The International AIDS Conference Continues the Fight Online
by Jeannie Wraight
This year’s International AIDS Conference (IAC) was set to take place in San Francisco and Oakland, California, this July. But, like most other large gatherings, the AIDS2020 live event was derailed by the COVID-19 pandemic. The sponsors of the conference, The International AIDS Society, decided to adapt, launching the first ever virtual IAC.
Attendance at AIDS2020: Virtual was much lower than the 15,000 participants once expected at the live event, with the attendee count often hovering below 4,000. The number of presentations were also a fraction of the normal overwhelming amount of session choices. However, the resilience of this biennial event is commendable and speaks to the utter strength of those committed to the fight against HIV.
In years past, the conference has witnessed tragedy and triumph. It has seen the loss of two amazing researchers: Dr. Johnathan Mann in 1998 and Joep Lange in 2014, both killed in plane crashes en route to the conference. In 2000, in Durban South Africa, it was where the world took a stand and demanded access to ARVs for every person living with HIV across the globe. Attendees have included Nelson Mandela, Bill Gates, Elton John, Bono, Kenneth Cole [A&U, November 2011], Bill Clinton, and countless other history makers.
In the midst of another pandemic, one thing remains clear: the fight against HIV will continue until this pandemic, which has claimed over 30 million lives, has been eradicated.
Possible case of HIV remission
Researchers report a novel case of a potential HIV remission. In 2015, a five-person study was conducted at the Federal University of São Paulo, using a latency-activating agent and intensified ART. Nicotinamide was used to “wake up” HIV lying dormant in viral reservoirs. Two additional ARVS (dolutegravir and maraviroc) were temporarily added to the participants’ existing regimens to intensify their ability to kill off existing HIV. In one of the four study participants, an unidentified thirty-six-year-old Brazilian man on a regimen of TDF, 3TC and efavirenz, researchers were unable to find signs of HIV. His ARVs were discontinued in March 2019. He has since remained off treatment with an undetectable viral load and only a low level of antibodies.
Dolutegravir is as safe in pregnant women as other ARVs
Data from the ongoing Tsepamo Study found the incidence of neural tube defects (deficits of the brain, spinal cord or spine) to be nearly the same as other ARVS, for babies born to mothers on dolutegravir at the time of conception. This data is important as earlier preliminary data from Tsepamo showed a possible increased risk for neural tube defects, temporarily resulting in dolutegravir not being recommended as a first line regimen, particularly for women with child-bearing potential. The study confirmed the drug to have only a 0.1% increase over efavirenz with two incidences out of every 1,000 infants, allowing for a broader use in pregnant women and women of child-bearing age.
Imbokodo HIV vaccine trial moves forward.
HVTN 705/HPX2008, also known as Imbokodo, progresses with the completed administration of all immunizations to study participants. The study, a collaboration between the HVTN and Janssen Pharmaceuticals, enrolled 2600 young women between the ages of eighteen and thirty-five in five sub-Saharan countries. Initial results are expected in late 2021.
90-90-90 goal unlikely to succeed
In 2015, UNAIDS spearheaded the goal of ending HIV by the year 2020. A vital milestone of this goal was for at least 90% of people living with HIV to know their status, 90% to be on treatment and 90% of those on treatment to be virally suppressed by the end of 2020. Only a small handful of countries have reached these goals. UNAIDS reports reasons for not reaching these milestones include a lack of funding, continued stigma preventing testing and seeking treatment, and not a large enough uptake of prevention efforts including condoms and PrEP.
The COVID-19 pandemic is affecting the fight against HIV
The World Health Organization reports that seventy-three countries are at risk of HIV antiretroviral drug shortages due to COVID-19. In addition, a study conducted by the Imperial College London reports that deaths in people living with HIV in low- and middle-income countries with high HIV burden may increase by 10% over the next five years due to the COVID-19 pandemic. Reasons for this include the disruptions in medication, disruptions in services leading to a lower rate of viral suppression, HIV testing and initiating treatment.
Most HIV-positive people not at a higher risk of COVID- 19
Several studies show no link to a higher rate of positive test results or severe illness with COVID- 19 in people living with HIV, regardless of viral load. However, Dr.Anthony Fauci, head of NIAID, has said those with damage to their immune system are likely at the same increased risk as those on immunosuppressive drugs. There had been some speculation that ARVs might offer some degree of protection, yet no new data was reported specifically on this hypothesis nor on COVID-19 and co-morbidities common in people living with HIV.
Jeannie Wraight is the former editor-in-chief and co-founder of HIV and HCV Haven (www.hivhaven.com) and a blogger and writer for TheBody.com. She is a member of the Board of Directors of Health People, a community-based organization in the South Bronx and an advisor to TRW (Teach me to Read and Write), a community-based organization in Kampala, Uganda. She lives with her husband in New York City.