BREAKTHROUGHS ANNOUNCED FROM THE RECENT INTERNATIONAL CONFERENCE ON HIV/AIDS (AIDS2024, JULY 2024 IN MUNICH, GERMANY)

The AIDS 2024 Conference brought groundbreaking scientific updates and significant changes in the global response to HIV/AIDS, as well as community-led initiatives, efforts to address major issues related to access to the latest scientific information and products, and a promise of new political commitments to sustain an effective HIV response – all aimed at “Putting People First”!

Below are some key breakthrough points highlighted from the sessions at the AIDS 2024 Conference:

1. Curing HIV:

The conference is poised to be a groundbreaking event in the field of HIV cure as three known individuals who have been cured of HIV shared their stories in a pre-conference session. Adam Castillejo (formerly known as the London patient), Marc Franke (the Düsseldorf patient), and Paul Edmonds (the City of Hope patient) shared their journeys. Their hope is to inspire researchers and people living with HIV to continue striving for a cure for everyone.

Following this was the story of the “next Berlin patient” – a 60-year-old man who received a stem cell transplant for leukemia in 2015, stopped antiretroviral therapy in 2018, and has remained HIV-free for over five years since. Notably, this time, for the first time, the donor had only one CCR5-delta32 mutation instead of two, a genetic factor associated with HIV resistance. This may hold promise for large-scale HIV cure strategies based on gene therapy.

Many HIV cure studies continue to show promising prospects, and people living with HIV are encouraged to adhere to regular treatment to maintain a healthy quality of life.

2. “Long-Acting” Technology

Currently, three pharmaceutical companies are testing, producing, and announcing three lines of long-acting HIV pre-exposure prophylaxis drugs:

Cabotegravir (CAB-LA) by GSK, an injection given once every two months, has been approved in over 20 countries, with Vietnam still on the waiting list for approval. Lenacapavir by Gilead, an injection given once every six months, is still undergoing trials, with no official approval information in any country yet. MK-8527 by MERCK, currently in phase 3 clinical trials as a monthly oral medication.

Winnie Byanyima, Executive Director of UNAIDS, described Gilead’s twice-yearly Lenacapavir injection as a “miracle prevention tool” for HIV. Results from the PURPOSE 1 trial, presented at AIDS 2024, confirmed that Lenacapavir provides 100% protection against HIV infection in transgender women.

Alongside the excitement from this discovery are calls from activists for “Access for All.” Questions have been raised about the cost of Lenacapavir and whether this miracle tool is too expensive to be used in low- and middle-income countries. As former IAS President Sharon Lewin pointed out during the closing session, “medical breakthroughs only matter when those who need the drugs can access them.”

Long-acting injectable products offer a more discreet option compared to daily PrEP, addressing challenges in daily medication access and adherence. Two years ago, WHO urged countries to consider long-acting injectable Cabotegravir (CAB-LA), a safe and highly effective HIV prevention option. However, cost has been a major barrier, keeping it out of reach in low- and middle-income countries.

To date, real-world implementation studies of CAB-LA on the African continent have been lacking, and AIDS 2024 saw the release of critical evidence to fill this gap. In Uganda and Kenya, over half of the participants in the SEARCH Dynamic Choice HIV prevention trial opted to start CAB-LA over oral PrEP or PEP.

3. Leadership, Policy, And Funding:

One of the biggest obstacles to realizing the vision of ending the HIV pandemic as a public health threat and personal welfare issue by 2030 is the decline in funding. UNAIDS pointed out that international funding for HIV in 2023 dropped by nearly 20% from its peak in 2013. It stated that the $19.8 billion available for HIV programs in low- and middle-income countries in 2023 falls short by nearly $9.5 billion of the amount needed by 2025.

German Chancellor Olaf Scholz reaffirmed Germany’s strong commitment to the HIV response, announcing at the opening session that Germany has become the 39th signatory of the Global Partnership to Eliminate All Forms of HIV-Related Stigma and Discrimination by 2030. Close to the conference, the Mayor of Munich called on the state of Bavaria to legalize drug injection rooms, and Munich became a “Fast-Track City” on the opening day of the conference.

