AVAC on World AIDS Day: We’re 20. We’re not giving up.

When AVAC was founded in 1995, we were called the AIDS Vaccine Advocacy Coalition. Our singular goal was to advance swift, ethical research for a vaccine that was then — and is today — essential to bring the epidemic to a conclusive end.

Twenty years later, AVAC is still focused on swift and ethical research, but our scope has expanded. Along with vaccines, we advocate for PrEP, microbicides, voluntary medical male circumcision and more.

Through it all, our message has been the same: prevention is the center of the AIDS response. Not just any prevention but smart, evidence-based, community-owned, rights-based strategies.

We do this work because it’s essential. We are able to do it because of our robust partnerships worldwide. We will keep doing it — with your help — until the epidemic has, finally, come to an end.

We’ve experienced 20 years of breakthroughs and disappointments in prevention research. A vaccine that many had given up on was the first to provide modest protection. One microbicide everyone hoped for didn’t pan out. Male circumcision and PrEP studies overcame skepticism and, together with antiretroviral therapy, paved the way for a prevention revolution.

Through it all, AVAC has worked with partners to maintain the field’s focus and press for continued research into an AIDS vaccine, a cure and more.

When AVAC was founded, the only biomedical HIV prevention options for adults were male and female condoms. The pathway for introducing any new strategy was largely unmapped. No one knew where the gaps would be—between trial result and country action, between guidance and financial support. Now we do.

Over two decades, AVAC has not only identified the gaps; we’ve worked to bridge them, so that products reach people in programs that work — without delay.

Twenty years ago, advocacy for HIV prevention hardly existed. So AVAC helped build a global network of advocates equipped with effective advocacy strategies and the latest evidence.

With our support, they are putting prevention on the agenda in countries and communities around the globe.

When the world lacked a plan for ending AIDS, we helped create one.

Now we’re holding global leaders accountable for results — demanding the resources, policies and evidence-based plans needed to deliver all of today’s prevention options to the people who need them, and to plan for the rapid rollout of new options as they emerge.

Communities’ support for prevention research can never be taken for granted — it has to be earned. For 20 years, we’ve helped build trust between researchers, funders and communities to speed the ethical development and rollout of new prevention options.

And when controversy threatened to derail those efforts, AVAC provided leadership and resources to help get them back on track.

Your gift to AVAC will support our efforts to accelerate the development and delivery of HIV prevention options to men and women worldwide. With your help, we can continue to convene, collaborate and communicate a strong, clear and cohesive vision for HIV prevention today, tomorrow and to end the epidemic.

It will take all of us working together to end AIDS. Please join us.

Global Investment in HIV Cure Research and Development 2014

Now in its third year, this annual report, a collaboration between AVAC and the International AIDS Society Towards a Cure Initiative, analyzes global investment in HIV cure research.

New Frontiers in HIV Prevention, Treatment and Cure: An advocate’s webinar on passive immunization

This webinar focused on “passive immunization”—a scientific term for an expanding area of research that’s highly relevant to treatment, prevention and cure work. There are trials in humans happening in many regions of the world—and data are beginning to come in that advocates need to understand, analyze and consider. The webinar featured Dr. Sarah Schlesinger (Rockefeller University) who provided an overview of recent developments across the field including new published data.

Living Below Detection: Another case of HIV remission

Jessica Handibode is an AVAC staff member.

Whenever I see or deliver a presentation about the state of HIV cure research one of the most interesting topics is how the field is defining what it means to be cured of HIV infection. Many researchers and community groups have pushed for the term “remission” to be used since there are no scientifically proven tests to determine whether an individual’s HIV will return. Recent cases of HIV “cures”—as they were reported in the media—like the two men from Boston and the Mississippi Child, have all ended in viral rebound. This further strengthens the case for the use of the term remission.

At the IAS 2015 conference on Monday, Dr. Asier Sáez-Cirión, of the Pasteur Institute in Paris, the same researcher working with the VISCONTI Cohort, introduced the world to an eighteen-year-old HIV-positive female living without treatment for over 11 years. This young woman offers a proof-of-concept for long-term control of HIV without treatment and pushes how the field might define remission of HIV.

