Policy

Jul. 27, 2022
AIDS 2022 spotlights a game-changing tool to prevent sexually transmitted infections and key advances in HIV cure research
Studies highlighted at the 24th International AIDS Conference provide insights on new and existing strategies to help end the HIV epidemic.

27 July 2022 (Montreal, Canada) – New studies presented at AIDS 2022, the 24th International AIDS Conference, hosted by IAS – the International AIDS Society – demonstrate promising advances in the global HIV response.
 
Speaking at a virtual press conference, authors shared:

  • Successful results from a trial of the antibiotic doxycycline to prevent sexually transmitted infections (STIs)
  • Reports of two adults in long-term remission off antiretroviral therapy (ART)
  • A new method using microfluidics to define a biomarker of the HIV reservoir
  • News of Botswana surpassing global 95-95-95 targets to nearly eradicate the epidemic in the country
  • Promising results of a triple-therapy regimen for people living with both HIV and hepatitis B

“A cure remains the Holy Grail of HIV research,” Sharon Lewin, IAS President-Elect and Director of The Peter Doherty Institute for Infection and Immunity, said. “We have seen a handful of individual cure cases before, and the two presented today provide continued hope for people living with HIV and inspiration for the scientific community. What’s more, we are now seeing an advance in the great challenge of finding a biomarker for the HIV reservoir – a truly exciting development.”
 
Today’s scientific press conference highlighted six studies selected from thousands of abstracts being presented over the next week in Montreal and virtually. 
 
Doxycycline significantly reduces risk of STIs after condomless sex by 65%

The DoxyPEP study found that taking 200mg of doxycycline within 72 hours of condomless sex significantly reduces the risk of gonorrhoea, chlamydia and syphilis among men who have sex with men and trans women. Among those randomized to take doxycycline, 65% fewer were diagnosed with an STI each quarter than those not taking doxycycline.

Participants in the study were male sex at birth, living with HIV or taking HIV pre-exposure prophylaxis (PrEP) and had a history of an STI and condomless sex with a male partner within in the past year. They were randomized 2:1 to take open-label doxycycline after condomless sex versus continued standard of care without doxycycline.

Among the 327 participants taking PrEP, there was a 66% reduction in new STIs per quarter (doxycycline 10.7% versus control 31.9%, p<0.001). Of the 174 participants living with HIV, there was a 62% reduction per quarter with doxycycline (11.8% vs 30.5%, p<0.0001).

Participants reported taking doxycycline 87% of the time after condomless sex; 54% reported taking fewer than 10 doses per month, 30% took 10-20 doses per month, and 16% took more than 20 doses per month. No serious or > Grade 2 adverse events were attributed to doxycycline.

Analyses of the impact of intermittent doxycycline on antimicrobial resistance and the gut microbiome are ongoing.

The DoxyPEP study was stopped early in May 2022 when a planned interim analysis showed that those randomized to take doxycycline had substantially fewer STIs.

Co-principal investigator Annie Luetkemeyer, Professor of Medicine at Zuckerberg San Francisco General Hospital at University of California, San Francisco, noted that doxycycline taken after sex is a promising prevention strategy for populations disproportionately impacted by high rates of STIs.
 
"DoxyPEP represents an important advance in reducing STIs within two vulnerable populations – men who have sex with men and transgender women," Lewin said. "I look forward to learning more about the implementation of this prevention measure and any long-term effects of using antibiotics for STI prevention."

The trial was funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, through grant R01AI143439. It was conducted at the HIV clinic at Zuckerberg San Francisco General Hospital and the San Francisco City Clinic, both part of the San Francisco Department of Public Health, and the Madison Clinic and the Sexual Health Clinic at Harborview Medical Center, both at the University of Washington.
Abstract and session: Doxycycline post-exposure prophylaxis for STI prevention among MSM and transgender women on HIV PrEP or living with HIV: high efficacy to reduce incident STI's in a randomized trialCo-Chairs Choice (13231, Track B)
 
Stem-cell transplant recipient becomes fourth known adult case of HIV cure
 
A 66-year-old Caucasian man who received a stem cell transplant is the fourth known person to go into HIV remission. Data presented today by Jana Dickter of City of Hope describes the case of the man, diagnosed with HIV in 1988, who received chemotherapy and an allogeneic hematopoietic stem cell transplant (aHCT) after developing acute myelogenous leukaemia in 2018. Previously, he had an undetectable HIV-1 viral load on ART for many years.

