Breakthroughs Blog: HIV/AIDS

Yesterday, at an event hosted by ONE and (RED) to commemorate World AIDS Day, President Obama declared the beginning of the end of AIDS: “Today is a remarkable day. Today, we come together, as a global community, across continents, faiths and cultures, to renew our commitment to ending the AIDS pandemic –once and for all.” I was honored to join a group of distinguished guests to witness the President’s World AIDS Day address and to hear comments from former Presidents George W. Bush and Bill Clinton; the current President of Tanzania; and a powerful panel that included a few superstars—Bono and Alicia Keys—members of Congress, business leaders, and activists. The powerful panel that included a few superstars—Bono and Alicia Keys—members of Congress, business leaders, and activists.For thirty years, the US government has led the fight against HIV and AIDS, and has played an important role in advancing science to better understand HIV and how to prevent, treat, and diagnose infection. Over the last three decades, we’ve witnessed the fruits of that leadership and the longstanding investment US policymakers have pledged to research on HIV and AIDS: from the first AIDS treatment drugs, to this year’s news that medicines to treat HIV infection could actually help prevent it, too.Yesterday’s speakers reinforced the notion that our commitment to fighting AIDS must not waiver. President Bush declared that when budget constraints exist, we need to set priorities and focus on what works. He added that there is no greater priority than living out the mandate of “to whom much is given, of him much shall be required.” His perspective was reinforced by Alicia Keys, who said, “We have the opportunity to be a global community that leaves the legacy of an AIDS-free generation. If we have the power to, then we must.”Recent research results show that we have many of the tools we need to forever change the trajectory of the epidemic. But, as Obama said, now is not the time to be complacent. We still lack a vaccine, a microbicide gel, and other tools that could help us win the war against AIDS.I’m encouraged to see the continued commitment by the Obama Administration to fighting this disease coupled with bipartisan support from congressional leaders like Congresswoman Barbara Lee and Senator Marco Rubio. My hope is that this commitment translates to continued support for research that will lead us to the next generation of tools to fight HIV and AIDS. As Sanjay Gupta, moderator of the event, said, eradicating AIDS is a goal that “allows us to stand at that most perfect union of audacity and achievability.” Will our government rise to the challenge?

Roger I. Glass, M.D., Ph.D., is director of the Fogarty International Center at the National Institutes of Health (NIH), where he oversees research and research training programs for U.S. and foreign scientists working to improve health in the developing world. Over the last four decades, about 5,000 scientists worldwide have received significant training through Fogarty programs. In addition, Dr. Glass serves as Associate Director for Global Health to the NIH Director, providing guidance on global health, facilitating international research collaborations and convening the world’s best scientific minds to address the most pressing health research questions. As we commemorate World AIDS Day 2011, I am both encouraged by the recent discoveries that are improving and prolonging lives and reminded of the challenges that remain in our battle to defeat this terrible disease. I was heartened to gather earlier this year with many of Africa’s premier infectious disease scientists and medical educators as we—together with PEPFAR—launched our Medical Education Partnership Initiative. Through this effort, we hope to make an enduring impact on the quality and availability of health care workers and researchers throughout the continent. This is vital to our goal to establish true country ownership and enable Africans to set their own research agendas, based on the most pressing local needs. Peruvian scientist Dr. Isaac Alva, of Universidad Peruana Cayetano Heredia, has conducted extensive field work studying HIV and AIDS and other diseases among indigenous communities in Peru. He is currently earning his master’s in public health through Fogarty’s AIDS International Training and Research Program. (Photo by David Snyder for Fogarty/NIH) I was also fortunate to see firsthand many of the researchers funded by the National Institutes of Health who are working on the front lines. During this year—the 30th anniversary of the beginning of this epidemic—it is appropriate we acknowledge the advances made against this and other infectious diseases by the National Institute of Allergy and Infectious Diseases (NIAID) and its director, Dr. Anthony S. Fauci, and by the many scientists around the world supported by NIAID and other institutes and centers of the NIH. But if the great advances have been made standing on the shoulders of giants, in Isaac Newton's phrase, I think Fogarty has a hand—or a