R4P Day 1: Synergies Across HIV Prevention, Ebola Parallels, B-Cell Research and More
Greetings from the first official day of the HIV R4P conference. With multiple sessions on a wide range of topics, it's impossible to provide a complete overview of every day. The good news is that the conference is fully webcast with sessions up on the web 24 hours after they take place -- and is also being live-tweeted by many participants, who are providing a sense of quotable quotes, key data and unanswered questions in real time. You can follow that at #HIVR4P.
For those who may want more than 140 characters and fewer than 32 hours of webcast video -- the AVAC team and our partners will be providing a daily look at various selected highlights. Here's a whirlwind tour of Day 1. Please note the webcasts are available 24 hours after they were presented -- available here. Additional resources, including copies of selected speakers' remarks are available at www.avac.org/HIVR4P.
Helen Rees, Conference Co-Chair and Executive Director of the Wits Reproductive Health and HIV Institute, opened the conference and set the stage very eloquently. She spoke of the synergies across the HIV prevention field that make this conference so exciting, and the reasons why South Africa is an ideal location with such remarkable research capacity, and intense need for additional prevention tools, particularly for women. She spoke about the parallels between Ebola and HIV (stigma, decisions based on politics not science, products not being tested). She also honored Joep Lange and the five other members of the AIDS community who died on the downed plan over Ukraine on the way to AIDS 2014. She reminded us he'd be frustrated we're going too slowly and would tell us to push the barriers.
Naledi Pandor, South African Minister of Science and Technology, spoke engagingly about the successes in South Africa and what still remains to be done -- including a strong pitch for combining behavioral and biomedical prevention into truly effective combination prevention.
Desmond Tutu's daughter accepted the inaugural Desmond Tutu Award for HIV Prevention Research and Human Rights on behalf of her father.
From there, it was on to the scientific speakers. South African vaccine researcher Lynn Morris (National Institute for Communicable Diseases) walked through the state of B-cell research. This area -- focused on the arm of the immune response that includes broadly-neutralizing antibodies against HIV -- is covered in several sessions. While the topic is science-heavy, it's of relevance to advocates and is generating a great deal of excitement. It is, as NIAID head Anthony Fauci described in his remarks, "changing every week." AVAC will develop an "Antibodies in Plain Language" guide to this science in the coming weeks. Watch this space!
University of Washington researcher Jared Baeten spoke about ARV-based prevention and had five basic messages -- plus a terrific picture of his daughter, who turned five today. The messages are below -- and the talk is well worth viewing. They are:
- When ARVs [for treatment or prevention] are taken, they work.
- You don't always have to be perfect to be good enough.
- Barriers are real, and sometimes they are us.
- PrEP is wanted, but it is not forever, it is not for everyone and it is not one-size-fits-all.
- There are risks in doing but there are greater risks in not doing enough.
Finally, Dr. Fauci made his remarks by video -- unable to attend due to the "epidemic of fear and concern" over Ebola in the United States. He focused on the full array of strategies needed for effective combination prevention.
Also at the Conference
What We Talk About When We Talk About Anal Sex
Advocates interested in why social science is important -- and what "translation" means when it comes to clinical research -- should make a beeline for the webcast of Zoe Duby's (Desmond Tutu HIV Foundation) presentation on the language, terminology and understanding of anal sex in participants in the VOICE trial.
Therapeutic Vaccines Are Still a Challenge
Harriet Robinson (GEOVAX, Inc) presented data from a therapeutic vaccine intervention in which people with HIV on ART received a DNA-MVA vaccine combination (GEOVAX-B11) and then underwent a treatment interruption. The good news: HIV-specific responses were on hand; the bad news -- there was no evidence of control. Watch the presentation to see Dr. Robinson on what's next for this strategy and cure research.
Early ART Initiation and HIV-Specific Immune Responses
Early ART limits a person's exposure to replicating HIV. Effective ART limits viral replication, which limits immune stimulation, which limits the development of HIV-specific immune responses. Alexandra Schuetz (AFRIMS, Henry M. Jackson Foundation) presented on immune responses in people starting treatment early, really really early, and during chronic infection. (The technical terms for "early and really, really early" are scores on something known as a Fiebig stage. Watch the presentation to see what happens.)
History Affects HIV Prevention
Cheryl Louw (Madibeng Centre for Research, South Africa) worked with The Ring Study trial site close to the Marikana platinum mine that was the site of a strike-related massacre in 2012. After the massacre, women began reporting increased aggression from male partners, as well as resistance to the rings (tested in the study) and to trial participation. Louw described the successful steps taken to address the surge in trial discontinuation -- but it's a thought-provoking talk about how real events can put women (and men) at risk, even when they are using a strategy successfully.
Tenofovir Gel Reduces HSV-2 Risk
One of the added benefits of oral tenofovir-based PrEP is that it appears to reduce the risk of HSV-2 acquisition and/or ulcer-related adverse events. Today Jeanne Marrazzo (University of Washington) described a similar finding in women who used tenofovir gel in the VOICE trial.
Treatment Is Prevention -- So Is Prevention
The treatment as prevention symposium provided an overview of the range of large-scale implementation studies looking at the potential impact of treatment as prevention. It begs the question -- asked in the session -- of how to deal with delivery of other "primary" prevention options like condoms, VMMC, PrEP and behavior change. Want to find out the answer? Watch the session.
Broadly Neutralizing Antibodies Are Giving Up Some Secrets
The afternoon non-abstract driven session "Overcoming Barriers to Broadly Neutralizing Antibody Induction" featured a series of talks that unpacked the latest increments of progress -- and the specific hurdles -- in inducing these potent immune responses. Most accessible to advocates with a grounding in immunology, this session -- along with Lynn Morris's plenary, is a great way to get the current state of this field that is evolving as much as the immune responses that it is studying -- which is to say, a lot.
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