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:

Decoding Cure Science: A CUREiculum webinar series

The CUREiculum is a suite of tools that provides simple, accessible information on HIV cure research. As part of the effort to increase research literacy around cure, the CUREiculum team, a collaboration of community educators, researchers and advocacy organizations, will be presenting a webinar series that focus on issue-specific topics crucial to understanding the research landscape.

Check out the first three webinars in the series!

Stakeholder Engagement in Cure Research
Friday March 13, 11 am ET
Watch a recording of the webinar!

This webinar, led by Jessica Handibode of AVAC, will discuss how the Good Participatory Practice (GPP) guidelines, developed by UNAIDS and AVAC, can be applied to HIV cure research. GPP provides trial funders, sponsors and implementers with systematic guidance on how to effectively engage with all stakeholders. Drawing from the literature and past HIV prevention trials, the webinar will explore the history and importance of engaging community stakeholders early in the research process.

Latency Reversing Agents
Thursday March 26, 4 pm ET
Watch a recording of the webinar!

This webinar will feature Dr. David Margolis, Principal Investigator of the CARE Collaboratory at University of North Carolina at Chapel Hill, and Dr. Sharon Lewin member of the DARE Collaboratory and Director of the Infectious Disease department at Monash University. Latency reversing agents are biological compounds used to “wake up” HIV infected cells from their resting state in the body. The drugs are used as the “kick”, the first in a two phase strategy often called “kick and kill”. Both researchers will discuss what latency reversing agents are and how the research might contribute to a combination curative strategy.

Early ART
Thursday April 2 at 11 am ET
Watch a recording of the webinar!

Dr. Jintanat Ananworanich, Associate Director for Therapeutics Research at the U.S. Military HIV Research Program (MHRP) of the Walter Reed Army Institute for Research (WRAIR), will present the scientific mechanisms of early treatment and explain how it relates to HIV cure research. Administering early antiretroviral therapy can have a significant impact on limiting the reservoir—the cells that contain non-replicating HIV—in an HIV-positive individual. Starting ART very early after HIV infection has been linked to very low viral loads and even to apparent “remission” (periods of no detectable viral load).

For more information, please contact Jessica (jessica@avac.org) or Karine (karine_dube@med.unc.edu). The full schedule for the 2015 CUREiculum webinar series is available.

AVAC Report: HIV Prevention on the Line

AVAC’s annual report of the field, the upcoming CROI meeting and why the coming year is the best and worst of times for HIV prevention

Next week, scientists, advocates and clinicians will gather in Seattle for the Conference on Retroviruses and Opportunistic Infections (CROI), a venerable HIV meeting that often triggers media coverage of the AIDS epidemic and the potential for curbing it and preserving health in people living with HIV.

A range of data is expected from CROI including “late-breaker” abstracts that will showcase data from IPERGAY and PROUD, two trials of oral PrEP using TDF/FTC in gay men and other men who have sex with men in Europe and Canada, and another trial of the microbicide 1% vaginal tenofovir gel in South African women. There will also be data from a PrEP “demonstration project” that provided the strategy in a real-life context for Kenyan and Ugandan couples with one HIV-positive and one HIV-negative partner.
We don’t know what the specific headlines will be, but we can say with confidence that one take-away must be this: The future of HIV prevention is on the line.

In our latest report, AVAC Report 2014/15: Prevention on the Line, we provide a clear agenda for what needs to happen, what’s missing, and why it matters now more than ever before.

Specifically, we argue that:

  • Ambitious prevention goals matter. They can galvanize new action, in part by expanding our sense of what’s possible.
  • But these goals will only work if they’re feasible, well-defined, measurable, and backed by adequate resources and political support. The prevention goals issued so far are inspiring but they don’t yet meet those requirements.
  • As the UNAIDS “Fast Track” for 2020 set aspirational goals, clear short-term targets are also urgently needed. We can’t wait for five years to see if the world is on track to end the AIDS epidemic.
  • The global AIDS response is running at a major financial deficit. New targets will not be met—and may even be irrelevant—if we fail to close a growing global funding gap.

Recent breakthroughs in HIV research have transformed the ability to curb new infections, making it possible to contemplate the end of the global AIDS epidemic. But prevention could be left behind if global leadership fails to make it a priority.

