Letters from the Director: Focus on Prevention: Reflections from HIVR4P

Greetings! I recently returned from Madrid, Spain where Dr. Paul Gaist of the OAR and I attended the HIV Research for Prevention (HIVR4P) 2018 conference. It is the only global conference that focuses on biomedical HIV prevention research and provides a venue for connecting with other HIV prevention experts. Reducing the number of new cases of HIV remains a top research priority for the NIH and there is a need to decrease the number of new cases—1.8 million globally in 2017^[1]—to control the pandemic. The NIH prevention agenda combines biomedical research into new or improved strategies—including vaccines and nonvaccine methods—and addresses the behavioral and social factors that impact prevention.

People who are at risk for HIV infection can take HIV drugs to prevent it, a measure known as Pre Exposure Prophylaxis (PrEP). Studies of systemic PrEP medications looked at retention, impact on the pandemic, and research on long-acting formulations, such as implants or injectables. Studies of long-acting PrEP^[2] included preventive use of the HIV-treatment drugs cabotegravir for men and rilpivirine for women. Additional research examined the effectiveness of topical PrEP medications applied vaginally or rectally to prevent HIV upon exposure.

The Antibody Mediated Prevention (AMP) trials test broadly neutralizing antibodies (bNABs) for prevention and will provide insight into how cutting-edge research may lead to novel prevention strategies. Earlier research demonstrated that certain bNAbs can block infection by several strains of HIV. AMP is testing whether the VRC01 antibody can prevent HIV acquisition, the appropriate dose, and how long the protection lasts. Full enrollment of 4,625 participants was completed this fall.^[3]

Researchers presented updates on current HIV vaccine studies, including the major clinical trials HVTN 702 and HVTN 705; their findings will be available in 2020 and 2021, respectively. The Global HIV Vaccine Enterprise released a new report on a 5-year plan to accelerate the research pipeline to develop an HIV vaccine.

Discussion of Treatment as Prevention (TasP) research as the basis for the undetectable = untransmittable (U=U) movement provided hope for many people with HIV and their partners. U=U refers to the findings that people with HIV who take their antiretroviral medicine as prescribed and maintain an undetectable viral load have effectively no risk of transmitting HIV to their sexual partners.

A key theme that emerged throughout the conference was the concept of choice in HIV prevention. Effective and appropriate options are important to meet people’s varying needs. To understand and address the prevention needs of populations disproportionately affected by HIV, we need to combine behavioral and social science interventions with biomedical ones. Kostyantyn Dumchev’s presentation, “An Integrated Intervention to Increase ART [Antiretroviral Therapy] and MAT [Medication-Assisted Therapy] Reduces Mortality Among PWID [People Who Inject Drugs]: Results from the HPTN 074 Randomized Trial,” provided an example of a scalable HIV intervention that combined system navigation and psychosocial counseling. The intervention resulted in a strong impact on mortality among people who inject drugs. Other studies looked at how to reach female sex workers, girls and young women, transgender women, men who have sex with men in sub-Saharan Africa, and other key populations.

I had the pleasure of facilitating a session on Contraception and HIV Risk: Still Between a Rock and a Hard Place and participating on a discussion panel on Human Centric Vaccine Discovery.

A few studies looked specifically at women’s preferences for a vaginal HIV prevention product and found that women want a product that is highly effective, multipurpose in that it provides protection against HIV and pregnancy, and easy to use (e.g., does not require daily use). The preference for the form the product takes varied greatly among the women studied.^[4] Some studies, such as the POWER study—Prevention Options for Women Evaluation Research—found that partner or parent disapproval can affect PrEP use.^[5] This type of behavioral research is key to developing products that people will use once they are on the market.

One thing is clear: To gain control of the epidemic and stop new infections from occurring, prevention options need to be further developed and expanded. Integrating behavioral and social sciences research into early biomedical prevention studies will enable us to develop effective implementation strategies to reach more people.

The NIH looks forward to continued collaboration with U.S. and global colleagues in advancing HIV prevention science.

More highlights and information from this conference may be found: www.hivr4p.org.

Maureen M. Goodenow, Ph.D.
Associate Director for AIDS Research and
Director, Office of AIDS Research
National Institutes of Health

^[1]  UNAIDS. 2018. “Global HIV & AIDS Statistics — 2018 Fact Sheet.” Available at http://www.unaids.org/en/resources/fact-sheet.
^[2]  Nassaka, F. 2018. "Global HIV Prevention Conference Kicks Off in Spain.” The Independent. www.independent.co.ug/global-hiv-prevention-conference-kicks-off-in-spain Accessed November 13, 2018.
^[3]  HIV Vaccine Trials Network, “Antibody Mediated Prevention (AMP) Studies Fully enrolled. October 19, 2018.
^[4]  Montgomery, E., et al. “Preference and Choice of Four Vaginal HIV Prevention Placebo Dosage Forms Among Young African Women: Results of the Quatro Randomized Crossover Trial.” HIV Research for Prevention Conference (HIVR4P 2018), Madrid, October 2018, abstract OA05.04.
^[5]  Nassaka, F. 2018. “A Buffet of Choices for HIV Prevention.” www.independent.co.ug/a-buffet-of-choices-for-hiv-prevention. Accessed November 15, 2018.