This year marks the 30th anniversary of World AIDS Day, a time to celebrate and support people worldwide living with HIV, commemorate those we have lost and reaffirm our efforts to end this epidemic as a public health threat. The theme for this year is “Know your status.”
The HPTN has been at the forefront of several advances in non-vaccine prevention as part of continued efforts to meet the United Nations Program on HIV/AIDS (UNAIDS) 90-90-90 targets. In 2018, HPTN 074 was completed among people living with HIV who inject drugs and their injection partners in Ukraine, Indonesia and Vietnam. The study demonstrated an enhanced strategy led to nearly double their antiretroviral therapy usage and achieved higher viral suppression as well as medication-assisted treatment usage through the enhanced intervention. Mortality was also reduced by more than half, compared to the standard of care arm. These encouraging findings can help advance HIV control efforts among people who inject drugs around the world. Another completed study, HPTN 075, revealed more than half of the men and transgender women living with HIV recruited from Kenya, Malawi and South Africa were unaware of their status and at alarmingly high HIV incidence. Importantly, the study was successful in recruiting and retaining individuals from these populations, paving the way for their inclusion in tailored HIV prevention intervention studies. Similarly, early findings from HPTN 078 suggest deep-chain respondent-driven sampling could be a tool to find and recruit men who have sex with men (MSM) in the U.S. with unsuppressed viral load.
The HPTN has also focused on another population deemed vulnerable for acquiring HIV infection: young women in sub-Saharan Africa. Initial results from HPTN 082, which recruited young women in South Africa and Zimbabwe, showed most participants felt they could take pre-exposure prophylaxis (PrEP) every day and planned to disclose its use. We expect final study results will be presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in March 2019.
It is exciting to note three joint studies with the HIV Vaccine Trials Network (HVTN) are now fully enrolled. The Antibody Mediated Prevention studies (HVTN 703/HPTN 081 and HVTN 704/HPTN 085) are evaluating the safety and efficacy of VRC01, a broadly neutralizing antibody (bnAb) in men and transgender people who have sex with men in North America, South America and Switzerland, and women in sub-Saharan Africa, respectively. At the same time, HVTN 127/HPTN 087 is testing VRC07-523LS, a long-acting bnAb, in healthy, HIV-uninfected adults in Switzerland and the U.S.
Pursuing new long-acting antiretroviral drugs for PrEP is another high priority for the HPTN. We are currently conducting two large studies evaluating the use of long-acting intramuscular cabotegravir among MSM and transgender women who have sex with men in the Americas, Asia and South Africa (HPTN 083), and women in sub-Saharan Africa (HPTN 084).
Finally, the HPTN Scholars program achieved another year of strong performance, recently passing the 50th scholar recruited milestone. Established in 2010, the program, which supports early-career minority investigators, has enabled these investigators to get 29 primary-authored publications to date and was recently expanded to include international scholars.
Looking ahead to next year, we eagerly await HPTN 071 (PopART) primary results, which we expect to be presented at CROI 2019. Reaching nearly a million people, this is the largest HIV prevention study conducted to date. HPTN 071 focused on communities in South Africa and Zambia, evaluating whether a combination prevention approach, centered on universal HIV testing (i.e., knowing your status) and linkage to treatment with prompt treatment initiation would lead to a reduction in HIV incidence.
Our efforts would not be possible without support and collaboration from all the funders and pharmaceutical partners. We also recognize that none of this important work could be done without the remarkable HPTN community of study participants, advocates, educators, site staff and investigators. Thank you for your commitment.
Myron S. Cohen, MD
Wafaa El-Sadr, MD, MPH, MPA
HPTN Principal Investigators