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Putting AIDS 2018 Into Perspective: Clinical Implications

Jaime Rosenberg
The 2018 International AIDS Conference in Amsterdam brought a plethora of new clinical implications for HIV care, reflecting ongoing investments in research efforts and optimism across all clinical domains, including vaccines, prevention, and new treatment approaches. However, with the excitement also came caution in other areas, such as stagnant incidence rates.
The 2018 International AIDS Conference in Amsterdam, the Netherlands, brought a plethora of new clinical implications for HIV care, reflecting ongoing investments in research efforts and optimism across all clinical domains, including vaccines, prevention, and new treatment approaches.

However, with the excitement also came caution in other areas, such as incidence rates, where rates of new infection among adolescents and adults are not decreasing enough to gain control of the epidemic.

Following the conference, experts in the space convened in Washington, DC, to recap the meeting’s findings and discuss what they mean and what’s next.
Vaccine Potential
While we’re still in the era of trying to nail down an effective HIV vaccine, there’s no shortage of researchers assessing new approaches and vaccine paradigms, according to Chris Beyrer, MD, professor, Johns Hopkins Bloomberg School of Public Health and past president of the International AIDS Society.

These novel approaches include new small molecules that mimic the CD4 receptor medical compounds and new immunogens known as SOSIPs. “The challenge is that we’re learning more and more about neutralizing antibodies, but we want to do is make the human immune system generate the kind of antibodies and cellular responses that can really neutralize a variety of wildtype viruses,” said Beyrer.

Beyrer highlighted the phase 2 APPROACH trial, which included nearly 400 participants. The trial assessed the safety, tolerability, and immunogenicity of vaccine regimens that included 2 doses of a prime vaccine to stimulate an initial immune response and 2 boost vaccinations using various combinations of Adv.Mos.HIV, or modified vaccinia Ankara, with or without 2 different doses of clade C HIV gp140 envelope protein containing an aluminum adjuvant.

He also highlighted the large-scale South African phase 3 HVTN702 trial, which is testing the safety, tolerability, and efficacy of a vaccine using a prime boost strategy.

New Approaches to a Cure
The AIDS conference put a large focus on HIV reservoirs—a group of immune cells in the body that are infected with HIV but are not actively producing new HIV. With this, the method of action has shifted from a sterilizing cure to a functional remission, with the goal of getting numbers so low that people may be able to function off treatment for some time, explained Beyrer

A number of presentations focused on the shock-and-kill approach, where researchers wake up the reservoir with an activating agent and then kill the virus. While studies have shown they can wake up the reservoir, there has been no success in effectively killing the virus. Beyrer noted the RIVER trial, which experimented with adding a vaccine boost. Unfortunately, he said, it was not effective.

During the conference, there was the introduction of a new approach: shock and block, where researchers are able to lock down the reservoir and keep it quiescent.



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