Turning the Page to a New Era in HIV Prevention Research

AVAC Report warns promising developments in biomedical HIV prevention could be undermined by current conditions of the global AIDS response 
A new report from AVAC surveys the state of biomedical HIV prevention research, including the first evidence of vaccine-induced protection in humans and the emergence of ARV-based prevention—and provides strategic recommendations for moving forward in a time of constrained resources and faltering commitment to ending AIDS. Turning the Page, AVAC’s 13th annual report on the state of the HIV prevention research field, offers unique context and a timely critique for issues that will be center stage at the upcoming XVIII International AIDS  Conference (IAC) in Vienna, Austria. These issues are also central to the AIDS response outlined in the first ever US National HIV/AIDS Strategy, released on 13th of July 2010. Read more

As the report describes, scientific developments in several arenas of biomedical prevention research have re-energized the search for additional strategies. In the vaccine field this includes the first evidence of vaccine-induced protection and strides in identification of new potent, HIV-specific neutralizing antibodies. Antiretroviral-based prevention also shows potential, and the report provides context for the upcoming results of the CAPRISA 004 microbicide trial, the first effectiveness trial of an ARV-based prevention strategy in HIV-negative people.

The biomedical prevention research field must now develop strategies for pursuing new scientific leads and following through on promising developments without the guarantee of expanded financial resources. In addition, the implications of recent breakthroughs need to be explained clearly to diverse audiences. As the report describes, the next phase of human clinical trials will involve complex designs and questions, and their success will depend on the support of all stakeholder groups. It will be difficult to execute this ambitious research agenda in the context of fiscal constraint—and the field needs to address this head on.

“We face yawning gaps in funding for proven prevention and treatment and a crisis in financial and political will,” said Mitchell Warren, AVAC Executive Director. “There is skepticism about whether disease-specific funding for AIDS is cost effective and skepticism about whether limited funds for AIDS should include funding for AIDS prevention research.”

“The recent report from UNAIDS that proven HIV prevention is having a demonstrable impact on the epidemic in many African countries is good news. But to really have an impact on the epidemic we need additional funding and political commitments for AIDS treatment and prevention programs AND more funding for HIV prevention research,” Warren added.

“The AVAC Report makes the critical point that to capitalize on recent breakthroughs in HIV prevention, we must find smart and innovative ways to make the best use of available funding,” said Chris Collins, AVAC Board Member and Vice President and Director, Public Policy at amfAR, The Foundation for AIDS Research.

The HIV prevention research field has been buoyed by major breakthroughs in recent months and Turning the Page calls for researchers, funders and others to prioritize collaboration and nimble and adaptive planning for replenishing the pipeline with new products and designing clinical trials that will yield the most information to move the field forward.

In recent years, the HIV prevention research agenda has broadened beyond vaccines and microbicides to include antiretroviral-based prevention, including pre-exposure prophylaxis, and, more recently, efforts to understand the role of treatment as prevention. At the same time, HIV treatment programs—once thought to be impossible to implement in developing countries—have expanded to reach millions of people around the world.

“The HIV prevention research agenda must take into account the new realities of the fight against AIDS. We believe that new prevention programs cannot be built while current treatment programs are faltering,” Warren said. “To reach the goal of universal access to healthcare—which includes comprehensive AIDS treatment and prevention—advocates, researchers, health care providers, funders and policy makers must speak with one voice.”

Turning the Page lays out the critical components of a response to AIDS that unites treatment and prevention, including:

* Sustain and expand current treatment and care programs: Funding restrictions are beginning to take a damaging toll on AIDS treatment programs at the precise moment that data are emerging to show that ARV treatment prevents deaths, lowers health care costs and can reduce the risk of HIV transmission. Donors and policy makers must take the critical steps needed to forestall further damage and put treatment programs back on track.

* Actively explore treatment as prevention: There is compelling evidence that earlier initiation of antiretrovirals in HIV-positive people can reduce the risk that they will infect sexual partners with HIV. Additional data will come from an ongoing clinical trial, but the world should begin exploring the practical approaches and implications of scaling up HIV treatment as prevention that can help guide policy makers’ decision-making about potential introduction of treatment as prevention when the data become available.

* Plan for ARV-based prevention: Neither oral PrEP nor topical ARV-based microbicides have yet been proven to have benefit. But, if they do, they will need to be delivered strategically, in programs that provide clear, integrated messages about the risks and benefits of ARVs for prevention in HIV-negative people. Results from CAPRISA 004, the first ARV-based microbicide effectiveness trial, will be delivered next week at AIDS 2010 and results from initial PrEP effectiveness trials are expected in the next 12 months. The field needs to be prepared to address the many questions that will emerge from these results and develop rational plans for ensuring the best use of the potential new options.

“We must also be ready to be surprised. The greatest advances in the fight against AIDS have come about because people and institutions refused to accept conventional wisdom about what was possible,” Warren said. “In 15 years of advocating for AIDS vaccines, we at AVAC have witnessed many moments when an AIDS vaccine was deemed a scientific impossibility. Yet, a trial that had been all but discounted by many provided evidence that a preventive AIDS vaccine is possible. And AIDS treatment programs and their clients have flourished in every possible context around the globe in the face of those who said it was impossible.”

“Now is the best time to invest in an expanded response to the AIDS epidemic. AVAC stands with the global community of advocates for HIV prevention, treatment, research and implementation to expect and demand an extraordinary response to this unprecedented epidemic—our only hope of closing the book on AIDS,” Warren added.

Turning the Page and other AVAC publications, including an upcoming report on anticipating the results of ARV-based prevention trials are available online at www.avac.org 

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