Virtual CROI 2022 Roundup for Advocates: It’s all about choice

Welcome to Virtual CROI week two!

Here’s a roundup of the exciting science heard last week across the spectrum of HIV prevention, and on cure research (more on this further down) with a groundbreaking new case of HIV remission. We also want to be sure you are all aware of the CROI Margarita Breakfast Club dialogues—both last week and this week. Superb discussions last week and three more this week are not to be missed—recordings from last week’s conversations and registrations for this week are here.

The overarching message coming from CROI last week was clear: no one biomedical strategy will do the job, the world needs multiple options and real choices. In this round up, the importance of choice leads our coverage. (And listen to Carlos del Rio from Emory University put it all in context in a terrific US National Public Radio interview here.)

Choice and the Ring

New data from the REACH study, which incorporated informed choice into its design, made this point unmistakable. Almost all (98 percent) of the 247 adolescent girls and young women in this study where both daily oral PrEP and the Dapivirine Vaginal Ring were offered, chose one of the products over none at all. All participants tried each product for 6 months, followed by 6 months where they could choose their preferred method. Kenneth Ngure, presenting on the REACH Study, said about ⅔ of the participants chose the ring. But most of the women who had very high adherence to the daily oral pill preferred the daily pills to the ring. Ngure said overall adherence in the REACH trial surpassed levels seen in previous studies. More findings on factors driving adherence is under analysis. “REACH is just a small example of what the potential impact could be in the real world of HIV prevention, simply by allowing young women and girls the ability to choose,” said Ngure.

Choice and Injectable PrEP

HPTN 083, evaluating injectable cabotegravir as PrEP among gay men, transgender women and other men who have sex with men (MSM), presented updated data that evaluated new infections that have occurred since the trial unblinded in May 2020. Raphy Landovitz, from UCLA and HPTN 083 protocol chair, reported that adherence went down during this phase of the trial, but break-through infections among those receiving on-time injections remained rare. (He reported a total of 7 such cases in the life of the study that covers 4,660-person years.) The data continue to confirm both the safety and efficacy of cabotegravir for PrEP. Reflecting on the significance of the drop in adherence to both daily oral PrEP and injectable cabotegravir during the unblinded phase, Landovitz said complex barriers to adherence make it clear that “no one biomedical prevention option will address all issues in HIV prevention”.

Additional data from Susan Eshleman of John Hopkins University School of Medicine and the HPTN 083 team deepened the discussion on effective and feasible testing. Detecting HIV is a crucial part of prevention strategies that rely on antiretrovirals (ARVs). Exposure to a single ARV, which is the protocol for PrEP (in contrast to combination ARV used in treatment), can lead to resistant HIV. Eshleman reported on data showing that using a highly sensitive RNA-based HIV test to confirm a person is HIV negative could reduce the risk of someone with undetected HIV developing resistance to first line treatment. But she said access to these tests should not limit access to this highly effective intervention, “In the context of proven high efficacy, CAB-LA should be considered for HIV PrEP in settings where HIV RNA screening is not readily available.”

Choice and Vaccines

IAVI’s Mark Feinberg summarized the state of vaccine science. One the one hand, two recent large-scale trials showed no efficacy (Uhambo and Imbokodo). On the other hand, Feinberg said cutting edge approaches offer “a strong and vibrant source of promise” for HIV vaccine development, particularly the development of broadly neutralizing antibodies (bNAbs). Looking ahead, Feinberg predicted the next major priority to make a large-scale trial a possibility will be validating a “correlate of protection”, a mark or sign in the immune system that can be linked to preventing HIV acquisition.

As this research evolves, the need for many options that deliver real choices remains clear. In a later session on immune responses, South Africa Medical Research Council and HVTN leader Glenda Gray said the high rate of HIV in hard-hit places (as high as 4 percent) will mean effective prevention may well require a combination of strategies. “We will likely need a combination of PrEP with vaccines to combat high rates—4 percent incidence rate is just too much for a vaccine alone to overcome.”

