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Biomedical HIV prevention Bridget Haire
This presentation…. ,[object Object],[object Object],[object Object]
Food for thought…. ,[object Object],[object Object],[object Object]
The modalities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Definitions ,[object Object],[object Object],[object Object]
Vaccines ,[object Object],[object Object],[object Object]
HIV Prevention Trial Design  (Sharon Hillier, PM2008)‏ Randomisation Active Drug 1 Placebo Active Drug 2  Safe sex counseling Diagnosis & treatment of STIs Condom provision Primary Endpoint HIV seroconversions
What happens to seroconverters? ,[object Object],[object Object],[object Object],[object Object]
Anticipated Prevention Trial Results  [slide from FHI] 2006 2008 2009 Female Barrier- Diaphragm Male Circumcision - Susceptibility 2010 2007 Microbicides –  CS-1 CS-2 Carraguard Male Circumcision - Infectiousness ,[object Object],[object Object],[object Object],[object Object],Oral PrEP - IDU HSV-2 Treatment - Infectiousness HSV-2  Treatment –  Susceptibility ,[object Object],[object Object],[object Object],2012 Index Partner Treatment Vaccines - Adenovirus-1 Adenovirus-2 Vaccines - Prime/Boost Community VCT and HIV Support Oral PrEP - West Africa  Microbicides –  SAVVY
Actual Trial Results 2006 2008 2009 Female Barrier- Diaphragm No benefit shown Male Circumcision – Susceptibility Success!! 2010 2007 Microbicides –  CS-1 CS-2 Carraguard No effect on HIV infection Male Circumcision - Infectiousness ,[object Object],[object Object],[object Object],[object Object],Oral PrEP – IDU Oral PrEP MSM US HSV-2 Treatment - Infectiousness HSV-2  Treatment –  Susceptibility Didn’t decrease HIV transmission ,[object Object],[object Object],[object Object],2012 Index Partner Treatment Vaccines - Prime/Boost Community VCT and HIV Support Oral PrEP - West Africa Statistically insignificant result   Microbicides –  SAVVY Failed: futility Vaccines - Adenovirus-5 Adenovirus-5 Trial halted: More infections in vaccine arm ORAL PrEP TDF; TDF+ FTC   Kenya Uganda (serodisco)   FEM Prep Africa Women  TDF+ FTC Microbicide/PrEP VOICE study Women TDF; TDF+FTC; TDF gel Microbicides MTN 115-116; (preg)‏
Within the next two years… ,[object Object],[object Object],[object Object]
Why PrEP results require preparation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What does ‘partially effective’ mean? ,[object Object],[object Object],[object Object],[object Object]
PrEP and ARV resistance ,[object Object],[object Object],[object Object],[object Object]
Unknowns in PrEP ,[object Object],[object Object],[object Object]
Conclusion ,[object Object],[object Object],[object Object]

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Biomedical HIV prevention

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  • 7. HIV Prevention Trial Design (Sharon Hillier, PM2008)‏ Randomisation Active Drug 1 Placebo Active Drug 2 Safe sex counseling Diagnosis & treatment of STIs Condom provision Primary Endpoint HIV seroconversions
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