Track B report by Jose R Arribas
The Science of HIV: What Lies Ahead? MOSS03
Very interesting roundtable about the status and prospects of HIV research.
Vaccine: Dr. Nabel estimated that an effective preventive vaccine might be 10 years away. He is optimisitic because in the last two years we have gone from knowing only about four broad neutralizing antibodies to hundreds of new ones. There is also detailed research on how these antibodies work. The challenge of finding an antigen that elicits the formation of broad neutralizing antibodies still remains. His prediction was that in 2020 we would be in the midst of a clinical trial of an effective vaccine.
Cure: Dr. Siliciano spoke about the tremendous impact of the single case of HIV cure to reinvigorate this area or research. The combination of ablative chemotherapy, graft versus host disease and replacement of the immune system with a delta32 stem-cell transplantation effectively cured Timothy Brown. However this is a very high-risk intervention that cannot be generalized.
There is active research in other cure approaches that purge the reservoirs and modify the immune response so the activated reservoir cells can be eliminated. In addition, patients can be infused with modified cells that lack CCR5 receptors using zinc finger endonucleases. His prediction was than in 2020 we would be in the midst of several clinical trials focused on cure.
Antiretroviral therapy: Dr Eron discussed the prospects of long acting antiretrovirals, the high proportion of patients who currently are suppressed due to the efficacy of current ART and the diminishing importance of acquired and transmitted resistance. One extremely important problem is how to engage in care a substantial number of patients who currently are not receiving ART. His prediction was than in 2020 we would have better knowledge about how to engage patients in care and what makes some treated patients to have a non-activated immune system.
Prevention of mother to child transmission: Dr. Musoke spoke about the importance of using the B+ strategy in all pregnant women. B+ is not only providing the same triple ARV drugs to all HIV-infected pregnant women beginning in the antenatal clinic setting but also continuing this therapy for all of these women for life. Her prediction for 2020 was that the B+ strategy would be generalized, there would be better ART formulations for infants and long-acting antiretrovirals for adolescents.