New COVID-19 Research and HIV Intervention Breakthroughs Are on the Menu at CROI 2021

[Editor's Note: CROI 2021 took place from March 6 through March 10, 2021. This article was published prior to the start of the conference; for our full coverage of the meeting, browse our CROI 2021 collection, including our bite-sized recaps of new research on HIV treatment/care, HIV prevention/epidemiology, HIV complications/comorbidities, and HIV and COVID-19.]

Arriving on the one-year anniversary of nationwide COVID-19 shutdowns, the 2021 Conference on Retroviruses and Opportunistic Infections (CROI 2021) will emphasize the new pandemic, with abstracts and lectures on SARS-CoV-2 alongside the important HIV prevention and treatment updates that have characterized the meeting in past years.

TheBodyPro spoke with several clinician-researchers on the CROI 2021 scientific committee, as well as HIV prevention and treatment advocates, to get a feel for the science they're most eager to see presented at this year's conference.

COVID-19 and HIV Will Be Front and Center

Last year, organizers had to scramble to move CROI 2020 online with very little time. Attendees were informed on March 6, 2020—just two days before the conference began, and after some had already arrived at the meeting’s planned location in Boston—that CROI would take place virtually.

Although the virtual conference was almost entirely focused on HIV, a rapidly arranged special session featured the most recent data then available on the novel coronavirus, including a snapshot from Anthony Fauci, M.D., on the federal research response. At the time, the clinical community had only unanswered questions about how bad this health crisis could get—and how people living with HIV (PLWH) and HIV services might be impacted.

One year, 2.5 million global deaths, and several highly effective vaccines later, the CROI 2021 agenda features new research and insights into COVID-19 treatments, vaccines, and comorbidities, including the intersections of SARS CoV-2 and HIV. Fauci will be back in the meeting’s opening session on March 7, covering what’s been learned over the past year regarding the concurrent COVID-19 and HIV pandemics. Throughout the meeting, he and other researchers will try to answer the big question: Is this the beginning of the end for COVID-19, or just the end of the awful beginning?

Several sessions at CROI 2021 may shine new light on the relationships between HIV and SARS-CoV-2, the virus that causes COVID-19. John Coffin, Ph.D., a professor of molecular biology and microbiology at Tufts University and member of CROI’s scientific program committee, touted an oral abstract session on March 8, “HIV/SIV Host and Cellular Interactions: Virology, Immunology, and Pathogenesis”—and not just because he’s moderating it.

“Back in July, when we were planning sessions, we wanted something on possible [SARS-CoV-2] variations,” Coffin said. “Now, here we are with many new variants, and it turns out this could be one of the hottest topics.” It’s one of many abstract sessions that will feature five speakers each talking for five minutes, then a half hour of discussion, a format that is new for CROI. “I expect the discussion to be pretty lively,” he said.

In addition to that session, Coffin said that an interactive session on March 9, “HIV-1 and SARS-CoV-2: Durability of Host Immune Responses from Vaccination or Infection,” is among the most likely to present groundbreaking data on the relationship between HIV and COVID-19.

Other COVID-related immunology sessions include an interactive discussion on March 10 entitled, “SARS-CoV-2 and the Host Immune Response: Good vs Bad Immunity”; an on-demand symposium on lessons learned from CoV-2 vaccine research; and an oral abstract on how the COVID-19 pandemic has impacted HIV prevention and care.

Lynda Dee, an HIV treatment activist and co-founder of AIDS Action Baltimore, told TheBodyPro she’s especially interested in seeing data regarding the effect of HIV infection on the severity of COVID-19. Some of the data presented “could affect [COVID-19] vaccine prioritization,” she said.

Dee is among the leaders of an ongoing effort by many advocates and organizations to push the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) toward explicitly including all PLWH on the CDC’s list of people with specific medical conditions that result in increased risk of severe illness from COVID-19. So far, the CDC has not prioritized PLWH, although the National Institutes of Health (NIH) Interim Guidance for COVID-19 and Persons With HIV did recommend that PLWH be prioritized for COVID-19 vaccination, and a dozen states and jurisdictions have placed PLWH in phase 1c of their vaccine rollout.

