Rio de Janeiro hosted AIDS 2026, the 26th International AIDS Conference, from July 26 to 31, drawing roughly 7,000 delegates under the theme "Rethink. Rebuild. Rise." The theme turned out to fit the week closely. Coverage divided into two parallel stories, one about some of the most important scientific progress the HIV field has made in years, and the other about funding cuts moving quickly enough to threaten that progress before it reaches the people who need it most.
In prevention, long-acting options reached a meaningful milestone. Results from the PURPOSE 1 and PURPOSE 2 trials showed twice-yearly injectable lenacapavir reducing new infections to near zero among participants who received it, with adherence above 90% in both trials and most participants choosing to continue it when offered the option. In treatment, the ISLEND-1 and ISLEND-2 trials presented a once-weekly oral regimen (islatravir/lenacapavir) that performed as well as daily standard-of-care treatment while demanding much less of patients from day to day.
Dr. Max Lataillade, a physician-scientist who spent over two decades developing HIV medicines at Bristol Myers Squibb and ViiV Healthcare, sees the results as a reason for the field to rethink long-acting therapy. In his view, it should be treated as a range of options, oral and injectable, dosed weekly, monthly, every two months, twice a year, and ultimately, potentially even less frequently, that can meet patients where they are, and not as one injectable category.
"Going from 365 dosing decisions a year to 52 is not a cosmetic improvement," Lataillade says. "It changes the number of opportunities for adherence to break down." He points to the LATA study in adolescents, where long-acting cabotegravir/rilpivirine outperformed daily oral therapy, as evidence that the shift is about more than convenience: "In populations where daily adherence is difficult, reducing the number of opportunities for adherence failure actually translates into better clinical outcomes."
"Daily ART transformed the biology of HIV. The opportunity now is to use long-acting medicines to transform how HIV prevention and treatment are delivered. Long-acting is a delivery revolution."
Two other studies presented at the conference measured what disruptions to US PEPFAR funding have already cost. Among 166 implementing partners in 46 countries, more than half reported contract terminations and over three-quarters had to cut back services. The disruptions shut down 1,714 service sites, over 1,000 of them public health facilities, and there were more than 77,000 fewer children on PEPFAR-supported HIV treatment in fiscal 2025 than the year before, a 14% decline. In South Africa alone, nearly 31,000 fewer children received treatment support.
Lataillade, who now leads HIV drug development and strategy at the Gates Foundation, is worried about exactly this gap. He says the field is nearing some of its most powerful tools just as the infrastructure needed to deliver them comes under serious strain.
"A medicine can be extraordinarily effective and still have very little public-health impact if the systems aren't there to deliver it," he says. "We cannot spend years optimizing a medicine and only near the end ask how it will reach the populations with the greatest need. Access has to become part of product development itself."
"Innovation is only transformational when it becomes accessible," Lataillade told attendees at the AVAC symposium at AIDS 2026.
Brazil provided some of the week's better news. The host country used the conference to showcase its elimination of mother-to-child HIV transmission, an achievement that contrasted sharply with the funding news elsewhere on the program and showed that steady, well-targeted investment still pays off even as the broader funding outlook worsens.
Lataillade avoids treating Brazil as a template to copy or as an exception to set aside. He is more interested in which of the principles behind its success can work in other countries.
"Eliminating mother-to-child transmission doesn't come from a single breakthrough," he explains. "It comes from sustained political commitment, reliable access to testing and treatment, strong public-health infrastructure and the ability to keep delivering over many years."
"Sustained investment works. The lesson isn't that every country needs to become Brazil. It's that when scientific innovation is matched by durable political commitment, financing and delivery infrastructure, eliminating HIV transmission can move from aspiration toward an achievable public-health outcome."
By the end of the week, the field's central problem was hard to miss. Tools capable of ending the epidemic are arriving faster than the money to put them to use. The long-acting breakthroughs rank among the biggest advances in HIV prevention and delivery in years, but without infrastructure, access planning, and lasting political commitment behind them, they could end up as treatments with no reliable way to reach patients.
ABOUT THE EXPERT
Dr. Max Lataillade is a physician-scientist who spent over two decades in HIV drug development at Bristol Myers Squibb and ViiV Healthcare. He now leads HIV drug development and strategy at the Gates Foundation and also runs his own consulting practice, Health and Pharma Solutions LLC.
Published by Medicaldaily.com
