Where Should HIV Research Be Focused in the Future?

The medical community has made incredible strides in the treatment and prevention of HIV over the past couple of decades, but there is plenty more to be accomplished. How can researchers meet the Joint United Nations Program on HIV and AIDS (UNAIDS) benchmark of diagnosing 90% of everyone who has HIV, giving antiretroviral therapy (ART) to 90% of those diagnosed, and seeing that 90% of those on ART achieve viral suppression, all by the year 2020? The key to meeting this so-called 90-90-90 goal, says one expert, may be to meld the discrete areas of research into a more cohesive effort in order to take advantage of the gains being made in very different areas—from scientific advances in clinical trials to the ability of community-health organizations to get people to embrace prevention strategies such as the use of condoms and/or pre-exposure prophylaxis (PrEP).

The gaps in HIV prevention and treatment are real, says Carl W. Dieffenbach, PhD, director of the Division of AIDS at the National Institutes of Health’s (NIH) National Institute of Allergy and Infectious Diseases (NIAID). “You have a large number of HIV-infected individuals that are able to access treatment, and you have a large number who aren’t,” he told Contagion^®. “In the meantime, you have this ongoing level of transmission that’s going on around the world. We still need to do something to protect the HIV-negative people.”

According to Dr. Dieffenbach, a preventive vaccine would be, as he put it in a recent blog post on the NIAID web site, “the ultimate game-changer,” as vaccines are more economical than other preventive measures and don’t require users to adhere to a potentially cumbersome treatment regimen. However, he and other HIV experts say that such a vaccine is years away.

“The vaccines we have either have just entered or are about to enter clinical trials,” Dr. Dieffenbach stated, adding that we’ll still be dealing with only a predicted 50% to 60% level of efficacy that might be achieved. He would like to see clinical trials that combine various prevention and treatment strategies such as one that tests both an HIV vaccine along with effective monoclonal antibodies, or one that might add adult male circumcision to the mix, as that procedure has been shown to offer a 60% to 65% rate of protection from transmission to young heterosexual men in Africa.

“PEPFAR [the government initiative to help stamp out AIDS worldwide] has made adult male circumcision one of their cornerstones,” Dr. Dieffenbach told Contagion^®. “But not every culture can be accepting of this as a strategy.” Circumcision works to prevent the transmission of HIV because the foreskin contains cells that are particularly receptive to the virus.

One particular trial Dr. Dieffenbach is enthusiastic about is the AMP Study, which NIAID is helping to sponsor. AMP, which stands for antibody-mediated prevention, involves intravenously administering an antibody known as VRC01 every 8 weeks. VRC01 was discovered some years ago in the blood of an HIV-positive patient, and by directly infusing it into at-risk individuals instead of waiting for a vaccine to trigger an antibody response, scientists hope to prevent HIV transmission. “People are lining up around the world to get into this study,” according to Dr. Dieffenbach. If it’s effective, he anticipates the next step will be a study that involves a combination of directly administered antibodies, or perhaps an antibody infusion with a vaccine.

The important thing, he stressed, is that the scientific community develop the methods to eradicate HIV and then join up with organizations that can help them implement them in the years to come. “We’re about the innovation, but then we’re about handing off the new, cool tool to the right partners,” he said.

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.