What are the facts?
This young woman was born to a woman living with HIV who did not have viral control. Shortly after birth, the young woman was put on antiretroviral therapy and confirmed to be HIV-positive four weeks later. The mother reports that her daughter had challenges taking medication consistently during the first seven years of her life and that she stopped ART altogether twice.

During both treatment interruptions she experienced viral rebounds 75,190 copies/mL of blood & 97,000 copies/ mL of blood respectively. After both viral rebounds, she started treatment again and achieved virologic suppression. When the girl was about six years old, she stopped treatment and doctors’ visits. In research parlance, she was “lost to follow-up”. When the young woman returned to care a year later, she had an undetectable viral load. Since then, this young woman, who is now 18 years old, has remained undetectable without treatment except for two viral blips. Viral blips, or viremia, are periods where the number of viral copies rises above the limit of detection (40 viral copies/mL of blood). The first viral blip occurred at 11 years (509 copies/mL of blood) and the second at 14 years (48 copies/mL of blood). However she hasn’t been cured. In lab tests, HIV can be isolated and grown from cells from her blood.

What does this all mean?
Well, first it means that this young woman can control her virus without treatment, but her virus has not been eradicated. Since researchers can stimulate her cells to start producing virus in the lab, it is possible that she could experience another rebound. This is also supported by the two viral blips she experienced at 11 and 14 years old. In spite of this, she is capable of long-term virologic control—without ART.

Is she in remission or is she just controlling her virus?
She’s doing both! Long term post-treatment control has become a new area of discussion as cases like the VISCONTI cohort and this young woman are introduced to the field. The VISCONTI cohort, a group of French post-treatment controllers, were all treated early (within the first six months of infection) and were on suppressive treatment for a median time of three years before stopping treatment. The individuals in this cohort have been able to maintain control at very low or undetectable levels for about nine years off treatment. Post-treatment controllers differ from rare natural controllers known as “elite controllers” and “long-term non-progressors”. Both elite controllers and long-term non-progressors have protective immune responses that allow these individuals to control HIV without treatment. These individuals also have greater immune and inflammatory responses than HIV-positive individuals on ART. Remission, like cure, is a term with a specific emotional resonance. It is often thought about as the period of time where the disease is absent but could return. Both terms are fairly commonly used in the cancer field where, for instance, you are considered “in remission” for a certain number of years before you are “cancer-free”.

But there are so few cases of either remission or cure in HIV that it is very difficult to say when and how they should be used—or how to define them. With an individual like this young woman, it’s not possible to predict—because there are no comparators for her experience—when, if ever, she might have a rebound of HIV. She has been undetectable longer than the Berlin Patient has been cured, yet the presence of virus in her body means that she doesn’t meet the criteria for being cured. With so much uncertain science, the language sometimes fails us. But regardless of whether you describe this young woman as being in remission or a post-treatment controller, her experience pushes the science of HIV cure research forward and offers new hope for the future.

New Report on HIV Prevention R&D Investment Highlights 2014 Global Funding Trends

The recent UN Report on the Millennium Development Goals (MDGs) calls out the 40 percent reduction in new HIV infections since the MDGs were established in 2000 as a singular MDG achievement1. That progress reflects 15 years of HIV research in many forms—from female condoms and voluntary medical male circumcision, to new strategies for preventing vertical transmission to the scale-up of ART. Over the years, this progress has been supported by investments from many government, philanthropic and private sector funders of HIV prevention research.

The 11th annual report on the state of HIV prevention research investment, HIV Prevention Research & Development Funding Trends 2000–2014: Investment Priorities To Fund Innovation In An Evolving Global Health and Development Landscape, suggests that this work is still on the agenda for funders, albeit with a small cohort supplying the bulk of the resources.

The new report, released in Vancouver at the IAS 2015 conference, was prepared by the HIV Vaccines & Microbicides Resource Tracking Working Group (RTWG), led by AVAC, in partnership with the International AIDS Vaccine Initiative and UNAIDS. HIV Prevention Research & Development Funding Trends 2000–2014: Investment Priorities To Fund Innovation In An Evolving Global Health and Development Landscape documents that absolute funding levels have been stable over the past few years. This reflects an overall decline in real spending given biomedical research inflation.

