HIV News Around The Globe

The Conference on Retroviruses and Opportunistic Infections (CROI) was established in 1993 to provide a forum for basic scientists and clinical investigators to present, discuss, and critique their investigations into the epidemiology and biology of human retroviruses and associated diseases. This year, The 31st Conference on Retroviruses and Opportunistic Infections was held in Denver,Colorado from 3rd-6th March.

The conference presentations featured numerous studies focused on biomedical prevention, all emphasising a consistent message: Pre-exposure prophylaxis (PrEP) is effective, and having options is crucial! Advocates have persistently emphasised the importance of choice, and now scientific evidence confirms its effectiveness for individuals while also contributing to reductions in population-wide incidence rates.

In this month's Monday Press , we shall cover brief highlights from the conference that was very well attended.

Dr Moses Kamya at CROI 2024. Photo by Roger Pebody.

A programme in rural Kenya and Uganda has already demonstrated a dynamic, person-centred HIV prevention intervention, resulting in a substantial increase in the number of people covered by PrEP or PEP, displaying the added benefits of offering a choice between PrEP pills and PrEP injections.

When services were offered in the usual way, a minority of people used oral PrEP or PEP while when they were optimised to provide choice and flexibility, uptake more than doubled. Moreover, in the latest stage of the randomised study – with the additional option of PrEP injections – 70% of people used some form of biomedical HIV prevention.

When services were offered in the usual way, a minority of people used oral PrEP or PEP. When services were optimised to provide choice and flexibility, uptake more than doubled. And in the latest stage of the randomised study – with the additional option of PrEP injections – 70% of people used some form of biomedical HIV prevention.

In the first phase, presented at last year’s CROI, results were reported separately for the three different settings in which the intervention was provided. One was community health workers going door-to-door in villages: in the standard-of-care arm, PrEP or PEP was used for 0.5% of the time, rising to 28% of the time in the intervention arm. In antenatal clinics, prevention coverage was 29% in the standard-of-care arm, compared to 70% in the intervention arm. Finally, in outpatient departments at health facilities (used for a wide range of health needs in these rural areas), coverage was 18% and 48%, respectively.

Not satisfied with this level of coverage, the researchers extended the study, with injectable PrEP (cabotegravir) as an additional option, alongside oral PrEP, PEP and condoms. Although the dapivirine vaginal ring was not an option in this phase of the study, it will be in phase III.

The cabotegravir injections are every two months, without an oral lead-in. They must be provided at government clinics, so there is less choice of location with this option.

Read more on this report and it’s findings here

The Deliver Study investigating efficacy of the dapivirine vaginal ring (DVR) among pregnant and lactating people (PLP) provided data from people in the second trimester of pregnancy. Building on earlier findings in later stages of pregnancy, investigators reported no increased rate of adverse outcomes compared to pregnancy outcomes in the community, and that “data support using DVR” as an HIV prevention option for PLP. Pregnant people are estimated to be three times more likely to acquire HIV through sexual intercourse than similarly aged people who are not pregnant. The large clinical study was conducted in Malawi, South Africa, Uganda and Zimbabwe by the Microbicide Trials Network, an international research network funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health.

The monthly dapivirine vaginal ring and daily oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine were each found to be safe for HIV prevention among cisgender women who started using one of them in their second trimester of pregnancy, according to findings presented last week at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI) in Denver. Read more on this findings here and here.

At this time, 11 countries have approved DVR, but this data is needed for regulators to approve its use for people who are pregnant. See AVAC’s PrEP tracker for the latest on DVR initiations, regulatory approvals and more on this.

At this year’s CROI, which just concluded, HIV activists are still angered that a significant number of attendees—many of them clinicians, researchers and other scientists—ducked out as HIV activist Dr. Frank Mugisha spoke about battling homophobia and laws that criminalise LGBTQ+ people in his home country, Uganda, and around the world, including the United States.

Activists sent a letter to organisers of the conference, CROI Foundation, IAS-USA, as well as to the CROI Scientific Planning Committee and the Community Liaison Subcommittee, calling on them to “clearly and unequivocally condemn this appalling lack of respect for community lives. We demand a direct apology to Dr. Frank Mugisha.”

The letter details the incident. “This year’s opening plenary at CROI, which took place Sunday evening March 3 in Denver, Colorado, included talks from Dr. Barney S. Graham, who spoke about modern vaccinology and the legacy of HIV research, and Dr. Dorothy Mboir-Ngacha, who reflected on ending paediatric HIV.”

The final speaker was Dr. Mugisha's, whose powerful speech drew a standing ovation.

“Sadly, the audience was significantly smaller than the audience for the other lectures,” the letter says. “When it was Dr. Mugisha’s turn to speak, hundreds of researchers at the foremost scientific HIV conference in the world got out of their chairs, turned around, and walked out.”

Read this opinion piece here and If you haven't had a chance, you can sign on to show support here: https://www.change.org/p/centering-lgbtq-rights-at-croi.

See some of the collaborative pieces done with Dr.Frank by advocates around the world

A shot in the arm podcast:- Uganda's Legalized persecution of LGBTQI/ Personal Public Threat