Posted by: davidjolson | 07/20/2011

A remarkable day in HIV prevention research

This is a guest blog by Lisa Chensvold of the University of North Carolina Institute for Global Health & Infectious Diseases and was co-published on their blog.

ROME  — For the past two months, things have been pretty crazy around our institute. On May 12, we announced the results of a couples’ HIV prevention study well before the study was finished, because the results were so compelling. The study, HPTN (HIV Prevention Trials Network) 052, found that giving antiretrovirals early to people infected with HIV led to a 96% reduction in transmission to their HIV-negative partners. The story was covered around the world, and I’ve been busy fielding calls and emails from journalists ever since.

Meanwhile, the study team has also been busy – let’s face it, busier than I by orders of magnitude – analyzing and preparing the preliminary data to present to the scientific community in two forms: in an article in the New England Journal of Medicine and here in Rome at a special session of the 6th IAS Conference on HIV Pathogenesis, Treatment, and Prevention, the world’s largest open scientific conference on HIV/AIDS.

Yesterday afternoon I was standing with Irving Hoffman, a UNC professor and a member of the 052 team, and Ward Cates, head of research at FHI 360 and one of our close collaborators, outside the conference venue. They were chatting about the HPTN 052 session later that day, and Irving remarked on how nice it is to be at IAS this year, with all the good news. “It’s so much better than two years ago,” he said. “That year was bleak. . .nothing was working.”

The mood in the room for yesterday’s session was anything but bleak. In fact, I would describe it as jubilant (a good Latin word for our Rome meeting). And the hall was packed. I sat close to the front, just behind a section filled with HPTN study team members and UNC faculty members, not to mention Anthony Fauci, head of NIAID, which funded the study.

We heard four excellent presentations on different aspects of HPTN 052: principal investigator Mike Cohen on the study design and population, Sue Eshelman on the genetic analysis of the linked transmissions (the cases where we know HIV was transmitted from the partner co-enrolled in the study, and not from a partner outside the relationship), Mina Hosseinipour on disease progression and geographic differences (the study was conducted in nine countries), and Beatriz Grinsztejn on clinical outcomes, during which we learned that early treatment not only prevented transmission, but also led to a 40% lower risk of clinical events (illness).

At the close of the presentations, the woman sitting immediately to my right, who had been furiously taking notes throughout the talks, was the first one on her feet in the standing ovation. The room erupted in applause, cheers, and whistles. After a while, the entire session panel joined the audience and stood to acknowledge Mike Cohen and his leadership.

I watched the people in front of me, the ones who have worked so hard on the study and subsequent article. They were wearing impossibly large grins, hugging, and snapping photos. I’m pretty sure I saw some tears, too. To those who believe the stereotype that scientists are overly rational and detached: you might want to rethink that one.

This day was the culmination of years of planning and work, and the team had every reason to savor it. Nor am I surprised by the depth of feeling expressed. Yes, the investigators wanted to prove a concept – that treatment is also an effective prevention strategy – but they also wanted to actually prevent people from getting sick and help couples have meaningful relationships in the face of HIV.

As Dr. Cohen said at the end of his remarks, none of this would have been possible without the participation – and trust – of more than 1,700 couples around the world for whom HIV is not a concept, but a reality.

Yesterday was a good day.

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