Important Advances in HIV Prevention Unveiled: New PrEP Formulas & Broadly Neutralizing Antibodies
The opening press conference of the 4th HIV Research for Prevention Conference on 26 January.

While global attention has fixated on the coronavirus, the forty-year long fight against HIV, which has claimed 33 million lives, is seeing new breakthroughs in preventive tools.

New discoveries of “broadly neutralizing antibodies” as well as novel regimens of pre-exposure prophylaxis (PrEP), could strengthen the world’s toolbox to prevent the disease, announced the International AIDS Society (IAS) at the opening of the 4th HIV Research for Prevention Conference

The IAS-sponsored Conference, which is taking place virtually over four days, is the only conference in the world that is exclusively focused on research in HIV prevention. 

“COVID-19 has disrupted research around the world, so it’s especially exciting to see this new progress,” said IAS President Adeeba Kamarulzaman in a press release. “These research advances on options like broadly neutralizing antibodies and injectable PrEP could help significantly strengthen our HIV prevention toolkit.” 

Adeeba Kamarulzaman, President of the International AIDS Society, at the HIVR4P Conference.

The latest results on broadly neutralizing antibodies (bnAb) are particularly promising. In a pair of parallel trials, researchers from the Fred Hutchinson Cancer Research Center found that one of its bnAb’s prevented HIV infection 75% of the time over 20 months, thus providing an important “proof of concept” to prevent sexually-transmitted HIV in the future, said the study’s  authors. In this case, the bnAb’s were developed to recognize the ‘CD4’ binding site of the HIV virus.

In the two parallel trials, researchers injected participants with a placebo or two doses (10mg/kg and 30 mg/kg) of their antibody. In the American arm of the trials, enrolees included men and transgender persons who have sex with men, while the Sub-Saharan arm of the trial recruited cisgender women.

More Practical PrEP Regimens Also On Horizon

Meanwhile, two longer-acting and thus more practical PrEP regimens have been developed. They have the potential to replace common treatments that have to be taken on a daily basis, such as tenofovir/emtricitabine (TDF/FTC), also known as “Truvada”. 

They include cabotegravir, the first long-acting injectable regimen, as well as islatravir, a pill that would only need to be taken once a month.

As well as improving adherence to PrEP, these novel treatments could also bolster global PrEP uptake, which still falls short of the 3 million target set by UNAIDS despite a six-fold increase in uptake over the past four years, found the AIDS Vaccine Advocacy Coalition in a study that was also featured at the conference.

Cabotegravir – Injectable PrEP Regimen Works Better Than Existing Treatment 

Based on a study in over 3,000 women in Sub-Saharan Africa, PreP candidate cabotegravir, was deemed safe and far superior to Truvada, complementing similar findings from another earlier trial in cisgender men as well as transgender women who have sex with men.

In this latest trial, participants received either cabotegravir plus a placebo of TDF/FTC or a placebo of cabotegravir and active TDF/FTC. Alongside daily administration of oral TDF/FTC for five weeks, participants received intramuscular injections every eight weeks.

On a positive note, women in the cabotegravir group were 89% less likely to contract HIV compared to the group that received TDF/FTC, probably because it is easier to adhere to a treatment that’s taken every 8 weeks compared to a pill that must be taken every day, noted researchers.

But more funding is needed to reach global targets to eliminate HIV, warned another study that was also presented at the conference, and presented by St Luke’s University.

Based on over a hundred nationally-representative datasets representing more than 1.4 million sexually active people, the study projected that the probability of reaching the 2030 targets set by UNAIDS is “very low” – ranging between 0% to 28.5% for HIV testing and 0% to 12.1% for condom use.

Unless more attention is given to the disease, the prospects of reaching these bold targets to put a stop to HIV/AIDS are rather slim, concluded the study.  

Africa Should Not Be left Behind in HIV Prevention & Control 

Along with reviewing new research breakthroughs, members at the Research for Prevention Conference examined the state of HIV prevention and control measures – which highlighted key concerns for the African  continent. 

Phuong Nguyen of St. Luke’s International University presented data analysis that showed African countries are largely not on track to reach key UNAIDS targets for HIV testing and condom use by 2030. 

Trends in oral PrEP use globally as countries introduce and scale up PrEP programs.

Relying on 114 nationally-representative datasets representing more than 1.4 million sexually active people, the team estimated coverage of annual HIV testing and condom use at last higher-risk sex for each country and year to 2030, and the probability of reaching UNAIDS testing and condom use targets of 95% coverage by 2030.

They reported that the probabilities of reaching the 2030 targets were very low for both HIV testing (0% to 28.5%) and condom use (0% to 12.1%). 

Within Africa, they predicted that the countries with the highest coverage of annual HIV testing in 2030 will be Eswatini with 92.6%, Lesotho with 90.5%, and Uganda with 90.5%. The countries with the highest proportion of condom use will be Eswatini with 85%, Lesotho with 75.6%, and Namibia with 75.5%.

The researchers concluded that there is little prospect of reaching global targets for HIV/AIDS elimination. They made the case for more attention to funding and expanding testing and treatment in Africa.

On the brighter side, Africa is making progress on expanding access to existing PreP formulations – and that should accelerate with the new breakthroughs just announced. 

Geographic representation of the number of PrEP initiations globally as of late 2020.

AIDS Vaccine Advocacy Coalition’s (AVAC) Kate Segal noted that sub-Saharan Africa  expanded PrEP access from 4,154 initiations in 2016 to 290,981 by mid-2020, comprising 44% of the global total.

She used data from AVAC’s Global PrEP Tracker to identify global and regional PrEP initiation trends from the third quarter of 2016 through the second quarter of 2020. 

“While PrEP initiations have grown exponentially in several countries, global uptake falls far short of UNAIDS’ target of 3 million users, indicating a need for sustained demand creation where PrEP programs exist, and scale up where PrEP is provided by demonstration projects with limited reach,” the study concluded. 

Find out more about the event here.

Image Credits: Flickr, HIVR4P, Global Advocacy for HIV Prevention.

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