Diversity, Equity and Access to HIV Research

On May 2, 2024, AVAC staffer Jessica Salzwedel gave a presentation on diversity, equity and access in HIV research at the Ending the HIV Epidemic Conference at Weill Cornell Medicine. Check out the full presentation in PDF format.

“When we think about what engagement is important for research, it involves building systems of trust.” – Jessica Salzwedel

Elina Mwasinga

Elina is an experienced advocate focused on HIV/AIDS and Sexual Reproductive Health & Rights (SRHR). She wears many hats as an expert and as an advocate. Her positions include national coordinator for the National Association for Young People Living with HIV, a member of AVAC’s Cure ROAR program, a fellow alumni of the Advocacy for Cure Academy, a member of the board of trustees for the Baylor College of Medicine Children’s Foundation, a member of the Coalition of Women Living with HIV (COWLHA) the Youth Forum for National Transformation (YOFONAT). As an AVAC 2024 Advocacy Fellow, Elina’s focus is on U=U and viral load suppression in children as a pathway to an HIV cure.

Media

Unpacking Cure at CROI: A Q&A with Jessica Salzwedel

This year’s Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, Colorado, was the setting for important updates on the HIV reservoir lending to new insights into potential cure strategies. AVAC’s Senior Program Manager for Research Engagement, Jessica Salzwedel, leads AVAC’s advocacy for HIV cure research and serves as the community engagement coordinator for three of ten NIH-funded international collaboratories: the Research Enterprise to Advance a Cure for HIV (REACH), Immunotherapy for Cure (I4C), and Pediatric Adolescent Virus Elimination (PAVE). These are aimed at developing therapeutic interventions to cure HIV infection. Jessica shares her highlights from the research and what it means for advocacy. 

There was so much on HIV cure presented at CROI. What stood out to you as most important for advocates to follow?

I was really excited to see advances in both basic science and clinical research. Four results in preclinical and clinical research stood out because they advanced how researchers might tailor cure strategies to optimize the impact for people with HIV. We heard more about the potential role of sex hormones in directing the immune system in a study looking at fetus acquisition of HIV by Gabriela Cromhout. Another study by Toong Seng Tan of the Ragon Institute showed that women may be better candidates for the so-called “block and lock” strategy. We also heard results from IMPAACT P1115 trial by Deborah Persaud, which showed that early HIV treatment can lead to control of the virus in children. Finally Maurico Martin’s nonhuman primate study of adeno-associated virus, which delivered broadly neutralizing antibodies (bNAbs) and may offer a pathway to a scalable, durable control option for pediatric cure. In basic science, Katherine Bar presented data that suggests researchers, and by default advocates, should be looking at autologous neutralizing antibodies in some people to delay rebound. And finally, I’m excited about early-career investigator Louise Leyre’s research out of Weill-Cornell, which is looking at rare T-cells that seem to resist killing, which could be important in developing strategies that could lead to durable control and eradication of HIV. 

Can you break down the research on sex hormones? Will biological sex play a role in cure strategies?

We’ve got more evidence now that biological sex plays a role. Cromhout showed differences in HIV acquisition between male and female fetuses in utero, building off data she presented at IAS 2023. This data analyzes the virus from a cohort of 281 mother-infant pairs. Her team found that male fetuses tend to acquire a “high fitness” virus sensitive to IFN-1, a first-line immune defense, while female fetuses acquire a “low fitness” virus resistant to IFN-1. Viral fitness refers to the ability of the virus to replicate. Cromhout showed that the acquisition of HIV in utero is driven by the immune system of the fetus and not differences in the virus of the mothers. Understanding the host-virus relationship, and how the immune system puts pressure on the virus to change in the early stages of infection is important for directing future cure strategies.   

In the study of people with HIV who have long-term suppression via ART, presented by Toong Seng Tan from the Ragon Institute, biological sex is a factor in determining reservoir composition over time.  Tan looked at intact versus defective proviruses (the pieces of HIV that have integrated into DNA) as well as where HIV had integrated into a person’s DNA. He did not find any significant difference between the amount of intact virus (which can cause harm) and defective virus between men and women. But women had a higher portion of HIV integrated into areas of their DNA that were “transcriptionally silent”, meaning HIV could not rebound, after long-term suppression on ART. The women in the study were all post-menopausal at the time of enrollment, so more work is needed to understand how hormones shape reservoir characteristics in women, both cis and trans, at younger ages. The results suggest that women may be better candidates for a cure strategy under investigation known as “block and lock”. The strategy is trying to drive HIV deeper into latency so it cannot rebound.   

We’re seeing more results on children’s ability to control HIV off treatment, how significant is this? 

