The Latest on HIV Care, Cure, and PrEP

Heather Boerner

July 13, 2021

The COVID-19 pandemic has overshadowed innovations in HIV care and prevention, says Tonia Poteat, PhD, MPH, PA-C, a primary HIV care and HIV preexposure prophylaxis (PrEP) clinician and associate professor of social medicine at the University of North Carolina, Chapel Hill. So even though the US Food and Drug Administration approved monthly injections of cabotegravir/rilpivirine (Cabenuva) in January, none of her patients are taking it.

"We moved our clinic three times during the pandemic," Poteat said. "I'm really interested in how on earth we're going to integrate injectable products into our workflow. We don't have systems set up yet, so we're in the process of figuring out what the structure is going to be like. We have people who are interested on a wait list."

Indeed, in an HIV world still reeling from the dual impact of HIV and COVID-19, the International AIDS Society Conference on HIV Science (IAS 2021) will bring a more coherent narrative on the future of HIV treatment and prevention. That narrative involves long-acting treatment and setting up the systems to make it available to everyone. And IAS offers data showing exactly how much people living with HIV risk poor COVID-19 outcomes.

The conference will be online for the second year in a row and, unlike in 2020, the focus will be much more on HIV treatment and prevention than on that other big infectious disease making news these days.

There will be new data on long-acting forms of prevention, such as the intravaginal ring and monthly PrEP pills. There will be new data on PrEP on demand (2-1-1 PrEP) and the results of a large trial looking at breakthrough HIV infections among those taking daily oral PrEP.

On the treatment side, trial results will be announced on cabotegravir/rilpivirine and islatravir long-acting treatment, as well as additional data on the effectiveness of two-drug antiretrovial therapy dolutegravir/lamivudine (Dovato) and bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) specifically in Black participants.

On the cure front, intriguing animal studies and ex vivo studies look into the use of cancer immunotherapies for an HIV functional cure, as well as the use of CAR-T to stop HIV replication in the absence of daily medication.

Poteat is not alone in being interested specifically in the PrEP and long-acting studies. Jonathan Baker, a PA in private practice in New York City, also wants to see the data on the ring and other expanded PrEP options.

But "a prevention method can only work when people are able to use it," he said. "So [the session] 'Reducing Barriers to PrEP' is really relevant as we see inequitable intake failing the populations who need PrEP most."

This is a concern Poteat has too. That's why she's glad to see there will be sessions on systemic inequities, particularly around what it will take to address those inequities in the US by 2030 in line with "Ending the HIV Epidemic: A Plan for America." She's looking forward to sessions on novel service-delivery models with low thresholds of entry for people experiencing homelessness or people who inject drugs; on access to affordable medications; on trans-led care for transgender women in the global South; and on the comorbidities of aging that are keeping her patients sick these days. 

To that end, there are sessions on common comorbidities with HIV, such as reinfection with hepatitis C, sexually transmitted infections, heart disease, and weight gain as a result of newer drug options, as well as drug-drug interactions between HIV medications and those used in gender-affirming care for transgender adults.

"I can count on one hand the number of people for whom the issue is finding the right antiretroviral," she said. "That's rarely the issue. The issue is often how do we manage their other comorbid conditions, and what about drug-drug interactions with those conditions. HIV is not the only condition many of them have."

Baker reports that his clinic receives funding from Merck, Innovio, and Antiva. Poteat is a consultant for ViiV Healthcare and serves on a study advisory board for Merck.

International AIDS Society Conference on HIV Science (IAS 2021). To be held July 18-21, 2021 (virtual)

Heather Boerner is a science journalist and author who has been covering HIV for a decade. Her book, Positively Negative: Love, Sex, and Science's Surprising Victory Over HIV, came out in 2014.

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