Article & Photos By: Al Ballesteros & Pepe Torres
The AIDS 2024 International Conference was held in Munich, Germany July 20 to 26. It included more than 40 oral abstract sessions, 50 invited-speaker sessions, 20 workshops, 30 symposia sessions, 100 satellite sessions and 2,200 poster presentations. There was a Global AIDS Village and a vendor section with pharmaceutical companies booths. More than 11,000 attended the conference in person from countries around the world and several thousand more attended online.
The opening session was held Monday, July 22, 2024, and Co-Chairs, Sharon Lewin, Christoph Spinner and Andriy Klepikov welcomed delegates. “We’ve seen incredible breakthroughs at AIDS 2024, including a new case of long-term HIV remission and a promising twice-yearly injection to prevent HIV,” Sharon Lewin, IAS President and AIDS 2024 International Co-Chair, said. “While these advances are cause to celebrate, science doesn’t happen in a vacuum. All around the world, regressive policies, attacks on human rights, the spread of misinformation, cuts to global health funding, and waning trust in international institutions are roadblocks to progress. To end HIV as a threat to public health and individual well-being, we need an evidence-based HIV response and a political climate that respects science.”
The theme of AIDS 2024 called on the global community to Put people first! “Putting people first means that whether in the design of clinical trials or implementing new policies and programs, people living with and affected by HIV must be not just beneficiaries but actors driving our efforts,” Lewin said.
German Chancellor Olaf Scholz talked about Germany’s leadership in the HIV response. He says Germany will meet the AIDS 2030 goal of having 95% of persons living with HIV know their status. According to Germany’s Public Health Institute, at the end of 2023, Germany had 96,700 persons living with HIV and an estimated 8,200 undiagnosed. About 8% of estimated total HIV cases. This is quite good when compared to our United States data where approximately 13% of those living with HIV are not aware of their status. At the end of 2022 there were an estimated 1.2 million people in the United States aged 13 and older that had HIV, according to the CDC. Of this number, 156,000 were unaware of their status. The US goal for knowing one’s status is set at 95% by 2025, so the US is behind its own set goal.
The Global Village is a place where the world’s community of people living with HIV and the activists come together. Advocacy and awareness were the theme of the Global Village. Many of the booths and presentations were about U=U, or undetectable viral load equals untransmittable to others; sex positive workshops and group discussions about genders and gender understanding and inclusion in all our work. Some of the other interesting booths were CureCanvas featured art projects, workshops and interviews exploring topics like community involvement in HIV cure research; Send a Message in a Bottle was a networking zone where you can paint empty ARV bottles and share medication adherence stories. There was a booth that sold African artists’ paintings to support travel expenses of delegates to the International AIDS Conference from Africa.
The Silver Zone put older people living with HIV first. It hosted a wide range of activities, from intergenerational dialogues and panel discussions to art projects, workshops, film screenings and storytelling. Around the world a movement continues to acknowledge that many people living with HIV are aging. To this end, research must respond to understanding the relationship between aging and long term HIV infection.
The Global HIV / AIDS Epidemic continues to expand, unfortunately: Citing The Urgency of Now, AIDS at a Crossroads, UNAIDS Executive Director Winnie Byanyima shared that despite global targets to reduce new HIV acquisitions to below 370,000 by 2025, the number remains more than three times higher, at 1.3 million new acquisitions in 2023.
“The new data…shows that success or failure will be determined by the actions taken this year,” Byanyima said. “We are calling on leaders to take three critical steps: Resource the response; get long-acting treatment and prevention options to all low- and middle-income countries; and break down the discrimination and stigma that are pushing the most marginalized people away from health care. We know the path that ends AIDS but we have no time to wait.”
Chris Collins, President and CEO of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, spoke about the critical role of disease-specific funding programs in the current political environment. “For over 20 years, American leaders across political parties have come together, recognizing the critical need to end the AIDS epidemic. Misinformation held up the five-year reauthorization of PEPFAR this year, but bipartisan commitment to the program remains solid in the United States,” said Collins. “Lawmakers know that the Global Fund and PEPFAR are saving millions of lives and if we backtrack on our commitments on AIDS, TB and malaria, the immediate result would be disease resurgence and the squandered opportunity to end the deadliest infectious diseases.”
AIDS 2024 included a special focus on Eastern Europe and central Asia, regions with one of the fastest-growing HIV epidemics in the world. “While most other regions around the globe have managed to stabilize their HIV epidemics, in eastern Europe and central Asia, it is rapidly increasing,” Andriy Klepikov, Regional Co-Chair said. “Only half of people living in our region are on antiretroviral therapy, nowhere near the global target of 95%. At the root of the regions epidemic are drug use, stigma and harmful policies, all exacerbated by violent conflict.