This is significant, but we know early treatment is not for everyone. Deborah Persaud of Johns Hopkins University presented the results of IMPAACT P1115, which enrolled 54 infants who acquired HIV in utero and received combination therapy within 48 hours of birth. Six children met the criteria for an analytic treatment interruption (ATI). These criteria were sustained viral suppression from 48 weeks onward, normal CD4 count, negative HIV serostatus using a highly sensitive assay, and no detectable virus. Of the six children who underwent an ATI, four achieved durable control, defined by the study as remaining undetectable over 44 weeks. One of the four controllers rebounded at 80 weeks while the other three remain on an ATI. Two of the six children who met the criteria for ATI rebounded at eight and ten weeks respectively. The study confirms that early treatment can lead to control of the virus in some children; however, it is not a strategy for all. Even with the vastly reduced reservoir size caused by almost immediate treatment, the virus is not completely eradicated and may rebound in some children off therapy.  

Another study, this one in nonhuman primates, presented by Maurico Martins of the University of Florida, showed promising progress toward a 4-dose single injection regimen that led to durable control in all animals treated with the investigational product. This study evaluated the adeno-associated virus (AAV) vector delivering antibodies. AAV is a unique platform because it has been shown to last for the duration of the cell. This study is targeting muscle cells, some of the longest-lived cells in the body, to deliver the AAV vector. The next step is to move this strategy into human clinical trials. This approach could offer a durable, scalable and cost-effective way to control or cure pediatric HIV.  

For advocates new to cure, why is the reservoir important and what can you tell us about these rare T-cells and their role?  

The “reservoir” is the collection of cells that have HIV integrated into the DNA but are not replicating. They are important because once cell replication begins, so does virus production. In the absence of ART, this is the cause of rebound. At CROI, we saw several advances in basic understanding, targeting and reactivating the reservoir. Early-career investigator Louise Leyre of Weill-Cornell presented research on a potential mechanism for why a small subset of HIV-infected T-cells resist being killed by natural killer cells. These rare HIV-infected T-cells are “slippery and squishy” and avoid being killed due to weak adhesion proteins on the cell surface. This prevents the killer cell from attaching properly. This is important for cure research because a small subset of cells can lead to viral rebound off therapy. Identifying why some cells resist killing is important to develop strategies that can lead to durable control and eradication of HIV.  

Lastly, I wanted to highlight Katherine Bar’s presentation on the potential of autologous neutralizing antibodies. Autologous neutralizing antibodies are the antibodies the body makes against the virus. In natural infection the virus is always one step ahead. When treatment is started, virus evolution pauses.   To see what role autologous antibodies play, Bar tested the sensitivity of the reservoir and rebound virus of trial participants in the BEAT-2 trial, which evaluated the impact of a combination of bNAbs (3BNC117 and 10-1074) and type 1 interferon (IFN-1) with an ATI against the autologous antibodies. When a researcher says “testing sensitivity” they are looking at whether a virus is neutralized by an antibody or not. Bar and her team found that the two participants who experienced delayed rebound in the trial had reservoir virus sensitive, meaning it could be neutralized, by autologous antibodies. This may have delayed rebound after the broadly neutralizing antibodies waned from their system. It is important for cure research because autologous antibodies may be another approach to increase the duration of control off therapy. Researchers may look at approaches to enhance these antibodies before a treatment interruption in future combination approaches.

So, what are our key points for advocacy coming out of CROI? 

  1. Diversity matters. It is critical clinical research includes participants from all geographic locations, age, and sex.
  2. Cure will not bring a one-size-fits-all strategy, and it is important to learn the combination strategies currently being pursued in clinical research as well as the future strategies that basic science discovery is generating.
  3. There are still basic questions that need to be answered for researchers to find a safe, scalable, durable and affordable cure. Advocates should follow the science and encourage funders to continue to invest, build community and research infrastructures to translate knowledge, and prepare for future clinical research.

HIV Cure Updates and Opportunities

Last week’s Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, Colorado, was full of new research, provocative discussion and debate on a wide range of issues from longer-acting injectable PrEP; the dapvirine vaginal ring (DVR) in pregnancy; doxycycline as post-exposure prophylaxis (DoxyPEP) to prevent sexually transmitted infections (STIs); and so much more. Check out our daily summaries of highlights from CROI and recordings and resources from the daily Community Breakfast Club sessions

It was also the setting for important updates on the HIV reservoir lending to new insights into potential HIV cure strategies. Progress in HIV cure research, as part of a pipeline of biomedical tools to help end the epidemic, must be supported and guided by an advocacy agenda that puts communities first. Read on for cure highlights from CROI, new opportunities for cure advocates, and an upcoming webinar on pediatric cure research with Deborah Persaud and Gabriela Cromhout.

