The AIDS 2020 Conference Showcases 2 Major Developments for Treatment and Prevention

Researchers announced two potentially game-changing developments in the fight against HIV/AIDS at the 23rd annual International AIDS Conference. During the virtual conference, researchers announced that there’s an injection that can be administered once every two months that may be more effective than daily oral pills at preventing HIV infection. Additionally, a man may be in long-term HIV remission, which would make him the third person to be cured of the virus.

The AIDS 2020 conference, a virtual event that kicked off on July 6, includes 600 virtual sessions and events where the latest HIV science, advocacy, and knowledge is presented. So far, the following announcements are two of the most notable to come out o the conference.

The biggest announcements at the 2020 International AIDS Conference

1. HIV-prevention injection

A drug called cabotegravir was studied by the HIV Prevention Trials Network, a worldwide clinical trials network, in a randomized double-blind trial. This trial is one of eight currently testing the drug for its efficacy in both HIV treatment and prevention (the HIV Prevention Trials Network is running three of these studies). The trial announced at the conference found that one injection every eight weeks was superior to daily oral pills in HIV prevention for cisgender men and transgender women who have sex with men.  It’s worth noting that the oral pills, commonly known by brand names like Truvada and Descovy, already provide a 92 to 99 percent reduction in risk when taken correctly.

The trial included nearly 4,600 transgender women and cisgender men who have sex with men. Twelve percent of the participants were transgender women. It was conducted at 43 sites in Argentina, Brazil, Peru, South Africa, Thailand, the United States, and Vietnam. Two-thirds of study participants were younger than 30 and half of the U.S. participants identified as Black or African American. The trial began by offering one group of participants the pill and the other half cabotegravir. A total of 52 HIV infections occurred during the trial. Thirty-nine infections happened in the pill group while 13 happened cabotegravir group.

Raphael J. Landovitz, MD, the protocol chair of the trial and a professor of medicine at the University of California, Los Angeles, says in a press release that these results “have the potential to transform the landscape of HIV prevention.”

“We know that some people have difficulty with or prefer not to take pills, and an injectable product such as long-acting [cabotegravir] could be a very important option for them,” says Dr. Landovitz, who is also co-director of the UCLA Center for Clinical AIDS Research & Education. “We want to thank the study participants and research staff, as this study would not have been possible without their dedication and commitment.”

The HIV Prevention Trials Network is in the middle of a trial testing the efficacy of the drug in cisgender women living in Botswana, Kenya, Malawi, South Africa, Swaziland, Uganda, and Zimbabwe.

2. Man in long-term remission from HIV

A 36-year-old man in Brazil is believed to be in remission from HIV following treatment with antiviral drugs. There are currently two people in the world who have been cured of HIV, one in 2019 and the other in 2007. Both were cured during risky and expensive bone-marrow transplants for their cancers.

“Although still an isolated case, this might represent the first long-term HIV remission” without a bone-marrow transplant, the scientists said, according to The New York Times.

The study, which was conducted by the Federal University of São Paulo and has not yet been published, included just 30 participants in a clinical trial to investigate different ways to cure HIV.  The man, who has been HIV-positive for eight years, was “one of five given a highly intensified antiretroviral therapy with the drugs dolutegravir and maraviroc and 500mg twice daily of nicotinamide, a form of vitamin B3, for 48 weeks,” reports CNN. He stopped the therapy in March 2019, and he has had his blood tested every three weeks since. The researchers reported blood tests have not shown any signs of lingering HIV infection and that he doesn’t have any detectable HIV antibodies.

At a virtual press conference for AIDS 2020, Ricardo Diaz, MD, the clinical investigator running the study out of the Federal University of São Paulo, said he doesn’t know whether the patient is cured. Dr. Diaz says that the man has “very little” antigens that trigger the production of antibodies and other immune responses. But he notes his team has not sampled the man’s lymph nodes or gut for the virus since he stopped treatment.

The researchers at the Federal University of São Paulo have offered to send samples for confirmatory tests to other labs.

“These are exciting findings, but they’re very preliminary,” Monica Gandhi, MD, an HIV expert at U.C.S.F. and one of the AIDS 2020 conference organizers, tells The New York Times. She says that nicotinamide has been used in many other studies without these results and that no drug “has worked so far in terms of long-term remission. I’m not even sure this has worked. It’s one patient, so I think we can’t say we can achieve remission this way.”