Myron S. Cohen, MD Associate Vice Chancellor Director, Institute for Global Health The University of North Carolina.

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Presentation transcript:

Myron S. Cohen, MD Associate 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 HIV Reduced Infectivity INFECTED YEARS UNEXPOSED Behavioral, Structural Circumcision Condoms STIs Cohen et al, JCI, 2008 Cohen IAS 2008 HOURS Vaccines ART PrEP Microbicides EXPOSED (precoital/coital) 72h Vaccines ART PEP EXPOSED (postcoital)

HPTN 052: What’s Next The HPTN 052 Cohort July /1763 index cases (96% retention) 1502 discordant couples (85% retention) DURABILITY OF PREVENTION? DELAYED CLINICAL EVENTS?

The “Test and Treat” Movement Granich 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)

Transmission Virus Concentration in Extracellular Fluid or Plasma (Copies/ml) Time Post Exposure (days) Reservoir Virus dissemination Transit eclipse ? T0T0 Acute Phase Reactants Days -5 to-7 Immune Complexes Day 9 Onset cytokines apoptosis, Day 7 Free Antibody, Day 13 CD8 T Cell Responses CTL Escape Autologous Neutralizing Antibody Autologous Neutralizing 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 2012 Available on-line 1 PM 25 July 2012