The transplant recipient continued ART for 25 months after aHCT and his ART levels remained undetectable 12 months post-analytic treatment interruption. As of 14 months after stopping treatment and 39 months post-transplantation, there is no evidence of HIV RNA rebound and no detectable HIV DNA.
 
Declining HIV-1 specific humoral and no detectable HIV-specific cellular immune response was observed. The man’s CD8-depleted peripheral blood mononuclear cells remained uninfected after an ex vivo challenge with HIV R5 strains. Immunological studies 37 months after the aHCT and 12 months post-analytic treatment interruption showed a robust response to cytomegalovirus stimulation and no response to HIV CD4 and CD8 T cells.
 
This case may open up the opportunity for older people living with HIV and blood cancer to receive a stem cell transplant and go into remission for both diseases.

For more information, visit
 
Abstract and session: The 'City of Hope’ Patient: prolonged HIV-1 remission without antiretrovirals (ART) after allogeneic hematopoietic stem cell transplantation (aHCT) of CCR5-Δ32/Δ32 donor cells for acute myelogenous leukemia (AML)
Late breaker Track B (12508, Track B)
 
Latest functional cure case sheds new light on post-treatment controllers
 
A 59-year-old woman with sexually acquired HIV and enrolled in the “Immune-mediated PHI trial” has maintained an undetectable viral load for more than 15 years without ART. Núria Climent, researcher at Hospital Clínic-IDIBAPS/University of Barcelona, presented an analysis of her case.
 
After receiving antiretroviral and immunomodulatory treatment, including eight weeks of cyclosporine, during primary HIV infection, the woman has maintained undetectable viral load in plasma for more than 15 years without ART. A pronounced and progressive fall of the viral reservoir was observed in total HIV-DNA (from 4,573.50 to 95.33 copies/106 CD4+ T-cells) and integrated proviral DNA (from 85.37 to 5.25 copies/106 CD4+ T-cells).
 
The authors noted that study results showed that replication-competent HIV-1 could be isolated by qVOA. They also reported that NKG2C+-memory-like NK-cells and Yd+CD8+ T-cells could contribute to the control of viral replication and functional cure observed.

For more information, visit.  

 
Abstract and session: Exceptional post-treatment control associated with strong NK and ϒɗ cytotoxic T-cells, Responding to the virus: Advance in HIV immunology (5149, Track A)
 
Advances in the search for a biomarker for the HIV reservoir 
 
Eli Boritz of the Vaccine Research Center (VRC) at the National Institute of Allergy and Infectious Diseases (NIAID) presented results from a study using a custom microfluidics process that was developed for gene expression profiling of rare HIV-infected cells, including those cells harbouring latent HIV DNA genomes.
 
The research team, which included scientists from VRC/NIAID, UCSF and Brigham and Women’s Hospital, used a microfluidic droplet-sorting technology termed FIND-Seq (Focused Interrogation of cells by Nucleic acid Detection and Sequencing) to sequence the transcriptomes of HIV DNA+ memory CD4 T cells from the blood of six people living with HIV who received long-term ART initiated during chronic infection. Host cell transcriptomic profiles of HIV DNA+ and uninfected memory CD4 T cells were compared by differential gene expression, co-expression network analyses and gene ontology.
 
HIV DNA+ memory CD4 T cells showed inhibition of six transcriptomic pathways, including death receptor signalling, necroptosis signalling and Ga12/13 signalling. Gene co-expression network analysis revealed two small gene clusters associated with HIV DNA+ cells. Gene ontology revealed significant enrichment of these clusters for factors related to gene regulation, RNA processing and the regulation of cell activation, proliferation and survival. Individual genes in these clusters included HIV transcriptional activators that were lower in HIV DNA+ cells and HIV silencing factors affecting both transcriptional and post-transcriptional steps in HIV gene expression that were higher in HIV DNA+ cells.
 