Recently, UNAIDS issued broad goals for HIV testing, ART provision and virologic suppression over the next five years. According to the agency, achieving these “90-90-90” goals would put the world on track to effectively end the AIDS epidemic by 2030.

On the prevention front, UNAIDS seeks to reduce new infections worldwide from 2.1 million in 2013 to 500,000 in 2020, and to eliminate stigma and discrimination. These are ambitious goals and worth aspiring to. But something important is missing from the picture—intervention-specific targets with the specificity, strategy and resources to match. The goal is great. What’s missing is how to get there.

In twenty years, we will have ample hindsight as to whether today’s targets mattered in the quest to end AIDS.

But right now, foresight and focus are urgently required. We’re concerned about whether the targets that have been set are the right ones, how much targets matter—particularly in the context of a global response running at a disastrous funding deficit—and where prevention targets other than those focused on the antiretrovirals in HIV-positive individuals—fit in. We’re also cognizant that targets can turn from audacious to absurd in the blink of an eye if financing, political will and community buy-in are missing.

AVAC works in coalitions in many of the countries hardest hit by the epidemic. Targets that are developed Geneva, Washington DC and other corridors of power can bear little resemblance to the realities of AIDS endemic countries and communities. Where there’s no reality, there’s no relevance. It’s essential that countries have the technical and financial resources to make global targets relevant to national context. Otherwise, the loftiest goals will be ignored.

As we argue in this Report, targets have played a critical role in changing the course of the epidemic. Likewise, a poorly-thought out target can have no impact at all. Right now, it’s critical that targets and tactics are matched to the lofty but achievable goal of bringing an end to AIDS. This is why we’ve devoted the first section of the Report to a look at why targets matter, what targets are missing, and how advocates for a comprehensive response need to work together to ensure smart, strategic targets across the spectrum of prevention options.

We also focus on issues that underpin (and, sometimes, undermine) the ability to meet these targets. We identify three specific areas for action:

  • Align high impact strategies with human rights and realities. Biomedical advances of the past eight years have made it scientifically plausible to talk about ending the epidemic. But plausible doesn’t mean possible. Today some scientists and public health professionals are focused on what can be achieved biomedically—without enough attention to the structural and social contexts in which treatment prevention are delivered. At the same time, some rights-focused partners speak of HIV as being exclusively pill-oriented, suggesting that there isn’t any dynamism or action on the rights-based fronts. It need not be a permanent rift—indeed it cannot be. If science does not get synched up with human rights then then there is little hope of bringing the epidemic to a conclusive end.
  • Invest in an oral PrEP-driven paradigm shift. The world is failing to deliver the most effective interventions with smart strategy and at scale. Daily oral PrEP for HIV prevention is just one example. Global targets for PrEP may be released in the coming months, but there aren’t any plans in place to meet them. Demonstration projects are small and disconnected, funding is limited and policy makers aren’t heeding the growing demand from men and women, including young women in Africa. Now is the time to spend and act to fill these gaps.
  • Demand short-term results on the path to long-term goals. It will be years before the world has an AIDS vaccine, cure strategies, long-acting injectable ARVs or multipurpose prevention technologies that reduce the risk of HIV acquisition and provide contraception. But there’s plenty of activity in clinical trials and basic science for these long-term goals. This activity needs to be aligned with short-term goals that can be used to measure progress and manage expectations.

As AVAC Report goes to press this week and as we prepare for CROI next week, the United States is grappling with profound questions about the ways that the lives of Black men and women are valued under the law. The world is trying to understand how the West African Ebola epidemics got out of control—and how to bring them to an end. And there is continued concern and vigilance over anti-homosexuality laws in Nigeria and the Gambia, and in hate-mongering environments and legislation that endanger LGBT individuals and many other marginalized groups around the world.

These events are not separate from the work that we do to fight AIDS. They embody the issues of racism, inequity, poverty and security that drive the epidemic that must be addressed to end it. In addition to the HIV-specific work laid out in these pages, it is essential to work towards fundamental, lasting and positive change in each of these areas. That will be history-making, indeed.

