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IAS 2023 HIV Science Conference – Latest HIV Science breakthroughs
Yearly injectable ARVs; a functional HIV cure; statins to protect cardiovascular health; and breastfeeding closer to U=U. These were just some of the ground-breaking science presented at the 2023 HIV Science Conference organised by the International AIDS Society (IAS) in Brisbane in July.
By Heather Ellis, PWV communications and engagement coordinator
The scientific breakthrough in ARV treatment using long-acting injectables paired with bNABs (broadly neutralizing antibodies), means that HIV suppression without daily pills can last 12 months on average. However, the science is still experimental and not yet available, and clinical trials are continuing. Presently, in Australia, we have access to long-acting injectables for two months, but in early 2024 a six month long-acting injectable will be available and it may even suit those with HIV drug resistance.
Studies presented at IAS2023 showed that long-term HIV suppression with the long-acting combination (ARV injection and infusion with bNABs) without daily ART was possible for up to nearly 18 months in some cases. And for the lucky few, even longer. However, these PLHIV referred to as post-treatment controllers (PTC), could have achieved their PTC status regardless after their treatment interruption. While this treatment is not yet available, clinical trials are being rolled out and depending on results, this long-acting combo could well be a game-changer in the future of HIV treatment.
This combo was also being touted by some of the more optimistic researchers at IAS2023 as a ‘functional cure’ for HIV where after several years, the person’s own immune system would be able to stop any HIV rebound if it emerges from the HIV reservoir. However, other scientists were not convinced and presented findings of just how smart HIV was in hiding inside the DNA of immune cells to avoid detection.
While the science looks promising for this long-acting treatment leading to a potential functional cure, there was also hesitation. This is partly, because bNABs don’t work for everyone and more research is needed to have the therapy individualised. There was also excitement about the potential of bNABs in developing a vaccine for HIV.
Another breakthrough was research on the use of statins in protecting the cardiovascular health of people living with HIV even with low to moderate risk. Not only do statins reduce cholesterol, but also low-level inflammation which occurs even when viral load is undetectable. This research is a huge break-through for people with HIV, especially as we age as it is well known we have a higher risk of cardiovascular disease as a result of this inflammation. Talk to your HIV doctor about whether or not statins are for you as part of your HIV treatment. Scientists also presented emerging research that showed the potential of statins to help support ART. But this science is very early days.
Breastfeeding also moved a step closer to U=U (undetectable equals untransmissible) with the presentation of the updated WHO policy brief, which is key to supporting those countries where mothers with HIV are not supported to breastfeed and their only infant feeding option is formula. The term used in this presentation was ‘negligible’ risk of HIV transmission when the mother is on ART with a sustained undetectable viral load and is supported by healthcare providers. However, in many resource-limited settings, viral load testing is not widely available as it is in countries like Australia so there are limitations in knowing if the mother has an undetectable viral load. Researchers, clinicians and community all called for this lack of viral load testing to be urgently addressed not only for breastfeeding mothers and their babies but all people living with HIV to identify viral load rebound from drug resistance, which is often related to adherence issues. WHO researchers also presented findings that showed limited mixed feeding did not present any increased transmission risk. However, scientists called for more research into the impact of ART consumed by the baby via breastmilk over six months and 12 months of exposure.
Based on strong evidence from trials, researchers also announced that when a mother has an undetectable viral load and is on ART then PEP for newborns may not provide any additional benefit and is likely to be no longer necessary. They called for present guidelines globally to be changed.
WHO are now updating their guidelines on breastfeeding for mothers with HIV, which are due to be released in early 2024. Talk to you HIV specialist who can advise you on these new findings with regards to PEP for newborns, breastfeeding and limited mixed feeding.
HIV Community Collaborations:
A key theme in many of the sessions presented at IAS2023 was the importance of the collaboration between community, scientists, clinicians and government in ending the HIV epidemic and eliminating AIDS by 2030.
The pre-conference sessions highlighted these collaborations with several key events held:
- Indigenous Peoples Conference on HIV and Hepatitis for Health Equity attended by over 150 indigenous people from around Australia
- U=U Global Roundtable on Research, Policy and Political Priorities. Read more about U=U
- HIV Community Social Hub and launch of the HIV Stigma Campaign developed by Queensland Positive People
- HIV Science as Art
- HIV Cure and Immunotherapy Forum
- ACT NOW on global HIV migration, mobility and health equity
(Heather Ellis was kindly supported to attend IAS2023 in Brisbane by the International AIDS Society (IAS) and The Peter Doherty Institute for Infection and Immunity).