6th IAS Conference On HIV Pathogenesis, Treatment and Prevention

Use of Antivirals in Prevention: Current Challenges and Controversies TUBS02

Bridging Session Back
Venue: SR 1
Time: 16:30 - 18:00, 19.07.2011
Code: TUBS02
Chairs: Chris Beyrer, United States
Glaudina Loots, South Africa

Use of antivirals in prevention brings together disciplines and speakers from Tracks A, B, C and D. The concept is to look at the "big picture" questions of the potential use of antiviral drugs, including for oral and topical (vaginal and rectal) chemoprophylaxis, HAART's role(s) in prevention, use of post-exposure prophylaxis, and the synergies and challenges in implementation science and challenges to scale up of ARV-based prevention approaches. Speakers will be asked to address controversies, challenges including ARV resistance, adherence, cost-effectiveness, and programmatic challenges to these potential approaches.

Presentations in this session:


Slides with audio
Treatment as prevention
Presented by Nancy Padian, United States

Slides with audio
Oral and topical prophylaxis
Presented by Ian McGowan, United States

Slides with audio
Community and advocacy perspectives on ARV for prevention
Presented by Mitchell Warren, United States

Regulatory and ethical issues for ARV-based prevention
Presented by Tim Farley, Switzerland

Moderated discussion
Tim Farley, Switzerland
David Haerry, Belgium
Ian McGowan, United States
Nancy Padian, United States
Mitchell Warren, United States


Powerpoints presentations
Treatment as prevention - Nancy Padian

Oral and topical prophylaxis - Ian McGowan

Community and advocacy perspectives on ARV for prevention - Mitchell Warren
Community and advocacy perspectives on ARV for prevention - Mitchell Warren

Rapporteur report

Track C report by Adaora A. Adimora

Nancy Padian focused on implementation science issues related to use of ART for prevention.  Use of ART for prevention will require increased human resources, structural resources, and commodities, such as test kits and drugs. Substantial increases in HIV testing will be required. There is a particular need for an acute infection incidence assay, given the marked risk of transmission during this phase of infection. Adherence remains a major challenge. Innovative strategies are needed for monitoring adherence in real time. Products are needed that require lower adherence (rings, implants, patches) and are better tolerated. We will need to resolve how distribution of ART is prioritized. Ensuring equity will be a challenge, as treatment is not yet available to all who need it. 
Ian McGowan reviewed oral and topical antiretroviral prophylaxis. One benefit of topical antiretroviral administration is attainment of high drug levels at the site of administration. Several animal studies have demonstrated proof of concept of the potential efficacy of rectal microbicides’ potential efficacy in preventing HIV infection. Phase 1 studies in human are underway. Studies are also currently evaluating viral resistance, differences between oral and topical PrEP in safety and efficacy, and use of topical PrEP during adolescence and pregnancy. Use of ART for PrEP involves several challenges: increasing adherence, obtaining licensure for tenofovir 1% gel, bridging between the end of PrEP effectiveness trials and community availability of PrEP agents, and reducing the cost of delivering PrEP. Future research priorities include development of rectal microbicides, evaluation of extended release PrEP agents, combination HIV prevention strategies, and implementation of research findings. 
Mitchell Warren discussed the future of treatment and prevention. He stressed the need for prevention that combines all available intervention modes: behavioral interventions, HIV counseling and testing, male and female condom use, STI treatment, male circumcision, effective topical microbicides, treatment for prevention, positive behavioral prevention, pre-exposure prophylaxis, post-exposure prophylaxis, and vaccines and presented a time line for rolling out interventions available, noting that scientific data do not change the world – programs and policies backed by civil society, donors, implementer, and governments do. 
Tim Farley discussed regulatory issues related to licensing of ART for new indications. Discussions concerning regulatory approval for new indications are underway between US and European drug regulating agencies and pharmaceutical companies that hold marketing authorization, patents, and/or licenses for oral and topical antiretrovirals with demonstrated efficacy in preventing HIV infection. The daily cost of Viread in the US is about $23, the price for low/middle income countries is $1.00, compared to $0.21 for the generic drug (tenofovir). This price differential is reportedly required for intellectual property return on investment and incentive for innovation. An audience member, noting the substantial proportions of HIV-infected adults in the US who cannot afford ART, expressed concerns about the high cost of drugs in that country.  He asked how the pharmaceutical company had managed not to recoup its investments already, given the huge number of patients in the US who had been treated with Viread and Truvada. 


    The organizers reserve the right to amend the programme.

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