Since the beginning of the HIV/AIDS pandemic, investigators have been exploring different avenues of research for how to stop transmission of the virus once and for all.
As scientific research continues to advance, experts in health care continue to discuss potential timelines for an HIV vaccine or an HIV cure, but HIV elimination and even further, eradication, are also on the minds of many.
In a plenary lecture at the HIV Research for Prevention (HIV R4P) conference, being held in Madrid, Spain, Anthony Fauci, MD, Director of the National Institute for Allergy and Infectious Disease presented a session entitled “Ending the HIV/AIDS Pandemic: The Critical Role of HIV Prevention Science.”
With 1.8 million new infections reported in 2017, Dr. Fauci explained how rather than concentrating on elimination and eradication, the research community should focus on HIV control.
He backed this argument by pointing out that smallpox is the only human disease to be eradicated worldwide and that although several other human diseases have been eliminated from certain areas of the world, none have been eradicated completely.
According to Dr. Fauci, prevention pathways toward ending the HIV/AIDS pandemic should focus on the synergy and convergence of vaccine and nonvaccine prevention.
In the category of nonvaccine prevention, elements include condoms, prevention of mother-to-child transmission, voluntary male circumcision, treatment as prevention, and pre-exposure prophylaxis (PrEP).
In his lecture, Dr. Fauci discussed the need for investigators and physicians to think realistically, not theoretically. In theory, if we could identify all individuals infected with HIV and put them on suppressive antiretroviral therapy, we could theoretically end the HIV/AIDS pandemic tomorrow, said Dr. Fauci. However, for various reasons—including rates of adherence, and barriers in surveillance—it is not realistic for that to occur.
Oral PrEP has been a successful prevention option in many populations, but it is also critical to optimize broadly neutralizing antibodies for prevention and treatment of HIV. According to Dr. Fauci, areas of research in this category should focus on pinpointing more potent antibodies and extending their half-life, analyzing vector-based antibody production in vivo, and focusing on successfully using combinations of antibodies.
In addition to clinical research, it is critical to focus on incidence “hot spots,” said Dr. Fauci. It is imperative to pinpoint where there are HIV clusters or prevalence and compare and contrast if PrEP prescriptions are being administered and filled in those areas.
In addition to geographic trends, it is also important to look at demographic trends to determine in which populations HIV cases are most prevalent.
Finally, Dr. Fauci addressed the concept of an HIV vaccine and in his opinion, it could be approached in 2 ways.
First, investigators could produce a vaccine based on the empiric approach, testing the candidate and identifying a correlate of immunity which is a typical approach to vaccinology. However, it is also possible that the vaccine could be developed by assuming a correlate of immunity and designing a vaccine to induce this correlate.
Regardless of the method, the level of efficacy required to make the vaccine acceptable worldwide is still unknown. How good is good enough?
In closing his presentation, Dr. Fauci concluded, “Development of a moderately effective vaccine together with optimal implementation of existing treatment prevention modalities could end the current HIV pandemic.”
By Michaela Fleming