CROI 2019: What News to Expect in HIV Science and Policy

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Myles Helfand

Next week, thousands of clinicians and scientists will make their way to Seattle for the annual Conference on Retroviruses and Opportunistic Infections (CROI), to be held March 4-7, 2019. As one of the largest HIV conferences, CROI brings together scientists, researchers, and advocates -- all working toward the common goal of HIV elimination.

CROI is highly regarded for its robust scientific presentations. However, this year, the plan for CROI's opening session took an abrupt political turn after President Donald Trump's unexpected pledge in his Feb. 5 State of the Union address to end the U.S. HIV epidemic by 2030.

Elaine Abrams, M.D., professor of pediatrics and epidemiology at Columbia University Medical Center, said she was "surprised" by the president's announcement that the government would redouble its efforts to eradicate HIV in the United States.

After the State of the Union address, CROI's scientific programming committee -- of which Abrams is co-chair -- invited Anthony Fauci, M.D., the director of the National Institutes of Health, to give a special opening session about the government's HIV eradication plan.

"We're anticipating that Dr. Fauci will put some color to that story and give us a sense of what [the White House is] thinking," Abrams said. "It's the perfect venue. There will be 4,000 people in the room who [have] been working in this area, many of them for quite a long time."

Outside of Fauci's somewhat impromptu appearance, CROI programming will feature important incremental advances in HIV treatment and prevention science.

Sebastian Kaulitzki for Hemera via Thinkstock

Chipping Away at HIV Basic Science

On the first day of the conference, a Monday, attendees will be greeted by a series of pre-conference workshops that offer a sample of what's on the agenda throughout the four-day conference, including updates on HIV basic science, new long-acting treatments, common HIV comorbidities and how to treat them, as well as the latest in HIV prevention science.

It wouldn't be CROI without important research in HIV basic science, and this year will be no different. Abrams, who cautioned that basic science is not her area of expertise, said progress on the HIV viral reservoir and the immune system has been "incremental," but she also noted that this year's conference will feature exciting presentations on primate research.

Monday's programming includes an afternoon session on engineering the latent reservoir and a concurrent session on new ways to quantify that reservoir. On Thursday, two afternoon sessions will shed light on the HIV virus, including one session on the loss of innate lymphoid cells in HIV and SIV, and another session on memory natural killer cells in HIV and SIV.

Long-Acting Antiretrovirals in New Populations

Another key feature of CROI programming is updates on clinical research, from drugs just entering Phase I trials to post-market research on medications that have been approved for years.

This year, we'll see updates on long-acting cabotegravir, alone and in combination with rilpivirine (Edurant). We'll also see data on maturation inhibitors and capsid inhibitors that are still in the earliest stages of clinical development.

Much of this data will be summarized in the oral abstract on antiretrovirals that takes place each year, Abrams said. Importantly, this year, much of the data on new therapies will include data on their use in pregnant women.

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HIV Comorbidities: Heart, Brain, and Bones

This year's program is filled with new research on how to improve outcomes for patients living with HIV and one or more other comorbidities, such as cardiovascular disease, cognitive disorders, and osteoporosis.

"For providers who are in the field, treating patients, I think there is a lot of data emerging on comorbidities and long-term complications that are both HIV and [antiretroviral therapy]-related," Abrams said.

CROI will also feature at least three sessions on hepatitis C, which will offer valuable insights for providers who treat patients with coinfection.

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Prevention, Prevention, Prevention

Prevention will once again be a major theme at CROI, with an entire symposium on Thursday afternoon dedicated to prevention efforts in teens and young adults, including transgender teens, young women in Sub-Saharan Africa, young men who have sex with men (MSM), and heterosexual men.

As well, Thursday afternoon will feature a session on pre-exposure prophylaxis (PrEP) failures and the implications of those cases. Prevention research will also be on display in the conference's many abstracts and poster sessions, with Abrams pointing to an exciting late-breaking abstract that will include updates on the HIV Prevention Trials Network PopART study.

This is a small selection of some of our anticipated conference highlights, but stay tuned here for TheBodyPRO's coverage of clinically noteworthy study presentations and curated symposia, and for an update on the government's plan to eradicate HIV by 2030 in the United States.

Sony Salzman is a freelance journalist reporting on health care and medicine, who has won awards in both narrative writing and radio journalism. Follow Salzman on Twitter: @sonysalz.