Purpose: Differences in injection site reaction (ISR) acceptability and tolerability are important considerations when choosing long-acting injectable (LAI) antiretrovirals. The CLARITY study (NCT06970223) was designed to provide detailed insights into ISRs and the acceptability, tolerability, and preference of single-dose cabotegravir (CAB) IM and lenacapavir (LEN) SC injections.
Methods: CLARITY is an open-label, randomized crossover study (CAB IM and LEN SC, 1 dose each) in 63 adults without HIV-1. The primary endpoint was participant-reported local reaction acceptability 7 days after injection using the Perception of Injection (PIN) questionnaire. Participants (n=60) and healthcare providers (HCPs; n=7) also completed preference questionnaires. Additional endpoints evaluate investigator-assessed ISR incidence, severity, duration, and imaging through a 6-month follow-up. Here we report primary endpoint and preliminary data on ISRs up to 21 days after administration of each drug.
Results: A diverse group of 63 participants were enrolled (33% female; mean age, 48 years). Based on PIN acceptability domain scores, participants perceived CAB injections as more acceptable (75% “totally” or “very acceptable” with CAB vs 57% with LEN). After both drugs were administered, participants and HCPs preferred CAB (90% participants; 86% HCPs) versus LEN (10% participants; 14% HCPs). After receiving both doses, ISR profiles showed LEN ISRs were more frequent (LEN, n=540 vs CAB, n=117) and participants experienced more visible ISRs (induration 86% vs 21%, nodules 74% vs 18%, erythema 58% vs 10%, and swelling 57% vs 34% in LEN and CAB, respectively). No serious adverse events were reported.
Conclusions: The CLARITY study found clinically relevant differences in ISR acceptability and tolerability favoring CAB over LEN injections after 1 dose of each drug. LEN injections led to more frequent and visible ISRs with participants and HCPs preferring CAB. These data are important in empowering individuals and their HCPs to make fully informed decisions regarding LAI antiretrovirals.

BACKGROUND:
Reducing new HIV infections among women requires increased offering and uptake of HIV prevention medications from providers. We assessed provider-level awareness and practices related to HIV prophylaxis for women.

METHODS:
We conducted a cross-sectional survey study of attitudes and offerings toward HIV prophylaxis among nurse practitioners (NP), family physicians and obstetricians/gynecologists in Canada (May 2023-December 2024). Participants were identified through networks, organizations, and fax databases. Survey questions examined practice characteristics, HIV knowledge, prevention familiarity and prescribing practices for women. Respondents rated their knowledge and familiarity with PrEP/PEP on a 5-point Likert scale. Barriers to prescribing, including gender-related factors were explored using multiple-choice/select-all-that-apply questions.

RESULTS:
149 surveys were initiated with 114 (95.8%) completed and included in the analysis. Most specialized in primary care: 51 NPs (46%) and 34 physicians (30%). 23% (SD: 29%) reported caring for those at high-risk for HIV. In the past year, respondents reported a mean of 45 (SD: 221) patient inquiries about HIV prevention, 50 (SD: 226) counselling instances, and 76 (SD: 409) HIV prophylaxis prescriptions. Respondents felt knowledgeable (rating 4/5) about HIV transmission (74%), risk factors (79%), and medication-based prophylaxis (73%). Despite 78% of respondents indicating familiarity with PrEP (ratings of 3-5), when asked about their willingness to prescribe, 17% reported avoiding prescribing, with 54% prescribing only when asked. The main prescribing barrier was provider knowledge and comfort (59%). Despite 74% of respondents indicating familiarity with PEP (ratings of 3-5), 50% refereed patients elsewhere. Notably, 67% were more likely to discuss HIV prevention with men than women, and 90% felt medical education focused on HIV prevention for women could improve access.

CONCLUSIONS:
Limited provider knowledge remains a key barrier to prescribing HIV prevention for women. Educational interventions and provider-level guidance should address hesitations and knowledge gaps to reduce bias and discomfort.

Background
Cis and trans women face increasing rates of HIV, yet prevention medication uptake remains low. While there is literature on PrEP for women, there is less known about post-exposure interventions. Non-occupational post-exposure prophylaxis (PEP) among women is used after sexual assault but not widely used otherwise. PEP-In-Pocket (PIP) is a self-initiated PEP option for infrequent high-risk exposures and could offer increased autonomy over sexual health; yet community perspectives on PIP and uptake remain understudied.

Methods
Rodgers’ evolutionary concept analysis was used to examine PEP and PIP among women. A systematic search (January 2012-May 2025) of Ovid, Medline, Emcare, and Global Health identified 30 peer-reviewed studies with disaggregated PEP or PIP data for women. Two reviewers screened and extracted data using Covidence. Rodger’s methodology is a flexible, non-linear approach, ideal for examining evolving health concepts using three phases: defining the concept; identifying key attributes, antecedents, and consequences; and interpreting findings to guide future research.

Results
PEP, attributes include reactive use after potential exposure, clinical initiation, and time-sensitive access. PIP was characterized by self-initiation, episodic use, autonomy, and accessibility outside healthcare settings. Shared antecedents include low PrEP uptake, access barriers, and the need for adaptable HIV prevention. PIP-specific antecedents include infrequent but high-risk exposures and a desire for greater individual control, especially for those who cannot /do not engage with healthcare. Consequences of both strategies include reduced HIV acquisition risk and expanded options. Unique to PIP are increased agency, empowerment, and potential to fill critical prevention gaps. Overall, the literature on PIP implementation and awareness was limited.

Conclusions
PEP and PIP are promising HIV prevention strategies that support autonomy and timely access to care but remain underused. This analysis identifies significant gaps in research and implementation, underscoring the need for further investigation to advance equitable, women-centered HIV prevention.

Background: Gay, bisexual, and other men who have sex with men (GBMSM) have experienced a disproportionate burden of the mpox outbreak that started in 2022. GBMSM who meet the eligibility criteria (i.e., sexually transmitted infection [STI] in the past year, have two or more sexual partners, and attend venues for sexual contact, or have anonymous sex) were prioritized for publicly funded mpox vaccination (two-dose series). We identified factors associated with receipt of mpox vaccine among GBMSM living with HIV and receiving HIV care in Ontario.

Methods: Using annual questionnaires (2023-2024) from the Ontario HIV Treatment Network Cohort Study (OCS), we measured self-reported receipt of mpox vaccine. We used a modified Poisson regression to calculate prevalence ratios and 95% confidence intervals adjusted for age, education, and OCS site in the entire sample and a subset who were eligible for publicly funded vaccination.

Results: Of the 1518 GBMSM included in the sample (median age: 58 years; 72% white; 66% born in Canada; 73% in Toronto area), 607 (40.0%) had received ≥1 dose; among one-dose recipients, 330 (54.4%) completed the two-dose series. There was higher receipt of mpox vaccine (≥1 dose) among GBMSM who were born in Canada, received care in Toronto or Ottawa, had CD4 cells count of ≥500 cells/mm3, had higher income, used recreational drugs, were concerned about mpox, had been diagnosed with a STI, had multiple sexual partners, sought sexual partners from sex venues or using dating apps/websites, and had received other vaccines. Findings were similar among the 576 GBMSM who were eligible for publicly funded vaccination although receipt of ≥1 dose was higher (58.9%) than the entire sample.

Discussion: Tailored strategies that address low risk perceptions, promote equitable vaccine access and uptake, and ensure completion of the two-dose series are needed given the ongoing mpox virus transmission in Ontario.

Background: Antiretroviral therapy has transformed HIV infection into a manageable condition, but it cannot eliminate long-lived HIV reservoir cells. While rare HIV cures have been achieved through allogeneic hematopoietic stem cell transplantation for blood cancers, until recently it was believed such cures required donors who are homozygous for the CCR5-delta32 mutation that confers resistance to infection by most HIV strains. However, two recent HIV cures achieved with CCR5-delta32 heterozygous, or wild-type donors have overturned this paradigm, and indicate that transplant-related cures can occur through mechanisms beyond CCR5-mediated resistance. This also raises the possibility that undetected transplant-related HIV cures may have already occurred in Canada.

Objectives: We are establishing CATCH (Canadian Alliance for Transplant-related Cures in HIV), a pan-Canada network of people living with HIV including individuals with transplant experience, community organizations, researchers, clinicians, testing laboratories, and health service providers to monitor and investigate potential HIV cures following allogeneic hematopoietic cell transplantation.

Methods: CATCH has four objectives: (1) to extend existing transplant-related HIV cure research protocols to additional Canadian sites and expand these to recruit people with HIV who previously underwent allogeneic hematopoietic cell transplantation; (2) to engage community and individuals with living experience; (3) to validate a CCR5-delta32 genotyping assay to enable screening of Canadian hematopoietic cell donors, eliminating the current need to seek international donors when CCR5 genotype is sought; and (4) to form an expert panel to develop clinical guidance for pre-transplant assessment and post-transplant monitoring, including treatment interruption criteria.

Progress/Impact: CATCH is a coordinated Canadian response to an exciting new development in transplant-related HIV cure research. CATCH will enhance clinical care for people with HIV undergoing allogeneic hematopoietic cell transplantation, improve Canadian donor utilization through national CCR5 genotyping capacity, and ensure Canada's continued international leadership in HIV cure research. Participants are already being enrolled at four sites.

Introduction: Women living with HIV experience shorter life expectancy and earlier onset of age-related conditions compared with women without HIV, suggesting altered biological aging trajectories. Leukocyte telomere length (LTL), a biomarker of cellular aging that reflects cumulative replicative stress and chronic immune activation, is shorter in people living with HIV. Sex hormones like estradiol play a role in immune regulation and cellular processes, yet their contribution to biological aging in this context remains poorly understood. Examining estradiol’s relationship with LTL may provide insight into aging among women living with HIV.
Methods: We examined biological correlates of LTL among premenopausal women living with (N=116) and without HIV (N=171) enrolled in the BCC3 cohort (Dec 2020-Oct 2025) with estradiol measurements. Multivariable linear regression was used to assess associations between LTL and age, HIV status, estradiol level, and non-HIV chronic/latent viral burden.
Results: Women living with HIV had significantly shorter LTL compared with women without HIV after adjustment for age, estradiol level, and non-HIV chronic/latent viral burden. Older age was independently associated with shorter LTL, whereas current estradiol did not explain LTL differences. Higher non-HIV chronic/latent viral burden showed a trend toward shorter telomere length (R²=0.1774, data found in Table 1).
Conclusions: Ongoing analyses will extend this work by measuring free and bioavailable estradiol, and incorporate composite measures of lifetime estradiol exposure and psychosocial stress and resilience to characterize how hormonal and psychosocial experiences across the life course shape biological aging among women living with and without HIV.