HIV Prevention was a major focus. We’ve known about doxycycline post-exposure prophylaxis (DoxyPEP) for some time. Now there is doxycycline post-exposure prophylaxis (DoxyPrEP), taking the antibiotic before sex. Authors of two small studies from opposite sides of the world presented findings at the conference. One such study from Canada involving men who have sex with men, living with HIV and with a history of syphilis, showed reductions of 79% in syphilis, 92% in chlamydia and 68% in gonorrhea in those taking doxycycline compared with a placebo.
Presented were full results from the PURPOSE 1 trial of twice-yearly injectable lenacapavir for HIV prevention. The results confirm that lenacapavir demonstrated 100% efficacy for HIV prevention in cisgender women. Sharon Lewin, President of the International AIDS Society and Co-Chair and Director of the Peter Doherty Institute for Infection and Immunity at the University of Melbourne in Australia said the following: “These data confirm that twice-yearly lenacapavir for HIV prevention is a breakthrough advance with huge public health potential. If approved and delivered – rapidly, affordably, and equitably – to those who need or want it, this long-acting tool could help accelerate global progress in HIV prevention. We all owe a debt of gratitude to the thousands of young women in South Africa and Uganda who volunteered to be part of this study.
Key Take Aways:
Cure: The tone was set that this would be a groundbreaking conference for HIV cure discussions when three people known to have been cured of HIV came together in a pre-conference: Adam Castillejo (formerly known as the London Patient), Marc Franke (formerly the Düsseldorf Patient) and Paul Edmonds (formerly the City of Hope Patient) shared their stories. Their hope was to inspire researchers and people living with HIV to keep on track to find a cure that would work for everyone.
Then came details about the “next Berlin patient” who appears to be the seventh person cured of HIV: a 60-year-old adult male who had received a stem cell transplant for leukaemia in 2015, stopped taking antiretroviral treatment for HIV in 2018, and remains in HIV remission more than five years later. The details came with a twist: for the first time, the donor had a single, rather than double, CCR5-delta32 mutation, a genetic factor related to HIV resistance. This could have promising implications for more scalable HIV cure strategies based on gene therapy. The treatments which seemed to have cleared HIV from just a few individuals appear to be complicated stem cell procedures. Because of this, it seems that accessible HIV cure treatments are still far off in the future.
Long-acting technologies: A “miracle prevention tool” is how many described Gilead’s twice-yearly injectable lenacapavir for HIV prevention. Full results from the PURPOSE 1 trial confirmed that lenacapavir gave 100% protection against HIV acquisition in cisgender women.
Beyond the excitement of this game changer from science was the chanting of activists: “Shame, shame. Access for all.” Questions were raised about the pricing of lenacapavir and whether this miracle tool would be simply too expensive for use in low- and middle-income countries, such as South Africa and Uganda, where it was tested among more than 5,000 women, including pregnant women and adolescents. A study presented estimates that lenacapavir could be priced as low as $100 US dollars per person per year and even less if mass produced in a generic version under voluntary licensing. Outgoing IAS President Sharon Lewin pointed out in the closing session that “breakthroughs in medicine are only meaningful when the people who need those medicines can access them”. Cost is a major factor and reason for these medicines being kept largely out of reach in low-and middle-income countries. Access to these drugs could substantially slow down the spread of HIV across the globe and they must be made available.
Long-acting injectables offer a more discreet option to taking daily PrEP to prevent one from becoming HIV positive. These overcome challenges in accessing daily medication. Two years ago, the World Health Organization called on countries to consider injectable long-acting cabotegravir (CAB-LA), a safe and highly effective HIV prevention option.
Leadership, policy and funding: One of the biggest obstacles to realizing the vision of ending the HIV pandemic as a threat to public health and individual well-being by 2030 is a fall-off in funding. UNAIDS points to international resources for HIV in 2023 being almost 20% lower than at their peak in 2013. It says the $19.8 billion in US dollars available for HIV programs in low- and middle-income countries in 2023 is almost $9.5 billion short of the amount needed in 2025.
AIDS is still with us: UNAIDS shared updated global HIV data. The data reflect the huge strides we have made, with the number of new HIV acquisitions falling by 39% globally since 2010 – and 56% in central, eastern, southern and western Africa. But there is real concern that the world will not meet their 2030 targets to get HIV under control. The report shows that 39.9 million people were living with HIV in 2023 (from 39 million in 2022). About 1.3 million people acquired HIV in 2023 – more than three times the 2025 target of 370,000. About 630,000 people died from AIDS-related illnesses worldwide in 2023 – a death every minute and way above the 2025 target of 250,000.
A study led by UNAIDS set out the cost of inaction and failure to meet the targets. It found that if we fail to meet the 95-95-95 targets, the human cost will include 34.9 million new HIV acquisitions and 17.7 million AIDS-related deaths from 2021 to 2050.