The results presented by Boritz describe HIV-infected memory CD4 T cells as a distinctive cell population with gene expression patterns that can promote HIV persistence through HIV latency, cell survival and cell proliferation.
 
Abstract and session: Transcriptional programs of HIV silencing and cell survival in HIV-infected memory CD4 T cells under antiretroviral therapy, Co-Chairs choice (12900, Track A)
 
First-ever comparison of TAF versus TDF in people living with HIV and hepatitis B virus (HBV)
 
A Phase 3, multi-country ALLIANCE study comparing bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) and dolutegravir + tenofovir disoproxil fumarate (DTG+F/TDF) for the treatment of adults with both HIV-1 and HBV found that B/F/TAF resulted in superior HBV DNA suppression and significantly more HBeAg seroconversion despite both B/F/TAF and DTG+F/TDF having high HIV suppression at one year.
 
Study participants were randomized 1:1 to initiate blinded treatment with B/F/TAF or DTG+F/TDF; primary endpoints were proportion of participants with HIV-1 RNA <50 copies/mL and plasma HBV DNA <29 IU/mL at 48 weeks. Antiretroviral regimens containing tenofovir are currently recommended for most people living with HIV and HBV, but this is the first randomized study evaluating TAF versus TDF in treatment-naive individuals with co-infections.
 
Those treated with B/F/TAF had numerically higher HBsAg and HBeAg loss, HBeAg seroconversion and ALT normalization. However, both ART regimens achieved HIV-1 RNA <50 copies/mL (95% versus 91%) with mean CD4 gains of 200 and 175 cells/mL, respectively. The most frequent adverse events were upper respiratory tract infection, COVID-19, pyrexia, ALT increase and nasopharyngitis. ALT flares occurred in 11 participants but resolved.
 
Anchalee Avihingsanon of HIV-NAT, Thai Red Cross AIDS Research Centre, noted that the clinical course of HBV in individuals with HIV is marked by accelerated disease progression, and this study represents an important advancement in successfully treating the many people living with HIV/HBV.
 
"The ALLIANCE study findings are very exciting given the superior activity of B/F/TAF on hepatitis B markers," Lewin noted. "These findings not only have implications for people living with both HIV and hepatitis B, but also for the many people living with HBV alone."
 
Abstract and session: Week 48 results of a Phase 3 randomized controlled trial of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) vs dolutegravir + emtricitabine/tenofovir Disoproxil Fumarate (DTG+F/TDF) as initial treatment in HIV/HBV-coinfected adults (ALLIANCE), Co-Chairs choice (12565, Track B)
 
Botswana achieves 95-95-95 targets
 
Botswana has become one of the very few countries to surpass the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, a population-based survey confirmed. The survey found that 95.1% of people living with HIV in Botswana were aware of their status, nearly all (98%) of those aware of their status were on antiretroviral therapy, and 97.9% of those on ART achieved viral suppression.
 
Since offering free HIV treatment to all citizens, Botswana has expanded treatment coverage and implemented test-and-treat programmes that provide immediate treatment to people who test positive for HIV.
 
The rigorous, population-based survey involved visiting thousands of households to offer HIV and viral load testing.
 
Presenter Madisa Mine of the Botswana Ministry of Health and Wellness noted that the country is well-positioned to end its HIV epidemic by 2030 despite the fact that approximately one in five adults in Botswana are living with HIV.
 
"The results from this large-scale survey of Botswana's progress are truly breath-taking,” Lewin said. “This important milestone demonstrates exactly what evidence-based policies can deliver."
 
Abstract and session: Botswana achieved the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets: Results from the Fifth Botswana HIV/AIDS Impact Survey (BAIS V), 2021Poster presentation (12921, Track C)
 
New UNAIDS report launches today
 
Also timed with the conference, UNAIDS will launch a new report entitled In Danger: The UNAIDS Global AIDS Update 2022. Noting the impact of recent crises on the global AIDS response, the report will outline the latest changes in access to HIV resources and new data on the number of global acquisitions.
 
