HIV Prevention Funding Cuts Threaten Progress, Experts Warn

Global Health Leaders Advocate for Collaboration Amidst Shifting Financial Landscape

Significant reductions in U.S. funding for HIV prevention research are compelling global health experts to emphasize collaboration and community-inclusive strategies. These discussions, held at the International AIDS Society meeting in Kigali, Rwanda, highlight the urgent need for innovative approaches to maintain momentum in combating the epidemic.

NIH Slashes $200 Million from HIV Prevention Research

The session, co-hosted by the Bill & Melinda Gates Foundation, Gilead, Merck, and the Reproductive Health Institute, zeroed in on adapting to a changing financial environment. A major concern voiced by attendees was the recent termination of 191 HIV-specific grants by the U.S. National Institutes of Health (NIH), which resulted in over $200 million in funding cuts. These reductions are expected to disrupt early-stage research, behavioral interventions, and vaccine development.

Nyaradzo Mavis Mgodi, MBChB, a specialist in biomedical HIV prevention methods at the University of Zimbabwe Clinical Trials Research Centre, stated, We saw that $99 million was cut from HIV prevention, including the work that I do in HIV, biomedical products, behavioral interventions and access barriers and key populations were not spared. The cuts have adversely affected us all.

Rethinking Trial Design for Efficiency and Inclusivity

Key takeaways from the Future of HIV Prevention Clinical Trials Summit, held in Johannesburg, South Africa, underscored the push for smarter, more agile clinical trials. Speakers stressed the importance of community engagement and innovative trial designs utilizing modeling and artificial intelligence to accelerate development while maintaining rigor and inclusivity.

Grace Kumwenda, regional program manager at AVAC in Malawi, commented, The context for HIV prevention research is rapidly evolving. We are facing shifting epidemiology. Some populations are seeing lower incidence, and others remain quite underserved. At the same time, how do we design and prioritize research?

New Oral PrEP Options Emerge Amidst Research Shifts

Merck has initiated Phase 3 clinical trials for MK-8527, an investigational once-monthly oral HIV PrEP medication. The EXPrESSIVE-11 trial will evaluate its safety and efficacy across 16 countries, beginning enrollment in August 2025. This new compound, a nucleoside reverse transcriptase translocation inhibitor (NRTTI), will be compared against generic emtricitabine/tenofovir disoproxil fumarate.

Rebeca Plank, M.D., senior principal scientist for clinical research at Merck, highlighted the careful consideration of trial comparators. This was done in consultation with various stakeholders from the beginning and even before the protocols really began to be drafted, she noted, explaining the choice to compare MK-8527 with emtricitabine/tenofovir disoproxil fumarate before the approval of twice-yearly lenacapavir (Yeztugo).

Vaccines Remain Crucial in HIV Prevention Arsenal

Despite decades of research and challenges in developing an effective HIV vaccine, some promising signals have emerged. The RV144 trial in Thailand, conducted nearly a decade ago, showed a statistically significant decrease in HIV infection, although protective immunity waned. Mgodi argued that vaccines are essential, especially for individuals who struggle with adherence to PrEP or do not perceive themselves at risk, potentially preventing between 8.4 million and 19 million new HIV infections depending on efficacy.

Advances in Passive Immunization with Broadly Neutralizing Antibodies

Research continues into passive immunization using broadly neutralizing antibodies (bnAbs), which can target diverse HIV strains. Organizations like IAVI and the Scripps Consortium for HIV/AIDS Vaccine Development (CHAVD) are actively involved. In May 2025, IAVI and Scripps Research released data from two Phase 1 trials demonstrating that a targeted vaccine strategy can successfully activate early immune responses relevant to HIV, with findings published in the journal *Science*.

ViiV Healthcare is also developing bnAbs. In March 2025, data from a Phase 2b study showed that N6LS, a bnAb administered every four months, effectively maintained undetectable viral loads when combined with Apretude (cabotegravir) in adults living with HIV who were stable on treatment. According to UNAIDS, approximately 39 million people were living with HIV globally in 2023. (UNAIDS, 2023).

Steroid Use Linked to Worse Outcomes in Lung Cancer

For individuals with non–small cell lung cancer (NSCLC) undergoing immunotherapy, a new study reveals that baseline corticosteroid use correlates with poorer results and less reliable biomarker data, prompting calls to re-evaluate steroid prescriptions.

Study Links Steroids to Diminished Immunotherapy Efficacy

Research featured in Cancer Research Communications indicates that patients with NSCLC who were using corticosteroids at the start of immune checkpoint inhibitor (ICI) treatment experienced significantly lower response rates, plus shorter progression-free and overall survival. The research was headed by **Fumito Ito**, an oncologist at the University of Southern California.

According to the American Cancer Society, NSCLC accounts for approximately 87% of all lung cancers. Survival rates remain low: for patients diagnosed between 2015 and 2021, the five-year survival rate hovered around 32%.

While ICIs like Keytruda and Opdivo have improved outcomes, steroids are often prescribed for symptom management. The new data suggests that such use before or during treatment blunts the effectiveness of immunotherapies.

Key Findings on Steroid Impact

The study found that even discontinuing steroids before ICI therapy led to better results than continuing their use. “The mere use of steroids was a more influential prognostic factor than the presence of brain metastases,” the study authors stated. Moreover, higher steroid doses correlated with worse outcomes.

Additionally, steroid use skewed blood-based immune markers, such as CX3CR1+ CD8+ T cell levels, complicating interpretation. Likewise, the typical association between a low neutrophil-to-lymphocyte ratio (NLR) and better prognosis disappeared in patients on steroids. These findings coincide with reports that nearly 40% of cancer patients are prescribed steroids, often for extended durations (Cureus, 2022).

Mouse Model Confirms Steroid Interference

Experiments involving tumor-bearing mice further validated these concerns. Steroids diminished the therapeutic benefits of anti–PD-L1 therapy and hampered T-cell development, even if steroids were stopped before treatment.

Looking Ahead

While acknowledging the study’s limitations, including a small sample size, the authors advocate for minimizing steroid use prior to ICI treatment. They propose that future research should investigate whether reducing or discontinuing steroids could improve clinical outcomes for these patients.