April 4, 2014
In a field of research as rapidly evolving as HIV, new developments come fast and furious; anticipating the research that's most likely to make waves can be a challenge. That's why we turn to experts for their thoughts, predictions and educated guesses.
While at CROI 2014, one of the biggest HIV research conferences of the year, we asked attendees -- some of the world's most well-informed HIV researchers, clinicians and advocates -- what developments they were most eager to see this year. Their responses span a wide range of topics, and testify to the activity and excitement that still pervades HIV research more than three decades into the pandemic.
Zero Transmissions From Condomless Sex
"We've known for a while that people on suppressive therapy are much less likely to infect a partner. We saw a presentation from the highest possible risk cohort, the PARTNER study, in which the negative partner has the highest-possible-risk -- sex, MSM (men who have sex with men), anal receptive, with ejaculate exposure from their positive partner on therapy. In their study, albeit of only a few hundred men, observed for only a year, there were zero transmissions in the men on therapy, even though these guys were at the highest possible risk for transmission.
"That's pretty important because, number one, we didn't know that. We hoped for that, but there it is. Number two, there are still possible ways in which this is an overstatement of it, and it could go wrong. There are lots of ways it could go wrong. But I think it will increase the passion around treatment as prevention because, even with the highest risk, condomless anal sex, this is working. So I think that if anything might infuse an extra level of importance, to me that was stunning."
-- Calvin Cohen, M.D., M.S., Director of Research, Community Research Initiative of New England, Boston.
Emerging Therapies and Cure Strategies
"As a longtime treatment activist, I'm always interested in what the new emerging therapies are looking like. But increasingly the work around cure and helping us understand what some of our targets can be is very exciting to me. I think it's also really interesting to talk about PrEP (pre-exposure prophylaxis), and how we might actually be able to use it more broadly."
-- Dawn Averitt, The Well Project.
Simpler Regimens and Less Frequent Doses
"I think there's an interesting paradigm developing in HIV, whether we're going to see the further development and refinement of single-tablet regimens that are once-daily, with great tolerability. The cobicistat-assisted darunavir, the elvitegravir-cobicistat have already been great and the coming of dolutegravir and abacavir/3TC are all very exciting options.
"At the same time, there's an emerging second stream of agents that might be given once a month, or agents that might be given once every two months. So the issue about what will be better for keeping people who are in care, and keeping people engaged -- whether it's less frequent dosing regimens or simple, easy, well-tolerated once daily -- that's something that I'm looking forward to seeing data about."
-- Richard Elion, Director of Clinical Research, Whitman Walker Health.
Expanding Prevention Access and Technologies
"I'm most eager to see the new developments in HIV prevention technology. A lot of this has to do with the use of things like vaginal rings, films, PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis), and how those different forms can really expand access to HIV prevention.
"But I'm also really interested in seeing how some of the most affected populations, like drug users and the transgender community, how they can really use these interventions and be able to afford it and have access to it. Basically, prevention justice, access to any of these prevention modalities and being able to have full use of them as these new technologies are coming out in the landscape."
-- Suraj Madoori, Coordinator, HIV Prevention Justice Alliance.
Long-Acting HIV Treatment
"I think one of the most exciting things that we're seeing here is a presentation from the LATTE study, which is actually taking a look at switching from a combination of three drugs to a combination of two drugs in oral versions of GSK744, which is an integrase inhibitor, plus oral rilpivirine, which is a currently improved NNRTI (non-nucleoside reverse transcriptase inhibitor).
"What's really important about this study is that documenting the efficacy of those two drugs to maintain viral load suppression will allow us to conduct another study, which will be looking at long-acting versions of those agents, which are basically liquid formulations. They're nano-suppression formulations which will be infused intramuscularly and administered only once a month.
"So we need to see that these two drugs being used together can maintain viral load, which is really a groundbreaking study looking at the use of long-acting drugs to maintain viral load suppression in people living with HIV."
-- Tim Horn, HIV Project Director, Treatment Action Group.
Easier Adherence and PrEP
"I was very excited about the new GSK compound, the new integrase inhibitor. It has a very long half-life, but what's more interesting is that there's these new formulations where persons with HIV or at risk for HIV could potentially give themselves intramuscular injections that could last up to three months. So I think that could be a really big breakthrough, in terms of really solving this whole issue around adherence to antiretrovirals."
-- Antonio Urbina, M.D., Associate Medical Director, Spencer Cox Center for Health, St. Luke's-Roosevelt Hospital, New York.
For More Information
To explore the issues raised by these HIV care providers, researchers and advocates in more depth, check out the following resources on TheBodyPRO.com: