HIV: 2022’s Advancements In Care, Research, And Prevention

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2022 was a significant year for HIV research and healthcare.

Advancements have ranged from some progress in the long, winding road toward a cure to newly approved forms of preexposure prophylaxis (PrEP) for HIV prevention.

Healthline sat down to talk with Dr. Philip Chan, an associate professor in the Department of Medicine at Brown University, and Dr. Roger Shapiro, a professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, about the progress that has been made over the past year and the potential impact it may have on the future of HIV research, treatment, and prevention.

Advancing toward a cure
The past year has seen several positive headlines surrounding individuals who have seen their HIV go into remission as a result of stem cell treatments for cancer.

Shapiro said these stories had fueled continued hope in the push to find a cure for HIV. However, he pointed out that these cases are very specific to people receiving stem cell treatments for cancer and don’t indicate a broader method for curing HIV.

“Cure research is always exciting, and in 2022 there was some progress. We learned about two more patients who have been cured using stem cell transplants and another who went into remission with immunotherapy,” Shapiro said. “So we are up to about 5 patients now who have been cured or put into remission by a specific scientific intervention. These are small numbers, but each case helps us gain confidence that these lines of research hold promise.”

“There has also been some forward progress using gene editing techniques to remove HIV from cells or to improve the immune system’s ability to attack HIV,” he added.

The arrival of long-acting injectable antiretroviral treatments

Chan said that long-acting injectable antiretroviral therapies for HIV are at the top of his list of 2022 innovations.

As an example, he cited lenacapavir, an injectable medication that “works differently than other existing HIV medications and therefore also works against resistant HIV.”

“Lenacapavir can potentially be given every six months and is effective in people starting antiretrovirals for the first time and those who have been previously treated and have a resistant virus. Lenacapavir has been approved for use in Europe and is under review by the FDA in the United States,” Chan added.

Chan also cited Cabenuva (cabotegravir combined with rilpivirine), an injectable currently approved by the FDA as a once-a-month injection to treat HIV.

“Cabotegravir alone was approved for preexposure prophylaxis (PrEP) for the prevention of HIV in December 2021 as two injections a month apart and then every two months thereafter. Uptake of cabotegravir as PrEP has been limited by general education and awareness, as well as insurance coverage,” Chan said. “However, these medications herald a ‘new phase’ of HIV treatment and prevention where people could take medications as an injectable twice a year. Other long-acting antiretroviral formulations are in development.”

Shapiro added that these long-acting agents “offer a lot of promise” to ensure people adhere to their medications, ultimately improving health outcomes. Going in for a periodic injection is easier for many people than remembering to take a daily regimen of pills.

Innovations in postexposure prophylaxis (PEP)

Chan cited the use of a medication called doxycycline as a form of postexposure prophylaxis (PEP) as a form of HIV prevention and an important tool for “those who may be at higher risk to prevent other bacterial STIs.”

“Preventing other STIs will likely reduce the risk of acquiring HIV since having another STI (i.e., syphilis, gonorrhea, or chlamydia) increases HIV risk significantly. Recently in 2022, the randomized open-label clinical trial (DoxyPEP) evaluated people living with HIV or on HIV PrEP and was ended early after the data safety monitoring board found that oral doxycycline hyclate 200mg self-administered within 72 hours after condomless sex significantly reduced other STIs including syphilis, gonorrhea, and chlamydia,” Chan explained.

Pushes for a vaccine have had mixed results in 2022
Shapiro said news on developing an HIV vaccine had been a mixed bag.

“There was another large study from South Africa that failed to show efficacy, but a few new constructs — including mRNA technology similar to the COVID-19 vaccines — have people more optimistic that we can create smarter vaccines that generate broadly neutralizing antibodies,” he said. “Trials for mRNA vaccines got underway in 2022.”

The rise of bNAbs

“Broadly neutralizing antibodies, or bNAbs, are antibodies we create in a laboratory to treat or prevent HIV. We want our immune systems to create these with vaccines, but for now, we can only make them outside the body. These antibodies are becoming better every year, and in 2022 we learned that two potent antibodies could maintain viral suppression in selected patients without the need for standard antiretroviral treatment,” Shapiro said of another top development in HIV treatment and prevention.

He said these antibodies appear to reduce the viral reservoir of HIV in the body “in a way that standard treatment does not.”

Shapiro explained that this offers optimism that this kind of therapy could lead us down a path where we can “create natural control or remission” of HIV.

“In 2022, our group in Botswana reported that bNAbs successfully treated some children with HIV as well,” he added.

Improved therapies for children
Shapiro pointed to a development that was announced on the second-to-last day of 2021 as being on his 2022 list.

The ODYSSEY study revealed that dolutegravir-based antiretroviral treatments had better outcomes than past therapies for children and adolescents living with HIV.

“This has sparked programs worldwide to switch to this preferred regimen for all children. It is really important that we close the gap between children and adults and provide the same options to children that adults have had for many years, and in 2022 we made a lot of progress,” Shapiro said.

HIV education, treatment, and prevention in 2023 and beyond

Today, about 1.2 million people are living with HIV in the United States, with the virus continuing to disproportionately affect vulnerable populations in the nation, including racial and ethnic minorities and the LGBTQ community — particularly gay, bisexual, and other men who have sex with men, according to the U.S. Department of Health and Human Services.

While many strides have been made since the height of the HIV crisis in the 1980s and 1990s, a lot more work needs to be done.

“I think we have made tremendous progress in the fight against HIV. New diagnoses are generally decreasing, and advancements in prevention and treatment mean that people are living longer and/or not being infected at all,” said Chan. “However, I also think we have a ways to go. Importantly, significant disparities exist related to HIV that need to be addressed. These include disparities related to sexual orientation, gender, race, and ethnicity.”

Chan told Healthline that to address HIV effectively, societal factors need to be acknowledged that place some communities at greater risk than others.

“Addressing HIV requires addressing other social determinants of health such as access to healthcare, housing, substance use treatment, mental health treatment, food security, etc. We will never truly be able to address the HIV epidemic unless these other social determinants of health are also addressed,” he explained.

Similarly, Shapiro said we are “not at the finish line yet, even though many people want us to have this box checked” regarding HIV.

“HIV still greatly impacts health disparities, and co-morbidities need to be understood and addressed. Overall I would say we are doing really well with treatment; we have the potential to greatly improve prevention using long-acting PrEP if we can implement it better — and President Biden’s 2023 budget proposal requested $850 million for this — and we are now solidly out of the starting gate for cure efforts. Still, with a long way to go,” he told Healthline.

Additionally, Shapiro said he’s hoping to see better availability and implementation of PrEP as a powerful preventive tool. He hopes PrEP becomes “a more routine part of practice all over the world,”, especially in some African countries that are hit hardest by HIV.

“I think new bNAb studies will allow more research patients to control HIV using antibodies rather than standard antiretrovirals. While this won’t immediately change practice because of cost and complexity, it may show us what is needed for effective immunologic control,” Shapiro added. “Ultimately, the goal still remains to find a vaccine that can train our immune systems to control HIV on our own.”

Chan has similar hopes for long-acting injectable medications.

“I think these and other long-acting formulations in 2023 and beyond will significantly change how we treat HIV in the future,” he added.