Background: In April 2024, Saskatchewan expanded access to HIV PEP by enabling all authorized prescribers, not just specialized HIV/ARV prescribers, to prescribe HIV PEP. This change supported more timely and widespread PEP initiation in emergency and urgent care clinical settings. To support this change, a provincial HIV PEP continuing medical education (CME) group was created to develop educational and clinical resources to empower prescribers in Saskatchewan to provide HIV PEP.
Method: The HIV PEP education group included 8 clinicians from emergency medicine, infectious diseases, pharmacy, and public health. The group was granted approval by the Saskatchewan Health Authority (SHA) to lead the development of an evidence-based Blood and Body Fluid Exposure (BBFE) order set for use in emergency and urgent care settings. Saskatchewan-specific HIV PEP content was developed for the SHA facilitated Firstline mobile application, including resource links, prescribing guidelines and a risk assessment tool. In October 2025, an online CME course, Prescribing HIV PEP in Saskatchewan, was launched alongside the release of the new BBFE order set. A live webinar was delivered that included an HIV PEP overview and demonstration of the use of the BBFE order set and Firstline app.
Results: Between October 1, 2025, and December 31, 2025: The Firstline HIV PEP content was accessed 377 times. 242 people registered to receive the webinar recording (with 133 attending live). The online course enrolled 145 learners, primarily Saskatchewan-based (86%), with 82% (118/145) front-line health care professionals representing 29 provincial communities. A 100% post-course assessment quiz pass rate (87/87) indicates strong comprehension of essential HIV PEP concepts.
Conclusion: The combined approach of developing continuing medical education and clinical resources was used to increase timely HIV PEP initiation and enhance provider readiness. The uptake of educational and clinical resources is empowering prescribers to increase access to HIV PEP in Saskatchewan.

Background: Gender is a social determinant of health that intersects with other identities and influences health care access. Understanding trends in gender disparities in direct-acting antiviral (DAA) uptake for HCV treatment can inform targeted interventions. We examined gender differences in DAA uptake among HIV-HCV co-infected participants in Canada over time.
Methods: The Canadian Co-Infection Cohort is a prospective, multicentre study following HIV-HCV co-infected participants across 20 centres nationally. All HCV RNA-positive participants were followed from November 2013 (approval of second-generation DAA) until July 2025. The primary outcome was time from eligibility to DAA initiation. We assessed the effect of self-reported gender on DAA uptake using a piecewise exponential proportional hazards model, adjusting for age, ethnicity, and province, and excluding mediators (e.g. injection drug use). Enrollment period was modeled as a categorical variable: pre-pandemic, pandemic, and post-pandemic.
Results: Of 961 eligible participants, 286 (29%) identified as cisgender women; mean age was 45 years; 651/961 (68%) initiated treatment during follow-up. DAA uptake rates among cisgender women were 23.3 (pre-pandemic), 16.4 (pandemic), and 34 (post-pandemic) per 100 person-years in (Table 1). Compared with cisgender MSM, cisgender women had lower uptake pre-pandemic (rate ratio [RR]=0.76; 95%CI: 0.57-1.00) and during the pandemic (RR=0.26; 95%CI: 0.08-0.84), while post-pandemic estimates and comparisons with cisgender men non-MSM were less precise.
Conclusion: Although post-pandemic estimates of treatment uptake and comparisons with cisgender men non-MSM were imprecise, findings suggest that the COVID-19 pandemic may have disproportionately impacted DAA uptake among HIV-HCV co-infected cisgender women compared to cisgender MSM.

Background: HIV care cascades demonstrate progress towards UNAIDS targets but may not fully capture dynamic and long-term outcomes. Using data from the Quebec HIV Cohort (QHC), we examined cascade and longitudinal patterns of care engagement, viral suppression (VS), and loss to follow-up (LTFU) over five years.
Methods: The QHC includes 12939 people receiving HIV care at six clinics across Quebec since early pandemic. We here included individuals with ≥1 HIV viral load (VL) reported in 2017-2023. Cascade variables were defined as: “engaged in care” (≥1VL measurement within a year), “on antiretroviral therapy (ART)” (prescribed ART before/during the year), “VS” (VL <200 copies/mL at last measurement of year). For longitudinal analyses, individuals were assigned mutually exclusive annual statuses: “New patient” (regardless of VL), “VL<200”, “No VL but stable” (no VL that year but VS documented before and after), “VL>200”, “Moved”, “Died”, and “LTFU” if none of previous applied.
Results: A total of 8882 people living with HIV were engaged in care at some point between 2018 and 2023. Among those engaged in care, ART coverage was 98% (95%CI:97-98) in 2018 and 98% (95%CI:98-98) in 2023. Of those on ART, VS was achieved by 97% (95%CI:96-97) in 2018 and 97% (95%CI:97-98) in 2023. Stratified cascade analyses for 2023 showed VS below 95% among individuals aged <30 years; of Indigenous ethnicity; with a lifetime history of injection drug use; and those with vertically acquired HIV. Annually, 242-427 new patients entered the cohort, 5-15% of people with VS in the previous year were LTFU, while 11-22% of those LTFU were re-engaged after a median of 2 years (range 1-5).
Conclusion: High ART coverage and VS were observed using cross sectional cascades, yet longitudinal analyses demonstrated frequent transitions into and out of care. Integrating longitudinal measures provide a more complete understanding of HIV care continuity.

Background: Antiretroviral therapy in pregnancy has reduced rates of vertical HIV transmission, resulting in a growing population of children born HIV-exposed uninfected (CHEU). CHEU experience poorer neurodevelopmental outcomes than their HIV-unexposed peers; the contributing mechanisms are not fully understood. Alterations in fetal brain development may arise from pathological changes to the in-utero environment. We utilized the EcoHIV mouse pregnancy model to explore HIV-associated in-utero changes and effects on the fetal brain. Here we report on chitinase-3-like protein 1 (CHI3L1), a glycoprotein that mediates inflammation, macrophage polarization, and apoptosis, which has been associated with growth and developmental deficits in CHEU.

Methods: 7-week-old C57BL/6 mice were infected with 2.5×10⁶pg EcoHIV virus or mock-infected and mated one week post-infection. Pregnant dams were euthanized on gestational day (GD) 14.5 or 18.5 (N=5/group). HIV gag expression was used to quantify viremia. CHI3L1 protein levels were quantified in fetal brain and placental lysates, and maternal plasma using Luminex assays. Mann-Whitney U test was used to compare between groups. Correlations were assessed using Spearman rank correlation coefficient.

Results: Placental CHI3L1 protein levels were significantly higher in EcoHIV-infected dams vs. controls at GD14.5 and 18.5, while maternal plasma CHI3L1 levels were higher only on GD14.5. Fetal brain CHI3L1 levels were significantly higher at GD14.5 in EcoHIV-exposed fetuses vs. controls. Fetal sex differences in CHI3L1 expression were observed only in the fetal brain in the EcoHIV-exposed group, with levels being higher in female fetuses. We observed an association between fetal brain and maternal plasma CHI3L1 levels in the EcoHIV group at GD14.5.

Conclusions: Our findings support an association between maternal HIV infection and altered CHI3L1 expression in the fetal brain. Associations between maternal plasma and fetal brain CHI3L1 support further investigation on its utility as a perinatal biomarker of neurodevelopmental deficits.

Uptake of HIV pre-exposure prophylaxis (PrEP) among people who use drugs (PWUD) in Canada remains low despite its proven effectiveness. We examined self-perceived risk and objective HIV risk indicators, and how these correlated with PrEP interest among PWUD in Vancouver’s Downtown Eastside (DTES).

PWUD aged 19 and older recruited from 6 DTES primary care and addiction clinics completed questionnaires assessing drug use patterns, self-reported HIV risk (high/low), self-reported HIV risk status as a barrier to start PrEP, and PrEP acceptability. We considered scoring >45 on a modified ARCH-IDU scale (omitting points for use of “shooting galleries”) to be an objective indication for PrEP. Among participants found to be objectively eligible for PrEP, demographic characteristics, drug use patterns, and willingness to use PrEP were compared by whether participants reported low self-perceived HIV risk as a barrier to PrEP.

Of 293 participants indicating past-6-month drug use, 83% self-identified their risk as low, while 42% actually met substance use criteria indicating PrEP eligibility. Among participants with objective indicators for PrEP (n=124), 52% reported low self-perceived HIV risk as a reason not to start PrEP. Within these participants with objective HIV risk, those who perceived themselves as low risk were significantly less willing to take PrEP compared to those who perceived themselves at higher risk (61.5% vs 86.4%, p=0.002).

Risk perceptions among PWUD did not correlate with objective HIV risk, and self-perceived lower risk was associated with lower PrEP interest. Tailored public outreach efforts on risk indications may improve PrEP uptake in this population.

Purpose: People with HIV (PWH) who require complex ART regimens due to resistance, intolerance, or drug–drug interactions may benefit from regimen optimization. ARTISTRY-1 is evaluating switching from complex regimens (CRs) to a BIC/LEN STR, with the aim of optimizing treatment for PWH who are virologically suppressed (VS) on CR. Here, we describe baseline demographics and clinical characteristics of this Phase 3 population with an unmet clinical need.
Methods: ARTISTRY-1 (NCT05502341) is an ongoing, randomized, open-label, global, multicenter Phase 2/3 study. In Phase 3, participants who were VS on CR (≥6 months prior to screening) were randomized 2:1 to switch to an STR of BIC/LEN (75/50 mg) or continue their CR. The primary endpoint is HIV-1 RNA ≥50 copies/mL (FDA Snapshot) at Week 48.
Results: In Phase 3, 557 participants were enrolled and treated. At baseline, median age was 60 years; >66% had at least one comorbidity; median HIV treatment duration was 28 years; many had extensive treatment experience and multi-class resistance as evident by the diversity of baseline CRs shown in the Figure. Median (range) number of pills per day was 3 (2–11); 39% of participants had a twice-daily dosing frequency.
Conclusion: At baseline, ARTISTRY-1 Phase 3 participants who were VS on CR were predominantly aged >50 years, with a high rate of comorbidities, extensive HIV treatment experience, multi-class resistance, and high pill burden; nearly three-quarters were on a PI-containing regimen. This population could benefit from treatment optimization by switching to a BIC/LEN STR.

Background: People who use drugs (PWUD) face stigma, discrimination, and prolonged wait times in healthcare. In Saskatchewan, First Nations and Métis peoples are disproportionately impacted by HIV and other STBBIs, reflecting colonial legacies, systemic racism, and inequitable access to care. Saskatchewan reports one of the highest incidences of HIV in Canada, with high rates of syphilis and hepatitis C. The healthcare barriers experienced by PWUD- particularly Indigenous PWUD—remain under-documented. Peer-led qualitative research interviews explored barriers and facilitators to HIV and STBBI care following harm reduction pop-up testing events.

Methods: Since June 2025, peer-led pop-up events provided point-of-care testing for HIV, syphilis, and hepatitis C, with safer drug use and safer sex education. Quota sampling was used to recruit PWUD for semi-structured interviews a week later. 12 interviews have been completed. Trained peer researchers with lived experience, including Indigenous peers, co-developed and conducted interviews on healthcare access, drug use, and experiences navigating healthcare. Interpretive phenomenology was applied to explore lifeworld’s of drug use, determinants of harm, and meaning-making around healthcare access. Cultural safety principles guided peer training and data collection, with emphasis on Indigenous accountability.

Results: Participants consistently reported long emergency department wait times, often leaving without care. Many reported stigma related to drug use, while Indigenous participants reported racism. Housing instability further limited access to scheduled appointments. Participants frequently reported using drugs alone in concealed spaces due to fear of stigma and judgment. Needle exchange programs were described as safe, welcoming environments where trusted staff and peers fostered dignity, sense of belonging, and engagement in care.

Conclusion: Peer-led, community-based harm reduction approaches build trust and reduce barriers to HIV and STBBI care for PWUD. Findings underscore the importance of culturally safe, community-driven, and Indigenous-led models that integrate testing, education, and care within low-barrier settings to address persistent health inequities.

