Transcript Vaccines and Microbicides

Vaccines and Microbicides
Rebekah Webb, AVAC
STOPAIDS All Members Meeting:
Re-prioritising Prevention
London, 12th May 2016
“It’s not just about putting pills in
peoples’ mouths!”
- Dr Marie Laga, Be-PrEP-ared study
HIV Prevention
90-90-90
90% of PLHIV know their status
90% of those PLHIV on treatment
90% of those PLHIV undetectable
Why do we still need research?
• More options = more infections averted
• No epidemic has ever been ended without a
vaccine
• Need for “women-friendlier” and people-friendlier
options
• Microbicides and vaccines are more sophisticated
(PrEP = a systemic drug)
• Constant learning and innovation – link to a cure?
Will we ever have a vaccine?
• Preventive and therapeutic vaccines
• Proof of concept 2009: RV144 Thailand
• Pox-Protein Public-Private Partnership (P5)
Consortium (Gates, HVTN, NIAID, SAMRI +Pharma)
• HVTN 702 late-2016/early-2017 - results in 6 yrs
• Two approaches:
– PLWHIV Antibodies (Bnabs): passive immunisation
(AMP)
– T-cell responses (Louis Picker monkey study)
• Moving towards a cure?
ARV-Based Prevention
• Includes PrEP, microbicides (gels and rings), long-acting
injectables (LAIs), films, etc.
• These products being explored in clinical trials to date
incorporate a single ARV or a combination of two ARVs
• Work also focused on non-ARVs and dual-purpose products
(with contraception—called multipurpose prevention
technologies or MPTs)
Dapivirine Ring
• Flexible ring of elastic silicone
• Inside vagina, ring releases dapivirine
slowly over time
• Two Phase III trials of 4-week vaginal
dapivirine ring
• Modest HIV protection found!
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IPM Ring Study
1950 women
South Africa and Uganda
31% protection
DREAM OLE (not PEPFAR)
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MTN ASPIRE Study
2629 women
Malawi, South Africa, Uganda,
Zimbabwe
27% protection
HOPE OLE
PDPs
• Prevention research is often led by product
development partnerships (PDPs)
• Lack of Pharma interest in prevention
• Non-profit mission with pharmaceutical expertise
• Focus on access: availability, affordability,
acceptability, and adopted into the local health
system; end-user experience
• Particularly useful in European context to pool
resources
EU Prevention Research Investment
• Investment focused on
early treatment and
vaccines
• No investment in PrEP
• Limited investment in
microbicides
Advocacy Agenda
• Deliver what we have. Provide oral PrEP to those at
substantial risk (WHO)
• Advocate for full funding of the DREAM OLE and
related studies (MDP401)
• Broaden and sustain the pipeline. Research into
LAIs, vaccines, vaginal and rectal microbicides,
MPTs & Bnabs must also continue
• Advocate for properly funded social science/
behavioural research components in clinical trials
Recommended Reading
• EATG Position Paper on Prevention (October 2015)
– http://www.eatg.org/news/173091/EATG_HIV_Preventio
n_Position_Paper_now_available
• EATG AVAC Prevention Summit report (2016)
– http://eatgavacprevention.tumblr.com/
• AVAC PxWire Vol 9. No.2: Dapivirine Ring results
– http://www.avac.org/sites/default/files/resourcefiles/PxWire_Vol9_No2.pdf
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