In a recent interview, Dr. Christopher Hurt discussed three studies (HPTN067, the U.S. PrEP Demonstration Project and ATN110) that demonstrate the feasibility of wide-scale implementation of pre-exposure prophylaxis in the United States.
UNC CFAR Investigator Carol Golin, MD, and Alexis Dennis, MPH, Duke Global Health Institute, were recently interviewed about their newly published manuscript, “’You’re in a world of chaos:’ Experiences accessing HIV care and adhering to medications after incarceration.
These findings were announced on Monday, July 20 by researcher Dr. Myron Cohen at the 8th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment & Prevention in Vancouver, Canada. Cohen, UNC’s chief of the Institute for Global Health & Infectious Diseases, has headed the HPTO 052 global research project for a decade and studied more than 1,700 couples.
HPTN 052 began in 2005 and enrolled 1,763 HIV sero-discordant couples – where one person is HIV-infected and the other is not – at 13 sites in nine countries. The majority of the couples were heterosexual (97 percent). HIV-infected partners were assigned to start ART at the beginning of the study, called the “early” arm, or later in the study, called the “delayed” arm. Those on the delayed arm started ART when their bodies’ immune systems were declining. HPTN 052 was funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH).
“These findings demonstrate that antiretroviral therapy, when taken until viral suppression is achieved and sustained, is a highly effective, durable intervention for HIV prevention,” said Myron Cohen, Principal Investigator for HPTN 052. “The HPTN 052 trial was designed to address two questions: whether providing antiretroviral therapy to an HIV-infected person would prevent HIV transmission to a sexual partner, and whether earlier antiretroviral therapy offered long-lasting health benefits, and the answer to both is a
The significance of the research findings cannot be understated – when used consistently, medication can break the chain of HIV transmission and has the potential to eradicate the virus when all infected people die natural deaths. For the foreseeable future, however, such a medical strategy will disproportionately benefit industrialized countries whose residents have wider, though far from universal, access to modern health care.
Click here to see all the UNC IAS coverage.
From the International AIDS Society meeting in Vancouver:
CFAR Dr. Audrey Pettifor’s HPTN 068 trial did not show a decrease in the number of high school-aged girls in South Africa’s rural Mpumalanga area contracting HIV despite the girls being given cash transfers.
“Cash transfers play a key role in social protection in many settings‚ including South Africa‚ but in this study setting they were not protective for acquiring HIV‚” said Audrey Pettifor‚ Study Chair and Associate Professor in the Department of Epidemiology at UNC’s Gillings School of Global Public Health.
The provision of cash conditional on school attendance has been proposed as an intervention to prevent HIV infection in young women. Read more about the study here.
CFAR Investigator Dr. David Margolis has been featured on NPR’s The State of Things talking about how studies led by UNC investigators continue to make progress in HIV prevention, treatment and eradication research. He also discusses in layman’s terms all of the HIV news to come out of the International AIDS Society (IAS) meeting in Vancouver last month.
Research into an HIV cure has come alive recently with the infusion of new funding and new relationships such the UNC-Chapel Hill-GSK partnership as that announced on May 11, 2015. This relationship will launch the formation of a new company, Qura, to develop and take a cure to persons living with HIV.
Several heavily reported cases of possible cure and sustainable HIV remission have also sparked public interest in the field. In 2013, the President of the United States pledged 100 million dollars of funding to the field for the next three years, paving the road for new global research.
The cure field presents new challenges to trial conduct, design, risk, and a host of other issues in the scientific, biological, social, ethical and regulatory fields. There has been an expressed need among members of the community to increase literacy around the growing HIV cure research field in order to adequately participate in and make decisions about HIV cure research. Jessica Handibode, Program Coordinator at AVAC, shared that “Empowering lay or non-scientific stakeholders to be independent decision makers is key to ethical research. The HIV cure research field is complex, but moving quickly. There is a lot of interest, and people receive information from the media about the advances in the research without a context or background understanding.” In response, members of the Martin Delaney International Community Advisory Board (CAB), the MDC Collaboratories (CARE, DARE and defeatHIV), and international community educators from advocacy organizations (including AVAC, The Advocacy Group, and Project Inform) formed a steering committee with the goal of creating a well-rounded HIV cure research training curriculum. The “CUREiculum”, as the group calls it, allows communities the chance to form and voice opinions on the cure research agenda.
