The world congress of the international aids Society (IAS 2017), started on Sunday the 23rd of July, has showcased a number of studies and initiatives that could contribute greatly to the fight against the epidemic of HIV and aids. And why not to reach the target of “90-90-90” by 2020, set by Unaids. To be clear, the organization is hoping that 90 % of people with hiv are aware of their status in three years. 90 % of them would follow a treatment, and 90 % of these patients having access to antiretroviral drugs would be able to achieve an undetectable viral load. Detailed review of the latest advances and research in the fight against the human immunodeficiency virus (HIV), which could contribute to achieving these objectives.
A decrease of the viral load sufficient to prevent the development of the virus ?
It is one of the major breakthroughs of the year against the human immunodeficiency virus. The French biotech Abivax presented at the beginning of may very good results for the ABX464, a drug capable of significantly reducing the viral load (40 % decrease on average). The biotech hopes to achieve a “functional cure” of HIV, that is to say, to sufficiently reduce the viral load so that it does not progress any more. The company announced the presentation of new data from its clinical trial, phase IIa, when the IAS 2017, “confirming the impact of the molecule on the HIV reservoirs”. Nevertheless, caution is needed, given the number of patients tested (29 during the first part of phase IIa).
To treatments less heavy ?
Two leaders in the treatment against HIV, Viiv (a joint venture of GSK, Pfizer and Shionogi) and Johnson & Johnson have partnered to develop a treatment monthly injectable combining a molecule beacon of each laboratory : the cabotegravir and rilpivirine. When the IAS 2017 Monday 24 July, the two companies have presented the results of a phase II study demonstrating the safety and effectiveness of a monthly injection of these two combined treatments are similar to those of a daily follow-up of combination therapy a reality for people affected by HIV. The viral load of 87 % of the 230 patients remained undetectable at the end of 96 weeks with once monthly, compared to 84 % with a follow-up classic. This development could in the future facilitate the life of patients affected by HIV and also reduce the risk of ill-treatment follow-up, which may adversely affect the control of the virus.
Nevertheless, in a first time, patients who could benefit from such a step are those having a viral load already undetectable (the person carries the HIV, but its load is below the threshold of 50 copies of virus per ml of blood, which dramatically reduces risk of transmission of the virus).
HIV vaccine : a new hope
A vaccine to protect HIV could well be the ultimate weapon to eradicate the virus. If this therapeutic strategy has experienced many failures, like Mecck in the 2000s, it sharpens even the appetite of a few pharmaceutical companies. Thus, Janssen (a pharmaceutical subsidiary of Johnson & Johnson) ensures Tuesday, July 25, to have developed a vaccine that is yielding results “encouraging” blocking the path to infections. In a phase I/IIa, the therapeutic product has been tested on 393 people, Thailand, the United States and in three african countries. It has also led to an immune response in these patients. During the proof-of-concept,the candidate vaccine had been used on monkeys, and the infection had even been blocked in two-thirds of the animals tested. But for the moment, it is premature to say if the vaccine blocks the transmission of HIV in humans. The phase IIb, which must show that the vaccine is capable of reaching that goal, will start in November 2017. And the final results are expected in 2021, with first data in 2020.
Another therapeutic product of this kind is being developed by Sanofi and GSK, with an objective similar to that of the u.s. laboratory. Companies in france and the uk have announced that in October 2016 the launch of a phase III trial of more than 5,000 people are sexually active and not infected. The final results are expected in 2021.
Progress in the prevention
“An era of progress without precedent”. It is in this way that Linda-Gail Bekker, the president of the International AIDS Society (IAS), has called the research around HIV prevention. Several studies presented at the IAS 2017 have outlined new priorities for effective prevention, and mentioned successful initiatives.
A clinical study Ipergay conducted by the public Agency French research on aids and viral hepatitis (ANRS) and Inserm ensure that the use of Prep (drugs such as Truvada by Gilead to reduce the risk of HIV transmission) is effective. The two organizations are interested in the use of Truvada in 362 gay men reporting risk behaviors. The effectiveness of Prep increases to 97 %, analyze the two institutions that rely on the reduced number of transmissions of the virus after two years of follow-up. Another study, also conducted by Inserm and the ANRS, has been expanded to 3,000 people. It is expected to provide new results in 2020.
Prevention, it is also increasing the frequency of screening for the virus. The university of California conducted an experiment in Zambia, on more than 900 prostitutes to see what was the best strategy to adopt to get tested. A third of them received individual testing, another third of the strip to perform a test at a clinic or a pharmacy, and the third group could require the standard procedure of screening. The self-test has been the most widely used and by far, this is certainly the best way, to encourage testing, concludes the study,