BREATHER Plus: Can adolescents with HIV safely take weekends off treatment?

Daily pill-taking is a heavy burden for the 1.5 million adolescents living with HIV worldwide, nearly 90% of whom are in sub-Saharan Africa — a group that consistently struggles with adherence and faces poorer outcomes than adults. BREATHER Plus is the first randomised trial to ask whether a “short-cycle” approach — five days on treatment, two days off over the weekend — works as well as daily therapy when using modern dolutegravir/tenofovir-based ART. Running across Kenya, South Africa, Uganda and Zimbabwe, the trial enrolled 470 virologically suppressed young people aged 12 to under 20 and is tracking whether viral rebound rates stay non-inferior to continuous daily treatment over 96 weeks. If it works, short-cycle therapy could offer adolescents genuine choice in how they manage lifelong treatment — fewer pills, less toxicity, and weekends free from the daily reminder of their status.