Research Feed

March 07, 2011

1

Highlights From CROI

By Miguel Gomez, AIDS.gov Director

On Wednesday, March 2, Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases at HHS spoke with Dr. Carl Dieffenbach about his reflections on the 18th Conference on Retroviruses and Opportunistic Infections (CROI) Exit Disclaimer in Boston. Dr. Dieffenbach serves as the Director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH).

Please watch their conversation on what participants took away from the conference and what the research community is doing to support the National HIV/AIDS Strategy (NHAS).

To watch presentations from CROI, visit the conference Webcast Sessions’ page Exit Disclaimer.

March 03, 2011

0

Effective HIV Prevention Programs in the U.S.

By Miguel Gomez, AIDS.gov Director

On Monday, February 28, Dr. Jonathan Mermin gave a plenary presentation at the 18th Conference on Retroviruses and Opportunistic Infections (CROI) Exit Disclaimer in Boston. Dr. Mermin is the Director of the Division of HIV/AIDS Prevention at the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.  His talk was titled The Science and Practice of HIV Prevention in the U.S Exit Disclaimer. We encourage you to view and/or listen to his presentation, which includes slides and data.

Dr. Ronald Valdiserri had the opportunity to talk with Dr. Mermin after his presentation, and we wanted to share their conversation with you. Please enjoy the following podcast and give us your feedback.

To watch other presentations from CROI, visit the conference Webcast Sessions page Exit Disclaimer.

March 01, 2011

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Podcasting CROI: Bringing the Science to You

By Miguel Gomez, AIDS.gov Director

I've been at the 18th Conference on Retroviruses and Opportunistic Infections (CROI) Exit Disclaimer this week in Boston. As we mentioned in earlier posts and tweets, the CROI conference committee has been making scientific session available as webcasts and podcasts Exit Disclaimer.

As Dr. Valdiserri mentioned in last week's post, "The conference provides a critically important global forum for basic scientists, clinicians, and global health researchers to present, discuss, and critique their investigations into the epidemiology and biology of human retroviruses and the diseases they produce with the ultimate goal of translating laboratory and clinical research into progress against the AIDS epidemic—at home and abroad."

We encourage you to take a look at the video, audio, slides and downloads that are available on the conference site Exit Disclaimer. It's another example of how new media helps to level the playing field - providing us all with access to information, like the research and news coming from CROI. And continue to stay tuned to this blog for Dr. Valdiserri's updates.

February 27, 2011

5

Using Pre-Exposure Prophylaxis (PrEP) as a Prevention Tool for MSM: The Promise Comes with Challenges

By Ronald Valdiserri, M.D., M.P.H, Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

CAPTION

Dr. Ronald Valdiserri

On Saturday, February 26th, I attended a day-long meeting organized by the Centers for Disease Control and Prevention (CDC) and hosted by the Fenway Community Health Center in Boston. The theme of the meeting was “Moving forward with PrEP Implementation.” Meeting participants included researchers involved in the original iPrEX study and other ongoing HIV prevention studies, health care providers caring for men-who-have-sex-with-men (MSM), state and local health department program directors, MSM community advocates, policy experts, and federal officials.

The meeting began with a detailed review of the iPrEx study, which included nearly 2,500 participants from Peru, Ecuador, Brazil, Thailand, South Africa, and the United States. Participants were MSM engaging in high-risk sex with other men—including a small number of transgender women who reported high-risk sex with men. The study findings, released in November 2010, showed that sexually active MSM who took a once-daily pill containing 2 anti-HIV drugs were 44% less likely to become infected with HIV, compared with participants who took a placebo.

Because iPrEx was a “blinded” study, participants did not know if they were receiving active drugs or placebos (inactive drugs). As such, all study participants received intensive risk-reduction counseling. Along with this counseling, all study participants also received monthly HIV testing, condom provision, and treatment for other acquired sexually transmitted diseases.

When these results were summarized at the Saturday meeting in Boston, the audience was reminded that the level of protection experienced by study participants who received the active drug varied widely, depending upon how consistently they took their daily pills. For those who took the daily drug at least 90% of the time, HIV risk was reduced by 73%. Others, who took the drug less frequently, had only a 21% reduction in HIV risk. Given this finding, a significant theme of our discussion in Boston was the critical role that adherence counseling must play in any future efforts to develop and implement PrEP programs for MSM.

