Threatened HIV Funding Cuts in Limelight at IAS 2017

Heather Boerner

July 17, 2017

PARIS — Researchers, clinicians, and advocates converging in Paris for the International AIDS Society (IAS) 2017 Conference will not only be talking about new HIV treatment and prevention and how to roll out innovative medications in a comprehensive, integrated way, they will also be making a case to funders.

The conference comes as American leaders hint at or request drastic cuts to key HIV funding programs, including the President's Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health.

"If funders feel the progress we're making, it will create dividends in more ways than one," said International AIDS Society President Linda-Gail Bekker, MD, PhD, from the University of Cape Town in South Africa. "We may see some threatened cuts put on hold."

The cuts are being proposed as research is heading in directions that will soon change practice, according to meeting organizers.

New Drugs and Delivery Models

Included in the research most likely to translate to the clinic are data on new drugs, such as two long-acting injectables — cabotegravir for prevention and rilpivirine for treatment — said Steven Deeks, MD, from the University of California, San Francisco.

"The next big paradigm shift will be the approval, in the next couple years, of these drugs, which are given as injections once every 2 or 3 months," said Dr Deeks.

"This will have a huge impact in terms of how to manage a very important group of people who are not able to access regular care for mental health and substance abuse," he explained. "You give those folks a shot a few times a year; that's going to have a huge effect."

In addition to presentations on injectables, data on Merck's once-weekly nucleoside reverse transcriptase translocation inhibitor will be unveiled. And bictegravir will be presented as a treatment option in combination with emtricitabine and tenofovir alafenamide, in accordance with data previously reported by Medscape Medical News.

Researchers will also present phase 3 efficacy data on the monthly dapivirine ring, how American adolescents feel about the ring, and the impact of vaginal bacteria on dapivirine concentrations.

We could have a stockpile of pills and injectables and they may never make it to those who need it most.

But Mitchell Warren, a member of the PEPFAR Scientific Advisory Board and executive director of AVAC, a global advocacy group for the prevention of HIV based in the United States, worries that we will end up with "a stockpile of pills and injectables that may never make it to those who need it most."

"We're sitting here in 2017 and we haven't delivered oral pre-exposure prophylaxis at scale yet," he said. "Delivery is as complex as product development."

This issue will be addressed in sessions on the scale-up of HIV self-testing and on financial and nonfinancial incentives related to treatment and prevention. The real-world impact of the test-and-treat strategy will be reported, and there will be a symposium on the creation of pathways unique to different at-risk populations.

This focus reflects a "coming of age" for the HIV community, said Dr Bekker. We are "moving away from the hunt for a silver bullet that will fix everything for everyone."

"The epidemic is made up of individuals and particular populations," she said. "And each of those populations needs a very specific intervention."

To this end, researchers will present case studies on a child who received treatment weeks after birth and an adult who began treatment on the first day of detectable HIV antibodies.

"Both studies raise the question of whether treatment by itself, at the right time for the right duration with the right person, is curative in terms of long-term remission," said Dr Deeks.

There's tremendous similarity between what oncologists deal with and what we deal with in trying to cure HIV.

Dr Deeks is also cochair of a preconference forum on HIV Cure and Cancer, which is already at capacity and has a 700-person waiting list. During the forum, researchers will discuss cancer immunotherapy for HIV-related cancers and newly discovered biomarkers for HIV reservoirs.

"There's tremendous similarity between what oncologists deal with and what we deal with in trying to cure HIV," said Dr Deeks. "We are trying to leverage the outstanding amount of progress in the oncology world to help us in the HIV cure world."

Dr Bekker and Dr Deeks have disclosed no relevant financial relationships.

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