Another Step in the Journey Toward a Cure

A fourth person was reported to achieve HIV remission, the first case among women, according to data from Yvonne Bryson from the David Geffen School of Medicine at University of California. The New York woman has no detectable HIV since she stopped treatment 14 months ago. Her treatment interruption followed a stem cell transplant from a donor with an HIV resistant mutation. As in the other three cases, the stem cell transplant was an urgent intervention to treat advanced cancer. This stem cell transplant pioneered an innovation where a family donor provided stem cells in combination with stem cells from umbilical cord blood that had the needed mutation. One possible implication for cure research is confirmation of the role of a critical receptor on white blood cells known as CCR5. HIV relies on CCR5 to enter and infect the cells. Mutations to CCR5 have once again led to a case of remission, and two of these cases have endured long enough to be confirmed as a cure. Want to learn more? One of last week’s Margarita Breakfast Club discussion was River Deep, Mountain High: Pathways Toward a Cure for HIV, with a wonderful discussion about these findings.

There’s more CROI coverage coming and please continue to follow along with us this week,, and check out great summaries from our friends at aidsmap.

Virtual CROI 2022

This year’s annual Conference on Retroviruses and Opportunistic Infections (CROI), February 12-24, begins this weekend and will once again, be virtual! This forum offers the latest from research on HIV, tuberculosis (TB) and hepatitis (HEP) and now also features findings from COVID-19 studies. The opening session begins Sunday Feb. 13. Plenaries and oral abstract sessions run from Monday, Feb. 14 through Wednesday, Feb. 16. Symposia are offered Tuesday Feb. 22 through Thursday Feb. 24. You must be registered to access the sessions during the virtual meeting, however, this email shares other ways to follow along and join in the discussion and debate. Note that all sessions will be available (without registration) 30 days after the conference ends.

Follow Along

Conference coverage is available via aidsmap, AVAC on Twitter: @hivpxresearch and the conference hashtag: #CROI2022.

Preview CROI

CROI’s Community Liaison Subcommittee (CLS), AVAC and EATG hosted a preview of CROI for global advocates to explore some of the key research on the program, get tips for how to get the most out of the conference, and learn where and how to stay connected. Here is a link to the recording.

Participate in Daily Research Updates at the Margarita Breakfast Club (CROI registration not required)

7:15–8:15 am MT (time converter) Feb 14-24
The Margarita Breakfast Clubs (MBCs) are one-hour Zooms that provide an intimate setting for dialogue between researchers and community advocates on the hottest #CROI2022 science being presented this year. These sessions are open to anyone and are made possible through a collaboration including the CROI Community Liaison Subcommittee, AVAC, EATG and other groups.

  • Topic: From Long to Longer – How New ARVs are Rewriting the Script for HIV Prevention and Treatment
    Date: Monday, February 14

    Speaker: Dr. Chloe Orkin
    Moderators: Ntando Yola and Jim Pickett
    Watch the recording.
  • Topic: River Deep, Mountain High: Pathways Toward a Cure for HIV
    Date: Wednesday, February 16

    Speakers: Dr. Katharine Bar and Moses Supercharger
    Moderators: Danielle Campbell and Michael Louella
    Watch the recording.
  • Topic: Aging with HIV – Frailty, Comorbidities and a Call to Action
    Date: Tuesday, February 22

    Speakers: Dr. Kristine Erlandson and Jules Levin
    Moderator: Jeff Taylor
    Watch the recording.
  • Topic: Rings and Injectable Things: Moving from options to choices for HIV prevention in cisgender women
    Date: Wednesday, February 23

    Speakers: Drs. Sinead Delany-Moretlwe and Kenneth Ngure
    Moderator: Danielle Campbell and Breanne Lesnar
    Watch the recording.
  • Topic: Long COVID – What We Know, What We Need to Know, and What We Need to Do
    Date: Thursday February 24

    Speakers: Dr. Steve Deeks and JD Davids
    Moderator: Michael Louella
    Watch the recording.

CROI 2022 Conference Materials

Check out the conference agenda and FAQs.

