Final HIV Prevention Research Highlights from HIV R4P 2018

Cross-posted from NIAID Now Blog

At this week's HIV Research for Prevention (HIV R4P)Exit Disclaimer conference in Madrid, scientists have reported progress in numerous areas of HIV prevention research. NIAID-supported scientists highlighted the need to expand HIV prevention and treatment services among populations greatly affected by HIV, described early findings from a study assessing the safety of a vaginal ring containing both an anti-HIV drug and a birth-control agent, and reported the added benefits of an intervention designed to facilitate treatment for HIV and injection drug use.

Men who have sex with men (MSM) and transgender women (TGW) at four sites in sub-Saharan Africa have a very high rate of HIV infection­­—6.96 per 100 person-years, on average—according to findings from the HPTN 075 clinical trial. The study is one of the first to measure HIV incidence among MSM and TGW in sub-Saharan Africa. According to the investigators, the new data indicate that there is an urgent need to expand access to HIV prevention services for this population, which experiences high levels of stigma and violence. The investigators measured HIV incidence over one year among 329 MSM and TGW in Kenya, Malawi and South Africa. The rate varied widely by country, with the lowest in Malawi and the highest in South Africa. The findings were presented yesterday at an oral scientific sessionExit Disclaimer and a press conferenceExit Disclaimer.

In a study presented at an oral scientific session today, researchers reported that a substantial increase in viral suppression is needed in the next five years to halve new HIV infections among men who have sex with men (MSM) in Atlanta, a city disproportionately affected by HIV. Because a person who is durably virally suppressed cannot transmit HIV to a sexual partner, an increase in viral suppression at a population level can reduce new cases of HIV. As part of the HPTN 078 study, co-funded by NIH’s National Institute of Mental Health, researchers created a mathematical model based on behavioral data from 2004 to 2014. The model revealed that viral suppression among MSM living with HIV must increase from an estimated 42 percent in 2018 to 71 percent in 2023 to cut the rate of HIV acquisition among Atlanta-area MSM in half. If access to pre-exposure prophylaxis (PrEP) were also expanded among HIV-negative MSM, the model predicts that viral suppression could increase to approximately 68 percent in 2023 and still achieve the same overall reduction in new HIV infections.

A vaginal ring containing both the anti-HIV drug dapivirine and the birth control agent levonorgestrel was as safe as a vaginal ring containing dapivirine alone in a two-week pilot study with 24 female volunteers, researchers announced at a scientific sessionExit Disclaimer yesterday and a press conferenceExit Disclaimer today. Scientists designed the so-called “multipurpose prevention technology” to prevent both HIV and pregnancy. While the small study did not assess the ring’s effectiveness, the new ring was found to achieve expected concentrations of dapivirine and levonorgestrel in the vagina and bloodstream. A 90-day safety study of the experimental ring is under way.

An intervention designed to facilitate treatment for HIV and substance use was associated with a 50 percent reduction in mortality for people living with HIV who inject illicit drugs, the HPTN 074 study has found. The intervention consisted of psychosocial counseling along with guidance and support navigating the healthcare system. In addition, the investigators found that participating in HPTN 074 yielded a broad range of benefits for people living with HIV who inject drugs beyond the immediate goals of the intervention. Study participants reported improvements in social and financial well-being, mental and physical health, and overall quality of life. The findings were presented yesterdayExit Disclaimer and today.

HIV R4P drew to a close today with a plenary session focused on the opportunities and challenges that HIV prevention researchers and advocates face as they strive to help end the HIV/AIDS pandemic. John Mascola, M.D., director of NIAID’s Vaccine Research Center, delivered a lecture on the path forward toward development of a safe and effective vaccine to prevent HIV.

For additional highlights from HIV R4P, read the NIAID Now blog post describing selected research findings from the first two days of the conference.

References 

TGM Sandfort et al. HIV incidence among men who have sex with men and transgender women in sub-Saharan Africa: Findings from the multi-country HPTN 075 cohort study

K Mitchell et al. Potential impact of increased ART and PrEP coverage on the HIV epidemic among MSM in Atlanta: mathematical modelling for HPTN 078

S Achilles et al. Safety and pharmacokinetics of dapivirine and levonorgestrel vaginal rings for multipurpose prevention of HIV and pregnancy

K Dumchev et al. An integrated intervention to increase ART and MAT reduced mortality among PWID: Results from the HPTN 074 randomized trial

J Sugarman et al. Beneficial impacts related to participating in an international HIV prevention trial involving people who inject drugs

J Mascola. A path forward for HIV vaccines