Biomedical AIDS research: Recent and upcoming advances

UNAIDS Biomedical AIDS research Recent and upcoming advances.pdf

UNAIDS have published a report on biomedical AIDS research. Written by Scientific Expert Panel members, it provides summaries of the top ten biomedical research advances in 2014 and highlights five important research findings anticipated for 2015. An overview section presents the views of the Chair of the Scientific Expert Panel.

The topics are divided into three main categories on the advances in:

  1. the treatment of HIV and co-morbidities
  2. HIV prevention
  3. HIV pathogenesis, diagnostics and cure

The report contains a comprehensive bibliography for further reference.

10 highlights of 2014

Biomedical findings have significance for STRIVE, but number 7 is particularly relevant, as it emphasises the need for a structural approach to implementation. Quoting from the report:

  1. Latest epidemiological estimates are a sober reminder that HIV remains a public health threat despite the global decline in new HIV infections. HIV is increasing in some groups such as gay men, other men who have sex with men (MSM) and young women in southern Africa. Further, the number of people living with HIV continued to rise (to about 35 million in 2013) because of people newly acquiring infections and because of improved survival as a result of antiretroviral therapy (ART) becoming more widely available.
  2. ART coverage expands to 13.6 million people, but several million more still to go. Almost 14 million people are receiving treatment, but the challenges of retaining people in care and the prospect of antiretroviral resistance are emerging. Scaling up ART among children also remains a significant challenge. 
  3. Prevention benefits of treatment. New results from serodiscordant couples showed no linked transmission events if the HIV-positive partner had a viral load of less than 200 copies/ml. Clinical therapeutic benefits of earlier initiation of ART and modelling studies estimated the cost–effectiveness of earlier ART.
  4. The world takes a step closer to eliminating the mother-to-child transmission (MTCT) of HIV. New results in 2014 confirmed the effectiveness of triple ART among pregnant women (option B) in preventing mother-to-child transmission (PMTCT). 
  5. At last. A cure for hepatitis C. Clinical trials showed more than 90% cure rate with sofosbuvir when used in combination with simeprevir or ledipasvir. These results are set to change the hepatitis C landscape, provided the drug is made available at an affordable price.
  6. Oral antiretroviral prophylaxis is highly effective in preventing HIV among gay men and other MSM and among serodiscordant couples. The use of daily oral pre-exposure prophylaxis by the HIV-negative partner in serodiscordant couples for the first six months after the HIV-positive partner initiated ART reduced HIV acquisition substantially. 
  7. A new focus on marginalised key populations. Studies have highlighted the challenges of prevention among and treatment access by key populations, who tend to use too few health services and who are discriminated against in many societies. Failure to provide HIV services to these groups undermines global progress in the HIV response.
  8. Antibody findings bring new hope for a vaccine. Hope for a vaccine rose substantially in 2014 based on new animal data showing that broadly neutralizing antibodies, while effective in preventing a simian/human immunodeficiency virus challenge in monkeys, may also have therapeutic benefits and even raised the prospect of a cure.
  9. Mississippi baby not cured. One of the greatest disappointments of 2014 was the report that the Mississippi baby turned out to be harbouring HIV in quiescent reservoirs. A new study in 2014 showed that the reservoir is seeded very early during HIV infection, even before HIV can be detected in the blood. 
  10. A future for gene therapy? A study among 12 people showed that a genetic approach to treatment, where the CCR5 gene is “edited”, was both feasible and safe. This study investigated the impact of CCR5-modified autologous CD4 T-cell infusions on CD4 cell counts, a promising approach that requires substantial further research.

Research findings expected in 2015

Again, one area of enquiry is most directly relevant to STRIVE: number 3 below.

  1. The first in-human neutralizing antibody trial results. Results are expected from the study of VRC01, a broadly neutralizing monoclonal antibody to reduce MTCT.
  2. Sustainability of the prevention and prognostic benefits of early ART initiation among HIV-serodiscordant couples. Follow-up of participants in the HPTN 052 trial ends in 2015 and is expected to provide data on the sustainability of the effect of ART in preventing HIV infection.
  3. Cash incentives for HIV prevention in adolescents. The results of the CAPRISA 007 trial and the HPTN 068 are expected in 2015/6.
  4. Novel vaccine candidates. Safety studies of a recombinant CMV-HIV vector vaccine, which has shown promise in animal model experiments, are expected to start soon.
  5. HIV cure strategies by activating the latent reservoir. The results from several HIV cure-related clinical trials evaluating latency activation with romedepsin and high-dose disulfiram, immunomodulation with anti-PD1 and enhanced approaches using gene therapy to eliminate CCR5 are also likely to become available in late 2015.

UNAIDS Scientific Expert Panel

Created in 2013, this body serves to enhance scientific contributions in HIV policy and programming. It comprises more than 40 scientists from around the world with expertise in a wide range of disciplines, including epidemiology, behavioural science, virology, diagnostics, pathogenesis, immunology, treatment, prevention and cure.

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