Cure Highlights from CROI – Q&A with AVAC’s Jessica Salzwedel

AVAC’s Jessica Salzwedel who leads our advocacy for HIV cure research and serves as the community engagement coordinator for Research Enterprise to Advance a Cure for HIV (REACH), Immunotherapy for Cure (I4C), and Pediatric Adolescent Virus Elimination (PAVE) shares her highlights from the research presented at CROI and insights into what it means for advocacy in this Q&A.

Read the Q&A

“Four preclinical and clinical results stood out because they advanced how researchers might tailor cure strategies to optimize the impact for people with HIV. We heard more about the potential role of sex hormones in directing the immune system in a study looking at fetus acquisition of HIV. Another study showed that women may be better candidates for the so-called “block and lock” strategy. We also heard results from the IMPAACT P1115 trial, which showed that early HIV treatment can lead to control of the virus in children. And a nonhuman primate study of adeno-associated virus (AAV), which delivered broadly neutralizing antibodies (bNAbs) may offer a pathway to a scalable, durable control option for pediatric cure. In basic science new data suggests that autologous neutralizing antibodies in some people delay rebound. And finally, we heard about rare T-cells that seem to resist killing, which could be important in developing strategies that could lead to durable control and eradication of HIV. ” Read the Q&A to see what it all means.  

Join Us for the 2024 Cure Academy

The Advocacy-for-Cure Academy, organized in partnership with the International AIDS Society, awards fellowships to advocates or peer educators to take part in workshops on HIV cure advocacy with international experts. The academy develops fellows’ cure research literacy and reinforces their advocacy and engagement skills in line with recommendations from Research priorities for an HIV cure: International AIDS Society Global Scientific Strategy 2021Applications are now open. Deadline Monday, 25 March 2024. The next Cure Academy runs June 8 – 10, 2024 in eastern Africa. 

And check out what five alumni from the program are doing with their fellowships intended to create solutions that advance HIV cure research in their local context. 

Webinar

Updates on Pediatric HIV Cure Research From CROI

Thursday, March 2, 10:00-11:30 am EST

Researchers Deborah Persaud and Gabriele Cromhout join AVAC’s Jessica Salzwedel to discuss the latest from CROI on pediatric cure.

REGISTER NOW

Resources

Avac Event

Updates on Pediatric HIV Cure Research From CROI

Researchers Deborah Persaud and Gabriele Cromhout join AVAC’s Jessica Salzwedel to discuss the latest from CROI on pediatric cure.

Recording / Gabriele Cromhout Community Slide

Join us at CROI 2024!

Dear Advocate, 
 
The 31st annual Conference on Retroviruses and Opportunistic Infections (CROI) kicks off this weekend, and runs from March 3-6 in Denver, Colorado. CROI is the go-to forum for groundbreaking science in the HIV field, and this years’ program is full of exciting new research.  

At AVAC, we’re tracking data and discussion on long-acting, injectable PrEP; the dapvirine vaginal ring (DVR) in pregnancy; doxycycline as post-exposure prophylaxis (DoxyPEP) to prevent sexually transmitted infections (STIs); and the latest in HIV cure and control. We’re also very excited for this year’s Martin Delaney Presentation – Unveiling the Power of Uganda’s LGBTIQ Advocacy in Shaping HIV Response and Health Care Access – that will be delivered by Frank Mugisha of Sexual Minorities Uganda (SMUG) in Uganda and couldn’t be more timely. Be sure to check out the conference program.  

AVAC and partners have worked to follow and explain the research presented at CROI for many years, making the science more accessible, connecting the findings to community priorities, and ensuring civil society and affected communities are represented within the program, and ultimately the research. For those attending or not, this email shares ways to follow along and join in the discussion and debate. 

 Follow Along 
 Be part of the conversation by following AVAC on X (Twitter) at @hivpxresearch for real-time updates using the conference hashtag #CROI2024, and be sure to sign up and follow our partner, Aidsmap, who will be reporting from the conference. 
 
Community Breakfast Clubs (CROI registration not required 
 Join the CROI Community Liaisons, AVAC, the European AIDS Treatment Group, and partners for daily Community Breakfast Clubs. These virtual webinars feature researchers and advocates discussing some of the most consequential science being presented at CROI. They are open to all, CROI registrants and non-registrants alike.  
 

Monday, 4 March, 7:00am – 8:00am MT (Click here to determine the time in your location.) 

Spotlight on Social and Behavioural Science at CROI 2024 

Tuesday, 5 March, 7:00am – 8:00am MT (Click here to determine the time in your location.) 

Living with HIV for a Lifetime – It’s Complicated 

Wednesday, 6 March, 7:00am – 8:00am MT (Click here to determine the time in your location.) 

Research Roundup: Scientists and Advocates Offer Fresh Perspectives and Seasoned Analyses of CROI 2024 Research 

Looking forward to seeing you at the daily Breakfast Club sessions and to working together to unpack the research and be sure it is applied! 

