The unfinished business of ending the HIV epidemic: We’ve come far but have further to go
Dr Anthony Fauci (former NIAID director) kicked off the 30th CROI meeting, reminiscing on the achievements made for HIV treatment and prevention over the last 30 years, and positing on what is yet to come. During his talk Dr Fauci remarked that long-acting ARVs are a game-changing technology, acknowledging their recent addition to the arsenal of drugs available for HIV-1 management. Turning to emerging technologies, Dr Fauci envisions the renaissance of broadly neutralizing antibodies (bnAb) for pre-exposure prophylaxis (PrEP). Despite sobering AMP trial outcomes, which tested single bnAbs, Dr Fauci pointed out that “we have to do with bnAbs what we did for ART – combine them”. bnAb combinations could further expand the options for long-acting therapies by simultaneously targeting different epitopes on the HIV envelope or be used together with other long-acting injectables. Dr Fauci closed by sharing his sentiment for an HIV cure, and acknowledging the role HIV vaccines may play in ending the HIV pandemic: “We can end the pandemic even without a cure or vaccine, BUT that does not mean we should not try.”
Whilst opportunity may exist for bnAbs in the management of HIV, the need to appropriately combine bnAbs to target different epitopes to achieve viral suppression may impact their use as an effective HIV treatment, as questions such as “which bnAbs should be combined?” remain unanswered. Different potencies and pharmacokinetics could pose significant challenges, particularly for combinations of two or more bnAbs. Gilead’s Phase 1 data (to be shared at CROI 2023) may provide insights into the potential for bnAbs-ARV combination therapies to move successfully through clinical development. Stay tuned for more CROI updates from Lifescience Dynamics!