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HIV Progress and Challenges
IAS 2025: HIV Progress and Challenges in Canada and Globally

Released: August 07, 2025

Alexander Wong
Alexander Wong, MD, FRCPC
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Key Takeaways
  • Rising HIV rates in Canada, particularly in the provinces of Manitoba and Saskatchewan, demand innovative strategies for HIV prevention.
  • Data supporting the use of long-acting cabotegravir in pregnant people and people with HIV viremia provide hope that long-acting prevention methods may hold the key to reducing HIV transmission.

For me, the most important theme at International AIDS Society (IAS) 2025 was the dramatic and tragic impact that cuts in HIV funding are having—and will continue to have—on global efforts to achieve the World Health Organization 95-95-95 targets. These cuts disproportionately affect sub-Saharan African countries and vulnerable populations worldwide, including people who use drugs and gender-diverse individuals. For those of us in Canada and around the world who provide care for people living with HIV, I believe we have a professional obligation to advocate for the immediate restoration of this life-saving funding.

Relieving the Burden of HIV in Canada
The number of new HIV diagnoses in Canada continues to grow year over year. In 2023, 2434 people were newly diagnosed with HIV, a 35.2% increase over 2022. The national rate of new HIV diagnoses has grown to 6.1 per 100,000 people. Although these rates vary across Canada, the highest by far continue to be seen in the Prairie provinces of Manitoba (19.3 per 100,000) and my home province of Saskatchewan (19.4 per 100,000). Despite our best efforts, Saskatchewan has continuously led Canada in rates of new HIV diagnoses for nearly 20 years.

In this context, a high number of people newly diagnosed with or at risk for HIV in Manitoba and Saskatchewan are females of childbearing potential. Early data were presented from the Antiretroviral Pregnancy Registry on pregnant individuals exposed to long-acting (LA) cabotegravir for both HIV prevention and treatment. Outcomes from 42 individuals were reported; 3 were initially exposed during pregnancy, with the remainder exposed preconception. Among the 35 live births reported, only 1 congenital defect was recorded (an infant with congenital ptosis). Although this study is promising, the numbers are small, and data are still limited on the safety of cabotegravir in pregnancy.

Many Canadian healthcare professionals now use LA injectable HIV therapies "off-label" in carefully selected individuals who are unable to suppress their HIV viral load with oral antiretroviral therapy. Real-world data from the OPERA cohort, presented at the conference, support this approach. In this large American clinical database, 368 people with HIV-1 RNA ≥50 copies/mL initiated LA injectable therapy. Among those who completed the initial 2-dose series, 85% achieved viral suppression (HIV-1 RNA <50 copies/mL) within 6 months. Furthermore, over 80% maintained suppression at their last recorded viral load, and only 3 individuals developed confirmed virologic failure. 

Several of my Canadian colleagues also presented exciting research at the meeting.

Dr Bertrande Lebouché and his team presented their AI chatbot, MARVIN, designed to provide support for HIV self-management in a virtual and stigma-free manner.

Dr Nadine Kronfli shared important data on the prevalence of sexually transmitted and blood-borne infections in provincial prisons in Quebec, highlighting the importance of using routine point-of-care testing for HIV and other communicable diseases in carceral settings.

Pierre Giguere and his colleagues from the University of Ottawa also presented the latest updates to their case series of persons resuppressing HIV viremia with bictegravir/emtricitabine/tenofovir alafenamide after experiencing virologic failure with LA cabotegravir and rilpivirine.

Looking Forward With Hope
To end on an upbeat note, on the heels of the FDA's recent approval of lenacapavir for HIV prevention, Canadian healthcare professionals are optimistic that lenacapavir will be approved for our country in the coming months. This would add another tool to our HIV prevention toolkit, which already includes LA cabotegravir. Phase II safety and pharmacokinetic data for an oral once-monthly translocation inhibitor for HIV prevention, MK-8527, were presented at the meeting. MK-8527 will be moving into global phase III studies soon, offering the promise of additional options for HIV prevention in the future.

Despite the uncertainty that clouds our current reality, the impressive caliber of research along with the passion demonstrated by all the investigators alike at IAS 2025 continue to strengthen my faith in the future of our global HIV response.

Your Thoughts
What challenges do you face with HIV prevention in your own practice? How do you think healthcare professionals and policymakers should balance local public health priorities with global advocacy responsibilities to ensure equitable progress toward ending the HIV epidemic?

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