 
Best, 
AVAC 

HIV Cure and the Environment

How location informs cure research

AVAC and REACH for the Cure hosted a webinar to discuss how the environment may impact HIV cure strategies. During this webinar, both organizations explored how clades, co-infections, early treatment, and other factors can help inform existing approaches to HIV cure research. Dr. Adam Ward of Weill Cornell Medicine shared the latest data followed by an informal conversation.

Recording / Dr. Adam Ward Slides

Webinars to Look Out for in February!

2024 is off and running and a slew of webinars are on the calendar. This selection of topics is both broad and deep, providing updates on the pipeline from cure to vaccines, insights on critical advocacy, a conversation with the new director of NIAID, and opportunities for you to engage. Scroll down for what’s coming up and recordings of webinars from December and January that you may have missed.  

Coming up!

AVAC in Conversation with NIAID’s Jeanne Marrazzo

February 27, 11:30 am – 12:00 pm EST 

Join AVAC in conversation with the new Director of NIAID, Jeanne Marrazzo. Register here.

The New Public Health Order: How is Africa preparing for pandemics?

February 29, 9:00-10:30 am EST 

WACI Health and The Choice Agenda invite you to join us for a webinar introducing key initiatives of the Africa CDC and the African Union. It will illuminate roles for civil society and community engagement. Register here.

The Adolescent Medicine Trials Network (ATN): Research addressing HIV health inequities among US adolescents and young adults

Join The Choice Agenda for an overview of the newest cycle of the Adolescent Medicine Trials Network! This webinar includes highlights of: ATN 165: Linking Youth to PrEP Services, which tests an innovative mobile delivery and mHealth intervention for PrEP adherence and persistence among sexual minority men; ATN 167: Legal, Economic, and Affirming Peer Support (LEAP) for transgender and gender diverse youth; and how the network prioritizes and amplifies the voices of youth directly impacted by the ATN’s pivotal research. Register here.

Advocacy Navigator Program Info Session

February 13, 10:00-11:00 am EST

This webinar is intended for anyone interested in applying to participate in AVAC’s Advocacy Navigator program. The session will provide an overview of the program, expectations, eligibility, and application process, followed by Q&A with the AVAC team. 

In case you missed it!

Reporting the African Science Story: Decoding scientific research to support public health in Africa

Through the Media Science Café Program, AVAC partners with health media associations in Kenya, Tanzania, Uganda, Zambia and Zimbabwe to bring journalists together with researchers, implementers, civil society, policy makers, regulators and policy makers to build relationships that will foster accurate reporting of HIV, COVID and other science or health stories in those countries. Learn about the model! Recording, slides and resources.

PrEPVacc: An in-depth look at the trial, and what’s next

This webinar reviewed key aspects of PrEPVacc, including its innovative study design, implementation, integrated social science, and data analysis plans. An engaging conversation about what we’ve learned from PrEPVacc, what we can still learn, and what this may mean for the HIV prevention field. Recording, slides and resources.

Cervical Cancer Awareness Month Webinar Series

Check out our 4-part webinar series on cervical cancer, which featured a deep dive on: what cervical cancer is, who is impacted, and prevention and treatment options; advocacy strategies to bring more attention to cervical cancer and its impact on communities; options for screening and treating cervical cancer along with ongoing research; and the impact of cervical cancer on key populations and those vulnerable to HIV infections. Recording, slides and resources.

HIV Cure and the Environment: How location informs cure research

This webinar reviewed core concepts discussed in the previous webinar, Let’s Talk About HIV Cure Research: An Introduction to the science under investigation, and introduced how the environment may impact cure strategies. Recording, slides and resources.

Learn more about the townhall discussion on Black Gay Men and HIV in the US featuring influential figures in the Black Gay community, including Ace Robinson, Daniel D. Driffin, and Kenyon Farrow by checking out highlights on AVAC’s Twitter page and watch the full recording

Thanks for checking out these conversations. We hope you will join us in these rich discussions and watch this space for future webinars!  

Avac Event

HIV Cure and the Environment: How location informs cure research

AVAC and REACH for the Cure hosted a webinar to discuss how the environment may impact HIV cure strategies. During this webinar, both organizations explored how clades, co-infections, early treatment, and other factors can help inform existing approaches to HIV cure research. Dr. Adam Ward of Weill Cornell Medicine shared the latest data followed by an informal conversation.  

Recording / Dr. Adam Ward Slides

Avac Event

AVAC in Conversation with NIAID’s Jeanne Marrazzo

The new director of National Institute of Allergy and Infectious Diseases (NIAID), Dr. Jeanne Marrazzo joined AVAC Executive Director in conversation.