Exploring the key topics ahead of CROI 2020

Dr Ben Young, Head, Global Medical Directors, ViiV Healthcare

Over the years, the Conference on Retroviruses and Opportunistic Infections (CROI) has provided the stage for some of the most momentous announcements and advancements in HIV science.

CROI 2020 - which kicks off on 8 March in Boston, USA - promises to be no different.

In several of my recent meetings with physicians around the globe, I’ve been asked my views, on what I feel, are some of the key topics in HIV science at present and likely to secure significant share of mind during the conference. 

So, I thought I’d share my responses…

Adjusting expectations to ensure people are living well with HIV.

As a physician who has been treating patients for more than 25 years, I must remind myself of the quite staggering advances made within HIV science over our lifetime. 

From the AIDS hysteria of the early 80’s to a now-manageable, chronic condition; HIV has changed almost beyond recognition. 

For many, the reality of living with HIV has been transformed by the tireless commitment to scientific innovation. But, in line with that change, so should our aspirations as healthcare professionals.

As a community, it’s imperative that we adjust our expectations and ask ourselves “how can I help my patients not just survive, but thrive with HIV?

Looking ahead to another exciting scientific programme, it’s inspiring to now see the growing consideration for living and ageing well with HIV.  

We must continue to look beyond viral suppression to the new horizon and standard for care that is quality of life for people living with HIV (PLHIV) and optimised treatment regimens that fit a long life with HIV.V.

Leaving no person living with HIV behind: exploring sub-populations through real-world evidence.

HIV is far from a one-size-fits-all. Not only does the clinical impact of the virus differ from patient to patient, so too does the associated stigma. This enduring stigma will often have a sizeable impact on the adherence and subsequent outcomes for a PLHIV.

 It’s imperative that the scientific community continue to understand the differing clinical outcomes across patient cohorts through real world evidence and implementation science. I’m particularly interested in the ongoing discussions about what makes an epidemic recede.

Immediately ahead of the main conference in Boston, several colleagues will be attending the HIV in women workshop to help deepen our understanding and close the gender gap in HIV research which hampers our understanding of a community which makes up over half of people living with HIV worldwide. 

The two-day workshop will cover a range of topics from pregnancy and mother-to-child transmission (also referred to as vertical transmission) of HIV, to comorbidities, to psychosocial issues and well-being.

HIV cure: the end goal.

CROI 2019 played host to the fascinating and inspiring story of the London Patient – a case where, through stem cell transplant, a person previously living with HIV later reported no trace of HIV in their system – despite many months without taking antiretrovirals.1

Although it is worth noting that this data is very new and needs further research, it is a reminder that this virus can be beaten. 

Indeed, two very recent publications on reversal of HIV and SIV latency 2,3,4, the so-called “kick and kill” strategy, supported in part by ViiV at the Collaboratory of AIDS Researchers for Eradication at the University of North Carolina Chapel Hill, give us cause for renewed optimism.  In this light, sessions on novel cure interventions will be of interest.

Make no mistake, a cure for HIV remains the end goal. Until that day, we as a physician community must remain endlessly curious and guard each other against complacency in the fight to end HIV and AIDS once and for all.

References:
  1. https://www.bmj.com/content/364/bmj.l1019
  2. CC Nixon, M Mavigner et al. Systemic HIV and SIV latency reversal via non-canonical NF-κB signalling in vivo. Nature DOI: 10.1038/s41586-020-1951-3 (2020).
  3. JB McBrien et al. Robust and persistent reactivation of SIV and HIV by N-803 and depletion of CD8+ cells. Nature DOI: 10.1038/s41586-020-1946-0 (2020).
  4. NIH-supported scientists reverse HIV and SIV latency in two animal models. February 2020.