Press Release

With future of HIV prevention “on the line,” AVAC calls for sharper, bolder strategy to end the epidemic

Contacts

Mitchell Warren, mitchell@avac.org, +1-914-661-1536

Kay Marshall, kay@avac.org, +1-347-249-6375

New York — In a report issued today, AVAC warned that global HIV prevention efforts are in jeopardy due to an absence of strategic targets, resources and specific implementation plans to translate science, slogans and goals into action. The report calls for a robust set of global HIV prevention targets tailored to specific interventions and demands action in several key areas of the global AIDS response, including expanded rollout of daily oral pre-exposure prophylaxis, or PrEP, and alignment of science and human rights-based agendas.

“We’re at a make-or-break moment and the future of HIV prevention is on the line,” said Mitchell Warren, AVAC’s executive director. “Advances in HIV treatment and prevention research have made it possible to contemplate ending the AIDS epidemic in our lifetimes, but that will only happen with smarter planning, increased resources and greater accountability.”

The report was released ahead of the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle (Feb. 23-26), where researchers are expected to present data from several major HIV prevention trials, including studies that could help drive global implementation of PrEP, as well as a key study of a tenofovir-based vaginal gel for women.

Report calls for smart, realistic goals and targets for HIV prevention

Today’s report, entitled Prevention on the Line, takes a close look at global goals for HIV prevention and what it will take to make them a reality. UNAIDS recently adopted the broad goals of reducing new HIV infections worldwide from 2.1 million in 2013 to 500,000 and eliminating stigma and discrimination, both by the year 2020.

Drawing upon lessons from WHO’s “3 x 5” HIV treatment initiative and other case studies, the AVAC Report concludes that ambitious prevention goals are critical – but that they will only work if they’re feasible, well-defined, measurable and supported with adequate resources and political commitment. In the case of the new UNAIDS prevention goals, the report points to a critical need for more specific, interim targets that can be tracked between now and 2020; for better data and monitoring approaches; and for resource allocations that are directly tied to achieving those targets.

“The UNAIDS prevention goals for 2020 are ambitious and inspiring,” said Warren. “But something important is missing from this picture: how to get there. We need a clear path forward, including short-term targets, so we don’t wait five years to see if the world is on track. And new targets won’t be met – and may even be irrelevant – if we fail to close the growing global funding gap for HIV prevention.”

Bold action needed to advance AVAC’s agenda to end AIDS

The report also recommends key actions to advance AVAC’s three-part agenda to end AIDS. First issued in 2011, the agenda calls for sustained efforts to deliver proven prevention tools, demonstrate and roll out new options such as PrEP and develop long-term solutions such as long-acting ARV-based prevention, vaccines and cure strategies.

Key recommendations for 2015 include:

1. Align high-impact HIV prevention with human rights and realities. Research has demonstrated the potential of high-impact prevention strategies, including biomedical approaches like HIV treatment for people living with HIV and voluntary medical male circumcision (VMMC). But these strategies won’t succeed in the real world if we give short shrift to human rights concerns, or if we fail to involve affected communities in designing and implementing prevention programs. Recent experience with treatment and VMMC, in particular, has shown that community buy-in is an essential ingredient of successful rollout and scale-up.

2. Invest now to scale up access to PrEP. Landmark trials have shown that daily oral PrEP is a powerful HIV prevention tool, and studies at next week’s CROI meeting could provide additional support. But the pace of rollout remains far too slow. Demonstration projects are small and disconnected, funding is limited and policy makers are not yet heeding growing demands for access. Funders should invest now in large-scale targeted implementation of PrEP, linked to national programs. National regulatory authorities and health ministries should prioritize licensure and rollout.

3. Accelerate research into long-term solutions. We must sustain and accelerate research on solutions such as an effective AIDS vaccine, long-acting antiretroviral prevention and treatment and a cure. Just like the rest of the AIDS response, this research needs its own short-term targets, aligned to long-term goals.

The new report and related resources, including downloadable graphics, are available now at www.avac.org/report2014-15.

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About AVAC: Founded in 1995, AVAC is a non-profit organization that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of AIDS vaccines, male circumcision, microbicides, PrEP and other emerging HIV prevention options as part of a comprehensive response to the pandemic.