
18-21 July. The conference officially opens Sunday with remarks from speakers including German Chancellor Angela Merkel;
and a panel discussion on the COVID-19 and HIV pandemics with global health experts including Anthony Fauci, director of
the U.S. National Institute of Allergy and Infectious Diseases.
The IAS featured five studies at a press conference held today to preview scientific highlights for media.WHO report finds HIV infection is an independent risk factor for severe COVID-19 illness
A new global analysis from WHO concludes that HIV infection is a significant independent risk factor for both severe
illness at hospital admission and in-hospital mortality.
Informed by these findings, the IAS called on countries to add people living with HIV to the list of groups prioritized
in vaccine rollout efforts.
“This study underscores the importance of countries including all people living with HIV in the list of priority
populations for national COVID-19 vaccine programmes,” IAS President and IAS 2021 International Co-Chair Adeeba
Kamarulzaman said. “The global community must also do much more to bring COVID-19 vaccines to countries around the world
with high prevalence of HIV and other diseases. It is unacceptable that as of today, less than 3% of the entire African
continent has received a single dose of the vaccine and less than 1.5% have received both doses.”
Previous evidence regarding the impact of HIV infection on the severity and mortality of COVID-19 has been limited and
sometimes conflicting, and most analyses have been based on relatively small cohorts of individuals in specific
settings. In this report, WHO researchers analysed clinical data submitted to the
from 24 countries on more than 15,500 people living with HIV who were hospitalized for COVID-19.
The mean age of these patients was 45.5 years. About 37% were male, about 92% had received antiretroviral therapy and
about 36% had severe or critical COVID-19 illness on admission. Their most common underlying chronic conditions were
hypertension, diabetes and obesity. Among patients with a known outcome, 23% died in hospital. The study team determined
that HIV infection was associated with an increased risk of severe or critical COVID-19 presentation (aOR 1.13, 95% CI:
1.09–1.17), after adjusting for age, sex and comorbidity burden, and of in-hospital mortality (aHR 1.30, 95% CI:
1.24–1.36) after adjusting by age, gender, disease severity and comorbidities burden.
Positive results from ZeNix, a Phase 3 trial seeking to improve a key treatment strategy for highly drug-resistant TB,
could lead to changes in TB treatment guidelines and have real benefits for people living with TB. The study enrolled
181 people with highly drug-resistant TB in South Africa, Russia, Georgia, and Moldova. They were treated for six months
with daily bedaquiline and pretomanid, and daily linezolid (a combined regimen known as BPaL) starting at 1,200mg for
either six or two months or 600mg for either six or two months.
A high relapse-free cure rate was observed in all four study arms. In addition, people who received reduced doses and/or
shorter durations of linezolid were less likely to experience adverse events of peripheral neuropathy and
myelosuppression. They were also less likely to require linezolid dose modification. According to the study team, these
results confirm the high relapse-free cure rate for the BPaL regimen in highly drug-resistant TB and suggest that
reduced doses and/or shorter durations of linezolid than 1,200 mg for six months have similar efficacy and improved
“This month, we will mark 100 years since the BCG vaccine for tuberculosis was first administered. This vaccine has
saved many lives – but unfortunately, it has very limited effectiveness and it is still the only TB vaccine we have,”
IAS 2021 Local Co-Chair Hendrik Streeck, the Director of the Institute of Virology and Professor of HIV Research at the
University of Bonn in Germany, said. “This anniversary is a reminder of the urgent need for improved prevention and
treatment options, including for highly drug-resistant TB.”
A study from the Global Evaluation of Microbicide Sensitivity (GEMS) project found high rates of drug resistance in
individuals who were diagnosed with HIV while participating in HIV pre-exposure prophylaxis (PrEP) rollout programmes in
The project implemented drug resistance monitoring for PrEP users who were diagnosed with HIV during participation in
oral TDF-based PrEP programmes in Eswatini, Kenya, South Africa and Zimbabwe. Of the 204 participants with reported
seroconversions on PrEP, 175 provided a sample for the study. These participants had a median age of 24 and
three-quarters were female.