Over 370 parliamentarians from more than 45 countries unanimously committed to “Putting People First” in rebuilding political support to end HIV transmission as part of the Declaration to establish the Global Parliamentary Platform for HIV and AIDS.

4. HIV Is Still Here And At A Crossroads

At the conference, UNAIDS shared the latest updated global data on HIV. The data showed that new HIV infections have decreased by 39% globally since 2010 – and by 56% in Central, Eastern, Southern, and Western Africa. However, the reality remains that every 2 minutes, someone is newly infected with HIV, and there are concerns that the world will not achieve the UNAIDS 95-95-95 targets by 2030.

The report showed that 39.9 million people were living with HIV in 2023 (up from 39 million in 2022). Approximately 1.3 million people acquired HIV in 2023 – more than three times the target of capping it at 370,000 by 2025.

Around 630,000 people died from AIDS-related illnesses globally in 2023 – one death every minute, far exceeding the target of reducing AIDS-related deaths to just 250,000 by 2025. Compared to the 95-95-95 targets, the results achieved are still at 86-89-93.

A study led by UNAIDS highlighted the cost of “inaction” and the failure to achieve the targets. It showed that if we do not reach the 95-95-95 targets, the humanitarian cost would include 34.9 million new HIV infections and 17.7 million AIDS-related deaths from 2021 to 2050. The economic cost of “inaction” will be over $8,200 per person in low- and middle-income countries by 2050. “Silence is not an option,” the researchers concluded.

5. DoxyPrEP And DoxyPEP:

AIDS 2024 saw the introduction of the term “DoxyPrEP” (pre-exposure prophylaxis against bacterial infections using doxycycline) to complement the more widely known “DoxyPEP” (post-exposure prophylaxis against bacterial infections using doxycycline). Researchers from around the world presented findings demonstrating the effectiveness of DoxyPEP in preventing sexually transmitted infections (STIs).

A trial from Canada involving men who have sex with men, living with HIV, and with a history of syphilis, showed a 79% reduction in syphilis, a 92% reduction in chlamydia, and a 68% reduction in gonorrhea in the doxycycline group compared to the placebo group. A study from Japan on female sex workers showed a reduction in STI rates from 232.3 to 79.2 per 100 person-years. The syphilis rate dropped to zero; there was a significant reduction in chlamydia and no significant change in gonorrhea.

The STI rate among young women using PrEP in Central, Eastern, Southern, and Western Africa is very high. Previous research has shown that DoxyPEP effectively prevents STIs in cisgender men and transgender women but not in cisgender women due to low usage rates of DoxyPEP, with barriers such as side effects, medication burden, stigma, and concerns about partner reactions.

A major question raised is the potential for antimicrobial resistance (AMR) with prolonged use of doxycycline. Large-scale and continuous surveillance is needed to gather more evidence on AMR.

6. Stigma, Discrimination, and Criminalization:

The aforementioned obstacles to the HIV response have not lessened. On the contrary, an analysis of data from 842,169 people, including 70,109 people living with HIV, across 33 African countries revealed the interconnected impact of stigma on reduced engagement at all stages of HIV care. Researchers analyzed three stigma measures, all associated with reduced HIV testing rates in the past year: 1) discriminatory attitudes towards people living with HIV (reported by 36% of people); 2) shame related to associating with people living with HIV (18%); and 3) perceived HIV stigma (79%). When community-level discriminatory attitudes increased by 50%, people living with HIV were 17% less likely to use ART and had a 15% lower viral load suppression rate.

More than half of the 18,430 healthcare workers across Europe expressed concerns about providing care to people living with HIV. Nearly half of the 8,128 participants in a study on HIV criminalization and stigma conducted in Eastern Europe and Central Asia reported experiencing stigma in healthcare settings.

Theo iasociety.org