Fauci: Follow the Science to End the HIV/AIDS Epidemic

Marcia Frellick

October 24, 2016

GLASGOW, United Kingdom — The possibility of controlling HIV without eradicating the virus is a hot new area of research, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said here during the opening session of HIV Drug Therapy 2016.

In fact, he presented results from a study of an antibody against the cell receptor alpha4beta7 integrin, the homing receptor for CD4-positive T-cells, earlier this month at the HIV Research for Prevention meeting in Chicago.

In that study, monkeys infected with the simian version of HIV were treated with antiretroviral therapy. They were then given the antibody and treatment was discontinued.

Almost 2 years later, the monkeys "have replication-competent virus but they have no viremia," Dr Fauci reported. "I have no idea what the mechanism of that is, but that's something we're really pursuing."

The National Institutes of Health recently started an exploratory open-label study of vedolizumab — the commercially available version of that antibody — in human subjects.

"We entered the first patient in August and, hopefully, by the end of 2017 or early 2018, we will have some answers," said Dr Fauci.

The potential for this is exciting, said Andrew Phillips, PhD, professor of epidemiology at University College London in the United Kingdom, who is chair of the conference.

"The sterilizing cure of eradication seems not to be on the horizon for HIV. I would be amazed if that was to come in the next decade," he told Medscape Medical News. But the early data showing that people's immune systems might be able to control HIV replication suggests a cure "may be closer than I thought."

Statistics Not Promising

The statistics cited by Dr Fauci are not promising, though. Around the world, there 36 million people living with HIV and, in 2015, there were 1 million deaths and 2 million new infections.

Still, "over 35 years, the science has been nothing short of breathtaking," he said.

In 1981, before HIV had a name, people presenting with symptoms could expect to live only about a year. Now, the average 20-year-old patient who is diagnosed with HIV early and immediately put on treatment can expect to live another 50 years, he pointed out.

"We have 17 million people now receiving antiretroviral therapy, which has averted almost 9 million deaths in the past 16 years, " Dr Fauci reported.

He pointed to three major trials that have had a substantial impact on treatment and have answered key questions.

The SMART trial revealed that continuous therapy is more effective than episodic therapy (N Engl J Med. 2006;355:2283-2296); the HPTN 052 study showed that if you treat the infected partner in a discordant couple, as opposed to waiting, you can decrease the likelihood that the virus will be sexually transmitted to the uninfected partner by 96%; and the START study showed that everyone with HIV should be treated immediately after diagnosis, regardless of CD4 count (N Engl J Med. 2015;373:795-780).

And treatment as prevention, which was a focus of the recent Controlling the HIV Epidemic with Antiretrovirals Summit held in Geneva, led to the current 90-90-90 goals.

I believe within a reasonable period of time, we will reach the beginning of a durable end to the HIV epidemic.

In the United States, care on the continuum has been disappointing. In fact, "13% of people don't know they're infected," Dr Fauci said.

"As for linkage to care and suppressive therapy, we're still at 55%. Two years ago, we were at 30%," he reported. "That is really unconscionable when you talk about the tools we have."

If everyone who is infected with HIV was diagnosed and put on therapy, you would decrease new infections in the United States by 92%, he explained.

But other countries, such as Botswana and Sweden, the first to reach 90-90-90 targets, are doing well. In the history of medicine, this relatively short period between the identification of disease and the suppression of it is "unprecedented," Dr Fauci said.

"I believe that in a reasonable period of time, we will reach the beginning of a durable end to the HIV epidemic," he added. "The reason we will get there is that we will do what we have been doing for the last 35 years: following the science."

Dr Fauci and Dr Phillips have disclosed no relevant financial relationships.

HIV Drug Therapy 2016. Presented October 23, 2016.


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