Overcoming HIV Obstacles in 2015

January 1, 2015

AVAC’s Executive Director, Mitchell Warren, recently spoke with the Voice of America. This article first appeared here.

The head of a prominent HIV/AIDS advocacy organization says 2015 will be a year of great opportunities and great challenges. The epidemic is nearly 35 years old and more than 30 million people are estimated to be living with HIV.

Mitchell Warren said one challenge of the New Year will be to translate recent scientific advances into practice. Warren is executive director of AVAC, which, he said, “aims to accelerate the ethical development and global delivery of HIV prevention tools as part of a comprehensive response.”

“This is a year that will define the AIDS response. We’re now over 34 years into the epidemic. And it is truly a point at which we will know if we are on the right track to ever ending this epidemic, or if we continue to muddle through year by year hoping we do the right things, but not knowing for sure,” he said.

Promising prevention option

Early in 2015, results should be announced regarding a promising HIV prevention option – an effective microbicide.

“As you may recall, back in 2010, we had the initial proof of concept of the CAPRISA trial that showed the tenofovir gel provided some partial protection for women in South Africa,” he said.

Tenofovir is an antiretroviral widely used to subdue the virus within the body. But it’s also been shown to be effective in preventing infections.

Since 2010, a study has been underway to confirm and expand on the CAPRISA findings. It’s called FACTS001 and is also taking place in South Africa. The study is funded by the U.S. and South African governments and the Gates Foundation.

Warren said FACTS001 could confirm whether tenofovir gel, used before and after sex, can prevent HIV infection.

“The results were expected in the first quarter of the year. If that’s a positive result and if it confirms the CAPRISA finding, we would then be looking at how do you take that product forward — outside of clinical trial – into practice? So a very exciting first quarter I think just because of that trial result.”

At the end of 2015 and in early 2016, the results of two other microbicide studies are expected to be released. One will look at the effectiveness of a vaginal ring filled with an antiretroviral drug.

Also, in South Africa, an AIDS vaccine trial gets underway this year. It’s a follow-up to the 2009 Thailand vaccine trial that showed protection against HIV was possible. The results from the South Africa trial and related studies, however, will not be available for several years.

Improving detection

Meanwhile, greater use of antiretrovirals as a preventive measure is expected. It’s called PrEP, or pre-exposure prophylaxis. But the AVAC executive director said the predominant use will remain as treatment for those infected.

“2014 ended with the calls by the United Nations AIDS program, UNAIDS, to really set a new target about treatment. The UNAIDS new target is this 90/90/90, trying to make sure that 90 percent of people who are infected know their status. That 90 percent of them get onto treatment and that 90 percent of those on treatment are, what we call, virologically suppressed. And if they’re virologically suppressed it means they are very unlikely to transmit HIV,” he said.

He said an “ambitious, but feasible” goal would be to have 15 million people on HIV treatment by the end of 2015.

“That would be a terrific step in the right direction, but of course there are over 30 million people infected with HIV. So we have a very long way to go to really see treatment scale up to the degree that we need it to. But it is on the right trajectory. Drug pricing is coming down because you have much higher volumes.”

However, he added that there are antiretroviral supply problems at some clinics in developing countries.

“For all of the excitement around prevention, around treatment, it really becomes a resource question. Because this success in the AIDS response does not come cheap and it certainly does not come free. And the question really becomes are we as a global community going to continue to scale up our investments in the things that we know can work? Because all the talk of ending the epidemic is predicated on good science and on real resources. And we’re beginning to see those resources eroding,” he said.

Warren does not foresee an end to the HIV/AIDS epidemic for at least 10 years. One of the obstacles is ongoing stigma and discrimination. He said unless that problem is solved, no vaccine or antiretroviral will be effective in the long-term. He said that “there is no medical response that can address people’s perceptions of others.”