CROI Research Highlights Affirm Strength of New HIV Discoveries

The 2024 Conference on Retroviruses and Opportunistic Infections (CROI), held in Denver, Colorado, provided an opportunity for global exchange of research findings and community voices on HIV and other infectious diseases. While I have attended CROI many times over the years it was particularly exciting to see the renewed energy and focus on HIV. There were still talks focusing on Covid but there were also fewer people wearing masks and excitement about interacting more closely again. I always appreciate gaining new insights from the incredible depth and breadth of HIV research underway today, much of it supported by NIH. Presenters at CROI introduced novel foundational science findings, implementation strategies, and intervention approaches. Many new discoveries came from early career investigators, and community advocates shared their valuable lived experiences with stigma and other challenges that persist among people with HIV.

In this piece, I am pleased to share select highlights and impressions from the research and commentary shared at CROI.

Foundational Science Findings

Basic scientific research remains critical to global efforts to end the HIV pandemic. At CROI, researchers presented some groundbreaking new discoveries, including:

• Four children born with HIV who were treated with antiretroviral therapy (ART) within 48 hours of birth experienced remission for more than a year after stopping treatment in an NIH-funded study.
• The size of the HIV reservoir in people with HIV who restarted ART following a period of interruption seems to be influenced by the timing of their initial ART initiation. Those who started ART during the early or acute stages of HIV infection saw their reservoir return to baseline levels upon resuming ART. However, for people who began ART during the chronic stage of HIV infection, the reservoir remained elevated even after restarting ART.
• Researchers presented findings that deepen our understanding of how HIV assembles and matures, knowledge that will enable investigators to develop new interventions.

Early Career HIV Investigators

Research from early career investigators (ECIs) was prominently featured throughout the event. For example:

• One ECI-led study found that in a large pregnancy cohort from Zambia, women with HIV were less likely to experience preeclampsia—a high blood pressure complication and common cause of maternal and fetal morbidity—compared to those without HIV.
• Another ECI-led study revealed that Tat, a viral protein that drives HIV expression but is neurotoxic, could be modified to remove its toxicity and delivered as a latency reversal agent for use in HIV reservoir and cure studies.

ECIs remain essential to enhancing the sustainability of research discovery and the implementation of findings by a diverse workforce, and NIH is committed to effectively supporting their needs.

Implementation

Some CROI presenters focused on the implementation of new technologies and clinical approaches to HIV. Highlights included:

• Researchers emphasized the efficacy of personalized approaches to Pre-exposure prophylaxis (PrEP), including user preferences, phone calls, and adherence benchmarks.
• A plenary session on the future of diagnostics for HIV and related infections highlighted that 14 percent of people with HIV worldwide and 13 of people with HIV in the United States do not know their status. In the United States, 92 percent of new HIV transmissions involve people who do not know their HIV status or are not receiving care.
• The elevated cardiovascular disease risk among people with HIV is even greater than predicted by a standard risk calculator in several groups, including Black people and cisgender women, according to analyses from a large international clinical trial primarily funded by NIH. The risk of having a first major cardiovascular event was also higher than previously predicted for people from high-income regions and those whose HIV replication was not suppressed below detectable levels.

As HIV prevention, treatment, and cure interventions are shown to be efficacious, their findings must be translated to inform practice and to connect with communities and the general public in order to maximize their public health impact. Implementation research can identify how best to facilitate effective adaptation, uptake, integration, and scale-up of evidence-based HIV interventions.

Interventions

Intervention tactics are an essential step towards ending the HIV pandemic. Researchers at CROI revealed some effective and popular new intervention methods that reduce the occurrence of both HIV and other sexually transmitted infections (STIs).

• Study sites in Seattle and San Francisco conducted a clinical trial offering doxycycline post-exposure prophylaxis (doxyPEP) to participants and active PrEP users during clinic visits. Researchers observed high demand for doxyPEP and noted a significant decline in overall STI incidence, particularly for chlamydia and syphilis.
• In a plenary session on HIV diagnostics, a speaker reported that app-based digital engagement with HIV self-testing in a South African study led to 99 percent linkage to care.

Knowledge gleaned from fundamental, pre-clinical, and translational research to inform clinical trials and other intervention studies are a main focus of the NIH Strategic Plan for HIV and HIV-Related Research.

Community Advocates

Community advocates and people with lived experience with HIV continued to bring critical perspectives to formal and informal discussions at CROI. For example, Frank Mugisha, Ph.D., a Ugandan LGBTQI+ advocate and executive director of Sexual Minorities Uganda (SMUG) International, spoke at the opening plenary about the importance of community access to results and resources from HIV research in light of stigma and discrimination toward the LGBTQI+ community.

“Scientists have made gains; advocates have made gains,” Dr. Mugisha said. “All the gains we have made over the years are getting reversed, not only in Africa but here [in the United States] as well. It is urgent that we need to work together, and we need to look at homophobia and transphobia as a global problem; it is not only an African problem.”

Another community perspective came from Victor Reyes, who shared his experience as someone born with HIV in the 1990s, a time when children born with HIV were not expected to live into adulthood. Now a father himself—celebrating his son’s first birthday on the day of his talk—Reyes is an after-school program director and advocate for children and adolescents with perinatally acquired HIV. Reyes highlighted the need for dedicated biomedical and behavioral research to support people with perinatally acquired HIV, whose needs are often distinct from other adults aging with HIV. Reyes. His powerful remarks reminded all of those in attendance of the incredible ultimate impact of HIV research discoveries.

Looking Ahead

I was impressed by the rigor and the diversity of voices, research, and personal testimonials presented at CROI. Reflecting this diversity in the future of the NIH HIV research program is essential to building on scientific progress to end the HIV pandemic. To that end, OAR is actively seeking input on the next NIH Strategic Plan for HIV and HIV-Related Research. Please consider providing feedback by March 28 to help inform the future of the NIH HIV research program.

Read the previous blog.