Breakthroughs Blog: HIV/AIDS

In this guest post, Anupama Dathan—health research assistant for ONE—writes about a new report that examines global commitments to ending the AIDS pandemic. With world leaders calling for ambitious goals like an AIDS-free generation and achieving the beginning of the end of AIDS, ONE and many of its partners in the scientific and advocacy communities have been working to define this vision. Also known as the AIDS tipping point, the beginning of the end of AIDS occurs when the number of people newly added to treatment in any given year is equal to or exceeds the number of people newly infected with HIV. To track global progress towards this point, ONE recently released a new report, called The Beginning of the End? Tracking Global Commitments on AIDS. This new report is the second in a series of annual AIDS accountability reports. The good news in the report is that the world is making steady progress. 1.6 million people around the world received AIDS treatment for the first time in 2012, compared with 2.3 million people who were newly infected. At first glance, this is a vast improvement from just a decade ago, when the epidemic was raging out of control, as more than 3 million people were newly infected per year and almost no one was added to treatment. A new report from ONE finds that funding needs to be scaled up appropriately to support research on new, diverse HIV and AIDS interventions. Credit: PATH And though it is a vast improvement, a closer look also reveals it is very one-sided. Despite a reduction in the number of new HIV infections, most of the progress stems from an annual accelerations in the number of people newly accessing treatment each year. Truly ending the AIDS epidemic will be next to impossible without also dramatically reducing new HIV infections, a feat that requires renewed attention to HIV prevention measures. This is why ONE is calling for increased funding and support for HIV research and development (R&D). AIDS treatment mechanisms, such as antiretroviral drugs (ARVs), came into existence thanks to focused, well-funded research. This same focus must now be paid to HIV prevention. Unfortunately, we are headed in the opposite direction. Instead of well-funded research, we’re seeing a steady decline in HIV R&D funding, something that has hindered the development of new prevention tools that could combat HIV even more effectively. A few promising trials of tools and products are in progress, but funding needs to be scaled up appropriately to support research on new, diverse interventions. Innovations like an HIV preventive vaccine have yet to be found. Arguments can be made that the focus should be on improving access to existing prevention mechanisms—pre-exposure prophylaxis, male and female condoms, prevention of mother-to-child transmission, to name a few. While this is a valid point, existing mechanisms are only part of the solution. A recent study estimated that depending on its characteristics and level of coverage, an AIDS vaccine could reduce the number of new infections by five to 10 million between 2020 and 2030 while also saving between $46 billion to $95 billion in averted costs of ARV provision. More research is also needed to test recently discovered prevention mechanisms, including the use of treatment-as-prevention. It’s encouraging to see the progress the world is making towards the beginning of the end of AIDS, but we need to remember that treatment alone isn’t enough. More research into effective ways to prevent AIDS is urgently needed, which is why ONE calls for increased R&D funding in this latest report. Without it, the path to the end of AIDS will be longer, more expensive, and, most of all, will cost many millions more lives.

In this guest post, Emily Donaldson—program coordinator atAVAC: Global Advocacy for HIV Prevention—writes about an upcoming congressional briefing on November 18 that will highlight the latest in HIV and AIDS research and development. The world has made enormous strides in beginning to end the AIDS epidemic. Yet, there were still 2.3 million people newly infected with HIV in 2012. In order to continue to bring down new infections, it is essential to achieve high coverage rates of treatment and prevention methods, including voluntary medical male circumcision, male and female condoms, and harm reduction. In the long-term, new prevention tools, especially an effective preventive HIV vaccine, are critical for achieving maximum impact and ending the AIDS pandemic. Research to develop new prevention tools is critical for achieving maximum impact and ending the AIDS pandemic. Credit: PATH/Evelyn Hockstein. Since the Military HIV Research Program’s (MHRP) landmark RV144 trial first showed that an HIV vaccine was possible, MHRP, the National Institutes of Health (NIH), and partners have worked to build on those results. Additionally, US government-supported research in a range of new vaccine candidate strategies are moving forward in trials and in basic research for future clinical testing. At the same time, NIH and the US Agency for International Development (USAID) are developing new antiretroviral-based prevention options, such as treatment-as-prevention, pre-exposure prophylaxis, and microbicides. Through research programs like those at the MHRP, NIH, and USAID, the US can dramatically advance science and play a critical role in stopping the spread of the epidemic. Join us at a congressional briefing, Monday, November 18, as we call on Congress to invest in HIV prevention research. amfAR, The Foundation for AIDS Research AVAC: Global Advocacy for HIV Prevention Center for Global Health Policy International AIDS Vaccine Initiative In cooperation with Congresswoman Barbara Lee invite you to a Congressional Briefing The Role of HIV Research in Ending AIDS: New Developments in HIV Vaccine and Prevention Science Monday, November 18, 2013 12:00-1:30 p.m. Capitol Visitor Center, South Congressional Meeting Room Lunch will be provided Speakers include: Carl Dieffenbach, director of the National Institute of Allergy and Infectious Diseases’ Division of AIDS Margaret McGlynn, president and chief executive officer, International AIDS Vaccine Initiative Fredrick Sawe, associate director International Clinical Research, MHRP Christina Polyak, research physician, MHRP, Walter Reed Army Institute of Research Christine Lubinski, vice president for Global Health, Infectious Disease Society of America Kevin Fisher, policy director, AVAC: Global Advocacy for HIV Prevention, moderator For more information or to RSVP, please contact Emily Donaldson at AVAC at edonaldson@avac.org or 646-369-1476.