The U.S. Public Health Service is currently at work on guidelines for PrEP use among MSM. In the meantime, CDC has released interim guidance, as well as a fact sheet on Pre-Exposure Prophylaxis for HIV Prevention (PDF). But, as our meeting in Boston highlighted, there are many critical questions that must be answered before we can move this important prevention research finding from the pages of a scientific journal and into the day-to-day lives of MSM who are at high, ongoing risk for HIV infection. Several of the major questions raised by participants were:

  • Among the diverse communities of MSM in the U.S., what subset of men would be the most appropriate candidates for this new prevention tool?
  • Given the disproportionate burden of HIV infection among MSM of color—many of whom also live at or near the poverty level—how will daily drug treatments be financed?
  • In the real world of competing needs and resource constraints, how should PrEP programs for MSM be combined with other prevention approaches for MSM to result in the greatest pay-off in terms of decreasing new HIV infections?
  • How do we build the needed capacity among medical providers, health departments, and community-based organizations so that PrEP can be implemented as part of a comprehensive package of HIV prevention services for MSM at risk for HIV?
  • Could PrEP serve as a “gateway” into other equally effective—and perhaps less costly—prevention approaches for MSM?

While everyone at the Boston meeting recognized the promise of this new tool, there was a general consensus that PrEP is not a “magic bullet” and that it should not be viewed as the sole approach to reducing new HIV infections among MSM.

Moving forward with discussions about how to implement PrEP as a new prevention strategy for MSM, let’s keep in mind the necessity of supporting combined biomedical, behavioral, and structural approaches—all of which are called for in the National HIV/AIDS Strategy. Given the ongoing burden of new HIV infections among MSM communities in the United States, we are obliged to carefully examine our current approaches and, when called for, make changes in where and how we deliver our HIV prevention services.

February 24, 2011

2

The National HIV/AIDS Strategy: Grounded in the Best Science

By Ronald Valdiserri, M.D., M.P.H, Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

CAPTION

Dr. Ronald Valdiserri

The President has committed the Federal government to implementing a National HIV/AIDS Strategy (NHAS) that is “grounded in the best science.” Scientific research efforts have greatly expanded our understanding of HIV/AIDS and produced a large number of critical tools and interventions to help us diagnose, prevent, and treat HIV. The past year has been particularly productive with impressive scientific advances in microbicides and pre-exposure prophylaxis (PrEP), among others.

But our knowledge of this deadly disease remains incomplete and both a cure and a vaccine are, for the time being, elusive. Simply stated, we cannot achieve the vision of the NHAS without continued and sustained progress in biomedical, behavioral, and social science. Reducing new infections will require additional research to identify and evaluate new prevention strategies as well as population-specific information on the most effective combination of approaches to prevent new HIV infections. Improving health outcomes for people living with HIV/AIDS requires continued investments in research to develop safer, cheaper, and more effective treatments as well as ongoing research to find a cure. Additional research is also needed to better understand, prevent, and treat co-infections, co-occurring conditions, and complications of HIV disease. Nor can we afford to neglect the policy, operational and social questions that often arise as a result of new research findings—these, too, require thoughtful inquiry and study.

To learn more about rapidly evolving HIV/AIDS research, I will be attending —along with a number of other Federal colleagues—the 18th Conference on Retroviruses and Opportunistic Infections (CROI Exit Disclaimer) in Boston, Massachusetts beginning Sunday, February 27. The conference provides a critically important global forum for basic scientists, clinicians, and global health researchers to present, discuss, and critique their investigations into the epidemiology and biology of human retroviruses and the diseases they produce with the ultimate goal of translating laboratory and clinical research into progress against the AIDS epidemic—at home and abroad. At the CROI a diverse community of some 4,000 scientific experts, providers, and community leaders will interact with one another and share information and perspectives about recent scientific and technical advances in HIV/AIDS.

I hope you will have an opportunity to read this blog next week, as I look forward to sharing important information with you from the conference. In addition, CROI will be making all conference sessions available as webcasts and podcast on the CROI website Exit Disclaimer approximately 8 hours after the conclusion of each session. See the CROI pocket program Exit Disclaimer for a complete listing of the plenaries, symposia, scientific overviews, oral abstract sessions and themed discussions.

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