Progress and pitfalls in prevention at AIDS 2016
- New estimates from both UNAIDS and the Global Burden of Diseases Study suggest that HIV incidence has not declined substantially in the past 5 years.
- “Why haven’t we beaten this epidemic?” asked Charlize Theron (whose Africa Outreach Project works to combat HIV/AIDS among young people) in an impassioned and rousing speech at the opening session. “Too expensive, too daunting, too politicized: these are not answers, just excuses. The real answer is we value some lives more than others. We value men more than women, straight love more than gay love, white skin more than black skin, the rich more than the poor, and adults more than adolescents.”
- One of the great unmet needs in HIV prevention is an effective and usable approach for women
- Just ahead of the meeting, the Kaiser Family Foundation reported that contributions from donor governments fell in 2015 for the first time in 5 years, from US$8·6 billion in 2014 to $7·5 billion.
HIV/AIDS: Growing Unmet Need & Declining Interest?
- Yet with the rapid level of pharmaceutical innovation against HIV, prevalence remains high, and growing at surprisingly rapid rates in several “Western” countries. India and South Africa are becoming countries with large populations of HIV positive patients.
- The prevalence of treated AIDS patients varies substantially from country to country, with Brazil and (surprisingly) the United Kingdom leading the way. Outside the traditional major pharmaceutical markets, however, is where the numbers become scary. For example, the HIV Prevalence in India is “only” 0.3%. But due to the large population, that translates to over 2 million people living with HIV, which is nearly half the total of the HIV prevalent population in the 8 major markets combined. The fraction of these patients who are actively treated is uncertain.
- So while AIDS remains a problem with no effective solution in sight, progress has definitely been made in a relatively short period of time. Effective antiretroviral therapies, coupled with increased awareness of the importance of overall health (such as reduced smoking), is driving this trend. Now, physicians advise their patients that a normal life span is possible if treatment is continued as prescribed, especially for patients with an early diagnosis. Indeed, we may have reached the point that “clean living” has resulted in many AIDS patients outliving their otherwise healthy peers. But again, life expectancy correlates with early diagnosis.
- The challenges associated with the development of an HIV vaccine are tremendous, many of which with no easy solution:
- Live, attenuated, viral vaccines are not advisable due to the risk of reinfection;
- Good animal models for human HIV remain elusive;
- Retrovirus can “hide” by incorporating their genome onto ours, so complete elimination of infected cells may be impossible;
- Favorable pricing and reimbursement for a modestly successful vaccine will be challenging.
- Now that AIDS and HIV is no longer in the news as it once was, awareness of the disease has actually declined. According to the CDC, 44% of HIV positive individuals 18-24 years of age do not know they are HIV positive. Perhaps it is the good news about declining cases of HIV infection which is relegating this to a disease of the past. Indeed, HIV infection is no longer the death sentence that it once was. But, a) disease prevalence is growing globally, and b) regional reductions in incidence do not translate to disease eradication, which should be the goal of any infectious disease program.
- Phase III: Of the 15 programs in Phase III, four of them are combinations of various existing antivirals developed by multinationals (J&J, ViiV, and Merck). Eleven out of the fifteen are small molecules. It is unclear if any of these will have a dramatic impact on how HIV/AIDS is currently treated.
- Phase II: There are 21 vaccines and 13 cell therapy programs in Phase II. Big Pharma has a significant presence in vaccine development, with Johnson and Johnson, GSK, Sanofi Pasteur, and others sponsoring development programs. Cell therapies and monoclonal antibody approaches are also being explored in the clinic, with the latter targeting the CD4 binding site of gp120.
- Phase I: Nearly 60% of the Phase I programs are vaccines. A cursory glance suggests that the majority of these programs are driven by small companies and universities, although Merck appears to have at least two Phase I vaccine programs in their pipeline.
- Discovery and Preclinical – There are nearly 300 programs at this early stage of development, and they include small molecules, peptides, vaccines, and cell and gene therapies.
RESEARCH SHOWS PROMISING TRENDS IN HIV TESTING AND EARLIER DIAGNOSIS AMONG GAY AND BISEXUAL MEN—BUT MANY LIVING WITH HIV STILL HAVE UNMET NEEDS
- CDC reported an increasing percentage of gay and bisexual men who have had a negative HIV test during the 12 months before being diagnosed with HIV (48% in 2007 and 56% in 2013 among those with a known previous negative HIV test). These findings suggest a trend toward increased HIV testing and earlier HIV diagnosis among persons most at risk for HIV—a positive outcome from focused HIV testing.
- Lack of awareness of available services or insufficient resources for obtaining them were listed as barriers to these important services. Meeting the needs of young black and Hispanic/Latino gay and bisexual men who reported substantial unmet needs for ancillary services could help address the age and racial/ethnic disparities in HIV diagnoses and HIV-related health outcomes.
- The control of HIV is an ongoing process, one that starts with HIV testing, continues through diagnosis and linkage to care, and ends with viral suppression, a state that allows for the best possible health of the individual living with HIV and greatly reduces the risk of transmission.
Unmet needs among men with human immunodeficiency virus in community mental health care: a cross-sectional study. Durbin A, Sirotich F, Antoniou T, Roesslein K, Durbin J, Lunsky Y. AIDS Care. 2016 Jul;28(7):878-83. doi: 10.1080/09540121.2016.1154133. Epub 2016 Mar 13.
- Despite living in a setting with universal health insurance, men with HIV receiving community mental health support had greater unmet need in basic and health domains than HIV-negative men receiving such support.
- Further research is required to develop and evaluate interventions to best support community-dwelling persons with HIV and mental health disorders.
AIDSWAtch 2016 – AIDS United
- Summary of Legislative Asks