Towards ending AIDS epidemic by 2030

*HIV vaccine elicits antibodies in animals that neutralize dozens of strains

Scientists have made giant strides towards the global target of ending Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) by 2030.

An experimental vaccine regimen based on the structure of a vulnerable site on HIV elicited antibodies in mice, guinea pigs and monkeys that neutralize dozens of HIV strains from around the world.

The findings were reported last week in the journal Nature Medicine by researchers at the United States National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and their colleagues.

Peter D. Kwong, Ph.D., and John R. Mascola, M.D., led the study. Dr. Kwong is chief of the Structural Biology Section at the NIAID Vaccine Research Center, and Dr. Mascola is the center director.

“NIH scientists have used their detailed knowledge of the structure of HIV to find an unusual site of vulnerability on the virus and design a novel and potentially powerful vaccine,” said NIAID Director Anthony S. Fauci, M.D. “This elegant study is a potentially important step forward in the ongoing quest to develop a safe and effective HIV vaccine.”

A preliminary human trial of the new vaccine regimen is anticipated to begin in the second half of 2019.

The Nature Medicine report reflects one of two broad, complementary approaches NIAID is pursuing to develop an HIV vaccine. In one approach, scientists first identify powerful HIV antibodies that can neutralize many strains of the virus, and then try to elicit those antibodies with a vaccine based on the structure of the HIV surface protein where the antibodies bind. In other words, scientists start with the most promising part of the immune response and work to develop a vaccine that will induce it. This method was used to design the vaccine described today.

The other, empiric approach to HIV vaccine development begins by evaluating the most encouraging vaccine candidates for efficacy in people through clinical trials. Then scientists try to build on successful trial results by, for example, examining blood and other clinical specimens from study participants who received the vaccine to identify the most promising parts of the immune response. Researchers subsequently use this information to improve vaccination approaches for future trials. This method was used to develop the HIV vaccine regimen tested in the RV144 clinical trial and the HIV vaccine regimens currently under study in the HVTN 702 and Imbokodo clinical trials.

Meanwhile, Board members of UNAIDS have expressed their support for the programme and underscored the critical role that the organization has to play in ending the AIDS epidemic.

The members at UNAIDS’ 42nd Programme Coordinating Board meeting, which took place in Geneva, Switzerland, on June 26-28, said ending AIDS by 2030 is possible.

Executive Director of UNAIDS, Michel Sidibé, in his opening address, the welcomed the Board’s support and reiterated the importance of focusing on the challenges and opportunities ahead in reaching the 2020 Fast-Track commitments agreed by the United Nations General Assembly. “The 37 million people who are living with HIV today, along with the 1.8 million who will acquire HIV over the course of this year, are counting on us. AIDS is not over—but it can be—and at UNAIDS we are fully committed to ending the AIDS epidemic.”

The Board requested UNAIDS to continue to strengthen joint and collaborative action at the country level as part of United Nations reform efforts. Members also requested UNAIDS to continue to strengthen performance reporting aligned to national targets, with a focus on impact, results and the identification of areas which are off-track and bottlenecks, with actions to address those issues.

The Board encouraged donor governments to make multiyear contributions and release their contributions towards the 2016–2021 Unified Budget, Results and Accountability Framework as soon as possible to fully fund the 2018–2019 UNAIDS budget of US$ 484 million. During the meeting, an important funding announcement to UNAIDS was made by Australia, which confirmed it was pledging nearly US$ 1 million in additional funds for HIV prevention in the Asia–Pacific region.

Board members expressed their support for the measures that UNAIDS is putting in place to address harassment in the workplace. The Board heard Mr Sidibé’s commitment to lead change as he outlined the proactive actions under way at UNAIDS to prevent sexual harassment, unethical workplace behaviour and all forms of abuse.

“UNAIDS is taking concrete actions to ensure zero tolerance and zero impunity for harassment and abuse of authority,” said Mr Sidibé. “I am committed to ensuring a workplace where everyone can work with respect and dignity.”

Measures include a five-point plan to ensure that all forms of harassment and abuse of authority are identified early, dealt with swiftly and effectively with due process and to ensure that survivors and whistle-blowers are protected. UNAIDS has also set up an anonymous and confidential Integrity Hotline, released its new Gender Action Plan 2018–2023 and called for the establishment of an Independent Expert Panel on harassment to provide policy recommendations on how UNAIDS can improve its response and identify areas where reform is needed. The Board welcomed this request and has moved quickly to establish terms of reference for the independent expert panel. The panel will report to the Board to ensure that the oversight of the panel remains entirely independent.

The UNAIDS Staff Association made a statement to the Board to emphasise the genuine will and commitment of the staff to bring about positive change. The Staff Association also presented data from a recent staff survey in which 89% of staff responding said that their commitment to the goals of the organization is what motivates them to come to work each day.

During the meeting, the Board heard from several representatives of key populations on a variety of issues, including ensuring respect and dignity in the use of terminology, funding and support and meaningful consultation with civil society, respect for human rights and gender equality. In addition, concerns were raised about the specific and increased needs of displaced people in humanitarian settings and of people in prison settings.

Sidibé invited the First Lady of Panama and UNAIDS Special Ambassador for AIDS in Latin America, Lorena Castillo de Varela, to present her groundbreaking work on zero discrimination to the Board.

On the final day of the meeting, the Board participated in a thematic session on ending tuberculosis (TB) and AIDS. Around 10 million new cases of TB occur every year and TB remains the leading cause of death among people living with HIV, accounting for one in every three AIDS-related deaths. The participants discussed the urgent need to scale up joint efforts to address the dual, intertwined epidemics of TB and HIV.

Representatives of United Nations Member States, international organizations, civil society and nongovernmental organizations attended the three-day meeting, which was chaired by Anna Wechsberg, Policy Director for the Department for International Development of the United Kingdom of Great Britain and Northern Ireland, with Cui Li, Vice-Minister of National Health and Family, China, serving as Vice-Chair and Algeria as Rapporteur.