Friday, Dec. 1, is World AIDS Day – a day dedicated to raising awareness of HIV/AIDS as a persistent public health threat while recognizing the advances made by the global medical community in the ongoing search for more effective treatments.
As part of PAREXEL’s observance of World AIDS Day, we caught up with Dr. Nathalie Sohier, Senior Medical Director and Global Head of Infectious Diseases Therapeutic Area, and Dr. Roger Inouye, Senior Medical Director, to discuss the state of HIV/AIDS treatment and research.
Q: What do you see as the next major breakthrough in HIV/AIDS treatment?
Nathalie Sohier: In terms of public health, ensuring access to antiretroviral (ARV) treatments for HIV patients is critical. ARV treatments suppress HIV and prevent the virus from replicating. In addition to improving the lives of patients, ensuring access to ARV medications diminishes the incidence and prevalence of HIV in their communities.
We’ve seen encouraging progress in this area. According to UNAIDS, 57% of people diagnosed with HIV – approximately 21 million people – were receiving ARV treatments as of June 2017. Further, more than 66% of people living with HIV knew they were infected, 77% of those who knew their status had access to treatment, and 82% were virally suppressed. These numbers indicate significant progress toward UNAIDS’s ’90-90-90 Targets for 2020’, which would be a major breakthrough.
Roger Inouye: The ultimate goal of HIV/AIDS medicine is to go from suppressing HIV to eradicating it. Advances in ARV medications have allowed for the effective suppression of HIV replication. This reduces viral loads in the patient’s bloodstream. However, these treatments do not eradicate HIV from latently infected immune cells.
To continue suppressing the virus, patients must follow strict treatment regimens for the rest of their lives. The indefinite treatment course creates the risk of long-term side effects. On the other hand, deviating from the regimen creates the potential for the virus to re-emerge in the patient and/or mutate into a drug-resistant form. Accordingly, eliminating HIV from the patient’s latently infected immune cells is essential for a cure.
Q: The World Health Organization and Center for Disease Control report that incidence of drug-resistant HIV has increased from 11% in 2001 to 29% today. How is the clinical research community responding to this trend?
Roger Inouye: Unfortunately, drug-resistant forms of HIV have always been a feature of the landscape. I discussed this last year in a blog post about my experience as a clinician in the U.S. during the HIV/AIDS pandemic of the 1980s and 1990s. During that time, academia and the drug development industry worked frantically to develop new treatments as the virus invariably developed resistance to previously ‘cutting edge’ medications.
In the absence of a cure, the research community is always exploring ways to make it easier for patients to adhere to their treatment regimens, such as combining several HIV medications into a single capsule and developing treatments with less frequent dosing schedules. Still, the research community must anticipate the ever-present potential for the virus to develop resistance to currently available ARV medications.
Nathalie Sohier: Poor treatment adherence is the main driver of drug-resistant HIV incidence today. Therefore, initiatives aimed at tackling the causes of treatment non-adherence are necessary to reduce the risk of emerging forms of drug-resistant HIV.
Educating patients regarding HIV infection and treatments is essential for promoting adherence. However, drug shortages, wait times at clinics and drug dispensaries, the number of clinics in an area, distance from patients’ homes to clinics and dispensaries, and the cost of care (even when, and if, the drugs themselves are distributed free of charge) are all major causes of non-adherence that need to be addressed.
Q: What trends are you witnessing in HIV/AIDS research?
Nathalie Sohier: The recent discovery of highly potent, broadly neutralizing, HIV-specific monoclonal antibodies (bNAbs) could provide a new class of potential therapies. We’ve known for a long time that neutralizing antibodies can target the HIV envelope and suppress the virus’s ability to replicate itself. However, several factors limited the practical use of bNAbs until recently.
The field has changed dramatically in just the last five years. New tools have allowed researchers to isolate more potent forms of monoclonal antibodies with the ability to target more strains of HIV. As a result of these developments, several laboratories are now exploring whether bNAbs may contribute to strategies for eradicating, rather than suppressing, HIV.
Roger Inouye: Exploring vaccine strategies and developing pre-exposure prophylaxis regimens remain critical priorities for research. However, these initiatives represent just one part of the overall solution. Social programs, including harm reduction services, opioid substitution therapy, and programs aimed at reducing HIV-related stigma and discrimination are also crucial to solving the global public health problems posed by HIV/AIDS.
Global Drug Development
World AIDS Day