IAS 2019: A week in review

IAS 2019: A week in review

Thank you for being a part of IAS 2019!

This week, you and more than 5,900 other professionals from nearly 130 countries made IAS 2019 a conference to remember. Across 1,300 abstracts, selected from more than 3,000 submissions, this 10th IAS Conference on HIV Science marked several key milestones in the global response to HIV.

The research at IAS 2019 was more diverse than ever and so were the speakers. Women represented half of all abstract presenters here this week and more than one-third of presenters were under 35 years old. Throughout the week, we witnessed the extraordinary leadership of community members in driving the agenda, highlighting the most pressing challenges before us and proposing solutions for a more effective HIV response.

As we conclude our week in Mexico City, here are some of the key themes that came out of the conference this week.

En-gendering a better health response

The recently completed ECHO study put to rest fears that hormonal contraception increases vulnerability to HIV acquisition but revealed extremely high rates of HIV and other STIs among young women in sub-Saharan Africa. Responses to those findings, led largely by women from affected communities, generated calls to increase comprehensive responses to sexual and reproductive health and make those services more accessible for women and girls, in order to simultaneously address three key health issues for women - HIV, STIs and unintended pregnancy. Building on ECHO, new data presented here took a deeper dive into vulnerability to HIV and STI acquisition for women and girls, while many sessions called for a re-examination of the sexual and reproductive health needs of all people vulnerable to acquiring HIV.

Meanwhile, multiple sessions looked at a related issue also driven by community leadership – the safety of the antiretroviral drug dolutegravir (DTG) for women. When data presented at AIDS 2018 indicated a possible increased risk for neural tube defects (NTDs) among infants born to women taking DTG, it was women who demanded better science and greater community involvement in determining the safety of the drug. Studies presented here showed less risk of NTDs than previously reported and helped inform updated WHO guidance on antiretroviral treatment including DTG. IAS 2019 International Scientific Chair Anton Pozniak reinforced the vital role of the community: “Community engagement, including input from women living with HIV, has played a key role in updating these guidelines and community engagement will be critical to rolling them out.”

A shot in the arm for vaccine research

For researchers and advocates who have never given up the search, IAS 2019 brought the sense that we may be taking important steps towards one of the most challenging and elusive goals in the global HIV response – an effective vaccine. Encouraging new data from multiple clinical and pre-clinical studies, and the recent announcement of a new phase III vaccine efficacy trial, Mosaico, which joins three other phase III vaccine efficacy studies underway, had conference-goers in Mexico envisioning the long-awaited day in which one or more vaccines could finally be added to the HIV prevention toolbox. The financial support of industry partner Johnson & Johnson in developing the investigational mosaic-based vaccine to be studied in was also seen as a key and encouraging step in the ongoing effort to reengage pharmaceutical funders in HIV vaccine research. Other sessions at IAS 2019 examined the multiple challenges still confronting vaccine research, such as understanding partial efficacy and challenges in vaccine trial design.

Advocates also noted that research progress offers an important call to the field to prepare for a range of possible vaccine study outcomes and for challenges related to the possible future approval and use of an effective vaccine.

Better treatments treat you better

HIV therapy has long been associated with cumbersome treatment regimens, challenges with drug resistance and the possibility of serious side effects. With a 90-90-90 treatment target of 30 million people on therapy by 2020, researchers, drug developers and advocates are placing increasing emphasis on the development of new drugs and more efficient treatment regimens that offer the promise of fewer pills, less toxicity and lower cost.

Multiple presentations at IAS 2019 addressed the promise of the integrase inhibitor DTG in adults and children. 96-week data presented here from the GEMINI 1 and 2 studies found that a two-drug regimen of DTG and lamivudine (3TC) was non-inferior to a three-drug combination of DTG, tenofovir and emtricitabine among treatment-naïve patients; while interim 24-week data from the TANGO study found that the same two-drug combination was non-inferior to the three-drug option for individuals switching after achieving viral suppression.

Meanwhile, research presented here found that a 4-pills-a-week treatment regimen was non-inferior to daily treatment among people who were virally suppressed when they switched.

IAS 2019 also featured promising data on MK-8591, the first drug in a new class of treatments known as nucleoside transcriptase translocation inhibitors (NRTTIs). In research presented here, large proportions of treatment-naïve study participants achieved viral suppression when taking the drug, at a variety of doses, in combination with doravirine, a new-generation non-nucleoside reverse transcriptase inhibitor.

An ounce of prevention is priceless

New approaches to making HIV prevention more effective, more durable, easier to use and more responsive to people’s lives were the focus of dozens of sessions and presentations at IAS 2019. On the agenda this week: the first human trial of an implant designed to provide HIV PrEP for a full year, studies of new and potentially more effective PrEP drugs and research on reducing roadblocks and improving PrEP adherence in Latin America through same-day PrEP initiation.

The IAS 2019 programme was also loaded with the latest research on a growing array of prevention tools in development, including long-acting injectables, transdermal and topical PrEP and multi-level prevention strategies, as well as vaginal rings and antibody-based prevention approaches.

Moving beyond advances in product development, a strong consensus emerged among conference-goers on the need to support greater community engagement to develop prevention interventions, conduct prevention trials and design prevention access strategies.

Refining targets and raising the cash to reach them

As the 90-90-90 treatment and prevention targets edge closer, HIV resources from donor governments are stalled at roughly the same level as a decade ago and prevention R&D resources are also declining. Advocates and implementers gathered here shared strategies to increase and maximize the impact of funding, strengthen political will, reach current and future goals, and, critically, ensure that these efforts benefit all people and communities in need.

Sessions this week focused on engaging indigenous communities and parliamentarians in the global HIV response, strengthening political will to reach key targets, learning from prevention implementation studies such as PopART, reaching those left behind in current target-driven efforts, promoting better use of resources and financing expanded global responses, and setting the next generation of global treatment and prevention goals.

Also at IAS 2019, a new report, “Translating Progress into Success to End the AIDS Epidemic” by amfAR, AVAC and Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, looked at how dramatic reductions in HIV incidence and mortality have been accomplished in six very different settings around the world and offered a roadmap to translate those successes to other settings.