By Lee Storrow
The science of HIV treatment and prevention is changing at a meteoric pace.
Last month, North Carolina scientists presented leading-edge research on some of those advancements at the International Conference on HIV Science (IAS 2019) in Mexico City, Mexico.
The conference is the world’s largest convening focused on HIV research and its applications, with over 6,000 people in attendance. Over the course of the conference, researchers presented on a number of major scientific breakthroughs that have the potential to change the landscape for HIV prevention.
On the first day of the conference, Myron Cohen presented at a symposium session entitled New prevention products in the pipeline on the future of long-acting injectable HIV medications. Cohen is a professor at the UNC Chapel Hill Gillings School of Global Public Health and the director of the UNC Institute for Global Health and Infectious Diseases. He was the architect and principal investigator of the groundbreaking study that demonstrated that viral suppression in someone living with HIV will prevent sexual transmission of the virus.
“We are just about at the end of a long journey,” Cohen stated as he opened his presentation.
He discussed two major double-blind studies, HPTN 083 and HPTN 084, that studied the effectiveness of cabotegravir, a long-acting HIV prevention medication given in the form of a shot.
HPTN 083 focused on gay cisgender men who have sex with men and transgender women who have sex with men. HPTN 084 enrolled sexually active women 18-45 years old in Africa.
Though the studies are not final yet, Cohen reported that both have had strong enrollment and present promising potential for a new way to deliver HIV prevention medication.
Currently, the only Food and Drug Administration-approved HIV prevention medication is Truvada, which is taken as a daily pill.
Mehri McKellar, an infectious disease specialist at Duke University and the director of the Duke Pre-Exposure Prophylaxis (PrEP) Clinic, said that the potential for injectable HIV prevention is very exciting.
“The patients in studies using injectable medications seem to be very happy and haven’t complained much about injection site pain. It’s certainly great to have more options, especially for patients who may not be good pill-takers,” she said.
McKellar does have concerns about the logistics of injectables.
“In our clinics, we will need to make sure we have well-trained staff to provide the injections,” she said. “We will need to stay organized in terms of scheduling so that patients don’t miss their injections and go without medication.
“I also am interested to see what the cost will ultimately be – there may be some additional charges such as nursing costs for administering the injections or hospital-associated fees.”
Local support for HIV services
Another piece of North Carolina-generated research included collaborative work done by the NC AIDS Action Network (Note: Storrow leads the NCAAN) and the Latino Commission on AIDS.
In 2018, the two organizations commissioned a public opinion poll to determine awareness and support for PrEP amongst the North Carolina general public.
“The South is the epicenter of the HIV epidemic, and we’ve known for years what is needed to drive down new HIV transmissions,” said Judith Montenegro, program director for the Latino Commission on AIDS’ Latinos in the Deep South project, in a press release on the updated poll.
The poll was expanded and replicated in 2019, in addition to polling six other states in the south.
In North Carolina about half of the respondents had never heard of PrEP. But after hearing an explanation of the medication and its benefits, a majority of people supported programs to provide PrEP to low-income individuals by a 3:1 margin. A majority also would support a bill to require insurance companies to cover PrEP without copays.
In all six states polled, results showed strong support for Medicaid expansion from the general public. Fifty eight percent of North Carolinians supported Medicaid expansion and 26 percent opposed expansion.
Advocates hope that if Medicaid was expanded in North Carolina, many living with HIV would gain access to full health insurance, instead of only receiving free HIV medication through the NC Division of Public Health’s HIV Medication Assistance Program.
IAS 2019 featured attendees from over 160 countries, and conference organizers said diversity was top of mind for this year’s conference and beyond.
On the last day of the conference, Joaquin Carcarno, director of community organizing at the Latino Commission on AIDS, spoke about his experience as a trans activist attending the conference.
“Sitting in the audience for the plenary, I was surrounded by people captivated by what was being shared, absorbing everything they could, sometimes reacting in shock and other times nodding their heads in agreement,” Carcano said.
“I remain hopeful.”