Looking toward Vienna: Kenneth Mayer, MD

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Kenneth H. Mayer, MD, Professor of Medicine & Community Health at Brown University and Director of the Brown University AIDS Program

The 2010 International AIDS Conference starts on Sunday. Ken Mayer, MD, is on his way to Vienna to participate, and ScienceSpeaks interviewed him briefly about what studies he anticipates regarding prevention as treatment and other topics at the conference.

Kenneth H. Mayer, MD is a Professor of Medicine & Community Health at Brown University and Director of the Brown University AIDS Program. He is the co-chair of the Global Center’s Scientific Advisory Committee and was recently elected to serve on the International AIDS Society (IAS) Governing Council. As Medical Research Director of the Fenway Community Health Center in Boston, Dr. Mayer has conducted studies of the natural history and transmission of HIV since 1983. While doing his fellowship in Infectious Diseases at Harvard Medical School, Dr. Mayer was one of the first clinical researchers in Boston to see patients with AIDS and HIV infection. He is also an Adjunct Professor at the Harvard School of Public Health.

What topics are you most anticipating regarding HIV prevention at the conference?

There are going to be a couple of study results that look at using antiretrovirals (ARV) as prevention. The biggest headline will be the release of the first efficacy data from CAPRISA 004 study. It involved about 900 South African women looking at whether 1 percent tenofovir gel applied topically as a vaginal gel will protect them from HIV infection. If successful, this would be the first topical ARV identified as protective from HIV infection. And this is big; this would allow women to be in control of their own protection from HIV.

The other PrEP-related findings that will be released at this conference …are part of the CDC safety study. This study followed 400 MSM in three U.S. cities – Atlanta, San Francisco and Boston. This study looks at whether tenofovir is safe and well tolerated in at-risk MSM. It checks if there are lower levels of side effects in healthy people, because HIV positive persons can experience low levels of kidney dysfunction and bone demineralization.

These are the first of many studies that are going to follow over the next couple of years involving ARV treatment as prevention. For example, next February, at the Conference on Retroviruses and Opportunistic Infections (CROI), the Lorex study results will be released looking at emtricitabine and tenofovir as a single pill to prevent HIV infection in MSM.

It is important that there is so much research in this field, because not all prevention methods will work with every population. So now we have to fill in the dots.

What do you see coming out of this?

The broader discussion that comes with these studies involves risk compensation or behavioral disinhibition. If a person is taking a pill intended to prevent HIV infection, will they end up engaging in riskier behavior?

Also, you have a finite amount of dollars in the world to buy ART – clearly you want to see fewer new infections, but on the other hand you want to make sure that those that need medication and are infected are getting medication. So discussion needs to happen regarding that issue as well.

Any thoughts on the news that broke last week from National Institute of Allergy and Infectious Diseases (NIAID) scientists’ discovery of three human antibodies that neutralize more than 90 percent of the current circulating HIV-1 strains? Is this a potential basis for an HIV vaccine?

I think it’s very exciting – the difference between that and say the CAPRISA study is that CAPRISA is the end result of a trial in humans. The NIAID findings are exciting because it’s opening a whole new way of doing the science. Prior to now we didn’t have so many antibodies to block the virus. These were found through a very careful process of discovery. It will be helpful for the field to know what immunized antibodies will look like, now that they’ve seen it.

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