Beginning to End the AIDS Epidemic: What’s the Research Agenda?

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Capitol Hill briefing highlights research agenda to end AIDS

The following is a guest blog post by Chris Collins, vice president and director of Public Policy at the Foundation for AIDS Research (amfAR) and Mitchell Warren, executive director of AVAC.

A slide from Dr. Baeten's presentation outlining use of truvada as a pre-exposure prophylactic.

Looking back over three decades of AIDS, it’s hard to point to a better investment than research. Over the past three years, a string of HIV prevention research breakthroughs has put the ambitious goal of even talking about an end of AIDS within sight for the first time. With more strategic use of the tools we have today, we can bend the curve of new infections.

Yesterday, leading researchers, policy makers and advocates joined our organizations and the Congressional HIV/AIDS Caucus at a briefing on the research agenda for beginning to end the AIDS epidemic.

Carl Dieffenbach, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases (NIAID), Dázon Dixon Diallo, founder and president of SisterLove, Inc., and Jared Baeten from the University of Washington presented from their unique perspectives on what science is teaching us and how to act on that science.

Dieffenbach provided an overview of the research agenda needed to bring the epidemic to a close, with special focus on a review of the status of existing and upcoming scientific research in two critical areas: combining current interventions effectively to bend the curve of HIV incidence in the coming years, and progress on vaccine and cure research that will be needed to ultimately end the epidemic. “AIDS in America is in some ways becoming a forgotten epidemic. This remains a significant challenge for us as Americans and for us as members of the global community,” Dieffenbach noted.

A slide from Dr. Baeten's presentation showing the impact of combining effective prevention modalities on AIDS incidence.

He outlined remarkable progress at the National Institutes of Health (NIH) and the broader field, across the spectrum of research into HIV prevention options including treatment as prevention and vaccines. He described recent advances in understanding how the vaccine studied in the Thai RV144 trial might have worked to provide the protection that it did, as well as the excitement around recent discoveries of a range of new antibodies that could provide new targets for vaccine research.

“The challenge we face is taking where these antibodies bind on the virus and figuring out how to turn them into an appropriate vaccine,” Dieffenbach said.

Baeten provided an important historical note: 30 years into the HIV epidemic, new research has demonstrated that we now have powerful interventions to prevent new infections. “For the first time, there is rational discussion that we can not just fight HIV, but stop its transmission – on a large scale,” Baeten said.

The panel discussed the recent, historic meetings at the U.S. Food and Drug Administration (FDA) where advisory committees in the past two weeks reviewed both pre-exposure prophylaxis (PrEP) with oral TDF/FTC (Truvada) and OraSure Technologies’ over-the-counter, in-home HIV test. While there are enormous challenges with both, these were presented as opportunities to advance prevention and treatment access.

Baeten talked about the prospect of treatment as prevention: “We need to change the conversation – antiretroviral treatment isn’t just about preventing sickness, it’s about maintaining health.”

All the speakers highlighted the importance of HIV testing as the entry point for HIV prevention and treatment. “It should be a badge of honor to know your HIV status and be on treatment if you have HIV, and on remaining HIV free if you do not,” Baeten said.

Baeten also described testing as a critical component of any future PrEP program, both before initiating PrEP use and for ongoing monitoring, especially to prevent possible drug resistance. He acknowledged the possibility of resistance emerging but talked about ways to manage the risk through regular testing and adherence counseling and support.

Dazon Dixon Diallo outlined the framework communities and researchers together have to work with:

  • Deliver what we have for immediate impact, especially testing, antiretrovirals (ARVs), medical male circumcision, and male and female condoms;
  • Demonstrate the added value of the emerging options, including ARV-based PrEP and microbicides; and
  • Develop new options, especially additional ARV-based options, a vaccine and a cure.

“The toolbox is now growing and it keeps getting bigger,” Diallo said. “Today community is catching up to the new science, but for the first two decades of the epidemic, community was out front in all of it: driving the science, driving the policy, driving all of it. Now we need to be sure science and community work together in realizing the promise of these recent results.”

The panelists all spoke to the importance of considering new interventions in combination. No one intervention will be perfect or enough alone; there is now a growing body of research studying combination prevention and recognizing that each new option is additive, not a replacement.

Looking forward to the upcoming International AIDS Conference to be held July 22-27 in Washington, DC, the briefing made it clear that the message must be,We can end the epidemic; now we must do it.”

We need to finance the response, make strategic choices about what to bring to scale (and what not to) and stop discriminating against high-risk populations.  Whether you’re a researcher, policymaker or advocate, this is the time to press for strategic use of current interventions and accelerated research to begin to end the epidemic.

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