In addition to virology and medical research, CROI 2021 will also feature a March 10 panel on COVID-19 disparities entitled, “COVID Disparities: How Can They Help Move the Needle Forward?”—a recognition that, just as with the much older HIV pandemic, certain populations are at once more vulnerable to and less likely to receive effective treatment for COVID-19, including communities of color (e.g., Black people and Native Americans) and incarcerated people. Panel co-moderator Monica Gandhi, M.D., M.P.H., a professor of medicine at the University of California-San Francisco and a member of the CROI 2021 scientific committee, also noted another presentation that covered similar topics: a March 8 plenary entitled, “Disparities in Health: From HIV to COVID-19 and Beyond,” by James E.K. Hildreth, M.D., Ph.D., of Meharry Medical College.

On the HIV Front, Special Interest in Long-Acting Drugs and New Ways to Get to Zero

Jeremiah Johnson, HIV project director of Treatment Action Group, told TheBodyPro that, while he’s excited to learn about COVID-related research, he hopes those findings won’t detract from the HIV-focused presentations that will make up a hefty chunk of the CROI 2021 scientific program. “My background is in HIV prevention, so I’m most interested in seeing data that adds to our understanding of research, such as how to design [HIV vaccine] trials,” he said.

Johnson noted that prior to the approval of pre-exposure prophylaxis (PrEP), it was easier to ethically design HIV prevention trials, because study investigators could offer participants the interventions that were available at the time (condoms and counseling, mostly) and gauge how well a new intervention prevented new HIV infections compared to the control group. Ironically, the success of the interventions we now have makes such studies far more difficult: “How do you design a study measuring efficacy but showing zero new [HIV] infections?” he said.

Just in the past year, other prevention-research milestones, such as trials on long-acting injectable PrEP, oral monthly PrEP, and the AMP studies evaluating broadly neutralizing antibody infusions, have sparked excitement about additional opportunities to bring new HIV infections to zero. A March 9 plenary session featuring presentations by Marina Caskey, M.D., of Rockefeller University, and Linda-Gail Bekker, Ph.D., MBChB, of the University of Cape Town, will explore some of these issues.

Of course, long-acting therapy is also very much on the minds of HIV treating clinicians, given the approval of injectable cabotegravir/rilpivirine (Cabenuva) by the U.S. Food and Drug Administration in January. “From the HIV world, a particularly interesting interactive session will be ‘From Daily Pills to Monthly Shots for HIV Prevention and Treatment: Can Efficacy Be Translated into Effectiveness?’ about the opportunities and challenges of long-acting injectable therapy,” Gandhi told TheBodyPro. That panel discussion will take place on March 9.

Gandhi also noted that she was interested in oral abstracts on resistance data from HPTN 083 (which studied long-acting injectable PrEP in men who have sex with men and transgender women who have sex with men) and further details from HPTN 084 (which studied the same intervention in cisgender women; very encouraging data were recently presented at the 2021 HIV Research for Prevention meeting.

Also on the HIV prevention front, Annette H. Sohn, M.D., the vice president of global initiatives at amfAR and a CROI scientific committee member, said she was especially keen about an on-demand symposium she will be co-convening entitled, “Adolescents, Youth, and PrEP.” That session will include presentations she feels will bring new perspectives to the broader discussion around supporting youth who are at risk for HIV to both start and stay on PrEP.

A presentation by Claude Ann Mellins, Ph.D., of Columbia University, for instance, is expected to suggest “that instead of focusing on the challenges of PrEP adherence among youth, we capitalize on the positive aspects of adolescent development—such as their willingness to consider new interventions and utilize technology [and] their ability to tolerate ambiguity better than adults in order to take positive risks,” Sohn said.

And a talk by Elzette Rousseau, M.A., of the Desmond Tutu Health Foundation in South Africa, will likely use the metaphor of fast-food restaurants to push attendees to think beyond the usual public-health frameworks of PrEP delivery. “If McDonald’s can create quick and easy access to multiple food options that youth want to eat, why can’t we do that for PrEP?” Sohn said. “Social marketing has to be a higher priority if we hope to scale up PrEP delivery.”