shoulder, perhaps—in a number of the research breakthroughs. Trainees supported through Fogarty-funded grants have helped contribute to the work that led to this progress. We're pleased to see our 20-year investment in some of these developing country sites paying off with trainees who are well qualified to move forward the research funded by NIAID and others. A singular breakthrough in the news is the study known as HPTN 052, which revealed that men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners through early initiation of oral antiretroviral therapy (ART). Fogarty grantee Dr. Myron "Mike" Cohen, who runs the global health institute at the University of North Carolina, is the principal investigator of the study, funded mainly by NIAID with additional funding from other institutes. Dr. Roger I. Glass, director of Fogarty International Center at the National Institutes of Health, visited Africa to see firsthand the health improvements HIV and AIDS advances have brought to the continent. (Photo courtesy of Fogarty/NIH) This is the first randomized trial to definitively indicate that an HIV-infected individual can reduce sexual transmission of HIV to an uninfected partner by beginning ART sooner. This adds very strong scientific evidence that you can use treatment of HIV as an effective prevention modality by decreasing the possibility that a person who is infected would transmit HIV to their sexual partner. More than 30 Fogarty-supported trainees in Malawi, India, Botswana and Thailand worked on the study. Very recently, the conclusions of this discordant couples trial were buttressed by results from a pre-exposure prophylaxis, or PrEP, trial that showed that heterosexual participants who took a daily Truvada pill had a significantly lower chance of being infected. Fogarty trainees are also at the forefront of the studies to determine the effectiveness of an antiretroviral microbicide (tenofovir gel) in preventing sexually transmitted HIV infection in women. The training was supported by a grant under Fogarty's AIDS International Training and Research Program (AITRP). Dr. Quarraisha Abdol Karim of Columbia University, who directed the CAPRISA-004 study, is the director of the Fogarty training grant and has mentored many trainees continuing this work. Moreover, Fogarty Scholar Dr. Kogie Naidoo has reported a randomized clinical trial conducted at Durban demonstrated that antiretroviral treatment should begin at the same time as TB treatment. This result has caused the WHO to change its guidelines for TB treatment. Finally, Dr. Sten Vermund of Vanderbilt University has directed a multi-country study, funded partly by NIAID with some Fogarty trainees participating, demonstrating the effectiveness of ART therapies in stopping mother-to-child transmission of the HIV virus. Sten's program has trained 64 individuals in degree programs, nearly all of whom have returned to their home countries. There remains much to be done in the effort to achieve "a world without AIDS," in Dr. Fauci's phrase. As we mark World AIDS Day and the 30th anniversary of that effort, Fogarty is pleased to have played a significant role in training many of the researchers who are positioned to lead the battle.

Nelson L. Michael, M.D., Ph.D is the Director of the U.S. Military HIV Research Program (MHRP) at the Walter Reed Army Institute of Research (WRAIR), an international HIV vaccine research program that successfully integrates HIV and AIDS prevention, care and treatment. In this post, Col. Michael reflects on the progress being made in HIV prevention science. December 1 marks the commemoration of World AIDS Day—a day to reflect on an epidemic that has affected millions of lives worldwide for three decades now and how far we’ve come towards an end. This year’s focus and theme is a right on target: “Leading with Science, United for Action.” Recent scientific achievements have brought us closer to eliminating AIDS than we have ever been. Results from the landmark RV144 trial, an international collaboration that involved more than 16,000 Thai volunteers, were announced in 2009. While it took a quarter of the century from the discovery of HIV to show that a vaccine is possible, the results of RV144—which showed the first scientific evidence of vaccine efficacy—have propelled the HIV vaccine research field forward. Earlier this year, we announced the results of extensive follow-up laboratory studies that provide new clues about the types of immune responses that may have played a role in the protection seen in RV144. These new advances were the result of nearly two years of work by more than 100 researchers at 25 institutions worldwide. We now have a better understanding of how the vaccine may have prevented infection and a renewed scientific direction to help guide future vaccine development. We are united in our efforts to end AIDS; no one organization can do it alone. As we move forward, MHRP’s collaborators are leading a tremendous effort to identify correlates of protection. Additionally, a new collaboration—a public-private partnership called P5 that comprises