Young people living with HIV should take their HIV medicines daily
16 Jul 2025
Taking HIV medicines every day without taking breaks remains the best way to keep the virus under control in young people living with HIV who are taking the most widely used combination of medicines. This is according to new results from the BREATHER+ trial, presented today at the IAS Conference on HIV Science in Kigali, Rwanda.
The BREATHER+ trial investigated whether young people living with HIV, who were taking dolutegravir/tenofovir-based triple antiretroviral therapy, could safely take weekends off their HIV medicines. It included 470 young people aged 12-19 years from Uganda, South Africa, Zimbabwe, and Kenya.
Around 1.5 million young people are living with HIV worldwide, and they often have worse outcomes than adults living with HIV. Taking HIV medicines every day may be particularly hard for young people. New treatment approaches that make it easier for them to take their HIV treatment could help improve their quality of life and clinical outcomes.
The BREATHER+ trial tested short-cycle therapy, where people took HIV medicines for five consecutive days, and then had two days off treatment. This was compared to continuous therapy, where people took their HIV medicines every day. The aim of the trial was to test whether short-cycle therapy was as safe and as effective at keeping the virus under control as the continuous therapy.
To participate in the trial, young people needed to already be on dolutegravir-based antiretroviral therapy and have an undetectable HIV viral load.
After at least two years of follow-up, BREATHER+ found that short-cycle therapy was not as good as continuous therapy in terms of keeping the HIV virus suppressed. The proportion of young people with two consecutive tests with viral loads ≥50 copies/mL was 10% in the short-cycle therapy, compared to 5% of those in the continuous therapy group.
These results reinforce that the current treatment, which involves taking HIV medicines every day, is the best way to keep the virus under control. Therefore, young people living with HIV should continue to take their tablets every day without breaks.
The results from BREATHER+ differ from previous trials of short-cycle therapy, which have found that short-cycle therapy is as good as continuous therapy when used in adults or young people on a different combination of drugs, all of whom had frequent viral load monitoring. This may have helped reduce the risk of confirmed viral load rebound through identifying blips earlier and using adherence counselling to help participants resuppress the virus quickly without returning to continuous therapy.
Although disappointing, BREATHER+ findings were very clear. We are continuing to work on new trials to help young people living with HIV manage their treatment more easily. For example, our LATA trial is investigating whether long-acting injectable HIV medicines work as well as HIV medicines to keep the virus under control. We expect to find out the results from LATA in 2026.
BREATHER+ was funded by the European and Developing Countries Clinical Trials Partnership [RIA2017MC2005] supported by the European Union.
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