Fighting AIDS: Despite years of prevention, the issue still raises "concern"
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Fighting AIDS: Despite years of prevention, the issue still raises “concern”

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In recent years, scientific research on HIV treatments has made significant progress, improving patients’ lives. But the number of infections is still high, and an effective vaccine has not yet emerged. An update with Gilles Pialoux, Vice President of the French Society Against AIDS (SFLS).

1Verse December marks World AIDS Day, a disease caused by HIV, which affects more than 38 million people worldwide. And the United Nations warned, in a report published on Tuesday, of an exacerbation of pollution with the discovery of 1.5 million new infections in 2021 and 650,000 deaths.

Despite significant advances in treatment, which is now possible by injection, access to care remains extremely unequal worldwide and there is still no vaccine against AIDS. Since the COVID-19 pandemic, a new clinical trial based on messenger RNA has been launched, to see if this technology can also protect against HIV.

Gilles Pialoux, Head of the Department of Infectious Diseases at Tenon Hospital (AP-HP) and Vice President of the French Society Against AIDS (SFLS), answers questions from France 24.

FRANCE 24: The Human Immunodeficiency Virus (HIV) was discovered in 1983. How do we explain this with nearly 40 Years later, despite advances in technology, pollution numbers are still high ?

Jill Bialux: Since the discovery of the virus, science has advanced greatly and today we benefit from highly effective treatments. TasP (Prophylaxis) allows people living with HIV to live a normal life and prevents transmission of the virus, even in relationships without condoms. This treatment also allows a pregnant woman to avoid transmitting the virus to the baby.

For people without HIV, pre-exposure prophylaxis (PrEP) is a very effective preventive treatment that helps protect against infection. However, these treatments are still very little used. In France, only 28% of men who have sex with men use PrEP even though they account for 43% of new infections. In women, who account for 32% of infections, that number drops to 4%. So the real problem of awareness about this disease continues. We must use more means to publicize advances in the fight against HIV.

There is also a problem with sorting. While disparities in access to testing still exist across the world, Covid-19 has caused a major setback. This health crisis has affected all countries, including those that have been little affected by the coronavirus, in Africa in particular. This decline in screening is due to confinement and a general sense of fear, but also to logistical issues, such as reagent shortages, that have affected laboratories. We conducted 950,000 fewer tests in France alone in 2020, a decrease of 13%. In 2021 we have increased our testing by 8% but we are not yet able to return to the level of 2019. HIV testing is now possible without a prescription in France, which is excellent news. But here again, this action must be accompanied by effective information campaigns.

Several clinical trials have been launched recently – including Moderna’s trial that uses RNA technology, which is effective against Covid-19 – to develop a vaccine against HIV. Where are these studies and do they have a chance of success? ?

While it is true that Covid-19 has in many ways harmed the fight against HIV, it must be recognized that at the research level, the pandemic has instilled a new enthusiasm. The American laboratory Moderna has launched Phase I trials to assess the immune response and side effects of a vaccine based on RNA technology, taking into account the specifics of HIV. In France, the Vaccine Research Institute (VRI) has also launched a new innovative clinical trial.

This virus poses a great difficulty because it mutates tremendously, in infected persons but also during transmission as well as depending on the environment and regions. Several clinical trials have already been conducted to obtain a vaccine, but they have not exceeded 31% efficacy, which is insufficient. If we can get to 50 or 60%, that would be really huge progress. The advantage of RNA is that this technology is easier to build and thus saves time. Scientists have developed a consensus model, with one injection to prime the immune response and then the second to boost it. However, it is necessary to temper the enthusiasm because we are still in the beginning. The third phase, which must confirm the vaccine’s efficacy before marketing, alone will take between three and four years. [La phase 2 n’a pas encore été lancée, NDLR.]

Only one Phase 3 HIV vaccine clinical trial is underway. This is the Mosaico project, which should report its conclusions at the end of 2023.

Much work is also being done to enhance and improve the intake of therapies. Could you explain these developments and the importance of this approach? ?

This work aims to respond to a strong demand for relief from patients because treatment against HIV is a long-term treatment, which generates fatigue but must be fully respected because the virus becomes more resistant in case of forgetfulness.

We have been able to relieve our trichiasis, which can now be taken four days a week instead of every day. For just over a year, two antivirals can now be given by injection, once every two months. This treatment remains in the minority because it is still unknown and requires the use of a nurse. But it has the advantage of allowing greater latitude towards the family and professional environment, and avoiding the “reminder effect” of taking medication, which is complicated to live with on a day-to-day basis. Other improvements are under way to develop a monthly or even semi-annual pill or even develop a subcutaneous implant, which dispenses the product for a year, over the model already used for contraception.

>> Read also: Injections instead of daily tablets are a “revolution” for some patients

In addition to the practical aspect, these developments aim to make life easier for patients, in the context of strong differentiation. This is the case in France, where certain jobs such as those of a policeman or gendarme remain off-limits to people living with HIV, where it is sometimes difficult to obtain insurance and thus access to property and sometimes even to get appointments. Despite all these years of awareness raising, the topic of HIV remains a taboo in the community and fuels fears. Even within the medical profession, there is still a sense of malaise over this difficult and intimate subject. Too many specialists prefer to avoid it and don’t encourage enough screening, causing their patients to miss out on opportunity.

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