Background
In an open-label, phase 3, randomized clinical study in virologically suppressed adults with HIV-1, switching to doravirine with islatravir (DOR/ISL 100/0.25 mg) once-daily showed non-inferior efficacy to continuing oral antiretroviral therapy at Week 48 (W48). We report on efficacy and safety through Week 96 (W96).
Methods
After W48 of the comparative portion of the study, all participants receive open-label DOR/ISL (100/0.25 mg) through Week 144. Discontinuation is required for participants with 2 consecutive HIV-1 RNA≥200 copies/mL 3-5 weeks apart or confirmed decline from baseline in total lymphocytes.
Results
On Day 1, 366 participants switched to DOR/ISL (Group 1) and 185 continued their baseline ART (bART; Group 2). At W48, 177 participants (95.7%) in Group 2 switched from bART to DOR/ISL, for a total of 543 on DOR/ISL. At W96, HIV-1 RNA was ≥50 copies/mL in 9 participants: 7 (1.9%) from Group 1 and two (1.1%) from Group 2, while virologic suppression was maintained in 92.6% and 96.6%, respectively. No participant developed treatment-emergent resistance to either DOR or ISL through W96. Adverse event rates in Group 2 (W48-96) were similar to those in Group 1 (W0-48). Mean % change in CD4+ T-cell and total lymphocyte counts were comparable across the groups at W96, with no discontinuations due to decreased CD4+ T-cell or total lymphocyte count.
Conclusions
Switching to DOR/ISL (100/0.25 mg) maintained a high rate of viral suppression over 96 weeks with no emergent resistance to DOR or ISL. DOR/ISL was well tolerated and did not adversely affect lymphocyte counts.

Background:
Persistent inflammation in people with HIV (PWH) despite effective antiretroviral therapy (ART) contributes to increased risk of non-AIDS comorbidities. Co-infection with cytomegalovirus (CMV) exacerbates inflammation and contributes to HIV persistence. We conducted a randomized controlled trial to evaluate whether 14 weeks of treatment with letermovir, a CMV-terminase inhibitor, could reduce inflammation and HIV reservoir markers in CMV-seropositive ART-treated PWH.
Methods:
Thirty-three CMV-seropositive PWH on ART for ≥3 years were randomized: 21 received letermovir daily for 14 weeks in addition to their ART; 12 continued ART alone. Plasma and PBMCs were collected at baseline, during, and after treatment. We used conventional assays to quantify plasma inflammatory markers, humoral and cellular anti-CMV responses, and HIV DNA and RNA.
Results:
Participants had a median age of 53 and had been living with HIV for a median of 20 years. 32/33 were male. Median CD4 count was 742 cells/μL and CD4/CD8 was 1.1. Letermovir was well tolerated. CD4 counts increased slightly in the letermovir group (+15 cells/μL) and decreased in controls (–14 cells/μL). Plasma LPS levels, a biomarker of gut permeability, declined in the letermovir group (–9.2 pg/mL) and rose in controls (+4.5 pg/mL), without reaching statistical significance (p=0.31). Markers of inflammation (sTNFRII, sIL6R, cytokines) remained unchanged. Anti-CMV IgG levels and frequency of CMV-specific IFN-γ producing CD4 T-cells significantly decreased in the letermovir group (p=0.02 and 0.03) but not in the control arm, and anti-CMV IgG rebounded 12 weeks post-treatment. HIV DNA levels remained stable in both groups. However, participants receiving letermovir displayed a 39% reduction in cell-associated HIV RNA relative to baseline (p=0.046), indicating reduction of HIV transcription.
Conclusions:
Letermovir was safe, reduced CMV-specific IgG and T-cell levels, and HIV transcriptional activity, supporting CMV inhibition as a potential strategy to modulate immune activation and HIV persistence in ART-treated PWH.

Background: The penile urethra is a primary site of HIV acquisition in males, but little is known about urethral determinants of HIV acquisition. Inflammation at other genital sites enhances risk, and studies in adults suggest that some inflammatory bacteria may be acquired from the vagina of female sexual partners. Here, we characterize the impact of sexual debut on the microbiome and immune milieu of the penile urethra in adolescent males from Uganda.

Methods: A cohort of 185 sexually naïve adolescent males were enrolled in a 3-year longitudinal study in Rakai, Uganda with follow-up every 3 months, and urethral swabs collected annually. Urethral levels of 9 soluble immune factors (IL-1α, IL-1β, IL-8, MIP-1β, sEcad, resistin, TIMP-1, VEGF, and MMP-9) were quantified by chemiluminescent multiplex immunoassay, and 16S rRNA sequencing was performed to characterize the urethral microbiome. Unsupervised clustering and mixed-effects models were used to evaluate the impact of sexual debut on the urethral microbiome and immune milieu.

Results: Median participant age at enrollment was 16 years, and during the follow-up period 80/185 (43%) reported penile-vaginal sexual debut. Although the urethral microbiome was highly diverse, at 36 months unsupervised clustering identified two distinct Community State Types (CSTs): CST-1 was dominated by Streptococcus mitis/oralis and CST-2 by BV-associated bacteria (Gardnerella vaginalis, Sneathia spp. and Fannyhessea vaginae). CST-2 was greatly enriched at 36 months compared to baseline and was strongly associated with prior sexual debut (LR= 6, p=0.01). Bacterial species enriched in CST-2 were significantly associated with both sexual debut and urethral inflammation, independent of serum testosterone and circumcision status.

Conclusion: Sexual debut resulted in colonization of the penile urethra by BV-associated bacteria. This may have adverse effects on male reproductive health by inducing urethral inflammation and may serve as a reservoir for reintroduction of BV-associated bacteria into the vagina of female sexual partners.

Objective
In Canada, approximately half of patients aged ≥40 years seen in primary care have dyslipidemia. Women living with HIV have a higher risk of both dyslipidemia and cardiovascular disease than women without HIV. Hence, it is important women be aware of their lipid levels. Here, we assessed accuracy of self-reported lipid status among women living with and without HIV.

Methods
We conducted a cross‐sectional analysis of 604 nonpregnant female participants ≥16 years of age (275 women living with HIV and 329 women without HIV) in BC and enrolled in the BCC3 study between December 2020-2024. Clinical designation of dyslipidemia was positive if participants a) were taking lipid medication, or b) had dyslipidemia based upon interpretation of clinical lipid values according to current Canadian guidelines. Self-report lipid status was extracted from answers to the study question “Has a doctor ever told you that you have high cholesterol?” Univariate analysis used Wilcoxon rank-sum and Chi-square tests for continuous and categorical variables, respectively. Multivariable logistic regression included variables with p<0.2 univariably to estimate an adjusted odds ratio (AOR).

Results
In this cohort, 141/604 women self-reported having dyslipidemia, while 271/604 had dyslipidemia according to laboratory measures. 68.9% of participants self-reported lipid status accurately. Younger participants (AOR: 1.16 (1.01-1.33) per year of age, p=0.004, those with lower body mass index (BMI) (AOR: 1.06 (1.03-1.08), p<0.001), and African/Caribbean/Black women (AOR: 2.34 (1.15-4.97), p=0.03) were more likely to accurately report lipid status. HIV status was not associated with accuracy of self-report.

Conclusion
Results from this cohort suggest that a majority of women knew their lipid status independent of HIV status. However, efforts are needed to improve awareness, particularly among older women with high BMI.

Introduction: Transitions between primary and specialist care are critical for older adults living with HIV, who manage both age-related comorbidities and HIV over long, often complex care trajectories. This study examined how older adults living with HIV navigate transitions between primary and specialist care, identified barriers and facilitators to coordinated care, and co-developed patient journey maps to inform improvements in care delivery.
Methods: We conducted a qualitative study informed by constructivist epistemology and process journey mapping. Data were collected in Toronto, Ontario, between January and April 2025 through four staged, facilitated focus groups involving 55 older adults living with HIV (aged 50 years and older), four family caregivers, and 30 healthcare providers across primary care, HIV specialty care, and allied health. Sessions were segmented by stakeholder group and used a semi-structured guide to co-construct visual maps of care experiences. Data were analyzed using qualitative content analysis, with iterative theme refinement and validation through member checking.
Results: Participants described fragmented, non-linear care journeys characterized by repeated referrals, disengagement, and re-entry into care. Five overlapping phases were identified: (1) referral from primary care, (2) initiation of specialist care and co-management, (3) shared care and transition to age-focused services, (4) system navigation and self-advocacy, and (5) re-referrals and provider switching. Experiences were shaped by provider communication gaps, lack of structured pathways, and reliance on sustained self-advocacy. While some participants benefited from stable, affirming care relationships, others, particularly those who were racialized, 2SLGBTQ+, living in rural settings, or facing socioeconomic barriers, experienced delays, stigma, and disengagement.
Conclusions: Transitions for older adults living with HIV are rarely linear or well coordinated and often depend on individual provider practices and patients’ capacity to self-advocate. Strengthening transitions will require investment in coordinated care models, culturally responsive provider training, and sustained support for peer and community networks.
 

Background
Material deprivation (MD) is linked with poorer HIV clinical outcomes. In Canada, migrants with HIV (MWH) represent a growing population, yet the extent and implications of MD in this group remain underexplored. This study examined the prevalence and nature of MD at Week 4 of antiretroviral therapy (ART) initiation and its sociodemographic and clinical correlates.

Methods
A sub-study analysis was conducted using data from 56 ART-naïve migrants enrolled in the Antiretroviral Speed Access Program (ASAP), a rapid ART cohort at the McGill University Health Centre, Montréal, Canada. MD was measured using a 17-item index, with deprivation defined as reporting ≥2 items. Analyses included Fisher’s exact test, Wilcoxon signed-rank test, McNemar’s exact test, and correlation coefficients.

Results
At Week 4, 48/56 participants (85.7%) reported MD, most commonly difficulty covering unexpected expenses (49/56, 87.5%), affording dental care (41/56, 73.2%), or buying small gifts (41/56, 73.2%). MD was significantly associated with occupation (p = 0.027), with higher prevalence among employed (7/7, 100%) and unemployed (36/40, 90%) participants compared with foreign students (2/5, 40%). MD was also associated with immigration stream (p = 0.016), being more frequent among asylum seekers (33/36, 91.7%) and visitors (11/12, 91.7%) than foreign students (3/7, 42.9%). No statistically significant associations were observed between MD and HIV clinical outcomes, although descriptive trends suggested longer times to ART initiation (mean: 19.3 vs. 5.5 days) and viral suppression (mean: 60.8 vs. 45 days) among deprived participants. MD scores declined significantly by Week 48 (median: 7.5 to 4.0; p < 0.001), although 67.9% (38/56) remained deprived. Significant improvements were observed in five MD items spanning financial, social, and nutritional domains (p < 0.05).

Conclusion
MD was highly prevalent and persistent among MWH initiating ART. Although MD improved over time, its continued burden underscores the need to address material needs alongside HIV care.