MHRP, the Division of AIDS/NIAID, the Bill and Melinda Gates Foundation, Sanofi Pasteur, Novartis, and the HIV Vaccine Trials Network—is planning the next set of Phase IIb trials to build on the results of RV144 and bring us closer to a vaccine product with a public health impact. MHRP’s commitment to ending AIDS extends beyond developing an efficacious vaccine to creating innovative programs to prevent and treat HIV through the President’s Emergency Plan for AIDS Relief (PEPFAR). In 2011, our site in Uganda, the Makerere University Walter Reed Program launched the first ever mobile circumcision clinic with the ambitious goal to circumcise 6,000 men by year’s end, Kenya has become a leader in the prevention of mother-to-child transmission (PMTCT) due in large part to the efforts of the Walter Reed Project, and the number of patients currently receiving antiretroviral therapy at all of MHRP’s African sites—Kenya, Nigeria, Tanzania and Uganda—exceeded 100,000. A world without AIDS seems more achievable now than any other time in history. However, one prevention strategy alone will not be the end all to this pandemic. We must maintain the momentum and commitment to both scaling up currently available and evidence-based prevention strategies and finding a long-term solution to eliminate AIDS. In the meantime, MHRP is uniquely positioned to move HIV vaccine science forward and to inform HIV prevention, care and treatment with scientific data to develop best practices and to ensure the best, most efficient practices are provided around the globe.

Mitchell Warren, the executive director of AVAC and a founding member of GHTC, wrote the following op-ed in reaction to Secretary of State Hillary Clinton’s speech at the National Institutes of Health and her announcement to prioritize achieving an AIDS-free generation. This op-ed originally appeared in The Hill’s “Congress Blog” this week. Last week at the National Institutes of Health (NIH), Secretary of State Hillary Clinton laid out an ambitious vision to end the HIV and AIDS pandemic. In a statement that no US leader has made before, Clinton said that it is possible to achieve an AIDS-free generation. The goal Secretary Clinton lays out is indeed possible, and we welcome her announcement of an additional $60 million for implementation of a combination of prevention strategies in four sub-Saharan African countries and evaluation of their impact. But this funding can only be viewed as a down payment on the work that needs to be done. In order to get there, the Obama administration, along with developed and developing country governments around the world, need to add specific commitments, milestones, and strategies to the vision. And they need to commit to the long haul. It is 16 days to World AIDS Day, and we expect to hear additional commitments and see leadership from President Obama, with an eye to both the international and domestic epidemics. The good news is that, as Secretary Clinton emphasized, there is a strong foundation on which to build. Thanks in large part to prior US support for HIV research and implementation, particularly via the NIH, we have today three key tools to help end the epidemic: voluntary medical male circumcision, effective treatment for people living with HIV, and prevention of mother-to-child transmission. If taken to scale, the number of new infections will plummet. But Secretary Clinton also noted the need to continue developing new tools for tomorrow. The commitment to both research and implementation must be unwavering. There are three critical research priorities that require long-term investment to truly close the door on AIDS. First, we need real-world research to understand how best to use additional HIV prevention tools that were recently found effective in clinical trials, including topical microbicides and pre-exposure prophylaxis, or PrEP. Second, we need to sustain the search for a vaccine to prevent HIV, especially now that the vaccine field is being re-energized by promising new scientific advances. Third, we need to pursue the increasingly real possibility of developing a functional cure for HIV infection. It is critical to sustain investments in research and development for additional powerful prevention tools. On World AIDS Day, we will be listening for a strong, specific commitment to scaling up the tools we have at our disposal immediately, with a focus on combination prevention and an emphasis on HIV testing and counseling, which is the gateway to male circumcision, prevention of mother-to-child transmission, and treatment and care for HIV positive people. Now is the best possible moment to invest in research, when the possibilities for long-term success are greater than ever before. This is when we should double down on some of the amazing successes we’ve seen in the past few years. As Secretary Clinton said in her speech, it is possible to create an AIDS-free generation. Research has made this goal possible, and we must stay focused on the future. We cannot turn back now. Not when there is a potential end to this epidemic finally in sight.