Myron S. Cohen, MDAssociate Vice Chancellor

Director, Institute for Global Health The University of North Carolina

Essential New Technologies• HIV Incidence

-An algorithm (HPTN 043)

-CDC• -IgG3• Point of Care Viral Load

-Alere

-Others

Four HIV Prevention Opportunities

YEARS

Treatment Of HIVReduced Infectivity

INFECTED

YEARS

UNEXPOSED

Behavioral,Structural

Circumcision

CondomsSTIs

Cohen et al, JCI, 2008Cohen IAS 2008

HOURS

VaccinesART PrEP

Microbicides

EXPOSED (precoital/coital)

72h

VaccinesART PEP

EXPOSED (postcoital)

HPTN 052: What’s Next

The HPTN 052 Cohort July 2012

1682/1763 index cases (96% retention)

1502 discordant couples (85% retention)

DURABILITY OF PREVENTION? DELAYED CLINICAL EVENTS?

The “Test and Treat” MovementGranich et al. Current Opinion in HIV, 2011

More than 50 studies described!!• US HPTN 065 Linkage in NYC, DC• ANRS/Africa Center-South Africa• THE PEPFAR Combination Prevention Trials:

– CDC- BOTSWANA– NIH HPTN 071 -South Africa, Zambia – USAID JHU-Tanzania

HPTN 071 Intervention Package Community HIV Care Providers (CHiPs team):

• Counselling, condom provision, syndromic STI Rx• Referral of pregnant women for ANC/PMTCT services• Universal voluntary HIV testing house-to-house • HIV-uninfected men offered circumcision • HIV-infected persons

− Arm A: Immediate ART (analogous to HPTN 052)− Arm B: “Enhanced” Standard of Care (CD4<350)− Arm C: Standard of Care (CD4<350)

10-5

10-4

10-3

10-2

10-1

0

101

102

103

104

105

106

107

108

Transmission

Vir

us

Conce

ntr

ati

on in E

xtr

ace

llula

r Fl

uid

or

Pla

sma (

Copie

s/m

l)

Time Post Exposure (days)

0 5 10 15 20 30 3525 40 45 50 55 60 65 70

Reservoir

Virus

di

ssem

inat

ion

Transit

eclipse?

T0

Acute Phase ReactantsDays -5 to-7

Immune ComplexesDay 9

Onset cytokinesapoptosis, Day 7 Free Antibody, Day 13

CD8 T CellResponses

CTL Escape

AutologousNeutralizing Antibody

AutologousNeutralizing

Antibody Escape

Acute HIV-1 Infection: A Challenge Cohen et al, NEJM, 2011

The Next PrEP/Microbicides

• Do the results increase adherence: iPREX OLE?• Can Truvada schedule change (HPTN 066,067)• Can Maraviroc be used as PrEP (HPTN 069)• Other oral agents? • Other topical agents• The Ring• Can injectable agents be developed as PrEP

Can We Cure AIDS?

To be published 26 July 2012Available on-line 1 PM 25 July 2012