Chiva conference: Key research updates from CROI 2025 and beyond

Expert clinicians who attended the 2025 Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco, shared critical insights with attendees at the 19th Annual Chiva Conference on 4 April 2025.

One of the most pressing concerns shared at CROI was the state of global HIV care following the PEPFAR (The U.S. President’s Emergency Plan for AIDS Relief) stop-work order of January 2025. In a survey of 153 partners in 27 countries, 71% reported full programmatic cancellations, particularly affecting HIV testing, PrEP (Pre-exposure prophylaxis), gender-based violence response, and care reengagement. A modelling study revealed that, without sustained donor support, low- and middle-income countries could see up to 10.75 million new HIV infections and 2.93 million related deaths by 2030. Activist Rebecca Denison’s keynote reflected on 40 years of advocacy and called for renewed courage.

Dr Anna Turkova, Consultant Paediatrician at Great Ormond Street Hospital, presented on two main studies that address maternal and child health. The ORCHID study, involving 1,908 pregnant women, found no association between TLD-based ART (Tenofovir DF + Lamivudine + Dolutegravir-based antiretroviral therapy) and adverse birth outcomes, confirming the safety of dolutegravir during pregnancy. 

Meanwhile, the iTAP-2 study reinforced the importance of HBIG (Hepatitis B Immune Globulin) in hepatitis B prevention in newborns, despite recent WHO (World Health Organization) guidelines.

Paediatric care studies brought hopeful developments. The CRAYON and AFINAty trials confirmed the safety and effectiveness of long-acting ART in children and adolescents. Lenacapavir, a long-acting PrEP agent, showed excellent safety and efficacy in adolescents in the PURPOSE-1 trial and early adult studies, supporting the case for annual PrEP injections.

Dr Alasdair Bamford, PID Consultant at Great Ormond Street Hospital, presented the CHAPAS-4 study that evaluated second-line ART regimens in African children. Despite high baseline resistance to lamivudine/emtricitabine, virologic failure remained low at 96 weeks. dolutegravir resistance was rare but noted, especially when combined with zidovudine, reaffirming the need for careful drug selection. These results will inform second-line paediatric treatment guidelines.

The PETITE-DTG study evaluated dispersible tablets and oral films of dolutegravir in neonates. Both formulations, dosed every 48 hours initially and then daily, met pharmacokinetic targets and were safe, with only mild adverse events. Mothers reported high acceptability for both methods.

Broader paediatric issues also emerged. Dr Caroline Foster, AID Consultant at Imperial College Healthcare, highlighted that although children represent only 3% of people with HIV, children accounted for 12% of HIV deaths in 2023, due to late diagnosis and post-discharge mortality. The EMPIRICAL and Co-SAM clinical trials aim to improve pneumonia care and diagnostics and treatment in this group.

Irene Njuguna’s analysis showed that globally, just 57% of children are on ART, versus over 80% of adults. Addressing this gap requires better testing, stigma reduction, and treatment access. Adolescents also face sexual health challenges, including low rates of HIV status disclosure and intimate partner violence (IPV), both of which impact adherence.

Mortality data in the U.S. shows that between 1978-2022, 35% of people with perinatally acquired HIV died. Comparatively, between 2020-2022, 2.5% of this cohort died and the median age at death was 29.

Dr Caroline Foster also presented data on long-term immune response to routine vaccines in people with perinatally acquired HIV. Data emphasises the need for timely boosters, even among individuals whose HIV is virally suppressed, to avoid a decrease in antibodies that provide immunity against infections.

Overall, CROI 2025 highlighted both progress and persistent gaps, underscoring the need for sustained funding, innovation, and equitable access to care.

Additional research presented

The Chiva conference also highlighted clinical research updates from CHARS (Children’s HIV and AIDS Reporting System), which has tracked paediatric HIV care in the UK from 2000. 

Dr Jeannie Collins, Professor of Epidemiology at University College London, presented one major finding: young people who began ART before age five and had higher CD4 levels in childhood maintained more stable immune health into their 20s – comparable to the general population. However, those with lower childhood CD4 levels faced persistent challenges with CD4 levels into their 20s regardless of the age they began taking ART.

This implies that immune reconstitution may not only rely on starting ART early but also on the immune system’s ability to maintain a normal level of CD4 T-cell numbers during childhood. 

Further research covered seroprevalence of SARS-CoV-2 (Covid) among 900 youth with HIV in Europe and South Africa. Only 11% reported or had documented evidence of Covid infection and three needed hospital admission. By 2022, 78% had antibodies, 65% even among the unvaccinated, suggesting most had mild or asymptomatic infections.

Outcomes from dolutegravir use in approximately 1,200 patients showed long-term viral suppression rates of 88–92% over nearly four years. However, outcomes varied based on prior ART experience and viral load levels. Confirmed viral failure remained low at 8.3%.

Looking ahead, Chiva’s research agenda focuses on lifelong outcomes for youth with perinatal HIV. With over 660,000 globally aged 20–24 in 2023, efforts are underway to link data across life stages to better understand aging, ART effects, and health trajectories.

Two studies in adult HIV looked at mental health and cardiometabolic burden in those living with HIV using GP records linked data. There’s potential to do something similar in children.

In response, researchers held workshops with Chiva young people to explore their understanding and awareness of unconsented surveillance data and routine health records and potential for use for research. Overall there was high awareness and support for use of records, recognising potential to improve future care. Young people stressed the need for youth involvement and collaboration. Transparency is key.

Recent UK studies emphasised the need for integrated, long-term care systems that consider both clinical and psychosocial factors.

The Chiva conference reinforced a bold, data-driven, youth-centred approach, where patient voices and long-term research converge to shape a responsive future in HIV care.

Critical Reviewer: Nguilulu R. Messa, PhD Candidate, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin