Comments on: Future Priorities for NIAID’s HIV Prevention Research

By: Barry Brewer

Barry Brewer — Mon, 27 Feb 2012 16:25:55 +0000

It is apparent to me from the content of these comments that most readers are not aware of the clinical trials that are demonsrating what is being called a “functional cure” by many scientists and many media publications.
There should be much new info regarding these clinical trials from the upcoming CROI conference.
Until then I suggest a visit to the Sangamo Biosciences website.

By: Irvin IV

Irvin IV — Tue, 01 Feb 2011 10:25:47 +0000

More research more funding healthier happier people

By: Anne Davis

Anne Davis — Wed, 08 Dec 2010 14:50:57 +0000

I am concerned about the health of women in the United States, particularly as it has been disproportionately impacted by HIV. I wish to support the following areas discussed and prioritized by the HANC Legacy Project during a first-time-ever Consultation on HIV Research and Women on June 11th and 12th, 2010. Their review reflects key concerns such as sensitivity to culture, quality of life, and the changing needs of women across the lifespan.
I respectfully ask that NIAID includes the following priorities related to HIV prevention and treatment for United States’ women:
Epidemiological data must continue to drive research priorities. Awareness of the impact that HIV has had on women in the United States has been heightened through the use of epidemiological data from the Centers for Disease Control and Prevention. The CDC guidance mandates prioritizing HIV prevention efforts for those populations who are most burdened by infection.
HIV treatment research for women continues to be an urgent priority. Prior to the availability of HIV treatment women were 10% less likely than men to die from AIDS defined illnesses. In today’s HIV treatment era, however, women are 20% more likely than men to die from AIDS. While research has answered key questions and has provided specific strategies and treatments to reduce mother-to-child transmission, research must now seek to gain greater insight into gender disparities in treatment successes.
There is a critical need for research that seeks to understand the relationship between women’s reproductive health, gender and economic inequalities and HIV prevention and treatment. United States’ health policies and programs that are designed to reduce the risk of HIV and other sexually-transmitted infections must be improved to explicitly address overall economic disempowerment among women, as well as disparities in poverty among ethnic populations. Research is needed that will help provide the data necessary to make those improvements.
There is a critical need for increased involvement of women in the design and implementation of research. It is understood that HIV prevention and treatment research must include growing numbers of adolescent and adult women. Low retention rates for women in HIV research studies are believed to be influenced by study designs intended for men, but were later altered to accommodate women.
There is a critical need for research involving men who report primarily having sex with women (MSW). The majority of HIV positive women report being infected through heterosexual intercourse or through intravenous drug use. Few studies have focused on the prevention and linkage to healthcare needs of men who primarily identify as having sex with women.
There is a critical need for research in genetics, pathogenesis, and pharmacology of HIV positive and negative women. Understanding women’s physiologic risk; resilience; genetics; drug efficacy; dosing requirements and variables such as pharmacogenomics, is key to enabling adherence, improvements in health and quality of life, and the specific, gender-based care women need and deserve.
Thank you and Sincerely,
Anne Davis

By: Charlene Dezzutti

Charlene Dezzutti — Thu, 23 Sep 2010 16:15:17 +0000

The HIV prevention networks have been productive to date. Merging both prevention networks into one will likely result in unintended consequences.
The HPTN has developed a successful niche in their TLC program and dealing with HIV and drug addition. The MTN has developed a successful niche in their microbicides and PrEP programs. Both groups are focusing on those populations who will likely benefit the most. The HPTN and MTN communicate between all levels of leadership. While both groups are dealing with HIV prevention, merging them will dilute their efforts and impede their success for several years due to dealing with the re-organization.
I have experience with a similar situation in which several CDC Divisions and Centers were re-organized into a “Super Center”. I worked at the CDC for 13 years. During my last 5 years, there was a need to re-organize with the thought of merging efforts to centralize the information and work flows between programs. The opposite occurred. There was no transparency and the mandates that were made created confusion. With this re-organization, new layers of bureaucracy were created slowing the work and halting the interactions between Divisions. While the Super Centers are now being dismantled, the re-organization effects remain.
With the immediate need to stop the spread of HIV and the shrinking dollar, it makes more sense for the programs that have been successful so far and will make the biggest impact on the epidemic to continue not encumbered by “re-organization”.

By: Jeffrey T. Safrit

Jeffrey T. Safrit — Tue, 14 Sep 2010 23:18:58 +0000

PREVENTION of mother-to-child-transmission of HIV….arguably the most successful prevention tool available today. We clearly know how to reduce MTCT in utero and intra-partum to 1-2% in resource rich settings and are working towards that goal in the rest of the world where access to ARVs and PMTCT services is challenging. We are also tackling transmission during breastfeeding through PROMISE as mentioned above. At this point, It would be easy to say ‘mission accomplished’.
However, the reality is that there are still 1200 infants born with HIV EVERY DAY, necessitating more research on many fronts. Understanding how to bring these proven prevention methods to scale is an obvious area of research that has implications for every prevention modality from PMCTC to PrEP and microbicides. If we can’t reach the populations that need these prevention tools, the best prevention methods are useless. And while we may know how to reduce transmission to low levels with ARV, we still don’t really understand the basic science of mother-to-child transmission events. Critically, why is it that 60% of infants born to HIV+ women will remain uninfected despite no therapy whatsoever? Why can an infant be exposed to HIV in mother’s milk every day for up to 2 years and not get infected? If we knew the answers to these questions, we’d be that much closer to the ultimate prevention tool, an HIV vaccine.
As the Clinical Trial Networks are restructured to address the global HIV pandemic, we must maintain a focus on the unanswered basic and implementation science questions that will reduce the number of infants born with HIV. The most efficient way to do this is by maintaining a network dedicated to HIV in women and children. This will also ensure that advances in other areas of research, in therapeutics and vaccines, will not leave women and children behind.
Respectfully submitted,
Jeffrey T. Safrit, PhD
Director, Clinical & Basic Research
Elizabeth Glaser Pediatric AIDS Foundation
http://Www.pedaids.org

By: Eddie

Eddie — Thu, 02 Sep 2010 00:38:25 +0000

I think that everyone who test for HIV or any other STD’s should be tested for a CCR5 mutation and store in a data base so that when someone needs a bone marrow transplant can go to a data base of millions of people and see if a match of HIV resistant virus can be found, and then be given to that particular person that may need it, and thus avoid disease-grafting complications and ultimately be “cured” of HIV. I think we should have a data base here in the states and in every country in the world. The more people we have with a HIV resistance virus,the more chances we have to find a donor.We will have them in that data base instead of going out there and try to find them. Kind of like the Berlin patient. I just wanted to throw it out there.

By: Alin Cintean

Alin Cintean — Fri, 02 Jul 2010 04:13:36 +0000

The post mentioned “a multi-pronged approach tailored to different communities is the best way to end the global HIV/AIDS pandemic.” What about the jail and prison system? Is anyone working on an approach tailored to that section of society or have we just given up?
Prisoners are at a much higher risk for infection because of, among other, the association of injection drug use with incarceration. According to many studies HIV is five to six times more prevalent among people who are incarcerated.

By: Jim Pickett

Jim Pickett — Fri, 25 Jun 2010 08:23:41 +0000

Thank you for the chance to provide input. As chair of IRMA – International Rectal Microbicide Advocates – I appreciate the chance to share some of the goals and objectives we laid out in our new document “From Promise to Product – Advancing Rectal Microbicide Research and Advocacy.”
The comprehensive document reports on the growing scientific activity in the rectal microbicide field, capturing the optimism among researchers and advocates alike as the field sets its sights on the development of safe and effective rectal-specific products that will provide protection against HIV during anal intercourse. Additionally, IRMA continues to call for a Global Rectal Microbicide Development plan by which stakeholders can coordinate efforts across the full range of scientific activities, developing strategies and setting priorities. Such a plan does not yet exist. An updated resource tracking of funds specifically allocated to rectal microbicide research and development — the only such exercise — is followed by a call for escalating funding over the next 10 years and for increased diversity in the funding portfolio as well.
Below are the bullets. For more details, see section 5 of “From Promise to Product.”
http://rectalmicrobicides.org/materials.php
Increase activity in all areas of rectal microbicide research (basic, pre-clinical, clinical,s ocio-behavioural).
Create a Global Rectal Microbicide Development Plan.
Bring more researchers to the rectal microbicide field.
Determine the safety of lubricants for rectal use.
Frame the discussion of RMs and other HIV prevention options in the context of anal health.
Recognise anal intercourse as a driver of the HIV pandemic—among gay men and other men who have sex with men (MSM), and between women and men.
Address the burden of HIV among gay men and other MSM around the world.
Thanks for your consideration.

By: Richard Maskiewicz

Richard Maskiewicz — Wed, 23 Jun 2010 17:44:22 +0000

It may not be appropriate to arbitrarily separate and differentiate between “microbicide” and “PrEP”.
Sustained duration microbicides would most certainly be considered prophylactic, and the earlier in the infection process a PrEP’s mechanism of action is involved, the more it behaves like a topical microbicide in terms of decreased probability of adverse systemic effects.

By: Rick Church

Rick Church — Wed, 23 Jun 2010 16:33:06 +0000

True HIV prevention will put the power to stop HIV transmission in the hands of everyone. I would like to see an emphasis on Microbicide research that empowers receptive partners, in sexual intercourse both heterosexual and homosexual, to take control of safer sex practices. These would include Microbicide strategies to be used -at the time of sexual intercourse. Scientific priorities must include availability and access as key components of HIV prevention research.
Whether anti-retroviral medication is given prior to infection or post-infection I believe it is a disservice to people most at risk for HIV infection to consider these medications as HIV prevention. It only takes an observation of the failure to distribute HIV/AIDS therapies worldwide to predict similar PrEP failures.
I believe it is important to emphasize that HIV is ultimately shared through sex and needles. Where condom use has failed other microbicides must succeed. The scientific agenda must become aware and engage in the cultural and religous obstacles to HIV prevention worldwide. International faiths such as Catholicism, Islam and Judiasm must be partners in this scientific agenda or new HIV prevention strategies will suffer a similar fate as condom use.