myron s. cohen, md associate vice chancellor director, institute for global health the university of...
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Myron S. Cohen, MDAssociate Vice Chancellor
Director, Institute for Global Health The University of North Carolina
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Essential New Technologies• HIV Incidence
-An algorithm (HPTN 043)
-CDC• -IgG3• Point of Care Viral Load
-Alere
-Others
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Four HIV Prevention Opportunities
YEARS
Treatment Of HIVReduced Infectivity
INFECTED
YEARS
UNEXPOSED
Behavioral,Structural
Circumcision
CondomsSTIs
Cohen et al, JCI, 2008Cohen IAS 2008
HOURS
VaccinesART PrEP
Microbicides
EXPOSED (precoital/coital)
72h
VaccinesART PEP
EXPOSED (postcoital)
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HPTN 052: What’s Next
The HPTN 052 Cohort July 2012
1682/1763 index cases (96% retention)
1502 discordant couples (85% retention)
DURABILITY OF PREVENTION? DELAYED CLINICAL EVENTS?
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The “Test and Treat” MovementGranich et al. Current Opinion in HIV, 2011
More than 50 studies described!!• US HPTN 065 Linkage in NYC, DC• ANRS/Africa Center-South Africa• THE PEPFAR Combination Prevention Trials:
– CDC- BOTSWANA– NIH HPTN 071 -South Africa, Zambia – USAID JHU-Tanzania
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HPTN 071 Intervention Package Community HIV Care Providers (CHiPs team):
• Counselling, condom provision, syndromic STI Rx• Referral of pregnant women for ANC/PMTCT services• Universal voluntary HIV testing house-to-house • HIV-uninfected men offered circumcision • HIV-infected persons
− Arm A: Immediate ART (analogous to HPTN 052)− Arm B: “Enhanced” Standard of Care (CD4<350)− Arm C: Standard of Care (CD4<350)
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10-5
10-4
10-3
10-2
10-1
0
101
102
103
104
105
106
107
108
Transmission
Vir
us
Conce
ntr
ati
on in E
xtr
ace
llula
r Fl
uid
or
Pla
sma (
Copie
s/m
l)
Time Post Exposure (days)
0 5 10 15 20 30 3525 40 45 50 55 60 65 70
Reservoir
Virus
di
ssem
inat
ion
Transit
eclipse?
T0
Acute Phase ReactantsDays -5 to-7
Immune ComplexesDay 9
Onset cytokinesapoptosis, Day 7 Free Antibody, Day 13
CD8 T CellResponses
CTL Escape
AutologousNeutralizing Antibody
AutologousNeutralizing
Antibody Escape
Acute HIV-1 Infection: A Challenge Cohen et al, NEJM, 2011
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The Next PrEP/Microbicides
• Do the results increase adherence: iPREX OLE?• Can Truvada schedule change (HPTN 066,067)• Can Maraviroc be used as PrEP (HPTN 069)• Other oral agents? • Other topical agents• The Ring• Can injectable agents be developed as PrEP
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Can We Cure AIDS?
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To be published 26 July 2012Available on-line 1 PM 25 July 2012