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News from IAS
As the recent IAS Conference on HIV Science in Paris has shown, extraordinary progress continues to be made against HIV. And, as Rebecca Benson reports, findings of an Aussie-led study took centre stage.
It was arguably the scene-stealing news of the three-day conference: results from a ground-breaking Australian-led study unequivocally validated that people with HIV on treatment with an undetectable viral load cannot pass the virus on to their sexual partners. In short: undetectable equals untransmittable. Even shorter: U=U.
In the Opposites Attract study, 358 couples reported almost 17,000 acts of condomless anal sex with zero HIV transmission. “Our research means that we can say, with confidence, that effectively treated HIV blocks transmission in couples of differing status,” said chief investigator Professor Andrew Grulich. “This is a massive relief for these couples and means undetectable viral load is up there with condom use in eliminating HIV transmission.”
Described as “life-changing”, the news was seized upon by advocates. “The evidence from Opposites Attract adds further strength to the U=U tagline of the Prevention Access Campaign,” said Gus Cairns of aidsmap. The campaign — set up to promote the U=U message — has garnered worldwide support. Of the Australian findings, its founder, Bruce Richman, said: “This is transmission-stopping information.”
Dr Anthony Fauci (pictured), one of the world’s leading immunologists and head of the US National Institute of Allergy and Infectious Diseases, said the findings put scientists in a remarkable position. “We never like to use the word ‘never’ of a possible risk. So it’s an unusual situation when the overwhelming evidence allows us to be confident that what we are saying is fact.”
In response to the news, UNAIDS released a document stating: “This knowledge can be empowering for people with HIV. The awareness that they are no longer transmitting HIV sexually can provide people living with HIV with a stronger sense of being agents of prevention in their approach to new or existing relationships.” It’s also hoped that the U=U message will help break down discrimination against people with HIV. “There should be no reason to fear a person with HIV,” said Professor Grulich, “and there should be no reason why there should be any stigma against a person with HIV.”
Child ‘virtually cured’
Other news from the IAS conference that made world headlines was that of a South African nine-year-old who had contracted HIV at birth but who was now showing no signs of an active virus. After being given a burst of treatment shortly after being born, the child has remained HIV-free for eight-and-a-half years. The case boosted hopes among researchers of finding a functional cure for HIV.
“It captures the imagination,” said Professor Diana Gibb of University College London. “It is exciting to see cases like this.” There have only been two previous examples of long-term HIV remission in a child following early, limited treatment of antiretroviral drugs. The first — dubbed the Mississippi baby — remained viral free for 27 months; the second, a French child, now 20, stopped treatment at age six and has maintained virus suppression ever since.
The South African child’s doctor, Avy Violari, doesn’t believe remission has been achieved by treatment alone. “We don’t really know why this child has achieved remission — we believe it’s either genetic or immune system-related,” she said. Replicating remission through new drugs or a vaccine would have the potential to help other people living with HIV. “By studying these cases, we hope we will understand how one can stop [treatment],” said Dr Violari.
The next revolution
Injectables are poised to revolutionise the treatment of HIV. Early data presented at the IAS conference has shown that injections of HIV drugs every one or two months are as effective as a daily pill regimen. During a 96-week trial, participants were administered antiretroviral treatment orally via a daily pill, a monthly injection or a two-monthly injection. Results showed, of those on the single tablet, 84 percent suppressed the virus, compared to 87 percent with monthly injections, and 94 percent with two-monthly injections.
Dr David Margolis, one of the researchers behind the ViiV Healthcare study, said: “Long-acting antiretroviral injections may represent the next revolution in HIV therapy by providing an option that circumvents the burden of daily dosing.” ViiV Healthcare is repackaging two of their HIV medicines (cabotegravir and rilpivirine) into tiny nanoparticles that can be injected into muscle. This provides long-lasting protection as the nanoparticles slowly release their contents into the body.
Reviewing the research, Professor David Cooper from the Kirby Institute said: “The study marks yet another remarkable milestone in the evolution of HIV therapeutics.” A larger and longer-term study is already underway to try to confirm the results.
Cure turns to cancer drugs
The search for a cure for HIV has led researchers to turn their attention to new cancer treatments. In recent years, outstanding progress has been made in boosting the immune system against cancer, with some patients recording complete remission. The hope is that the same drugs can be used to clear HIV.
Much like HIV, cancer evolves to survive attacks by the immune system. Cancer cells can produce proteins on their surface which disables any assault. However, a new class of immunotherapy drugs — checkpoint inhibitors — keep the immune system fighting. So far, the results have been promising. In one trial, a fifth of people with terminal melanoma cleared the disease after receiving the new drugs.
“That raises the question whether we could develop a strategy for HIV cure similar to the novel treatment in the field of cancer,” said Nobel Prize-winner and co-discoverer of HIV, Francoise Barre-Sinoussi. Speaking at the HIV Cure & Cancer Forum, Professor Sharon Lewin, of the Doherty Institute in Melbourne, agreed that the similarities between HIV and cancer could prove fruitful: “There are a lot of parallels … I think it’s huge.”
- Success has been made. For the first time, more people with HIV — 53 percent — are on treatment than not.
- 90-90-90 is achievable. Seven countries — Botswana, Canada, Denmark, Iceland, Singapore, Sweden and the UK — have already hit the target, and many more are very close to it.
- Early diagnosis is key. The earlier people are retained in care, the quicker they’ll reach an undetectable viral load.
- BNabs, baby! Broadly neutralising antibodies are showing great potential to be powerful tools for HIV prevention and treatment in the future.
- Inching towards a vaccine. The so-called ‘mosaic vaccine’ — currently being clinically trialled on humans — has shown to be well-tolerated and capable of generating an anti-HIV immune response.