Karine Dube, co-chair of the CUREiculum project and Program Manager of CARE, explained that “UNC has been an integral partner in developing and implementing the CUREiculum effort. Since the program aims to strengthen community capacity to participate in and make decisions about HIV cure research, we are very excited about the UNC (academic) – AVAC (advocacy) partnership that the CUREiculum represents.”
This HIV Cure Research “CUREiculum” seeks to strengthen capacity around HIV cure research by providing basic information on a variety of topic areas. The curriculum will be comprised of seventeen individual modules that can be taught individually or as part of a larger set. Each module, developed by a scientific and community lead, will have PowerPoint slides, pre- and post-assessment quizzes and participatory activities for training sessions. Modules include lessons on informed consent, stem cell transplants, vaccines, the latent HIV reservoir, HIV cure trials, early ARV treatment, and ethics, and pediatric cure research.
The target audience for the curriculum is anyone interested in learning more about HIV cure research. Ms. Handibode shared that “new tools and resources will be created and added to cater to different levels of science literacy in the future.” The team hopes that the CUREiculum will be a user-friendly tool to “catalyze the stakeholder engagement effort of HIV cure research” and by independent users to “break down complicated science using interactive methodology.” She shared that “there is a lot of misconception and hyperbole that float around about the state of the field because there were few resources that provide overall context.” The team hopes that “the materials provide that context and build a solid foundation of knowledge amongst interested groups around the globe who may have only seen stories on newsfeeds.”
Currently, there is a real debate happening in the field about accurately describing risks and benefits to participants and examining the vital questions about the goals of cure research. Ms. Handibode explained that “bringing community deeper into this debate is the goal of the CUREiculum”. Questions about how to ethically build capacity in resource limited settings and how to manage expectations in pediatric and adult research are essential in the conversation about cure research, and will pave the way for how the field progresses forward.
UNC CFAR hosted the annual HIV symposium for clinicians and non-clinicians, in conjunction with the The UNC – Chapel Hill School of Medicine, The Center for Infectious Diseases at UNC – Chapel Hill, North Carolina AIDS Training and Education Center, Greensboro AHEC and The Eshelman School of Pharmacy at UNC – Chapel Hill.
This symposium provides health care providers with an update on the care and treatment of HIV infected patients who are now living longer lives. Presentations and discussions centered around management of the HIV/Hep C co-infected patients, pre-exposure prophylaxis, STD update, syphilis/HIV, and caring for adolescent HIV+ patients. A specific track was offered at the conference for case managers, nurses, psychologists and substance abuse counselors who care for HIV infected patients developed to help them address HIV-related issues of HIV adolescent risk perception, support for an adolescent population and cultural competency.
Dr. Myron Cohen, CFAR Investigator and Director of the UNC Institute for Global Health and Infectious Diseases, is featured in the first installment of BBC Radio’s five-part series The Truth about AIDS.
In this episode, Tony Fauci looks back at the scientific breakthroughs that have transformed HIV/AIDS from a death sentence to a disease that can now be treated and prevented. Having watched in horror as his patients quickly died from the disease in the US in the early 1980s, as director of the National Institute of Allergy and Infectious Diseases, he has dedicated his career to fighting it.
Fauci talks to the activists who pushed the development of HIV/AIDS medications forward and the scientists whose discoveries lie at the heart of the global fight against the disease. Dr. Cohen speaks at minute 23 about the groundbreaking treatment as prevention trial.
CFAR Investigators Dr. Joseph Tucker and Dr. Stuart Rennie are experts in the field of HIV research. As a part of their searcHIV project, a multi-site, multi-disciplinary working group focusing on investigating the biosocial implications of curing HIV infection, they have created a Q & A page to answer questions about HIV cure. The goal of the Q&A section is to provide an open, transparent, bidirectional dialogue about HIV cure research.
Read their answers to “How close are scientists to a cure?” and “How do I get selected for an HIV trial” here. More questions and answers will be posted in the months to come.
A team of researchers has discovered HIV can begin replicating in the brain as early as four months after initial infection. After following 72 treatment naïve participants during the first two years of HIV infection, researchers observed that 20 percent of subjects showed replication in the central nervous system (CNS) at four months.
“This shows that viral replication and inflammation can occur early in infection with the concern being that the damage caused could be irreversible,” says study virologist Ronald Swanstrom, PhD, Director of the University of North Carolina’s Center for AIDS Research (CFAR) and Professor of Biochemistry and Biophysics at UNC’s School of Medicine. “HIV and inflammation have the potential to accelerate the aging process and cause neurocognitive impairment, in the extreme case resulting in HIV-associated dementia.”
Read more here.