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In recent years, scientific research on HIV treatments has made significant progress, improving the lives of patients. But the number of contaminations remains high and so far no effective vaccine has emerged. Update with Gilles Pialoux, Vice President of the French Society for the Fight Against AIDS (SFLS).
1Ahem December marks World AIDS Day, a disease caused by HIV, which affects more than 38 million people worldwide. In a report published this Tuesday, the United Nations warned about the progression of contamination with 1.5 million new infections detected in 2021 and 650,000 deaths.
Despite significant advances in treatment, now possible by injection, access to care remains highly unequal around the world and there is still no vaccine against AIDS. Since the Covid-19 pandemic, a new clinical trial based on messenger RNA has been launched to find out if this technology can also protect against HIV.
Gilles Pialoux, head of the department of infectious diseases at the Tenon hospital (AP-HP) and vice president of the French Society for the Fight against AIDS (SFLS), answers questions from France 24.
France 24: The human immunodeficiency virus (HIV) was discovered in 1983. How to explain that almost 40 years later, despite technological advances, the pollution figures are still so high ?
Gilles Pialoux: Since the discovery of the virus, science has advanced considerably and today we benefit from very effective treatments. TasP (Treatment as Prevention) allows HIV-positive people to lead a normal life and blocks the transmission of the virus, even in relationships without condoms. This treatment also allows pregnant women to avoid transmitting the virus to the child.
For HIV-negative people, PrEP (pre-exposure prophylaxis) is a highly effective preventative treatment that helps protect against contamination. However, these treatments are still underused. In France, only 28% of men who have sex with men use PrEP despite accounting for 43% of new infections. In women, who account for 32% of infections, this figure drops to 4%. Therefore, a real problem of awareness about this disease persists. We must deploy more media to publicize the progress in the fight against HIV.
There is also a detection problem. While disparities in access to testing persist around the world, covid-19 has caused a dramatic setback. This health crisis has affected all countries, including those that, paradoxically, have been little affected by the coronavirus, particularly Africa. This decline in screening is due to lockdowns and a general feeling of fear, but also to logistical problems, such as the shortage of reagents that has affected laboratories. We performed 950,000 fewer tests in France alone in 2020, a 13% decrease. In 2021, we increased our testing by 8%, but we have not yet managed to return to the level of 2019. HIV testing is now possible without a prescription in France, which is excellent news. But here again, this measure must be accompanied by effective information campaigns.
Several clinical trials have recently been launched – including Moderna’s that uses RNA technology, effective against Covid-19 – to develop a vaccine against HIV. Where are these studies and do they have a chance of success? ?
Although it is true that in several aspects Covid-19 has harmed the fight against HIV, it must be recognized that at the research level, the pandemic has instilled new enthusiasm. The American laboratory Moderna has launched phase 1 trials to evaluate the immune response and side effects of a vaccine based on RNA technology, taking into account the particularities of HIV. In France, the Vaccine Research Institute (VRI) has also launched a groundbreaking new clinical trial.
This virus presents a great difficulty because it mutates enormously, in infected people but also during transmission and depending on the environment and regions. Many clinical trials have already been carried out to obtain a vaccine, but these have never exceeded 31% efficacy, which is very insufficient. If we managed to reach 50 or 60%, that would already be a huge advance. The advantage of RNA is that this technology is much easier to build and therefore saves time. Scientists have developed a consensus model, with one injection to prime the immune response and then a second to stimulate it. However, it is necessary to moderate the enthusiasm because we are at the beginning. Phase 3, which must confirm the efficacy of the vaccine before its commercialization, will take between three and four years. [La phase 2 n’a pas encore été lancée, NDLR.]
Only one HIV vaccine clinical trial is currently in phase 3. It is the Mosaico project, which should report its conclusions by the end of 2023.
A lot of work is also being done to promote and improve the taking of treatments. Can you explain these developments and the importance of this approach? ?
This work aims to respond to a strong demand for relief from patients because the treatment against HIV is a long-term treatment, which causes fatigue but must be respected absolutely because the virus becomes more resistant in case of forgetfulness.
We have managed to lighten the triple therapies, which can now be taken four days a week instead of daily administration. For just over a year, two antivirals can now be given by injection, once every two months. This treatment is still in the minority because it is still little known and requires the use of a nurse. But it has the advantage of allowing greater discretion with the family and professional environment, and of avoiding the “reminder effect” of taking medication, which is difficult to live with on a day-to-day basis. Other improvements are underway to develop a monthly or even semi-annual tablet or even develop the subcutaneous implant, which distributes the product for a year, on the model already used for contraception.
>> Read also: Injections instead of the daily tablet, “a revolution” for some patients
In addition to the practical aspect, these advances are intended to make life easier for patients, in a context of strong discrimination. This is the case in France, where certain jobs such as police or gendarme are still prohibited for HIV-positive people, where it is sometimes more difficult to get insurance and therefore access property and sometimes even get medical appointments. Despite all these years of raising awareness, the subject of HIV is still taboo in society and fuels fears. Even within the medical profession, a malaise persists over this difficult and intimate subject. Too many professionals prefer to avoid it and do not promote screening enough, resulting in missed opportunities for their patients.
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