This year, the annual Conference on Retroviruses and Opportunistic Infections (CROI) was held in a virtual format due to the COVID-19 coronavirus outbreak. For the first in our video coverage series for 2020’s meeting, we’re revisiting a feature from 10 years ago on the future of HIV research, which is not so different from the most pressing research issues today.
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MedPage Today: Treatment as prevention has become a cornerstone of trying to end the HIV epidemic, with “U equals U” (undetectable equals untransmittable), where research has now proven virally suppressed people do not transmit the virus to their partners.
Fauci: But the real underscoring that I did in the talk was to talk about prevention. There are a couple of ways that we’ve got to get prevention and that is really the answer. We can’t, even though we have good treatment that’s not in a vacuum alone going to do it. So the three ways that I spoke about treatment as prevention were microbicides. First of all, we failed in the microbicide trials because microbicides have not worked because they weren’t antiretrovirals in the microbicide. They were more of a detergent. A big trial just recently failed just a few months ago.
Prevention and early PrEP research
Fauci: So the next trials that are ongoing are trials that use a microbicide like a vaginal gel, but incorporate into that a long acting antiretroviral. So we’re looking forward to the results of those trials. Secondly is what’s called prep or preexposure prophylaxis. We know it works with other diseases like malaria, number one. Number two, we know postexposure prophylaxis works and we know that mother to child transmission prevention works. We’re doing a number of clinical trials to test the concept of whether we can actually prevent infection by preemptively treating people who are practicing high risk behavior.