Days 1 to 3; July 22-24, 2024 

The meeting opened Monday night.  We are lucky to have Jeff Taylor from HARP-Palm Springs share the following comments on the 2nd Berlin patient.

The “Towards a Truly Global HIV Cure” pre-conference workshop on Sunday, featured a panel discussion with all three “out” people who have been cured of HIV. “Düsseldorf Patient” Marc Franke, “London Patient” Adam Castillejo, and “City of Hope Patient” Paul Edmonds joined a panel discussion chaired by IAS co-chair Sharon Lewin and Jeff Taylor. All three shared their amazing stories of receiving stem cell transplants that cured both their blood cancers and their HIV—the tribulations of the procedure, the challenges they still face living as transplant recipients, and the rather surreal experience of being cured, and the media attention, and how the media often distorts their stories.

 The audience of researchers & community advocates from around the world flocked to the stage afterwards to shake their hands, and of course take lots of selfies. All three gentlemen will be featured in other IAS sessions—especially around interrupting HIV treatment during cure trials, and in multiple media stories coming out of the conference. Both Adam Castillejo and Paul Edmonds will be in San Diego for a town hall meeting on cure research produced by the RID HIV cure research Collaboratory on Sunday, Oct 6. Stay tuned for more details…

Also announced at the conference was the latest person cured of HIV–“The New Berlin Patient”. This 60-year-old man also received a stem cell transplant to treat his blood cancer, but with one key difference—the donor stem cells only had one, not two genes of the rare mutation in T-cells that makes them immune to HIV infection. People with these cells can acquire HIV, but typically are so-called “slow progressors” who don’t get as sick nearly as quickly as most people and can go a long time before they need to start on HIV treatment.

This is the first case like this, so it’s unknown whether they could possibly become reinfected with HIV or not. The “Geneva Patient” announced at last year’s IAS conference in Brisbane received normal stem cells without that mutation, yet the transplant process appears to have eliminated HIV in their bodies anyway. Since these are the first cases like this, it’s unknown whether they could possibly become reinfected with HIV or not.  We have a lot more to learn…

The conference’s first full day was today, Tuesday. 

It is good to see public health and political figures visible and speaking at the conference.

Featured speakers included the German Olaf Scholz, Chancellor of the Federal Republic of Germany; the former Prime Minister of New Zealand Helen Clark; Francoise Barre-Sinoussi, the winner of the Nobel Prize in Physiology or Medicine in 2008; and First Lady of the United States Jill Biden.  The First Lady’s 2 min speech “”Empowering youth in HIV prevention and treatment,” included stories about PLH taking control of their own health.  https://www.instagram.com/aids_conference/reel/C9xbZ8qOmhl/

Chancellor Scholz reminded us that someone dies of HIV every minute and the importance of language. “Language changes how we perceive reality. A person labelled “AIDS-infected” is perceived differently from a person “living with HIV.” That’s why it is key to communicate in a people-centered way instead of putting the disease first.” Other speakers included the IAS President Sharon Lewin; and Dr. Meg Doherty, Director of the Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes (HHS) at the World Health Organization (WHO).

Highlights Day 2

  1. PURPOSE-1 study—Stunning 100% prevention of HIV with an every-6-month injection. Not one of study participants contracted HIV during the study and, in fact, the study was so successful that the blinded phase was ended early and study participants who’d been using oral PrEP were given the option to switch to lenacapavir, the injectable. Bekker-full name? presented that adherence levels were high and adverse effects were mostly minor.

A PURPOSE-2 trial is planned, which will test lenacapavir in cisgender men, trans women and men, and nonbinary individuals. It won’t be until this trial has concluded that the regulatory process can begin to bring the medication to the market.

  1. The 2nd Berlin Patient, has been cured of HIV. “The procedure used with the next Berlin Patient is yet another stem cell transplant and, thus, not a viable option for the vast majority of the nearly 40 million people living with HIV. But his case is unique in that, unlike most other successful stem cell transplant HIV cures, his donor has only one copy of the CCR5-delta32 mutation that renders a person almost completely immune to HIV, rather than two. It will require further study to determine to full ramifications of this case, but it could open the door to a cure for many more people who already require a stem cell transplant for the treatment of cancer; while only about 1% of people with northern European ancestry have two copies of the CCR5 mutation, as many as 16% have one copy.

