Although Global Funding Levels Are Flat, Researchers Continue to Make Breakthroughs in HIV/AIDS Prevention and Treatment

A report released at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) in Kuala Lumpur, Malaysia, says that despite breakthroughs in HIV prevention and treatment research, global funding for vital research is stagnant, jeopardizing further progress in the fight to end the AIDS epidemic.

The report, titled From Research to Reality: Investing in HIV Prevention Research in a Challenging Environment, was compiled by the HIV Vaccines and Microbicides Resource Tracking Working Group. It notes that the US is by far the largest public-sector investor in HIV/AIDS research and development, spending a total of $925 million in 2012, which accounted for 70% of the total global investment in HIV prevention research.

Characterizing 2012 as “a year of follow-up research seeking to confirm results of past studies, move forward with new clinical research and roll out proven new prevention modalities” in the wake of the significant breakthroughs in preventive HIV vaccines and treatment made in 2011, the report summarizes several important and promising studies and insights made in the past year, including:

• Data from the RV144 trial (“the first HIV vaccine clinical trial to show modest efficacy”) has provided intriguing clues as to how and why the vaccine worked, setting the stage for additional clinical trials to launch in Thailand and South Africa in 2016.
• Results from the Phase IIb HVTN505 trial (which was halted in April 2013 “after an independent scientific review board determined that the DNA/rAd5 vaccine regimen being tested was not effective in preventing HIV infection”) will enable researchers to home in on other vaccine strategies currently in development.
• In 2012, there were more than 30 vaccine candidates in Phase I trials
• Research into the structure of broadly neutralizing antibodies, including “how they are produced by the immune system, and which sites they target on HIV,” is “paving the way for the design of new vaccine candidates that can elicit these antibodies, and ultimately prevent HIV—in most of its variations—from establishing an infection”
• Results from the VOICE (MTN 003) trial demonstrated that none of the three interventions (daily oral tenofovir, daily oral TDF/FTC, and daily 1% tenofovir gel) under investigation provided protection against HIV among the women in the study population. Analysis of data indicate that “too few women in the trial adhered to prescribed use of the trial products to allow for evaluation of their effectiveness.”
• According to this release, “The ongoing FACTS trial of 1% tenofovir gel as well as microbicide ring trials are working to incorporate lessons learned from the VOICE trial around understanding and supporting participant adherence.”

According to the authors, “2012 saw a shift in the HIV/AIDS field toward a growing consensus that the end of the global epidemic is an attainable goal. HIV science has taken rapid strides toward new, safe and effective methods of prevention and treatment that have the potential to drive down infection rates. Yet, the fact that there are still 2.5 million new HIV infections globally each year speaks to the need for continued investment implementing existing prevention modalities, while also developing new ones, in order to ultimately take that number to zero.”

The report also identifies several promising areas of HIV prevention research to watch going forward, including the development of multipurpose prevention technologies, which are designed “to address two or more sexual and reproductive health indications simultaneously, combining protection against unintended pregnancy and at least one sexually transmitted infection;” innovative devices that could “increase uptake and accelerate scale-up of adult male circumcision,” a proven preventive measure (data from Kenya, South Africa and Uganda have shown that male circumcision reduces the individual risk of HIV infection by 60%); pre-exposure prophylaxis (PrEP) technologies (such as daily oral TDF/FT); and treatment as prevention approaches.

Finally, the report offers several closing insights regarding the current state of investment in HIV prevention and treatment research, including:

• Partnerships are vital to advancing products in the pipeline -- Collaborations such as the P5, the IPM and the MTN joint trials and the START treatment as prevention trial “are clearly advancing the field of HIV prevention”
• In order to effectively roll out products and approaches, implementation research needs to expand -- Treatment as prevention, PrEP and medical male circumcision “offer great potential for curbing the epidemic;” however, “to effectively implement these technologies, there must be continued research into how to best deliver them to the populations most in need and in combinations that foster their acceptance, use and impact”
• Budget realities in the US highlight the need for other donors to enter (and re-enter) the HIV prevention R&D funding space — As austerity-driven budget reductions across US government agencies cut into research budgets, it is essential that “researchers and policy-makers in both donor countries and regions heavily impacted by HIV seek to engage non-traditional donors in HIV prevention R&D”