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Myron S. Cohen, MD Associate Vice Chancellor Director, Institute for Global Health

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. EXPOSED. UNEXPOSED. EXPOSED.

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Myron S. Cohen, MD Associate Vice Chancellor Director, Institute for Global Health

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

  2. Essential New Technologies • HIV Incidence -An algorithm (HPTN 043) -CDC • -IgG3 • Point of Care Viral Load -Alere -Others

  3. EXPOSED UNEXPOSED EXPOSED (precoital/coital) (postcoital) Behavioral, Structural Vaccines ART PEP Vaccines ART PrEP Microbicides Circumcision Condoms STIs YEARS HOURS 72h Four HIV Prevention Opportunities Cohen et al, JCI, 2008 Cohen IAS 2008 INFECTED Treatment Of HIVReduced Infectivity YEARS

  4. HPTN 052: What’s Next The HPTN 052 Cohort July 2012 1682/1763 index cases (96% retention) 1502 discordant couples (85% retention) DURABILITY OF PREVENTION? DELAYED CLINICAL EVENTS?

  5. The “Test and Treat” MovementGranich 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

  6. 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)

  7. 0 5 10 15 20 25 30 35 40 Acute HIV-1 Infection: A Challenge Cohen et al, NEJM, 2011 Onset cytokines apoptosis, Day 7 Free Antibody, Day 13 Immune Complexes Day 9 Acute Phase Reactants Days -5 to-7 Autologous Neutralizing Antibody 108 107 106 ? 105 104 eclipse Reservoir 103 102 Virus Concentration in Extracellular Fluid or Plasma (Copies/ml) 101 Virus dissemination CTL Escape 0 CD8 T Cell Responses 10-1 Autologous Neutralizing Antibody Escape Transit 10-2 T0 10-3 10-4 10-5 45 50 55 60 65 70 Time Post Exposure (days) Transmission

  8. 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

  9. Can We Cure AIDS?

  10. To be published 26 July 2012 Available on-line 1 PM 25 July 2012

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