Photo Credit: Natali_Mis

AIDS 2024 recently convened thousands of people living with, affected by, and working on HIV to share knowledge and lessons learned from the HIV response.

AIDS 2024 recently kicked off in Munich, Germany. The 5-day meeting brought more than 10,000 attendees from around the world.

“AIDS 2024 will convene thousands of people living with, affected by, and working on HIV to share knowledge, best practices, and lessons learned from the HIV response over the past 40 years, as well as from the responses to COVID-19, mpox, and other public health threats,” said organizers from the International AIDS Society (IAS).

Person-Centered Healthcare

The theme of the 2024 meeting is putting people first. “Putting people first means thinking of solutions from the point of view of those most affected,” according to the IAS.

To achieve the goal of putting people first, the objectives of the event included:

• Innovation through scientific discovery to help guide innovative approaches to preventing and treating HIV and related co-infections and comorbidities;
• Implementation science that is aimed at the challenges and opportunities of implementing novel prevention and treatment modalities;
• Key and vulnerable populations that help bridge the gap in HIV response and move towards person-centered care; and
• Eastern Europe, where there are complex dynamics of the growing epidemic.

The Latest in HIV

During the event, study authors presented new research aimed at bettering the care of patients with HIV.

Transplants with functional CCR5 were previously deemed ineffective for sustaining HIV remission without antiretroviral therapy (ART), according to study authors. However, a patient known as the Berlin patient demonstrated extended viral control for 18 months after allogeneic hematopoietic stem cell transplants (aHSCT) from a wild-type CCR5 donor.

To find the next “Berlin patient,” a study followed patient samples from 2009 to 2024, including gut biopsies, testing for HIV RNA, HIV DNA, viral tropism, CCR5 expression, viral outgrowth, antiretroviral drug levels, and HIV-specific immune responses. The results showed prolonged HIV remission exceeding five years without ART following heterozygous CCR5 WT/Δ32 aHSCT for acute myeloid leukemia (AML) in a heterozygous CCR5 WT/Δ32 male. Pre-aHSCT, HIV RNA, and total HIV DNA were detected with predicted R5 viral tropism. Transplantation from an HLA-matched unrelated donor in October 2015 led to full-donor chimerism and AML remission. Acute graft-versus-host disease was limited and treated with topical steroids. CD4+ T cell CCR5 expression matched CCR5 WT/Δ32 controls. HIV remained undetectable in plasma for 5.5 years after treatment interruption (TI) in September 2018, with repeated negative HIV DNA measurements in blood and gut biopsies. No viral outgrowth was detected, antiretrovirals were undetectable throughout TI, and HIV-specific antibody levels decreased with no detectable T cell responses post-aHSCT.

These findings suggest that an HIV cure induced by aHSCT is not restricted to homozygous CCR5Δ32/Δ32 donors. Effective reservoir reductions and durable HIV remission can be achieved with functional viral co-receptors, indicating that allogeneic immunity fundamentally contributes to HIV eradication.

The Future of HIV

Additional research presented during the event examined the cost of inaction in meeting the 95-95-95 AIDS Targets across 114 countries by 2050. Researchers compared a scenario achieving these targets to a business-as-usual scenario that maintains 2020 levels of HIV-related services. The benefits were calculated using the full-income approach, which considers income changes and mortality rates. They estimated the value of reducing the mortality rate in HIV programs as the amount an average person would pay to lower their death risk by one in 10,000 annually, factoring in income elasticity.

The findings reveal significant human and economic repercussions if the 95-95-95 AIDS targets are not met. This includes 34.9 million new infections and 17.7 million AIDS-related deaths between 2021 and 2050. Economically, inaction costs $8,291 per person in low- and middle-income countries by 2050, with an average cost per capita of $670. Country-specific analysis highlights the importance of considering both return on investment (ROI) and cost of inaction (COI). For instance, South Africa exhibits a high COI, while Kenya and Haiti show a higher ROI.

“The cost-benefit analysis of the AIDS response using a full-income approach enables measuring the return on investment and the cost of inaction of meeting or failing to meet the 95-95-95 AIDS Targets,” the authors concluded. “Failing to meet these targets bears a tremendous human and economic cost. The idle position is not an option.”