Engagement Matters: Providing New Perspectives on HIV/AIDS from CROI

February 24, 2015

This blog by DaShawn Usher, Community Education and Recruitment Manager at New York Blood Center-Project ACHIEVE and an AVAC PxROAR member. It is the first in a series written by community delegates attending CROI 2015.

In addition to the CROI Community Educator Scholarship Program, AVAC and the Black AIDS Institute—with support from the CROI Community Liaison Subcommittee—are supporting a pilot program that provides an opportunity for additional community reps to attend the meeting. Delegates are mentored and supported with supplemental programming to help translate big science into accessible language for our communities. Expect daily updates from the meeting.

The first day of the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle kicked off with a great start, especially for the first cohort of the CROI Community Delegate Program through the Black AIDS Institute, AVAC and the CROI Community Liaison Subcommittee. Community Delegates and Community Education scholarship recipients were welcomed in the morning by Phil Wilson of the Black AIDS Institute and Mitchell Warren of AVAC. The two gave perspectives of why we were selected to be at CROI and reminded us that this particular program has been years in the making. Mr. Wilson, gave an overview of the Black AIDS Institute’s recent report “When We Know Better, We Do Better: The State of HIV/AIDS Science and Treatment Literacy in the HIV/AIDS Workforce in the United States.”

The Program Committee Workshop for New Investigators and Trainees featured a wonderful consortium of research from all fields of HIV prevention and treatment. Dr. Galit Alter’s “A Path to an HIV Vaccine,” provided a very engaging overview of HIV vaccine options that would prevent HIV. The options include two main points: 1) Block infection and 2) Kill fast at the site of infection. Dr. Alter described that any vaccine that will be effective in fighting HIV must work in two days, since by day 3 the virus will have formed enough to replicate and create the HIV reservoir. I thought this was particularly interesting because it aligned with Post Exposure Prophylaxis (PEP) science of attacking HIV before it has the chance to replicate. Dr. Alter then went on to describe how 30% of infected patients generate neutralizing antibodies within 2–3 years. [Editor’s note: Click here for background on this science.] It was stimulating to learn that this process can occur naturally in HIV positive people—even though the antibodies that evolve aren’t usually able to neutralize the virus that’s present in the body at the same time. Instead, the antibodies are effective against virus that existed earlier—and has since evolved. One key take away point, therefore: Vaccines have to act faster, since HIV is faster than the immune response.

Next Dr. Guido Silvestri’s “Animal Models of Prevention and Cure” was most fascinating as it provided understanding of early phase clinical research trials that occur with Non Human Primates (NHP) and humanized mice. Listening to Dr. Silvestri’s speak reinforced the need for continued research that seems promising in animals to be developed for human clinical trials.

Following Dr. Silvestri’s presentation, Dr. Susan Buchbinder, discussed HIV Prevention 2.0: What’s Next. Dr. Buchbinder’s talk highlight the evolution of HIV prevention, which now includes three pillars: 1) Circumcision 2) PrEP, and 3) Treatment as Prevention. While highlighting the advances in HIV prevention, I thought it was interesting to see that new issues continue to emerge. For PrEP, the mixed messaging around adherence (which will be even more complicated when the IPERGAY trial presents its data during CROI about efficacy in gay men and other men who have sex with men who were prescribed a dosing regimen centered on sexual activity, rather than daily dosing), continues to pose concern. Right now there are a lot of ways of talking about PrEP use: including time based and event based, and periodic dosing. But we don’t know who these strategies work for, if they work, and how they are understood in the real world.

Even with current studies underway for addressing adherence to daily oral PrEP, there are ongoing studies of injectable PrEP, which could provide a month or more of protection after a single shot. This poses the question of will people continue to get the shot. Especially when studies of injectable contraceptives show that over time people drop off from receiving their scheduled injections.

One remaining point from Dr. Buchbinder’s talk was how traditional pillars of HIV prevention aren’t enough to curve the epidemic. Condoms, public health campaigns, and HIV testing and counseling each have strengths and areas where they ned to be improved. For HIV testing and counseling, some studies have show that counseling is not effective. I believe that the context of counseling sessions prior to biomedical interventions may not have been the most effective, however, biomedical interventions like PrEP and PEP can now be used in that session time to educate clients about other options of remaining HIV negative.

Finally, Dr. John Coffin, presented on “HIV Cure Research.” He reported on the infamous Berlin patient, now known to be Tim Brown, as the only person truly cured from HIV. I thought it was interesting that he highlighted that although people commonly refer to Tim Brown as being “cured” that their may be lingering HIV cells in Mr. Brown. I liked that he discussed the effectiveness of ART and how these drugs greatly suppress the viral load of HIV but the “rebound reservoir” of HIV keeps these drug from being a cure. Dr. Coffin also mentioned that ART blocks infection, but does not have an effect on infected cells.

Following that session, the Martin Delaney lecture occurred. Appropriated called “How to End the HIV Epidemic: Community Perspectives,” this session featured panelist, Damon Jacobs (PrEP Advocate), Connie Celum (Treatment as Prevention Advocate), and Matthew Sharp (Cure Advocate) and was moderated by Steven Wakefield. This session highlighted the need across the field that more needed to be done. For PrEP, people need to be educated about the benefits of it. Treatment as Prevention (TasP), showcased the need for more focus on getting people into care. Cure research, was highlighted by Matthew Sharp’s personal narrative of his involvement of cure research.

The day continued on with additional presentations and preparations for the full CROI conference. The welcome reception was held at Nordstrom, which was actually a lot more fun then I expected. I had a conversation with a CDC Director that encouraged me to advocate for other young community delegates to attend conferences like this. While at Nordstrom not only did I get a chance to network with colleagues from CROI, but I also got to meet some fascinating Nordstrom employees that were very nice and engaging (Shout out to Lilly, Blake, and Gavin at Nordstrom). I ended up browsing through the store’s latest collection and end of season sales racks. Not only did I get a chance to learn about the latest in HIV research today, I learned a lot of the local history of Seattle (Note: If you’re in Seattle check out Capital Hill and Fremont). This experience continues to add to my continual learning that I will bring back to the communities I serve locally and nationally. I look forward to day two of CROI.