In the past, the United States has contributed to important breakthroughs in global health—from the eradication of smallpox to a 74 percent drop in measles deaths worldwide. Because of longstanding US leadership and support for global health research and development (R&D), Americans and millions around the world no longer live in fear of diseases like polio and measles, and many more are on treatment for diseases like HIV and AIDS and malaria. In fact, the US government is the largest supporter of global health R&D in the world, supporting the development and delivery of vaccines, drugs, diagnostics, microbicides, and devices. However, as we sit at a very important moment in global health product development, the political and economic environment in the United States is causing some to worry. Budget constraints have put funding at risk at many of the federal agencies involvement in global health R&D. Because of longstanding US leadership and support for global health research and development (R&D), Americans and millions around the world no longer live in fear of diseases like polio and measles, and many more are on treatment for diseases like HIV and AIDS and malaria. Photo: PATH/Evelyn Hockstein Today, the GHTC launches a new fact sheet outlining the important contributions the US government has made to global health R&D and why it’s critical the United States continues to robustly support the global health research pipeline. There are currently more global health products in the pipeline than ever before—with more than 365 new tools under development as of April 2012. Contributing to the success of many of these products is the US government’s partnerships with nonprofit product developers. These organizations partner with the public and private sectors to maximize resources and create tools for patients in low- and middle-income countries. Increased investments in global health research by the United States have the potential to increase the amount of tools combating global diseases. Just some of the products currently in the research pipeline include: The RTS,S malaria vaccine candidate, which is currently being tested and a policy recommendation for its use could be issued as early as 2015. Such a vaccine could reduce the burden of sickness and death from malaria. A new oral drug for sleeping sickness, fexinidazole, which recently entered late-stage clinical trials in patients in the Democratic Republic of the Congo. As a simple, short-course oral pill, fexinidazole could transform care for African sleeping sickness, which is fatal without treatment, and could potentially reduce its incidence among the most afflicted populations and accelerate elimination of the disease. Cost-effective diagnostics that are under development for malaria, tuberculosis, and neglected tropical diseases. These diagnostics could be administered in a variety of health care settings and could rapidly and accurately identify sick patients. An antiretroviral‐based microbicide which offers hope for women’s HIV prevention. Though more testing is needed following promising results from a 2010 advanced clinical trial, a microbicide could give women the power to protect themselves with or without their partners’ cooperation. In sub-Saharan Africa, where the epidemic has hit hardest, women 15 to 24 years old are at least twice as likely to be infected with HIV as young men.   In the research pipeline for global health products, 200 of the 365 products under development have some sort of US government support. With so much investment from the United States, there is even more at risk if funding is cut. Over the past several years, the US Congress has not been able to agree on a long-term budget for the federal government. Policymakers have allowed sequestration, or widespread automatic budget cuts, to affect all federal programs. These constraints have the potential to push back or halt promising research supported by several federal agencies involved in global health R&D—including the Centers for Disease Control and Prevention, the Department of Defense (DoD), the US Food and Drug Administration, the National Institutes of Health (NIH), and the US Agency for International Development (USAID). Due to sequestration: DoD is expected to receive budget cuts between 8 and 10 percent in fiscal year (FY) 2013. The DoD has been instrumental in the development of several global health technologies, many of which are used to protect Americans soldiers serving abroad. These cuts could affect the Walter Reed Army Institute of Research, the Naval Medical Research Center, and the Military HIV Research Program. NIH, the largest funder of global health R&D in the world, was forced to cut $1.7 billion from its budget by the end of FY 2013. NIH conducts nearly half the early-stage global health research, and supports thousands of domestic jobs all around the United States. USAID—with a presence in more than 100 countries—is best suited to support the clinical trials in low- and middle-income countries that ensure basic research is translated into appropriate health products. USAID is the largest supporter of HIV vaccine and microbicide development—both of which will be essential to achieve an AIDS-free generation. For many of the products currently in the global health research pipeline, continuous US support is essential. Without it, much of the breakthrough research that pushed these products to later-stage development will be lost—sometimes forever. US leaders should seize upon the recent successes in global health R&D and pass a long-term budget that ensures America’s legacy as a leader in innovation and science is not forgotten.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. At the annual Grand Challenges meeting in Brazil this month, the Bill & Melinda Gates Foundation announced a new partnership with pharmaceutical companies to accelerate vaccine research and development (R&D). For the first project, the Gates Foundation will partner with GlaxoSmithKline on early-stage research for vaccine thermostability. According to studies published in Nature, a potential new HIV treatment has a "profound and unprecedented" impact on the virus. The trials were performed by Harvard Medical School and the National Institute of Allergy and Infectious Diseases. GHTC member Treatment Action Group released a new report on tuberculosis (TB) research funding. The report finds that after seven years of slow and unsteady increases in funding, TB R&D investors reported a drop in spending in 2012 that threatens to undermine the tenuous gains made since 2005. The Centers of Disease Control and Prevention released a report stating that the number of malaria cases in the United States is at the highest level in forty years. Nearly all the cases were Americans or foreign travelers bringing it into the country. About two-thirds were infected in Africa, where malaria is common. A new analysis published in The Lancet Global Health found that only 37—or four percent—of the 850 drugs and vaccines registered from 2000 to 2011 were for neglected diseases. The study also found that just 1 percent of existing clinical trials are for the development of tools for neglected diseases.