HIV Cure Research Highlights at IAS 2014
By Karine Dubé – 29 July 2014
Despite the viral load rebound of the Mississippi child in July 2014 (NIH news release), the IAS 2014 meeting in Melbourne, Australia revealed that we are in the midst of the golden age for HIV cure research. Dr. Jack Whitescarver opened the two-day HIV cure research symposium on July 19 – 20, 2014 by re-affirming that HIV cure research remains a top priority of the U.S. National Institutes of Health (NIH).
Major HIV cure research highlights at the IAS 2014 meeting relevant to the searcHIV include:
HIV Cure Research Symposium: July 19- 20, 2014 (Program at a Glance)
- Dr. Debbie Persaud (John Hopkins)’s update on the Mississippi child at the HIV cure research symposium on July 19th, 2014. The Mississippi child remained with undetectable replication-competent CD4+ T cells for 27 months off therapy. Using phylogenetic analysis, scientists confirmed mother-to-child transmission of HIV-1 infection to the child following virological rebound. While this case underscores the unique challenges of HIV cure research, the Mississippi child case study is a success story in that it led to new insights in the path towards pediatric HIV cure research. This case also highlights the unpredictable nature of virological rebound as well as the need to plan for long-term longitudinal follow-up during analytical treatment interruption in HIV-1 cure studies. Dr. Persaud discussed the various ways to improve on the Mississippi child study, including starting treatment earlier and adding monoclonal antibodies to the treatment regimen.
- Dr. Edwina Wright (Australia) led a roundtable on the topic of analytical treatment interruption (ATIs) at the HIV cure symposium on July 19th, 2014. The panel emphasized that ATIs are needed in HIV cure research, but must be performed safely as there are no predictive parameters of virological rebound. Close monitoring of patients will also remain extremely important, with viral measurements performed twice weekly if possible. We will also need more research into the biomarkers that presage viral rebound. Jeremy Sugarman emphasized that ATIs should be justified scientifically and ethically. Procedures to ensure patient agency, voluntariness, consent and fair selection of the participants should be safeguarded.
- Dr. Dan Barouch (Harvard University)’s groundbreaking presentation at the HIV cure research symposium on July 19th, 2014 that the HIV viral reservoir can be established within 3 days of infection in the SIV rhesus monkey models. This finding shows the difficulty of curing HIV infection, even when early treatment is initiated. The results were published in the Nature in July 2014 (http://www.ncbi.nlm.nih.gov/pubmed/25042999).
- Dr. Paula Munderi (Uganda) led a panel discussion on the preparedness for HIV cure research in resource-limited settings at the HIV cure research symposium on July 20th, 2014. Two HIV cure research modalities would be best suited for implementation in the developing world at this time, including early ART and pediatric HIV cure research. Implementation of HIV cure research in resource-limited settings will require education, infrastructure development and the recognition that HIV cure research is prone to failure. Joseph Tucker recommended that implementation of HIV cure research be done in the context of strengthening health systems.
- Dr. Joseph Tucker (UNC-CH) and Colleagues’ poster on stakeholder engagement and lessons learned from other fields was presented at the HIV cure symposium on July 19th – 20th, 2014. This team analyzed five examples of HIV interventions targeted at both higher-risk HIV-uninfected and HIV-infected individuals, including 1) HIV vaccines, 2) PrEP, 3) treatment as prevention (TasP), 4) PMTCT and 5) treatment during acute HIV infection. Based on this analysis, the team proposed a five-step process to promote stakeholder engagement in HIV cure research (abstract).
Main Conference Program – HIV Cure Research Highlights:
- Dr. Jintanat Ananworanich (MHRP)’s plenary presentation on July 21st, 2014 on the state of HIV cure research. Dr. Ananworanich mentioned that there has been remarkable progress in the field of HIV cure research in recent years, although we do not yet know the main biomarkers of HIV remission. Main achievements include: 1) early ART as a modality to prolong the time to virological rebound; 2) advancements in measuring the size of the HIV reservoir and measuring replication-competent provirus; and 3) research into new strategies to eliminate HIV persistence, including therapeutic vaccinations and use of latency reversing agents. Dr. Ananworanich concluded her talk by emphasizing the need to put social and ethical considerations at the forefront. (Session information, webcast and PowerPoint presentations)
- Drs. David Margolis (UNC-CH), Jeffrey Lifson (NCI) and Sarah Palmer (Australia)’s Cure 101 session on July 22nd, 2014. This session was so popular that it had to be repeated later the same day. This panel of scientists facilitated discussion around key concepts in HIV cure research, including the differences between cure, functional cure and remission. Workshop participants also gained an understanding of the HIV reservoir and how it can be measured as well as insights into how scientists are proposing to reduce or eliminate the size of the HIV reservoir. Bill Whittaker, from the National Association of People with HIV Australia (NAPWHA) provided an overview of current community questions and concerns. (Session information and PowerPoint presentations)
- The Community Engagement Event on HIV Cure Research on July 22nd, 2014 was a success. Professor Barré-Sinoussi (IAS 2014 co-chair) emphasized the need to engage in a strong dialogue with communities in the search for a cure. Anna-Laura Ross (IAS) introduced the IAS HIV Cure Initiative, which aims at facilitating scientific discussion, exchange and collaboration to promote and accelerate research towards a cure for HIV and provide leadership in advocating for increased investment and resource optimization in HIV cure research. Dr. Diana Finzi from NIAID/DAIDS provided an overview of HIV cure research in 2014 and NIH’s plans for the future to support basic and translational research, pilot clinical studies and phase I – IV clinical trials. David Evans (Project Inform) gave an overview of the role of community in HIV cure research. The workshop included a discussion of the role of media in reporting HIV cure research (Session information and PowerPoint presentations).