Day 5, July 26th 2024

By Joe Caperna

More than 40 oral abstract sessions, 50 invited-speaker sessions, 20 workshops, 17 pre-conferences, 30 symposia sessions, 100 satellite sessions and 2,200 posters.

Another Hope for cure

First Human CRISPR gene therapy

Researchers are slowly finding a safer way to cure, than the reported stem cell transplants.

“This study is highly unique,” added Chantelle Ahlenstiel, PhD, a senior research fellow in immunovirology and pathogenesis at the Kirby Institute at the University of New South Wales in Sydney, Australia. “It was a high-risk study that showed a very promising safety profile,” she said.

HIV RNA levels rebounded in all four participants who had antiretroviral interruption, but One patient had a delayed rebound of almost 16 weeks along with a significant drop in the HIV reservoir.

“This is the most promising result but only seen in one person,” Presti said during an interview. 

https://www.medscape.com/viewarticle/first-human-trial-crispr-gene-therapy-hiv-2024a1000dx5

AI

Important session on the rapid growth of AI in healthcare including with PLH.   Surprisingly, or sadly, AI has been shown to be more compassionate than healthcare workers.  It’s faster, cheaper, and we all need chatbot psychotherapy?

The machine is less personal, less intimidating. Maybe more approachable. Self-service gas. Self-checkout. These are inhuman. Antisocial.

Real people need to understand and experience the benefits of compassion.

The idea is to be other-centered.  And remember the benefits of human community

Improving PrEP uptake by fewer appointments??: Six-monthly PrEP monitoring as a standard of care, instead of every three months, could address an obstacle to PrEP uptake and reduce the total number of visits without resulting in increased STI positivity, leading to cost reductions of PrEP programs. These are preliminary results of the EZI-PrEP trial in the Netherlands. PrEP users monitored every six months made more additional STI visits than those who were monitored every three months but had fewer visits overall.

Dr Caperna:  “I’m not so sure this is the way to go.  Six months seems too long to wait to screen for STI’s in PLH who have even one new partner a month.  My take on this for now.”

Stigma and discrimination: A session peeled back the layers of HIV stigma and discrimination. A survey of 18,430 healthcare workers across Europe showed significant HIV stigma and discrimination: 69% did not agree with accurate statements related to HIV prevention and more than half are worried when providing care to people living with HIV. Almost half of 8,128 respondents in a study on HIV criminalization and enacted stigma in eastern Europe and central Asia had experienced enacted stigma in healthcare settings. In Uganda, the Tackle programme uses football to reduce self-stigma (which affects almost 85% of people living with HIV), increase ART adherence and improve health outcomes for young people living with HIV. 

Cure: The tone was set that this would be a groundbreaking conference for HIV cure when three people known to have been cured of HIV came together in a pre-conference. Adam Castillejo (formerly known as the London Patient), Marc Franke (formerly the Düsseldorf Patient) and Paul Edmonds (formerly the City of Hope Patient) shared their stories. Their hope was to inspire researchers and people living with HIV to keep on track to find a cure that would work for everyone. 

Then came details about the “next Berlin patient”, who appears to be the seventh person cured of HIV.

Long-acting technologies: A “miracle prevention tool” is how UNAIDS Executive Director Winnie Byanyima described Gilead’s twice-yearly injectable lenacapavir for HIV prevention. Full results from the PURPOSE 1 trial, presented at AIDS 2024, confirmed that lenacapavir gave 100% protection against HIV acquisition in cisgender women; between 1% and 2% of women using daily F/TAF or F/TDF acquired HIV. 

Leadership, policy and funding: One of the biggest obstacles to realizing the vision of ending the HIV pandemic as a threat to public health and individual well-being by 2030 is a fall-off in funding. UNAIDS points to international resources for HIV in 2023 being almost 20% lower than at their peak in 2013.   This will lead to more infections, and no hope for elimination.

AIDS is still with us: UNAIDS shared updated global HIV data.   There is real concern that the world will not meet the UNAIDS 2030 95-95-95 targets. The report shows that 39.9 million people were living with HIV in 2023 (from 39 million in 2022). About 1.3 million people acquired HIV in 2023 – more than three times the 2025 target of 370,000. About 630,000 people died from AIDS-related illnesses worldwide in 2023 – a death every minute and way above the 2025 target of 250,000.

A study led by UNAIDS set out the cost of inaction and failure to meet the targets. It found that if we fail to meet the 95-95-95 targets, the human cost will include 34.9 million new HIV acquisitions and 17.7 million AIDS-related deaths from 2021 to 2050. The economic cost of inaction will be huge, more than USD 8,200 per person.

One of my patients shared this poem with me:
Still Not Stopping, by David B. Prather – The Ekphrastic Review 

Stop AIDS, by Keith Haring (USA) 1989


Still No Stopping
  
Just as my body was ready
for desire, AIDS crept into daily life,
even into the hidden hinterland
 
of West Virginia. I was terrified of sex
before I knew what it was,
what it could be. I was terrified
 
of the red serpent I knew
must slither through the woods waiting for me
to be baptized in those intimate waters.
 
All those years ago, such desires.
And all these years later,
still no stopping.
 
Overwhelmed by attraction,
my blood flowed inconveniently
at the sight of women, the visions of men.
 
I didn’t know I could separate pleasure and love
and still be human. I grew up
where religion was a disease, not a path
 
to enlightenment.
It got into an open wound
and flourished in my body until I hated myself.
 
I cocooned my fear,
let it butterfly into self-destruction,
all those unprotected nights, those at-risk days.
 
Somehow, I’m still here.
But so is that viper with its needle-sharp fangs,
its venom in so many lovers’ veins.

David B. Prather
​
David B. Prather still lives a life of Sunday dinners and lawn mowing in Parkersburg, WV. He is the author of three poetry collections: We Were Birds (Main Street Rag, 2019), Shouting at an Empty House (Sheila-Na-Gig, 2023), and the forthcoming Bending Light with Bare Hands (Fernwood Press, 2024).

DoxyPrEP and DoxyPEP: AIDS 2024 saw the term, “DoxyPrEP” (doxycycline pre-exposure prophylaxis to describe taking the antibiotic before sex), make its debut to join the better-known “DoxyPEP” (doxycycline post-exposure prophylaxis).  

So, daily doxycycline versus only as needed, which is the current recommendation.

Researchers from opposite sides of the world presented findings on daily doxycycline. A trial from Canada involving men who have sex with men, living with HIV and with a history of syphilis, showed reductions of 79% in syphilis, 92% in chlamydia and 68% in gonorrhoea in the doxycycline arm compared with the placebo arm. A study from Japan among female sex workers showed a drop in STI incidence from 232.3 to 79.2 per 100 person-years. Syphilis incidence was reduced to zero; there was a marginally significant reduction in chlamydia and no significant change in gonorrhoea.  

A big question mark hangs over the potential for antimicrobial resistance (AMR) with the prolonged use of doxycycline. Large-scale and continued surveillance is crucial to gain further evidence around AMR.