The report will be made available online later today at www.unaids.org
 
Note: Press summaries are based on abstracts; final data presented at the conference may change.

 
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IAC  the International AIDS Conference  is the premier global platform to advance the HIV response. As the world’s largest conference on HIV and AIDS, it sits uniquely at the intersection of science, advocacy and human rights, bringing together scientists, policy makers, healthcare professionals, people living with HIV, funders, media and community. Since its start in 1985, the conference continues to serve as an opportunity to strengthen policies and programmes that ensure an evidence-based response to HIV and related epidemics.

The 24th International AIDS Conference – known as AIDS 2022 – will be hosted in Montreal, Canada, and virtually from 29 July to 2 August 2022.

For more information, visit www.aids2022.org


IAS – the International AIDS Society – convenes, educates and advocates for a world in which HIV no longer presents a threat to public health and individual well-being. After the emergence of HIV and AIDS, concerned scientists created the IAS to bring together experts from across the world and disciplines to promote a concerted HIV response

Today, the IAS and its members unite scientists, policy makers and activists to galvanize the scientific response, build global solidarity and enhance human dignity for all those living with and affected by HIV.

The IAS also hosts the world’s most prestigious HIV conferences: the International AIDS Conference, the IAS Conference on HIV Science and the HIV Research for Prevention Conference. 


For more information, visit www.iasociety.org.
 
Jul. 27, 2022

Progress in prevention and treatment is faltering around the world, putting millions of people in grave danger. Eastern Europe and central Asia, Latin America, and the Middle East and North Africa have all seen increases in annual HIV infections over several years. In Asia and the Pacific, UNAIDS data now show new HIV infections are rising where they had been falling. Action to tackle the inequalities driving AIDS is urgently required to prevent millions of new HIV infections this decade and to end the AIDS pandemic.

MONTREAL/GENEVA, 27 July 2022—New data from UNAIDS on the global HIV response reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are at risk as a result. The new report, In Danger, is being launched ahead of the International AIDS Conference in Montreal, Canada.

Globally the number of new infections dropped only 3.6% between 2020 and 2021, the smallest annual decline in new HIV infections since 2016. Eastern Europe and central Asia, Middle East and North Africa, and Latin America have all seen increases in annual HIV infections over several years. In Asia and the Pacific – the world’s most populous region – UNAIDS data now shows new HIV infections are rising where they had been falling. Climbing infections in these regions are alarming. In eastern and southern Africa rapid progress from previous years significantly slowed in 2021. There is some positive news, with notable declines in new HIV infections in western and central Africa and in the Caribbean, but even in these regions, the HIV response is threatened by a tightening resource crunch.

“These data show the global AIDS response in severe danger. If we are not making rapid progress then we are losing ground, as the pandemic thrives amidst COVID-19, mass displacement, and other crises. Let us remember the millions of preventable deaths we are trying to stop,” said UNAIDS Executive Director Winnie Byanyima.

Faltering progress meant approximately 1.5 million new infections occurred last year – over 1 million more than the global targets.

Marked inequalities within and between countries, are stalling progress in the HIV response, and HIV is further widening those inequalities.

New infections occurred disproportionately among young women and adolescent girls, with a new infection every two minutes in this population in 2021. The gendered HIV impact, particularly for young African women and girls, occurred amidst disruption of key HIV treatment and prevention services, millions of girls out of school due to pandemics, and spikes in teenage pregnancies and gender-based violence. In sub-Saharan Africa, adolescent girls and young women are three times as likely to acquire HIV as adolescent boys and young men.

During the disruptions of the last few years, key populations have been particularly affected in many communities – with rising prevalence in many locations. UNAIDS data have shown increasing risk of new infections faced by gay men and other men who have sex with men (MSM) globally. As of 2021, UNAIDS key populations data show MSM have 28 times the risk of acquiring HIV compared to people of the same age and gender identity while people who inject drugs have 35 times the risk, sex workers 30 times the risk, and transgender women 14 times the risk.

