3 APRIL 2020 VOLUME 22 ISSUE 13

HIV researchers present some of the most important and cutting-edge studies each year at the Conference on Retroviruses and Opportunistic Infections (CROI). This year the face-to-face meeting was cancelled at the last minute and a virtual conference was held instead.

One of the most important HIV conferences of the year, the Conference on Retroviruses and Opportunistic Infections (CROI 2020) took place in the second week of March, just as many people’s attention was engulfed by the new coronavirus.

Amid the current coronavirus crisis, HIV antiretrovirals have been getting far more mainstream attention than they usually do. First, it was thought that the longtime (and outdated) HIV medication lopinavir/ritonavir (Kaltera) might have some activity against COVID-19, which is actually the name of the illness, with SARS-CoV-2 being the actual name of the virus. (Much as HIV is the name of the virus, and “AIDS,” or now “HIV disease,” is the name of the illness.)

South African researchers are poised to start enrolling patients in an international clinical trial launched by the World Health Organization (WHO) which will compare the safety and effectiveness of four different drugs or drug combinations against COVID-19.

Given sex differences in viral reservoir dynamics, the role of oestrogen in maintaining viral latency and subtle immunological differences between women and men, biological sex is likely to be a crucial factor affecting the success of strategies working towards the remission or cure of HIV, Dr Eileen Scully of the Johns Hopkins University School of Medicine said in a plenary presentation to the recent Conference on Retroviruses and Opportunistic Infections (CROI 2020).

In December, the Food and Drug Administration (FDA) declined to approve ViiV Healthcare’s long-acting injectable antiretroviral regimen Cabenuva (cabotegravir/rilpivirine). The federal agency’s surprise decision centered on concerns regarding the two-drug regimen’s chemistry and manufacturing controls.

Mouse models can provide fast and cost-effective systems to test HIV-1 vaccine candidates at the preclinical stage. To serve this purpose, mouse models are engineered to express the precursors of human broadly neutralizing antibodies (bnAbs) against diverse HIV-1 strains. Immunization of such mouse models can evaluate the ability of vaccines to mature the precursor antibodies into bnAbs. However, due to the unusual properties of bnAbs, mouse models expressing their precursors often have B cell developmental defects. Herein, we devised and validated a strategy to address this problem.

Our study showed that very high HIV testing and treatment coverage can be achieved through persistent delivery of universal testing, facilitated linkage to HIV care, and universal treatment services. The ART coverage target of 81 percent was achieved overall, after 4 years of delivery of the PopART intervention, though important gaps remained among men and young people. Our findings are consistent with previously reported findings from southern and east Africa, extending their generalisability to urban settings with high rates of in-migration and mobility and to Zambia and SA.

A novel urine assay to measure and deliver information on adherence to PrEP in real-time will be tested for the first time in this trial planned among women on PrEP in Kenya. Study findings will inform a larger-scale trial assessing the impact of real-time adherence monitoring/feedback on HIV prevention. Improving adherence to PrEP will have long-term implications for efforts to end the HIV epidemic worldwide.

Among patients newly prescribed ART, single-tablet regimens (STR) initiators were significantly less likely to discontinue therapy and had greater adherence and persistence compared to multi-tablet regimens (MTR) initiators. Regimens containing FTC/TAF as a backbone had higher persistence than those consisting of other backbones.

A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed.

HIV-1 infection in human beings has been an outcome of cross-species transmission event of simian immunodeficiency virus from chimpanzees (SIVcpz). Present study reveals differential features of envelope genes representing different categories of HIV-1 disease progression in human beings, namely, rapid progressors (RP), slow progressors (SP) and long-term non-progressors (LTNP) with respect to SIVcpz, based on their amino acid usage patterns.

<p>Human immunodeficiency virus type 1 (HIV-1) infection persists despite years of antiretroviral therapy (ART). To remove the stigma and burden of chronic infection, approaches to eradicate or cure HIV infection are desired. Attempts to augment ART with therapies that reverse viral latency, paired with immunotherapies to clear infection, have advanced into the clinic, but the field is still in its infancy. We review foundational studies and highlight new insights in HIV cure research.

Vaccination was initiated within the first week of life, with booster immunizations at weeks 6, 12, and 32. We demonstrate that both vaccine strategies were able to elicit durable Env-specific antibody responses that were enhanced by a late boost in infancy. Furthermore, we confirmed earlier data that intramuscular administration of the Env protein with the Toll-like receptor 7/8 (TLR7/8)-based adjuvant 3M-052 in stable emulsion (3M-052-SE) induced higher Env-specific antibody responses than vaccination with Env adjuvanted in Span85-Tween 80-squalene (STS) tested in a previous study.

High awareness of PrEP in high HIV prevalence settings in Kenya suggests effective public health messaging. Willingness to pay and preference for pharmacy access suggest that non-facility PrEP delivery may be useful.

In this review, we compare several potential strategies regarding HIV cure and focus on how we might utilize chimeric antigen receptor-modified T cells (CAR T) as a therapy to cure HIV infection.