Dawn Averitt, founder of The Well Project and Women's Research Initiative on HIV/AIDS, has been living with HIV for 33 years.
Now is the time where we should be looking at public health and considering how to balance individual and societal needs, while also learning more about long-acting treatment as both prevention and therapeutic change agents, noted Dawn Averitt, founder of The Well Project and Women's Research Initiative on HIV/AIDS, who has been living with HIV for 33 years.
Has the HIV/AIDS space has suffered setbacks from resources redirected toward the COVID-19 pandemic?
I think the HIV research space has certainly experienced a setback. I think there's been a setback in care. The number of diagnoses over the last year and a half, and in awareness, the kind of traction that we had, that may have suffered some setbacks. That said, we also experienced quantum leaps forward in people's understanding or interest—or at least engagement—around clinical trials and around vaccine development and around really hard conversations about science and medicine and the needs of the individual vs the needs of society.
This is a real opportunity for us to take a good look at public health and what it means to be part of a community and to balance your needs as an individual against the needs of all those around you and what your role to play is. I think that, in some ways, COVID-19 has helped us certainly highlight the places where we have a lot of work to do. But I think in some ways, it's also given us a bit of a leapfrog moment where we've put these things at least front and center.
What should be next steps in the approval process for longer-acting treatments for HIV and AIDS?
How do we effectively compare these to the things that we currently have? So, [asking] how do you know what an improvement is and what are the inherent risks of a long-acting agent, if you give somebody something that's going to stay in their system for weeks or months, or maybe even longer eventually, and they have a reaction to it. There are real pros and cons to long-acting [agents].
In the adherence space, it feels a little like a panacea. But I think we have to step back and say, “Okay, there's some really good things here and there are some challenges that we're going to have to figure out how to navigate in a slightly more sophisticated way, I think, than you do when you're just looking at a once-daily [regimen].”
That said, I think the appetite for long-acting [agents] is great and the applications are really, really interesting. Long-acting agents won't be the ideal for everyone, but they will certainly, I think, be a game changer in a number of different environments. And there's [also] the prevention space, so being able to use a long-acting preventative agent—which, in some ways, is kind of the halfway spot between here and a vaccine, that we can do this every 6 months or every year—and hopefully protect you. So there's a lot of excitement there.
On the therapeutic end, when we start talking about regular access and in environments where there is no health care infrastructure or there is no payer system, there are places where this could be really extraordinary—so I think we're going to have to navigate that. I don't envy the FDA or the EMA [European Medicines Agency], because this is a challenging, challenging space. But I think that there are a lot of reasons to be very excited about what's happening in the long-acting space, especially as we start to look at coformulations and so on.
And I can tell you that the fact that we've gone from 35—I think at my peak, 38—pills a day to 1 pill once a day to potentially being able to take something on a monthly or every-few-months basis is pretty extraordinary. And I think it's another way in which the HIV field has really been at the forefront and been driving our understanding about how to not only prevent disease, but to provide care over the long term.