In 2014 funders invested a total of US$1.25 billion in research and development (R&D) for HIV prevention—representing a decrease from the 2013 funding level which totaled US$1.26 billion.

In 2014, the US public-sector and the Bill & Melinda Gates Foundation account for 83 percent of all HIV prevention R&D funding and the number of philanthropic funders engaged in HIV prevention research has continued a steadily decline since 2010. Thus, the report points to the need for a broader funding base.

Despite the slight decline in funding, HIV prevention R&D is still delivering important advances. The 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver July 20-22, will showcase results for a range of groundbreaking research that has been supported over the past several years, including the Strategic Timing of Antiretroviral Treatment (START) trial, the HPTN 052 treatment as prevention trial and several groundbreaking oral PrEP trials.

Results from studies of a vaginal ring containing the antiretroviral dapivirine are expected in the next 12 months. Several different HIV vaccine candidates, neutralizing antibodies and long-acting injectable ARVs are currently in trials that could lead to multiple efficacy trials starting over the next two years.

While the report focuses on financial resources, in also highlights the essential role of individual trial participants. In 2014, there were over a million participants in HIV prevention research trials globally. With continued human and financial investment, the 40 percent reduction in new HIV infections attributed to the MDGs is hopefully only the beginning.

For more information on the HIV Vaccines & Microbicides Resource Tracking Working Group, the full report, executive summary, graphics and slides visit www.hivresourcetracking.org.

1 The MDGs consist of eight global goals, with goal six to combat HIV/AIDS, malaria and other diseases. For more information on the MDGs see: www.un.org/millenniumgoals/aids.shtml.

Selected Guide to Pipeline of Antibodies, Long-Acting ARVs and Vaccines

This graphic provides a quick primer on passive immunization with HIV-specific antibodies, long-acting antiretroviral injectables, and preventive vaccines, including a new, informative table reviewing the pipelines in research and development for all three research avenues.

New Frontiers in HIV Prevention, Treatment and Cure

It’s time to take an active interest in “passive immunization”—a scientific term for an expanding area of research that’s highly relevant to treatment, prevention and cure work. There are trials in humans happening in many regions of the world—and data are beginning to come in that advocates need to understand, analyze and consider.

AVAC hosted a webinar, New Frontiers in HIV Prevention, Treatment and Cure—An advocate’s webinar on passive immunization with a presentation from Dr. Sarah Schlesinger of Rockefeller University. Dr. Schlesinger provided an overview of recent developments across the field including new published data.

Downloads: Slides (PDF) / Audio (MP3) / Animation (Flash)

This webinar was just one in our year-long series, HIV Prevention on the Line. View webinars from the full series here.

The term passive immunization refers to the administration of laboratory-generated antibodies to people. It’s different from vaccine strategies, which teach our bodies how to make antibodies for ourselves.

Dr. Schlesinger is one of the authors of a recent study on passive immunization of a broadly neutralizing antibody (bNAb) called 3BNC117 in both HIV-negative individuals and people living with HIV. This was the first trial in humans of this particular bNAB. At least three other bNABs are currently in early phase clinical trials in humans. This research pipeline is exploring how passive immunization might be used as a treatment (to control HIV in people living with the virus); as a cure (to help clear HIV from viral reservoirs in people living with HIV); and as prevention.

Dr. Schlesinger provided a basic introduction to bNAbs and the ways that they are being studied, and described the work that she and her colleagues have recently published.

Further Reading
The most potent antibodies against HIV are known as broadly neutralizing antibodies—immune responses generated by a handful of people living with HIV. Scientists have analyzed blood from many people living with HIV and in a few have been able to find these bNABs that can block the activity of wide range of strains of HIV. In recent years, scientists have isolated a range of these potent bNAbs and have worked to modify them to make them even more effective, reduce the size of the dose needed for impact, and ensure that they are delivered to the sites of exposure—e.g., the vagina and rectum in the case of sexual exposure—where protection is needed most. Click here to see AVAC’s “Passive Immunization for Busy Advocates” resource, and click here for a recent presentation from Dr. Penny Moore at AVAC’s Advocacy Partners’ Forum.

