From vaccines to cure - breakthroughs in research, treatment and standards of HIV care at 18thEuropean AIDS Conference, London, 27 - 30 October
London 31 October, 2021: leading global scientists, clinicians and HIV activists at the 18th European AIDS Conference, 27 - 30 October, learned how the rapid development of COVID-19 vaccines could inform breakthroughs in the search for an HIV vaccine. Professor Robin Shattock, Imperial College, London, explained that while the HIV virus itself is far more variable than COVID-19, the technologies learnt from new mRNA based COVID vaccines, and work on how to stabilise the spike proteins of the surface of a virus, and then use them as vaccine constructs, could provide the tools to speed the development of a vaccine for HIV. Ironically the conference took place at ExCeL London, home of the of the seven NHS COVID emergency Nightingale hospitals. Around a quarter of the 3,000+ delegates attended in person, some of whom had also worked at the NHS Nightingale London during the COVID pandemic.
New approaches to HIV Cure
Despite today's effective medication, which enables people living with HIV to live a near normal life span, and prevents the virus being passed on sexually, the search for a cure continues. Philipp Schommers,University of Cologne, Germanydescribed how antibodies could potentially play a key role in future HIV-1 treatment and prevention strategies. First results from studies in non-human primates, as well as early phase human studies, suggest that broadly neutralizing antibodies (bNAbs) could be central to some future approaches. In a special session from the ANRS (the French Agency for Research on AIDS and Viral Hepatitis) Mariela Cabral-Piccin, CIMI, Paris, looked at new tools to enhance immune responses to HIV infection. In HIV-2 infection the natural immune response to the vírus is stronger. Unravelling this mechanism may help to find ways to increase the effectiveness of CD8+ T-cells, the cells that lead the fight against infection, towards HIV-1 infection
Marina Caskey, Imperial College, London gave an overview of how antibodies known as monoclonal bNAbs could potentially be integral to both vaccine and cure. Linos Vandekerckhove, Ghent, Belgium, gave a comprehensive review of what we know about how to locate and measure the reservoirs of the HIV vírus. These reservoirs permit the vírus to remain hidden and form a barrier to cure.
Opportunities emerging from adversity
The difficulties presented by the COVID pandemic also brought opportunities to improve both practice and treatment in HIV healthcare. There have been many innovations across Europe, including insights into the latest applications of telemedicine and digital health care. The conference provided the opportunity to share best practice examples but also threw a spotlight on the inequalities that persist for some groups, who do not have access to the technology or safe spaces that make digital consultations a viable option
Inequities for women
Inequities remain for women living with HIV, despite representing more than half - 52% - of people living with HIV globally. Professor Yvonne Gilleece, Consultant in HIV Medicine, Brighton and Sussex NHS Foundation Trust, summarised health inequalities linked to gender, race, ethnicity and HIV stigma. She highlighted the lack of data to manage women's health in the long term through inadequate representation of women in clinical research. Women with HIV are more susceptible to co-morbidities as they grow older, including greater risk of heart disease, bone problems, kidney disease and neurocognitive problems, in addition to increased risk of domestic violence.
Tailored treatment options
Marta Boffito, Chelsea and Westminster Hospital NHS Foundation Trust, UK described the increasing variety of HIV treatment strategies now available, providing guidance on the opportunities and challenges of long-acting (injectable) drugs in HIV therapy and pre-exposure prophylaxis (PrEP) Long-acting antiretroviral medications (ARVs) will soon be made available in formats ranging from monthly or bi-monthly injections to implants, patches, or weekly pills. She predicts that in the future people living with HIV will be able to choose from as many as 10 different methods of accessing their medication.
The conference offered the opportunity for the sharing of Standards of Care from the British HIV Association, European AIDS Clinical Society and the European Centre for Disease Prevention and Control, with guidance on good practice and how to avoid late diagnosis. It also highlighted that the elimination of co-infection of HIV and hepatitis C is now realistically achievable across Europe.
EACS Treatment Guidelines 2021
New EACS Guidelines (v11.0. October 2021,https://www.eacsociety.org/guidelines/eacs-guidelines/were launched at the conference,available as a pdf and web-based version, and as a free App for iOS and Android devices, in nine languages.They provide updated and preferred treatment options, including advice on women and pregnancy, or women considering having children. There are also updates to HIV Drug-Drug Interactions, in collaboration with the University of Liverpool, and new sections covering the interaction of HIV medications with drugs used to treat commonly occurring conditions in people living with HIV, such as TB, anxiety and hormone replacement therapy. Comorbidities covered now include mental health, with a detailed section on anxiety disorders. There are updates to the hepatitis section, a new section on COVID-19 in people living with HIV, and new paediatric treatment guidelines developed in partnership with the Penta Child Health Scientific Network.
For further information: see full EA daily Scientific Programme via this link: https://eacs2021.abstractserver.com/program/#/program/1/horizontal
or contact EACS Media team: media@eacsociety.org or call Jo Josh +44 (0) 7 306 39 18 75 or Tom Hayes +44 (0) 7 475 86 86 14