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CROI 2026 Management of HIV Coinfections
Advances in Management of HIV Coinfections From CROI 2026: Perspectives for Asia and Beyond

Released: March 31, 2026

Iskandar Azwa
Iskandar Azwa, MD
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Key Takeaways
  • Ultra-short TB preventive therapy is effective and scalable in people living with HIV in the Asia Pacific region.
  • Benzathine penicillin–based regimens remain the cornerstone for syphilis treatment, but advances in combination therapy are expanding treatment options.

The 2026 Conference on Retroviruses and Opportunistic Infections (CROI) highlighted a rapidly evolving landscape in HIV clinical care, with advances in antiretroviral therapy (ART) optimization, long-acting treatment and prevention strategies, and integrated management of comorbidities. It presented pivotal research with significant implications for the Asia Pacific region, particularly for coinfection treatment strategies.

Evidence Supporting Ultra-Short Courses of Rifapentine-Based Tuberculosis Preventive Therapy
Tuberculosis (TB) remains a leading opportunistic infection and a significant cause of mortality in people with HIV in Southeast Asia. To mitigate this burden, rifapentine-based preventive regimens for TB have become increasingly relevant, owing to their shorter treatment duration compared to isoniazid courses. 

However, there are long-standing data gaps regarding efficacy, safety, and effects on HIV virologic outcomes with these regimens in Southeast Asian countries with high TB burden, and among people with HIV on dolutegravir (DTG)-based ART. Investigators from the Thai Red Cross AIDS Research Centre in Bangkok, Thailand presented findings from an active-controlled, open-label, phase III trial of 2 different rifapentine-based regimens for TB prevention. In this study, 1500 people living with HIV without active TB and treated with efavirenz (EFV)- or DTG-based ART were randomized to either 1 HP (daily isoniazid plus rifapentine for 4 weeks) or 3HP (weekly isoniazid plus rifapentine for 12 weeks). Follow-up lasted 144 weeks.

Investigators reported that baseline characteristics were similar across both arms, with median CD4 counts of 350 cells/mm3 and 22.6% of participants with CD4 counts less than 200 cells/mm3. At study regimen initiation, 42% of participants were on DTG-based ART, and 58% were taking EFV-based regimens.

Results showed that 1 HP was noninferior to 3 HP for prevention of TB, TB-related death, and all-cause mortality. Only 3 patients developed TB (2 in the 1HP arm, 1 in the 3 HP arm, and all after the third year). Both regimens maintained durable HIV suppression with no DTG dose adjustment required. As global HIV programs increasingly prioritize integrated TB prevention, ultra-short regimens such as 1HP will play an important role in improving uptake and completion of preventive therapy.

Combination Therapy for Enhancing Serologic Response in Early Syphilis Among People With HIV
Advances in the treatment of syphilis have also long been understudied. Despite dramatic reductions in syphilis-related morbidity and mortality in the age of penicillin, periodic resurgences of this sexually transmitted infection still occur. Recently, syphilis cases were on the rise in Japan and China, with persistently high prevalence in Southeast Asia.

Treatment guidelines for early syphilis in people living with HIV have traditionally recommended penicillin-based regimens as the preferred treatment over doxycycline and ceftriaxone. A study published in the New England Journal of Medicine last year confirmed what we had generally suspected: That people living with HIV with early syphilis could be safely treated with a single dose of benzathine penicillin G (BPG) without the need for additional doses, similar to persons without HIV. But could combination therapy further improve the serologic response?

Colleagues from Taiwan assessed the effectiveness of 3 BPG-based combination regimens for treatment of early syphilis in people living with HIV. This retrospective study included approximately 760 people with over 1000 episodes of early syphilis. Adding doxycycline to single-dose BPG significantly increased the serologic response rate 12 months post treatment, from 73% with BPG alone to 82% with BPG plus doxycycline. Adding ceftriaxone to BPG plus doxycycline increased responsiveness further, although this did not achieve statistical significance and was limited by smaller numbers.

With the ongoing prevalence of syphilis in the Asia Pacific region and the potential for more severe disease in people with HIV, these results provide timely clinical information and support further exploration of combination syphilis therapy in this population.

Your Thoughts
What are the coinfections or comorbidities that you see most often among patients with HIV in your practice? What are your most significant challenges in addressing them? Leave a comment to join the discussion!

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