What to Look for at AIDS 2016: IAS President Chris Beyrer’s Q&A, Part 3

photo of Chris Beyrer

 

Chris Beyrer, the Desmond M. Tutu Professor in Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health delivering a lecture in April 2015 at the Humphrey School of Public Affairs in Minnesota.

In a special preview, International AIDS Society President Chris Beyrer shares some of the big news and key talks to look for during next week’s AIDS conference in Durban, South Africa. Beyrer, the Desmond M. Tutu Professor in Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health, is co-chair of the 21st International AIDS Conference (AIDS 2016), which starts Monday, July 18 in Durban, South Africa. Before departing for Durban, Beyrer sat down for a Q&A with GHN editor-in-chief Brian W. Simpson. 

When you look forward just in the next several years, where do you see the epidemic trending? What would your prediction for 4 years from now be? 
If things continue the way they're going, we're going to see a substantial increase in HIV infections and in loss of life from AIDS in Eastern Europe and Central Asia. We're going to see continued HIV spread among young, gay men in the United States—particularly young men of color—and a worsening and deepening of that epidemic. And we are likely to see continued success and declines in heterosexual, generalized epidemics in Africa and Asia, which is wonderful. We're going to make more advances on reducing perinatal infections. But the problems that we are not addressing are going to get worse and that is really the problem of key populations. It is the problem of Eastern Europe. It's the problem of the Middle East and North Africa.

You’ve talked about the challenge of reaching African men with HIV treatment: It's not that there are not enough drugs available, it's more about actually getting the men into the system and taking the drugs?
That's right. Drug costs now with generic drugs and with the newer regimens and once-a-day dosing have really gotten down to the level where they are not the rate-limiting step. In many countries, we're at $50 or $60 a year per person for drug costs. So, it's the other things—the testing, the monitoring, the clinic visits, the staff. Those kinds of costs actually, now, are accounting for more of the cost than just drugs. There is really innovative science around this that's coming to the conference. I'll just give you one example—a very effective program—the SEARCH study in Kenya and Uganda, which is a joint US-African collaboration headed up by Diane Havlir. You see San Francisco had integrated, basically, outreach and all different kinds of community-based testing, getting out of the clinics, getting testing, but integrating it with things that men are actually interested in—hypertension screening, diabetes screening, you know—diseases that are not stigmatized. And they are really overcoming these barriers and getting much better at getting men into HIV testing and, then, linked into care. So, that data will be presented and I think it's going to shift for many of us the way we think about this. Last summer, at the International AIDS Society Science Conference in Vancouver, we had a terrific session called AIDS for Global Health with a distinguished health leader named [Bloomberg School Dean] Mike Klag, and he put forward that this is something that we should be doing. Having a built a platform for HIV testing and counseling, you know, it's a missed opportunity if you're not screening populations who are also at risk for hypertension and diabetes and other really important chronic diseases. Why should we not do that? Now, it turns out that we have empirical data that it is the right thing to do.

So, in addition to the SEARCH study, what other important news should we be looking for to come out of the conference?
So, the next generation of HIV vaccines and the next big trail, which is is basically adapting—the only successful vaccine we've had is the vaccine that was done jointly with the US and Thai militaries in Thailand. And that had about a 30% efficacy, which is the first positive signal we've had. The vaccines in that trial need to be adapted to the African viruses. They have been and we now have the first immunogenicity data, which is the go/no-go decision on whether or not that trial is going to go forward in African populations. I can tell you it's a go. That's already been announced by NIAID—by the Division of AIDS—in a press release, but nobody has actually seen the African immunogenicity data. So, that will be presented for the first time. We have very important data from what will be the first study of early treatment regardless of CD-4 for pregnant women living with HIV. That is going to be a very important—that's the promise study, again, funded by the NIH, but a collaboration in many countries—multiple countries. That really is very impressive.

There's going to be some great data on pre-exposure prophylaxis, PrEP, including the first real data on the French approach—the European approach—which is intermittent PrEP—so, not taking it every day, but taking it when you're sexually active—before and after. So, that already we know works, but it hasn't been seen in a real-world setting. So, this will be the first real implementation data there.

There are some very important studies on testing innovations—self-testing, home-testing, community-based testing, door-to-door testing, all different ways of getting out of the clinic and getting out of the hospital and getting HIV screening, at least, to people where they are and where they live.

What talks should we be looking forward to?
There are going to be, I think, some very important plenary talks that are going to help pull all of this together. So, for example, the Jonathan Mann Lecture in Health and Human Rights. Edwin Cameron will speak to it and he is really going to connect us between Durban 2000 and now. Larry Corey who is the head of the vaccine research enterprise, the HIV Vaccine Trials Network, is going to give the plenary and he also is going to make the announcement about the African trials. Our very own Debbie Persaud from Johns Hopkins School of Medicine is giving the plenary on HIV cure, and there is going to be some of the first data from a clinical trial of cure. We've had individual patients and we have one person who had been documented to be cured of HIV, the famous Berlin patient, but now we're starting to see the first clinical trials. This one is a disappointment. Everybody recurred, but if we're going to get to a cure we're going to have some failures along the way and I feel that it's very important that we also present the science that doesn't work for the world to see. So, I can tell you that that one wasn't going to be included in the program and I said, “Oh, no, no. Yes, it is because we need to learn from what doesn't work and it's early days for HIV cure research.” But this is an area of tremendous interest.


Read previous installments of Global Health NOW’s 4-part Q&A with Chris Beyrer here. 

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