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It is the biennial meeting of research against the human immunodeficiency virus. The International AIDS Society (IAS) is meeting July 18-21. A congress to which the Covid-19 was invited, which also requires the gathering to be held virtually, and not in Berlin as planned.

Thousands of researchers, students, politicians and activists gathered for three days to present and comment on the latest advances in HIV / AIDS research. The IAS Congress is always a highlight in the world of disease control.

Forty years after the discovery and presentation of the first case in a scientific journal, it is unfortunately still present. According to the latest UNAIDS report, 40 million people were infected with HIV in 2020. The same year, the virus killed nearly 700,000.

In recent years, the fight against the epidemic had already stalled and progress was slower than expected. The Covid-19 has further complicated a fight that was already not easy at the start. Containment, curfews, movement restrictions… The measures put in place to contain SARS-CoV-2 have had serious side effects on HIV patients. ” Covid-19 has had an impact on other chronic diseases », Explains Yazdan Yazdanpanah, head of the ANRS Emerging Diseases. “ In terms of screening, in terms of care, we have to make up for lost time. If people are diagnosed later, it is less good for them, because the treatment is delayed. It also has an impact on society. When we are screened later, we also transmit the disease to others. »

In addition, the Covid-19 pandemic has mobilized a great deal of resources, sometimes “borrowed” from the fight against HIV / AIDS. In its report, UNAIDS takes the example of KwaZulu Natal in South Africa: HIV testing has decreased by 48% after the first confinement in April 2020. At the same time, 28,000 caregivers linked to the community of HIV were reassigned to screening for Covid-19. Add to that a vaccine more than ever inequitably distributed between rich and poor countries and the picture grows even more gloomy.

A situation which pushed Winnie Byanyima, the executive director of UNAIDS, to go to the front: “ Rich countries in Europe prepare to take advantage of summer as their populations have easy access to Covid-19 vaccines, while countries in the South are going through crisis all over the world “. She continues: “ We are not learning anything from HIV, when millions of people were denied life-saving medicines and died because of unequal access. It is totally unacceptable. »

Treatment to cure HIV?

It is in this difficult context that this new congress dedicated to research against HIV / AIDS opens. Some clearings are to be expected from the laboratories. Indeed, if we know how to treat HIV / AIDS very well today – a patient who controls his viral load will not be able to transmit the disease – we cannot cure it. While great tools, like Prep, exist to prevent infection, there is still no vaccine. On the healing front, a study that brings an innovative approach will be presented this week.

Like what is done against cancer, it is immunotherapy and the results are encouraging even if very preliminary. « This was done with a group of 28 monkeys Says Steven Deecks of the University of San Francisco, California. “ This model is quite close to what happens in humans. The authors infected these monkeys and waited for the infection to become chronic. The primates then received standard antiretroviral therapy first before receiving immunotherapy. “ Of the monkeys that received this treatment, 80% were able to control the virus robustly. This is a proof of concept: in a situation of chronic infection, we therefore have the ability to manipulate the immune system to control the virus. It’s the Grail in the search for a cure for HIV “. This new approach thus raises a lot of hopes, even if they still remain measured. It is indeed necessary to pass the barrier of the monkey to the man, and the first tests should begin shortly.

While waiting for progress on the subject, the other blind spot in the fight against HIV / AIDS concerns the vaccine, still not developed effectively. On this subject, no progress is expected, but Yazdan Yazdanpanah does not despair: the remarkable success of mRNA vaccines developed against Covid-19 gives researchers ideas. “ Even if teams were working on it, more and more people are interested in these vaccine platforms. We’re not there yet, but I think the Covid-19 epidemic is making it possible to shift towards types of vaccines that were used less against HIV. Will it help to get there? Honestly, I can’t tell you. But these are interesting leads. »

Improve the existing

Cure and vaccine aside, the community still has remarkable tools to coping with the HIV / AIDS epidemic. In terms of prevention, PrEP, pre-exposure prophylaxis, continues to demonstrate its effectiveness. However, it comes up against a problem of adhesion: heavy to take, patients end up abandoning it.

However, new results from a South African study show that the solution of a six-month vaginal ring for young women (the population most at risk in sub-Saharan Africa) shows acceptability rates much higher than the traditional tablets.

The research carried out on treatments is also always in this idea of ​​improving the existing one. Well followed, triple therapies are today formidably effective and make it possible to make the viral load of a sick person undetectable. But here too, this is a cumbersome, restrictive and sometimes costly solution. Its implementation in the field is therefore sometimes complicated. It is for this reason that the dual therapy route is also being studied. Simpler, however, we must ensure that it retains the same efficiency.

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