Science and research

Around 10 million people living with HIV are still not on antiretroviral therapy

GENEVA, 7 February 2022—Newly published research from the Netherlands has revealed the existence of a more transmissible and damaging variant of HIV. People living with the newly revealed HIV subtype experience double the rate of immune system decline (CD4 count), have higher HIV viral loads (amount of virus in the blood) and are vulnerable to developing AIDS two to three times faster after diagnosis than if they were living with other strains of the virus. The study, led by researchers from the University of Oxford’s Big Data Institute, was the first to discover this highly virulent variant of the subtype-B of HIV. The study also revealed that the variant has been circulating in the Netherlands for years and remains receptive to HIV treatment.

The HIV pandemic continues to take a life every minute and scientists have long worried about the evolution of new, more transmissible, variants of HIV. This newly identified variant does not represent a major public health threat but underscores the urgency of speeding up efforts to halt the HIV pandemic.

“Ten million people living with HIV worldwide are not yet on treatment, fuelling the continued spread of the virus and potential for further variants,” said Eamonn Murphy, UNAIDS Deputy Executive Director, Programme, a.i. “We urgently need to deploy cutting-edge medical innovations in ways that reach the communities most in need. Whether it’s HIV treatment or COVID-19 vaccines, inequalities in access are perpetuating pandemics in ways that harm us all.”

HIV remains the deadliest pandemic of our time—an estimated 79 million people have become infected with the virus, for which there is still no vaccine and no cure. Some 36 million people have died from AIDS-related illnesses since the start of the pandemic and 1.5 million people were newly infected with HIV in 2020. Of the 38 million people living with HIV today, 28 million are on life-saving antiretroviral therapy, keeping them alive and well and preventing transmission of the virus.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

GENEVA, 24 November 2021—UNAIDS welcomes the first licensing agreement under the World Health Organization (WHO) COVID-19 Technology Access Pool (C-TAP) initiative, negotiated between Consejo Superior de Investigaciones Científicas (Spain’s High Council of Scientific Research) and the Medicines Patent Pool.

The C-TAP initiative builds on a successful model to increase access to HIV, tuberculosis and hepatitis C products in low- and middle-income countries and has proved to be effective in overcoming some barriers to access to health technologies for COVID-19. However, the initiative has so far been underutilized, and pharmaceutical companies and other holders of COVID-19 technologies have been reluctant to join C-TAP.

“I welcome this new agreement, but urge other pharmaceutical companies and COVID-19 technology-holders to share their know-how,” said Winnie Byanyima, Executive Director of UNAIDS. “Think of how many lives could be saved if COVID-19 vaccines, medicines and other technologies were available through this mechanism to everyone who needs them.”

The new licensing agreement shows that it is possible to share knowledge, technology and intellectual property rights in the fight against COVID-19.

The sharing of intellectual property rights, data and know-how should be a fundamental component of pandemic preparedness and response. UNAIDS encourages research institutes and holders of life-saving technologies, including vaccine manufacturers, to follow suit and join C-TAP and urges the governments of countries that host pharmaceutical companies to ensure that their technologies are offered to C-TAP as a matter of urgency.

The agreement contains key access provisions, such as the non-exclusive right to develop the licensed patents, know-how and material. There is no geographical limitation, so qualified companies worldwide will be able to develop the licences and commercialize the products derived from them. The terms of the agreement will be publicly available, ensuring transparency. The agreement includes a technology transfer package.

The agreement covers the licensing of a technology to detect antibodies to SARS-CoV-2, the virus that causes COVID-19, from either COVID-19 infection or a vaccine, and will allow the measurement of the effectiveness of vaccination programmes and help in the management of vaccination booster programmes. The tests derived from the technology are simple to use, which will allow their application in resource-limited settings, and companies based in low- and middle-income countries will not have to pay royalties for the technology’s use.

UNAIDS was a supporter of a call for action in May 2020, led by the Government of Costa Rica and WHO, which led to the setting up of C-TAP. UNAIDS is a member of the C-TAP Steering Committee.

UNAIDS thanks the Government of Spain for backing and facilitating the agreement and for its financial support of C-TAP.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The participants of the International AIDS Society (IAS) Conference on HIV Science session on an HIV vaccine were welcomed by Lucy Stackpool-Moore, Director, HIV Programmes and Advocacy at the International AIDS Society, after which Susan Buchbinder, from the University of California, San Francisco, and the San Francisco Department of Public Health, made introductory remarks. Two recorded presentations were then shown, by Kevin De Cock and Gabriela Gomez, speaking, respectively, on the need for and role of an HIV vaccine and on modelling science around the requirements and impact of a putative vaccine.

UNAIDS’ Science Adviser, Peter Godfrey-Faussett, then moderated a lively panel discussion that included Yazdan Yazdanpanah, Kundai Chinyenze, Rachel Baggaley, Daisy Ouya, Jerome Singh and Paul Stoffels.

The first question was on whether a vaccine for HIV, if it arrived, would be too late in view of the other HIV prevention modalities available. The consensus was that a vaccine is still needed, especially in low- and middle-income countries and for key populations. The participants then discussed how good a vaccine would need to be. Relevant issues include efficacy and durability, but a priority is proof of concept of activity. The participants acknowledged that initial inconvenient dosing schedules are justified if it can be shown that a product is protective. Minimum efficacy probably needs to be in the region of 50–60% for products to be taken forward. 

The discussion also covered engagement by big pharma—Johnson & Johnson is currently the major company pursuing HIV vaccine research, in conjunction with diverse governmental, nongovernmental and clinical partners. It was emphasized that people and individual motivations drive the science, both for HIV prevention and treatment. 