Racial inequalities are also exacerbating HIV risks. In the United Kingdom and United States of America, declines in new HIV diagnoses have been greater among white populations than among black people. In countries such as Australia, Canada and the United States, HIV acquisition rates are higher in indigenous communities than in non-indigenous communities.

The report also shows that efforts to ensure that all people living with HIV are accessing life-saving antiretroviral treatment are faltering. The number of people on HIV treatment grew more slowly in 2021 than it has in over a decade. And while three-quarters of all people living with HIV have access to antiretroviral treatment, approximately 10 million people do not, and only half (52%) of children living with HIV have access to lifesaving medicine; the gap in HIV treatment coverage between children and adults is increasing rather than narrowing.

The AIDS pandemic took a life every minute, on average, in 2021, with 650 000 AIDS deaths despite effective HIV treatment and tools to prevent, detect, and treat opportunistic infections.

“These figures are about political will. Do we care about empowering and protecting our girls? Do we want to stop AIDS deaths among children? Do we put saving lives ahead of criminalization?” asked Ms Byanyima. “If we do, then we must get the AIDS response back on track.”

There were significant differences between countries. Some of the countries with the biggest increases in the number of new HIV infections since 2015 included: Philippines, Madagascar, Congo and South Sudan. On the other hand, South Africa, Nigeria, India and United Republic of Tanzania had some of the most significant reductions in the numbers of HIV infections even amidst COVID-19 and other crises. Examples of progress point toward what effective pandemic response requires – with some of the strongest progress where community-led services, enabling legal and policy environments, and equitable services are clearest.

The report sets out the devastating consequences if urgent action is not taken to tackle the inequalities which drive the pandemic. It shows that on the current path the number of new infections per year would be over 1.2 million in 2025 – the year in which United Nations member states have set a goal of fewer than 370 000 new HIV infections. That would mean not just missing the pledge on new infections but overshooting that pledge by more than three times. Millions of avoidable HIV infections every year are making it ever harder and more expensive to ensure people living with HIV have access to lifesaving treatment and the targets to end the AIDS pandemic by 2030 are reached.

Global shocks including the COVID-19 pandemic and the Ukraine war have further exacerbated risks for the HIV response. Debt repayments for the world’s poorest countries reached 171% of all spending on healthcare, education and social protection combined, choking countries’ capacities to respond to AIDS. Domestic funding for the HIV response in low- and middle-income countries has fallen for two consecutive years. The Ukraine war has dramatically increased global food prices, worsening food insecurity for people living with HIV across the world, making them much more likely to experience interruptions in HIV treatment.

At a moment when international solidarity and a surge of funding is most needed, too many high-income countries are cutting back aid, and resources for global health are under serious threat. In 2021, international resources available for HIV were 6% lower than in 2010. Overseas development assistance for HIV from bilateral donors other than the United States of America has plummeted by 57% over the last decade. The HIV response in low- and middle-income countries is US$8 billion short of the amount needed by 2025. Global trade rules are obstructing low- and middle-income countries’ production of pandemic-ending medicines, including new and emerging long-acting HIV medicines, and keeping prices unaffordably high for these countries to procure at scale.

“When international support has been most needed, global solidarity has stalled. Leaders must not mistake the huge red warning light for a stop sign. This must become a moment for a surge of international support,” said Ms Byanyima.

It is still possible for leaders to get the response back on track. This requires both national action and international solidarity. Last year leaders agreed a roadmap, set out in the Political Declaration on HIV and AIDS, which can end AIDS by 2030 – if leaders fulfil it. It is eminently achievable and affordable – indeed, ending AIDS will cost much less money than not ending AIDS. Importantly, actions needed to end AIDS will also better prepare the world to protect itself against the threats of future pandemics.

The proven package for success includes; community-led, people-centred services; the upholding of everyone’s human rights, the removal of punitive and discriminatory laws, and the tackling of stigma; the empowerment of girls and women; equal access to treatment including new health technologies; and health services, education, and social protection for all.

“We can end AIDS by 2030 as promised,” said Ms Byanyima. “But what it takes is courage.”

Jul. 27, 2022