Background: We are creating a core outcome set of patient-reported outcome (PRO) measures for use in HIV care. Phase 1 involves outcome selection through a 2-round Delphi with two expert panels: people with HIV and healthcare/social service providers.
Objective: To describe outcomes reaching consensus in both panels at Round 1 and evaluate differences in panel ratings of outcomes attaining consensus in at least one panel.
Methods: Between August 2024-July 2025, adults with HIV and providers recruited in Montreal completed an online survey. They evaluated the importance of 14 broad outcome domains and 72 specific outcomes for a hypothetical annual patient questionnaire for HIV care. Panelists rated each from 1 to 3 (1=Not important enough;2=Important but not critical;3=Critical). ‘Core’ outcomes needed to meet these consensus criteria: >70% responding 3 and <15% responding 1, in each panel. Differences in rating distributions between panels were evaluated with Chi-square or Fisher’s exact tests, as appropriate.
Results: Round 1 included 45 people with HIV and 36 providers. Overall, 7/14 outcome domains and 9/72 specific health outcomes qualified as ‘core’ (see Table 1, in bold). Twenty other outcomes unequally reached consensus (10 per panel). For a few outcomes (n=6), importance score distributions differed significantly.
Conclusion: Both panels agreed on a set of PROs that matter most for HIV care follow-up. However, people with HIV alone reached consensus on more mental health, stigma, self-management and quality of life outcomes, while providers did so on more outcomes tied to substance use, symptoms, physical health, and socioeconomic issues.

Background
We developed a 7-item PROM, the I(Interference)-Score, to screen for barriers to HIV medication adherence within seven domains (i.e. habits/activities, thoughts/feelings, social situation, economic situation, medication, care, and health) and report on its feasibility for use in HIV care.
Methods
We conducted a 6-month mixed-method pilot study (CTNPT039) administering the I-Score at three-month intervals via a patient portal at the McGill University Health Centre (Montreal, Quebec). We report its qualitative results. Semi-structured, audio-recorded interviews held with participating people living with HIV (PWH) and physicians underwent content analysis, drawing on the updated Consolidated Framework for Implementation Research, to understand participant experiences.
Results
Twenty-five PWH (40% women, 48% African) and 4 physicians were interviewed (June 8, 2022-October 9, 2025) at 3-months and/or 6-months. Individual interviews with PWH lasted 19 minutes, on average. The three provider group interviews lasted 47-57 minutes. On the I-Score’s relative advantages, participants reported that it: “Helps the doctor,” “Gives the doctor advance knowledge of their patient,” “Eases the sharing of sensitive information”, “Fosters greater patient awareness”, “Introduces broader issues”, “Accounts for change”, and “Spurs conversations.” However, for some participants, it had “Little to no impact on care.” Regarding the I-Score’s complexity, participants remarked that it was “Easy” and “Quick to complete” but some noted it “Takes practice.” Concerning the I-Score’s design, participants found the I-Score questions “Acceptable” but, also “Hard to understand,” and that it “Provides limited information” (e.g., given its sole focus on adherence). In terms of need, participants expressed polarized views on the I-Score’s relevance (e.g., dependent on patients’ level of experience living with HIV, personal struggles with adherence).
Conclusion
Findings suggest overall feasibility and numerous potential benefits of I-Score use, notably, for patient-provider communication. Its lack of perceived impact, relevance and information, for some participants, is consistent with the variable nature of adherence problems.

Background: The NNRTI doravirine (DOR) and the investigational nucleoside reverse transcriptase translocation inhibitor (NRTTI) islatravir (ISL) have complementary mechanisms of action and resistance profiles. Primary analysis of the MK8591A-052 study in people living with HIV-1 (PLWH) demonstrated that switching to DOR/ISL 100 mg/0.25 mg was noninferior to continuing bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in maintaining virologic suppression at Week (W) 48. Here we present W96 efficacy and safety data from this study.

Methods: Phase 3, double-blind clinical trial (NCT05630755) in adults with HIV-1 RNA <50 copies/mL for ³3 months on BIC/FTC/TAF, CD4+ T-cell count ≥50 cells/mm3, and no prior therapy failure or known DOR resistance. Participants were randomized 2:1 to switch to DOR/ISL (100/0.25 mg) or continue BIC/FTC/TAF. Discontinuation was required for confirmed decline in total lymphocytes (≥30% and <1.0 x109/L) or CD4+ T-cells (≥30% and either <350 cells/mm3 if ≥350 at baseline or <200 cells/mm3 if ≤349 at baseline). The proportion of participants with HIV-1 RNA ≥50 copies/mL (FDA snapshot) at W96 was a secondary endpoint. Other virologic outcomes (HIV-1 RNA <50 and <200 copies/mL), safety, and tolerability through W96 were also assessed.

Results: Week 96 efficacy and safety results will be presented.

Conclusions: DOR/ISL (100/0.25 mg) had similar efficacy and a comparable AE profile to BIC/FTC/TAF at W96. These findings are consistent with the study’s primary W48 results.

Background: Doravirine/islatravir [DOR/ISL (100/0.25mg)] is an investigational once-daily single tablet regimen of DOR, abeing evaluated in Phase 3 studies in adults living with HIV-1. Participants with HIV-1 RNA <50 copies/mL and no known treatment failure or documented DOR resistance were randomized to switch to DOR/ISL (100/0.25mg) once-daily or to continue baseline antiretroviral therapy in P051 or BIC/FTC/TAF in P052. In P054, participants who previously received DOR/ISL (100/0.75mg) were switched to DOR/ISL (100/0.25mg) in a single-arm study. This analysis examined the prevalence and impact of preexisting resistance-associated mutations (RAMs) at baseline in proviral DNA on virologic outcomes among participants who received DOR/ISL through Week 48.
Methods: Preexisting RAMs present in proviral DNA were identified retrospectively using the GenoSure Archive assay (Monogram Biosciences). The impact of NNRTI RAMs and M184I/V was evaluated in participants with HIV-1 RNA ≥50 copies/mL at any time through Week 48.
Results: Of the 1227 participants with baseline resistance data who received DOR/ISL, 6 (0.5%), 23 (1.9%), and 71 (5.8%) met the criteria for DISC, LLV, or TV, respectively (Table 1). Among participants who received DOR/ISL, 26.3% had preexisting NNRTI RAMs and 5.7% had preexisting M184I/V. The percentage of participants in each category was similar between all participants and those with NNRTI RAMs or M184I/V.
Conclusions: Preexisting NNRTI RAMs or M184I/V did not impact virologic suppression through Week 48 in participants switching to DOR/ISL (100/0.25mg) in Phase 3 clinical studies.

Table 1: Virologic Outcomes in Participants with Preexisting NNRTI RAMs or M184I/V

Background;

African , Caribbean, and black (ACB) women in Ontario , particularly Toronto , are disproportionately affected by HIV. Although ACB communities represent less than 5% of Ontario's population, they accounted for 25% of new HIV diagnoses in 2015 . Despite advances in antiretroviral therapy( ART) , systemic barriers such as stigma, racism ,immigration challenges, and socioeconomic exclusion continue to limit equitable access to HIV care and treatment.

Methods:

A mixed- methods study was conducted in Toronto between 2022-2024
Quantitative : Surveys of n=250 ACB women living with HIV measured ART uptake viral suppression , and healthcare access.
Qualitative : In- depth interviews with n= 40 participants explored stigma , disclosure, and lived experiences in healthcare.
Data were analyzed using descriptive statistics and thematic analysis.

Results:

ART Uptake: 21/250 women (84%) reported current ART use
Viral Suppression : 175/250(70%) achieved viral suppression (,<200 copies/ml).
Barriers to Care:
60% reported HIV -related stigma
45% experienced racism in healthcare settings
30% faced economic barriers ( housing instability, unemployment ).
Disclosure & support: Only 40% felt comfortable disclosing HIV status to family/friends. Peer-based support programs improved care engagement by 25% .
Healthcare Access : 35% reported delay in seeing HIV specialists; 20% missed appointments due to childcare or transportation challenges.

Conclusions:

ACB women in Toronto demonstrate high ART uptake (84%) but lower viral suppression rate(70%) compared to provincial average, Persistent barriers - stigma , racism, and socioeconomic exclusion -limit optimal HIV care outcomes . Community-based, culturally tailored Interventions and peer support models significantly, improve engagement and adherence . Addressing structural inequities is essential to achieving equitable HIV care and treatment for ACB women in Ontario.

Background: Post-Exposure Prophylaxis (PEP) provides critical HIV prevention for individuals at risk, particularly when PrEP adherence or persistence is suboptimal. Examining PEP use can identify gaps in ongoing PrEP engagement.
Methods: We conducted a retrospective chart review of PEP requests among 3,239 individuals who had previously been initiated on PrEP at a Canadian community-based sexual health clinic between 2022 and 2025. Prescription patterns and PrEP adherence or persistence among PEP recipients were assessed. Adherence was defined as obtaining all PrEP refills within a ±14-day window of the expected date, and persistence was defined as continuous engagement in care without a ≥6-month lapse or documented discontinuation.
Results: During the study period, 100 PEP requests were documented. Of these, 48 received a PEP prescription, and 41 of those individuals who received a PEP prescription were categorized as either non-adherent to PrEP or non-persistent. No HIV seroconversions were documented among any of the individuals requesting PEP.
Conclusion: PEP use among individuals prescribed PrEP highlights adherence and persistence gaps. These findings underscore the need for improved PrEP engagement strategies, tailored adherence support, and proactive follow-up care to maximize HIV prevention in community-based settings.

Background: As people living with HIV (PLWH) live longer, aging-related needs increasingly intersect with continuing care (CC) needs, including home care and long-term care. Yet, little is known about older PLWH perspectives and knowledge of these services. Using a qualitative approach, we explored older PLWH perspectives and knowledge of CC services in Alberta to highlight what matters most and opportunities for improvement.

Design: We used purposive sampling to recruit 22 PLWH aged 50 or older who receive care at Southern Alberta Clinic in Calgary, Canada, and completed semi-structured interviews. Interview data were analyzed thematically using a framework approach guided by the 2024 Alberta Quality Matrix for Health (accessibility, acceptability, appropriateness, effectiveness, safety, efficiency) to map participants’ priorities and experiences.

Setting: Southern Alberta Clinic (SAC), Calgary, Alberta, Canada

Participants: A cohort of PLWH ≥50 years, receiving comprehensive HIV-care at SAC.

Results: Accessibility was the strongest priority. Participants described wait times, complex care pathways and cultural barriers as key factors influencing awareness of CC resources and whether CC felt feasible to use. Acceptability was also important; participants wanted care that was respectful, meaningful, and tailored to their needs and preferences. Safety was raised often, including concerns about confidentiality and privacy, the risk of unintended disclosure of their HIV diagnosis within the community, and trust in clinical care. Many participants described knowledge gaps around CC, such as who qualifies, and how to start the process. Efficiency was mentioned less often and was not a main driver of perceived quality.

Discussion/Conclusions: Older PLWH identified clear targets for improving continuing care: timely and in close proximity services, individualized and stigma-free care, and strong protections for privacy and confidentiality. Clearer information and navigation support may help address knowledge gaps and improve access. These patient perspectives should guide CC planning for PLWH.