Looking forward to seeing you at the daily updates!

PrEP and more PrEP: An update and important resources

2022 is a critical year for the evolving role of PrEP, anti-retroviral drugs (ARVS) used to prevent HIV. Currently, two types of daily pills (FTC/TDF and F/TAF), injectable cabotegravir administered every two months (CAB-LA) and a monthly Dapivirine Vaginal Ring (DVR) are approved in some countries for at least some populations. But each face challenges that must be overcome for these proven interventions to effectively reach people who need and want them.

In addition, the pipeline of next-generation PrEP products in research and development is intensely dynamic. But if advocacy, global coordination, funding, and community-centered responses come together now, PrEP programs can be scaled, and these biomedical options can be translated into actual choices. This work is essential for the world to hit 2030 targets for ending the epidemic.

AVAC is tracking all things PrEP. Here are some resources to keep you up to date and to help frame key issues for your advocacy.

Global PrEP Tracker

Check out global trends in oral PrEP initiations with AVAC’s just updated PrEP Tracker, found on 2021 saw marked increases in global PrEP uptake, up 50 percent from 2020. Five countries in sub-Saharan Africa are driving this growth with expanding programs: Kenya, Nigeria, South Africa, Uganda and Zambia. Get details on the data here.

Overview of the Pipeline

These trends can be put into context with the Biomedical HIV Prevention Research in 2022 and Beyond which provides a concise update on the full landscape of biomedical interventions, including: PrEP products in the market, next-gen products in the pipeline, including multipurpose products (MPTs) and vaccines and broadly neutralizing antibodies. And check our handy cheat-sheet on Evolving Designs for HIV Prevention Trials.

Primer on Injectable Cabotegravir for PrEP

With the recent US FDA approval of CAB for PrEP, we’ve updated our advocates’ primer to outline what’s known and what’s next for this new prevention option.

Two Training Packages for Peer-led Product Introduction

The HIV Prevention Ambassador Training Package for adolescent girls and young women (AGYW) supports them to play a meaningful role in the rollout of PrEP products in their communities. Developed by the PROMISE & CHOICE consortiums, it includes a training manual on essential topics and session instructions, and a toolkit. This version of the Ambassador Training Package is intended for all priority populations, including men who have sex with men, people who inject drugs, serodiscordant couples, pregnant and breastfeeding people, sex workers, transgender people as well as adolescent girls and young women.

A Strategy for the Future of PrEP, From Research to Rollout

The Biomedical Prevention Implementation Collaborative (BioPIC) is developing a model for a comprehensive and coordinated global platform for the introduction of new biomedical products for HIV prevention. The BioPIC Adaptable Framework incorporates stakeholders from all stages of product development and delivery, from research to rollout. And watch this space for the upcoming launch of BioPIC’s online dashboard that will be tracking efforts to introduce CAB for PrEP.

Learning Lessons from Oral PrEP – and Implications for the Future

AVAC’s six-year HIV Prevention Market Manager program produced a wealth of insights on how to get rollout right. Learning the lessons from oral PrEP introduction is essential, and this series of issue briefs distills the priorities for advocates, implementers, funders, product developers and ministries of health. And in case you missed it, check out the recent webinar recording and summary.

Resources to Support the Introduction of the Dapivirine Vaginal Ring

This package of resources supporting the introduction of the Dapivirine Vaginal Ring includes: advocacy messages, an introductory slide deck, FAQ’s and more.

Are We PrEPared This Time?

Just last week, the AIDS Foundation Chicago, AVAC and partners hosted a webinar, Are we PrEPared this time? Ensuring a Swift Translation of Research into Community Impact, featuring presentations and debate on what must happen for positive research results to effectively reach communities without delay. A link to the recording is here.

The PrEP field is moving at an historic pace, but significant obstacles threaten to derail the potential PrEP holds for contributing to the end of the epidemic by 2030. Our joint work will confront these challenges. Keep watching this space for the information, resources, analysis and convening opportunities to keep this work on track.