Director, Johns Hopkins Fogarty AIDS International Training and Research Program
Founder and Director, Center for Public Health and Human Rights
Johns Hopkins Bloomberg School of Public Health
Chris Beyrer, MD, MPH, President, International AIDS Society, has no real or apparent conflicts of interest to report.
The annual conference presented by the International AIDS Society (IAS) is one of the leading scientific conferences in the HIV field. Altogether, the upcoming meeting in Vancouver will feature approximately 1200 accepted abstracts, and we expect as many as 7000 delegates to attend. This should be an exciting event for all participants and an important global convening of the HIV scientific community.
There are 4 major areas of study that will be presented at the meeting which represent areas of outstanding new science: early treatment and treatment as prevention, preexposure prophylaxis (PrEP) and other biomedical prevention tools, HIV cure, and HIV coinfections, particularly HIV/hepatitis C virus (HCV) coinfection.
Early Treatment and Treatment as Prevention
IAS 2015 will include the inaugural results from START, an important randomized trial examining immediate vs deferred antiretroviral therapy (ART) initiation. This trial was terminated early by their data safety monitoring board owing to significantly improved outcomes—a 50% reduction in clinical outcomes among patients who started therapy early vs those who delayed the initiation of antiviral therapy. The results of the START trial should highlight the importance of early treatment for improved clinical outcomes.
In a similar context, the HPTN 052 trial was also stopped prematurely due to efficacy. This was a landmark study investigating early vs delayed ART as prevention in HIV-discordant couples. An interim analysis of this trial was presented in 2011; after 1.7 years of follow-up, a dramatic 96% reduction in HIV transmission was observed with earlier initiation of antiviral therapy by the infected partner. At this year’s IAS conference in Vancouver, the final results of this study, which will include > 9800 person-years of follow-up, will be presented. These results should underscore the extremely important finding that essentially none of the participants who achieved viral suppression transmitted HIV to their partners.
The results of these studies suggest that the initiation of early therapy for both individual treatment and HIV prevention should be universally adopted. IAS 2015 will feature an important announcement, which is embargoed until the conference, on the numbers of people worldwide whom we have now reached with antiviral therapy. However, more than half of people living with HIV globally are still not on antiviral therapy. The results of these 2 trials stress the importance of reaching as many now untreated patients as possible early on.
PrEP and Biomedical Prevention
Key new data on PrEP will also be presented. The initial results from the PrEP Brasil study, which describes PrEP implementation data through a public sector system in a middle-income country (Brazil), address the question of PrEP uptake and demand. We are delighted that PrEP uptake appears to be high in this patient population and also that the people who are most at risk are those who are most interested in initiating PrEP. Similar findings were observed in the open-label extension (OLE) of iPrEx.
The results of the US PrEP Demo project, which investigated real-world PrEP use, uptake, and adherence among men who have sex with men (MSM) and transgender women in public clinic settings in San Francisco, Miami, and Washington, DC, will also be reported. Additionally, we will see the first data from ATN 110, which evaluated younger MSM in 12 US cities who use PrEP and their challenges with adherence.
Taken together, the data from these studies will be critical for the implementation of primary prevention at the next stage of the epidemic.
In the area of HIV cure, there will be an important presentation of a new case involving a perinatally infected child in France who has experienced a sustained remission more than 11 years after ART discontinuation. We will also see data from the Visconti cohort examining posttreatment HIV controllers.
HIV cure is an area of fervent investigation and—particularly when faced with the arduous task now of providing antiviral therapy for 37 million people globally—we all recognize that a cure would be a transformation of the pandemic. A number of abstracts and presentations on basic science approaches toward discovery of a cure will be presented, in addition to the IAS Cure Initiative Symposium, a 2-day preconference meeting of more than 300 of the world’s leading cure scientists.
The major coinfection studies I am looking forward to at IAS 2015 show new clinical data with novel antiviral agents and strategies for treating HCV infection and HCV/HIV coinfection. These include the open-label phase III C-EDGE Coinfection trial, in which coinfected patients were treated with the novel HCV treatment regimen of grazoprevir/elbasvir, and the ANRS CO13 HEPAVIH cohort, which will provide real-world data about the use of oral direct-acting antiviral (DAA)–based regimens to treat HCV in HCV/HIV coinfection. These studies are leading us in an extraordinarily important direction with the potential for HCV cure in patients with HIV coinfection. Important data on HIV coinfection with tuberculosis and hepatitis B will also be presented at the meeting.
In addition to the major areas of focus described above, there will also be a great deal of interesting work presented in implementation and prevention science. Special sessions discussing the 90-90-90 targets put forward by UNAIDS will also be held, and exciting data will be presented regarding the strategic use of antivirals for treatment, care, and prevention.
What we’re hoping is that taken together this conference will really be a watershed, as the last conference in Vancouver was in 1996 where, of course, we learned for the first time that triple therapy was effective.
We hope that you will return frequently to the CCO Web site to view the Official Conference Coverage, including Capsule Summaries of key presentations, downloadable slides, and expert faculty analysis from this very important meeting.
What presentations are you most looking forward to this year? Please use the comments section below to share your insights.