“Towards an HIV Cure: engaging the Community workshop”
Durban, 16th of July 2016
Summarized by Julia G Prado, AIDS research institute Irsicaixa
The IAS 2016 pre-conference programme gave us the opportunity to attend the “Towards an HIV Cure: engaging the Community workshop” on Saturday morning. The workshop introduced by Francoise Barré-Sinousí (Institute Pasteur, France) was devoted to engage the community in HIV Cure research and draw the roadmap of the new cure agenda.
To initiate the workshop, a simple question was raised to the audience by social scientist Damian Kelly (EATG, UK) and Jessica Salzwedel (AVAC, USA); What does HIV Cure mean to you? Answers differ among communities but with the common idea that we will all benefit from the cure. The use of green and red cards by the audience to answer yes or no to the following questions, engages the public in a dynamic dialog to clarify the meaning of cure and the necessity of it. The coloured cards were mixed in the room and many additional questions came out from the discussion; Do we need a cure? What are the rights of people entering cure programmes? How these programmes will be implemented in poor-resource settings?
The discussion was followed by an introduction to the science of HIV cure by Ana Laura Ross (IAS/ANRS, France) with the idea to bring an overview of the basics of science behind the cure to the general public.
Ana Laura Ross introducing the science of HIV Cure
The first presentation by Dr. Asier Saez Cirion (Institute Pasteur, France) Hurdles on the path towards and HIV cure: Is HIV remission a first stage? sets the stage to the biological difficulties associated with the cure and line up key scientific concepts on HIV cure. Dr. Cirion explained how cure strategies aim to purge the HIV reservoir and reduce the number of infected cells to achieve a functional remission stage. Therefore, steps associated with HIV remission may involve the limitation of the reservoir size and the control of viral rebound in the absence of treatment. These scientific aims need to be agreed with the HIV community to make sure that they will be widely applicable.
In the second presentation, Sharon Lewin (The Doherty Institute, Australia) and Gus Cairns (NAM Publications, UK) gave an overview of the Current HIV Cure strategies & Ongoing clinical Trials. They analysed the challenges of the HIV biology (integration, variability) and the life-long antiretroviral treatment introducing the necessity for cure strategies. HIV cure strategies aim to remove HIV-infected cells from the body (Berlin patient), to make HIV more visible (shock and kill strategies) or to make HIV invisible (continuous viral silencing) to the immune system. Dr. Lewin described in details some of these strategies including gene therapy or bone marrow transplant with delta32 donor cells to remove infected cells to mimic the Berlin patient situation. However, these strategies are limited to the specific clinical condition of the HIV patients. In addition, shock and kill strategies have been already implemented in clinical trials. These trials combine the use of a “virus-awakening compound” generally an HDAC inhibitor in combination with an immune modulatory agent such as TLR7 agonists or an HIV vaccine. The results from the trial of HDACS/HIV vaccine demonstrated no effect in reducing the size of the HIV reservoir and indicated the presence of viral sanctuaries and the need for better drug penetration of the current antiretrovirals. In addition, Sharon Lewin reviewed the development of immune therapies for cure including the use of antibodies (broadly neutralizing antibodies, bispecific antibodies and antibody dependent cytotoxicity) and T-cells (anti-PD1 molecules) to elicit functional immune responses against reactivated cells.
The last session before the coffee break was Integrating social Research into the HIV Cure Agenda attended by Judith Auerbach (UCSF, US) and David Evans (Project Inform, US). They raised the concept that integrative social research is key for the cure agenda and stakeholders, clinicians and researchers should be aware of it. Consequently, there is a real need for the public understanding of the science behind the cure and how people fell about it. They present data on the US survey on the perception of cure among HIV-seropositive individuals with the following highlights; people do understand the notion of cure and the terminology. However, cure research raises ethical considerations such as the complexity of the process, the time of implementation or the rights of the people entering cure programmes.
The Panel Discussion joined Jintanat Ananworanich (US military research programme in Thailand, US), Paula Munderi (MRC/UVRI, Uganda), Moses Supercharger (Joint clinical research center, Uganda) and Marie Elizabeth Theunissen (University of Stellenbosch, South Africa) in a roundtable moderated by Mitchell Warren (AVAC, US). Their testimonies addressed the diversity among countries and communities with HIV infection. From the stigma and priorities to cure research (antiretroviral drug resistance) in Uganda (Moses) to the experience on Clinical trials in Thailand (Jintanat) in both pediatric and adult infection and the urgency of trials on remission seem as a direct benefit for early antiretroviral treatment implementation in the cure programmes. Moreover, cure research in youth South African was seemed as a big emergency due to the epidemiology of the infection (Marie) and there were concerns of cure strategies join to treatment interruption (Paula). So the message of the session was that communities worldwide are open to cure research, but they also open questions that the scientific community need to be aware of.
Roundtable from left to right Mitchel Warren, Moses Supercharger, Jintanat Ananworanich, Marie Elizabeth Theunissen and Paula Munderi
Finally, Kevin Osborne and Owen Ryan (IAS, Switzerland) deliver a strong message of advocacy for an HIV Cure by; “ Science and community come together to advocate for an HIV Cure” “ Cure, Science, and IAS 2016”.
Kevin Osborne during the closing remarks of the workshop