We continue to explore the potential for new HIV treatment and prevention innovations (broadly neutralizing antibodies [bNAbs] in HIV vaccines, oral pre-exposure prophylaxis [PrEP] for HIV prevention, and long-acting injectable antiretroviral [ARV] drug therapy) identified in the recent Reimagining Global Health report issued by the Innovation Countdown 2030 initiative, as well as other new technologies in the pipeline. In this installment, we hear from AIDS Foundation of Chicago (AFC), International Rectal Microbicide Advocates (IRMA), the International Partnership for Microbicides (IPM), and the Microbicide Trials Network (MTN). Read on to learn how new technologies could change the trajectory of the HIV/AIDS epidemic in the next 15 years.
Views expressed are those of the contributors and may not be shared by PATH.
As longtime supporters of research and development of new prevention technologies, we are excited about new items in the pipeline being created for the prevention buffet, such as vaccines with bNAbs and long-acting injectables for both prevention and treatment. We are equally enthusiastic about daily oral PrEP—a currently available intervention that has been proven to work exceptionally well to prevent HIV. It is concerning that this report not-so-subtly diminishes PrEP by pointing to poor adherence—despite this being a very new intervention with limited access, and despite conflicting data that would argue to the contrary. Daily oral PrEP will be the only new prevention technology we have for several years, or more, to come. We must do our best to make the most of it, and not degrade it prematurely.
And let’s be clear, “complete protection” from HIV does not, in fact, require the use of condoms with PrEP as the report suggests. PrEP works in the absence of condoms. New technologies like PrEP are being developed precisely because people can’t/don’t/won’t use condoms, so sending the message that new strategies must be paired with condoms doesn’t reflect real-world needs or real-world behaviors and can negatively impact uptake and adherence. PrEP doesn’t protect against other sexually transmitted diseases, but HIV remains singular in its devastating impact, and preventing it on its own is a worthy endeavor. We continue to strongly support the development of rectal microbicide products that can be used by men, women, and transgender individuals to protect themselves during anal intercourse. Even with other current and future advances, we believe a rectal lube or a douche with anti-HIV properties is still very much needed and requires sufficient resources, ongoing commitment, and active engagement. We are cautiously optimistic about the vaginal ring efficacy studies reporting in the next six months and are especially energized by scientific efforts underway around multi-compartment, multipurpose technologies.
[Ed. Note: While there is an ongoing conversation about what PrEP means for condom use, the recent UNAIDS oral PrEP report stresses that PrEP does not replace condoms, but rather “complements other evidence-informed prevention approaches, including condom and empowerment programmes for sex workers, harm reduction for people who inject drugs, and efforts to change the legal and social context that increase the risk of acquiring HIV for many people.” Similarly, the Centers for Disease Control and Prevention recommend that oral PrEP is used with other prevention options such as condoms. Ending the HIV epidemic will require a comprehensive strategy inclusive of testing, treatment, and prevention. ARV-based prevention options like oral and long-acting injectable PrEP would complement other HIV prevention strategies including an eventual vaccine, microbicides, condoms, voluntary medical male circumcision, treatment as prevention, and other options.]
The success of new technologies such as oral PrEP in preventing HIV shows how investments in scientific innovation are paying off, for men and women. It’s great news because ending the epidemic will require a range of options that fit within the context of people’s lives. With exciting technologies like injectable ARVs and a vaccine on the horizon, the next big breakthrough in HIV prevention for women could be a monthly vaginal ARV ring developed by IPM. Self-initiated, long-acting, and discreet products are an especially urgent need for young women in sub-Saharan Africa, who are at an increasing risk of infection. Efficacy results from two late-stage trials of the ring led by IPM and MTN are expected as soon as early 2016. By 2030, we could have the full toolkit of options needed to keep the epidemic at bay, from PrEP and even longer-acting ARV rings that also offer contraception, to injectables and a vaccine.
A huge thanks to all of our contributors for enabling our discussion of the HIV-related innovations featured in Reimagining Global Health. Agree or disagree with the experts speaking here? Leave a comment and join the conversation on Twitter with the hashtag #IC2030.