Advances in HIV treatment options and studies on HIV prevention for women and girls were among the highlights yesterday at the 10th International AIDS Society Conference on HIV Science (IAS 2019). On the third and final day of the conference, Carl Dieffenbach, Ph.D., Director of the Division of AIDS at NIH's National Institute of Allergy and Infectious Diseases (NIAID), and his colleague Anne Rancourt joined us for a Facebook Live session to discuss those studies, reflect on key meeting takeaways, and look ahead to research developments on the horizon.
Here's additional information on the issues and study findings highlighted in this conversation:
HIV treatment developments: A number of studies presented findings about HIV treatment options at the conference. These included studies focused on improving fixed dose (one-tablet-per-day) combination antiretroviral treatment (ART) by testing regimens with fewer drugs (i.e., two drugs rather than three), fewer side effects, and better durability. Other studies reported on investigations into long-acting HIV treatment options—including less frequent tablet regimens and injectable or implantable anti-HIV medication. Further study in both arenas is required, but both additional options for daily ART and long-acting regimens may be available in the future. Dr. Dieffenbach observed that such developments would give patients more choice in their HIV treatment regimens. For more information, see the abstracts from the session "Recent developments in antiretroviral therapy."
HIV prevention for women and girls: Dr. Dieffenbach and Ms. Rancourt also discussed the need for better prevention options to address high rates of HIV acquisition among young women and adolescent girls in sub-Saharan Africa. Young women and girls account for 3 million of the 4 million people aged 15-26 with HIV in the region. The NIH-sponsored HIV Prevention Trials Network (HPTN) reports that recent clinical trials had unacceptably high HIV incidence rates of 5-6% per year among young African women in this age group. Currently available forms of HIV prevention for women are limited, and many women are unable to negotiate condom use with male sexual partners. Dr. Dieffenbach and Ms. Rancourt discussed findings from two studies presented at the conference offering insight into improving HIV prevention options for this population:
One study, known as HPTN 082, examined how daily oral pre-exposure prophylaxis (PrEP) could be best implemented in the population. After counseling with research staff, 95% of the young women in this study accepted PrEP and a high percentage of this group returned for their first clinic visit 30 days later to pick up additional PrEP. Unfortunately, by the end of the 12-month study, only 31% of participants had detectable drug levels in their blood and only 9% had drug levels associated with high adherence. The take-away, says Dr. Dieffenbach, is that we have much to do to make sure PrEP can work well for this critical population, including finding better ways to support adherence and to reduce stigma related to PrEP. View the study abstract and read the NIAID news release.
Researchers also presented findings from the NIH-supported HIV Open Label Extension (HOPE) trial, which tested the efficacy of a vaginal ring that is inserted once a month and slowly releases the antiviral drug dapivirine. The wearer replaces the product herself once every four weeks. The study participants were women in southern and eastern African who had previously participated in the ASPIRE ring efficacy trial. ASPIRE and a sister trial called The Ring Study demonstrated in 2016 that the dapivirine ring reduced the risk of HIV infection by roughly 30% in women ages 18 to 45 years and was well-tolerated. Women from ASPIRE were invited to participate in the HOPE study whether or not they chose to accept or use the dapivirine ring. Ninety percent of the HOPE study participants chose to accept the ring at the study outset, and uptake remained high throughout the study, though it declined to 79% by month nine. Furthermore, 90% of the rings returned in routine study visits had evidence of some use. Statistical modeling by the HOPE study team estimated that the ring reduced the risk of acquiring HIV by 39% for those who used it. The dapivirine ring is now under regulatory review by the European Medicines Agency (the EU equivalent of the US FDA). Read NIAID's press release and view the HOPE study abstract.
Key conference take-aways: Dr. Dieffenbach shared his thoughts on key take-away messages from IAS 2019. These included the need for a wider range of choices for HIV prevention and the emergence of promising data on a growing variety of options:
He also noted that on the treatment front, studies presented indicate that HIV treatment continues to get better, safer, and easier to use.
Check out the video of their Facebook Live conversation for Dr. Dieffenbach's forecast of research developments to watch for in the near term.
About the Conference
The biennial IAS Conference on HIV Science is the largest open scientific conference on HIV and this year assembled more than 5,000 participants from more than 140 countries. This conference presents the latest critical advances in basic, clinical, and operational research that move science into policy and practice. Findings from research supported by the NIH as well as the Centers for Disease Control and Prevention and USAID were among the more than 1,000 abstracts presented.
Read more about Long-Acting HIV Prevention Tools.
[Note from TheBody: This article was originally published by HIV.gov on July 25, 2019.]