Objective: To assess the feasibility of implementation of an online community-based exercise (CBE) intervention in Toronto, Ontario.
Methods: We conducted an observational longitudinal study with adults living with HIV engaged in a six-month tele-coaching CBE intervention (biweekly exercise supervised online by a personal trainer, weekly group online exercise classes, monthly educational sessions, and e-learning modules). Participants were asked to wear a physical activity monitor (Fitbit) throughout. We administered a web-based questionnaire at month 2 and 6 to assess feasibility operationalized as: ease of use (7 items) and helpfulness (6 items) for components of the intervention [personal training sessions, group exercise classes, monthly educational sessions (all via Zoom); Fitbit; YMCA Virtuagym website; Sweat for Good App; self-directed e-learning modules], reliability of the technology (technology interruptions, need to reboot (2 items)), and satisfaction (10-item Telehealth Satisfaction Scale (TeSS)). We calculated frequencies and percentages for each item, and median (25th, 75th percentiles) of the TeSS (range: 10-40; higher scores indicating higher satisfaction).
Results: Of the 32 participants (70% men, median age 51.5 years) who initiated the intervention, 30 completed a questionnaire at month 2 or 6. Intervention components were rated as ‘easy or very easy to use’ by 35-96% of participants (for the Virtuagym website and monthly educational sessions, respectively), and ‘helpful or very helpful’ by 50-96% of participants (e-learning modules and Zoom, respectively). Most participants (50-79%) reported no interruptions or need to reboot technology. Median satisfaction (TeSS) scores were 38/40 (32, 40; month 2) and 37/40 (34, 40; month 6).
Conclusion: The online CBE intervention appears feasible for implementation among this sample of adults living with HIV. Personal training and group educational sessions (via Zoom), and the Fitbit were considered easiest to use and most helpful among participants. Results can inform ways to tailor online CBE interventions with adults living with HIV.

Background:
African, Caribbean & Black (ACB) women remain underrepresented in HIV care and support programs. For those navigating menopause and immigration, intersecting stigmas further limit access and engagement.
Methods:
Community dialogues with ACB women and service providers were analyzed using an intersectional HIV stigma and equity framework.
Results:
Key barriers include persistent HIV stigma and fear of disclosure; lack of culturally informed menopause support contributing to medical mistrust; and immigration-related stressors such as precarious status, financial pressures, and limited social networks.
Conclusion:
ACB women’s low uptake reflects structural and stigma-driven inequities, not disengagement. Improving access requires confidential, culturally grounded, and immigration-responsive HIV and menopause supports.
Keywords: HIV stigma; African

Background: Migrants with HIV arriving in Canada could benefit from rapidly changing antiretroviral therapy (ART) regimens when their medical history is uncertain, but little is known about their experiences and outcomes during this transition or how they vary by subgroup. Among migrants rapidly switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), we evaluated how sociodemographic variables were linked to psychosocial characteristics and adherence over time. 

Methods: The ASAP-Switch cohort includes newly referred ART-experienced recent migrants with HIV at two Montreal, Canada sites (McGill University Health Centre and Clinique L’Actuel), who were prescribed a free, on-site, rapid switch to B/F/TAF. Patient-reported measures (PRMs) were collected over 24 weeks (3 timepoints), including treatment change readiness, self-management confidence (SMC-MMT), psychological distress (K6), stigma (IA-RSS), social support (MOS-SSS), health worries (PoZQoL), ART adherence barriers (I-Score), and 30-day adherence. Descriptive analyses were performed. Linear mixed models examined PRMs over time and sociodemographic variables (age, gender, sexual orientation, and birth country).

Results: Forty participants completed a 24-week follow-up, including 29 (73%) people from Africa, 15 (38%) women, and 9 (22%) men who have sex with men. Mean age was 41 years (SD=10.4). At baseline, results suggest participants experienced importance and confidence to change to B/F/TAF (mean=9.3/10), self-management confidence (17.6/20), low distress (12.2/30), moderate stigma (3.0/6), some social support (59.0/100), and moderate health worries (3.4/5). After 4 weeks, participants reported limited perceived barriers to adherence (0.8-2.4/7) and high ART adherence (97.5/100). Over time, health worries (p=0.043), psychological distress (p<0.001), and adherence barriers tied to medication concerns (p=0.05) decreased significantly. Sociodemographic characteristics were not associated with PRMs.

Conclusion: Migrants rapidly switching to B/F/TAF showed several favourable psychosocial experiences and outcomes, including self-reported adherence, all unrelated to sociodemographic factors. However, health worries, as well as persistent stigma and limited social support, underscore the relevance of routine psychosocial support in HIV care.

Background: Timely progression through the HIV care continuum, from diagnosis to viral suppression, improves health outcomes and prevents transmission. This study describes care continuum and clinical characteristics among newly registered patients at the Chronic Viral Illness Service (CVIS), McGill University Health Centre (MUHC) in Montreal.
Methods: This retrospective cohort study used electronic medical records of adults (n=682) newly enrolled at the CVIS, MUHC, between 2022 and 2024. Information collected at first visit included sociodemographic and clinical data: diagnosis status, viral load (VL) and CD4 counts. Median time (days) and interquartile ranges (IQR) were calculated between continuum milestones, stratified by diagnosis type (new or previous).
Results: Of the 682 patients, 34% were women (n=232/682) and median age was 37.7 years old. Most were migrants (96%, n=652/682). 40% (n=274/682) had a new HIV diagnosis. Of those newly diagnosed, most (85%, n=234/274) had a detectable VL, with 28% (n=65/234) having a VL > 100 000 copies/mL; half (n=137/274) had CD4 counts ≤350 cells/mm³. For those previously diagnosed, majority had undetectable VL (80%, n=326/408) and CD4 counts >350 cells/mm³ (75%, n=308/410).
Timelines differed by diagnosis status (Table 1). Newly diagnosed patients had longer median intervals from entry into Canada to viral suppression than those previously diagnosed, though both groups initiated ARV rapidly once seen by a physician.
Conclusions: 96% of all newly enrolled patients were migrants. Delays in the HIV care continuum were more pronounced before linkage to care and between ARV prescription and viral suppression, highlighting key opportunities to improve timely engagement.

Objectives: Our aim was to describe experiences with technology uptake and usage among adults living with HIV participating in a six-month online community-based exercise (CBE) intervention.

Methods: We conducted a longitudinal qualitative descriptive study using interview data from adults aging with HIV in Toronto, Canada. Participants engaged in a six-month online CBE intervention in partnership with the YMCA, consisting of thrice weekly exercise, supervised biweekly with online personal coaching sessions, weekly group exercise classes, and monthly self-management education sessions (via Zoom©). Technology included Zoom© software and webcam; Sweat for Good YMCA App© and YMCA Virtuagym Website©; and participants wore a wireless physical activity monitor (Fitbit Inspire 2©) throughout. Participants completed interviews at baseline and post-intervention. We conducted a group-based content analysis of interview transcripts, focusing on digital access, setup, usage, and perceptions of technology. Questionnaire data describing digital literacy and access to technology provided additional context to the interview data.
Results: Eleven participants completed at least one interview (six women, five men; median age 52 years). Experiences with technology uptake and usage among adults aging with HIV were characterized by four components: i) preparations for technology; ii) interactions with technology; iii) facilitators and satisfaction with technology; and iv) challenges and frustrations with technology, that interacted with intrinsic contextual factors (prior exposure with technology) and extrinsic contextual factors (COVID-19 pandemic, technological and social support).

Conclusion: Experiences with technology among adults aging with HIV engaging in an online CBE intervention varied from increasing ease of use, to increasingly burdensome over time. Results highlight the need to incorporate personal preferences, and ongoing technological support when implementing online CBE intervention with adults aging with HIV.

Objective:To examine changes in disability among adults with HIV engaged in an online community-based exercise (CBE) intervention in Toronto, Canada.

Methods:We conducted a 12-month study with adults with HIV involving two phases: 1) Intervention: participants were asked to exercise 3 times/week, supervised biweekly with online personal coaching, and monthly online educational sessions(6-months), and 2) Follow-Up: participants were asked to continue exercising thrice weekly, independently(6-months). We measured disability bimonthly using the Episodic Disability Questionnaire(EDQ) which includes six domains: physical, cognitive, and mental-emotional symptoms; difficulties with day-to-day activities; uncertainty about future health; challenges to social inclusion. Higher scores (range:0-100) indicate greater presence, severity and episodic nature (within past week) of disability. We conducted a mixed-effects segmented regression analysis to assess changes between and within phases.

Results:Of 32 participants who initiated (69% males, median age:53 years), 22(69%) completed the intervention; and 18(56%) completed the study. Participants attended median 10/13(77%) coaching sessions. Highest EDQ scores at baseline were in the uncertainty domain for severity (34.1) and presence (64.5), and mental-emotional domain for episodic nature(27.5). At the end of the intervention, there was a significant mean decrease in EDQ uncertainty scores for severity (-5.2 points; 95%Confidence Interval(CI):-9.3,-1.0); increase in physical scores for severity (4.2; 95%CI:0.5,7.9) and episodic nature (10.3; 95%CI:0.2,20.5); and social scores for episodic (8.4; 95%CI:1.9,14.8). At the end of follow-up, there was a significant decrease (improvement) in the EDQ mental-emotional episodic scale (-14.9; 95%CI:-29.3,-0.4). During follow-up, there was an improvement for physical symptoms and reduction in benefits with uncertainty. There were no changes in EDQ presence scores.

Conclusion:Participants demonstrated an increase in severity of physical symptoms and improvement with uncertainty about future health during the online CBE intervention phase, which were diminished during follow-up. Future work should examine the clinical importance of disability changes and influence of contextual factors among persons with HIV.

Purpose:To examine the effectiveness of progressive resistance exercise (PRE) on immunological, virological, body composition, strength, cardiorespiratory, flexibility, and quality of life (QOL) outcomes in adults living with HIV.

Methods:We conducted an update of a systematic review using the Cochrane Collaboration protocol. We searched databases up to January 2021. We included randomized controlled trials comparing resistance exercise with no exercise or another intervention performed at least 3 times per week for at least 4 weeks among adults living with HIV. Two reviewers independently determined study eligibility. Data were extracted from studies that met inclusion criteria using standardized forms. We assessed risk of bias using Cochrane risk of bias assessment. Meta-analyses were conducted using random-effects models with Review Manger (RevMan) computer software.

Results:Forty-one (41) studies met inclusion criteria (20 from previous review; 21 from this update). There were 1,622 participants at study completion; the majority were men (57%), and the majority of studies (80%) included participants taking antiretroviral therapy (33/41 studies). Exercise interventions included PRE alone (15 studies) and/or a combination of PRE and aerobic exercise (27 studies), ranging from 6 to 52 weeks. Eighty-seven (87) meta-analyses were performed, 68 (78%) of which were new or updated for this review. Main results indicated statistically significant improvements in selected outcomes of body composition (lean body mass, body fat percent), strength (bench press, chest press, lateral pull down, quadriceps) and cardiopulmonary status (maximum oxygen consumption: combined aerobic and PRE) among exercisers compared with non-exercisers. No significant differences in change in CD4 count and viral load were found for the majority of meta-analyses.

Conclusions:Performing progressive resistance exercise or a combination of PRE and aerobic exercise at least 3 times per week for at least 6 weeks is safe and can lead to improvements in cardiorespiratory fitness, strength and body composition for adults living with HIV.

Background: HIV incidence in Ontario remains ongoing and disproportionately affects priority populations, including gay, bisexual, and other men who have sex with men (gbMSM), African, Caribbean and Black (ACB) communities, Indigenous peoples, people who inject drugs, women, and trans communities. Although PrEP uptake is highest among gbMSM, structural and access-related barriers continue to limit equitable HIV prevention across diverse patient groups.
Methods: GetaKit is an online service in Ontario that enables individuals to obtain requisitions for STI testing. Integrated within STI testing orders, GetaKit offers options for PrEP referrals to HIV-negative individuals not currently using PrEP who report demographic or behavioral indicators associated with elevated HIV risk or following infectious syphilis and/or rectal chlamydia or gonorrhea diagnosis. Referrals are facilitated through a formal partnership with Freddie, a virtual HIV prevention service that provides clinician-led PrEP assessment, prescribing, and follow-up care, reducing the need for in-person visits and facilitating additional points of access to HIV prevention services. We describe early outcomes from this integrated referral model.
Results: From June - December 2025, 1,341 individuals opted into PrEP referral through GetaKit. Of these, 297 (22%) completed a PrEP consultation with Freddie. Initial PrEP prescription was provided to 135 (45% of prior step; 10% of total referred) of individuals. Median time from referral to PrEP initiation was 20 days. Seventeen individuals (100%) received on time PrEP refills. The remaining patients who opted into a referral had not yet initiated follow-up.
Conclusion: Embedding PrEP referrals within an online STI testing platform and partnering with a virtual care provider is a feasible strategy to streamline PrEP access for priority populations. This integrated model demonstrates potential to reduce structural barriers to HIV prevention while highlighting opportunities to improve PrEP access to diverse population groups at elevated risk for HIV infection.

Background: PrEP adherence may be strengthened by positive patient-provider relationships, while also shaped by race, gender and other dynamics. We examined whether patient-provider relationship quality was associated with PrEP adherence.

Methods: ON-PrEP was a prospective multicenter cohort of Ontario PrEP users. Participants completed questionnaires assessing patient-provider relationship quality using 7 multi-item scales, at 6- and 18-months, each represented as a 0-100 value (low-high). Mixed-effects logistic regression models assessed associations between relationship quality and self-reported past 4-day adherence (optimal if 4/4 days, suboptimal if <4) among daily PrEP users, adjusting for age, White race, income, country of birth, and prior experiences of discrimination in healthcare.

Results: Among 730 participants, 431 were daily PrEP users who completed 6- and/or 18-month relationship questionnaires. Mean (SD) age was 39 (10.7) years, most were sexual minority men (96.8%), earning ≥$60,000/year (64.7%), Canadian-born (71.7%), and 40.1% were racialized. Overall adherence was high; 87.4% reported optimal adherence at 6 months and 88.4% at 18 months. Patient-provider quality of adherence dialogue scores were high, with 75.8% (323/426) and 78.9% (254/322) scoring above 75, at 6- and 18-months respectively. In adjusted analyses, the only scale associated with optimal adherence was Trust in Provider (aOR=1.03, 95%CI=1.01-1.05). Race, discrimination and other sociodemographics were also important.

Conclusions: Among these daily PrEP users, greater trust in providers was linked to higher adherence. Understanding the care factors that foster patient-provider trust may inform strategies to support PrEP adherence. Given the predominantly male, white, and higher-income cohort, further research in diverse PrEP populations is needed.

Background:
Potentially inappropriate medications (PIMs) and drugs with an elevated anticholinergic or sedative burden (ACB, SB) are of particular concern among people aging with HIV, given their association with frailty and falls. Artificial intelligence platforms may be clinically useful in identifying prescribing issues in this population, especially in settings lacking specialty pharmacists.

Methods:
We randomly selected 100 participants with polypharmacy (≥5 non-antiretroviral co-medications) from the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV age 65 years or older. Co-medication lists were individually submitted to ChatGPT-5 in November 2025 for PIM identification (yes/no) and ACB/SB score calculations (none/negligible/minimal=0, low/mild/weak=1, moderate=2, high/strong=3). Cumulative ACB and SB scores were calculated for each patient. Two reviewers independently assessed ChatGPT response accuracy compared to a blinded pharmacist assessment utilizing established tools (Beers criteria; Anticholinergic and Sedative Burden Catalogs). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each measure.

Results:
Median participant age was 69 years (range 65-85); 94% were male with median 5 comorbidities and 7 (range 5-26) co-medications. ChatGPT performed n=846 PIMs/ACB/SB assessments of 233 unique co-medications. Across 846 co-medication assessments, PIMs (83%) and ACB (81%) accuracy were highest; SB accuracy was 54%. ChatGPT identified ≥1 PIM in 80% of participants vs. 72% via pharmacist assessment, but under-reported cumulative ACB (25% of participants with score ≥3 vs. 36% by pharmacist assessment) and SB (56% with score ≥3 vs. 83 % by pharmacist assessment). PIMs/ACB/SB specificity was high (87%/94%/80%) but sensitivity poor (66%/34%/22%). NPV was 93%/84%/57%; whereas PPV was only 50%/60%/48%.

Conclusion:
ChatGPT-5 underestimated medication-related factors that could contribute to frailty and falls in older adults with HIV. While future models may address some performance limitations, caution is warranted regarding ChatGPT’s use for clinical decision making in this setting.

Background: Retention in HIV care is associated with higher rates of antiretroviral treatment adherence and viral suppression, as well as lower risk of AIDS-related morbidity and mortality. However, the multidimensional nature of retention complicates measurement standardization, limiting comparability and global evaluation. This study explored how HIV stakeholders define and assess retention, aiming to develop a patient-centred and conceptually robust understanding to inform research and practice.
Methods: We conducted a qualitative study using Interpretive Description (ID) methodology, an applied qualitative approach designed to generate practice-relevant knowledge in health research. We purposively sampled 20 stakeholders representing diverse areas of expertise and geographic regions across World Bank country income classifications. We conducted, video-recorded, and transcribed in-depth, semi-structured interviews. Using constant comparative analysis (CCA), we identified recurring, convergent, and contradictory patterns.
Results: The analysis identified five overarching themes. The first two, exploratory themes, included: Patient-Centred Understanding of Retention in HIV Care, which captured how stakeholders conceptualized retention in their respective contexts, and Operationalization of Retention Measures, which explored the key components used to measure retention. The next two, explanatory themes, included Purpose-Driven Definitions of Retention, which described how retention measures were selected based on their intended use; and Building Capacity through Shared Understanding and Integrated Action, which emphasized retention as a cyclical, interconnected process dependent on collaboration between patients and health systems. The final, prescriptive theme, Advancements Shaping Retention, reflected stakeholders' shared vision of improving retention through innovations in HIV treatment and technology.
Conclusions: The findings suggest that stakeholders operationalize retention measures in line with specific objectives and individual health goals, while remaining attentive to contextual realities. Retention measures should remain flexible and patient-centred, rather than relying on a single rigid standard.

Background
Globally, 1.3 million women living with HIV become pregnant each year, among them 85% receive Anti-Retroviral Therapy (ART). Integrase Strand Transfer Inhibitors (INSTIs) are highly effective at suppressing maternal viral load and reducing vertical transmission. However, their use has been associated with a higher risk of hypertension and metabolic dysfunction, which may increase long-term cardiovascular disease risk, especially during physiologically demanding states such as pregnancy that require maternal cardiac adaptation. Here, we examined the effects of INSTI-treatment on maternal cardiovascular remodelling using a mouse pregnancy model.

Methods
Starting gestational day (GD) 0.5, C57BL/6J female mice were orally administered either dolutegravir (5mg/kg/day, N=4), bictegravir (4mg/kg/day, N=1), cabotegravir (5mg/kg/day, N=5), or vehicle control (N=4) daily. Maternal hearts were collected at GD 18.5, fixed in formalin, and paraffin embedded. Cardiac sagittal sections at the levels of the mitral valve and transverse sections at the level of the papillary muscle were stained with Sirius Red/Fast Green to examine myocardial collagen deposition and fibrotic remodelling. Between 4-7 images per section were quantified.

Results
Collagen deposition was significantly increased in all INSTI-treated groups, with the mean (95% CI) percentage of tissue that was fibrotic for dolutegravir being 3.63% (2.05-5.22), cabotegravir 4.17% (3.17-5.16), and bictegravir 7.54%, compared to 1.00% (0.34-1.65) for control. In addition, we observed coronary vascular remodeling (i.e. increased fibrosis and increased interstitial space around the vessels) in maternal hearts within dolutegravir- and bictegravir-treated groups.

Conclusion and Future Directions
Our findings show increased fibrosis in maternal hearts at GD18.5, an irreversible marker of maternal cardiac maladaptation with long-term health consequences. Ongoing studies will assess INSTI treatment with ecotropic HIV infection on cardiac function in murine pregnancy. Comparing antiretrovirals will identify regimens that minimize maternal cardiovascular risk and improve outcomes for mothers and offspring.

Background: Manitoba continues to see growing numbers of incident HIV cases yearly and is the only Canadian province that did not meet the previous 90-90-90 UNAIDS targets. A recent retrospective cohort study of Manitoba’s incident HIV population described a unique HIV population made up of majority heterosexual individuals with a disproportionate number of females, houselessness, mental health comorbidities, and injection drug use. This study sought to report mortality rates and describe the characteristics associated with mortality in Manitoba’s incident HIV population.

Methods: This was a retrospective cohort study of all people 18 years and older newly diagnosed with HIV in Manitoba, Canada between January 1st, 2018 and December 31st, 2022. Retrospective data was collected up to December 31, 2025. Population variables were determined using frequencies for categorical variables and medians for continuous variables with interquartile range. A multivariate analysis using Poisson log regression was conducted to compare variable. A community-based research approach was applied.

Results: There were 604 people newly diagnosed with HIV in Manitoba from 2018-2022 and 79 died, representing 13.1% of the cohort and a mortality rate of 130.8. This population was composed of 44.8% females, 60.9% heterosexual, with 56.2% reporting injecting drug use, 35.1% reporting houselessness, and 40.3% reporting a mental health condition. Median age at time of death was 36. The main cause of death was substance related at 62%, followed by advanced HIV at 2.2%. The median CD4 count at time of diagnosis was 419 cells/mm3. Further data analysis continues specifically exploring the association of sex, substance use, and houselessness with mortality.

Conclusion: Manitoba has a distinct, growing HIV population. Preliminary data demonstrates this population has a high mortality rate driven by substance use disorder and advanced HIV.

Objectives: Comorbidities may result in health-related challenges, known as disability, among people living with HIV. Rehabilitation strategies such as physical activity may help to mitigate disability. Our aim was to characterize comorbidity profiles and examine their relationships with disability and physical activity among a cohort of older adults living with HIV in Canada.
Methods: We conducted a cross-sectional analysis of data collected from adults living with HIV aged 65 years and older and enrolled in the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study. We examined the presence of 14 comorbidities and performed hierarchical linear regression to assess the associations between number of comorbidities, disability (Stanford Health Assessment Questionnaire Disability Index), and physical activity (Rapid Assessment of Physical Activity Aerobic Scale) while sequentially adjusting for intrinsic (personal attributes) and extrinsic (HIV stigma and social support) contextual factors.
Results: Among the 516 participants (median age=69 years, interquartile range (IQR)=6), most identified as male (90%) and White (77%). Participants reported a median of two comorbidities (IQR=3) in addition to HIV. The most common comorbidities included dyslipidemia (51%), hypertension (45%), history of cancer (28%), diabetes (23%), and arthritis (21%). Diabetes and arthritis were each significantly associated with higher disability scores. Additionally, a greater number of comorbidities was associated with more severe disability (ρ=0.25, p<0.001). Yet, higher levels of physical activity attenuated the impact of each additional comorbidity on disability, and this moderating effect remained robust after accounting for the influence of intrinsic and extrinsic contextual factors.
Conclusion: Comorbidities are prevalent among older adults living with HIV in Canada and are associated with disability. Physical activity attenuated the negative associations between comorbidity and disability. Routine screening and management of chronic conditions, coupled with tailored physical activity interventions, may have a role in addressing disability among older adults living with HIV.

Background: Due to structural racism and growing houselessness, injection drug use and mental health concerns, people living with HIV (PLHIV) in Manitoba experience barriers to engage in and adhere to HIV care. These barriers contribute to a growing HIV epidemic in the province, high volumes of emergency department (ED) visits, and poor health outcomes among PLHIV. The Program to Access Treatment for HIV and Support (PATHS) was developed in Manitoba to provide wrap-around care with psychosocial and cultural supports to improve linkage and retention in HIV care, promote stabilization and enhance health outcomes for PLHIV.
Methods: The analysis used PATHS monitoring data for PLHIV who were referred to and received care from PATHS between July 8th, 2024 and June 30, 2025. PATHS indicators included anti-retroviral (ART) initiation and adherence, viral suppression, acute care use, and mental health and social supports.
Results: By June 30, 2025, 65% of PLHIV assigned to PATHS were on HIV treatment, compared to 42% of PLHIV on the PATHS waitlist. Only 18% of PLHIV on the PATHS waitlist had a suppressed viral load, compared to 45% of PLHIV assigned to a PATHS pod. Emergency department (ED) visits among PLHIV assigned to PATHS reduced by 45.1%. The most common clinical interventions delivered by PATHS included medication refills and mental health and substance use assessments. PATHS facilitated a broad range of non-clinical interventions, from cultural, social and service coordination supports to housing, mental health and substance use supports.
Conclusions: Findings show that PATHS is facilitating engagement in and adherence to HIV care and improving clinical stability and health outcomes among PLHIV in Manitoba. Early evidence suggests that interdisciplinary programming can slow the speed of the HIV epidemic in Manitoba and strengthen Canada’s progress toward 95 95 95 goals.

BACKGROUND: 2S/GBTQ people continue to face disproportionate rates of STBBIs in Canada. Evidence supports the use of doxycycline as pre- or post-exposure prophylaxis (doxy PrEP/PEP) to prevent bacterial STBBIs among 2S/GBTQ people, particularly syphilis and chlamydia. In December 2023, British Columbia (BC) implemented a provincially funded public doxy PEP program linked to the BC HIV PrEP and Treatment Programs. We aimed to identify key priorities and lessons learned from early implementation of doxy PrEP/PEP among community-embedded healthcare providers (HCPs) in BC.

METHODS: Peer researchers were trained to co-lead all phases of the study, including recruitment, data collection, and analysis. HCPs delivering 2S/GBTQ-focused sexual health care and/or involved in doxy PrEP/PEP implementation in BC were recruited. Between December 2024 and June 2025, peer-led, in-depth interviews with 21 HCPs were conducted, audio-recorded, transcribed, and analyzed using the Consolidated Framework for Implementation Research.

RESULTS: Key themes included: (1) the need for enhanced HCP training, stronger partnerships with community-based organizations, and clearer doxy PrEP/PEP clinical guidelines; (2) increasing HCP confidence in prescribing doxy PrEP/PEP and improving knowledge of 2S/GBTQ health; (3) implementation challenges related to linking doxy PrEP/PEP to BC’s centralized HIV PrEP/Treatment Programs; (4) benefits of a province-wide program to increase access for 2S/GBTQ people, particularly in rural BC; and (5) HCP observations of fewer cases of syphilis and chlamydia following doxy PrEP/PEP use, supporting continued promotion of the intervention.

DISCUSSION: This study provides early, practice-informed insights into integrating doxy PrEP/PEP within existing STBBI prevention, testing, and treatment services in BC. Key priorities include enhancing HCP support and training, tailoring health promotion messaging for 2S/GBTQ communities, leveraging existing STI prevention infrastructure, addressing access gaps for underserved populations (e.g., rural communities), and exploring pharmacy prescribing, online platforms, and delivery models. Lessons from BC’s early implementation may inform broader doxy PrEP/PEP rollout across Canada.

Background: Fostemsavir (FOS) and lenacapavir (LEN) are approved in Canada for treating multi-drug resistant HIV in people failing/unable to construct a suppressive regimen. These drugs have differing pharmacologic characteristics which may favour use for management of side effects, drug-drug interactions (DDIs), or adherence challenges, but real-world experience in such scenarios is limited. We describe the clinical characteristics and outcomes of patients who received FOS or LEN in a Canadian clinic setting.

Methods: Retrospective case series of patients attending the Toronto General Hospital Immunodeficiency Clinic, prescribed FOS or LEN outside of a clinical trial, with a minimum of 6 months of follow-up. All participants provided consent.

Results: From October 2021-June 2025, 6 patients (5 male) initiated FOS and 5 patients (4 male) initiated LEN with similar median age (66 vs. 61 years) and duration of antiretroviral therapy (ART) (32 vs. 30 years) between the groups, with a median 3-class drug resistance/patient. Individuals receiving FOS had more comorbidities and comedications versus those receiving LEN (6 vs. 2, and 7.5 vs. 4, respectively). All patients initiating FOS and 2 (40%) initiating LEN were virally suppressed at switch for a median 16.4 (4.1-22.5) and 9.4 (1.9-16.9) years, respectively. All patients initiated FOS to avoid protease inhibitor DDIs, while LEN was initiated for viremia (n=3) or intolerance (n=2). Median optimized susceptibility scores of new regimens were 3 (2-4.5) for FOS and 2 (1.5-2.5) for LEN, with median daily oral ART pill burden of 4 (3-5) and 1 (0-2), respectively. Median follow-up was 31.3 months on FOS and 20.6 (6-36) months/4 (2-7) injections on LEN. All patients achieved/maintained viral suppression.

Conclusion: FOS and LEN are well-tolerated and effective in patients with multi-drug resistant virus. FOS can be used to avoid PI-related DDIs, while twice-yearly LEN injections are appealing for those intolerant/non-adherent to standard oral ART.

Background: Lenacapavir (LEN) is a substrate of CYP3A4 and p-glycoprotein, and can be decreased by moderate/potent inducers. When LEN is used for pre-exposure prophylaxis, the US monograph recommends a supplemental SC (463.5 mg) dose every 6 months if a moderate enzyme inducer is initiated; however, there is no guidance for initiating LEN treatment in patients on chronic enzyme inducers. We report LEN concentrations in a patient initiating LEN while on stable rifabutin for disseminated M. avium complex (MAC).

Methods: A 30-year-old male with multi-drug resistant HIV and a history of non-adherence (CD4 <10 cells/mm3, HIV RNA 28,000 copies/mL) was hospitalized with P. jirovecii pneumonia and disseminated MAC. Antiretroviral treatment (ART) was re-initiated with bictegravir/tenofovir AF/emtricitabine and darunavir/cobicistat and later changed to dolutegravir, lamivudine, darunavir/ritonavir and tenofovir DF when rifabutin was added for enhanced MAC efficacy. After viral suppression (<20 copies/mL), ART was simplified to LEN plus daily darunavir/ritonavir. Increased LEN loading doses (900 mg po Days 1-2) and 1390 mg SC (3 x 1.5 mL injections Day 1) were administered and the original oral ART was continued for the first week after LEN initiation. Plasma samples for LEN therapeutic drug monitoring (TDM) were obtained daily (week one), weekly (month 1) and at months 2 and 3.

Results: All LEN concentrations were above the target value of 15.5 ng/mL (4xEC95), with a median value of 54.4 ng/mL. Median LEN values were similar to cohort LEN data (Le et al. CROI 2025). The week 2 LEN value was similar/higher than observed from CAPELLA in those on boosters (Jogiraju et al. ID Week 2024). Viral load suppression was maintained after LEN initiation.

Conclusions: LEN concentrations in the setting of rifabutin-mediated CYP3A4 induction, increased loading and injection doses and concomitant ritonavir were sufficient to maintain HIV viral suppression.

Background: People with HIV-1 (PWH) on injectable cabotegravir + rilpivirine (CAB+RPV) may switch back to oral therapy for various reasons. Bictegravir (BIC)/emtricitabine/tenofovir alafenamide (B/F/TAF) is a guideline-preferred once-daily oral regimen, but the overlap of the two integrase inhibitors, CAB and BIC, has not been evaluated.
Methods: This prospective, single-arm, open-label, interventional Phase 4 study (NCT06104306) included PWH who chose to switch from every-2-month CAB+RPV, having maintained HIV-1 RNA <50 copies(c)/mL for ≥6 months at screening, to daily B/F/TAF due to intolerance, adverse events (AEs), or personal preference. Coprimary endpoints were the proportion of participants experiencing treatment-emergent Grade 3/4 study drug–related AEs and Grade 3/4 laboratory abnormalities through Week (W)12. Secondary endpoints included the proportion of participants with HIV-1 RNA ≥50 c/mL at W12, and the proportion of participants discontinuing B/F/TAF by W12.
Results: Twenty-nine participants from North America switched to B/F/TAF around the time of their next scheduled CAB+RPV dose (see Table for demographics and baseline characteristics, and key safety and efficacy data). The most common reason reported for switching from CAB+RPV to B/F/TAF was side effects (55.2%). No participants experienced treatment-emergent Grade 3/4 study drug–related AEs and one experienced treatment-emergent Grade 3/4 laboratory abnormalities, deemed unrelated to study drug, through W12. One participant had HIV-1 RNA ≥50 c/mL at W12. One participant discontinued B/F/TAF by W12 for reasons other than efficacy/safety (they moved away).
Conclusions: These safety and efficacy data support switching from injectable CAB+RPV to oral B/F/TAF when needed or desired.

Background: Sexual activity and function decline with age, but positive dimensions are important, and contribute to overall quality of life. We explored the correlates of sexual activity and satisfaction in an aging cohort of persons with HIV in Canada.

Methods: The CHANGE HIV (Correlates of Healthy Aging in Geriatric HIV), is an ongoing prospective cohort of 553 Canadians > 65 years. We evaluated baseline questionnaires regarding sexual activity (oral, anal or vaginal intercourse) and sexual satisfaction (NSSS-s scale, Cronbach’s alpha 0.9-.96). Logistic regression determined predictors of reporting sexual activity. Linear regression assessed the relationship between sexual satisfaction and covariates of interest after adjusting for reported sexual activity.

Results: Overall, 399 participants (365 men, 30 women) completed baseline questionnaires on sexual activity. Those completing were more likely white, male and in a steady relationship than those who did not complete the questionnaire. Of those completing, 43% of the men and 8% of the women reported being sexually active in the previous 6 months. On multivariable analysis, for men, the predictors of reporting sexual activity (aOdd’s; 95% CI) included lower age (.57; .34-.97), being in a steady relationship (2.27; 1.44-3.59), a having higher healthy aging score (1.16:1.04-1.29). We found no correlation with frailty, stigma, substance use, loneliness, depression, or overall physical activity. After adjusting for being sexually active, linear regression revealed significant relationships (p<.05) between sexual satisfaction and HAS, frailty, depression, quality of life, loneliness as well as being physically active.

Conclusion: In this cohort of older adults less than half the men and only 8% of women reported being sexually active. Increased sexual satisfaction was associated with higher physical and mental health scores and with overall improved quality of life. Sexual activity and sexual satisfaction are important components of healthy aging in persons with HIV and should be routinely assessed.

Purpose: The primary objective of this analysis is to describe the enrollment rates and baseline characteristics of participants enrolled in the BRAVVO study, a single-arm, prospective, observational cohort study designed to evaluate the impact of an integrated, multidisciplinary model of HIV care among inner-city residents with a history of substance use and non-adherence to their ARV medication.