Tenofovir-diphosphate was detectable in most of the samples and most participants self-reported good or fair adherence
to PrEP. A total of 104 of the 175 samples were successfully genotyped and at least one major HIV drug-resistant
mutation was detected in 45% of them. The study team determined that the high frequency of HIV drug resistance in people
living with HIV on PrEP exceeds background levels of transmitted nucleoside and nucleotide resistance in sub-Saharan
“Drug resistance in PrEP breakthrough infections could threaten treatment effectiveness, contribute to spread of
resistance and undermine efforts to prevent HIV,” Prof Streeck said. “These findings reinforce the need for PrEP rollout
programmes to check for acute infections before starting people on PrEP and to conduct ongoing HIV drug resistance
Interim results from the REACH HIV prevention study show encouraging levels of adherence to both the dapivirine vaginal
ring and oral PrEP among adolescent girls and young women in Africa. The study assessed safety, adherence and
acceptability of both products among adolescent girls and young women.
The study enrolled nearly 250 HIV-negative, non-pregnant young women aged 16 to 21 years from South Africa, Uganda and
Zimbabwe. Participants were randomized to either the monthly dapivirine ring or daily oral PrEP for six months and then
switched to the second product for six months. Most participants had at least moderate adherence to the ring and oral
PrEP. High adherence was observed in about half of the ring users and about 22% of oral PrEP users. Adverse events of
Grade 2 or higher were experienced by 78% of ring users and 77% of oral PrEP users.
Acceptability varied, with about 88% liking the ring and about 64% liking oral PrEP. Only one HIV acquisition was
reported among study participants. The study team concluded that adherence to the dapivirine ring and oral PrEP was
higher than previously observed among African adolescent girls and young women. Both products were well tolerated and
“Adolescent girls and young women account for most of the new HIV infections in sub-Saharan Africa. These findings
should accelerate efforts to make these two prevention options available to all those who can benefit,” Prof
Striking results from a large study in Uganda show that sexual violence reports and HIV exposure increased among females
during the country’s COVID-19 restrictions.
Researchers analysed routine programme data from the Uganda Health Management System and the Uganda Child Helpline to
correlate COVID-19 restrictions with gender-based violence reports, uptake of HIV post-exposure prophylaxis (PEP) and
teen pregnancy among Ugandan females. They compared data from two time periods: the six months prior to COVID-19,
starting in October 2019; and the first six months of COVID-19 restrictions, starting in April 2020.
They found that among women of all ages, during the first six months of COVID-19 restrictions, there was a 24% increase
in post-rape reports and an 18% reduction in PEP uptake compared with the pre-COVID-19 period. More than half of those
who reported for post-rape care after the recommended 72-hour intervention timeframe cited lockdown restrictions as the
main reason for coming late.
The study team also found that among Ugandan girls, the odds of reporting sexual violence during the COVID-19 period was
1.3 times higher than in the pre-COVID-19 period. There was also a 17% increase in teen pregnancy between the two
periods, but that was not found to be statistically significant. The research team concluded that investment in
unhindered, flexible and adaptable gender-based violence mitigation is important during pandemics.
“There has been a lot of concern about the potential for COVID-19 lockdowns to fuel what UN Women has called the ‘shadow
pandemic’ of increased gender-based violence and unintended pregnancy. This study confirms that HIV risk is also a major
concern that should be taken into account when designing pandemic response plans,” Prof Kamarulzaman said.
Also timed with the conference, the IAS released the latest episode of its new limited series podcast, HIV unmuted
, which marks the 40th anniversary of the first reports of AIDS and recounts the progress made over the past four
decades of the global response.
About the IAS Conference on HIV Science. The 11th IAS Conference on HIV Science – known as IAS 2021 – will be hosted virtually on 18-21 July 2021, with a local
partner hub in the original host city of Berlin, Germany.
The IAS Conference on HIV Science is the world’s most influentialmeeting on HIV research.This biennial conference
presents the latest advances in basic, clinical and operational HIV research and facilitates the critical discussions
needed to move science into policy and practice. Through its open and inclusive programme featuring diverse and
cutting-edge HIV research, the meeting sets the gold standard in HIV convenings.
For more information, visitwww.ias2021.org
About IAS – the International AIDS Society: The IAS leads collective action on every front of the global HIV response through its membership base, scientific authority
and convening power. Founded in 1988, the IAS is the world’s largest association of HIV professionals, with members in
more than 170 countries. Working with its members, the IAS advocates and drives urgent action to reduce the impact of
HIV. The IAS is also the steward of the world’s most prestigious HIV conferences: the International AIDS Conference, the
IAS Conference on HIV Science, and the HIV Research for Prevention Conference.
For more information, visit www.iasociety.org