What’s harder to convey is the feeling of excitement in the room at this session. The results of the lenacapivir study are truly a landmark and it felt like watching history in the making. To have the fullest effect possible, the injection will need to be made available at a reasonable price all around the world. That’s likely going to take some pushing, but for now it’s an incredibly jovial mood throughout the halls at AIDS 2024. https://www.amfar.org/news/aids2024/

3. HIV Science as Art Program. Twelve scientists were paired with 12 artists living with HIV.  HIV Full program here.

  1.  The U=U resource guide, which helps make this life-saving message accessible to everyone. If the HIV viral load is undetectable, the virus cannot transmit. This knowledge has allowed many PLH to have enjoyable and nurturing sexual relationships without fear of transmitting HIV.

A resource guide (PDF, 12.1 MB) was developed in partnership with the Prevention Access Campaign Exit Disclaimer and released during the pre-conference. The U=U resource guide is a community-led health message and global campaign to communicate the science behind the message of U=U, or undetectable equals untransmittable. Our colleagues also highlighted the important impact U=U is having globally and for individuals with HIV. Watch the conversation.

  1. Doxy-PEP and Doxy-PrEP. Dr Raul Macias, UCLA Infectious Disease, will review this later in the week. Looks like daily doxycycline before sex, so PrEP, Pre-Exposure Prophylaxis. While Doxy PrEP is not yet available, many were discussing whether the current practice of 200mg doxycycline after sex will change to daily and not as needed.

In a small pilot study of men living with HIV, researchers looked at the efficacy, tolerability, and use patterns of Doxy PrEP. They found that doxycycline was well tolerated overall, and observed 79%, 92%, and 68% reductions in syphilis, chlamydia, and gonorrhea respectively in the group who took doxycycline compared to those who took a placebo. View their conversation

  1. Weight gain with INSTI’s. INSTI’s are Integrase Strand Inhibitors.   There are five INSTIs currently approved by the Food and Drug Administration, including raltegravir, elvitegravir, dolutegravir (Tivicay), bictegravir, and cabotegravir (Apretude).  Some of these are in combination pills like Biktarvy, Cabenuva, Stribild, Genvoya).
  2. Testing problems with Apretude (cabotegravir) injectable every two months. A single laboratory-based HIV viral load test used by U.S. clinicians who provide people with long-acting, injectable cabotegravir (CAB-LA) HIV pre-exposure prophylaxis (PrEP) did not reliably detect HIV in a multi-country study. In the study, a single positive viral load test was frequently found to be a false positive result. However, a second viral load test with a new blood sample was able to distinguish true positive results from false positive results for all participants whose initial viral load test was positive. If you have a detectable viral load while using this drug, your medical provider needs to repeat the test.

A false positive can result in PrEP interruptions that create potential vulnerability to HIV acquisition, and more importantly causes profound psychological distress while a person awaits confirmatory results from a second test.

  1. Oral presentation: Week 48 outcomes from ARTISTRY-1: The latest data from an ongoing Phase 2/3 study designed to evaluate an investigational once-daily single-tablet regimen of bictegravir and lenacapavir in virologically suppressed people with HIV who are on a complex regimen.
  2. Abstract posters—many reports about depression and weight gain with INSTI’s. UCSD’s Dr Grelotti and med student Michael Schulte presented a poster on depression in PLH— “Examining the relationship between psychological wellbeing, self-efficacy, resilience, and depression among people with HIV.” Their conclusions: “Consistent with prior studies, we found that PWH exhibited greater depressive symptom severity.” Their report is the first report on lower psychological wellbeing among PWH using the NIH Toolbox Emotinalm Battery. Michael will summarize the study and give us comments on other reports of depression in PLH later in the week.
  3.  Navigating neuro-HIV: Approaches and treatment strategies –live panel discussion.

UCSD’s Dr Scott Letendre chaired the session. Jeff Taylor from HARP-Palm Springs participated. Remember the basics for brain health: exercise and sleep. A lot of discussions of evaluating cognition, memory, neurologic condition in PLW, but I did not hear suggestions on treatment. See the presentation: https://aids2024.iasociety.org/cmVirtualPortal/_iasociety/aids2024/session/0000039440/cca825d5347638eb046f37af6f4af7ca0f815ddf/0000000040

Jeff Taylor commented on hormone replacement for depression and memory. He also asked for routinizing neurocognitive assessments, and what specific tools to use. “The importance of sleep cannot be overemphasized.” (Amen to that, brother!)

  1. Abstract on uncontrolled hypertension as a risk factor for dementia in PLH. Abstract 88 (soon will be able to search abstracts on line)
  2. An Italian study on women and heart health. Researchers found that women do not reach targets for dyslipidemia, hypertension or diabetes, recommended by EACS (European AIDS Clinical Society) Abstract below.