May 25, 2012
Finally, the beginning of the end of the AIDS epidemic is in our sights thanks to the growing number of "tools" in our HIV eradication toolbox, which includes behavioral interventions, biomedical interventions and microbicides, to name a few. Effective implementation of these intervention strategies is framing the research agenda as scientists, clinicians, policy-makers, community-based workers and other HIV/AIDS advocates grapple with the question, "how can we most effectively deploy these strategies to end AIDS once and for all?"
On Wednesday May 23rd, amfAR, The Foundation for AIDS Research, and AVAC: Global Advocacy for HIV Prevention, in cooperation with the Congressional HIV/AIDS Caucus, hosted a Capitol Hill briefing on "Beginning to End the AIDS Epidemic: What's the Research Agenda?" The panelists included Carl Dieffenbach, PhD, Director, Division of AIDS, NIAID; Dazon Dixon Diallo, MPH, Founder and President, SisterLove, Inc.; and Jared Baeten, MD, PhD, Associate Professor, Departments of Global Health and Medicine, and Adjunct Associate Professor, Department of Epidemiology, University of Washington. They reviewed the existing and upcoming scientific research with special focus on microbicides, pre-exposure prophylaxis (PrEP), treatment as prevention, vaccines, and the search for a cure for HIV/AIDS.
HIV prevention research has a two-pronged approach: 1) combination HIV prevention to reduce the number of new infections, and 2) finding a cure to ultimately reduce the burden of HIV around the world. The latter would most likely come in the form of a vaccine. Currently, HIV therapy is extremely effective in reducing an HIV-positive person's viral load but it is not curative. That is, once an infected person discontinues his or her drug regimen, viral replication can rebound due to residual virus reservoirs. The reservoirs must be found and then eradicated in order to engineer a cure, defined as permanent remission in the absence of a continued antiretroviral therapy.
One promising large-scale HIV vaccine trial, known as RV144, emerged three years ago from the Thailand Ministry of Public Health, U.S. Military HIV Research Program (USMHRP) and National Institute of Allergy and Infectious Diseases (NIAID). RV144 showed that administering a combination of two vaccine candidates sequentially lowered the risk of HIV infection by 31%. "To be clear, the level of efficacy demonstrated by this vaccine is a modest one. However, it is the first time that we have ever seen a positive signal of efficacy in a human trial of any HIV vaccine -- a welcome and exciting result in a field that has been characterized by many disappointments for more than two decades," stated Anthony Fauci, NIAID Director, when the study results were announced in September of 2009.
Additionally, the panelists emphasized the incorporation of translating research literary into community practice, and vice versa, into the research agenda. As Dr. Dieffenbach pointed out, scientific breakthroughs are groundbreaking and encouraging, but if they cannot be translated into products that the community can use, then the failure falls on everyone's shoulders. Piloting community participatory-based research is one recommended approach to address this challenge. When questioned on how to implement new strategies in a context where there is not as much enthusiasm, Diallo believes it comes down to simple questions: "Do you want to end the AIDS epidemic or not?" "Do we want to pay now or pay later?" "How does the United States want to end their legacy on AIDS?" When Americans begin to face these questions, then they can decide whether the chapter on AIDS is ending -- or never-ending.