Inevitably, the comparison of vaccine development for COVID-19 and HIV came up. The panellists emphasized, however, that the reasons for a lack of success so far in HIV was largely related to the complex nature of HIV itself.

The discussion ended on a note of realistic optimism, with acknowledgment of the benefits of scientific investment in HIV vaccine research to date, including for COVID-19, but with recognition that long-term commitment is still required. The results of the two ongoing phase three trials (Imbokodo and Mosaico) are eagerly awaited.

The International AIDS Society (IAS) Conference on HIV Science opened on 18 July. The participants were welcomed by Adeeba Kamarulzaman, the Chair of the IAS, and Hendrik Streeck, the local Chair of the conference, who held up UNAIDS as an example of the multisectoral approach that was needed for the response to COVID-19. The opening address was delivered by Angela Merkel, the Chancellor of Germany, which was followed by a panel discussion.  

The panel’s speakers drew parallels between the need for global solidarity for COVID-19, especially with regard to access to vaccines, and for HIV, recognizing that both viruses spread regardless of borders and need a global response. They also spoke about the imperative to not let the HIV response be slowed because of the COVID-19 pandemic. Repeated emphasis was made on the bi-directionality of COVID-19 and HIV investments, reminding the audience of the importance of investment in HIV science for developments in COVID-19.

Jens Spahn, Germany’s Federal Minister of Health, accepted that the global response to COVID-19 has been slow but stressed that political decisions had been made to increase global vaccine access, and supply would increase briskly in the coming months. Yvette Raphael, a South African activist living with HIV, recounted her struggle to fight stigma and discrimination relating to HIV, gender and race/ethnicity. She reminded the audience that scientific data relate to real people with human relationships. 

Soumya Swaminathan, the Chief Scientist at the World Health Organization, reflected on the priorities of primary health care and universal health coverage. Perhaps the most frequent and strongly felt sentiments concerned the need to combat misinformation and disregard for science. “Follow the science” was a phrase that resonated over the course of the rich discussion.

A side event at the United Nations High-Level Meeting on AIDS, being held in New York and online from 8 to 10 June, has highlighted the science relevant to the new UNAIDS global strategy and targets and the changing scientific environment that will take the world to 2030, the Sustainable Development Goal target date for ending AIDS.

At the event, Science, HIV and COVID-19—Where are we Headed?, Jon Cohen, a leading science journalist, moderated a panel discussion that included Anthony Fauci, the Chief Medical Adviser to the President of the United States of America, Loyce Maturu, an activist working for Zvandiri in Zimbabwe, Soumya Swaminathan, the Chief Scientist at the World Health Organization, and other leading HIV scientists.

In the complexity and multidimensional nature of the global AIDS response, science has been a constant force, moulding and adapting how the world reacted. A similar role for science has been seen in the other ongoing pandemic—COVID-19. The side event was an opportunity to discuss the role of science and to review major and emerging scientific themes that will influence the trajectory of the HIV pandemic in the approach to 2030.

Mr Fauci emphasized the importance of long-term engagement and investment in surveillance and basic sciences to increase preparedness for future pandemics, noting that we must focus on building trust in science and explaining how knowledge evolves through the accumulation of reliable data that can alter clinical and public health guidance. The COVID-19 pandemic has taught us lessons in efficiency and in accelerating the translation of basic science into effective interventions, he said. However, we must address the challenges of access, intervention pricing and social biases that limit our global impact. He concluded that both the HIV pandemic and the COVID-19 pandemic have the power to strengthen the global community, and he committed the United States to being a global leader and reliable partner in those efforts.

Greg Millett celebrated the amazing fall in new HIV infections in several places, such as London, Denmark and Australia, where pre-exposure prophylaxis (PrEP) and effective testing and treatment is really working for gay men and other men who have sex with men.  He highlighted the importance of recent scientific advances that have led to new technologies, such as HIV self-tests and new PrEP modalities.

A major theme was around equity. For both COVID-19 and HIV, the participants noted that we must ensure that all people in all countries reap the benefits of science. Commentators in the audience reiterated that this is even more important given the participation of so many people across so many countries as the altruistic participants in the research that has led to the exciting new tools for HIV prevention and vaccines for COVID-19. And Mr Millet pointed out that we are all interrelated and interconnected. HIV infections and other diseases are, of course, in no way limited to national boundaries.

Loyce Maturu reminded everyone that young people are central to the HIV response. Young people are often left behind and treated as end users of services that are not specifically designed to suit their lifestyles. She acknowledged that science was the reason that she was with us, healthy, beautiful and empowered after falling sick with HIV-related illnesses as a child and witnessing the death of both her mother and brother from HIV. Young people need to be central to science and brought to the tables that set the research priorities.

Quarraisha Abdool Karim, and others, exhorted political leaders not to “drop the ball” for HIV. We need to finish the job and not allow the huge challenges of dealing with it deflect us.

All the participants pushed for HIV programmes to be based firmly on scientific evidence, and Wafaa El Sadr noted that the evidence base comes not only from biomedical laboratories and large clinical trials, but also from implementation and the social sciences. The Co-Chairs of the upcoming International AIDS Society Science Conference, in July 2021, Adeeba Kamarulzaman and Hendrik Streeck, hoped that the high-level meeting would be a boost for stronger engagement with science—registrations for the conference are as high as ever, despite the COVID-19 restrictions. Mr Streeck called for a massive effort to bring thousands of HIV vaccine scientists together in one huge effort, similar to the collaboration around the Large Hadron Collider or even the Manhattan Project.

In an optimistic conclusion, Ms Swaminathan hoped that the proven success of the scientific collaboration that has produced multiple COVID-19 vaccines so quickly should be a stimulus for greater enthusiasm and investment in collaborations to end not just AIDS but also other major public health challenges, such as tuberculosis, malaria and noncommunicable diseases.