Piecing Together the HIV Prevention Puzzle: AVAC Report Assesses Progress in AIDS Vaccine, Microbicide and PrEP Research and Calls for Urgent Coordination and Leadership in Advance of Upcoming Results
Monday, May 18, 2009
New York, NY -- "It's an exciting time in HIV
prevention research. We will see results from a
number of critically important HIV prevention
research trials this year, as well as see the
start of new trials around the world that will
yield important answers in the years to come,"
said Mitchell Warren, AVAC executive director,
at the release of AVAC's 13th annual report of
the field.
"But scientific, community
and political leaders must act now to plan for
continued research and implementation of
effective strategies, or this excitement will
be wasted."
The report -- Piecing
Together the HIV Prevention Puzzle -- looks at
AIDS vaccine research, where there is an
energized focus on discovery, innovation and
basic science and looks at the broader HIV
prevention field, particularly the implications
of pre-exposure prophylaxis (PrEP) and other
strategies in efficacy trials
today.
This analysis of the HIV
prevention field comes in a year that has
already brought disappointment as well as
intriguing results from various prevention
studies. At the same time, even trials that
failed to show overall benefit, such as the
Step Study of the Merck HIV vaccine candidate,
have continued to generate new, valuable
information and questions that would not
otherwise exist.
These trials have
succeeded as a result of increasingly robust
partnerships between researchers and
communities grappling with HIV, including gay
men around the world and heterosexual women in
Africa. These partnerships, along with the
persistently high rates of new infections, are
a continual reminder of the global commitment
to and need for continuing the search for new
prevention for as long as it takes.
"We
hope to have new prevention intervention pieces
to add to the puzzle in the next few years,"
said Warren. "But as the slow implementation of
male circumcision to reduce heterosexual men's
risk of HIV infection reminds us, we need
extensive planning and guidance to ensure
research results are translated into real
impact against the epidemic. We can't afford to
wait for efficacy results before we begin to
plan. We must anticipate and tackle the major
hurdles for implementation now."
The
Report identifies major issues for
implementation of new prevention options,
including:
- Ongoing
global failures to scale up access to HIV
testing and counseling
services.
- Persistent
inattention to the needs of gay men and other
men who have sex with men around the world.
- Gaps in health care
infrastructure that will complicate
introduction of any new strategy.
In the
Report, AVAC also underscores the importance of
WHO and UNAIDS getting involved in planning for
the results from PrEP trials before data are
available.
"WHO and UNAIDS, along with other
stakeholders, need to combine their strengths
now to provide leadership and coordination so
that the world is ready to work with results
from the many ongoing PrEP trials," said
Warren.
Positive results from current
vaccine, PrEP and microbicide trials will also
present challenges and opportunities for other
ongoing and planned HIV prevention
trials.
"There has been concern that
positive results from PrEP trials would require
vaccine or microbicide trials to become larger,
longer and more expensive, as PrEP could become
a standard of prevention in these trials," said
Warren. "But we believe that success in one
trial will open up possibilities and options
for research that could combine AIDS vaccines
and other interventions as they
emerge."
To help guide efforts in new
areas of research and sustain ongoing research,
AVAC calls for researchers and trial sponsors
to begin planning on how combination strategies
can be evaluated.
As the field looks to
fit the puzzle pieces together, the AVAC Report
also identifies a number of big questions in
AIDS vaccine research for 2009 and beyond,
focusing on issues such as cell-mediated viral
control, HIV genetic diversity, the role of
animal models, immune activation, antibodies
and adjuvants.
In its analysis of the
vaccine field, AVAC also assesses the progress
and future potential of the Global HIV Vaccine
Enterprise and considers the impact of results
from the Thai prime-boost vaccine trial that
are expected in September. With over 16,400
participants, this is the largest AIDS vaccine
trial ever undertaken.
"In AIDS vaccine
and HIV prevention research today, we see a
fertile mix of big science and individual
efforts, of product-oriented work and of slow
and steady basic science," Warren
added.
"What we need now is a quick,
strategic, scientific analysis of all the
efforts underway, with a goal of identifying
gaps and opportunities for synergy both within
the AIDS vaccine field and across the vaccine,
PrEP, and microbicide fields. AVAC is excited
to help move the HIV prevention field toward a
collaborative agenda and to prepare now for
implementing potential new prevention
options."
Piecing Together the HIV
Prevention Puzzle is available at http://www.avac.org/reports.htm.
About AVAC
Founded in 1995, the international non-profit AIDS Vaccine Advocacy Coalition (AVAC) seeks to create a favorable policy and social environment for accelerated ethical research and eventual global delivery of AIDS vaccines and other HIV prevention options as part of a comprehensive response to the pandemic. More information is available at http://www.avac.org/.