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HIV Care and Prevention in France
The French Revolution of HIV Care: Implementation of PrEP and Long-Acting ART

Released: March 18, 2026

Karine Lacombe
Karine Lacombe, MD, PhD
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Key Takeaways
  • Oral PrEP has greatly reduced HIV incidence in men who have sex with men born in France, but we now need other options targeted to difficult-to-reach people.
  • Real-world data confirmed the efficacy and tolerability of cabotegravir plus rilpivirine and lenacapavir.

HIV Incidence After PrEP Availability in France
The estimated yearly incidence of new HIV diagnoses in France has decreased modestly in the last decade, from 6396 in 2012 to 5750 in 2022, thanks in part to the 2016 implementation of HIV pre-exposure prophylaxis (PrEP) in France. Studies presented at CROI 2026 offer insights into how HIV prevention can be further improved in the region and in Europe more broadly.

First, investigators presented the final results of ANRS Prévenir (abstract 127). ANRS Prévenir was an open-label prospective cohort study that followed 3209 participants using either on-demand or daily oral PrEP from 2021 to 2025. The main objective of this cohort was to see if gaining access to PrEP would decrease the incidence of HIV by 15% among men who have sex with men and the transgender community in Paris.

Depending on the regimen, the discontinuation rate was approximately 13-17 per 100 person-years, which is quite substantial. However, HIV incidence was very low, approximately 1 per 1000 person-years of follow-up. There was no difference in HIV incidence between on-demand or daily oral PrEP.

Among French-born men who have sex with men, HIV diagnoses decreased 33%. Conversely, among foreign-born men who have sex with men, HIV diagnoses increased by 73% between 2015 and 2024. HIV incidence in transgender women also increased by 95%. Another result I found remarkable was the high incidence of bacterial sexually transmitted infections, with approximately 53% of participants diagnosed.

These results provide us with 2 key points of information. First, the substantial discontinuation rate indicates that people get fed up with oral PrEP, or their needs change over time. It shows that the field is in need of other modalities of PrEP.

Also, the availability of oral PrEP alone helps protect French men who have sex with men quite well, but not transgender women and foreign-born men who have sex with men. I think this further highlights the need for new modalities of PrEP.

HIV Resistance after PrEP
Another abstract that I found really interesting was the analysis of drug resistance in people who acquired HIV between 2014 and 2025 (abstract 565). This French team looked at the risk of PrEP failure due to encountering a resistant HIV strain for people using cabotegravir (CAB), lenacapavir (LEN), or tenofovir disoproxil fumarate/emtricitabine.

What I found interesting about these results was that primary resistance to CAB and LEN was less than 1%. Another very interesting result was the dynamics of resistance over time. Investigators reported that INSTI resistance was pretty stable over time, with an increase from 3.8% to 4.9% over 10 years. For NNRTIs, resistance decreased from 8.1% in 2014 to 6.2% in 2025, though there was a period of increase from 2021 to 2024. For NRTIs, resistance was also stable, changing from 3.4% to 3.1%. In protease inhibitors, the resistance rate increased from 1.4% to 5.7%, but I do not consider that clinically significant because protease inhibitors are hardly used anymore. Overall, the resistance data are quite reassuring and do not preclude the use of new PrEP options, given the low apparent risk of transmission of resistant HIV strains not covered by PrEP drugs.

Real-world Data With Long-Acting CAB/Rilpivirine and LEN in France
Another 2 important studies presented at CROI 2026 include real-world data on the implementation of long-acting antiretroviral therapy with CAB plus rilpivirine (RPV) and LEN.

First, the CAB plus RPV real-world data come from an observational cohort located in the southwest of France, consisting of 464 people with HIV who were using CAB plus RPV (abstract 526). What is really reassuring is that, at 36 months, 82% of participants were still on treatment, indicating that the retention rate is very good. That was a major question in the field, since CAB plus RPV requires injections every month.

The virologic failure rate was very low, at 4.3%. When people stopped treatment, it was rarely because of virologic failure (which led to discontinuation in only 2.8%), but more often for other reasons, including personal preference or wanting to go back to pills.

Investigators also assessed quality of life in this real-life cohort, with 75% of people reporting an increase in quality of life. No issues with metabolic parameters or BMI were observed.

Another very interesting abstract reported the first real-world data on the use of LEN in France (abstract 540). The primary difference between this cohort and past French cohorts was that this cohort enrolled the first people who used LEN after it received authorization. This cohort enrolled 77 patients, 22 of whom (28.6%) had HIV-1 RNA ≥200 copies/mL at initiation. These people were put on LEN primarily due to problems with adherence or intolerance of a high pill burden, with 42 participants exhibiting resistance to ≥2 drugs in ≥3 classes.

The continuation rate was 94.8% after 6 months and 81.8% after 12 months of treatment, which I would consider quite a good retention rate. Three participants discontinued LEN because of persistent viral replication. One participant stopped treatment due to death, and 2 were lost to follow-up. Three stopped LEN because of side effects, 2 of whom stopped due to painful nodules.

The data from these 2 abstracts indicate that, in the real world, CAB plus RPV and LEN are associated with high rates of success and continuation, and low rates of side effects. If patients stopped treatment, it was not because of virologic failure, but more for personal convenience or desire to return to oral treatment. This opportunity for implementation of injectables with a high rate of success is excellent news for everybody, HCPs and patients.

Your Thoughts
With many recent innovations in HIV prevention and treatment, how has the landscape of care changed in your country? Leave a comment to join the discussion!

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