Scientists Are Gaining Ground Against AIDS


The unnamed “London patient” — the second person apparently cured of H.I.V. — earned all the headlines. But other research released this week at the Conference on Retroviruses and Opportunistic Infections showed that scientists are making slow but steady progress on the tactics and medicines needed to fight the epidemic, especially in Africa.

Monthly injections of long-acting H.I.V. drugs proved as good as daily pills at suppressing the virus, according to two trials involving more than 1,000 patients. In another study, Descovy, a new formulation of the H.I.V. treatment Truvada, proved just as effective at suppressing the virus, and may have fewer — or at least different — side effects.

A study of the “test and treat” strategy in one million people in South Africa and Zambia — the largest H.I.V. prevention study ever conducted — produced mixed results.

Offering widespread home testing plus treatment to the sickest patients did reduce the number of new infections. But offering immediate treatment to all did not help as much as had been expected.

Doctors working in poor countries are eager for injections or implants that will release small daily doses of antiretroviral drugs because the devices can be used in secrecy. Providing injections may be harder than handing out pills, but the option may attract patients with H.I.V. who would otherwise stay away.

The trial, known as Discover, found that Descovy was slightly less likely than Truvada to harm kidneys or bone density, but other studies have suggested that Descovy is more likely to raise cholesterol.

Gilead said it will soon ask the Food and Drug Administration to let it market Descovy as PrEP. Some AIDS activists worry that people at risk will be urged to switch to Descovy just as low-cost generic versions of Truvada become available.

Truvada has been very safe for most patients, but its high price — now about $20,000 a year — and the red tape needed to help the uninsured pay for it have become major obstacles to ending the AIDS epidemic in the United States.

Gilead has already sold $33 billion worth of tenofovir; it is now shifting its new H.I.V. drug cocktails to TAF, which will remain patented — and, presumably, expensive — for many more years.

The trial in 21 neighborhoods in Zambia and South Africa — a region where H.I.V. infection rates are the world’s highest — was designed to see whether infection rates could be dramatically cut if teams of counselors went door-to-door, testing anyone who agreed and offering pills to anyone testing positive. Counselors also offered advice, condoms, circumcisions, tuberculosis tests and other incentives to lower infection rates during the trial, which is known as PopArt and ran from 2013 to 2018.

It was assumed that communities where patients were offered treatment immediately would have by far the lowest rates of new infection. But they did not, even though tests suggested that more people there were taking their pills; further analysis of that quandary will be done, the investigators said.

“PopArt is a head-scratcher,” Mitchell J. Warren, executive director of A.V.A.C., an advocacy group for H.I.V. prevention, said in an email.



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