Passive immunization using bNAbs is one of several strategies that is being explored for both prevention in people who are HIV-negative as well as treatment and cure strategies for people living with HIV. Long-acting injectable ARVs are also being studied in both populations, as are traditional vaccines. Want to understand the differences and the pipelines? Check out the section on injectable prevention in the recently released AVAC Report—and keep an eye out for the next issue of Px Wire, which will feature an extensive discussion of this expanding arena. Also, Richard Jefferys of the Treatment Action Group just published An HIV Cure and a Vaccine within the Next 15 Years?, a terrific overview of key concepts.

New Issue of Px Wire: Action on Oral PrEP and Updates on Antibodies

The new issue of Px Wire, AVAC’s quarterly newsletter on HIV prevention research and implementation, is now available.

Click here to download.

In this issue, you’ll find:

  • Updates on how WHO is approaching broader guidance on oral PrEP—and what advocates think should happen next.
  • A closer look at passive immunization, an expanding area of research referring to the administration of laboratory-generated antibodies. Passive immunization is being explored in people living with HIV in attempts to help control viral replication and/or serve as part of a cure strategy. It is also being explored for HIV prevention.
  • And this issue’s centerspread provides a quick primer on passive immunization with HIV-specific antibodies, long-acting antiretroviral injectables, and preventive vaccines, including a new, informative table reviewing the pipelines in research and development for all three research avenues.

New Overview of Cure and Vaccine Research from TAG

Richard Jefferys of Treatment Action Group, whose incredibly clear and detailed updates on immunology, virology and pathogensis (a.k.a. what immune system does, how the virus evolves, and what the virus does to the immune system) can be found on the Michael Palm Basic Science Blog, has just published an overview of vaccine and cure research in the TAG newsletter. The piece is a great introduction and update to a critical topic—and to learn more register for an upcoming AVAC webinar.

And for more on cure research, visit our CUREiculum page.

A New CUREiculum Launched

The number of HIV cure-related publications has risen exponentially in recent years. This is due in part to a burst of funding and scientific interest around HIV cure research in the last decade. At the 2014 Conference on Retroviruses and Opportunistic Infection (CROI), it became clear at a community meeting that we needed to provide resources to increase scientific literacy around HIV cure research. These resources to increase understanding can help manage expectations around HIV cure, but can also provide the foundation for ethical research. Scientific literacy is a way to allow community members to meaningfully engage around the research. Potential study participants can be also informed about the risks, benefits and scientific merits of a study. The CUREiculum concept was developed out of this need to make HIV cure science accessible to as many people as possible.

The CUREiculum initiative was launched at CROI 2015, one year later. The CUREiculum is a suite of tools developed by a collaboration between community educators, advocates and research institutions. Each module contains a set of learning tools that is designed to be used by either an individual learner or as part of a training session or workshop. In addition to an annotated PowerPoint slide deck and various participatory activities, each module contains a set of references chosen for their accessible content about specific topic areas.

On February 21st, 2015 the CUREiculum partnered with the defeatHIV Community Advisory Board (CAB) and the Seattle Public Library to hold the first of two kick off events. The meeting at the library had a diverse crowd of individuals simply interested in HIV cure research. Audience members learned about the Basics of HIV Cure Research, Pediatric Research on HIV Cure and Gene Therapy in HIV Cure Research. Audience members asked a range of thoughtful questions about obtaining informed consent from pregnant women and the potential risks of altering genes in the human body. A reception was held on February 22, following the annual Community Cure Workshop. This reception celebrated the involvement of the CUREiculum collaborators.

The complete suite of CUREiculum modules includes:

  • HIV/AIDS and Cure Basics
  • Stakeholder Engagement in HIV Cure Research
  • Regulatory Issues in HIV Cure Research
  • Ethics of HIV Cure Research
  • Informed Consent in HIV Cure Research
  • Participation in HIV Cure Studies
  • Concepts in Basic Sciences and Translational Research – The Main Pathways
  • Measuring the Latent HIV Reservoir
  • Early Antiretroviral Treatment
  • Pediatric HIV Cure Research
  • Latency Reversing Agents
  • Therapeutic Vaccines and Immune-Based Therapies
  • Gene Therapy and Stem Cell Transplant
  • Animal Models in HIV Cure Research
  • Combination Approaches and Conclusions – The Science Looking Forward

For more information about the CUREiculum please contact: