Official Press Release Day 3
Tuesday, 2 July 2013 (Kuala Lumpur, Malaysia)–Reflecting a broad range of issues, Tuesday’s plenary speakers speaking at the second plenary session of the 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) examined the issues of HIV and inflammation, an update on pre-exposure prophylaxis (PrEP), and the social determinants and structural barriers at play in Eastern Europe and Central Asia’s HIV epidemics.
The presentations reflected the breadth of expertise among the 4,700 researchers, clinicians and community leaders attending the conference, which runs from 30 June – 3 July in Kuala Lumpur, Malaysia.
“There are still too many unknowns when it comes to PrEP and key affected populations,” said Françoise Barré-Sinoussi, IAS 2013 International Chair and International AIDS Society President. “At a time when groups like men who have sex with men (MSM) and female sex workers are bearing the brunt of the emerging epidemic in South East Asia, new prevention tools are needed to ensure these vulnerable groups are protected.”
“Having heard so much about the success of harm reduction in Malaysia these past few days it is a crime against science that nearly one million people who inject drugs have become unnecessarily infected with HIV in Eastern Europe and Central Asia,” said IAS 2013 Local Co-Chair Adeeba Kamarulzaman, Director of the Centre of Excellence for Research in AIDS (CERiA) and Dean of the Faculty of Medicine at University of Malaya in Kuala Lumpur. “Those governments who are not basing their policies on scientific evidence are facing a stark choice – either accept the harm reduction evidence to bring down HIV infections or ignore it at a huge economic and human cost”.
The Relationship between HIV Disease and Inflammation
Daniel Douek (United States), Chief of the Human Immunology Section, Vaccine Research Center, National Institutes of Health, in his opening plenary remarks discussed the causes and consequences of immune activation in HIV disease, reviewing various therapeutic options to reduce immune activation and the rationale for doing so. He also discussed the advantages and disadvantages of anti-inflammatory therapy in HIV infection.
State of the evidence from Oral and Topical PrEP Efficacy Trials: What we know and what we still need to know
With PrEP at the forefront of current biomedical HIV prevention research, Javier R. Lama (Peru), Director of HIV Prevention Interventions Studies at the IMPACTA PERU Clinical Trials Unit, Asociación Civil Impacta Salud y Educación, examined existing PrEP efficacy data and key questions and issues ahead. Recently, proof-of-concept clinical trials of vaginally applied and daily oral tenofovir-based PrEP proved to be efficacious in preventing HIV-1 infection in different populations at risk, while other PrEP trials failed to show efficacy, raising many questions about applicability of PrEP to diverse populations, adherence promotion and monitoring, optimal dosing intervals, and method of delivery. Studies are being conducted or planned to assess these questions, while other studies are trying to translate positive PrEP findings into programmatic priorities.
Regulatory approvals and guidelines for PrEP vary widely and policymakers, with advocacy from populations at risk, are considering the implications of translating positive PrEP findings into programmatic priorities. It is still unknown which PrEP strategies such as oral or rectal, if efficacious, would work best to prevent HIV infection in populations at risk via unprotected receptive anal intercourse, as well as to whom each strategy would be targeted and the specifics of usage. Nonetheless, it is clear that if these products are found to be efficacious and are launched commercially, users will make choices about how and when to use them based on personal preferences. In addition to advocacy from populations at risk and governmental support of public health rollout, two key aspects of a successful prevention programme include a high-risk population willing to use such a method and providers willing to deliver it.
Social Determinants: Structural Barriers
Barbara de Zalduondo, Senior Advisor to the Deputy Executive Director for Programme, UNAIDS, summarized the evidence and expert consensus that structural factors — especially socio-cultural, economic and political factors, including stigma and punitive laws — largely account for the spread of HIV in Eastern Europe and Central Asia (EECA). Groups vulnerable to HIV are being left behind in much of the EECA region, and around the world, due to insufficient coverage of rights-based and evidence-informed prevention and treatment services. While EECA countries face low or concentrated HIV epidemics, they are extremely diverse and require local diagnosis, local leadership, and tailored and dynamic responses.
Zalduondo outlined progress in the conceptualization, implementation and measurement of social determinants and structural interventions available to support and enable HIV prevention and treatment programmes and highlight the lack of investment in research and implementation of these approaches. With over 15 structural intervention approaches available to diagnose and shift social barriers to HIV service delivery or uptake, it is time to invest in and appropriately evaluate them. Zalduondo challenged AIDS policymakers and advocates to better utilize social and political strategies to achieve the policy changes that they consistently demand, in the interest of more inclusive and effective HIV responses.