Methods: Participants are primarily recruited from VIDC patient populations, upon review of their medical records and identification of non-adherence to their medication(s) and/or a recent unsuppressed viral load. Community-based outreach events at which point-of-care HIV antibody testing is performed are also used to identify individuals who are eligible for study participation. The individuals included in this analysis were recruited from January of 2024 until June of 2025.

Results: On average, we have identified approximately 3 individuals every month (60 individuals over 18 months) who meet the study eligibility criteria and agreed to enroll in the study. The characteristics of these individuals are shown in Table 1.

Conclusions: We found that the demographics of our study participants are largely similar to the demographics of the overall population of individuals living with HIV in Vancouver’s inner city, with males and Indigenous individuals disproportionately represented. Our steady participant recruitment rates emphasize the urgent and a vital need for programs which help individuals remain adherent to their HIV treatment regimens and achieve viral suppression.

Purpose: BICSTaR is a 2-year, multicountry observational cohort study of B/F/TAF in treatment-naïve (TN) and treatment-experienced (TE) PWH. Follow-up was extended by 3 years (for a total of 5 years) in Canada, France, and Germany to assess long-term effectiveness and tolerability of B/F/TAF in routine clinical practice.
Methods: The final 5-year data (60 months [M]) for PWH enrolled in the three countries were pooled. Outcomes included virologic effectiveness (HIV‐1 RNA <50 copies/mL; missing=excluded), immunologic outcomes, quality of life (QoL; HIV Symptom Index [HIV-SI] bothersome symptoms and 36-Item Short Form Health Survey mental/physical component summary [M/PCS] scores), treatment satisfaction (HIV Treatment Satisfaction Questionnaire [HIVTSQ]), safety (drug-related adverse events [DRAEs], metabolic and renal parameters), and resistance.
Results: Of 823 (132 TN; 691 TE) PWH included, 493 (79 TN; 414 TE) entered the extension phase. At baseline, median age was 39 (TN) and 49 (TE) years (26.5% and 48.6% were aged ≥50 years, respectively); 63.6% TN and 84.1% TE participants had comorbidities. At 60M, 97.9% (47/48) of TN and 96.8% (306/316) of TE participants were virologically suppressed. Median CD4 cell count and CD4/CD8 ratio increased from baseline. At 60M, HIV-SI overall bothersome symptom count remained low. MCS and PCS scores improved from baseline, except a small decrease in PCS score in TE participants, and HIVTSQ scores were high with B/F/TAF. Changes in metabolic and renal parameters were small. Through 60M, DRAEs occurred in 18.9% (25/132) of TN and 14.6% (101/691) of TE participants, leading to B/F/TAF discontinuation in 5.3% and 7.7%, respectively. No treatment-emergent resistance to B/F/TAF was reported.
Conclusion: Through 5 years of follow-up, B/F/TAF was highly effective, generally well-tolerated, and associated with improvements in QoL and treatment satisfaction. These results further support long-term B/F/TAF use across a range of PWH and are consistent with data from other settings.

Background: Oral pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, yet its real-world impact is constrained by challenges with adherence and persistence. Addressing these gaps may help highlight areas for improving PrEP engagement and improve prevention outcomes.

Methods: We conducted a retrospective chart review using electronic medical records (EMR)s from a Canadian community sexual health clinic. Data from 3,239 individuals initiating PrEP between 2022 and 2025 were analyzed to assess adherence and persistence. Adherence was defined as obtaining all PrEP refills within a ±14-day window of the expected date, and persistence was defined as continuous engagement in care without a ≥6-month lapse or documented discontinuation. Multivariate logistic regression was applied to identify demographic and behavioral predictors.

Results: Overall, 47.9% of participants remained persistent and 49.8% were adherent. Higher adherence and persistence were associated with older age, self-identification as a gay male, and use of multiple PrEP agents. Individuals reporting exclusively insertive or receptive sexual positioning demonstrated lower engagement. These associations were consistent across both adherence and persistence models.

Conclusion: Key demographic and behavioral factors may influence PrEP engagement in community-based care. Tailored interventions that address these differences are critical to sustaining PrEP use and optimizing HIV prevention outcomes.

Background: Gaps in pre-exposure prophylaxis (PrEP) uptake, adherence, and persistence can lead to missed opportunities for HIV prevention. Understanding these gaps among newly diagnosed individuals can help inform targeted interventions.

Methods: We conducted a retrospective chart review of 162 individuals newly diagnosed with HIV at a Canadian community-based sexual health clinic between 2022 and 2025. PrEP history and documented offers were assessed to identify missed prevention opportunities. Among the 162 individuals identified as HIV-positive in the chart review, we analyzed 102 who presented at the initial clinic visit without a prior positive diagnosis

Results: Of the 102 new HIV diagnoses, 77 (47.5%) tested positive at their initial visit; all had received a PrEP offer at this initial visit prior to diagnosis; 4 (2.5%) were taking PrEP at diagnosis. Prior PrEP use was documented in 14 (8.6%) individuals who had discontinued before seroconversion, and 6 (3.7%) had multiple prior offers. Only one (0.6%) represented a true missed PrEP offer.

Conclusion: Most new HIV diagnoses were identified either prior to individuals’ first clinic visit or at the time of their initial presentation. These findings underscore the need for earlier, risk-informed PrEP initiation, and sustained support to close prevention gaps.

Purpose: The present study investigated longitudinal intellectual, language, and academic abilities in school-aged children who are HIV-exposed uninfected (CHEU) and children who are HIV-unexposed uninfected (CHUU).

Methods: CHEU and CHUU 6 to 12 years of age underwent two neurodevelopmental assessments approximately 2 years apart through the Kids Imaging and Neurocognitive Development (KIND) study at the Hospital for Sick Children. Intellectual, language, and academic abilities were measured using the WISC-V, CELF-5, and WIAT-II. Generalized linear models were used to investigate HEU status with each neurodevelopmental outcome at each timepoint. Sex effects were investigated with an interaction term. Linear mixed effects models were used to investigate longitudinal neurodevelopmental outcomes by an interaction term of HEU status by age. Significance was held at p <0.05.

Results: 41 CHEU (23 female) and 29 CHUU (12 female) underwent two developmental assessments at the median ages of 8 and 11 years of age. HEU status was associated with lower working memory scores at the first timepoint and lower working memory, full scale IQ, and expressive language at the second timepoint. HEU status was also associated with lower processing speed and math skills with age. At the first timepoint, male CHEU demonstrated lower scores in working memory, processing speed, full scale IQ, word reading, and spelling. At the second timepoint, male CHEU demonstrated lower scores in verbal comprehension, working memory, full scale IQ, word reading, and spelling. There were no differences observed in females by HEU status.

Conclusions: Male CHEUs were most susceptible to poorer performance on aspects of intellectual abilities and literacy skills over time, indicating the need for timely assessments and intervention. Future work will investigate potential contributions of pre-and peri-natal exposure to ARVs on cognitive development.

Background: Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is widely used in Canada and valued for its efficacy and tolerability, yet little is known about how long-term users integrate this regimen into their daily lives. This study examines the impacts of treatment satisfaction with B/F/TAF on the patient experience, quality of life, adherence, and persistence.
Methods: We conducted a qualitative study at Clinique l’Actuel with adults living with HIV actively receiving B/F/TAF for ≥24 months, and being on ART for ≥36 months. Participants completed a sociodemographic, behavioural, substance-use, and HIV Treatment Satisfaction questionnaire, as well as a semi-structured interview—either in French or English. Purposive sampling was used to increase the diversity of the participant population. Interviews were transcribed, translated into English when required, and analysed inductively using Braun and Clarke’s framework.
Results:
A total of 32 participants were interviewed. The median age was 62 years. Most participants were men (91%); no participants identified as transgender or non-binary. Key populations included 66.5% men who have sex with men, 6% identifying as bisexual, 34% migrants, 12.5% African, Caribbean, or Black individuals.
Overall, participants perceived high treatment satisfaction with B/F/TAF that enabled a sense of ease and normalcy with managing HIV within daily life. Compared to previous regimens, participants described B/F/TAF as simple and less toxic, with minimal to no experience of side effects. Combined with better perceived tolerability and high treatment satisfaction with B/F/TAF, ease of administration facilitation stable daily routines and trust in care relationships with healthcare providers supported adherence and long-term persistence with the regimen.
Conclusion:
In this Canadian observational study, B/F/TAF was perceived as a treatment regimen associated with stability, tolerability, and normality. Treatment satisfaction emerged as a multidimensional experience extending beyond the absence of side effects, and may be associated with sustained adherence and long-term persistence.

Background: HIV and HCV elevate inflammation which impacts health and aging. Women living with HIV in Canada have shorter health/life span than men, and HCV-related inflammation could be contributing. We investigated the effect of HCV clearance on selected markers of inflammation among women with HIV.

Methods: This longitudinal study included women ≥16y from the CARMA, BCC3, or CCC cohorts with baseline and follow-up visits ≥1y apart. Women were divided into four groups: HIV+/HCV RNA+ who cleared HCV between visits (G1), and comparators who remained with chronic HCV (G2), with HIV only (G3) and HIV-/HCV- (G4). These groups were matched based on age at visit, time between visits, and ethnicity as best possible. Plasma IL-10, IFN-, TNF-, IL-6, and IL-8, were measured by MSD multi-spot assay. Groups were compared cross-sectionally by Anova or Kruskal-Wallis and longitudinally by paired t- or Wilcoxon signed-ranked test.

Results: Among 48 women (n=12/group), age was similar between groups, but imbalance persisted around time between visits and ethnicity (Table 1). Cytokine levels differed between groups at baseline and follow-up (all p<0.003), with G1 showing higher levels in most markers. Longitudinally, IL-10 decreased in G1 and G4, while IL-8 increased for G3. No significant changes were observed in G2 (Table 1).

Discussion. Unlike the persistent inflammation among those with chronic HCV (G2), HCV clearance (G1) shows a favourable pattern, which itself could drive the 67% decrease in IL-10. This suggests partial improvement of inflammation with HCV clearance. Data from the full sample (n=39/group) will strengthen analysis.

Introduction: Women living with HIV (WLWH) face poorer health outcomes (such as metabolic and liver disease) compared to women without HIV as they age. We hypothesize that adverse social determinants of health (SDH) that disproportionately affect WLWH compared to women without HIV contribute to these disparities in metabolic and liver health.

Methods: Our study sample (n=765) included three groups of women ≥45y: BCC3 WLWH (n=173), sociodemographically-similar BCC3 women without HIV (n=167), and CLSA general population women without HIV (matched 3:1 to BCC3 WLWH; n=425). Two outcomes of interest - the Visceral Adiposity Index (VAI) for metabolic health (includes waist circumference, body mass index, high density lipoprotein (HDL), triglycerides) and the Non-Alcoholic Fatty Liver Disease (NAFLD) Ridge Score (NRS) for liver health (rules in/out NAFLD, composed of alanine aminotransferase, HDL, triglycerides, HbA1c, white blood cell count, hypertension), were calculated from self-reported survey data and clinical laboratory results. These outcomes were compared between the groups as shown in Table 1, alongside selected SDH available in both BCC3 and CLSA.

Results: The BCC3 groups show a more adverse SDH profile compared to CLSA (Table 1). Higher scores for VAI and NRS reflect worse metabolic health and higher prevalence of NAFLD, respectively, in the two BCC3 groups compared to CLSA.

Conclusions: Women in BCC3, regardless of HIV status, share a less favorable metabolic and liver health profile compared to CLSA women from the general population. This observation could be explained by different SDH profiles between the two cohorts, and will be investigated further.