HIV R4P: Three reasons to be excited about the future of HIV prevention

Frontline AIDS/Gemma Taylor/2018
An outreach worker on India’s WINGS programme demonstrates a male condom

Despite the enormous challenges posed by COVID-19, many scientists attending this year's virtual HIV Research 4 Prevention conference voiced optimism that we are entering a golden age for HIV prevention.

Recent advances in HIV prevention research, and the wealth of new products that are being developed or taken to market are a real cause for celebration. Suddenly the vision of an AIDS free world seems closer than ever.

So, here are three very good reasons to feel hopeful:

1. A triumph for long-acting injectable PrEP

Taken as an injection once every two months, cabotegravir, a new antiretroviral drug, has been found to be a safe and effective way to prevent HIV infections among many different populations, including cis- and transgender women, and cisgender men who have sex with men.

A presentation on the HPTN 084 study on injectable PrEP reiterated the good news announced in November 2020, but added more detail.

The study compared the use of cabotegravir injections with oral daily PrEP among cis-gender women. Researchers found that cabotegravir injections were 89% more effective at preventing HIV than taking daily pills.

These great findings complement the results reported by a sister study, HPTN 083 in 2020, which also found cabotegravir to successfully prevent HIV infections among men who have sex with men and transgender women.

This means we’re not only looking at a new method of prevention, but potentially a better method for women and other groups, who may struggle with adhering to daily pill treatment long-term.

If implemented correctly, injectable PrEP could prove to be a real game changer, providing more discreet options that fit into people’s existing sexual and reproductive health practices.

2. The expansion of HIV prevention tools designed for women

The monthly Dapivirine ring is a flexible silicone vaginal ring developed by the International Partnership for Microbicides, which women can insert autonomously to protect themselves from HIV acquisition. The ring is very well tolerated and works by delivering Dapivirine, a HIV drug, locally in the vagina over the course of 30 days.

The ring – which has been shown to reduce HIV infections in women by about 50%  – is a particularly welcome addition to the prevention toolbox, as it is the first discreet long-acting HIV prevention option specifically designed for women.

Excitingly, just before the conference started the ring was recommended by the World Health Organization as an additional prevention strategy for women as part of combination prevention approaches. This is extremely good news. The WHO recommendation paves the way for country-level approvals which means we could see the Dapivirine ring hitting shelves as early as next year.

And it doesn’t end here. Research is still ongoing into a 90-day dual purpose vaginal ring which could protect against both HIV and unintended pregnancy.

3. The promise of Broadly Neutralising Antibodies

Broadly Neutralising Antibodies –  or bNAbs for short – are a particular kind of antibody produced by some people living with HIV, which are capable of neutralising different strains of HIV. Because of this, they are of great interest as a potential new area of HIV prevention.

Two landmark studies were designed to test the efficacy of a particular kind of broadly neutralising antibody called VCR01. They found that long-term administration of VRC01 did show a preventative effect against some strains of HIV. While VCR01 had little effect on most strains of HIV, for those it was active against, new cases fell by 75%. This suggests that combining multiple antibodies could be effective in the future.

Our journey to understand the use of bNAbs is still ongoing. But importantly we now have proof of concept, to help guide advances in this exciting field.

HIV R4P is a bi-annual global conference that brings together the world’s most prominent researchers in the field of prevention. Find out more about this year’s conference here.

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